Health Occupations

Life Stages

Growth & Development

Begins @ birth, ends @ death During all stages, individual needs must

be met Need to be aware of the various stages

& needs in order to provide quality health care

Life Stages Individuals vary, but everyone passes through

certain stages of growth & development Four main types of growth & development in

each stage– Physical – body growth, muscle & nerve

development, body organ changes– Mental – development of the mind, problem solving,

judgment, & coping– Emotional – feelings, love, hate, joy, fear, excitement– Social – interactions & relationships with others

Life Stages

Each stage has own characteristics & contains specific developmental tasks

Tasks progress from simple to complex Each stage establishes foundation for

next stage Rate of progress varies (speech

development, puberty, etc)

Erikson’s 8 stages of psychosocial development A basic conflict or need must be resolved at each

stage If a person does not master conflict during the

stage, they will struggle with the conflict later in life Each life stage creates needs in people Factors affect life stages & needs

– Gender, race, heredity, culture, life experiences, & health status

– Injury or illness usually has a negative effect & impairs development or changes needs

Life Stage 1 – Infancy Ages – Birth to age 1 Physical

– Dramatic & rapid– Newborn – 6-8 lbs, 18-22 inches long– First year – weight triples (21-24 lbs, height now 29-30

inches)– Muscular & nervous systems immature @ birth – Reflexes present @ birth to allow infant to react to

environment• Morro – startle due to loud noise or movement• Rooting – touch to cheek causes infant to turn head & mouth to open• Sucking – caused by slight touch on lips• Grasp – response to object placed in hand

Infancy – Physical changes

Muscle coordination develops in stages– Newborns can lift head slightly– 2 months – roll– 4-5 months – turn body around, hold head up when

sitting, accept objects handed to them, grasp stationary objects

– 6-7 months – sit unsupported, grasps moving objects, crawl on stomachs

– 12 months – freq walk without assistance, grasp objects with thumb & forefinger, throw small objects

Born without teeth, 10 –12 by end of 1st year

Infancy – Physical changes

Vision –– Poor at birth, limited to black & white, eye

movements uncoordinated– By age 1, close vision good, in color, & can

readily focus on small objects Smell, taste, sensitivity to hot & cold,

hearing good at birth but become more refined & exact

Infancy – Mental development

Rapid during first year Respond to discomfort by crying Gradually begin to recognize caregivers Speech

– At birth, cannot speak– 6 months – understand words, make sounds– 12 months – understand many words, use many

single words in their vocabulary

Infancy – emotional development

Newborns show excitement 4-6 months – distress, delight, anger,

disgust, fear 12 months- elation, affection for adults Events that occur in the first year of life

when these emotions are first exhibited can have a strong influence on their emotional behavior as adults

Infants – Social development

Self-centered newborns to recognition of others in environment

4 months- recognize caregivers, smile, gaze intently at others

6 months- watch others’ activities, are possessive, may have stranger anxiety

12 months – socialize freely with familiar people, mimic & imitate gestures & vocal sounds

Dependent on others for all needs – food, cleanliness, rest, love, security, stimulation

Early childhood – 1 – 6 years

Physical development– Slower than infancy, by age 6, weight is 45 lbs,

heights is 46 inches– Skeletal & muscle development helps child to look

more adult like• Legs & lower body grow faster than head, arms, chest• Muscle coordination improves & child can run, climb, &

move freely• Write, draw, use a knife & fork

– By 2-3, have most baby teeth & can eat most food– 2-4 years, develop bladder & bowel control

Early childhood – mental development Advances rapidly – verbal grows from several

words @ age 1 to 1500-2500 words at age 6 Age 2 – short attention span but interested in

many activities, remember details, begin understanding concepts

Age 4 – ask questions, recognize letters & words, make decisions based on logic not trial & error

Age 6 – very verbal, want to read & write, memory develops so child can make decisions based on past & present experiences

Early childhood – emotional development Age 1-2 – Begin to develop self awareness,

accept or defy limits, feel impatient & frustrated when they try to do things beyond their ability, temper tantrums, like routines

Age 4-6 – begin to control their emotions, understand right & wrong, more independent, less frustrated, less anxiety when there is a new situation

Early childhood – social development Self-centered to social Early years – attached to parents, fear

separation, begin to play with others but still are possessive, parallel play

Later years – put self aside, take more interest in others, trust others, make more effort to please others, more social & agreeable, like to have friends their own age

Early childhood needs

Food, rest, shelter, protection, love, security – just as infant does

Routine, order, & consistency Must be taught responsibility &

conformity to rules Need to make reasonable demands

based on their ability to comply

Late childhood (6 – 12 years) – Physical development Slow but steady, weight gain 5-7 lbs.

per year, height increases 2-3 in/year Muscle coordination well developed Physical activities complex Primary (baby) teeth lost, permanent

teeth erupt Visual acuity at its best Sexual maturation begins at age 10-12

Late Childhood – mental development Life centers around school – increases

rapidly Speech skills develop Reading & writing skills have been learned Use information to solve problems Memory becomes more complex Abstract concepts – loyalty, honesty, values,

morals More adept at making judgments

Late childhood- emotional development Achieve greater independence & more

distinct personality Age 6 – frightened & uncertain, need

reassuring parents & success in school to gain confidence, coping replaces fears, learn to control emotions

Age 10-12 –puberty leads to periods of depression followed by joy, emotional changes can cause children to be restless & anxious & difficult to understand

Late childhood – social development Age 7 – like activities they can do alone, want

approval of others Age 8-10 – more group oriented, form groups

with members of own sex, ready to accept others’ opinions, learn to conform to rules & standards of behaviors

Age 10-12 – make friends more easily, develop awareness of opposite sex, gradually move away from their parents & dependency upon them

Late childhood needs

Basic needs of infancy & early childhood

Reassurance, parental approval, & peer acceptance

Adolescence (12-20) – Physical development

Most dramatic in early period Growth spurt – girls age 11-13, boys age 13-15 Muscle coordination does not occur as quickly,

leads to awkwardness or clumsiness Puberty – sexual organs & secondary sexual

characteristics develop– Menstruation in girls, sperm/semen in boys– Females – pubic/axillary hair, breast & hip development,

body fat distribution– Males – deeper voice, more muscle mass, broader

shoulders, pubic/facial/body hair

Adolescence – mental development Increase in knowledge & sharpening of

skills Learn to make decisions & accept

responsibility for actions Causes conflict because treated as both

children & adults (grow up vs. be a kid)

Adolescence – Emotional development Stormy & conflicted Uncertain, feel inadequate & insecure in trying

to establish independence & identity Worry about appearance, ability, relationships Peer group influences – can change attitudes &

values Later years – self-identity established & feel

more comfortable with who they are, focus on who they will become, gain more control of feelings, become more mature emotionally

Adolescence – social development Move away from family to association with

peers Security with people own age with similar

problems & conflicts If peers help them develop self-confidence,

become more secure & satisfied Later years – develop more mature attitude &

patterns of behavior that identify them as adults

Adolescence Needs

Reassurance, support, understanding along with basic needs

Conflict & feelings of inadequacy & insecurity can lead to development of problems– Eating disorders, drug/alcohol abuse,

suicide– These occur in other stages, but are

frequently associated with adolescents

Eating Disorders Often develop from excessive concern about

appearance Anorexia nervosa - psychological disorder where food

intake is drastically reduced or nonexistent– Can include excessive exercise– Results in metabolic disturbances, excessive weight loss,

weakness, death if untreated Bulimia – psychological disorder where bingeing

alternates with fasting or purging– Can result in metabolic disturbances, damage to teeth,

weakness, death if untreated More common in females, but does occur in males

Chemical abuse Use of drugs or alcohol to the point of developing a

chemical dependence Frequently begins in adolescence Reasons for use

– Relieving anxiety/stress– Peer pressure– Escape from problems– Experimentation or instant gratification– Heredity or cultural influences

Can lead to physical & mental disorders & disease Treatment directed toward total rehab

Suicide

One of leading causes of death in adolescents

Reasons for suicide– Depression– Grief over loss or love affair– Failure in school– Inability to meet expectations– Influence of suicidal friends/parents– Lack of self-esteem

Suicide

Causes for increased risk– Family history– Major loss or disappointment– Previous suicide attempts– Recent suicide of friends, family, role

models Impulsive nature increases risk

Warning signs of suicide Verbal statements – “I’d rather be dead” Sudden changes in appetite or sleep habits Withdrawal, depression, moodiness Excessive fatigue or agitation Neglect of personal hygiene Alcohol or drug abuse Loss of interest in other aspects of life Injuring one’s body Giving away possessions Saying goodbye to loved ones

Suicide

Attempts are a cry for help– Usually person responds to assistance– Should NEVER be ignored

Prevention of suicide– Provide support & understanding– Psychological or psychiatric counseling

Early adulthood (20-40) – Physical development Frequently most productive life stage Development complete Motor coordination at its peak Prime childbearing time

– Usually produces healthier babies– Male/female sexual development at its

peak

Early adulthood – mental development Continues through this stage –

additional education common Make many decisions, form judgments

– Deal with independence– Make career choices– Determine life style & select marital partner– Start a family– Establish values

Early adulthood – emotional development Preserving stability established

previously Many emotional stressors – family,

careers, marriage Find satisfaction in achievements Take responsibility for actions Learn to accept criticism & profit from

mistakes

Early adulthood – social development Move away from peer group Associate with others who have similar

ambitions & interests, regardless of age Own family becomes very important Do not necessarily accept traditional sex

roles & frequently accept nontraditional roles (both male & female nurses, doctors, administrators, teachers, etc)

Middle adulthood (40-65) – Physical development Physical changes

– Hair grays & thins– Wrinkles appear, muscle tone decreases– Hearing & vision loss– Weight gain occurs– Females -Menopause – end of menstruation– Males have slowing of hormone production, often

called male menopause but never lose the ability to reproduce unless due to injury, disease, or surgery

Middle adulthood – mental development Mental ability continues to increase Many seek educational opportunities Acquired life understanding Confident decision makers Excellent at analyzing situations

Middle adulthood – emotional development Can be period of contentment & satisfaction or a

time of crisis Emotional status is determined by emotional

foundation of previous stages Emotional satisfaction – job stability, financial

success, end of child rearing, good health Emotional stress – loss of job, fear of aging/loss of

youth, illness, marital problems, problems with children or aging parents

Emotional status varies determined by events occurring during this stage

Middle Adulthood – social development Family relationships may see a decline

– Children begin lives of own– Parents die

Work relationships may replace family Marital relationships may become

stronger or can end in divorce Friendships are usually with people who

have same interests & lifestyles

Late adulthood (65 and up) – Physical development Declining with all body systems affected Skin dry, wrinkled, thinner with brown or yellow

spots Hair thin, loses shine Bone brittle & more porous, likely to fx Cartilage between vertebrae thins leading to

stooped posture Muscle tone decreases Hearing & vision loss Decreased tolerance for heat & cold

Late adulthood – physical development Heart is less efficient, circulation

decreases Kidney & bladder less efficient Breathing capacity decreases These changes occur SLOWLY & many

people DO NOT show signs until their seventies or eighties

Late adulthood – mental development Varies, people who remain active show less decline Short term memory first to go Alzheimer’s disease

– Irreversible loss of memory– Deterioration of intellectual function– Speech & gait disturbances– Disorientation

Arteriosclerosis – thickening & hardening of arterial walls that can decrease blood to brain & cause a decrease in mental acuity

Late adulthood – emotional development Some cope well with aging, others become

lonely, frustrated, withdrawn, or depressed Emotional adjustment necessary

– Retirement– Death of spouse or friends– Physical disabilities– Financial problems– Loss of independence– Knowing that life must end

Usually people adjust as they have previously

Late adulthood – social development Retirement – can lead to loss of self-esteem,

especially if identity is closely related to work More limited circle of friends Many people start new activities & make new

friends while others limit relationships Changes in social relationships occurs with

spouse & friend deaths & moves to new environment

Development of social contacts important– Senior centers, golden age groups, churches

Late adulthood needs

Same as those of all ages Sense of belonging Self-esteem Financial security Social acceptance & love

Death & Dying

Final stage of growth Experience by everyone, cannot be

evaded Young people tend to ignore it Elderly often think of own deaths

Terminal disease

Disease that cannot be cured & will result in death Some people react in fear

– Pain, abandonment, loneliness– Unknown– Anxious about loved ones– Anxious about unfinished work & dreams

Others view death as a final peace– Lived a full life– Strong religious beliefs– Relief from suffering, pain, loneliness

Elisabeth Kubler-Ross

Extensive research on death & dying Results of research show

– Most HCP believe that pt. should be told of approaching death

– Should be left with some hope & reassured that they won’t be left alone

– Important to know how much info pt has & how they reacted

5 stages of grieving

Experienced in preparation for death Stages may not occur in order & may overlap

or be repeated several times Some patients may not progress through

them May be in more than one stage at the same

time Denial, anger, bargaining, depression,

acceptance

DENIAL

“No, not me!” Usually occurs when first told Cannot accept reality of death or feel

loved ones cannot accept “The dr. doesn’t know anything”, “Tests

must be wrong” Seek a second opinion, want more tests Refuse to discuss illness

Dealing with denial

Help pt. discuss feelings & listen to pt Provide support without confirming or

denying “It must be hard for you”, “You feel more

tests will help?” Allow pt to express feelings

ANGER

Pt is no longer able to deny death “Why me?”, “It’s your fault” May strike out at HCP, are hostile & bitter Blame themselves, loved ones, or HCP for

illness Understand that anger is not personal attack on

HCP but is due to situation HCP should provide understanding & support by

listening to pt & making every attempt to answer demands quickly & kindly

BARGAINING

Pts accept death but want more time May turn to religion Will to live is strong Pt fights hard to achieve goals set – wait to

die until child graduates, arrange care for family, hold a grandchild

May make promises to God HCP role – be supportive & listen, help pts

achieve goal if possible

DEPRESSION

Occurs when pt realizes death will come soon – will no longer be with family & are unable to complete goals

May express regrets or become withdrawn & quiet

HCP role – let pt. know it’s ok to be depressed, provide understanding, support, touch. Allow pts to cry or express grief

ACCEPTANCE

Understand & accept the fact that death is going to occur

May complete unfinished business Try to help loved ones deal with death Gradually separate selves from world &

others HCP role – provide emotional support,

realize presence is important

Care of dying patients

Provide supportive care HCP need to understand own feelings

about death & come to terms Feelings of fear, frustration, &

uncertainty about death can cause HCP to avoid dying pts or provide poor care

Hospice care Palliative care – provides support & comfort NOT

cure Usually in pts home, but can be inpatient Usual life expectancy is 6 months or less Pt may be reluctant to start care – almost at

acceptance that death will come Philosophy – DEATH WITH DIGNITY & COMFORT Provides opportunity for closure Provides comfort – hospital equipment, counseling,

free or reduced cost pain meds

Hospice care

Want pt to have quality of life Personal care, nursing care, social

work, minister, respiratory therapy, volunteers

After death, hospice personnel often maintain close ties with families

Right to die

Ethical issue Pts have right to refuse care Advance directives – living will, durable

power of attorney Euthanasia illegal, but can withhold

CPR, ventilators, pacemakers, etc.

Human Needs

Needs – lack of something that is required or desired

Humans have needs from birth until death

Needs motivate us to behave or act to meet the need

Certain needs have priority over others– Food more important than social status

Maslow’s Hierarchy of Needs

Abraham Maslow

Maslow’s Hierarchy of Needs

- Lower needs must be met first- Once lower need is met, then can move

up hierarchy

Maslow’s Hierarchy

1st level – physiological needs– Physical – required for life– Food, water, oxygen, elimination, sleep, protection

from temperature extremes– If some are not met, death occurs (priority needs)– Sensory & motor needs allow us to respond to

environment (hearing, sight, touch, smell, taste, mental stimulation)

– Many needs are controlled automatically by body– HCP need to be aware of how illness interferes with

needs – NPO, anxiety, sleep, meds, age

Maslow’s hierarchy

2nd level – Safety– Freedom from anxiety & fear, feeling of

security in environment– Need for order, routine, familiar – changes

threaten safety– Illness a major threat – pts may not

understand illness, tests, meds, etc. HCP needs to explain fully & help pt. adapt to situation

Maslow’s hierarchy

3rd level – Love & affection– Social acceptance, friendship, & love– Motivated by need to belong & have

relationships with others– Satisfied with friendships, social contacts,

acceptance, sexuality– Sexuality continues throughout life – infant

through late adulthood, may be threatened by illness

Maslow’s hierarchy

4th level – Self Esteem– Feelings of importance & worth– Others show respect, approval,

appreciation– Illness can cause lack of self esteem

• Dependent upon others for personal cares• May become incontinent• Worry about job or income loss, wellbeing of

family, disability or death

Maslow’s hierarchy

5th level – Self actualization– Self-realization – person has obtained the

full potential, they are what they want to be– Confidence, willing to express beliefs &

stick to them, willing to help others

Meeting needs

Needs met, successful action = happy person

Needs unmet, unsuccessful = tension & frustration

Sometimes need to determine priority – for example, food vs. sleep

Feel needs at different intensities, greater need, more motivated to act

Methods of meeting needs

Direct– Work at meeting need & obtaining satisfaction– Hard work, goal setting, evaluating situation,

cooperating– In working to pass test

• Can work harder (study longer, listen more)• Set realistic goals (read new material, study every night)• Evaluate situation to see why may be failing (too tired,

fall asleep in class = get more sleep)• Can cooperate with others (get help from teacher, study

group, tutor)

Methods of meeting needs

Indirect methods– Work at reducing need or relieving tension produced

by unmet need.– Need is still present, but intensity decreases– Defense mechanisms main method

• Unconscious acts helping a person deal with unpleasant situations or unacceptable behavior

• Everyone uses them• Maintain self esteem & relieve discomfort• Can be healthy, allows coping• Can be unhealthy if used all of the time & substituted for

appropriate ways of dealing with need

Defense Mechanisms

Rationalization– Using reasonable excuse for behavior to

avoid real reason or true motivation– If you need a lab test, avoid it by saying “I

can’t get time off of work” rather than admit fear.

Defense Mechanisms

Projection– Placing blame for your own actions on someone or

something else rather than accepting responsibility– “I failed the test because the teacher doesn’t like

me” rather than “I failed because I didn’t turn in my work”

– “I’m late because the alarm didn’t go off” instead of “I’m late because I didn’t set the alarm clock”

– Lets you avoid saying you made a mistake

Defense Mechanisms

Displacement– Transferring feelings about one person to

someone else– Usually occurs because person cannot

direct feelings towards person who is responsible

– Made at your mom so you hit your sister

Defense Mechanisms

Compensation– Substitution of one goal for another goal in

order to achieve success– Can be healthy if substitute goal meets

needs– Can’t sing so you play the guitar– Want to be a dr. but can’t afford med

school, so you become a nurse

Defense Mechanisms

Daydreaming– Dreamlike thought process occurring when person

is awake– Means of escape when person is not satisfied with

reality– Good if it helps a person establish realistic goals– Bad if it is a substitute for reality– Person dreams about becoming a dr. but doesn’t

do any work in school.

Defense Mechanisms

Repression– Transfer of unacceptable or painful ideas, feelings,

& thoughts into unconscious mind– Person not aware this occurs, so it allows them to

forget fear or feeling– Feeling does not vanish, but often resurfaces in

dreams or affects behavior– Person afraid of heights but doesn’t know why,

perhaps something occurred in childhood that they have repressed

Defense Mechanisms

Suppression– Similar to repression– Aware of unacceptable feelings but refuses to deal

with them– May substitute work, hobby, or project to avoid

situation– Woman finds breast lump, refuses to go to dr.,

goes to gym & fills up time with exercise– Ignoring situation causes increased stress– Eventually will have to deal with problem

Defense Mechanisms

Denial– Disbelief of an event or idea that is too

frightening to cope with– Often not aware that you are in denial– Frequently occurs with terminal diagnosis– Dr. is wrong, I want a second opinion– Denial turns into acceptance when person

ready to deal with event or idea

Defense Mechanisms

Withdrawal– Cease to communicate or remove self physically

from situation– Can be a satisfactory way to avoid conflict\– Example – you are working with an unpleasant

individual so you ask for a transfer– At times, interpersonal conflict CANNOT be

avoided– Need to use open & honest communication in

order to improve the relationship