Principles and theories of

growth and development

Learning Guide 1

Text Book Pages

Kozier & Erbs Fundamentals of Nursing
concepts, process and practice. 8 th edition.
Chapters 20.
Pages: 349 364.
Maslows theory: 273-275
Neumans system model: 46-47

Principles and theories of

growth and development
The clients stage of growth and
development determines his capacity to
take up responsibilities.

Growth: Physical change and increase in size.

Features of growth
Quantitative Can be measured.
The pattern of physiologic growth is similar for all
individuals.
Indicators of growth are height, weight, bone size and
dentition.
Growth rate varies during different stages of growth and
development. Growth rate is very rapid during prenatal,
neonatal, infancy and adolescent stages. Growth rate slows
during childhood. Physical growth is minimal during
adulthood.

Development: Increase in functioning and skills.

Development is the behavioral aspect of growth.
It is qualitative, i.e. Not measured.
E.g. A child develops the ability to walk, to talk and to run.
Growth and development are independent and inter
related. i.e. The infants muscles, bones and nervous
system must grow to a certain point before the infant can
sit up or walk.

Maturation
The process of being mature or fully
developed; development of inherited traits.

Principles of growth and development

1.Growth and development are continuous,
orderly, sequential processes influenced by
maturational, environmental and genetic factors.
2. All humans follow the same pattern of growth
and development.
3. The sequence of each stage is predictable. The
time of onset, the length of the stage and the
effects of each stage vary with person.

Principles of growth and development

4.Learning can either help or hinder the
maturational process.
5.Each developmental stage has its own specific
characteristics.
6.Growth and development occur in the cephalocaudal direction. ie. Starting at the head and
moving to the trunk, the legs and the feet.

Cephalocaudal and
proximodistal growth

Principles of growth and development

7. Growth and development occur in a proximal to
distal direction. i.e. Center of the body outward. E.g.
Infants roll over before they start grasping objects.
8. Development proceeds from simple to complex.
9. Development becomes increasingly differentiated.
i.e. A child has generalized responses at first. Later
reacts with specific responses. E.g. A newborn
responds to a loud noise with a startle reflex where
as a child may respond with crying.

Principles of growth and development

10.Certain stages of growth and development are
more critical than others. E.g. First 10-12
weeks after conception are very critical.
11.The pace of growth and development is
uneven. Growth spurt is seen in prenatal,
neonatal, infancy and adolescent stages.

Components of growth and development

1.
2.
3.

Physiologic Bodily changes

Cognitive Intellectual
Psychosocial Personal and social
relationships
4. Moral Related to rules and regulations
of life
5. Spiritual Related to the faith.

Stages of human growth and

development
Stage 1
Significant characteristics

Nursing implications

Stages of human growth and

development
Stage 2
Significant characteristics

Nursing implications

Stages of human growth and

development
Stage 3
Significant characteristics

Nursing implications

Stages of human growth and

development
Stage 4
Significant characteristics

Nursing implications

Stages of human growth and

development
Stage 5
Significant characteristics

Nursing implications

Stages of human growth and

development
Stage 6
Significant characteristics

Nursing implications

Stages of human growth and

development
Stage 7
Significant characteristics

Nursing implications

Stages of human growth and

development
Stage 8
Significant characteristics

Nursing implications

Stages of human growth and

development
Stage 9

Significant characteristics

Stages of human growth and

development
Stage 9

Nursing implications

Theories

Freud
Erikson
Piaget
Kohlberg
Fowler

Theories of psychosocial development

Psychosocial development Personality
development
Personality : Outward expression of the inner
self. It includes a person's temperament,
feelings, character traits, independence, selfesteem, self-concept, behavior, ability to interact
with others and ability to adapt to life changes.
The major theorists are
Freud and
Erikson

Freuds theory of personality development

According to Freud the personality of an individual
is controlled by his mind. The mind is divided
into three.
Conscious mind: About which the individual is
aware about.
Subconscious mind: About which the individual is
partially aware about.
Unconscious mind: About which the individual is
not aware about.
The personality of an individual has 3 aspects. Id,
ego and super ego.

Aspects of Human Personality

Id: Instinctive and unconscious urges. Concerned with
pleasure and gratification. Chiefly sexual in nature.
Ego: Formed by the person to make effective contact
with social and physical needs. Through ego the id
impulses are satisfied.
Super ego: Conscience of the personality. A control on
the id. The source of feelings of guilt, shame and
inhibition.
There is always conflict between the forces of id and
super ego. There is an inner energy which balances the
forces of id, ego and super ego. This inner energy is
called libido.

Personality development
According to Freud the personality develops in
five overlapping stages from birth to adulthood.
The libido changes its location of emphasis
within the body from one stage to another.
Therefore a particular area of the body has
special significance to a client at a particular
stage.

Freuds stages of personality development

1.

Oral : 0-1 year

2.

Anal : 2-3 years

3.

Phallic : 4-5 years

4.

Latency : 6-12 years

5.

Genital : 13 years and above

The first three stages are called pre-genital stages. If an
individual does not achieve a satisfactory resolution at
each stage, the personality become fixated at that stage.
i.e. The person is unable to proceed to the next stage
because of anxiety.

Stage

Age

Oral

Birth 1 yr

Characteristics
Mouth is the center of pleasure.
Feelings of dependence arise and
can persist through life. Fixation
can lead to difficulty in trusting
others, nail biting, drug abuse,
smoking, over eating, alcoholism,
argumentativeness and over
dependence.

Nursing Implications
Feeding procedures should be pleasurable and provide a sense
of comfort and safety. Feeding should be pleasurable and
provided when required.

Stage

Age

Anal

2 & 3 years

Characteristics
Anus and rectum are the centers of
pleasure. This is the time of toilet
training. Fixation leads to obsessive
compulsive personality traits
obstinacy, stinginess, cruelty and
temper tantrums.

Nursing Implications
Controlling and expelling feces provides pleasure and sense of
control. Toilet training should be a pleasurable experience.
Praising helps to develop a creative and productive personality.

Stage

Age

Characteristics

Phallic

4 & 5 years Genitals are the center of pleasure. Sexual

and aggressive feelings associated with
genitals come into focus. Masturbation is
pleasurable to the child. Male child exhibits
attraction to his mother and hostile to
father (Oedipus complex). Female child
exhibits attraction to her father and hostile
to mother (Electra complex). Fixation can
result in difficulties with sexual identity and
problems with authority.

Nursing Implications
The child identifies with the parent of the opposite sex and later
takes on a love relationship outside the family. Encourage identity.

Stage

Age

Latency

6-12 years

Characteristics
Energy is directed to physical and
intellectual activities. Sexual
impulses are repressed.
Unresolved conflicts can lead to
obsessiveness and lack of self
motivation.

Nursing Implications
Encourage child with physical and intellectual pursuits.

Stage

Age

Characteristics

Genital

13 years
and after

Energy is directed toward attaining a mature

sexual relationship. This stage involves a
reactivation of the pregenital impulses.
These impulses are displaced and the
individual passes to the genital stage of
maturity. Inability to resolve conflicts can
lead to sexual problems frigidity,
impotence, and inability to have a
satisfactory sexual relationship.

Nursing Implications
Encourage separation from parents, achievement of
independence and decision making.

Eriksons theory of psychosocial

development
Erik Erikson expanded Freuds theory to include the entire
life span. People continue to develop throughout life. He
described 8 stages of development. According to Erikson
ego is the conscious core of personality. Erikson
believed life as a sequence of levels of achievement.
Each developmental stage has a task to be achieved.
Developmental task: A task which arises at or about a
certain period in the life of an individual, unsuccessful
achievement of which leads to unhappiness in the
individual, disapproval by society and difficulty with later
tasks.

Eriksons theory of psychosocial

development
The task achieved can be complete, partial or
unsuccessful. The greater the task achievement
the healthier the personality of the person.
Failure to achieve a task influences the ability to
achieve the next task. After attaining one stage,
the person may fallback and needs to approach
it again.
Erikson describes both positive and negative
resolution of the critical life periods. The
individual must find a balance between these.

Eriksons stages and tasks

Infant
Toddler
Preschool age
School age
Adolescence
Young adult
Middle age
Late adulthood

Trust vs mistrust.
Autonomy vs shame and doubt.
Initiative vs guilt.
Industry vs inferiority.
Identity vs role confusion.
Intimacy vs isolation.
Generativity vs stagnation.
Integrity vs despair.

Theory of cognitive development - Piaget

Cognitive development refers to the manner in which people
learn to think, reason and use language. According to
Piaget cognitive development is an orderly sequential
process, in which a variety of new experiences must exist
before intellectual abilities can develop.
Piaget described cognitive development in 5 major phases
Sensory motor phase
Pre-conceptual phase
Intuitive phase
Concrete operational phase
Formal operational phase

Piagets phases of cognitive development

Phases & Stages Age
Significant behaviour
Sensory motor

Birth 2 yr

Stage 1: Use of
reflexes

Birth 1 month

Most actions are reflexive

Stage 2: Primary
circular reaction

1-4 months

Perception of events is centered

around the body. Objects are
extension of self.

Stage 3 :
4-8 months
Secondary circular
reaction

Acknowledges the external

environment. Actively makes
changes in the environment.

Stage 4 :
Coordination of
secondary
schemata

Can distinguish a goal from a

means of attaining it.

8-12 months

Piagets phases of cognitive development

Phases & Stages Age
Significant behaviour
Sensory motor

Birth 2 yr

Stage 5: Tertiary
circular reaction

12-18 months

Tries and discovers new goals and

ways to attain goals. Rituals are
important.

Stage 6:
Inventions of
new means

18-24 months

Interprets the environment by

mental image. Uses make-believe
and pretend play.

Preconceptual
phase

2-4 years

Ego centric approach to the

demands of the environment.
Everything relates to me.
Explores the environment.
Language development is rapid.
Associates words with objects.

Piagets phases of cognitive development

Phases & Stages Age
Significant behaviour
Intuitive thought
phase

4-7 years

Egocentric thinking diminishes.

Thinks of one idea at a time.
Includes others in the
environment. Words express
thoughts.

Concrete
operations
phase

7-11 years

Solves concrete problems. Begins

to understand size. Understands
left and right. Aware of view points

Formal operations 11-15 years

phase

Rational thinking. Reasoning is

deductive and futuristic.

Learning processes
In each phase the person uses 3 primary abilities
to learn.
1. Assimilation: The process by which individuals
encounter and react to new situations by using
the mechanisms they already possess. Thus
they acquire knowledge, skills and insight into
the world around them.
2. Accommodation: Based on the new knowledge
assimilated, the individual increases ability to
solve problems that were unsolvable before.
3. Adaptation: Coping behavior. Ability to handle
demands made by the environment.

Moral Development
Moral development includes learning what is to be
done and what should not be done.
Morality: Requirements necessary for people to
live together in society.
Moral behavior: The way a person perceives these
requirements and responds to them.
Moral development: The pattern of change in
moral behavior with age.

Kohlbergs theory of moral development

Kohlberg focuses on the reasons an individual
makes a decision. According to Kohlberg moral
development progresses through 3 levels and 6
stages. Levels and stages are not always linked
to a certain developmental stage, because some
persons progress to a higher level of moral
development than others.

The levels of moral development

Level 1: Pre-conventional or pre-moral
Stage 1

Stage 2

Punishment and Accepts cultural rules of good

obedience
and bad or right and wrong.
orientation
They interpret it in terms of
reward or punishment.
Instrumentalrelativist
orientation

The levels of moral development

Level 2: Conventional
Stage 3 Interpersonal
concordance
Stage 4 Law and order
orientation

The child is concerned about

maintaining the expectations
of the family or society and
sees this as right.

The levels of moral development

Level : Post-conventional; Autonomous or Principled level
Stage 5 Social contract,
legalistic
orientation
Stage 6 Universal-ethical
principles

People make their own values

without regard to outside
authority or expectations of
others.

Spiritual theories
Spiritual development refers to the individuals
understanding of their relationship with the
universe and their perceptions about the
direction and meaning of life.
Faith: The force that gives meaning to a persons
life.
Fowler described 7 stages of spiritual
development.

Fowlers theory
Age

Stage

Concept

0-3 years

0 Undifferentiated

No concept.

4-6 years

1 Intuitive-projective

Beliefs & images given

by parents mixed with
childs own experience
& imagination.

7-12 years

2 Mythic-literal

Adds fantasy to the

beliefs. Symbols
represent something
specific. Believes in
dramatic stories and
myths.

Fowlers theory
Age
Adolescent

Stage
3 Syntheticconventional

Concept
World is structured by
the expectations and
judgment of others.

After 18
years

4 Individuatingreflexive

Developing ones
own system of faith
and worship.

After 30
years

5 Paradoxicalconsolidative

Aware of truth from a

variety of view points.

Final
(may
never)

6 Universalizing

Becomes an
incarnation of the
principles of love and
justice.

Theory of Human Needs and Motivation

Self
Actualization
Self esteem

Love and belonging

Safety and security

Physiologic needs

Maslows Hierarchy of Needs

1.
2.
3.
4.

5.

Physiologic needs : Survival needs. Air, water, food,

shelter, rest, sleep, activity and temperature maintenance.
Safety and security needs : Physical and psychological
safety and security. Includes environmental safety and
satisfactory personal relationships.
Love and belonging needs : Giving and receiving affection,
attaining a place in a group.
Self-esteem needs : An individual needs both the self
esteem (feelings of independence, competence and selfrespect) and esteem from others (recognition, respect and
appreciation).
Self actualization : Need to develop ones maximum
potential and realize ones abilities and qualities.
Throughout their life time, individuals strive to meet needs.
Satisfaction of needs leads to positive health, a good self
concept and satisfactory achievement of developmental
stages.

Systems theory Betty Neuman

Extrapersonal

Intrapersonal

Flexible lines of defense

Normal
lines of
defense

Interpersonal

Lines of resistance

Betty Neumans Systems Theory

Human beings are open systems which are dynamic in
nature. Individual is in constant interaction with stress and
adaptation to stress is the state of reconstitution.
Human systems constitute a central core of energy with five
inter related variables physiological, psychosocial, sociocultural, developmental and spiritual.
The central core is surrounded by two concentric rings called
the lines of resistance. They represent internal factors that
help the client defend against a stressor.
The lines of defenses also defend the individual.
The inner/normal line of defense represents the persons
state of equilibrium/adaptation maintained over time that is
considered normal for that person.
The flexible line of defense is a protective buffer that prevents
stressors from penetrating the normal line of defense. It is
rapidly changing.

Betty Neumans Systems Theory

Nursing interventions are carried out on three levels of
prevention.
Primary prevention: Protecting the normal line of defense
and strengthening the flexible line of defense. E.g.
identifying risk factors and eliminating risks.
Secondary prevention: Strengthen internal line of
resistance, reduce the reaction, and increase resistance
factors. E.g. Interventions or treatment after developed
the symptoms.
Tertiary prevention: Readaptation and stability and
protects reconstitution and or return to wellness following
treatment. E.g. education to prevent relapses.

Table 21-6

Kohlbergs Stages of Moral Development

From Health Promotion Strategies through the Life Span (pp. 252-253), by R.B. Murray & J.P. Zentner, 2001, Upper Saddle River, NJ:
Prentice Hall. Adapted with permission.