Key Takeaways
- Erik Erikson's 8 stages of psychosocial development span from birth to death, each presenting a crisis that must be resolved for healthy personality development
- Jean Piaget's 4 cognitive stages progress from sensorimotor (0-2 years) through formal operational (12+ years), describing how children develop logical thinking
- Trust vs. Mistrust (infancy) is the foundation of all future development - consistent, responsive caregiving builds trust
- Adolescents in Identity vs. Role Confusion focus on peer acceptance, body image, and establishing independence
- Understanding developmental stages helps nurses provide age-appropriate education and anticipatory guidance
Growth and Development Theories
Understanding human development is essential for nursing practice. Two foundational theories guide how nurses assess clients and plan age-appropriate care: Erik Erikson's psychosocial development and Jean Piaget's cognitive development.
Why Development Matters for Nurses
Nurses use developmental knowledge to:
- Assess appropriateness - Is this child meeting expected milestones?
- Educate effectively - Match teaching methods to cognitive abilities
- Anticipate concerns - Guide parents on upcoming developmental challenges
- Identify delays - Recognize when referrals are needed
Erik Erikson's Stages of Psychosocial Development
Erik Erikson described eight stages of development, each centered on a psychosocial crisis. Successfully resolving each crisis leads to a virtue; failure creates difficulties in later stages.
| Stage | Age | Crisis | Virtue | Key Focus |
|---|---|---|---|---|
| 1 | 0-1 year | Trust vs. Mistrust | Hope | Consistent caregiving |
| 2 | 1-3 years | Autonomy vs. Shame/Doubt | Will | Self-control, independence |
| 3 | 3-6 years | Initiative vs. Guilt | Purpose | Exploration, imagination |
| 4 | 6-12 years | Industry vs. Inferiority | Competence | Achievement, skill-building |
| 5 | 12-18 years | Identity vs. Role Confusion | Fidelity | Self-identity, peer group |
| 6 | 18-35 years | Intimacy vs. Isolation | Love | Close relationships |
| 7 | 35-65 years | Generativity vs. Stagnation | Care | Contributing to society |
| 8 | 65+ years | Integrity vs. Despair | Wisdom | Life review, acceptance |
Nursing Implications by Stage
Trust vs. Mistrust (Infancy)
- Respond promptly to infant cries
- Maintain consistent routines
- Encourage parental bonding
- Explain to parents that "spoiling" an infant is not possible
Autonomy vs. Shame and Doubt (Toddler)
- Offer simple choices ("Red cup or blue cup?")
- Allow safe exploration
- Expect negativism ("No!") as developmentally normal
- Use positive reinforcement for toilet training
Initiative vs. Guilt (Preschool)
- Encourage imaginative play
- Answer "why" questions patiently
- Provide safe boundaries for exploration
- Recognize magical thinking is normal
Industry vs. Inferiority (School-Age)
- Praise effort and accomplishments
- Support academic and social development
- Encourage participation in groups/teams
- Help children develop real skills
Identity vs. Role Confusion (Adolescence)
- Respect privacy and growing independence
- Provide health education without judgment
- Recognize peer influence is paramount
- Support identity exploration
Jean Piaget's Stages of Cognitive Development
Jean Piaget described how children develop logical thinking through four stages. Each stage represents a qualitatively different way of understanding the world.
| Stage | Age | Key Characteristics | Limitations |
|---|---|---|---|
| Sensorimotor | 0-2 years | Learns through senses and actions; develops object permanence | No symbolic thought yet |
| Preoperational | 2-7 years | Symbolic thinking (language, pretend play); egocentric | Cannot think logically; centration |
| Concrete Operational | 7-11 years | Logical thinking about concrete objects; conservation | Cannot think abstractly |
| Formal Operational | 12+ years | Abstract and hypothetical thinking | Not all adults achieve fully |
Key Concepts Explained
Object Permanence (Sensorimotor)
- Understanding that objects exist even when not visible
- Develops around 8-12 months
- Before this: "out of sight, out of mind"
- Nursing tip: Separation anxiety peaks after object permanence develops
Egocentrism (Preoperational)
- Inability to see others' perspectives
- Child believes everyone thinks like they do
- Not selfishness - a cognitive limitation
- Nursing tip: Preschoolers may believe illness is punishment
Animism (Preoperational)
- Belief that inanimate objects are alive
- "The tree is sad" or "My teddy feels cold"
- Use this therapeutically: dolls for procedure teaching
Conservation (Concrete Operational)
- Understanding that quantity remains constant despite appearance changes
- Classic test: Equal water in different-shaped glasses
- Achieved around age 7
On the Exam
Expect questions asking you to:
- Match behaviors to appropriate developmental stages
- Identify age-appropriate nursing interventions
- Recognize developmental red flags
- Apply theory to clinical scenarios
Comparing Erikson and Piaget
| Age | Erikson (Psychosocial) | Piaget (Cognitive) |
|---|---|---|
| Infant | Trust vs. Mistrust | Sensorimotor |
| Toddler | Autonomy vs. Shame/Doubt | Preoperational (early) |
| Preschool | Initiative vs. Guilt | Preoperational |
| School-Age | Industry vs. Inferiority | Concrete Operational |
| Adolescent | Identity vs. Role Confusion | Formal Operational |
Clinical Application
When caring for a 4-year-old (preschool):
- Erikson: Support initiative - encourage questions, allow choices
- Piaget: Preoperational - use concrete language, expect magical thinking
Exam Tips
- Erikson focuses on SOCIAL/EMOTIONAL development (crises, relationships)
- Piaget focuses on COGNITIVE development (thinking, reasoning)
- Memorize age ranges and key characteristics for each stage
- Trust vs. Mistrust is tested frequently - emphasize consistent caregiving
- Object permanence (8-12 months) relates to separation anxiety timing
A 2-year-old child repeatedly says "No!" when asked to do something. According to Erikson, this behavior indicates which developmental stage?
A nurse is preparing to teach a 5-year-old about an upcoming procedure. Based on Piaget's stages, which approach is most appropriate?
According to Piaget, at what age does a child typically develop object permanence?