Fundamentals of Nursing · Growth and Development
Specific Developmental Theories
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The stages of growth and development (previous topic) describe what happens as people grow. Developmental theories explain why — they are organized frameworks, built from observation and research, that predict what a person at a given stage needs, fears, and can understand. Nurses use these theories every shift, often without naming them: offering a toddler two choices instead of an open question (Erikson's autonomy), explaining a procedure to a 6-year-old with concrete steps instead of abstract reasoning (Piaget), or respecting an adolescent's need for privacy (identity development).
No single Theory A framework that organizes observations and predicts behavior Full entry → is the whole truth. Each one is a lens — useful for certain questions, weaker for others — and each was developed in a particular time and culture. This topic covers the theories most commonly taught in nursing fundamentals: Freud's psychosexual theory, Erikson's psychosocial stages, Piaget's cognitive development, Kohlberg's moral development, Fowler's faith development, attachment theory (Bowlby and Ainsworth), Havighurst's developmental tasks, and Maslow's Hierarchy of needs Maslow's ordered needs: physiological → safety → belonging → esteem → self-actualization Full entry →. For each: what the theory says, the stages a nurse should recognize, how it applies to care, and its limits.
Why this matters
- Theories tell nurses what to expect and what to do. If a hospitalized 2-year-old screams when the nurse enters, Erikson's autonomy stage and attachment theory both explain the behavior and suggest interventions (parent presence, consistent caregiver, choices).
- Teaching must match cognitive stage. Piaget's stages explain why a 4-year-old cannot understand "your blood sugar is high" but can understand "your body needs a drink of juice." Misjudging cognitive stage makes teaching fail.
- Behavior that looks "bad" may be developmentally normal. A toddler's "no" is autonomy practice, not defiance; an adolescent's risk-taking reflects identity exploration. Knowing this changes how nurses respond.
- Theories organize assessment. Asking "which stage is this person working on?" focuses the history, the teaching plan, and the family guidance.
- NCLEX connection: theory questions are application-based — "According to Erikson, the nurse would expect which behavior in a toddler?" — so learn the stage and its nursing implication.
The college version
Core Concepts
Erikson's psychosocial theory (the most exam-critical)
Erikson described eight stages across the lifespan; each is a crisis between two outcomes that must be reasonably resolved to move on. A positive resolution builds a Virtue The strength gained when a stage crisis is reasonably resolved Full entry →; a poor resolution leaves a weakness that later stages can still partially repair — no stage is a life sentence.
| Stage (approximate age) | Crisis | Virtue if resolved | Nursing application |
|---|---|---|---|
| Infancy (0–~1 yr) | Trust vs. mistrust | Hope | Respond consistently to cries; parent involvement; minimize separation |
| Toddler (1–3 yrs) | Autonomy vs. shame/doubt | Will | Offer choices within limits; allow self-feeding and self-dressing; avoid power struggles |
| Preschool (3–6 yrs) | Initiative vs. guilt | Purpose | Encourage imaginative play and trying new things; don't shame mistakes |
| School-age (6–12 yrs) | Industry vs. inferiority | Competence | Let the child help and complete tasks; praise effort; teach about their condition |
| Adolescence (12–19 yrs) | Identity vs. role confusion | Fidelity | Respect privacy; support peer relationships; confidentiality within legal limits |
| Young adult (20–40 yrs) | Intimacy vs. isolation | Love | Support relationships and life transitions (partner, career, parenting) |
| Middle adult (40–65 yrs) | Generativity vs. stagnation | Care | Support contribution to family/work/community; caregiver roles |
| Older adult (65+) | Ego integrity vs. despair | Wisdom | Honor life review and reminiscence; support dignity and independence |
Piaget's cognitive development
Piaget explained how thinking itself changes with age — not what children know, but how they reason.
- Sensorimotor (0–~2 yrs): infants learn through senses and movement; Object permanence Knowing something exists when it is out of sight Full entry → (knowing something exists when out of sight) develops near the end. Nursing: keep familiar objects present; talk while handling the infant.
- Preoperational (2–~7 yrs): language and symbolic play appear; thinking is egocentric (the world revolves around the child) and magical; logic is not yet available. Nursing: use concrete, simple explanations; a child this age may believe a procedure is punishment — clarify gently; prepare with play and honest, simple language.
- Concrete operational (7–~11 yrs): logical thinking about concrete things; understands Conservation Understanding that amount stays the same despite changes in shape Full entry → and cause-and-effect; still struggles with pure abstractions. Nursing: explain step by step with real objects (show the equipment); the child can reason "if I take this medicine, my cough gets better."
- Formal operational (11+ yrs): abstract, hypothetical, systematic thinking. Nursing: adolescents can grasp "why" and participate in complex decisions; respect their reasoning even when it disagrees with yours.
Freud's psychosexual theory
Freud proposed that personality develops through stages centered on bodily pleasure zones and unconscious conflicts: oral (infancy — feeding, mouth), anal (toddler — toilet training, control), phallic (preschool — gender identity), latency (school-age — dormant sexual focus; energy into school and peers), and genital (adolescence onward — mature relationships). Modern nursing uses Freud mostly for its enduring observations — that early experiences matter and that children have strong needs around feeding, elimination, and body awareness — not as a literal guide. Behavioral manifestations and biological drives are better explained by other frameworks.
Kohlberg's moral development
Kohlberg described Moral reasoning The way a person justifies right and wrong Full entry → in three levels: preconventional (young children — right/wrong judged by punishment and reward: "I won't take it because I'll get in trouble"), conventional (most adolescents and adults — right/wrong judged by rules, laws, and social expectations: "it's against the rules"), and postconventional (some adults — right/wrong judged by internalized universal principles that may override rules: "the rule is unjust"). Nurses see Kohlberg in action when a school-age child refuses medication "because my mom said so" (conventional) versus a preschooler who complies "to get a sticker" (preconventional). Note: the theory describes reasoning about moral questions, not whether someone behaves morally.
Fowler's faith development
Fowler described spiritual development in stages that begin in childhood (intuitive-projective faith in the preschool years — imagination and example) and mature through adolescence and adulthood (synthetic-conventional faith — adopting a group's beliefs; individuative-reflective faith — questioning and owning beliefs; later stages — universalizing). Nursing use: respect where a person is in their spiritual journey, support rituals and practices that matter to them, and involve chaplaincy or spiritual care resources when appropriate — without imposing any particular belief.
Attachment theory (Bowlby and Ainsworth)
Bowlby showed that infants form a deep emotional bond with caregivers that is essential for survival and later relationships. Ainsworth's "Strange Situation" studies identified patterns: Secure attachment A bond where the child uses the caregiver as a safe base Full entry → (child uses caregiver as a safe base, is comforted by them), insecure-avoidant (child ignores/avoids the caregiver), insecure-resistant/ambivalent (child is clingy and not easily comforted), and disorganized (confused, contradictory behavior, often linked with frightening caregiving). Nursing application: consistent caregivers, minimizing staff changes, supporting parents to room in and hold their infant, and recognizing that a child's difficult attachment behavior reflects experience, not a "bad" child.
Havighurst's developmental tasks
Havighurst framed each life period as a set of tasks to master — e.g., learning to walk and talk (infancy), forming values and preparing for career (adolescence), achieving civic and social responsibility (middle adulthood), adjusting to retirement and decreased strength (later maturity). The idea: healthy development means completing the tasks of each period; struggles predict difficulties with later tasks. Nurses use tasks to anticipate what families will be working on and what education to offer.
Maslow's hierarchy of needs
Maslow (technically a motivation theory, often taught alongside developmental theories) arranged human needs in a hierarchy: physiological (air, food, water, sleep, elimination), safety/security, love and belonging, esteem, and self-actualization. Lower needs generally take priority — a person who is cold, hungry, or in pain cannot focus on teaching about future goals. Nursing use: triage priorities in care and education (stabilize physiologic needs first), and recognize that "noncompliance" may really be an unmet lower-level need (no money for food, no safe place to sleep).
Using theories responsibly
Theories describe typical patterns; they are not laws, labels, or diagnoses. Stage boundaries overlap; individuals move at their own pace; culture, disability, life experience, and trauma shape development in ways the classic stage models under-represent. Use a theory to generate a hypothesis and a starting point — then confirm with the actual person and family.
Common Confusions
| Do Not Confuse | With | The Difference |
|---|---|---|
| Erikson | Piaget | Erikson = psychosocial stages/crises across the whole lifespan; Piaget = cognitive stages of how children reason |
| Trust vs. mistrust | Autonomy vs. shame/doubt | Infancy (trust) vs. toddlerhood (autonomy) — the toddler's "no" is autonomy, not distrust |
| Initiative | Industry | Preschoolers take initiative in play (initiative vs. guilt); school-age children work to master skills (industry vs. inferiority) |
| Preoperational | Concrete operational | Preoperational = egocentric, no logic (2–7); concrete operational = logic with concrete things (7–11) |
| Kohlberg's levels | Actual moral behavior | The theory describes how people justify right and wrong, not whether they do the right thing |
| A theory predicting a person | A theory describing a pattern | Theories describe typical patterns; individuals vary — never use a stage as a label |
| Secure attachment | Always happy behavior | A securely attached child can cry at separation — security is about being comforted and using the caregiver as a base |
| Freud's theory | Current nursing guidance | Freud's stage theory is largely historical in modern nursing; use current developmental evidence |
Eli explains
The same idea, in plain words
Explain it like I’m 10
Think of growing up like climbing a ladder with different kinds of rungs. One scientist said every age has a "big question" to figure out, like "Can I trust people?" (babies) and "Who am I?" (teenagers). Another scientist said kids' brains think in different ways at different ages — little kids believe what they see, and older kids can imagine "what if." These ideas are like maps: they don't tell you exactly what every person will do, but they help adults guess what kids need.
Worked example
Seven-year-old Leo is admitted for surgery. The nurse uses two theories at once. From Piaget (concrete operational), she knows Leo can follow logical steps but will misunderstand abstractions — so she explains with real objects: "First you'll drink sleepy juice through this straw, then you'll wake up in a room with your mom." She does not say "you'll be put to sleep," which Leo might take literally and fear. From Erikson (industry vs. inferiority), she knows Leo needs to feel competent — so she lets him press the call-light button, "help" hold his own bandage, and explains that his job is to cough and sip water after surgery, praising each success.
She also watches Leo's mother. When the mother is anxious, Leo looks to her before answering — an attachment signal. The nurse gives the mother clear, honest information and a role in Leo's care, because a secure parent makes a secure child. When Leo asks, "Is it my fault I got sick?" (preoperational-style magical thinking lingering at his age), the nurse answers gently and directly: "No — nothing you did made you sick." No single theory explained the whole visit; together they shaped communication, teaching, family support, and reassurance.
Key takeaways
- Erikson = the priority theory for nursing exams: 8 stages, each a crisis with a virtue (trust/hope, autonomy/will, initiative/purpose, industry/competence, identity/fidelity, intimacy/love, generativity/care, integrity/wisdom).
- Piaget = how thinking changes: sensorimotor (object permanence), preoperational (egocentric, no logic), concrete operational (logic with concrete things), formal operational (abstract reasoning).
- Kohlberg = moral reasoning levels: preconventional (punishment/reward), conventional (rules/social expectations), postconventional (internal principles).
- Attachment (Bowlby/Ainsworth): secure, avoidant, resistant/ambivalent, disorganized — consistent, responsive caregiving builds security.
- Maslow: physiological needs come first — a hungry, unsafe, or hurting person cannot focus on teaching.
- Havighurst: each life period has tasks; missing them makes later tasks harder.
- Fowler: spiritual development is staged too — meet people where they are, involve spiritual care resources as appropriate.
- Freud: mostly of historical interest in modern nursing; early experience matters, but the stage theory itself is not used as a literal guide.
- Theories are lenses, not labels — individual, cultural, and life-experience variation is the rule.
Check yourself
6 review questions from the chapter. Try each one, then open the answer.
According to Erikson, which crisis is a toddler working on, and what nursing approach supports a positive resolution?
Show answer
Autonomy vs. shame/doubt. Support: offer choices within safe limits, allow self-feeding/dressing, avoid power struggles, and give the child a sense of control.
A 4-year-old asks why she needs medicine. Using Piaget, how should the nurse explain it?
Show answer
Use simple, concrete language tied to what the child can see and feel — e.g., "This medicine helps your cough go away so you can play" — rather than abstract explanations about germs or immune systems.
What is object permanence, and in which Piaget stage does it develop?
Show answer
Object permanence is knowing that something still exists when out of sight; it develops in the sensorimotor stage (infancy).
Name the four attachment patterns described by Ainsworth and the caregiving behavior that promotes a secure pattern.
Show answer
Secure, insecure-avoidant, insecure-resistant/ambivalent, and disorganized. Consistent, responsive caregiving promotes secure attachment.
A patient who has not eaten in a day is being given discharge teaching. What would Maslow suggest the nurse do first?
Show answer
Meet the physiological need first — offer food/fluid and address comfort — because lower-level needs take priority before a person can focus on learning.
Why are developmental theories described as "lenses, not laws"?
Show answer
Theories describe typical patterns observed in particular times and cultures; individuals vary in timing, culture, ability, and experience. Use them to form hypotheses, then confirm with the actual person.
Study toolsKey vocabulary
Key vocabulary
- Psychosocial theory
- Erikson's 8 lifespan stages, each a crisis between two outcomes
- Virtue
- The strength gained when a stage crisis is reasonably resolved
- Object permanence
- Knowing something exists when it is out of sight
- Egocentrism
- Seeing the world only from one's own viewpoint
- Conservation
- Understanding that amount stays the same despite changes in shape
- Moral reasoning
- The way a person justifies right and wrong
- Secure attachment
- A bond where the child uses the caregiver as a safe base
- Developmental task
- A skill or achievement expected in a life period
- Hierarchy of needs
- Maslow's ordered needs: physiological → safety → belonging → esteem → self-actualization
- Theory
- A framework that organizes observations and predicts behavior
Sources & references
This lesson was adapted from the open educational references above; their licenses and attributions are preserved. See Copyright & Licensing.
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