1 Nursing in Family SystemsDevelopmental Perspectives on the Family

2 Development PerspectivesFamilies grow and develop over time Families experience the developmental stages of their members Development of individual members influence family development Though similar, it is not standard or linear

3 Family Interaction ModelFamily career: 1. Stages and tasks Transitions Individual development Patterns of health, disease and illness

4 Family Career Dynamic process of change Similar to family life cycle—includes stages and tasks Also includes transitions Allows for diverse and unique experiences: divorce, remarriage

5 Stages of Family DevelopmentChild-bearing family Pre-school family School age family Teenage family Launching family Middle-aged family Aging family

6 Family Tasks Provide shelter, food, clothingNurture emotional development Ensure socialization in community and other environment Contribute to the next generation Promote health of family members

7 Family Transitions Events that trigger changes 1. Developmental2. Situational—non-normative

8 Individual Development across the life spanAttachment Identity formation Cognitive development Moral development Spiritual development

9 Attachment Theory: Bowlby and AinsworthFoundations: Psychoanalysis Psychobiology General Systems Theory Cognitive Development Ethology

10 Attachment Definition:An affectional tie that one person forms to another specific person over time and that endures into adulthood

11 Attachment Goal: to attain or maintain proximity to and communication with the attachment figure (mother, father, grandmother).

12 Attachment: Behavioral SystemThe infant develops an “inner working model” (a cognitive map) of the mother’s behavior. Early “goal directed behavior” changes to “ goal corrected behavior” based on feedback from mother’s responses 1.      Attachment is based on the concept of a “behavioral system”. The infant develops an “inner working model” (a cognitive map) of the mother’s behavior. 2.      Early the infant’s cues, such as crying and making noises are random. This is called “goal directed behavior”. 3.      Gradually, the infant learns to adjust his/her behavior to obtain the desired results from the mother. This is “goal corrected behavior”.

13 Attachment: Phases 1. Preattachment: birth to 8 weeks baby signals, mother responds 2. Attachment-in-the-making: 2-6 months baby signals towards an attachment figure 3. Clear-cut Attachment: after 6 months baby knows mother (inner representation) 1.Attachment is formed through a series of phases: preattachment birth to about 8 weeks (when able to discriminate attachment figure) baby uses signaling behaviors (cries, makes sounds, roots and nurses) mother responds with care giving Attachment-in-the-making 2 months to 6 months orients and signals towards an attachment figure Clear-cut Attachment begins sometime after 6 months know mother (inner representation of attachment figure becomes more definite) Closeness to mother needed Locomotion, signaling Goal corrected behavior emerges as the child’s inner working model of mother’s behavior develops

14 Attachment: Behavioral SystemAttachment is reciprocal— Infant’s attachment behavior system is activated by hunger, pain, fear, need for reassurance Mother’s complementary behavioral system is the needed caring and protection Infant’s feedback is that needs are met

15 Attachment: Conditions neededboth mother and infant must give clear signals mother must respond to infant's cues & infant must respond to the mother's care giving the environment must facilitate the interaction

16 Attachment:Types Secure Infants needs are consistently met by motherInsecure Ambivalent– infants needs are sometimes met Avoidant– infants needs are not met

17 Attachment Stability If interaction between infant and mother remains stable, attachment will remain stable If conditions change, attachment may change (insecure -> secure) secure remains secure or insecure remains insecure Change: mother learns how to be responsive Mother becomes less available or responsive

18 Attachment & Separation AnxietyWhen stage 3 of attachment is achieved, separation from mother results in great anxiety, distress, anger, and loss. If prolonged separation occurs, the young child may show phases of protest, despair, and detachment.

19 Attachment beyond infancyAttachment behaviors: Are present through the life cycle May not always be evident Are not pathological in adults

20 Attachment Adult RelationshipsEarly attachment is the basis for affectional bonds to others later in life Internal working models (of self and mother) guide these later bonds Secure attachment facilitates positive relationship Insecure may interfere with relationships

21 Attachment & ParentingInternal working models of self and mother directs attachment to own child If own attachment was insecure, this pattern may be changed by changing behaviors

22 Attachment & ParentingThe best environment for a child is a stable, warm, family with a positive relationship and secure attachment between the infant and mother.

23 Identity Formation: Erik EriksonDevelopment of theory:1950 Theoretical bases: psychoanalytic (Freud) Social & cultural values = Psychosocial development

24 Identity Formation: Erik Erikson8 stages: Occur in a set order Common to all humans Occur at a set time Involves a psychosocial skill to be achieved

25 Identity: Stage I Age: infant (0-1 year)Task/Crisis: Trust Vs Mistrust Significant relationship: mother Event: Feeding Outcome: infant must form a trusting relationship with caregiver or develop a sense of mistrust

26 Identity: Stage II Age: Toddler (2-3 years)Task/Crisis: Autonomy vs Shame & Doubt Significant relationship: parents Event: toilet training Outcome: Child learns control but may develop shame if not handled well

27 Identity: Stage III Age: Preschooler (3-6 years)Task/Crisis: Initiative vs Guilt Significant relationship: family Event: Independence Outcome: Child become assertive and take initiative, but may be too forceful, leading to guilt

28 Identity: Stage IV Age: School-age (7-12 years)Task/Crisis: Industry vs Inferiority Significant relationship: Neighbors & school Event: school Outcome: Child learns new skills, but risks failure and sense of inferiority

29 Identity: Stage V Age: Adolescence (12-19 years)Task/Crisis: Identity Vs Role confusion Significant relationship: Peers, role models Event: Peer relationships Outcome: Adolescent must achieve sense of identity in work, hobbies, sex roles, & religion

30 Identity: Stage VI Age: young adult (20-40 years)Task/Crisis: Intimacy vs Isolation Significant relationship: Partners, friends Event: love relationship Outcome: young adult develops intimate relationships or a sense of isolation

31 Identity: Stage VII Age: middle adult (40-65 years)Task/Crisis: Generativity vs Self-Absorption Significant relationship: Family, friends at work Event: Parenting Outcome: Adult must find a way to satisfy & support next generation

32 Identity: Stage VIII Age: older adult (65 and beyond)Task/Crisis: Integrity vs Despair Significant relationship: Mankind Event: Reflection on and acceptance of own life Outcome: A sense of fulfillment and unity or sense of despair and fear

33 Cognitive Development: PiagetDevelopment of theory: 1920’s & on Studied how children’s thinking changes over time and how it differs from adult thinking. Demonstrated that children’s thinking is qualitatively different than adults

34 Cognitive Development (Piaget)Period I: Sensorimotor (birth – 2 years) Series of 6 stages Uses senses, motor skills and reflexes to explore Develop object permanence

35 Cognitive Development (Piaget)Period II: Preoperational (2-7 years) Only considers events from own point of view Begin to use symbols Cannot yet use mental operations/actions to understand world Difficulty with conservation of quantities (liquids), number, classification Living and non-living (ie sun is alive)

36 Cognitive Development (Piaget)Period III: Concrete Operations (7-11 years) Uses beginning logic to understand world Develops sense of fairness, collaboration, and competition

37 Cognitive Development (Piaget)Period IV: Formal Operations (12 years and on) Able to view world from many different perspectives Thought is abstract & flexible Can manipulate symbols Forms hypotheses, theories

38 Cognitive Development: Alternate ViewsPiaget’s stages are not as stable and structured as he proposed. Children can reason earlier than he proposed. Not all adults reach formal operations Learning is dependent on experience – Information Processing– not age & stage

39 Moral Development: KohlbergDevelopment began in later 1950’s Theoretical basis: Piaget’s work on moral development Focused on through process in decision making, not the final decision Studied mainly boys & men

40 Moral Development: KohlbergStage 0: Premoral No idea of right or wrong, rules or authority. Good = what is pleasant or exciting Bad = what is painful or fearful Impulses rule behavior Kolberg doesn’t identify specific ages for each stage. Generally Stage 0 is the younger child, infancy through toddler

41 Moral Development: KohlbergLevel 1: Preconventional Morality Stage 1:Obedience-Punishment orientation Morality is what adults say they should do Stage 2: Individualism / relativism Right behavior is acting in one’s own best interests Stage 1: right = what authority says is right. Doing the right thing is obeying authority and avoiding punishment. Stage 2, children are no longer so impressed by any single authority; they see that there are different sides to any issue. Since everything is relative, one is free to pursue one's own interests, although it is often useful to make deals and exchange favors with others.

42 Moral Development: KohlbergLevel II: Conventional Morality Stage 3: Good boy, good girl Do what gains approval of others Stage IV: Law and order Obey the law, do one’s duty, show respect for authority, maintain the social order At stages 3 and 4, young people think as members of the conventional society with its values, norms, and expectations. Stage 3: emphasize being a good person, having helpful motives toward people close to one Stage 4: concern shifts toward obeying laws to maintain society as a whole. Most adults do not move beyond this level

43 Moral Development: KohlbergLevel III: Post-conventional Morality Stage V: Social contract Understanding of social mutuality and interest in welfare of others (acts from legal viewpoint but open to change if needed for social utility) Stage VI: Principled conscience Respect for universal principle and demands of individual conscience At stages 5 and 6 people are less concerned with maintaining society for it own sake, and more concerned with the principles and values that make for a good society. Stage 5: emphasize basic rights and the democratic processes that give everyone a say, Stage 6:define the principles by which agreement will be most just Stage 6 may lead to civil disobedience: Martin Luther King Kolhberg believed in stage 6, but couldn’t find enough people at this level of moral develop to carefully define it or observe develop of it.

44 Faith Development: FowlerDeveloped in 1974 Theoretical bases: Erikson, Kohlberg Term “faith” used to mean Spiritual development

45 Faith Development: FowlerStage 0: Undifferentiated (Infancy) Development of trust forms the beginning of faith development Trust develops through relationship with primary caregiver (attachment)

46 Faith Development: FowlerStage 1: Intuitive-Projective (3-7 years) Children follow parental beliefs as part of daily life Toddlers imitative spiritual behaviors of others Preschoolers begin development of values and beliefs

47 Faith Development: FowlerStage 2: Mythical-literal (school-age) Spiritual development parallels cognitive development Strong interest in religion Belief in reward for being “good” and punishment for being “bad” Adult may remain at this level

48 Faith Development: FowlerStage 3: Synthetic-conventional Has a system of values and beliefs Has not personally examined this system through critical thinking Faith consists of mainly conventional beliefs Fowler found ¼ of adults to be at this stage or lower Adult may remain at this level

49 Faith Development: FowlerStage 4: Individuative-Reflective faith Critical evaluation of values and beliefs occurs Personal beliefs are differentiated from those of leaders in their religious system Rational thinking tends to result in viewing religious symbols as abstract concepts with less meaning Fowler found 60% of adults to be at this stage

50 Faith Development: FowlerStage 5 Conjunctive faith Merging of earlier Conventional beliefs with Individual perspective– unifying of mind and experience Experience the depth of religion emotions while recognizing the limitations of the abstract Fowler found about 20% of adults to be at this stage

51 Faith Development: FowlerStage 6 Universalizing faith Live a spirit of inclusive and fulfilled human community & compassion Challenge the systems of society and religion, Unconcerned with survival, security, and personal significance Examples: Mother Teresa, Gandhi, Martin Luther King, Abraham Lincoln Fowler found this stage in only 1 of the 349 adults studied -- rare