Relating Developmental Stages to Assessment and Teaching Approaches

Infant Toddler Preschool

(Birth – 12 months) (12 months - 36 months) (3 - 6 years)
Stages of Trust vs. Mistrust Autonomy vs. Shame and Initiative vs. Guilt
Development Needs maximum comfort Doubt Begins to initiate, not imitate,
with minimal uncertainty in Toddler works to master activities; develops conscience and
order to trust him/herself, physical environment while sexual identity.
others, and the maintaining self-esteem.
environment.
Developmental • Develops attachment to • Develops sense of • Develops sense of purpose
Tasks primary caregiver autonomy • Masters self-care skills
• Develops awareness of • Further develops sense of • Develops sense of self, gender,
self as separate person self identity, and family relationship
• Begins developing • Begins developing
communication skills socialization skills
What To Ask ƒ Does the infant respond ƒ Does the toddler prefer ƒ Which self-care skills does the
to the physical certain foods or activities? child perform at home?
presence of his/her ƒ How does he/she ƒ How does he/she keep busy at
parents? acknowledge parental home?
ƒ How does he/she distress or approval? ƒ What is his/her reaction to
communicate his/her ƒ Does he/she play with other schedules and routines?
needs and desires? children or adults? ƒ What would the child like to be
when he/she grows up?
ƒ What is his/her favorite activity?
ƒ Can he/she state his/her name
and identify family members?
What To Look ƒ Shows distress when ƒ Willing to follow whims ƒ Occupies free time
For family leaves. ƒ Plays alongside others or independently
ƒ Uses motor and verbal interacts with them ƒ Participates in self-care activities
skills to communicate ƒ Approaches others with ƒ Evaluates disapproval of others
needs and feelings. show-and-tell items ƒ Initiates activities rather than just
imitating others’ actions
Behavior In Under 7 months: ƒ Commonly experiences ƒ Experiences separation anxiety;
Hospital ƒ Responds well to nurse separation anxiety may panic or throw tantrums,
ƒ Allows parents to leave ƒ May show anger by crying, especially when parents leave
Over 7 months: shaking crib ƒ Often regresses (enuresis)
ƒ Anxious and unhappy ƒ Rejects attention ƒ Commonly shows eating and
ƒ Clings to parents and ƒ May become apathetic, sleeping disturbances
cries when they leave crying intermittently or
continuously
ƒ May reject parents and
respond to health
professional
Teaching ƒ Teach the parents to ƒ Teach the parents to ƒ Teach the parents to participate
Approaches participate in their participate in their child’s in their child’s care
infant’s care. care ƒ Use simple, neutral words to
ƒ Handle the infant gently ƒ Give the child simple, describe procedures and surgery
and speak in a soft, direct, and honest to the child
friendly tone of voice. explanations just before ƒ Encourage the child to fantasize
ƒ Use a security toy or treatment or surgery to help plan his/her responses to
pacifier to reduce the ƒ Use puppets or coloring possible situations
infant’s anxiety and books to explain ƒ Use body outlines or dolls to
elicit cooperation. procedures show anatomic sites and
ƒ Let the child play with procedures
equipment to reduce ƒ Let the child handle equipment
anxiety before a procedure
ƒ Let the child make ƒ Use play therapy as an
appropriate choices, such emotional outlet and a way to
as choosing the side of the test the child’s sense of reality
body for an injection
 School-Age Child Adolescent
(6 – 12 years) (12 - 18 years)

Stages of Industry vs. Inferiority Identity vs. Role Confusion

Development Tries to develop a sense of self-worth by refining Tries integrating many roles (child, sibling,
skills. student, athlete, worker) into a self image; under
role model and peer pressure.

Developmental ƒ Further develops sense of self through ƒ Establish self-identity

Tasks achievement ƒ Prepares for independent role in society
ƒ Develops sense of right and wrong ƒ Continues to develop relationships with peers
ƒ Shows more interaction with peers of both sexes
What To Ask • What does the child do best? • Is he/she in school?
• What is her / her favorite subject in school? • Does he/she want to attend college?
• Who is his/her best friend? • Who are his/her friends?
• What kinds of things do they do together? • Will they be visiting or calling while he/she is
• What would he/she do if he/she found a lost hospitalized?
item on the playground?
What To Look • Talks about friends, family, and activities • Expresses individuality through appearance or
For • Interacts with others and initiates conversation activities
• Participates in self-care activities • Interacts with significant peers and staff
• Attempts to improve his/her skills • Willing, if able, to continue school work
Behavior In • May have insomnia, nightmares, enuresis • Fluctuates in willingness to participate in care
Hospital from anxiety about the unknown because of need for independence and
• Alternately conforms to adult standards and approval
rebels against them • Shows concerns about how procedure or
surgery may affect appearance
Teaching ƒ Use body outlines and models to explain body ƒ Ask the patient if he/she wants his/her parents
Approaches mechanisms and procedures present during teaching sessions and
ƒ Explain logically why a procedure is procedures
necessary ƒ Give scientific explanations, using body
ƒ Describe the sensations to anticipate during a diagrams, models, or videotapes
procedure ƒ Encourage the patient to verbalize his/her
ƒ Encourage the child’s active participation in feelings or express them through artwork or
learning writing
ƒ Praise the child for cooperating with a ƒ Offer praise appropriately
procedure
 Young Adult Middle-Aged Adult
(18 – 30 years) (30 – 60 years)
Stages of Intimacy vs. Isolation Generativity vs. Stagnation
Development Learns to make personal commitment to another Seeks satisfaction through productivity in career,
as spouse, parent family, civic interests.
Developmental ƒ Establishes independence from parental • Establishes socioeconomic status
Tasks figures • Helps younger and older persons
ƒ Initiates a permanent lifestyle • Finds satisfaction through his/her work, as a
ƒ Adjusts to companionship style citizen and family member, or as a care
ƒ Integrates values into career and provider
socioeconomic constraints
What To Ask • Does he/she live at home with his/her • What is the most satisfying thing in his/her
parents? life?
• Does he/she live alone? • Who are the important people in his/her life?
• Or does he/she have a roommate or his/her • Is he/she active in community affairs?
own family?
• Is he/she employed or in school?
What To Look • Forms role-appropriate relationships with staff • Participates in job-related or community
For and others projects
• Copes with regulations • Forms social relationships
• Helps with and directs care
• Forms intimate relationship with another
person
Behavior In ƒ Directs and participates in his/her own care ƒ Copes with hospital regulations
Hospital ƒ Complies with hospital regulations ƒ Directs and participates in care
ƒ Freely asks questions hen he/she has
concerns or uncertainties
ƒ Demonstrates continued interest in personal
role
ƒ Show concerns about family and economic
results of hospitalization
Teaching • Negotiate learning outcomes with the patient • Address concerns before teaching
Approaches • Include family members in teaching • Help in prioritization
• Use problem-centered teaching • Involve in decision-making
• Provide for immediate application of learning • Listen to what patient says
• Let the patient test own ideas, take risks, and • Keep patient and family informed
be creative. Allow him/her to evaluate actions • Use adult teaching principles
and change behavior
• Use the patient’s past experience as a
learning resource
 Older Adult
(over 60 years)
Late Adult Stage Older Adult Stage
Stages of Integrity vs. Despair: Review life accomplishments, deals with loss and preparation for death
Development
Developmental ƒ Forms mutually supportive relationships with grown children
Tasks ƒ Adjusts to change in or loss of friends and relatives
ƒ Prepares for retirement
ƒ Uses leisure time in satisfying way
ƒ Adapts to aging
What To Ask ƒ Does he/she have any financial concerns?
ƒ What are the retirement plans?
ƒ What does he/she do in his/her leisure time?
ƒ Does he/she have friends his/her own age?
ƒ How does he/she feel about getting older?
What To Look ƒ Shows concern for children and grandchildren
For ƒ Keeps current on world events
ƒ Forms adult relationships with staff
ƒ Participates in care and decision making
Behavior In ƒ Demonstrates anxiety over new procedures or a change in routine
Hospital ƒ Often forgets new material or ideas or takes a long time to make decisions
ƒ Maintains interest in personal matters
ƒ Asks for instructions to be repeated
ƒ Requires frequent rest periods
Teaching ƒ The gradual decline in attention span ƒ Continued decline in sensory-perceptual
Approaches continues, as does a continued decrease in abilities may affect ability to learn
sensory perceptual skills. Assess learning (limited visual and hearing skills, diminished
ability, reading, hearing abilities, and teach ability to perform skills). Present one idea at a
within those limits. time with clear, concrete demonstrations.
ƒ Negotiate learning outcomes with the patient. ƒ Schedule frequent, short teaching sessions at
Determine the patient’s priorities and times of peak energy (10 minutes maximum).
resources and how they affect the patient’s Avoid holding sessions after the patient has
ability to learn. bathed, ambulated, or taken medications that
ƒ Include family members in the teaching. The affect learning ability, or if the patient has
patient’s support system may be more pain.
important to assist the patient in adapting to ƒ Determine if activities, treatments, or
health related changes, as the adult grows medications affect learning.
older. ƒ Determine necessary resources to make
ƒ Use problem-centered teaching with lifestyle changes before setting mutual and
immediate application and reinforcement of realistic learning outcomes with the patient.
learning. ƒ Involve the family / support system in
ƒ Determine if there are misconceptions or teaching.
denial that will interfere with learning. ƒ Determine if social isolation will be a barrier to
ƒ Let the patient test his or her own ideas, take learning.
risks, and be creative. ƒ Repeat / reinforce teaching with feedback
ƒ Encourage the patient to evaluate his / her continuously.
actions and change his / her behaviors. ƒ Encourage independence within ability.
ƒ Relate health care decisions to current life ƒ Check for memory deficit by asking for verbal
priorities. feedback
ƒ Use simple sentences, concrete examples,
and reminders, such as calendars or pillboxes
ƒ Speak slowly and distinctly in a conversational
tone
ƒ Use large-print materials and equipment with
oversized numbers.
ƒ Avoid using teaching materials printed on
glossy paper.

(Adapted from: Queen’s Medical Center, Honolulu, Hawaii, Health Education & Wellness Dept., 1997.)
© AHEC Clear Health Communication Program
The Ohio State University