Impacts of HIV on education, food security and health sectors

Module outcomes
• By the end of this module, the learner should;
Apply concepts of psychology in managing clients/patients
Integrate theories of personality development with provision
of nursing care
Identify and manage patients with deviations in growth &
development.

Course Outline
 Concepts of psychology
 Definition of terms
 Historical Background
 Scope of psychology
 Theories of personality development
 Human behavior and social interactions
 Learning and memory
 Classical conditioning
 Instrumental conditioning
3

Course outline ct’
 Observational cognitive avoidance and learning
 Motivation
 Types of personalities
 Stress and coping
 Crisis and crisis intervention
 Mental defense mechanisms
 Psychology in relation to nursing
 Stages of growth and development
 Application of theories of personality development in growth and
development

Definition of Terms
 PSYCHOLOGY
-The scientific study of human behavior and mental or cognitive
processes.
- The scientific study of human mind including its structure and
functioning, usually observed in behavior.
 BEHAVIOUR
- Any activity of an organism that is capable of being observed in
response to its environment.
- Behaviour includes all of our outward or overt actions and
reactions, such as verbal and facial expressions and movements.
7

MENTAL PROCESSES
 Refer to all the internal and covert activity of our mind
such as thinking, feeling and remembering.
NOTE:
The word Psychology has its origin from two Greek
words ‘Psyche’ and ‘Logos’, ‘psyche’ means ‘soul’ and
‘logos’ means ‘study’. Thus literally, Psychology means
‘the study of soul’ or ‘science of soul’.

 EXPERIENCE
Mental phenomena occurring directly to the
individual.
 CHARACTER
An evaluation of an individual`s personality
against some set standards within the society
focusing on morals and ethics.
9

Cont’d…
 ATTITUDE
A tendency to respond positively or negatively to either a
person, object or situation (an organism’s response to
stimuli).
 INTELLIGENCE
The ability to learn abstracts, which include learning of
vocabularies, numbers, concepts, reasoning, making
judgment and problem solving skills.
10

Historical Background
The development of psychology can broadly be traced into four
periods:
• Ancient Greek period,
• Pre-modern period,
• Modern period and
• Current status
11

Ancient Greek period:
Some of the key contributors were:
Socrates who was interested in studying the reincarnation
of soul (embodiment in fresh). Soul or mind was
considered as the representation of individuals.
Plato, a bright student of Socrates expanded Socrates
concepts in philosophy about life and soul.
12

Cont’d…
Aristotle in his book “para psyche” (about the mind or soul)
he introduced the basic ideas in psychology today, like law of
association.
However, the notion of psychology was primarily related to
study of soul or mind at that stage and never on the
behavior of the individual. That is why the attention was
diverted from the study of soul or mind.
13

Pre-modern Period:
It was during 1800's that Wilhelm Wundt established first
psychology laboratory in Leipzig, Germany.
He defined psychology as a science of consciousness or
conscious experience. He proposed the Theory called
structuralism.
14

Modern period:
Behaviorists (J.B Wastson, Ivan pavlov and B.F. skinner)
proposed that psychology should study the visible
behavior which can be objectively felt and seen. Hence
they defined psychology as the science of behavior.
They however only focused on observable behaviors and
ignored the role of mental processes. Also, they
undermined the role of unconscious mind and heredity
in behavior.
15

Current Definition:
• The modern day psychology is defined as the science
of behavior and mental or cognitive processes.
• This definition comprises these things: psychology is
science, it studies behavior and it studies mental
process.
16

Aim of Psychologists
• To find out why people act as they do to give us a
better understanding (insight) of our own
attitudes and reactions.
17

Scope of Psychology:
• The field of psychology can be understood by various subfields of
psychology making an attempt in meeting the goals of psychology.
1. Physiological Psychology:
• In the most fundamental sense, human beings are biological
organisms.
• Physiological functions and the structure of our body work
together to influence our behaviour.
• Biopsychology is the branch that specializes in the area. Bio-
psychologists may examine the ways in which specific sites in the
brain which are related to disorders such as Parkinson’s disease or
they may try to determine how our sensations are related to our
behaviour.

• Biological psychology studies how
physical and chemical changes in
our bodies influence behaviors
for example, how the brain,
nervous system and hormones
effect on behavior.

Scope of psychology ctd’
2. Developmental Psychology:
• Here the studies are with respect to how people grow and
change throughout their life from prenatal stages, through
childhood, adulthood and old age.
• Developmental psychologists work in a variety of settings like
colleges, schools, healthcare centres, business centres,
government and non-profit organizations, etc. They are also
very much involved in studies of the disturbed children and
advising parents about helping such children.

3. Personality Psychology:
• This branch helps to explain both consistency and change in a
person’s behaviour over time, from birth till the end of life
through the influence of parents, siblings, playmates, school,
society and culture.
• It also studies the individual traits that differentiate the
behaviour of one person from that of another person.

4. Health Psychology:
• This explores the relations between the psychological factors
and physical ailments and disease.
• Health psychologists focus on health maintenance and
promotion of behaviour related to good health such as
exercise, health habits and discouraging unhealthy behaviours
like smoking, drug abuse and alcoholism.
• Health psychologists work in healthcare setting and also in
colleges and universities where they conduct research. They
analyse and attempt to improve the healthcare system and
formulate health policies.

5. Clinical Psychology:
• It deals with the assessment and intervention of abnormal
behaviour.
• As some observe and believe that psychological disorders arise
from a person’s unresolved conflicts and unconscious motives,
others maintain that some of these patterns are merely learned
responses, which can be unlearned with training, still others are
contend with the knowledge of thinking that there are biological
basis to certain psychological disorders, especially the more
serious ones.
• Clinical psychologists are employed in hospitals, clinics and private
practice. They often work closely with other specialists in the field
of mental health.

6. Counselling Psychology:
• This focuses primarily on educational, social and career
adjustment problems.
• Counselling psychologists advise students on effective study
habits and the kinds of job they might be best suited for, and
provide help concerned with mild problems of social nature
and strengthen healthy lifestyle, economical and emotional
adjustments.
• They also do marriage and family counselling, provide
strategies to improve family relations.

7. Educational Psychology:
• Educational psychologists are concerned with all the concepts
of education.
• This includes the study of motivation, intelligence, personality,
use of rewards and punishments, size of the class,
expectations, the personality traits and the effectiveness of
the teacher, the student-teacher relationship, the attitudes,
etc.

8. Social Psychology:
• This studies the effect of society on the thoughts, feelings and
actions of people.
• Our behaviour is not only the result of just our personality and
predisposition. Social and environmental factors affect the way
we think, say and do. Social psychologists conduct experiments
to determine the effects of various groups, group pressures
and influence on behaviour.

9. Industrial and Organizational Psychology:
• The private and public organizations apply psychology to
management and employee training, supervision of
personnel, improve communication within the organization,
counselling employees and reduce industrial disputes.
Therefore, the physical aspects of employees are given
importance to make workers feel healthy.

10. Experimental Psychology:
• It is the branch that studies the processes of sensing,
perceiving, learning, thinking, etc. by using scientific
methods.
• The outcome of the experimental psychology is cognitive
psychology which focuses on studying higher mental
processes including thinking, knowing, reasoning, judging and
decision-making.

11. Environmental Psychology:
• It focuses on the relationships between people and
their physical and social surroundings. For example, the
density of population and its relationship with crime,
the noise pollution and its harmful effects and the
influence of overcrowding upon lifestyle, etc.

12. Psychology of Women:
• This concentrates on psychological factors of women’s
behaviour and development.
• It focuses on a broad range of issues such as discrimination
against women, the possibility of structural differences in the
brain of men and women, the effect of hormones on
behaviour, and the cause of violence against women, fear of
success, outsmarting nature of women with respect to men
in various accomplishments.

13. Sports and Exercise Psychology:
• It studies the role of motivation in sport, social aspects
of sport and physiological issues like importance of
training on muscle development, the coordination
between eye and hand, the muscular coordination in
track and field, swimming and gymnastics.

14. Cognitive Psychology:
• It has its roots in the cognitive outlook of the Gestalt
principles. It studies thinking, memory, language,
development, perception, imagery and other mental
processes in order to peep into the higher human mental
functions like insight, creativity and problem-solving.
• The names of psychologists like Edward Tolman and Jean
Piaget are associated with the propagation of the ideas of this
school of thought.

Note:
• Psychiatry- branch of medicine that deals with
emotional and behavioral disorders.
• A psychiatrist can prescribe medicine and is
considered a medical doctor (M.D.), NOT a
psychologist.

Impacts of HIV on education, food security and health sectors

PERSONALITY
• Definition: -
The unique characteristics each person develops in the course
of his life.
The sum total of a person, his/her psychological and
physiological characteristics that make him/her a unique
individual. E.g. behavior, conduct, temperament (mental
attitude), intellect.
36

Why study personality?
• It helps the health workers such as nurses and clinicians to
understand themselves, each other and their patients.
• It determines success and failure in the medical field, ability to
make friends and to adapt to different working conditions.
• It influences the way one copes with pain, illness and crises.
• It helps the health worker to understand why patients react
differently to a similar situation
37

Personality Trait
• A tendency to behave in a consistent manner in various
situations.
• Knowledge that a person possesses a particular trait makes
prediction of her behavior possible e.g. patience, honesty,
perseverance, bad temper, etc.
38

Factors Influencing
Personality
Heredity
• Studies have proved that individuals inherit certain
characteristics of personality from their parents, e.g. general
appearance, reaction tendencies (alertness, dull etc.)
39

Cont’d…
Environment
• Many environmental factors determine the personality of an
individual.
Social-cultural factors
• In most societies the male is supposed to be aggressive,
strong, not cry aimlessly and endure a lot of pain and on the
other hand girls are expected to be submissive and polite.
40

Cont’d…
Learning
• Plays a major role in moulding and influencing one`s
personality throughout life, beginning from infancy.
Self perception
• The environment helps the child develop self perception, and
the persons he interacts with reinforce that perception e.g.
failure in life or successful in life.
41

TYPES OF PERSONALITY
• There are quite a number of types of personality:
–Plato: body elements such as gold(rulers),iron(workers)etc
–Sheldon: body physique i.e. endomorphic, ectomorphic etc
–Hans: relativity to external world i.e
introversion/extroversion (broad categories)
–Hippocrates: body chemistry i.e. sanguines, melancholics etc
42

Introverts
• Are reserved, withdrawn persons who are pre-occupied
with their inner feelings and thoughts.
• They tend to be imaginative, slow in thinking, pessimistic,
shy, unfriendly, reserved, conservative, likes solitude,
cautious, passive, tender hearted and sympathetic and
often retreats after meeting difficulties.
43

Extroverts
• Are outgoing, active persons who direct their energies and
interests towards other people and things.
• They tend to be sociable, talkative, present oriented, tough
minded, unsympathetic, aggressive, friendly, adaptive, makes
and sticks to their own laws, optimistic, little fantasy and likes
other people’s company.
44

Sanguines (“let’s have fun”)
Great front-door person/salesperson
• Enthusiastic and expressive, makes friends easily,
• Creative and fun, volunteers for jobs, talkative, storyteller
• Don’t have much follow-through, talk too much, exaggerates,
• Many fans but few friends, self-centered, disorganized,
manipulates through charm
45

Melancholy (“let’s get
organized”)
• Analytical, genius prone, plans and organizes, neat and
orderly.
• Can be counted on to finish a job, detail-oriented,
economical, compassionate, perfectionists, creative.
• Easily depressed, assumes worst in people and
situations, low-self image, procrastinate through
planning, has unrealistic expectations.
46

Choleric (“let’s get moving”)
• Born leader, driven, goal-oriented, strong-willed, can run
anything, thrives on opposition.
• Independent, makes split-second decisions, solves
problems, is usually right, active.
• Doesn’t see faults, compulsive worker, needs control,
• Can come off bossy/domineering, not so good people
skills, unemotional and cold.
47

Phlegmatic (“let’s relax”)
• Easy-going, low-key, inoffensive, patient, calm, cool,
collected, realistic
• Mediator, good listener, dependable, cheerful.
• Not enthusiastic, dislikes change, procrastinates, can
seem lazy, indecisive, emotionally closed.
• Avoids conflict, has a hard time with discipline,
pessimistic
48

Others…
Obsessive: perfection, rigid and does not like change.
Schizoid: a loner, withdrawn, emotionally cold.
Cyclothymic: outgoing, very talkative, excited about life. Very
warm emotionally
Hysterical: seek a lot of attention, very selfish, dramatic.
Paranoid: suspicious of everyone, difficult to work with, rigid and
un-adaptable
49

THEORIES OF PERSONALITY
DEVELOPMENT

HUMANISTIC THEORY
MASLOW’S HIEARARCHY OF NEEDS
Abraham Maslow

Introduction
• Maslow's hierarchy of needs is
a theory in psychology proposed
by Abraham Maslow in 1943.
• Maslow's hierarchy of needs is often
portrayed in the shape of a pyramid
with the largest, most fundamental
needs at the bottom and the need
for self-actualization and
transcendence at the top. In other
words, the crux of the theory is that
individuals’ most basic needs must
be met before they become
motivated to achieve higher level
needs

 Abraham Maslow arranged human needs into a
hierarchy starting from the most basic to less basic
needs
 He emphasized on two things:
◘Capacity of human growth/self actualization
◘Individual’s desire to satisfy variety of needs
 He developed a hierarchy of needs known as
Maslow’s hierarchy of needs.
54

Maslow’s hierarchy of needs.

Cont…
Physiological Needs
 Physiological needs are considered the main physical
requirements for human survival. This means that
Physiological needs are universal human needs.
 These are basic needs for survival – Air, food, water,
elimination, sleep, rest, clothing, shelter, avoidance of
pain, sex etc.
57

Safety and Security needs
 When physiological needs are satisfied, concern for safety
and security from harm, both physical and psychological
emerges. The normal adult is able to protect himself, is safe
and usually does not feel endangered.
 These include job security, health, and safe environments.
 Safety and Security needs include:
Personal security
Emotional security
Financial security
Health and well-being
Safety needs against accidents/illness and their adverse impacts

Cont…
 Note: The patient may be afraid in response to the many
different people who enter his room. Diagnostic tests and
therapeutic procedures may increase his fear. The nurse
should promote the safety of the patient.
59

Social Belonging and Affection
 Every person desires companionship and acceptance from
others. Man as a social animal hates isolation. He needs a
family and friends who care.
 According to Maslow, humans need to feel a sense of
belonging and acceptance among social groups, regardless
of whether these groups are large or small
 Social Belonging needs include:
Friendships
Intimacy
Family

Self Esteem / Respect /Image / Concept
 Esteem needs are ego needs or status needs. People develop
a concern with getting recognition, status, importance, and
respect from others.
 This is conveyed by the recognition, time, attention and
thoughtfulness we give to each other as a unique personality,
worthy and dignified. If this need is unmet, one becomes
dependent on others, loses confidence and is incompetent.
 Psychological imbalances such as depression can distract the
person from obtaining a higher level of self-esteem.
61

Self Actualization
 Is self fulfillment or attainment of one`s potential. This is a
rarely reached level of needs. Many others are either
materially or psychologically deprived and are only able to
meet the lower level of needs. It calls for creativity, hard
work and determination to venture ahead.
 "What a man can be, he must be. "This quotation forms
the basis of the perceived need for self-actualization.
 Maslow describes this level as the desire to accomplish
everything that one can, to become the most that one can
be.
62

Ct,…
 Self-actualization can include:
Mate Acquisition
Parenting
Utilizing Abilities
Utilizing Talents
Pursuing a goal
Seeking Happiness

Transcendence
 In his later years, Abraham Maslow explored a further
dimension of motivation, while criticizing his original vision
of self-actualization.
 By this later theory, one finds the fullest realization in
‘giving oneself to something beyond oneself.’
 Transcendence refers to the very highest and most inclusive
or holistic levels of human consciousness, behaving and
relating.

Maslow’s dimensions of motives
65
Physical Dimension of motives
i. The basic physiological needs
ii. The safety and security needs
 Social Dimension of motives
i. Belonging and social activity
ii. Esteem and status in the society
 Psychic Dimension of motives
i. Self actualization and fulfillment(self development).

Conflicts of motives
66
Motivational conflicts always concern an
individual’s conflict within himself:
Approach-Approach
Approach-Avoidance
Avoidance-Avoidance

Psychosexual Theory
By Sigmund Freud
67

5 Stages of Development
• Freud argued that human beings
develop through series of five
psychosexual stages.
• These stages try to express the
sexual energy (libido) and
aggressiveness in various forms in
each stage. He further argued that
deprivation or overindulgence of
these energy leads to a scenario he
referred to as fixation.

1. Oral Stage (0 – 18months)
 In this stage, pleasure is achieved through
stimulation of the mouth e.g. thumb sucking,
suckling etc.
 Primary conflict: weaning. If fixation occurs, the
individual would have dependency or aggression.
Oral fixation can result in problems in eating,
drinking, smoking , pen/nail biting, gum chewing,
abusive.

2. Anal Stage(1½-3yrs )
70
 Pleasure is achieved from holding and expelling faeces
i.e. bladder and bowel movements. Conflict occurs
regarding toilet training.
 Praise and reward for using the toilet at the
appropriate time encourage positive outcomes and
help children feel capable and productive.

Cont’d…
71
 If punishment, ridicule or shame for accidents is used
then it can result in the anal expulsive personality
(lack of self control, generally messy, stubborn,
wasteful or destructive)
 If parents are too strict or begin toilet training too
early, anal-retentive personality develops in which
individual is stringent, orderly, rigid, obsessive and
perfectionist.

3. Phallic Stage (3 – 6yrs)
72
 Primary focus is on genitals, hence, is characterized by sex
and gender identification.
 Oedipus complex for boys and Electra complex for girls. Fear
of castration-known as castration anxiety; Girls develop
penis envy.
 Fixation: sexual deviances (overindulging or avoidance,
weak or confused sexual identity.

4. Latent Stage (6 – 12yrs)
73
 In this stage, sexual impulses are repressed.
 Individuals in this stage develop social friendship and
socialism characterized by group formation and fierce
group loyalties.
 Boys cling together and shun girls and girls despise
boys. The child identify peers, and is occupied by
school work and play.

Cont’d…
74
The child becomes creative and industrious and will
explore his talents and be ready to tackle his
problems for solutions.
If unsuccessful, because the parents were not
supportive and challenging, the child becomes scared
and timid and will hate competition, he will not try
anything because he knows he is a failure.

5. Genital Stage(12-18yrs)
• This is the adolescent stage. Gratification is obtained
from actual genital stimulation hence there is
development of intimate /romantic friendship with
the opposite gender.
• Identifies with an adult they want to emulate from the
previous stages and start behaving like those adults.
75

Cont’d…
• They tend to resent commands, disagree with parents,
want independence and behave like mature adults.
• Lack of support and understanding leads to rebellion,
run away (truancy) from the family, join gangs where
they start abusing drugs, present antisocial behavior
and will never be what or who they are expected to be
i.e. role diffusion.
76

Structure of Personality
 According to Sigmund Freud, personality is composed of
3 (three) major systems:
•The Id
•The Ego and
•The Superego
78

The Id
• Forms the original system of personality and is present
at birth. It is basically unconscious and has no
knowledge of the outside world.
• The id is the most primitive and is driven by impulses.
“I want it”
• It demands immediate gratification of the needs
because it is not governed by law of reason and logic.
• Also known as the “pleasure principle”.
79

The Ego
• It delays the satisfaction of a need until an appropriate
time, place, or object is available. It mediates between
the id and the super ego.
• Also called the rational self or the “reality principle,”
80

Cont’d…
• It develops as from the age of 2 years in the anal stage
when the child starts meeting social demands like
toilet training, discipline, holding on without
demanding immediate gratification.
• It involves logic, thinking, reasoning and finding
solutions to problems or in contact with reality.
81

The Superego
• This is the last system of personality to develop.
• It contains values, legal, moral regulations, and
social expectations (moral principle)
• It originates from the child`s assimilation of his
parents` standards regarding what is good or bad
and sinful.
82

Cont’d…
• It begins with the resolution of the Oedipus/Electra
Complex at age 5 – 6 years and is referred to as the
Sociological component of the personality.
• Its main function is to oppose the id
83

Psychosocial Theory
By Erick Erickson
85

86
 According to Erickson,
identity is very personal and
develops from our heritage
and history.
 Course of development is
determined by the interaction
of the body, mind and
cultural influences.
 The world gets bigger as we
go along and failure is
cumulative.

8 Stages of Development
1.Trust versus mistrust
2.Autonomy versus shame/doubt
3.Initiative versus guilt
4.Industry versus inferiority
5.Identity versus role confusion
6.Intimacy versus isolation
7.Generativity versus stagnation
8.Ego integrity versus despair
87

Basic Trust Versus Mistrust
• Occurs in infancy (birth-18 months).
• Babies must learn to trust their parents care and
affection.
• If not done the babies could develop a distrust and
view the world as inconsistent and unpredictable.
• The favourable outcomes are hope, trust and
optimism.
88

Autonomy versus shame/doubt
• In early childhood (18 months-3 yrs).
• Child learns to feed themselves and do things on
there own.
• Or they could start feeling ashamed and doubt their
abilities.
• Important Event: Toilet Training
• The child learns to perform physical skills, and
develops self-control & courage.
89

Initiative versus guilt
• 3 to 5years (late childhood)
• Child becomes assertive and takes initiative
• Being too forceful may lead to guilt
• The child is testing the ability to compete in the outside
world. They desire to copy the adults around them and take
initiative in creating play situations
• The desirable outcome is sense of purpose and initiative
90

Industry versus
inferiority
• 5 to 12 years (School age)
• Learn to follow the rules imposed by schools or home or the
child can start believing they are inferior to others.
• Desired outcome: competence, development of intellectual,
social and physical skills.
• The child must learn new skills or risk inferiority, failure, and
incompetence.
91

Identity versus role confusion
• Adolescence (13-18 years of age).
• Acquire a sense of identity or can become confused about ones
role in life.
• Questions who you are and if your happy.
• Source of interaction: Peer and groups
• Desirable outcome: identity in occupation, gender roles,
politics and religion.
92

Intimacy versus
isolation
• Young adulthood (18-40 years of age).
• Develop a relationship and joint identity with a partner or can
become isolated and stay away from meaningful
relationships.
• Questions if the person is ready for new relationships, or if
there is a fear of rejection.
• Desired outcome includes: forming close relationship and
career development
93

Generativity vs. Stagnation
• Adulthood (40-65 years of age).
• Making use of time and having a concern with helping
others and guiding the next generation or can become
self-centered, and stagnant.
• Questions what the person will do with their extra
time.
• Desired outcome :care and concern for family and
society.
94

Integrity vs. Despair
• Late adulthood/old age (60 and above).
• Understand and accept the meaning of the life spent or
complains about regrets, not having enough time, and not
finding a meaning throughout life.
• Questions ones overview of their entire life.
• Source of interaction: mankind
• Expected outcome is satisfaction with life spent.
95

 Relatively permanent change in knowledge or
behavior resulting from experience.
96

Definitions:
97
Learning
 Relatively permanent change in knowledge or behavior
resulting from repeated experiences.
Reflex
 Is an inborn, involuntary response to a specific kind of
stimulus, as in limb-withdrawal reflex (withdrawing your
hand after touching a hot plate)

An Instinct
 An inborn complex behaviour found in members of a species
such as nest building in birds.
Maturation
 Is the sequential unfolding of inherited predispositions(such as
walking in human infants).
98

Types of Learning
 Psychomotor Learning: acquisition of physical skills,
coordination of muscles and body parts.
 Cognitive Learning: ability to think, form ideas and concepts,
synthesis, analyze and evaluate issues logically and creatively.
 Affective Learning: involves emotions, values, feelings and
attitudes of an individual.
99

Learning Theories
Classical Conditioning by Ivan Pavlov
Operant Conditioning by B.F. Skinner
Cognitive Learning by Jean Piaget
Social Learning by Albert Bandura
100

Classical Conditioning
101
 By Ivan Pavlov,(1849-1936). Was a Russian Physiologist who
experimented on dogs.
 Pavlov demonstrated that dogs could be conditioned to
salivate in response to new stimulus, such as ringing bell or
light, if this had been paired or presented together with food
several times.
 The food is the unconditioned stimulus (US) & the bell is
the conditioned stimulus (CS). Salivation is the
conditioned response (CR).
 Bell + food led to salivation; Salivation on eating and smell of
food; Later, salivation after ringing the bell without food, after
several episodes where the bell preceded the food.

Operant conditioning
103
• B.F. Skinner studied the relationship between behaviour and their
consequences.
• Animals and people learn to operate on the environment to produce
desired consequences.
• Learning in this case is under the control of the individual, who
operates or influences the environment, hence the term operant
conditioning
• There is a reward or a punishment for behaviour, hence learning
occurs.

Cognitive learning
104
 According to Jean Piaget, learning can occur without reinforcement
of overt actions, a process he called latent learning.
 The proponents of this theory argue that human being is not a
passive organism, but is capable of processing information and
comprehending the relationship between cause and effect. The
processed information is stored and may be retrieved later when
required.
 One actively constructs knowledge through negotiation and social
interaction with the immediate environment.

Social Learning Theory
 Albert Bandura.
 Considers how individuals learn through observing the
behavior of others. i.e. most human behavior is learnt
observationally through modeling.
 This theory proposes that people learn by imitating the
behavior of other people. Other terms used are role modelling
and identification.
105

The process by which information acquired is
encoded, stored and retrieved when needed.
106

 Memory refers to those processes involved in the acquisition
of information, its subsequent retrieval and use.
 Memory process can be divided into three main components:
 Registration
 Retention
 Recall and recognition

Memory ct’
 Memory plays an important part in learning. Learning implies
retaining of facts. If nothing is stored from previous
experience, then no learning can take place
 Thinking and reasoning are also done with remembered facts

Types of memory
 The following are types of memory:
 Immediate or short-term memory: for events that have occurred
within the past 30 seconds
 Recent memory: for events over the past few hours or days
 Recent past memory: this refers to information retained over the
pest few months.
 Remote memory: refers to the ability to remember events that
have occurred in the distant past.

Information Processing
110
• Encoding allows information from the outside world to be
sensed in the form of chemical and physical stimuli.
• Storage involves information maintenance over short periods
of time.
• Retrieval: Stored information must be located and returned
to the consciousness.
- Memory enables people to recall the who, what, when, where,
how and why in everyday life.

Factors Influencing Memory Loss
111
Interference can hamper memorization and retrieval:
Retroactive interference: when learning new information makes it harder
to recall old information and
Proactive interference: where prior learning disrupts recall of new
information.
However, there are situations when old information can facilitate learning of
new information (positive transfer)

Cont’d…
 Attention
 Organization of content
 Age
 Health and emotional status
 Association developed
 Intelligence
 Value of content
 Study and rehearsal skills
 Environment
 Level of information processing
 Methods of learning/teaching
112

Improving the Memory
113
Healthy eating(balanced diet)
Physical fitness(exercises)
Stress reduction measures
Memory exercises improves cognitive function and brain
efficiency e.g. brain teasers and verbal memory training
techniques
Adequate sleep.

STRUCTURE AND FUNCTIONS OF
THE MIND
 Part of the brain that is responsible for thoughts
and feelings.
 According to Freud, the mind is divided into three levels
of existence or consciousness:
114

The Conscious Level
 This is a small part which forms 1/6th of the total size of the
mind, regarded as the sense organ of attention.
 It functions only when the individual is awake. This first
level is responsible for – rational thinking, good judgment,
correct perception of the environment, emotions and
establishment of personal relationships.
115

Subconscious Level
 Forms 1/6th of the total size of the mind.
 It is accessible to both the conscious and the unconscious
levels of the mind.
 Acts as a censor (filter) of all information stored in the
unconscious level reaching the conscious, to store all
information and experiences from the conscious mind for
memory, and to select which experiences should be
repressed into the unconscious mind (never to be
remembered).
116

Unconscious Level
 Comprises 2/3rd of the entire mind.
 It contains all repressed ideas, psychological experiences,
information and emotions.
 Information stored at this level of the mind cannot reach the
conscious level unless through psychoanalysis.
 The information from this level can reach the conscious level
through – a dream but in a distorted way, slip of the tongue,
unexplained behavioral responses, jokes or lapses of memory.
117

DEFINITION
 MOTIVE: Something that has the power to initiate action.
Refers to the underlying factors that energize and direct
behavior.
 EMOTION: is the feeling, tone or response to sensory input
from the external environment or mental images.
 MOODS: Are states of emotional reaction that ls for only a
limited period
 Temperament: An individual’s habitual way of expressing
emotions

Theories of motivation
1. Homeostasis & the Drive Theory
 It is essential that the body maintains a constant internal
environment for its optimum functioning.
 Corrective measures are in place to ensure that the body’s
temperature, body fluids, and hormones are maintained within
a certain range.
 For instance, when blood glucose levels fall below a certain
limit, the organism feels hungry and will seek food in order to
rectify the anomaly. Likewise, when body fluids are depleted,
the organism will seek water as the kidneys also try to conserve
water.

2. Psychoanalytic theories
 Sigmund Freud stated that human behavior is determined by
two basic forces: the life instincts (eros) & the death instincts
(Thanatos). The former explains the behavior that is directed
towards the preservation of life while the latter leads to
destruction for example aggressiveness.

3. Behavioural theory
This theory holds that an organism is likely to engage in a
certain type of behavior if it were rewarded following
food-seeking behaviour.

4. Drive reduction theory
This theory suggests that tension builds up in an
organism in response to certain needs. As the goals are
achieved, for example obtaining food, tension is
reduced and this is accompanied by a pleasurable
feeling.

5. Humanistic theory
 By Abraham Maslow.
 Maslow reasoned that human motivations are organized in a
hierarchy of needs.
 He stated that the lower needs in the hierarchy must be partly
fulfilled before those at the next level can assume importance.
If they are not, then the organism remains preoccupied with
them until the needs are met.

Take away….
Discuss the application of the Humanistic
Theory in our daily lives.
Discuss the application of the motivation
theories in our daily lives.

STRESS
Definition
• Stress is a state of severe physiological and psychological response
to harmful or potentially harmful circumstances.
• It is a state of severe physiological and psychological tension or It
can be also defined as a non-specific response of the body to any
demand.
• A stressor is a stimulus which causes stress e.g. bereavement,
divorce or a critical event such as robbery or the demand of life
• One’s responses to stress are influenced by: personality (our
strength), the burden/type of stressor, subjective interpretation of
the stressors.
126

Causes of stress
- Stressors can be sudden, overwhelming or cumulative. Examples
include:
 Life crises e.g. accidents, death of spouse or divorce.
 Transitions e.g. divorce, bereavement and retirement.
 Catastrophes-natural and otherwise e.g. earthquakes and floods.
 Daily hassles, little things in life that go wrong.
 Frustration and conflicts.
 Uncertainty, doubt and inability to predict the future
• Physical stress: Pain, hunger, illness, fatigue, unmet basic needs.
• Psychological stress: Anything causing anxiety, tension or fear.
• Environmental stress: Weather, other human beings, pollution, natural
and artificial disasters. 127

Responses to Stress
• Stressors and to some extent stress are normal and at times are
necessary for one to achieve certain goals in life. It becomes
abnormal if they produce signs and symptoms that become the
problem.
• Individuals can be helped to cope with or minimize life stressors and
still lead a relatively normal lives with health education and support
systems.
128

• Physiological responses:
–The body prepares itself either to fight or for flight.
–All the body’s reactions to stress affect health.
–Prolonged stress may cause high BP, ulcers, heart
diseases, autoimmune disorders such as rheumatoid
arthritis & allergies
129

• Psychological responses:
–The individual may display self-destructive lifestyles & risk-
taking behaviors such as drug abuse, suicidal gestures and
self neglect.
–Aggressiveness due to frustration
–Anxiety. It may manifest with physical symptoms of
autonomic hyperarousal and activity.
–Depression
–Inhibited sexual drive
–Spiritual signs and symptoms of excessive stress may
include doubts about one’s faith, loss of self confidence or
loss of purpose.
130

Stress in Patients is
caused by:
Admission to hospital
Operations
Anesthetics
Sharing a ward with strangers
Use of bedpans
Injections and
Being done tests/investigations.
131

Signs and symptoms of stress
On the body
• Headache
• Muscle tension or pain
• Chest pain
• Fatigue
• Change in sex drive
• Stomach upset
• Sleep problems
132

On the mood
• Anxiety i.e. tension
• Restlessness
• Lack of motivation , focus, or concentration
• Irritability or anger
• Sadness or depression
• Frustration
133

On behaviour
• Overeating or under eating
• Anger outbursts
• Drug or alcohol abuse
• Tobacco use
• Social withdrawal
134

Stress Coping Mechanisms:
135
 Confronting the stressor
 Avoiding situations that may cause stress
 Change your stressors e.g. take a break, switch job
 Maintain a reasonable work and personal schedule
 Engage in a Physical activity
 Meditation, relaxation techniques e.g. slow music
 Discussing situations with a spouse / close friend/priest or
Praying/going to church
 Taking a bath or shower
 Laughing or crying
 Seeking counseling.

ANXIETY
Anxiety
• A vague sense of fear, dread, uneasiness
Phobia
• A pathologically strong fear attached to objects or situations
which in themselves are harmless.
• Anxiety may progress to panic and interfere with mental and
social functioning(Neurotic breakdown).
136

Degrees of Anxiety
Mild anxiety
• Motivates the person to be more physically and mentally
alert.
Panic states
• Very high levels of anxiety that incapacitate an individual.
137

CONFLICT AND ADJUSTMENT
Welcome

Frustration:
• Is the blocking of a motive by some kind of obstacle. An
obstacle could be like a traffic jam, personal shortcoming,
conflicting motives or conflicts.
• The frustrated individual becomes intolerant and physically
aggressive, more prone to misunderstanding while others are
more likely to speak hurtful words.
Conflict
• Is the simultaneous arousal of more incompatible motives,
resulting in unpleasant emotions, such as anxiety or anger. It’s
a pair of goals that cannot be solved together.

Types of conflicts
• There are three types of conflicts:
– Intrapersonal conflicts.
– Interpersonal conflicts.
– Unconscious conflicts.
• The word conflict has been derived from a Latin word
‘Conflicts’ which means ‘strike two things at the
same time’.
• Conflict is an opposition or a tug-of-war between
contradictory impulses.

1. Intrapersonal/ Goal conflicts
• These are conflicts caused within the individual.
• These conflicts arise as a result of two or more motives or
goals to be achieved at a time. Hence, these are called goal
conflicts. Lewin has described three types of goal conflicts.
• Examples of interpersonal conflicts are described below:-

Types of conflict
Approach-approach conflict
• In this type of conflict, individual will have two desires with
positive valence which are equally powerful.
• There are two goals, and to attain one means that the other goal
must be given up. E.g. a final year student medical student
cannot afford to be in night parties and still expectant to excess
academically. So, he gives up partying although he misses them a
lot.
• Another example, a person has two attractive job offers and he
has to choose any one of them- tension arises. Such conflicts are
not so harmful, because after selecting one, the other one
automatically subsides or loses its importance to him.

Avoidance-avoidance conflict
• This conflict involves two goals with negative valence. At times the
individual is forced to choose one among two negative goals. In such
conflicts, both are unwanted goals, but he cannot keep quiet without
opting also.
• Both alternatives are unpleasant and yet one has to choose either.
E.g. a patient has an abdominal tumour, which causes unbearable
pain and discomfort. Alternatively, surgery, which has very little
success rate is the only available remedy, yet the patient needs to be
relieved of the pain. It becomes naturally difficult for the patient to
choose either of these two.
• Another example, a woman must work at a job which she dislikes
very much or else she has to remain unemployed.

Avoidance-avoidance conflict ct’
• Here the individual is caught between two repelling threats,
fears or situations. When she cannot choose either of them
she may try to escape from the field itself. But the
consequences of the escape may also be harmful. For
example, a person who cannot convince the mother or the
wife may resort to Alcohol consumption which is otherwise
dangerous or some people may even commit suicide.
• In the event of such conflicts when there is no way to escape-
some people may find a way to reduce their tension by
developing ‘amnesia’ or defence mechanisms like regression
or fantasy.

Approach-avoidance conflict
• This is also a most complex conflict and very difficult to resolve.
Because in this type of conflict a person is both attracted and
repelled by the same goal object. Here the goal object will have
both positive and negative valences.
• The positive valence attracts the person, but as he approaches, the
negative valence repels him back. Attraction of the goal and inability
to approach it leads to frustration and tension.
• This occurs when fulfilling a motive which will have both pleasant
and unpleasant consequences. For example, a person is
approaching to accept a job offer, because the salary is attractive-
but at the same time he is repelled back as the job is very risky. A
man wants to marry to lead a family life, but does not want the
responsibilities of family life. Being married is attractive and socially
fulfilling, but it also means added responsibilities and restrictions.

2. Interpersonal conflicts
• Interpersonal conflict is caused between individuals.
This can be resolved through some strategies such as
avoiding, smoothing, forcing, confronting and
compromising. Assertive behaviour and ‘I am ok’, you
are ok interpersonal orientation help to resolve such
conflicts easily.

3. Unconscious conflict
• The mental conflict below the level of conscious awareness is called
unconscious conflict. The conflicts in conscious level, when
repressed, shifts to unconscious. Here the desires which cannot be
satisfied at conscious level are repressed to unconscious level as a
mechanism of escaping.
• Many of our wants raised by Id may not be socially acceptable. Such
wants are objected by the Ego and the Super ego. Hence these are
repressed to unconscious.
• The repressed desires remain active in the unconscious part of our
mind but may appear in the conscious level in form of dreams, slip
of the tongue, slip of pen, motivated forgetting etc. sometimes they
may appear in the form of peculiar behaviour and mannerisms.

Resolution of conflicts
• The conflicts may arise from frustrations, competing roles or goals
having positive or negative valences. Some conflicts are of great
danger to mental health of the individual. Hence, it is necessary to
resolve them as quickly as possible. Otherwise, they may be carried
on to the unconscious level, resulting in psychological problems and
psychosomatic disorders.
• Conflicts resolution depends upon the type of conflict.
1. PROBLEM FOCUSED:
• Define the problem
• Come up with alternatives
• Weigh the alternatives-cost and benefits
• Choose among the alternatives
• Implement the chosen alternatives

2. EMOTION FOCUSED:
• These are used when the problem is uncontrollable. They are
two types:
A) Behavioural strategies
Exercising
Using alcohol or other drugs
Venting anger
Seeking emotional support from friends

b) Cognitive strategies:
Temporarily setting aside thoughts about the problem
Changing the meaning of the situation
Reappraising the situation
Other coping strategies:
Isolating oneself
Thinking about how badly one feels
Worrying
Repetitively thinking about how bad things are
Engaging in a pleasant activity like going to parties

CRISIS AND CRISIS MANAGEMENT
Definition
• A sudden event in one’s life that disturbs homeostasis, during
which usual coping mechanisms cannot resolve the problem.
• A psychological crisis is a life event that an individual
perceives as stressful to the extent that normal coping
mechanisms are insufficient.
• Individuals go through many stressful situations and learn to
make the necessary adjustments to deal with the problems
that they face.
151

Characteristics of a Crisis
• Occurs in all individuals at some point and is not necessarily
equated with psychopathology
• It is precipitated by specific identifiable events.
• Crises are personal by nature.
• Crises are acute, not chronic, and will be resolved in one way
or another within a brief period.
• A crisis situation contains the potential for psychological
growth or deterioration.
153

Types of Crises
There are two main types of crisis:
• Maturational or transitional.
• Situational crises.
154

a) Maturational crisis
• This is part of growing up & occurs as a result of human
development from one developmental stage to another.
• Maturational crisis includes such crucial stages as beginning schl,
leaving home, beginning first employment, marriage & retirement.
• At each stage, one is forced to make adjustments, resolve anxiety &
conflicts necessitated by the transition. Successful resolution of
maturational crisis normally leads to personal growth, emotional
stability & good mental health
• Unsuccessful resolution may result in unresolved anxiety & internal
conflicts which may lead to unstable emotional disposition,
depression, maladaptive behaviour or personality disorders.

b) Situational crisis
• This results from a specific & intense environmental stressor,
hazardous event or threat to one’s life. These include:-
1. Suicidal behaviour:
• Suicide is defined as the human act of self-infliction, self-
intentional cessation. Suicidal behaviour is due to the following
factors:
– Biological factors- vulnerability to depression which is the leading cause
of suicide.
– Psychological factors- hostility, despair, shame, guilt, dependency &
helplessness.
– Interpersonal factors: for example rejection & feelings of inferiority.
– Family history of suicide: which can cloud the life of a person who may
later commit suicide.

2. Attempted suicide:
• During suicidal acts, death is not always the objective. Where the
goal is to attract attention, the act is called attempted suicide.
• Attempted suicide should be taken seriously and the survivor
assessed for suicide intent. This helps the assessor predict
occurrence of future suicide.
3. Accidents:
• Accidents are events that occur unexpectedly. They may cause
physical injuries, destruction of property, loss of life & destruction
of lifestyles & livelihoods.
4; Death & Bereavement:

Sources of crises
• Loss of a dearly loved person, possession or status.
• A severely disabling accident e.g. causing paraplegia, amputation or severe
disfigurement.
• Natural or unnatural disasters causing an anticipated change on one’s life
circumstances or loss e.g. floods, earthquakes, cyclones or war.
• Being diagnosed with a potentially fatal disease eg AIDS or inoperable
cancer.
• Being raped.
• Being arrested for a serios offence.
• Break-up of a relationship eg divorce or termination of an engagement.
• Failure of examination.
• Forced retirement.
• Separation or threatened separation of a child from its parents.

Clinical behavioural manifestations of a crisis
• The individual is unable to function in the usual manner
• The person withdraws from the usual social grps or contacts.
• The person feels distant or detached from other people
• The person acts impulsively.
• The person might refuse or reject help from others
• The person demands too much attention from others
• The person might behave as if nothing wrong had happened.

Coping with crisis
• There are two types of coping in a crisis:
–Avoiding the problems = defensive coping.
–Meeting the problem head-on = direct coping.

Defensive coping
• In defensive coping, the individual either runs away from the
problem and avoids going near the stress-inducing situation,
or blocks it our of their mind and denies that the situation is
stressful.
• The individual therefor uses emotion-reducing strategies.
These include:-
– Ventilation.
– Avoidance (refusing to think, avoiding people or reminders).
– Positive reappraisal (recognizing that the problem has led to some
good e.g. self-betterment).
– Accepting or rejecting responsibility (recognizing that one is at least
partly responsible for the problem & can deal with it or that one is
not responsible and need not react).

Direct coping
• Here the individual makes an objective analysis of the problem,
how it came about and how one is responding
• Individuals develop clear ideas of what they wish to achieve to
solve the problems (goals) and come up with mental road maps
or lists of approaches to reach the desired end.

MENTAL DEFENSE MECHANISMS
Description
• Defence mechanisms are the unconscious strategies that
people use to separate themselves from unpleasant events,
actions or thoughts. They limit awareness so that life-
threatening and anxiety cues can be excluded
• It does not solve the problem or alter the anxiety but changes
the way the person thinks about whatever is disturbing him.
• The idea of defense mechanisms comes from psychoanalytic
theory, first proposed by Sigmund Freud thus describing
personality as the interaction between three components: id,
ego and super ego.
164

Common Defense mechanisms
Denial (Self Deception)
• Involuntary and automatic distortion of an obvious
aspect of external reality. e.g. An ill person refusing to
accept a diagnosis even though a clear explanation was
given of which the patient understood.
165

Isolation
• In this defence mechanism, dangerous memories are
allowed back into the consciousness, but the
associated motives & emotions aren’t recalled.
• Separation of memory from emotion...can remember
and talk about the trauma but feels no emotion -- the
Person talks about the incident as if it is someone
else's story.
• Accomplished by talking ‘third perceptual thinking.’
166

Displacement
• This is the transfer/Shifting of affect or feeling, usually
anger or fear, from the source to another source less
threatening commonly known as "dumping on"
someone e.g. a man reprimanded by the boss may go
home and beat the wife, the beaten wife may beat the
children.
167

Conversion
• Mental conflict converted to a physical symptom...
e.g., a soldier on being deployed into battle is
conflicted about his desire to serve his country but
believes it is wrong to kill for any reason develops
paralysis, blindness, or deafness with no medical
cause.
168

Projection
• During projection, an individual unconsciously
disowns an attitude or attribute of his own and
ascribes it to someone else.
• Occurs when one`s own undesirable attitudes are
attributed to another person or object e.g. A person
who slips over an object on the floor and falls, and
blames the object rather than his own behavior for the
accident; ‘I hate you’ becomes ‘you hate me’.
169

Introjection
• In this defence mechanism, the victim takes in and
‘swallows’ the values of others.
• The opposite of projection - subconsciously "takes in"
to self an imprint (or recording) of another person
including all their attitudes, messages, prejudices,
expressions, even the sound of their voice, etc.
170

Reaction Formation
• When an individual gives a reason for his behavior
which is opposite of its true cause e.g. parents of un-
wanted child who spoil the child to reassure
themselves that they are good parents.
• People who use this defense mechanism recognize
how they feel, but they choose to behave in the
opposite manner of their instincts.
171

Rationalization
• The explanation of behavior in acceptable terms
that avoid giving the true reasons or avoid criticism
i.e. behavior justification. For instance a patient might
say he was going to look for his friends to justify his
wandering away from home.
• In rationalization, some attempt to explain
undesirable behaviours with their own set of ‘facts’.
This allows them to feel confortable with the choice
made even though they know on another level that
it’s not right.
172

 Sublimation
• It involves substituting unacceptable suppressed type of
behavior for another more acceptable form e.g. a
potential murderer becomes a butcher; unfulfilled need
to give maternal care may be gratified in the care of the
sick.
• This defense mechanism is considered a positive
strategy. For example, a company supervisor who’s
temperamental instead of lashing out at his employees
chooses to channel his frustration into kickboxing or
exercise. You could also funnel feelings into music, art or
sports. 173

Suppression
• Painful, frightening, or threatening emotions,
memories, impulses or drives that are consciously
pushed or "stuffed" inside.
• It takes a lot of energy to keep material
"stuffed"...energy that could be used for more
productive living.
174

Repression
• Painful, frightening, or threatening emotions, memories,
impulses or drives that are subconsciously pushed or
"stuffed" deep inside. The individual unconsciously
choces to hide the painful memories in hopes of
forgetting about them entirely, however, that does not
mean that the memories disappear entirely.
Aggression
• An attitude of hostility usually resulting from frustration
or a feeling of inferiority
175

 Regression
• Is turning back to an earlier method of behaving where
there was no threat.
• Giving up current level of development and going back
to a prior level... and older child under stress begins
wetting the bed or sucking a thumb after a long period
without that behavior.
• Adults can regress too. Adults who are struggling to
cope with events or behaviours may return to sleeping
with a cherishedstuffed animal, overeat foods they find
comforting, or begin chain smoking or chewing
pencils/pens
176

 Fantasy
• Using imagination to create a picture that exists only
in the mind e.g. day dreaming; an ill person may
imagine himself well and without the need for health
care.
• Fantasy thinking, unlike reasoning, occurs without
conscious control. One is largely cut off from the
outside world and from reality, and indulges in
“wishful thinking”.
177

 Identification
• People who feel inferior may identify themselves
with successful causes, organizations or persons
in the hope that they will be perceived as
worthwhile.
• Its utilized as a defense mechanism against
anxiety of inferiority.
178

 Compensation
• This is where one tries to put up a behavior that
makes one more satisfied in areas where one is
inadequate e.g. a short man makes most noise; a very
ugly girl excels academically; short women wear high-
heeled shoes to be taller.
179

PATIENT`S REACTION TO
HOSPITALIZATION
• Every patient reacts differently to illness and hospitalization due
to-;
Age
Experience in life
Nature of illness
Support given by significant others.
• The nurse has to assess the patient`s reaction, respond and
support him as an individual.
181

Cont’d…
• AIMS OF THE NURSE
Understanding the patient
Accepting the patient as he is
Assessing the patient to identify the coping
mechanisms in terms of the illness and hospitalization
Assisting the patient to use their resources to cope with
the illness and hospitalization
Establishing Nurse – Patient Relationship
182

NURSE – PATIENT RELATIONSHIP
• Is a relationship established between the nurse and
the patient with the aim of identifying patient`s needs
/ problems and together work out a solution.
183

Objectives:
• To establish rapport so as to make the patient feel accepted
and have free communication of his problems.
• To assess the patient`s condition
• To use the identified problems / needs to formulate a plan of
care
• Together with the patient work out solutions and meet the
patient`s needs
• To help the patient attain independence and self- reliance
184

Phases of Nurse – Patient Relationship
Introductory Phase
• This is the initial contact between the nurse and the
patient.
• Basically they’re strangers i.e. the patient who is in need
of help or assistance to solve his problems and the nurse
who has professional knowledge and willingness to assist.
• It is centered on mutual attempts to know each other and
work with each other.
185

Working Phase
• In this phase the patient is supposed to have accepted
and trusted the nurse as a dependable person.
• It consists of therapeutic actions that will help the
patient towards recovery.
• The nurse works on the patient`s problems and
together with the patient find solutions. It may take a
long or short time depending on the patient`s rate of
recovery and nature of illness.
186

Termination Phase
• The nurse attempts to gradually bring the relationship to an
end with the patient`s recovery through helping him develop
independence and self reliance towards the management of
his own health.
• It can be traumatic to the patient and the nurse if not well
handled due to mutual information they have shared together.
Hence the nurse must maintain and practice her ethics and
encourage the pt to use their own resources to keep healthy.
187

STAGES OF GROWTH &
DEVELOPMENT

Objectives
 To assist the students know:-
a. The normal growth and development so as to detect any
deviations early enough and take appropriate action
b. Factors that influence normal growth and development
c. Developmental milestones.
d. Application of theories of personality development in
growth and development.

Definitions
 Growth is an increase in physical size of the whole body
or its parts (i.e. maturity of the body structure) and can be
measured in centimeters and in kg.
 Development is the process of gradually acquiring
certain skills and feelings as the child grows up, or,
increase in complexity of the body`s structure, formation
and function, especially of the central nervous system
(CNS).

Cont…
 Milestone
An action or event marking a significant change or stage in
development.

Reasons for studying Growth &
Development
 Recognize the importance of primary care relationships
 Recognize the uniqueness of each child
 Have realistic expectations of young children
 Provide developmentally appropriate play and learning
activities
 Protect infants and toddlers from hazards
 Monitor how children are progressing in
order to detect delays

Factors That Influence Growth and
Development
 Heredity:
The height, weight and rate of growth are more alike in
brothers and sisters than among unrelated people.
Congenital abnormal conditions are also transmitted
through the genes.

Cont…
 Environment:
a) Before Birth.
 Malnutrition of the mother, especially deficiency of iron
(anemia), calcium or vitamin D.
 Infections – viral diseases e.g German measles (rubella),
chronic malaria , can be the cause of prematurity or small
full-term babies.
 Congenital diseases especially syphilis in the early
months of pregnancy.

Cont…
 Damage to the fetus caused by exposure to x-rays during
the early months of pregnancy.
 Mechanical injury or an abnormal position in the uterus.
 Lack of oxygen to the fetus due to poor development of
the placenta, drugs, alcohol, smoking etc.
 Physical disorders that cause mental retardation e.g.
Deafness, blindness. No matter how superior the
environment, a baby so affected will be retarded.

Cont…
 During Birth:
 Complicated births, birth injuries especially the brain due to
unskilled midwifery, prolonged labor, instrumental deliveries,
breech presentation.
 Following Birth:
a) Nutrition/malnutrition: “You are what you eat”.
Malnutrition due to failure of breast-feeding, poverty and
ignorance
c) Lack of adequate clothing or housing.
d) Unfavorable climate conditions e.g. extreme heat or cold.

Cont…
 Behavioral Influences
 Intellectual stimulation (books, music etc), -Motivation to
help in competition, - Interpersonal relationships, -
Education, - Presence of a handicap.

Cont…
 Sex
 Sex acts as an important factor of growth and development.
There is difference in growth and development of boys and
girls.
 The boys in general, taller, courageous than the girls but
Girls show rapid physical growth in adolescence and excel
boys.
 In general the body constitution and structural growth of
girls are different from boys. The functions of boys and
girls are also different in nature.

Cont…
 Nutrition
 Growth and Development of the child mainly depend on
his food habits & nutrition. The malnutrition has adverse
effect on the structural and functional development of the
child.
 Races
 The racial factor has a great influence on height, weight,
colour, features and body constitution. A child of white race
will be white & tall even hair and eye colour, facial
structure are governed by the same race.

Cont…
 Exercise
 The increase in muscular strength is mainly dye to better
circulation and oxygen supply. The brain muscles develop
by its own activity-play and other activities provide for
these growth and development of various muscles.

Developmental milestones
Milestones (0 – 5 Years)
These are the various skills the child learns in the
process of growth and development.

Cont…
At 4 – 6 Weeks
 The infant is attentive to a familiar face, which is usually
the mother as she is the source of food.
 The infant can lift his head from time to time when he is
supported on his mother`s shoulder.
 He can also turn his head a little from side to side while
lying on a flat surface.
 He will stare at a window or a light.

Cont…
At 8 Weeks
 He can lift his chest a short distance above a flat surface
when laid on his abdomen.
 He kicks his feet or pushes his legs when lying on his
mother`s laps or in the bath basin.
 Socio-personal development is marked by the attention
he pays to a speaking voice.
 His eyes have focused and will follow a moving object.
He may smile to a familiar voice.

Cont…
At 10 – 18 Weeks
 The infant can hold his head up steadily while being
supported on his mother`s shoulder, and turns his head
freely while looking at people and when lying on his back.
He smiles in response to a smiling face and shows pleasure
by making sound.

At 24 Weeks
 The infant has full head control and can sit with slight
support.
 He can roll from side to side in his cot. He will stretch out
and grasp brightly colored objects.
 He may begin to cut his first tooth which is generally one
of the lower incisors.
 He will start to learn about his surrounding by grasping
objects with both hands especially bright beads and putting
them into his mouth. He will have doubled his birth
weight at this age.

Cont…
At 9 – 10 Months
 He can sit alone without support and may try to crawl
when laid on his abdomen.
 He will now be able to recognize the difference between
strangers and familiar faces, family and friends.
 He may attempt to pull himself onto his feet by holding
furniture.
 He begins to develop one or two skills like saying
goodbye, clapping hands etc.

At 10 – 12 Months
 He can stand without support and walks with some help.
 He may start to hold a mug without dropping it.
 His weight will have tripled.
 He will obey simple orders although his vocabulary is
limited to one or two words.
 He will connect certain sounds with a particular object or
situation especially the words for food in his mother
tongue.
 He is beginning to acknowledge authority by listening to
his mother forbidding him certain actions

At 15 Months
 The young child can walk alone and can run around but still
rather unsteadily.
 He can hold a mug and drink from it.
 He can hold a spoon with increasing skill.
 His vocabulary may consist of four or more words, and he
makes serious attempts to talk but the words may be used in
the wrong sequence without making any sense.
 He should be able to eat all types of soft foods which are
commonly eaten in his family

At 18 Months
 The young child can climb into a chair or up steps.
 He can use a spoon for feeding himself with good muscular coordination.
 He usually has 10 – 12 teeth.
 He has a vocabulary of between 5 – 12 words or more and uses them as though
he were forming sentences.
 He can turn the pages of a large book and scribble with a pencil.
 Control of his bowels should have been established if toilet training has been
regular.
 He will be able to tell his mother that he wants use his pottie.
 He will still sleep for 14 – 16 hours in the 24 hours.
 He will point to his nose, hair or eye when these parts are named by his parents.
 He eats everything that his family eats apart from highly spiced or food
containing small bones.

At 24 Months (2 Years)
 His sense of balance has well developed so he has fewer
falls while walking around.
 He feeds himself with a spoon.
 He may be expected to have dry nights (but individuals
differ in response to habit training).
 He has 16 teeth, uses two or so words in combination and
can make simple sentences.
 He can amuse himself alone and likes playing with water
or mud etc.
 Play begins to be imitation of adult activities

Cont…
 He wants to help his mother sweep or mop the floor; help with
cooking and wants to pull up plants in the shamba.
 He can now pull off his shirt or dress but finds difficulty in
unfastening buttons, tapes or straps on sandals.
 He should be now four times his birth weight and his height
will be about 3 feet.
 He should have about 16 teeth at this age.
 He is very curious about his surroundings and will pull down
knives or pots from a table, so this is a very dangerous age for
accidents in the home.

Cont…
At 30 Months (2 ½ Years) – 20 Teeth
 The young child goes up and down stairs alone and can
help his mother in the house or shamba by carrying out
simple jobs.
 He is developing a strong sense of property, about the
ownership of toys and sweets.
 He likes going with his mother to the market and wants to
carry small objects.

Cont…
At 3 Years
 He can dress and un-dress himself and eats his meals
without help.
 He will say his name when asked, goes by himself to the
lavatory in the day time and should be dry at night.
 He will play with small groups of children of his own age.
 He asks questions like “Where do babies come from?” and
has a vocabulary of about 150 words. He is ready for
nursery school and can learn another language with ease.

Cont…
At 4 Years
 He can wash his hands and face and also clean his teeth,
dress himself and fasten his sandals with help.
 He can co-ordinate play and work activities, perform
simple jobs and go on short journeys by himself.
 He is beginning to realize that he is a separate person from
his family.

Cont…
At 5 Years
 He is beginning to realize the danger of motor cars, strange
animals and fire.
 His imagination is very strong and he will tell fantastic
stories as his idea of truth and falsehood is very confused.

Cont…
 From 6 Years to 12 years
 At 6 Years
 He is quite prepared for entry into the large world of school
and if his home background has been satisfactory and
secure, he will enter it with confidence.
 The formal learning of school will teach him concentration,
how to adapt to the larger world outside the home, the
ability to make friends and how to be responsible for his
own actions.

Cont…
 6 – 12 Years – The School Child
 This is sometimes called the Latency period as there are no
major emotional disturbances once the child has settled at
school provided there is no home break -up due to death or
separation, and he feels secure.
 The boy will begin to peer identify with older boys and
imitate their behavior. The same principle applies to girls.
 Second dentition takes place from 6 – 8 years of age.

The Adolescent 12 – 18 Years
 Physical Changes
Boys
 The adolescent growth spurt occurs between the 13th and
16th year and this is the period of male ascendancy. There
is a marked increase in the width of the chest and
shoulders.
 Muscle size increases but fat is lost at adolescence. This
accounts for the difference in body shape between males
and females . Hair grows over the pubic, axillary areas, the
chest and a beard begins to sprout on the chin, the vocal
cords lengthen and the voice becomes deep.

Cont…
 The sexual organs mature and spermatozoa, erection and
ejaculation of spermatozoa occur during sleep at night.
 If the testicles have not descended into the scrotum by the
time the boy is 12 years, an operation is necessary to bring
them down from the abdominal cavity.
 Testosterone acts on the body to make boy a man.
 If the testes remain in the abdominal cavity, they will not
develop to produce fertile sperms and therefore the boy
cannot produce children.

 Girls
 The adolescent growth spurt occurs between 10 1/2 and 13
years which is followed by menarche (1st menstruation).
 The physical changes include – growth of hair in the axilla and
over the pubic area, subcutaneous fat develops over the limbs,
chest and pelvic region.
 Breasts begin to develop and there is a widening of the hips to
produce the typical female figure.
 Skin changes and pimples appear.
 Due to glandular changes, oestrogen and progesterone act on
the reproductive system causing the monthly cycle of ovulation
and menstruation.

18 – 25 Years – Young Adulthood
 Physical and Psychological Changes
 The period of adolescence has passed and physical growth
of long bones ceases. The young adult is very concerned
about his physical appearance. Sexual interest will begin to
be focused on a definite member of the opposite sex and a
choice of a life partner will be made. Both young men and
women at this stage will be working hard at schools,
colleges or in various forms of training getting ready for
independent adult life that lies ahead.

25 – 40 Years – Maturity
 This is the stage when men and women have taken on the
responsibilities of adult life and accept the responsibility for their own
actions.
 Both men and women at this stage are at the height of their physical
powers and usually undertaking their careers whether in business,
professions or as employees. Women are going through the physical
changes of pregnancy, childbirth and lactating period.
 This may result in problems both physical and mental. The adult man is
expected to provide for his own family and to contribute to the general
good of the society in which he lives. Both men and women are
learning to adapt to a marriage partner, and the new responsibilities
which marriage has brought, especially the care of a family. A man
feels proud and satisfied when his wife gives him a child. But
sometimes he feels neglected because his wife is preoccupied by the
children.

40 – 55 Years – Middle Age
 Physical and Psychological Changes
 There is general slowing up of physical activity at this stage of life.
 In women there are changes associated with the menopause. The men
may be depressed by the reduction of their physical strength and fear of
competition of younger men.
 Middle aged people seem to suffer from many physical aches and pains,
which may not be very serious, but may be feared as the beginning of a
fatal illness.
 The physical health should be watched carefully, help and advice given
for minor complaints, as they can cause great distress and worry.
 There is often a feeling of discontent at this stage of life especially if the
marriage relationship has not been happy. In polygamous societies, this
causes jealousy and strong increase of resentment among the older
wives.

Old Age – 55 Years Onwards
 Physical Changes
 Slowing down of physical functions, stiffening of joints, loss of
balance and fragile bones.
 The heart is weaker with slower circulation. The person is easily
tired, feels feeble and gets breathless. This results in loss of
power to perform heavy work or carry loads.
 There is failing eyesight, progressing to partial or total blindness.
 Loss of hearing, which results in difficulties of communication,
feelings of isolation and suspicious of other people. There may
also be loss of the sense of smell.
 Bad teeth and poor digestion. This may lead to malnutrition. Old
people have poor appetite, therefore need small highly
nourishing meals at frequent intervals.

Cont…
 Psychological and Emotional Changes
 Old people dislike change and they find it difficult to adjust
to new ideas and situations. They dislike changing their
surrounding and desire to die in the areas they were born.
 Old people need to feel wanted, loved and respected. They
degenerate in their mental powers, become bad tempered
and easily irritated. They are unreliable due to loss of
memory and sometimes become hallucinated (vision of
people who may have died long ago suddenly appear and
talk to them) .This generally worries their families.


PSYCHOLOGY
LANGUAGE
DEVELOPMENT

Introduction
• Language development is a process starting early in human life,
when a person begins to acquire language by learning it as it is
spoken and by mimicry.
• Children’s language development moves from simple to complex.
Infants start without language yet by 4 months of age, babies can
read lips and discriminate speech sounds.

DEFINITION OF LANGUAGE
• Language, a system of conventional spoken, manual (signed), or
written symbols by means of which human beings, as members of
a social group and participants in its culture, express themselves.
• A language is a system of communication which consists of a set
of sounds and written symbols which are used by the people of a
particular country or region for talking or writing.

CONT.
• The definition of language is speech or other forms of
communication.
• An example of language is words spoken.
• Another example of language is words read in a book.
• Another example of language is people using their hands to
express themselves. ... A system of signs, symbols, gestures, or
rules used in communicating.
• Language development is therefore the process by which children
come to understand and communicate language during early
childhood.

CHOMSKY DEFINATION OF
LANGUAGE
• Language as conceived of by Chomsky is “a set (finite or
infinite) of sentences, each finite in length and constructed out of
a finite set of elements” (Chomsky 1957:13). ... Hence, once a
particular string of words or a sentence causes a feeling of
wrongness in a native speaker, then it can be classified as
ungrammatical.

LANGUAGE AND IT’S
IMPORTANCE
• Language is a vital part of human connection. Although all
species have their ways of communicating, humans are the only
ones that have mastered cognitive communication .
• Language allows us to share our ideas, thoughts, and feelings
with others. It has the power to build societies, but also tear them
down.

Two main areas of language
• Receptive language (understanding): comprehension of
language.
• Expressive language (using language): the use of language
thru’ speech, sign or alternative forms of communication to
communicate wants, needs, thoughts, and ideas.

Types of language
• There are three types of language or ways of writing or
speaking:
• Slogan.
• Factual.
• and Thoughtful.

Basic features of language
• The five main components of language are :phonemes (unique
sounds to create words, the basic building blocks of language eg
sound of b and p (‘buh and puh’), morphemes, lexemes, syntax,
and context.
• Along with grammar, semantics, and pragmatics, these components
work together to create meaningful communication among
individuals.
• Assignment : find the meaning of these words

CHOMSKY’S THEORY OF LANGUAGE
DEVELOPMENT
• Chomsky based his theory on the idea that
all languages contain similar structures and
rules (a universal grammar), and the fact
that children everywhere
acquire language the same way, and without
much effort, indicating that one is born
wired with the basics already present in our
brains.

• These theories proposed that the mind of the human infant is
endowed with a “format” of a possible grammar (a theory of
linguistic data), a method of constructing grammars based on the
linguistic data to which the child is exposed, and a device that
evaluates the relative simplicity of constructed grammars.
• The child’s mind constructs a number of possible grammars that
are consistent with the linguistic data and then selects the grammar
with the fewest rules or primitives.

• He believes that language is innate and that one is born with the
capability of language.
• That language acquisition occurs during critical stage of
development,
• Language rules are influenced by experience and learning

Universal grammar
• Universal grammar (UG) (noun): a theory in linguistics
usually credited to Noam Chomsky that suggests that the ability
to learn grammar is built into the human brain from birth
regardless of language. In the 1960s, linguists became interested
in a new theory about grammar, or the laws of language.

Cont.
• The Universal Grammar (UG) hypothesis—the idea that human
languages, as superficially diverse as they are, share some
fundamental similarities, and that these are attributable to
innate principles unique to language: that deep down, there is
only one human language.

Cont.
• Universal grammar (UG) is the linguistic term that refers to the
fact that all languages, no matter how different they may seem
from another, have in common that they can be broken down into
nouns and verbs and other grammatical forms.

Language Acquisition Theory
• Language rules are complicated and complex. If there is not a
Universal Grammar, how do children make sense of it all? When
the child begins to listen to his parents, he will unconsciously
recognize which kind of a language he is dealing with - and he
will set his grammar to the correct one - this is known as 'setting
the parameters'.

Cont.
• It’s as if the child were offered at birth, a certain number of
hypotheses, which he or she then matches with what is happening
around him. The child knows intuitively that there are some words
that behave like verbs, and others like nouns, and that there is a
limited set of possibilities for ordering them within a phrase. This
is not information that the child is taught directly by adults, but
information that is given for the child to decipher. This set of
language learning tools, provided at birth, is referred to by
Chomsky as the Language Acquisition Device.

summary
Key Concepts of Chomsky's theory:
• Some language ability is innate.
• A Universal Grammar exists for all languages.
• Children are equipped with a Language Acquisition Device.

4 STAGES OF LANGUAGE
DEVELOPMENT
1 pre-speech 0-6months
2 bubbling 6-8 months
3 One word (holophrastic) 9-18 months
4 Combining words(telegraphic) 18-36 months

6 STAGES
AGE ACCOMPLISHMENT EXAMPLES
0-2 Months Crying (express of hunger and discomfort) -
2-4 months Cooing( express satisfaction or pleasure) Early
vowel-like sounds that babies produce.
Aaahhh, ooooo
4-9 months Babbling, gurging, changing to echolallic
babbling. These are speech-like sounds that
consist of vowel-consonant combinations.
Mamamamamama
gagagagagaga
9-18 months One word utterance- refer to people in the
baby’s life
Juice, mama
18-2 ½ years One word utterance- the beginning of syntax
expanding to 3-word
Daddy
2 ½-41/2 years Telegaphic stage expand grammar vocaburary
etc
Eaten bread

Stages of death by Kubler Ross
1969
1. Denial and isolation: it is very difficult for any individual to
face the fact that death is to be faced soon. The most
common reaction is to isolate oneself until defences are
achieved.
 Denial permits hope to exist but most patients are ready to
accept the fact that they are dying but families continue to
express denial.
 Denial delay, communication of concerns with the patient
stopping denial and isolation by thinking about unfinished
business e.g. personal affairs, finances, arrangement for
spouse, children and others. 250

 2. Anger: the person experiences anger with the person
asking the question; why me? The patient is difficult to
nurse as nothing seems to please him or her. The person
wants to express their outrage and helplessness. After
expressing their anger they move on.
251

3. Bargaining: third phase of dying when the person
attempts to negotiate and trade. It usually involves a
deal with God; the physician or the nurse. E.g. If I can
live long enough to attend my son’s wedding I will be
ready to die. If possible patients should be granted their
request.
4. Depression: the patient is now aware that death is
inevitable. Defense mechanism are no longer effective.
Sadness and anguish are felt and expressed.
 The patient may organize to gain support from loved
one’s and nurses.
 The resolution leads to final stage. 252

5. Acceptance: it’s a time of relative peace. The patient wants
to review the past and think about the unknown future.
Patient may not talk a lot about but he/she wants other
people nearby. With pain relieve the person accepts death
and wants to be comforted by having significant others
nearby.
253

NURSING INTERVENTION
To give maximum help to the dying by examining the
nurse’s own feeling about death.
Patient is an individual and should be treated with respect
and dignity regardless of background or condition.
Social values may affect reaction to the dying person e.g.
age, attractiveness, socio-economic status, former
accomplishment. These may affect whether the person is
cared for or abandoned while dying.
254

Nurses usually become the most important link with life
for the dying person.
The nurse provides physical comfort and emotional
support. It is an emotional stress to the nurse assigned to
people who are dying and these need to share their
feelings and reactions with others to obtain support.
255

Bill of rights for a dying person
I have a right to be treated as a living human being until I
die
I have a right to maintain a sense of hopefulness, however
changing its focus may be.
I have the right to be cared for by those who can maintain
a sense of hopefulness, however changing this may be.
I have a right to express my feelings and emotions and
my approaching death in my own way.
I have a right to participate in decision concerning my
care.
256

I have a right to expect continuing medical and nursing
attention even though “cure” goals must be changed to
comfort goals.
I have a right not to die alone.
I have a right to be free from pain.
I have a right to have my questions answered honestly.
I have a right not to be deceived
I have a right to help from and for my family in accepting
my death.
I have the right to die in peace and with dignity
257

I have the right to retain my individuality and not to be
judged by my decision, which may be contrary to the
believes of others.
I have the right to discuss and enlarge my religious and
spiritual experience, regardless of what they mean to
others.
I have the right to expect that the sanctity of the human
body will be respected after death.
I have the right to be cared for by caring, sensitive and
knowledgeable people who will attempt to understand
my needs and will be able to gain some satisfaction in
helping me face my death.
258

Take away assignment
 Discuss the application of theories of personality
development in growth and development.
 Discuss the uses of classical conditioning in daily
life.

Any Question???
ThankYou, Be Wise

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