Kohlberg's Stages of Moral Development PDF

Prof. Magda Ali hasan Essawy Assist.Prof. Noha Mohamed Arafa Mohamed Kohlberg’s Stages of Moral Development Contents  Introduction  Stages of Moral Development Level 1: Pre‐conventional level Stage 1: Punishment and obedience orientation Stage 2...

Prof. Magda Ali hasan Essawy Assist.Prof. Noha Mohamed Arafa Mohamed Kohlberg’s Stages of Moral Development Contents  Introduction  Stages of Moral Development Level 1: Pre‐conventional level Stage 1: Punishment and obedience orientation Stage 2: Instrumental relativist Orientation Level 2: Conventional moral level Stage 3: Interpersonal concordance or good by \nice girl orientation. Stage4: Law and order orientation. Level 3: Post conventional moral level. Stage 5: Social Contract, legalistic Orientation. Stage 6: Universal Ethical Principle Orientations 36 Introduction: -It is very important for children to develop a solid sense of right and wrong. They are faced with moral decisions every day as cheating, lying, stealing and daily temptations in the school. -There are three distinct approaches to the study of morality in which each approach look at the moral development in a different way. The first is the child moral reasoning, which means idea about justice, right and wrong. The second is psychoanalytic view point which stress the development of a child`s conscience. The third is rather diverse social –learning and behavioral tradition which emphasize how such behavior honesty and altruism are learned. Morality: It is a system of beliefs about what is right and good compared what is wrong. Moral development: refers to change in moral beliefs as a person grows older and gain maturity. Lawrence Kohlberg views the development of morality in term of moral reasoning. The stages of moral reasoning at which people can be placed depend upon the reasoning behind their decision themselves. During middle childhood, children are challenged by situation that demand that they decide what behavioral are morally corrected. This is a short story that will be used her in explaining of moral development accordingly to Lawrence Kohlberg; the three levels Faten wants to be a doctor she studied very hard for her anatomy and physiology exam but find that she isn`t sure of the answer to some of the question. She knows that a few points on this exam may make the difference between the acceptance or rejection at medical school. She has the opportunity to cheat on the test by coping from the best student in the class who is sitting next to here. Should Faten do it? 37  Kohlberg sees moral reasoning as developing in three levels that is consisting of sex stages, these stages are sequential and universal that are applicable to every culture and no stages are ever skipped.Each stage requires more sophisticated skills than the one that preceded it. Level 1: Pre‐conventional level The preconvention level; in this level the people make decisions on the basis of reward and punishment and the satisfaction of their own needs. Ex. If Faten reasons she might cheat because this will satisfies her immediate desires, on the other hand she might not cheat if she afraid she might get caught and punished. Stage 1: punishment and obedience orientation An individual in stage one avoid breaking rules because it might lead to punishment. In this stage person show complete obedience to rules and the interests of others are not considered. Stage 2: instrumental relativist Orientation In stage two the right action are those that satisfy one`s own needs and only sometimes the need of the others. However the only reason for helping others is that they will then owe you something a debt to be collected at a later time. There is a sense of fairness in this stage and making a deal is acceptable. Fairness, reciprocity and equal sharing are present in this stage. Ex.If Faten reasons she might cheat to satisfy her own needs. Level 2: Conventional moral level Conformity is the most important factor. The individual conform to the expectation of the others including the general social order. Faten might cheat if she reason that everyone else is doing it, she might not if she reason that it is against the rules and she would not be doing the right thing. Stage 3 Interpersonal concordance or good by \nice girl orientation. 38  In this stage; living up to the expectation of others and being good are the important consideration for child. There is an emphasis on gaining approval from others by being nice. Stage4 Law and order orientation. The child in stage four is oriented toward authority and maintaining the social order and fixed rules. The emphasis on doing one`s duty and showing respect for authority. Sometimes children in this stage reason if everyone did it, then…... Level 3: Post conventional moral level Children in post conventional level have evolved moral value that have been internalized. This value is individualized and not depend on one`s membership in any particular group A child’s sense of morality is defined in terms of more abstract principles and values. If Faten is resoning at this level she may think that achievement are worthwhile only if one is true to one`s own values among which are honesty and integrity. On the other hand Faten might reason that if she became a doctor she could help people and that is overriding principle is more important than whether she checks her answer or not. Stage 5 Social Contract, legalistic Orientation In this stage; the correct behavior is defined in terms of individual rights and the consensus of society. Right is a matter of children`s values and opinions but an emphasis on the legal point of view is present here. Stage 6 Universal Ethical Principle Orientations In this stage; the correct behavior is defined as a decision of conscience in accordance with self-chosen ethical principles that are logical, universal and consistent. 39 People rarely reason solely in one stage. More often they me be predominantly in one stage but also partly in the stages before and after. N.B: Accordingly to Lawrence Kohlberg views of moral development, it could be simed that , the toddler and preschoolers are mainly reason in level one only, that is means stage one and two where children avoiding breaking rules to avoid punishment or they do thing to satisfy their own needs. While school- age children are using level one and two only in their reasoning i.e. they are using the first four stages. Regarding the adolescents, they are able to use the three levels in their reasoning i.e. the sex stages. It is stated that 40 % of people using mainly the first four stages in their moral reasoning. Reference: Hockenberry, M., Rodgers, C., Wilson, D. Wong's Essentials of Pediatric Nursing. (2020) 11th edition. St. Louis, Elsevier.pp.44-45. 40 Prof. Magda Ali hasan Essawy Assist.Prof. Omayma Mohamed Reda El- Sheshtawy Behavioral Theories Outline - Introduction. - Definition of learning. - Principle of learning - Types of theories and modules of behavior: 1. Pavlov's or classical conditioning theory. 2. Skinner's operant conditioning and behavior modification theory. 3. Thorndike's connectionism theory 4. Bundura's modeling/observational learning theory. - References. Introduction Behaviorism focuses on the idea that all behaviors are learned through interaction with the environment. This learning theory states that behaviors are learned from the environment, and says that innate or inherited factors have very little influence on behavior. Behaviorism started as a reaction against introspective psychology in the 19th century, which relied heavily on first-person accounts. Skinner rejected introspective methods as being subjective and unquantifiable. These psychologists wanted to focus on observable, quantifiable events and behaviors. They said that science should take into account only observable indicators. 41  - Behavior is objective and observable, where as what goes on in one’s mind can never really be known or measured (the mind is a “black box”) - Behavior is the response of an organism to stimuli. - Behavior is always being modified, new experiences affect learning, and what is learned may be forgotten.(1) - Definition of learning. Learning refers to the relatively permanent change in knowledge or behavior that is the result of experience (1). - Principle of learning 1. Learning takes time to learn and practice. It is important to be able to accurately remember the information that learn, recall it at a later time, and use it effectively in a wide variety of situations. 2. Learning is an active continuous process that begins at birth and continues throughout life. Learners use sensory input and construct meaning from it. 3. Motivation is a key component in learning. It prompts, compels and energizes an individual to act or behave in a particular manner, at a particular time for attaining some specific goals or purposes. 4. Learning involves language which affects learning. Language is a social and uniquely human means of representing, exploring, and communicating meaning (1,2). - Types of theories and modules of behavior: 1. Pavlov's or classical conditioning theory. Introduction It is one of the fundamental ways to learn about the world around humans. Learning can occur through both unconscious and conscious pathways. 42  Classical conditioning is one of those unconscious learning methods and is the most straightforward way in which humans can learn. Classical conditioning is the process in which an automatic, conditioned response is paired with specific stimuli. Ivan Pavlov (1927) is a Russian physiologist discovered classical conditioning in dogs (1). Some important theory terms Classical conditioning definition — It is systematic procedure through which associations and responses to specific stimuli are learned. Involves the pairing of a neutral stimulus with a stimulus that elicits a particular response (dr.magda' book). — Unconditioned stimulus. This is the thing that triggers an automatic response. Food is the unconditioned stimulus in Pavlov’s dog experiment. — Unconditioned response. This is what response naturally occurs when individual experience the unconditioned stimulus, such as salivating from the food. — Conditioned stimulus. This is considered a neutral stimulus. When individual presented with it over and over before the unconditioned stimulus (e.g., food), it will start to evoke the same response. The bell before the food is the conditioned stimulus. — Conditioned response. This is the acquired response to the conditioned stimulus (the bell), which is often the same response as the unconditioned response. So, the dogs salivated for the bell the same way they salivated for the food in front of them. 43 — Extinction. This term is used when individual start presenting the conditioned stimulus (the bell) over and over but without the unconditioned stimulus (the food). Over time, the dogs would unlearn their conditioning that the bell means food is coming. — Generalization. This refers to when individual can generalize similar things and respond the same way. Dogs began salivating at sounds similar to bells because they were generalizing what they learned. — Discrimination. The opposite of generalization, this is our ability to tell the difference when something is similar but not identical, so it won’t produce the same response. A horn sound, for instance, wouldn’t make the dogs salivate. Stages of Pavlovian conditioning process — Before conditioning — The dog food in Pavlov’s experiment is called the unconditioned stimulus (US) because it elicits an unconditioned response (UR). That is, without any kind of “training” or “teaching,” the stimulus produces a natural or instinctual reaction. In Pavlov’s case, the food (US) automatically makes the dog drool (UR). Other examples of unconditioned stimuli include loud noises (US) that startle us (UR), or a hot shower (US) that produces pleasure (UR). — At this point, the conditioned stimulus is still called the neutral stimulus because it currently has no effect. — During conditioning — On the other hand, a conditioned stimulus (CS) produces a conditioned response (CR). For example, in Pavlov’s experiment, the bell is 44  the conditioned stimulus. However, after multiple pairings of the bell with the presentation of food, the dog starts to drool at the sound of the bell. This drooling in response to the bell is the conditioned response (CR). Although it can be confusing, the conditioned response is almost always the same as the unconditioned response. However, it is called the conditioned response because it is conditional on (or, depends on) being paired with the conditioned stimulus (e.g., the bell). — After conditioning — Once individual have learned to associate the conditioned stimulus with the unconditioned response, it becomes the conditioned response. So, the bell creates salivation. In this way, individual have unconsciously learned to associate the new stimulus (whether situation, object, person, etc.) with the response. — Theory application - Although classical conditioning may seem “old” or “too simple” a theory, it is still widely studied today as a type of associative learning, a form of learning that relies on the repetitive pairing of stimuli such as treatment of enuresis. The child sleeps on a special pad that is connected to a buzzer. If the child urinates, it completes a circuit, and the buzzer wakes the child up. After a while, the child becomes conditioned to wake up when the bladder if full. (dr.magda). 2. Skinner's operant conditioning theory. Introduction B. F. Skinner, a behavioral psychologist contributed to human view of learning by expanding understanding of conditioning to include operant 45  conditioning. It was concluded that if a behavior is followed by reinforcement, that behavior is more likely to be repeated, but if it is followed by punishment, it is less likely to be repeated. Operant conditioning It is a theory of learning that focuses on changes in an individual’s observable behaviors. The learning process in which behavior is governed by its consequences (dr.magda). This involves conditioning voluntary, controllable behaviors, not the automatic physiological responses in Classical Conditioning. With Operant Conditioning the Response comes before the Stimulus (the opposite of CC) Theory process Skinner would place the rats in a Skinner box with a lever attached to a feeding tube. Whenever a rat pressed the lever, food would be released. After the experience of multiple trials, the rats learned the association between the lever and food and began to spend more of their time in the box procuring food than performing any other action. It was through this early work that Skinner started to understand the effects of behavioral contingencies on actions. It was concluded that the rate of response—as well as changes in response features—depended on what occurred after the behavior was performed, not before. Skinner named these actions operant behaviors because they operated on the environment to produce an outcome. (4). Operant technique/ Behavior modification Behavior modification is a set of therapies / techniques based on operant conditioning (Skinner, 1938, 1953). The main principle comprises changing 46  environmental events that are related to a person's behavior. For example, the reinforcement of desired behaviors and ignoring or punishing undesired ones. (Kaplam, P.S. (2015). A child’s Odyssey child and adolescent development (1 st ed.). Springer Publishing Company.) Punishment: It is presentation of an aversive stimulus for an undesired behavior to reduce the frequency of behavior. E.g., scolding a child who has taken a toy from a younger brother or sister. Positive Reinforcement: It is adding a pleasant stimulus to increase or maintain the frequency of a behavior or response. For example, a child cleans her room and is rewarded with a cookie. Negative Reinforcement: it is remove an aversive or unpleasant stimulus to increase or maintain the frequency of a behavior. For example, a child cleans her room and is rewarded by not having to wash the dishes that night. Token Economy/Reinforcement Token economy is a system in which targeted behaviors are reinforced with tokens (secondary reinforces) and later exchanged for rewards (primary reinforces).Tokens can be in the form of fake money, buttons, poker chips, stickers, etc. For example, allowing a young child to paste a star on a daily chart each day, the young remembers to empty the trash; at the end of week or month, the child exchanges the filled chart for a trip to the zoo. 47  Response cost It is the term used for removing reinforcement for an undesirable behavior. It is used in conjunction with a token economy such as the child may lose a star on his or her chary every time the child fights with a sibling. Extinction It is a procedure in which reinforcement of a previously reinforced behavior is discontinued or reduced its frequency such as completely ignoring a child whenever speaks in a whining voice. Time-out It is a term in which the child is removed from all positive reinforces condition upon a specific response such as child told to sit on chair away from the family members whenever the child speaks bad words. Behavior shaping It is a type of operant conditioning. Instead of waiting for a child to exhibit a desired behavior or novel response, any behavior leading to target behavior is rewarded such as the child had to be rewarded for each steps of action until finally the child was trained to do desired response. Modeling Initiation of a desired behavior first emitted by a model is reinforced. E.g., the 5 years old child observes 10 years brother washing dishes. The younger child asks if he may help wash dishes and is praised by parents for helping. 48  Theory application Through different behavior modification to bring the desired behavioral changes such as dealing with temper tantrum (dr.magda). 3. Thorndike’s Law of Effect Introduction Thorndike’s theory (1874-1949) of learning has become to be known as connectionism because he posited that learning was a process of forming a connection between stimulus and response. The law of effect is at work in every human behavior as well. From a young age, individual learn which actions are beneficial and which are detrimental through a similar trial and error process. While the law of effect explains behavior from an external, observable point of view, it does not account for internal, unobservable processes that also affect the behavior patterns of human beings. Defenitions: Law of Effect: A law developed by Edward L. Thorndike that states, “responses that produce a satisfying effect in a particular situation become more likely to occur again in that situation, and responses that produce a discomforting effect become less likely to occur again in that situation.” Behavior modification: The act of altering actions and reactions to stimuli through positive and negative reinforcement or punishment. Trial and error: The process of finding a solution to a problem by trying many possible solutions and learning from mistakes until a way is found. 49 Thorndike’s Experiments Thorndike’s most famous work involved cats trying to navigate through various puzzle boxes. In this experiment, he placed hungry cats into homemade boxes and recorded the time it took for them to perform the necessary actions to escape and receive their food reward. Thorndike discovered that with successive trials, cats would learn from previous behavior, limit ineffective actions, and escape from the box more quickly. It was observed that the cats seemed to learn, from an intricate trial and error process, which actions should be continued and which actions should be abandoned; a well-practiced cat could quickly remember and reuse actions that were successful in escaping to the food reward. The Law of Effect Thorndike realized not only that stimuli and responses were associated, but also that behavior could be modified by consequences. He used these findings to publish his now famous “law of effect” theory. According to the law of effect, behaviors that are followed by consequences that are satisfying to the organism are more likely to be repeated, and behaviors that are followed by unpleasant consequences are less likely to be repeated. Essentially, if an organism does something that brings about a desired result, the organism is more likely to do it again. If an organism does something that does not bring about a desired result, the organism is less likely to do it again. Example During a young age, human learn which actions are beneficial and which are detrimental through a trial and error process. For example, a young child is playing with her friend on the playground and playfully pushes her friend off the swing set. Her friend falls to the ground and begins to cry, and then refuses 50 to play with her for the rest of the day. The child’s actions (pushing her friend) are informed by their consequences (her friend refusing to play with her), and she learns not to repeat that action if she wants to continue playing with her friend (6-7). 4. Bundura's modeling/observational learning theory. Introduction This approach examines the broad range of learning that is accomplished by means of observation and imitation (modeling). Social learning theorists have maintained that much what individual learn is learned by watching the behavior of others rather than through the direct shaping or “conditioning” of responses (Bandura, 1973)(4)(dr magda). Theory process Human learn behavior through observation Observe behavior of others and repeat the behavior The children in Bandura’s studies observed an adult acting violently toward a Bobo doll. When the children were later allowed to play in a room with the Bobo doll, they began to imitate the aggressive actions they had previously observed (4,5). Bandura identified three basic models of observational learning: A live model, which involves an actual individual demonstrating or acting out a behavior. A symbolic model, which involves real or fictional characters displaying behaviors in books, films, television programs, or online media. 51  A verbal instructional model, which involves descriptions and explanations of a behavior. The Observational Learning theory 4 Steps Attention processes In order to learn, individual need to be paying attention. Anything that distracts individual attention is going to have a negative effect on observational learning. If the model is interesting or there is a novel aspect of the situation, individuals are far more likely to dedicate full attention to learning. Retention processes The ability to store information is also an important part of the learning process. Retention can be affected by a number of factors, but the ability to pull up information later and act on it is vital to observational learning. Reproduction processes Once you have paid attention to the model and retained the information, it is time to actually perform the behavior individual observed. Further practice of the learned behavior leads to improvement and skill advancement, such as driving a car Incentive and motivation processes Finally, in order for observational learning to be successful, individual have to be motivated to imitate the behavior that has been modeled. Reinforcement and punishment play an important role in motivation (4-6). 52 References 1. Krapfl,E.(2016).Behaviorism and society. Behav Anal,39 (1),123-9. 2. Cherry, K. (2020).Learning theory in psychology.Very wellmind.https://www.verywellmind.com/learning-theories-in- psychology-an-overview-2795082. 3. Kaplam, P.S. (2015). A child’s Odyssey child and adolescent development (1 st ed.). Springer Publishing Company. 4. Gorn, G.J. (1982). The effects of music in advertising on choice behaviour: A classical conditioning approach. Journal of Marketing, 46(1), 94-101. 5. Witte, K., & Allen, M. (2000). A meta-analysis of fear appeals: Implications for effective public health campaigns. Health Education & Behavior, 27(5), 591-615. 6. Cook DA, Artino AR. Motivation to learn: an overview of contemporary theories. Med Educ. 2016;50(10):997-1014. doi:10.1111/medu.13074. 7. Bajcar EA, Bąbel P. How Does Observational Learning Produce Placebo Effects? A Model Integrating Research Findings. Front Psychol. 2018;9:2041. doi:10.3389/fpsyg.2018.02041 8. Hammer TR. Social Learning Theory. In: Goldstein S, Naglieri JA. Encyclopedia of Child Behavior and Development. San Francisco: Springer; 2011. doi:10.1007/978-0-387-79061-9_2695 53 Prof. Azza Mostafa Darwish Mostafa Dr. Rasha Mohamed Mahmoud Abouhadida Spiritual Development Contents: 1-Introduction 2-concepts in spiritual health  Spirit  Spiritual Health  Spiritual Well-Being  Faith  Religion  Hope 3- Stages of spiritual development  Stage 0: undifferentiated  Stage 1: intuitive-projective  Stage 2: mythical literal  Stage 3: synthetic convention  Stage 4: individual reflexive  Stage 5: Conjunctive” Faith (Mid-Life Crisis).  Stage 6 –” Universalizing” Faith or” Enlightenment”. (Later Adulthood). 54 Introduction: Florence Nightingale believed that spirituality was a force that provided energy requird to promote a healthy hospital environment and that caring for a person’s spiritual needs was just as essential as caring for his or her physical needs. Today spirituality is often defined as an awareness of one’s inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself. A person’s health depends on a balance of physical, psychological, sociological, cultural, developmental, and spiritual factors. Spirituality is important in helping individuals achieve the balance to maintain health and well-being and adapt with illness. Research shows that spirituality positively affects and enhances health, quality of life, health promotion behaviors, and disease prevention activities Concepts in spiritual health: Spirit The word “spirit” is derived from the Latin words “spiritus” (meaning breath, courage, vigor, or soul) and the word “spirare” (meaning to breathe).Five characteristics of spirituality include: meaning, value, transcendence, connecting with oneself, others, God/supreme power and the environment. Spiritual Health People achieving spiritual health by maintaining a balance between their values, goals, and beliefs and their relationships within themselves and others. Throughout life a person often develops more spiritual, becoming increasingly aware of the meaning, purpose, and values of life. In times of stress, illness, loss, or recovery, a person uses previous ways of adjusting to a situation. These coping styles lie within the person’s spiritual beliefs. 55 Spiritual Well-Being: The concept of spiritual well-being is described as having two dimensions. The vertical dimension supports the supreme relationship between a person and God or some other higher power. The horizontal dimension describes positive relationships that people have with others. Spiritual well-being has a positive effect on health. Those who experience spiritual well-being feel among others and are able to find meaning or purpose in their lives. Those who are spiritually healthy experience good and are able to forgive themselves and others and have a positive sense of physical and emotional well-being which enhanced quality of life Faith Faith is a cultural or institutional religion such as Judaism, Islam, or Christianity. It is also a relationship with a divinity, higher power, authority, or spirit that incorporates a reasoning faith (belief) and a trusting faith (action). Reasoning faith provides confidence in something for which there is no proof. It is an acceptance of what reasoning cannot explain. Sometimes faith involves a belief in a higher power, spirit guide, God, or Allah. Faith is also the manner in which a person chooses to live. It gives purpose and meaning to an individual’s life, allowing for action. Many times patients who are ill have a positive outlook on life and continue to pursue daily activities rather than resign themselves to the symptoms of the disease. Their faith often becomes stronger because they view their illness as an opportunity for personal growth. Religion Religion is associated with the “state of doing,” that refers to the system of organized beliefs and worship that a person practices to outwardly express spirituality. It is important to understand the differences between religion and spirituality when providing spiritual care to a patient. Many people use the terms 56 spirituality and religion interchangeably. Although closely associated, these terms are not synonymous. Religious practices encompass spirituality, but spirituality does not need to include religious practice. Religious care helps patients maintain their faithfulness to their belief systems and practices. Spiritual care helps people identify meaning and purpose in life, look beyond the present, and maintain personal relationships and a relationship with a higher being or life force. Hope Spirituality and faith bring hope. When a person has the attitude of something to live for and look forward to, hope is present. It is a multidimensional concept that provides comfort while people endure life-threatening situations, hardships, and other personal challenges. It is closely associated with faith and is energizing, giving individuals a motivation to achieve and the resources to use toward that achievement. People express hope in all aspects of their lives to help them deal with life stressors. Hope is a valuable personal resource whenever someone is facing a loss or a difficult challenge Stages of spiritual development James W. Fowler (1940-2015) was an American theologian who was Professor of Theology and Human Development at Emory University. He was director of both the Center for Research on Faith and Moral Development and the Center for Ethics until he retired in 2005. He was a minister in the United Methodist Church. According to Fowler, there are seven primary stages of faith (including Stage 0) in the life of the individual. They are as follows: 57 Stage 0 – Primal Undifferentiated Faith (Ages Birth-2): This stage is similar to Erik Erikson’s first stage of” trust versus mistrust. The baby acquires experiences from the outer environment that either instills in him a feeling of trust and assurance (from being comforted, living in a secure and stable environment, and a experiencing a sense of consistency and care from parents). These personalized experiences, according to Fowler, essentially translate into feelings of trust and assurance in the universe and harmony with the divine. Conversely, experiences of parental or environmental neglect and/or abuse at this stage of development, can result in the formation of feelings of mistrust and fear with respect to the universe and the divine, sowing the seeds for later doubt and existential angst. This stage also compares with Jean Piaget’s sensory-motor stage of cognitive development, where thinking takes place in and through the body. Stage 1 –Intuitive-Projective Faith (Ages 3-7). Children at this stage have acquired language and the ability to work with symbols to express thoughts. Children at this stage imitate the religious gestures and behaviors of others without comprehending any meaning or significance to the activities. During the preschool years children assimilate some of the values and beliefs of their parents. Parental attitudes towards moral codes and religious beliefs convey to children what they consider to be good and bad. Children still imitate behavior at this age and follow parental beliefs as part of their daily lives rather than through an understanding of their basic concepts. This stage aligns with Piaget’s stage of pre-operational thinking (lacking consistent logical-mental structures). 58  Stage 2 – Mythic-Literal Faith (Ages 7-12). Children at this stage have a belief in justice and fairness in religious matters, a sense of reciprocity in the workings of the universe (e.g. doing good will result in a good result, doing bad will cause a bad thing to happen) and an anthropomorphic image of God (e.g. a man with a long white beard who lives in the clouds). For example, one 6-years-old child hospitalized for appendectomy said: "God saw all bad things I did, and he punished me". Reassurance that God does not punish children by making them sick reduces anxiety. This stage aligns with Piaget’s concrete operational stages of cognitive development, where true logical thinking begins to develop in the child’s mind. Stage 3 –Synthetic-Conventional Faith (Ages 12 to Adult). This stage is characterized by the identification of the adolescent/adult with a religious institution, belief system, or authority, and the growth of a personal religious or spiritual identity. They become increasingly aware of spiritual disappointments. They recognize that prayers are not always answered (at least on their own terms) and may begin to abandon or modify some religious practices. They begin to reason, to question some of the established parental religious standards, and to drop or modify some religious practices. Young adolescents in the stages of concrete operational thought are able to think logically. In this stage, children deal with the observable but also begin to see other points of view and to examine what they have learned and accept religious concepts related to everyday living. 59 Stage 4 –Individuative-Reflective Faith (Ages Mid-Twenties to Late Thirties). This stage is often characterized by angst and struggle as the individual takes personal responsibility for her beliefs or feelings. Religious or spiritual beliefs can take on greater complexity and shades of nuance, and there is a greater sense of open-mindedness, which can at the same time open up the individual to potential conflicts as different beliefs or traditions collide. Stage 5 – Conjunctive Faith (Mid-Life Crisis). A person at this stage acknowledges paradoxes and the mysteries attendant on transcendent values. This causes the person to move beyond the conventional religious traditions or beliefs he may have inherited from previous stages of development. A resolution of the conflicts of this stage occurs when the person is able to hold a multi-dimensional perspective that acknowledges” truth’ as something that cannot be articulated through any particular statement of faith. Stage 6 –Universalizing Faith or Enlightenment. (Later Adulthood). This stage is only rarely achieved by individuals. A person at this stage is not hemmed in by differences in religious or spiritual beliefs among people in the world but regards all beings as worthy of compassion and deep understanding. Here, individuals” walk the talk” of the great religious traditions (e.g.” the kingdom of God is within you”). One good example of this stage in the 60 life of an individual is the life of Count Leo Tolstoy, who in his later years emphasized the importance of equality among people, asceticism in one’s style of living, and the practice of compassion for all. Ref: Potter, P., Perry, A.(2013).Fundamentals of Nursing. 8 ed. Chapter 35; Spiritual health; Nurse key pp:691-93. Armstrong T.(2020).The Stages of Faith According to James W. Fowler. American institute for learning and human development. Available from” www. The Stages of Faith According to James W. Fowler | Thomas Armstrong, Ph.D. (institute4learning.com) 61 Prof. Azza Mostafa Darwish Mostafa Dr. Eman Arafa Ahmed Badr Attachment Theory Outlines: - Introduction. - Definition of attachment. - Attachment theory (John Bowlby, 1907-1990). - Characteristics of attachment. - Phases of attachment development. - Styles of attachment/ types of attachment patterns. - Children who are securely attached benefit in several ways. 62 Introduction Children need a relationship with a caregiver who is sensitive and responsive, who comforts the child when distressed and enables them to feel safe enough to relax, play, and learn. This is the basis of a secure attachment. Definition of Attachment:  Attachment is the deep and enduring connection (bond) established between a child and care giver in the first several years of life.  The caregiver could be the child's mother, father, grandparents, aunts, uncles another individual with whom a child develops a strong emotional bond.  It profoundly influences every component of the human condition - mind, body, emotions, relationships, and values. Attachment is not something that parents do to their children; rather, it is something that children and parents create together, in an ongoing, reciprocal relationship.  Attachment is developed when a caregiver's behavior includes touching, smiling, eye contact, positive interaction, and sensitivity to a child's needs. Although a child's first year is significant in terms of the establishment of attachment. Parent–Infant Bonding and Attachment: The terms bonding and attachment describe the affective relationships between parents and infants.  Bonding occurs shortly after birth and reflects the feelings of the parents toward the newborn (unidirectional). 63