NCM 100 Modules Prelims TFN PDF

NCM 100 – THEORETICAL FOUNDATIONS OF NURSING MODULE 1 – EVOLUTION OF NURSING LEARNING OBJECTIVES: After going through this module, the students are expected to be able to: 1. Define and discuss the terms in nursing theory using critical thinking skills. 2. Cite and discuss brief...

NCM 100 – THEORETICAL FOUNDATIONS OF NURSING MODULE 1 – EVOLUTION OF NURSING LEARNING OBJECTIVES: After going through this module, the students are expected to be able to: 1. Define and discuss the terms in nursing theory using critical thinking skills. 2. Cite and discuss briefly the characteristics of a theory. 3. Develop analytical skills differentiating the types of theory. 4. Explain the relationships of concepts and propositions to theory. 5. Display analytical thinking skills in differentiating the metaparadigms of the different nursing theories. 6. Explain the four ways of knowing. 7. Develop self-awareness or persona - knowledge (relationship to self, family, community). 8. Apply appropriate actions in nursing situation through using the four ways of knowing. 9. Acknowledge the importance of the different ways of knowing. 10. Improve oral proficiency in explaining the concepts. 11. Develop teamwork and unity in identifying the sources of knowledge. 12. Practice the steps of the scientific method in solving problem. 13. Identify and explain the scope of theories. 14. Demonstrate ability in analysis and evaluation of theories. 15. Enumerate the criteria of a profession. 16. Display critical thinking skills in discussing the significance of theories on research, education, practice, and nursing profession. LESSON 1 - INTRODUCTION TO NURSING THEORIES What is a Theory? - Theory maybe defined as a hypothesis or system of ideas that is proposed to explain a given phenomenon or idea. - Theory is a set of statements that tentatively describe, explain, or predict relationships among concepts that have been systematically selected and organized as an abstract representation of phenomenon. - An organized system of accepted knowledge that is composed of concepts, propositions, definitions and assumptions intended to explain a set of fact, event or phenomena. - A comprehensive explanation of a given set of data that has been repeatedly confirmed by observation and experimentation and has gained general acceptance within the scientific community but has not been yet decisively proven. Characteristics of a Theory 1. It correlates concepts in such a way as to generate a different way of looking at a certain fact or phenomenon. 2. Logical in nature. 3. Simple but generally broad in nature. 4. Can be a source of hypothesis. 5. Contribute to enriching the body of knowledge. 6. Can be used by practitioner to direct & enhance their practice. 7. Consistent with other validated theories, laws, & principles. Components of a Theory 1. Concepts Ideas and mental images that help to describe phenomena. Defined as an idea formulated by the mind or an experience perceived and observed such as justice, love, war and disease. Building blocks of theories. Two types of concepts: Abstract Concepts o Indirectly observed or intangible o It is independent of time and place. e.g. Love, care & freedom. Concrete Concepts o Directly observed or tangible. e.g. Nurse, mother & pain 2. Proposition or Assumption Explains the relationship of different concepts. A statement that specifies the relationship or connection of factual concepts or phenomena. 3. Definitions Composed of various descriptions which convey a general meaning and reduces the vagueness in understanding a set of concepts. Types of definition: Conceptual definition ▪ Meaning of the word is based on how a certain theory or relevant literature perceives it to be. Operational definition ▪ Meaning of the word is based on the method of how it was measured or how the person come-up with that perception. 4. Phenomenon Refers to an aspect of reality that can be consciously sensed or experienced. A sets of empirical data or experiences that can be physically observed or tangible such crying or grimacing when in pain. In Nursing, Phenomena can be: - A clinical or environmental setting of nursing, - Disease-Process, - Client’s Behaviour, - Interventions, or - Practices that are utilized in nursing theories & metaparadigm. Why theories are important? In science, the purpose of a theory is to guide research, support existing, knowledge, or generate new knowledge.  The ultimate goal is to support excellence in practice. Framework for thought in which to examine situations. Structure for organization, analysis, and decision making. A theory helps us to organize our thoughts and ideas. What are the different types of theories? 1. Descriptive Theories Also known as Factor-Isolating Theories and are known to be the primary level of theory development. They identify and describe major concepts of phenomena. However, they do not explain the relationship of the concepts. Its main purpose is to present a phenomenon based on the five senses together with their corresponding meaning. 2. Explanatory Theories Also known as Factor-Relating Theories and are the type of theory that presents relationship among concepts and propositions. These theories aim to provide information on how or why concepts are related. Cause and effect relationship are well explained using explanatory theories. 3. Predictive Theories Otherwise known as Situation-Relating Theories, are achieved when the relationships of concepts under a certain condition are able to describe future outcomes consistently. This kind of theory is generated and tested using experimental research. 4. Prescriptive Theories Also called as Situation-Producing Theories and deals with nursing actions, and test the validity and certainty of a specific nursing intervention This kind of theory is commonly used in testing new nursing interventions. What is Nursing? ❖ According to Association of Deans of Philippine Colleges of Nursing (ADPCN), Nursing is a dynamic discipline. It is an art and a science of caring for individuals, families, groups and communities geared toward promotion and restoration of health, prevention of illness, alleviation of suffering and assisting clients to face death with dignity and peace. ❖ Nursing was defined by the American Nurses Association (ANA) as the diagnosis and treatment of human responses to actual or potential health problems. ❖ International Council for Nurses (ICN) defined Nursing as an autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. ❖ International known theorist, Virginia Henderson definition of Nursing is toassist clients in the performance of activities contributing to health, its recovery or peaceful death that clients will perform unaided, if they had the necessary will, strength or knowledge. ❖ Nursing is focused in supporting communities, families and individuals in maintaining, restoring or achieving a state of optimum health and functioning. It  is both a science and an art that is concerned with the quality of life as defined by the clients. What about Nursing Theories? Nursing theories are group of interrelated concepts that are developed from various studies of disciplines and related experiences. Nursing theory provides the theoretical foundation of the profession. This aims to view the essence of nursing care. Nursing Theory defines what nursing is, what it does, and the goals or outcomes of nursing care. Why Nursing Theories are important? ✓ It guides nursing practice and generates knowledge. ✓ It helps to describe or explain nursing. ✓ Enables nurses to know WHY they are doing WHAT they are doing. ✓ It strengthened the Nursing Knowledge. ✓ It assists the nursing discipline in clarifying beliefs, values, and goals. ✓ Help to define the unique contribution of nursing in the care of clients. ✓ Standards of clinical practice are developed out of nursing theories. ✓ It organizes and analyzes patients’ data. ✓ It helps in understanding connections between pieces of data. ✓ Maintains professional boundaries in nursing. ✓ It makes sound clinical judgments based on evidence. ✓ It makes S.M.A.R.T (specific, measurable, attainable, realistic & time-bounded) effective plan of care. ✓ Helps in predicting and evaluating outcomes of interventions or plans of care. Types of Nursing Theories 1. Grand Theories. These are broad and complex. 2. Middle-Range Theories. These address specific phenomena and reflect practices. 3. Ethical Theories. These focus on nursing practice ethics. 4. Change Theories. These theories are about changes to nursing strategies. What is Paradigm and Nursing Paradigms? ❖ Paradigm is a model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline. ❖ Nursing Paradigms are patterns or models used to show a clear relationship among the existing theoretical works in nursing profession. What about Metaparadigm of Nursing? ❖ Metaparadigm came from the word ―meta, a Greek word which means ―”with” and a paradigm which means ―”pattern”. ❖ It embodies the knowledge base, theory, philosophy, research, practice, and educational experience and literature identified with the profession. ❖ Metaparadigm is the most abstract level of knowledge. ❖ In nursing, this is main concepts that encompass the subject matter and the scope of the discipline. What are the Four Metaparadigms of Nursing? 1. Person. The recipient of nursing care which includes individuals, families, groups and communities. 2. Health. The degree of wellness or well-being that the patients’ experiences. 3. Environment. Environment is the internal and external surroundings that affect the patient. This includes people in the physical environment, such as families, friends and significant others. 4. Nursing. The interventions of the nurse rendering care in support of or in cooperation with the client. What is Philosophy in Nursing? - Philosophy in nursing is the next knowledge level after metaparadigm. - It specifies the definition of metaparadigm concepts in each of the conceptual models of nursing. - It sets forth the meaning of phenomena through analysis, reasoning, and logical argument. - Philosophies have contributed to the knowledge development in nursing by forming a basis for subsequent developments especially in area of human science. What is Science? - Science came from the Latin word ―scientia, meaning ―KNOWLEDGE. - It refers to any systematic knowledge or practice in a discipline of study. - It refers to any system of acquiring knowledge based on scientific method. - Science is an organized body of knowledge gained through research. What are the Steps in Scientific Method? 1. Observation. Integration of knowledge and/or phenomenon by rational or sentiment being. 2. Gathering information or data. Recognition and collecting data for a particular or scientific problem or inquiry. 3. Formulation of hypothesis. An attempt to explain or suggest a nature of a phenomenon. 4. Experimental Investigation. A set of examinations done to solve the particular query raise through the hypothesis process. 5. Conclusion. A statement explaining a set of natural phenomena or scientific query derived from experimental investigation. What is Knowledge? - Knowledge can be defined as information, skills and expertise acquired by a person through various life experiences or through formal/informal learning such as formal education, self-study or vocational courses. - Knowledge acquirement involves several cognitive processes (perception, association, learning, reasoning, and communication). TYPES OF COGNITIVE PROCESS PERCEPTION Achieving understanding of sensory data. ASSOCIATION Combing two or more concepts/ ideas to form a new concept, or for comparison. LEARNING Acquiring experiences, skills, information and values.  REASONING Mental processes of seeking conclusions through reason. COMMUNICATION Transferring data from sender to receiver using different mediums or tools of communication. What are the sources of knowledge? 1. Traditional knowledge. This source of knowledge is a nursing practice passed from generation to generation. 2. Authoritative knowledge. Authoritative source of knowledge refersto an idea by a person of authority which is perceived as true because of his or her expertise. 3. Scientific knowledge. This type of knowledge which came from scientific method through research. These new ideas are tested and measured systematically using objective criteria. What about Nursing Knowledge? 1. Nursing knowledge is composed of both theoretical and practical knowledge. 2. Theoretical knowledge aims to stimulate thinking and broaden understanding of the science and practice of the nursing discipline. It includes and reflects on the basic values, guiding principles, elements and phases of conception of nursing. 3. Practical knowledge referred to as the art of nursing. LESSON 2. PURPOSES OF NURSING THEORY Purposes of Nursing Theories a. In Practice 1. It assists nurses to describe, explain and predict everyday experiences. 2. Serve to guide assessment, intervention and evaluation of nursing care. 3. Provide a rationale for collecting reliable and valid data about the health status of clients, which are reliable for effective decision-making and implementation. 4. It establishes criteria to measure the quality of nursing care. 5. Helps build common nursing terminology to use in communicating with other health professionals. 6. Enhances autonomy of nursing profession by defining its own functions. b. In Education 1. Provides general focus for curriculum design. 2. Guide curricular decision making. 3. It primarily ensure adequate & quality nursing delivery and to clarify and improve the status of the nursing as a profession. c. In Research 1. Offer framework for generating knowledge and new ideas. 2. Assist in discovering knowledge gaps in specific field of study. 3. Offer a systematic approach to identify questions for study, select variables, interpret findings and validate nursing interventions. What are the current trends influencing Nursing Theories? 1. Medical Science. 2. Nursing education. 3. Professional Nursing Organizations. 4. Evolving Research Approaches. 5. Global Concerns. 6. Consumer Demands. 7. New Technologies. Interdependence of Theory and Research - “Practice without theory, like a map without route, is blind; theory without practice, like route without map, is empty”. - The more research is conducted, the more learning is gained as to what extent a given theory can be useful in providing knowledge that will enhance client’s care. - Research is linked to theory in two –ways by generating and testing. a. Theory –generating research is designed to discover and describe relationships and phenomena without imposing predetermined notions on  the nature of the phenomena. In conducting this type of research, the investigators make observations with an open mind in order to view a phenomenon in a new way. b. Theory –testing research is utilized to determine how accurate a theory describes a phenomenon. The researcher already has some predetermined notions as to how phenomenon is and creates a hypothesis to test the assumptions of the theory. LESSON 3. FOUR WAYS OF KNOWING What are the Four Ways of Knowing? 1. Empirics - the scientific discipline of nursing. 2. Ethics - the moral directions of nursing. 3. Personal Knowledge - method by which nurses approach their patients. 4. Aesthetic or Esthetic - deals with the emphatic aspect of nursing. What is Empirical Knowing? 1. The first primary model of knowing. 2. It refers to any scientific, research-based, theoretical, factual information that the nurse makes use of. 3. The principal form relating factual and descriptive knowing aimed at the expansion of abstract and theoretical explanations. 4. Emphasizes that scientific research is important to nursing knowledge. 5. Empirical Knowing focuses on evidence-based research for effective & accurate nursing practice. a. Examples are knowledge obtained from textbooks, lectures, journals, literatures, credible online resources, and results of evidence-based researches. Evidence-Based Practice as part of Empirical knowing 1. An accurate & thoughtful decision-making about healthcare delivery for clients.  2. This is based on the result of most relevant & supported evidence derived from research in response to client’s preferences & expectations. 3. Evidence-based practice (EBP) promotes quality care that has been demonstrated to be effective. Practice founded on EBP can bridge the gap of nursing practice and research to provide basis for nurses to transform research into quality care. 4. There are six (6) characteristics of quality healthcare that reinforces aspects of Evidence-Based Practice (EBP); o Client-centered, o Scientifically-based, o Population-outcome based, o Develop through quality improvement and benchmarking, o Individualized to client’s need, and o Attuned with system policies and resources. What is Ethical Knowing? 1. Involves the judgement of right & wrong in relation to intentions, reasons and attributes of individuals & situations. 2. It requires knowledge of different philosophical views regarding what is good & right in making moral actions & decisions particularly in the theoretical & clinical components of nursing. 3. The code of morals or code of ethics that leads the conduct of nurses is the main basis for ethical knowing in the nursing profession. 4. It is deeply rooted in the concepts of human dignity, service and respect for life. What is Aesthetic or Esthetic Knowing? 1. This type of knowing is used in the process of giving appropriate nursing care through understanding the uniqueness of every patient, thus emphasize the use of creative & practical styles of care. 2. It is related to understanding what is of significance to particular patients such as feelings, attitudes, and point of view. 3. It is also the manifestation of the creative and expressive styles of the nurse. 4. Focuses on EMPATHY, the ability for sharing or vividly understanding another's feeling. 5. It also includes the nurse’s ability in changing ways and manner of rendering nursing care based on the client’s individual needs and perceptions. What is Personal Knowing? 1. This type of knowing is focused on realizing, meeting, defining the real true self or in other word ―self-awareness‖. 2. It encompasses the knowledge of the self in relation to others and to self. 3. It involves the entirety of the nurse - patient relationship. 4. It is most difficult to master and to teach. 5. It is the key to comprehending health in terms of personal well-being. LESSON 4. SCOPE OF THEORIES AND ANALYSIS What are the concepts to understand? - Theories unique to nursing help the discipline define how it is different from other disciplines. They are known to have a relative system of ideas that is intended to explain a give phenomenon or fact. - Nursing Theories reflect particular views of person, health, environment, nursing and other concepts that contribute to the development of a body of knowledge specific to nursing concerns. - Scope refers to the qualified level of precision of a certain theory and the accuracy of its concepts and propositions. - Basically, there are three categories that relate to the scope of a theory: Grand Theories, Middle – range Theories, and the Micro – range Theories. What are Grand Theories? 1. These theories are broadest in scope, representing universal and broad nursing phenomena. 2. Grand Theories are simply known to speak about broad range of important relationship among concepts of a discipline. 3. They are made up of concepts representing common and extremely complex phenomena. 4. Basically, its purpose is not expected to provide a perfect guidance for the formation of specific nursing knowledge but rather provides a general framework for creating and structuring broad and abstract ideas. 5. Commonly known grand theories in the nursing discipline are: Orem’s Self-care Theory of Nursing and Neuman Systems Model Theory. What about Middle – Range Theories? 1. These theories are known to have a narrower and detailed focus compared to grand theories. 2. Middle –Range Theories are least abstract level of theoretical knowledge because they include details specific to nursing practice. Descriptions, explanations, and predictions are made with the purpose of answering questions about different nursing phenomena. 3. They specify such things as the health condition, the patient population or age group, the location of practice, and the different interventions of the nurse. 4. Commonly known middle –range theories in the nursing discipline are: Psychodynamic Nursing by Hildegard Peplau, Human-to Human Relationship Model by Joyce Travelbee, Transcultural Theory in Nursing by Madeleine Leininger, and Model of Health by Margaret Newman. What about Micro –Range Theories? 1. These are known to be the most concrete and narrow in scope. 2. Micro –range Theories are situation –specific and limited to particular populations or fields of practice and also a linking of concrete concepts into a statement that can be observed in practice and research. Analysis and Evaluation of Theory Things to consider when evaluating a theory: The degree of usefulness to guide practice, research, education and administration. Providing a description of a theory through reviewing the entire work while focusing in its historical aspect. Critical reflection should be done by ascertaining how well a theory serves the profession’s progress. There are different ways in analysis and evaluating of a theory. Chinn and Kramer (1991) suggested the following criteria in evaluating a theoretical work which includes: Clarity, Simplicity, Generality, Empirical precision, and Derivable consequences What is Clarity? ▪ In evaluating this, semantics (study of meaning of the language, symbols and logic) and structure should be considered important. ▪ It involves identifying the major concepts& sub-concepts used in the theory. ▪ Words commonly used with multiple meanings within & across disciplines should be defined operationally or how it is used in the framework from which it is derived. ▪ Diagrams should also be clear and consistent all throughout. ▪ It should also follow a logical sequence which is understandable. ▪ Assumptions should be consistent with the defined goals of the theory. ▪ Questions to be asked: ✓ Is the theory clearly stated? ✓ How clear is the theory? ✓ Is it easily understood? What is Simplicity? A theory must be adequately comprehensive at a level of abstraction to offer direction. However, it must have as few concepts as possible having simple relations to assist clarity. The most useful theories are those that offergreatest sense of understanding. Questions to be asked: ✓ How simple is the theory? What is Generality? It is important to examine the scope of concepts and goals within the theory for this analysis criterion. As a rule of thumb, “the more limited the concept and goals is, the less general the theory becomes”. Consequently, the broader the scope of the theory, the greater its significance. Questions to be asked: ✓ How general is the theory? ✓ How broad is the scope of the theory? What is Empirical Precision? The degree in which the defined concepts are observable in actual setting. Empirical adequacy can be measured by the evidences that support the theory. According to Walker & Avant, a theory must generate a hypothesis and must add to the body of knowledge. Questions to be asked: ✓ Is theory accessible? ✓ How accessible is the theory? What is Derivable Consequences? A nursing theory should lead itself to research testing which would result to additional knowledge that would guide practice. Furthermore, nursing theory should give direction to research and practice, create new ideas and seek to distinguish the focus of nursing to other professions. Questions to be asked: ✓ How important is the theory? ✓ Does the theory have a significant contribution to nursing knowledge? LESSON 5. SIGNIFICANCE OF THEORY TO NURSING AS A PROFESSION What is a Profession? 1. Profession is a calling that requires special knowledge and skilled preparation. 2. It is generally distinguished from other kinds of occupation by: - Its requirement of prolonged specialized training acquiring a body of knowledge pertinent to the role to be performed. - An orientation of the individual toward service, either to community or organization. What are the Criteria for a Profession? 1. A profession applies its body of knowledge in practical services that are vital to human welfare, and especially suited to the tradition of seasoned practitioners shaping the skills of newcomers to the role. 2. It constantly enlarges the body of knowledge it uses and subsequently imposes on its members a lifelong obligation to remain current in order to ―DO NO HARM‖. 3. It functions autonomously (with authority) in formulation of professional policy and in monitoring its practice and practitioners. 4. It utilizes in its practice a well-defines and well - organized body of knowledge that is intellectual in nature and describes its phenomenon and practitioners. 5. A profession has a clear standard of educational preparation for entry into practice. 6. A profession is distinguished by the presence of specific culture, norms and other values that are common among its members. What are the Characteristics of a Profession? - A defined body of knowledge, - Power & authority over training and education, - Registration, - Altruistic service, - A code of ethics, - Lengthy socialization, and - Autonomy. How Theory is Significant to Nursing Profession? 1. Theory is significant mainly because it helps us to settle on what we know and what we need to know in the future. 2. It helps to differentiate what should form the basis of practice by clearly describing what nursing does and nursing is all about. 3. Ideally, nursing theory should provide the principles that support nursing practice. 4. Nursing theory helps the nurse to: ✓ Organize, examine, and analyze patient’s data, ✓ Make decisions about effective and efficient nursing interventions, ✓ Make S.M.A.R.T (Specific, Measurable, Attainable, Realistic, and Time- bounded) plan of care, and ✓ Predict and evaluate outcomes of care. What is a Professional Nurse? - Professional Nurse is one who has acquired the art and science of nursing through her basic education, who interprets her role in nursing in terms of the social ends for which it exists, the health and welfare of society and who continues to add to her knowledge, skills and attitudes through continuing education and scientific inquiry or the use of the results of such inquiry. Characteristics of a Professional Person Concerned with quality, Self-directed, responsible and accountable his actions, Able to make independent and sound judgement including high moral judgement, Dedicated to the improvement of human life, and Committed to the spirit of inquiry. Qualifications and Abilities of a Professional Nurse Faith in the fundamental values, Sense of responsibility, Faith in the reality of spiritual & aesthetic values and awareness of the value & the pleasure of self-development through the pursuit of some aesthetic interest. Have the basic knowledge, skills & attitudes necessary to address present-day social problems. Has skill in using written and spoken language. Appreciate & understand the importance of good health. Has emotional balance. Likes hard work & possesses a capacity for it. Appreciates high standards of workmanship. Accepts & tries to understand people of all sorts, regardless of race, religion and color. Knows nursing so thoroughly that every client will receive excellent care. REFERENCES 1. Alligood, M. R. (2018). Nursing Theorists and Their Work, 9th Edition. Elsevier (Singapore) Pte. Ltd. Incorporated, 3 Killiney Road, Winsland House I, 239519 Singapore. 2. Berman, A., Snyder, S., Frandsen, G. (2016). Kozier and Erb’s Fundamentals of Nursing: Concepts, Process and Practice, 10th Edition. Pearson Education Incorporated, 221 River Street, Hoboken, New Jersey, 07030. 3. Octaviano, E. F., Balita, C. E. (2020). Theoretical Foundations of Nursing: The Philippine Perspective: National Nursing Core Competency Standards Aligned Outcomes-Based Approach, 2020 Edition. Ultimate Learning Series, 2nd Floor Carmen Building, Sampaloc, Metro Manila, Philippines. 4. Octaviano, E. F., Balita, C. E. (2008). Theoretical Foundations of Nursing: The Philippine Perspective, 2008 Edition. Ultimate Learning Series, 2nd Floor Carmen Building, Sampaloc, Metro Manila, Philippines. 5. Smith, M. C., Parker, M. E. (2015). Nursing Theories and Nursing Practice, 4th Edition. F.A. Davies Company, 1915 Arch Street Philadelphia, PA 19103 6. Udan, J. Q. (2011). Theoretical Foundations of Nursing, 1st Edition. Educational Publishing House, 526-528 United Nations Avenue, Ermita, Manila, Philippines. 7. Udan, J. Q. (2009). Mastering Fundamentals of Nursing Concepts and Clinical Application, 3rd Edition. Educational Publishing House, 526-528 United Nations Avenue, Ermita, Manila, Philippines. 8. Udan, J. (2020), Theoretical Foundations of Nursing, 2nd Ed. MODULE TWO HISTORY OF THE NURSING PROFESSION LEARNING OBJECTIVES: After going through this module, the students are expected to be able to: 1. Trace and summarize the history and evolution of the nursing profession. 2. Develops oral communication skills in stating and describing the different nursing eras. 3. Explain and summarize the history and prominent pioneering leaders of the nursing profession in the Philippines. 4. Discuss the contributions of the Nursing Leaders of the 20thCentury. 5. Trace and discuss the history of the ULS COMPHM. 6. Explain and describe the history, principles, and impact of Environmental Theory by Florence Nightingale to the nursing profession. LESSON 6. EVOLUTION OF THE NURSING PROFESSION History and Development of Nursing Profession A. Period of Intuitive Nursing - Nursing started in the INTUITIVE PERIOD way of caring for the sick member of the family. - Nursing was untaught and instinctive. - It was performed out of compassion for others, out of the wish to help others. - Nursing was a function that belonged to women, and they are the ones who stayed at home & took care of the children, the sick and the aged. - In ancient civilizations, providing care revolves around the use of magical thinking, superstitious beliefs and religious beliefs. - During this time, beliefs about the cause of disease were embedded in superstition and magic and thus treatment often involved magical cures. - They believed that the medicine man called ―SHAMAN or witch doctor had the power to heal by using white magic. - TREPHINING was also being practice as last resort to drive the evil spirits from the body of the afflicted. - In Egypt, people worshipped the Goddess Isis & her son, Horus as they believed to manipulate the dreams of the sick. - Egyptians introduced the art of embalming, which enhanced their knowledge of human anatomy. - Ancient Egyptians developed community planning and strict hygienic rules to control communicable diseases. The first recorded nurses were seen. - In the Babylonian civilization, there were references to tasks and practices traditionally provided by nurses. Nurses are mentioned occasionally in Old Testament as women who provide care for infant, for the sick and dying and as midwives who assisted during pregnancy and delivery. - In ancient ROME, care of the sick and injuries was advanced in mythology and reality. Although medicine as a science was developed there was little evidence of establishing a foundation for nursing. - The ancient GREEKS, Gods were believed to have special healing power. In 460 BC, Hippocrates born and credited with being the Father of medicine. He proved that illness had natural cause and not to be of a religious or magical cause. - Hippocrates first proposed such concepts as physical assessment, medical Ethics, patient – centered care and observation and reporting. He  emphasized the importance of patient care that contributed a lot for the groundwork of nursing. B. Middle – Ages or Apprentice Period of Nursing - This period extends from the founding of religious order nursing orders in the crusades in 11th century and ended in 1836. - Pastor Fliedner and his wife established the Kaiserwert Institute for the training of Deaconesses (a training school for nurses) in Germany. - It is the period of ―On the Job Training‖. Nursing care was performed without any formal education and by people who were directed by more experience nurses. - During this time, monasticism and other religious groups offered the only opportunities for men and women to pursue careers in nursing. - It was the Christian value of "love your neighbour as the self" that had a significant impact on the development of western nursing. - The principle of caring was established with Christ’s parable (short story) of Good Samaritan providing care for a tired and injured stranger. - Care was done by crusaders, prisoners and religious nursing orders. - Men in religious orders were also providing nursing care in the middle ages (St. Benedictine Nursing Order, Knights of Hospitalers, Teutonic Knights, and Knightsof St. Lazarus). - Important nursing personages during the Period of Apprentice Nursing: 1. St. Clare, founder of the second order of St. Assisi; took vows of poverty, obedience service and chastity, gave nursing care to the sick and the afflicted. 2. St. Elizabeth of Hungary, known as the patroness of nurses. She used her wealth to make the lives of the poor happy and useful. She built hospitals for the sick and needy. 3. St. Catherine of Sienna, the first lady with a Lamp. At the age of seven, she pledged her life to service and was referred as little saint. She was a hospital nurse, prophetess, researcher and a reformer of society and the church. C. Dark Period of Nursing - Extends from 17th to 19th century. - In this period Monasteries were closed and the work of women in religious order was nearly ended. - Hundreds of hospitals closed and there was no provision for the sick and no one to care for the sick. - The few women who cared for the sick during this time were prisoners or prostitutes who had little or no training in nursing, and nursing went down to its lowest level.  - Because of this, nursing was considered as the most minimal of all tasks, and had little acceptance and prestige. D. Educated Nursing or Nightingale’s Era - From 19th – 20th century. - The development of Nursing during this period was strongly influenced by: Trends resulting from wars (Crimean War & Civil Wars), Arousal of social consciousness, and Increase educational opportunities offered to women. - Began from June 15, 1860 when Florence Nightingale School of Nursing opened at St. Thomas Hospital in London (St. Thomas Hospital School of Nursing). - Florence Nightingale, recognized as the ―Mother of theModern Nursing‖ and was known as Lady with a Lamp. - She advocated for care of those afflicted with diseases caused by lack of hygienic practices. - Three images influenced the development of modern nursing: Ursuline Sisters of Quebec organized the first training for nurses. Theodore Flender revived the deaconess movement and opened a School in Kaiserwerth, Germany, which was training nurses. Elizabeth Fry established the institute of Nursing Sisters. - Latter half of 18thcentury, Florence Nightingale (Founder of Modern Nursing) changed the form and direction of nursing and succeeded in establishing it as a respected profession. - In spite of opposition from her family and restrictive societal code for affluent young English woman to be a nurse, Nightingale believed she was "called” by God to help others and to improve the wellbeing of mankind. E. Period of Contemporary Nursing - This covers the period after World War II to the present. - Scientific, technological developments and social changes mark this period. - The role of nurses become defined depending on the different fields of expertise as time progressed. - Establishment of World Health Organization by United Nations. - Licensure of nurses started. - Specialization of hospital & diagnosis. - Training of nurses in diploma, baccalaureate and advance degree nursing programs. - Nursing involvement in community health is greatly intensified. - Development of expanded role of nurses (e.g. nurse anesthesist and etc.). - During the early 20thcentury, philosophers & scientists argued the use of EMPIRICISM and RATIONALISM. - The philosophers point of view is that knowledge should be based on the understanding of existing theories whereas scientists believe that knowledge should not only focus on theoretical existence but also on understanding what there is still to be observed.  - RATIONALISM makes use of reason gained thru expert study, tested theory and established facts to evidently provide something. - EMPIRICISM makes use of objective and tangible data or those that are perceived by senses (smell, sight, taste & feeling) to observed and collect data. - The development of knowledge in the 20th century was mainly affected by the different nursing leaders and theorist of the early 20th century. LESSON 7. NURSING PROFESSION IN THE PHILIPPINES Early Beliefs and Practices - Diseases are caused by another person (an enemy or witch) or evil spirits. - People believed that evil spirits could be driven away by person with powers; special gods of healing, priest-physician (word doctors) and herbolarios (the one using leaves or roots to heal). - Early Filipinos subscribed to superstitious beliefs and practices in relation to health and practices. - Herbmen were called “HERBICHEROS”, meaning one who practiced witchcraft. - Persons suffering from diseases without any identified cause were believed to be bewitched by the “MANGKUKULAM” or “MANGAGAWAY”. - Difficult childbirth and some diseases (called “PAMAO”) were attributed to “NONOS”. Healthcare during the Spanish Regime Religious orders exerted their efforts to care for the sick by building hospitals in the different parts of the Philippines. 1. Hospital Real de Manila (1577)–was established mainly to care for the Spanish King’s soldiers, but also admitted Spanish civilians. 2. San LazaroHospital (1578)–built exclusively for patients with leprosy. 3. Hospital de Indio (1586) – service was in general supported by alms and contributions from charitable persons. 4. Hospital de Aguas Santas (1590) – near a medicinal spring and was established in Laguna. 5. San Juan de Dios Hospital (1596) – support was derived from alms and rents, rendered general health service to the public. Nursing during the Philippine Revolution The prominent persons involved in nursing works were: 1. Josephine Bracken – wife of Dr. Jose Rizal and installed a field hospital in an estate house in Tajeros providing nursing care to the wounded night and day. 2. Rosa Sevilla de Alvero - converted their house into quarters for the Filipino soldiers during the Philippine – American war that broke out in 1899. 3. Dona Hilaria de Aguinaldo – wife of Emilio Aguinaldo who organized the Filipino Red Cross under the inspiration of Apolinario Mabini. 4. Dona Maria Agoncillo de Aguinaldo – second wife of Emilio Aguinaldo who provided nursing care to Filipino soldiers during the revolution, and the president of the Filipino Red Cross branch in Batangas. 5. Melchora Aquino (Tandang Sora) – Nursed the wounded Filipino soldiers and gave them shelter and food. 6. Capitan Salome – a revolutionary leader in Nueva Ecija who provided nursing care to the wounded when not in combat. 7. Trinidad Tecson – known as Ina ng ―Biak na Bato‖ who stayed in the hospital at Biac na Bato to care for the wounded soldiers. Earliest Hospitals and Schools of Nursing 1. Iloilo Mission Hospital School of Nursing in 1906 2. St. Paul’s Hospital School of Nursing in 1907 3. Philippine General Hospital School of Nursing in 1907 4. St. Luke’s Hospital School of Nursing in 1907 5. Mary Johnston Hospital & School of Nursing in 1907 6. Philippine Christian Mission Institute Schools of Nursing 7. San Juan de Dios Hospital School of Nursing in 1913 8. Emmanuel Hospital School of Nursing in 1913 9. Southern Island Hospital School of Nursing in 1918 First Colleges of Nursing in the Philippines 1. University of Santo Tomas College of Nursing in 1946 2. Manila Central University College of Nursing in 1947 3. University of the Philippines College of Nursing in 1948 Prominent Nursing Leaders in the Philippines 1. Cesaria Tan –first Filipino nurse who had Master’sDegree in Nursing in United States. 2. Socorro Sirilan –reformed social service for indigenous patients at San Lazaro Hospital. 3. Magdalena Valenzuela –first Filipino Industrial Nurse. 1. Annie Sand – founded the National League of Philippine Government Nurses. 4. Cornel Elvegia Mendoza – first female Military Nurse. 5. Loreto Tupaz – known as the Dean of Philippine Nursing Education and the Florence Nightingale of Iloilo. 6. Socorro Diaz – first editor of ―The Message‖. 7. Conchita Ruiz – first editor of ―The Filipino Nurses‖. 8. Dr. Julieta Sotejo– considered as the ―Florence Nightingale of the Philippines. a. Founder & first Dean of UP-College of Nursing (UPCN). b. Professor Emeritus of UPCN. c. The author of Code of Ethics for Nurses (PRC BON Res #633, 1982). d. Chairman, Committee on Legal Aspect of Nursing (created the first Philippine Nursing Law or RA No. 877 s. 1953). 9. Anastacia Giron Tupaz - first Filipino Nurse with a title of Nursing Superintendent Chief Nurse at PGH. e. Founder of Filipino Nurses Association (FNA) now Philippine Nurses Association (PNA). 10. Rosario Montemayor Delgado - first President of the Filipino Nurses Association (FNA). Nursing Organizations in the Philippines 1. Philippine Nurses Association (PNA) – This is the national organization of Filipino nurses. 2. National League of Nurses – The association of nurses employed in the Department of Health (DOH). 3. Catholic Nurses Guild of the Philippines. 4. Association of Deans of Philippine Colleges of Nursing Incorporated (ADPCN, Inc.). 5. Others: GNAP, ORNAP, MCNAP, IRNOP and etc. LESSON 8. HISTORY OF UNIVERSITY OF LA SALETTE, INC – COLLEGE OF NURSING, PUBLIC HEALTH AND MIDWIFERY Brief History of the College of Nursing, Public Health and Midwifery Philosophy Vision Mission Objectives Administrative Heads Faculty Members with Terminal Degrees in Nursing (PhDs or DScNs) LESSON 9. NIGHTINGALE’S ENVIRONMENTAL THEORY Background of the Theorist - Born on May 12, 1820 in Florence Italy. - A beautiful Victorian Lady, whose parents were wealthy and well - travelled. - She took her nursing program from Fleidener School of Nursing in Kaiserswerth, Germany (July 6, 1851 – October 7, 1851). - Then went back to England and used knowledge from Kaiserswerth to prove her cause as a reformer for the well- being of the citizens. - During Crimean War, battle between English and Turkish, she was requested by her friend, Sir Sidney Herbert (secretary at Great Britain) to help for the wounded soldiers. - With her lamp, she traversed the night to look for the wounded soldiers and heal them with her consoling hands. - Called as ―Lady with the Lamp‖ and the Founder and Mother of Modern Nursing. - Nightingale was truly a skilled nurse, and was an expert statistician who used statistics to present her case from hospital reform. - She was viewed as pioneer in the graphic display of statistics and was selected a fellow of the royal Statistical Society in 1858, and was bestowed with honorary membership in the American Statistical Association in 1874. - She was also an excellent writer, and her famous writing, Notes on Nursing was frequent cited of all time. - Her birthday marks the International Nurses Day celebration each year. Metaparadigm of Nursing 1. Person a. Viewed the essence of a person as a patient and envisioned as comprising physical, intellectual, emotional, social & spiritual components. b. The one who is receiving the care; dynamic & complex being. 2. Health a. According to her, ―Healthy is not only to be well, but to be able to use well every power we have‖. b. She believed in the prevention and health promotion in addition to nursing patients from illness to health. 3. Environment a. Anything that can be manipulated to place a patient in the best possible condition for nature to act. b. Those elements external to and which affect the health of the sick and healthy person. 4. Nursing a. Considered nursing as very essential for everybody’s well-being. b. She believed nursing to be a spiritual calling and nurses were to assist nature to repair the patient. Environmental Model in Nursing Nightingale viewed the manipulation of the physical environment as a major component of nursing care. She believed that when one or more aspects of the environment are out of balance, the client must use increased energy to counter the environmental stress. She believed that when one or more aspects of the environment are out balance, the client must use increased energy to counter the environmental stress, and these stresses that drains patients’ energy needed for healing She identified the 13canons in her theory as major areas of the physical, social, and psychological environment that the nurse could control: Ventilation & warmth Light Cleanliness Health and houses Noise Bed and bedding Personal cleanliness Variety Chattering hopes and advices Taking food What food? Petty management Observation of the sick Ventilation and warmth - Keeping the air as pure as the external air, without chilling him. - Believed that “noxious air” or “effluvia” or foul odors affects the client’s health. - Emphasized the importance of room temperature (not too warm or too cold). Light - Need for both fresh air and light – sunlight is beneficial to patients. Cleanliness - Check room for dust, dampness and dirt. - Keep room free from dust, dirt and dampness. Health and houses - Check surrounding environment for fresh air, pure water, drainage, cleanliness and light. - Remove garbage, stagnant water, and ensure clean water and fresh air. Noise - Check noise level in the room and surroundings. - Attempt to keep noise level in minimum. Bed and beddings - Check bed and bedding for dampness, wrinkles and soiling. - Keep the bed dry, wrinkle-free, and lowest height to ensure comfort. Personal cleanliness - Attempt to keep the patient dry and clean at all times. - Frequent assessment of the patient’s skin is essential to maintain good skin integrity. Variety - Need for changes in color and form, including bringing the patient brightly colored flowers and plants. - Advocated rotating 10-12 paintings and engraving each day, week, or month to provide variety for the patient. - Advocated reading, needlework, writing and cleaning as activities to relieve the sick in boredom. Chattering and hopes - Avoid talking without reason or giving advices that is without fact. - Continue to talk to the client as a person, and continue to stimulate patient’s mind. - Avoid personal talk. Taking food - Continue with the assessment of the diet to include type of food and drink the client likes or dislikes. - Attempt to ensure that the client always has some food or drink available that he or she enjoys. What food? - Addressed the importance of variety in the food served to patients. Petty management - Ensures continuity of care. - Documents the plan of care and evaluate the outcomes to ensure continuity. - House and hospital needed to be well-managed that is organized, clean, and with appropriate supplies. REFERENCES 1. Alligood, M. R. (2018). Nursing Theorists and Their Work, 9th Edition. Elsevier (Singapore) Pte. Ltd. Incorporated, 3 Killiney Road, winsland House I, 239519 Singapore. 2. Berman, A., Snyder, S., Frandsen, G. (2016). Kozier and Erb’s Fundamentals of Nursing: Concepts, Process and Practice, 10th Edition. Pearson Education Incorporated, 221 River Street, Hoboken, New Jersey, 07030. 3. Mindanao State University (2020). Special Order No. 410 on the Designation of Faculty Members to Administrative Position/s at the College of Health Sciences. 2nd Street, MSU – Campus, Marawi City, Philippines. 4. Octaviano, E. F., Balita, C. E. (2020). Theoretical Foundations of Nursing: The Philippine Perspective: National Nursing Core Competency Standards Aligned Outcomes-Based Approach, 2020 Edition. Ultimate Learning Series, 2nd Floor Carmen Building, Sampaloc, Metro Manila, Philippines. 5. Octaviano, E. F., Balita, C. E. (2008). Theoretical Foundations of Nursing: The Philippine Perspective, 2008 Edition. Ultimate Learning Series, 2nd Floor Carmen Building, Sampaloc, Metro Manila, Philippines. 6. Smith, M. C., Parker, M. E. (2015). Nursing Theories and Nursing Practice, 4th Edition. F.A. Davies Company, 1915 Arch Street Philadelphia, PA 19103 7. Udan, J. Q. (2011). Theoretical Foundations of Nursing, 1st Edition. Educational Publishing House, 526-528 United Nations Avenue, Ermita, Manila, Philippines. 8. Udan, J. Q. (2009). Mastering Fundamentals of Nursing Concepts and Clinical Application, 3rd Edition. Educational Publishing House, 526-528 United Nations Avenue, Ermita, Manila, Philippines. 9. Udan, J. (2020), Theoretical Foundations of Nursing, 2nd Ed. MODULE THREE THEORIES RELEVANT TO NURSING PRACTICE Learning Objectives After going through this module, the students are expected to be able to: 1. Explain and describe the history and roots of the different non-nursing theorists and their theory that is relevant to nursing profession. 2. Explain, describe, and apply the principles and concepts of the non-nursing theories to nursing profession. 3. Describe the impact and application of the selected non-nursing theories in the nursing profession particularly in practice. LESSON 10. MASLOW’S HUMAN NEEDS THEORY BY ABRAHAM MASLOW Background of the theorist: An American psychologist who developed a hierarchy of needs to explain human motivation. His theory suggested that people have a number of basic needs that must be met before people move up the hierarchy to pursue more social, emotional, and self- actualizing needs. Abraham Maslow was born on April 1, 1908, in Brooklyn, New York, where he grew up the first of seven children born to his Jewish parents who emigrated from Russia. Maslow later described his early childhood as unhappy and lonely. He spent much of his time in the library immersed in books. Maslow studied law at City College of New York (CCNY). After developing an interest in psychology, he switched to the University of Wisconsin and found a mentor in psychologist Harry Harlow who served as his doctoral advisor. Maslow earned all three of his degrees in psychology (a bachelor's, master's, and doctorate) from the University of Wisconsin. Abraham Maslow began teaching at Brooklyn College in 1937 and continued to work as a member of the school's faculty until 1951. During this time, he was heavily influenced by Gestalt psychologist Max Wertheimer and anthropologist Ruth Benedict. Maslow's Hierarchy of Needs Maslow first introduced his concept of a hierarchy of needs in his 1943 paper "A Theory of Human Motivation" and his subsequent book Motivation and Personality. This hierarchy suggests that people are motivated to fulfill basic needs before moving on to other, more advanced needs. While some of the existing schools of thought at the time (such as psychoanalysis and behaviorism) tended to focus on problematic behaviors, Maslow was much more interested in learning about what makes people happy and the things that they do to achieve that aim. As a humanist, Maslow believed that people have an inborn desire to be self- actualized, that is, to be all they can be. In order to achieve these ultimate goals,  however, a number of more basic needs must be met such as the need for food, safety, love, and self-esteem.1 There are five different levels of Maslow’s hierarchy of needs. Let's take a closer look at Maslow’s needs starting at the lowest level, known as physiological needs. Overview of Needs Maslow's hierarchy is most often displayed as a pyramid. The lowest levels of the pyramid are made up of the most basic needs, while the most complex needs are at the top of the pyramid. Needs at the bottom of the pyramid are basic physical requirements including the need for food, water, sleep, and warmth. Once these lower-level needs have been met, people can move on to the next level of needs, which are for safety and security. Further up the pyramid, the need for personal esteem and feelings of accomplishment take priority. Like Carl Rogers, Maslow emphasized the importance of self-actualization, which is a process of growing and developing as a person in order to achieve individual potential. Deficiency Needs vs. Growth Needs Maslow believed that these needs are similar to instincts and play a major role in motivating behaviour. Physiological, security, social, and esteem needs are deficiency needs, which arise due to deprivation. Satisfying these lower-level needs is important in order to avoid unpleasant feelings or consequences. Maslow termed the highest level of the pyramid as growth needs. These needs don't stem from a lack of something, but rather from a desire to grow as a person. While the theory is generally portrayed as a fairly rigid hierarchy, Maslow noted that the order in which these needs are fulfilled does not always follow this standard progression. For example, he noted that for some individuals, the need for self-esteem is more important than the need for love. For others, the need for creative fulfilment may supersede even the most basic needs. Physiological Needs The basic physiological needs are probably fairly apparent—these include the things that are vital to our survival. Some examples of physiological needs include: food, water, breathing, and homeostasis. In addition to the basic requirements of nutrition, air and temperature regulation, the physiological needs also include such things as shelter and clothing. Maslow also included sexual reproduction in this level of the hierarchy of needs since it is essential to the survival and propagation of the species. Security and Safety Needs As we move up to the second level of Maslow’s hierarchy of needs, the requirements start to become a bit more complex. At this level, the needs for security and safety become primary. People want control and order in their lives. So, this need for safety and security contributes largely to behaviors at this level. Some of the basic security and safety needs include: financial security, health and wellness, safety against accidents and injury. Finding a job, obtaining health insurance and health care, contributing money to a savings account, and moving into a safer neighbourhood are all examples of actions motivated by the security and safety needs. Together, the safety and physiological levels of the hierarchy make up what is often referred to as the basic needs. Social Needs The social needs in Maslow’s hierarchy include such things as love, acceptance, and belonging. At this level, the need for emotional relationships drives human behavior. Some of the things that satisfy this need include: friendships, romantic attachments, family, social groups, community groups, and churches &religious organizations. In order to avoid problems such as loneliness, depression, and anxiety, it is important for people to feel loved and accepted by other people. Personal relationships with friends, family, and lovers play an important role, as does involvement in other groups that might include religious groups, sports teams, book clubs, and other group activities. Esteem Needs At the fourth level in Maslow’s hierarchy is the need for appreciation and respect. When the needs at the bottom three levels have been satisfied, the esteem needs begin to play a more prominent role in motivating behavior. At this point, it becomes increasingly important to gain the respect and appreciation of others. People have a need to accomplish things and then have their efforts recognized. In addition to the need for feelings of accomplishment and prestige, esteem needs include such things as self-esteem and personal worth. People need to sense that they are valued and by others and feel that they are making a contribution to the world. Participation in professional activities, academic accomplishments, athletic or team participation, and personal hobbies can all play a role in fulfilling the esteem needs. People who are able to satisfy the esteem needs by achieving good self- esteem and the recognition of others tend to feel confident in their abilities. Those who lack self-esteem and the respect of others can develop feelings of inferiority. Together, the esteem and social levels make up what is known as the psychological needs of the hierarchy. Self-Actualization Needs At the very peak of Maslow’s hierarchy are the self-actualization needs. "What a man can be, he must be," Maslow explained, referring to the need people have to achieve their full potential as human beings. According to Maslow’s definition of self-actualization, "It may be loosely described as the full use and exploitation of talents, capabilities, potentialities, etc. Such people seem to be fulfilling themselves and to be doing the best that they are capable of doing. They are people who have developed or are developing to the full stature of which they capable." Self-actualizing people are self-aware, concerned with personal growth, less concerned with the opinions of others, and interested in fulfilling their potential. LESSON 11. PSYCHOSOCIAL DEVELOPMENT BY ERIK ERICKSON Background of the theorist: Born on June 15, 1902, in Frankfurt, Germany. His young Jewish mother, Karla Abrahamsen, raised Erik by herself for a time before marrying a physician, Dr. Theodore Homberger. The fact that Homberger was not his biological father was concealed from Erikson for many years. When he finally did learn the truth, Erikson was left with a feeling of confusion about who he really was. It's interesting to note that Erikson never received a formal degree in medicine or psychology. While studying at the Das Humanistische Gymnasium, he was primarily interested in subjects such as history, Latin, and art. His stepfather, a doctor, wanted him to go to medical school, but Erikson instead did a brief stint in art school. He soon dropped out and spent time wandering Europe with friends and contemplating his identity. Erikson met a Canadian dance instructor named Joan Serson who was also teaching at the school where he worked. The couple married in 1930 and went on to have three children. His son, Kai T. Erikson, is a noted American sociologist. Erikson moved to the United States in 1933 and, despite having no formal degree, was offered a teaching position at Harvard Medical School. He also changed his name from Erik Homberger to Erik H. Erikson, perhaps as a way to forge his own identity. In addition to his position at Harvard, he also had a private practice in child psychoanalysis. Erik Erikson's Stages of Psychosocial Development Erik Erikson was an ego psychologist who developed one of the most popular and influential theories of development. While his theory was impacted by psychoanalyst Sigmund Freud's work, Erikson's theory centered on psychosocial development rather than psychosexual development. The stages that make up his theory are as follows: ✓ Stage1:Trust vs. Mistrust ✓ Stage2:Autonomy vs. Shame and Doubt ✓ Stage3:Initiative vs. Guilt ✓ Stage4:Industry vs. Inferiority ✓ Stage5:Identity vs. Confusion  ✓ Stage6:Intimacy vs. Isolation ✓ Stage7:Generativity vs. Stagnation ✓ Stage8:Integrity vs. Despair Overview So what exactly did Erikson's theory of psychosocial development entail? Much like Sigmund Freud, Erikson believed that personality developed in a series of stages. Unlike Freud’s theory of psychosexual stages, however, Erikson’s theory described the impact of social experience across the whole lifespan. Erikson was interested in how social interaction and relationships played a role in the development and growth of human beings. Conflict during Each Stage Each stage in Erikson's theory builds on the preceding stages and paves the way for following periods of development. In each stage, Erikson believed people experience a conflict that serves as a turning point in development. In Erikson's view, these conflicts are centered on either developing a psychological quality or failing to develop that quality. During these times, the potential for personal growth is high but so is the potential for failure.  If people successfully deal with the conflict, they emerge from the stage with psychological strengths that will serve them well for the rest of their lives.3 If they fail to deal effectively with these conflicts, they may not develop the essential skills needed for a strong sense of self. Mastery Leads to Ego Strength Erikson also believed that a sense of competence motivates behaviors and actions. Each stage in Erikson's theory is concerned with becoming competent in an area of life. If the stage is handled well, the person will feel a sense of mastery, which is sometimes referred to as ego strength or ego quality. If the stage is managed poorly, the person will emerge with a sense of inadequacy in that aspect of development. PSYCHOSOCIAL STAGES Stage 1: Trust vs. Mistrust The first stage of Erikson's theory of psychosocial development occurs between birth and 1 year of age and is the most fundamental stage in life. Because an infant is utterly dependent, developing trust is based on the dependability and quality of the child's caregivers. At this point in development, the child is utterly dependent upon adult caregivers for everything they need to survive including food, love, warmth, safety, and nurturing. If a caregiver fails to provide adequate care and love, the child will come to feel that they cannot trust or depend upon the adults in their life. Outcomes: If a child successfully develops trust, the child will feel safe and secure in the world. Caregivers who are inconsistent, emotionally unavailable, or rejecting contribute to feelings of mistrust in the children under their care. Failure to develop trust will result in fear and a belief that the world is inconsistent and unpredictable. During the first stage of psychosocial development, children develop a sense of trust when caregivers provide reliability, care, and affection. A lack of this will lead to mistrust. No child is going to develop a sense of 100% trust or 100% doubt. Erikson believed that successful development was all about striking a balance between the two opposing sides. When this happens, children acquire hope, which Erikson described as openness to experience tempered by some wariness that danger may be present. Subsequent work by researchers including John Bowlby and Mary Ainsworth demonstrated the importance of trust in forming healthy attachments during childhood and adulthood. Stage 2: Autonomy vs. Shame and Doubt The second stage of Erikson's theory of psychosocial development takes place during early childhood and is focused on children developing a greater sense of personal control. The Role of Independence: At this point in development, children are just starting to gain a little independence. They are starting to perform basic actions on  their own and making simple decisions about what they prefer. By allowing kids to make choices and gain control, parents and caregivers can help children develop a sense of autonomy. Potty Training: The essential theme of this stage is that children need to develop a sense of personal control over physical skills and a sense of independence. Potty training plays an important role in helping children develop this sense of autonomy. Like Freud, Erikson believed that toilet training was a vital part of this process. However, Erikson's reasoning was quite different than that of Freud's. Erikson believed that learning to control one's bodily functions leads to a feeling of control and a sense of independence. Other important events include gaining more control over food choices, toy preferences, and clothing selection. Outcomes: Children who struggle and who are shamed for their accidents may be left without a sense of personal control. Success during this stage of psychosocial development leads to feelings of autonomy; failure results in feelings of shame and doubt. Children who successfully complete this stage feel secure and confident, while those who do not are left with a sense of inadequacy and self-doubt. Erikson believed that achieving a balance between autonomy and shame and doubt would lead to will, which is the belief that children can act with intention, within reason and limits. Stage 3: Initiative vs. Guilt The third stage of psychosocial development takes place during the preschool years. At this point in psychosocial development, children begin to assert their power and control over the world through directing play and other social interactions. Children who are successful at this stage feel capable and able to lead others. Those who fail to acquire these skills are left with a sense of guilt, self-doubt, and lack of initiative. Outcomes: The major theme of the third stage of psychosocial development is that children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt. When an ideal balance of individual initiative and a willingness to work with others is achieved, the ego quality known aspurposeemerges. Stage 4: Industry vs. Inferiority The fourth psychosocial stage takes place during the early school years from approximately ages 5 to 11. Through social interactions, children begin to develop a sense of pride in their accomplishments and abilities. Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority. Outcomes: Children who are encouraged and commended by parents and teachers develop a feeling of competence and belief in their skills. Those who receive little or no encouragement from parents, teachers, or peers will doubt their abilities to be successful.  Successfully finding a balance at this stage of psychosocial development leads to the strength known as competence, in which children develop a belief in their abilities to handle the tasks set before them. Stage 5: Identity vs. Confusion The fifth psychosocial stage takes place during the often turbulent teenage years. This stage plays an essential role in developing a sense of personal identity which will continue to influence behavior and development for the rest of a person's life. Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self. During adolescence, children explore their independence and develop a sense of self. Those who receive proper encouragement and reinforcement through personal exploration will emerge from this stage with a strong sense of self and feelings of independence and control. Those who remain unsure of their beliefs and desires will feel insecure and confused about themselves and the future. What Is Identity? When psychologists talk about identity, they are referring to all of the beliefs, ideals, and values that help shape and guide a person's behavior. Completing this stage successfully leads to fidelity, which Erikson described as an ability to live by society's standards and expectations. While Erikson believed that each stage of psychosocial development was important, he placed a particular emphasis on the development of ego identity. Ego identity is the conscious sense of self that we develop through social interaction and becomes a central focus during the identity versus confusion stage of psychosocial development. According to Erikson, our ego identity constantly changes due to new experiences and information we acquire in our daily interactions with others. As we have new experiences, we also take on challenges that can help or hinder the development of identity. Why Identity Is Important? Our personal identity gives each of us an integrated and cohesive sense of self that endures through our lives. Our sense of personal identity is shaped by our experiences and interactions with others, and it is this identity that helps guide our actions, beliefs, and behaviors as we age. Stage 6: Intimacy vs. Isolation Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation. This stage covers the period of early adulthood when people are exploring personal relationships. Erikson believed it was vital that people develop close, committed relationships with other people. Those who are successful at this step will form relationships that are enduring and secure. Building on Earlier Stages: Remember that each step builds on skills learned in previous steps. Erikson believed that a strong sense of personal identity was important for developing intimate relationships. Studies have demonstrated that those with a poor sense of self tend to have less committed relationships and are more likely to struggler with emotional isolation, loneliness, and depression.  Successful resolution of this stage results in the virtue known as love. It is marked by the ability to form lasting, meaningful relationships with other people. Stage 7: Generativity vs. Stagnation Adults need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world. During adulthood, we continue to build our lives, focusing on our career and family. Those who are successful during this phase will feel that they are contributing to the world by being active in their home and community. Those who fail to attain this skill will feel unproductive and uninvolved in the world. Care is the virtue achieved when this stage is handled successfully. Being proud of your accomplishments, watching your children grow into adults, and developing a sense of unity with your life partner are important accomplishments of this stage. Stage 8: Integrity vs. Despair The final psychosocial stage occurs during old age and is focused on reflecting back on life. At this point in development, people look back on the events of their lives and determine if they are happy with the life that they lived or if they regret the things they did or didn't do. Erikson's theory differed from many others because it addressed development through out the entire lifespan, including old age. Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret ,bitterness, and despair. At this stage, people reflect back on the events of their lives and take stock. Those who look back on a life they feel was well-lived will feel satisfied and ready to face the end of their lives with a sense of peace. Those who look back and only feel regret will instead feel fearful that their lives will end without accomplishing the things they feel they should have. Outcomes: Those who are unsuccessful during this stage will feel that their life has been wasted and may experience many regrets. The person will be left with feelings of bitterness and despair. Those who feel proud of their accomplishments will feel a sense of integrity. Successfully completing this phase means looking back with few regrets and a general feeling of satisfaction. These individuals will attain wisdom, even when confronting death. LESSON 12 KOHLBERG’S MORAL DEVELOPMENT BY LAWRENCE KOHLBERG Background of the theorist: American psychologist Born October 25, 1927, Bronxville, New York, U.S. Died January 17, 1987, Boston, Massachusetts), American psychologist and educator known for his theory of moral development. Kohlberg was the youngest of four children of Alfred Kohlberg, a successful silk merchant of Jewish ancestry, and Charlotte Albrecht Kohlberg, a Protestant and a skilled amateur chemist. When the couple divorced in 1932 after 11 years of marriage, each of the children was required by a court order to choose which parent he or she would live with. The two younger children chose their father and the older ones chose their mother. Kohlberg graduated from Phillips Academy in Andover, Massachusetts, in 1945. After serving in the U.S. merchant marine, he worked on a ship that had been hired by Haganah, the Zionist military organization, to smuggle Jewish war refugees into Palestine, past the British blockade. The ship was intercepted, however, and Kohlberg was imprisoned in a British internment camp in Cyprus. Returning to the U.S. in 1948, he enrolled at the University of Chicago, where he completed a B.A. in psychology in one year and a Ph.D. in psychology in 1958. He subsequently held teaching positions at various institutions before settling at Harvard University in 1968. Kohlberg's Theory of Moral Development Kohlberg classified their reasoning into the stages of his theory of moral development. Level 1: Pre conventional Morality The earliest stages of moral development, obedience and punishment, are especially common in young children, but adults are also capable of expressing this type of reasoning. At this stage, Kohlberg says, people see rules as fixed and absolute. Obeying the rules is important because it is a means to avoid punishment. At the individualism and exchange stage of moral development, children account for individual points of view and judge actions based on how they serve individual needs. In the Heinz dilemma, children argued that the best course of action was the choice that best served Heinz’s needs. Reciprocity is possible at this point in moral development, but only if it serves one's own interests. Level 2: Conventional Morality Often referred to as the "good boy-good girl" orientation, the stage of the interpersonal relationship of moral development is focused on living up to social expectations and roles. There is an emphasis on conformity, being "nice," and consideration of how choices influence relationships. This stage is focused on maintaining social order. At this stage of moral development, people begin to consider society as a whole when making judgments. The focus is on maintaining law and order by following the rules, doing one’s duty, and respecting authority. Level 3: Post conventional Morality The ideas of a social contract and individual rights cause people in the next stage to begin to account for the differing values, opinions, and beliefs of other people. Rules of law are important for maintaining a society, but members of the society should agree upon these standards. Kohlberg’s final level of moral reasoning is based on universal ethical principles and abstract reasoning. At this stage, people follow these internalized principles of justice, even if they conflict with laws and rules.