TFN Midterms Lecture PDF

NCM 100: TFN Hosanna Angeli D. Corpuz, MAN, RN Hildegard Peplau’s Theory of Interpersonal Relationship the first published nursing theorist since Florence Nightingale. Her achievements are valued by nurses worldwide and became known to many as the “Mother of Psychiatric Nursing” and the “Nurse of...

NCM 100: TFN Hosanna Angeli D. Corpuz, MAN, RN Hildegard Peplau’s Theory of Interpersonal Relationship the first published nursing theorist since Florence Nightingale. Her achievements are valued by nurses worldwide and became known to many as the “Mother of Psychiatric Nursing” and the “Nurse of the September 1, 1909 – March 17, 1999 Century.” Hildegard Peplau’s Theory of Interpersonal Relationship Interpersonal Relations Theory emphasized the nurse-client relationship as the foundation of nursing practice. It emphasized the give-and-take of nurse-client relationships. Peplau went on to form an interpersonal model emphasizing the need for a partnership between nurse and client as opposed to the client passively receiving treatment and the nurse passively acting out doctor’s orders. Hildegard Peplau’s Theory of Interpersonal Relationship For Peplau, Nursing is a “maturing force and an educative instrument” involving an interaction between two or more individuals with a common goal. This common goal provides the incentive for the therapeutic process in which the nurse and patient respect each other as individuals, both of them learning and growing due to the interaction. An individual learns when she or he selects stimuli in the environment and then reacts to these stimuli. Hildegard Peplau’s Theory of Interpersonal Relationship The four components of the theory are: person, which is a developing organism that tries to reduce anxiety caused by needs environment, which consists of existing forces outside of the person and put in the context of culture health, which is a word symbol that implies a forward movement of personality nursing, which is a significant therapeutic interpersonal process that functions cooperatively with another human process that makes health possible for individuals in communities. Therapeutic nurse-client relationship A professional and planned relationship between client and nurse focuses on the client’s needs, feelings, problems, and ideas. It involves interaction between two or more individuals with a common goal. The attainment of this goal, or any goal, is achieved through a series of steps following a sequential pattern. Hildegard Peplau’s Theory of Interpersonal Relationship The nursing model identifies four sequential phases in the interpersonal relationship: orientation, identification, exploitation, resolution.  1. Orientation Phase - Initial Phase The nurse’s orientation phase involves engaging the client in treatment, providing explanations and information, and answering questions. Problem defining phase It starts when the client meets the nurse as a stranger. Defining the problem and deciding the type of service needed Client seeks assistance, conveys needs, asks questions, shares preconceptions and expectations of past experiences. Nurse responds, explains roles to the client, identifies problems, and uses available resources and services.  2. Identification Phase The identification phase begins when the client works interdependently with the nurse, expresses feelings, and begins to feel stronger. Selection of appropriate professional assistance the patient begins to trust the nurse and feels comfortable sharing their thoughts and feelings. The nurse provides support and encouragement, and helps the patient to develop a sense of trust and security.  3. Exploitation Phase In the exploitation phase, the client makes full use of the services offered. Use of professional assistance for problem-solving alternatives Advantages of services are used based on the needs and interests of the patients. The individual feels like an integral part of the helping environment. They may make minor requests or attention-getting techniques. 3. Exploitation Phase The principles of interview techniques must be used to explore, understand and adequately deal with the underlying problem. Patient may shift on independence. Nurse must be aware of the various phases of communication. Nurse aids the patient in exploiting all avenues of help, and progress is made towards the final step. 4. Resolution Phase the client no longer needs professional services and gives up dependent behavior. The relationship ends. Termination of professional relationship The patient’s needs have already been met by the collaborative effect of patient and nurse. 4. Resolution Phase Now they need to terminate their therapeutic relationship and dissolve the links between them. Sometimes may be difficult for both as psychological dependence persists. The patient drifts away and breaks the nurse’s bond, and a healthier emotional balance is demonstrated, and both become mature individuals. Hildegard Peplau’s Theory of Interpersonal Relationship Stranger: offering the client the same acceptance and courtesy that the nurse would respond to any stranger Resource person: providing specific answers to questions within a larger context Teacher: helping the client to learn formally or informally Leader: offering direction to the client or group 2 Hildegard Peplau’s Theory of Interpersonal Relationship Surrogate: serving as a substitute for another such as a parent or a sibling Counselor: promoting experiences leading to health for the client such as expression of feelings Technical Expert: providing physical care for the patient and operates equipment Additional roles include: Technical expert Manager of environment Consultant Mediator Health teacher Administrator Tutor Recorder observer Socializing agent Researcher Safety agent 2 Peplau also discussed about ANXIETY Anxiety was defined as the initial response to a psychic threat. There are four levels of anxiety. Anxiety is common, and it can be both positive or negative Four Levels of Anxiety Mild anxiety is a positive state of heightened awareness and sharpened senses, allowing the person to learn new behaviors and solve problems. The person can take in all available stimuli (perceptual field). Moderate anxiety involves a decreased perceptual field (focus on the immediate task only); the person can learn a new behavior or solve problems only with assistance. Another person can redirect the person to the task. Four Levels of Anxiety Severe anxiety involves feelings of dread and terror. The person cannot be redirected to a task; he or she focuses only on scattered details and has physiologic symptoms of tachycardia, diaphoresis, and chest pain. Panic anxiety can involve loss of rational thought, delusions, hallucinations, and complete physical immobility and muteness. The person may bolt and run aimlessly, often exposing himself or herself to injury. Ida Jean Orlando’s Theory of Deliberative Nursing Process was an internationally known psychiatric health nurse, theorist, and researcher. Her theory allows nurses to create an effective nursing care plan that can also be easily adapted when and if any August 12, 1926 – November 28, 2007 complications arise with the patient. Deliberative Nursing Process Theory Orlando’s nursing theory stresses the reciprocal relationship between patient and nurse. What the nurse and the patient say and do affects them both. She views nursing’s professional function as finding out and meeting the patient’s immediate need for help. Deliberative Nursing Process Theory She also described her model as revolving around the following five major interrelated concepts: the function of professional nursing- organizing principle This means finding out and meeting the patient’s immediate needs for help. presenting behavior- patient’s problematic situation Through the presenting behavior, the nurse finds the patient’s immediate need for help. the nurse must first recognize the situation as problematic. Regardless of how the presenting behavior appears, it may represent a cry for help from the patient. Distress- The patient’s behavior reflects distress when the patient experiences a need that he cannot resolve, a sense of helplessness occurs. Deliberative Nursing Process Theory Immediate reaction- internal response The patient perceives objects with his or her five senses. These perceptions stimulate automatic thought, and each thought stimulates an automatic feeling, causing the patient to act.  Nurse’s Action When the nurse acts, an action process transpires. This action process by the nurse in a nurse-patient contact is called the nursing process. The nurse’s action may be automatic or deliberative. Automatic Nursing Actions are nursing actions decided upon for reasons other than the patient’s immediate need. Deliberative Nursing Actions are actions decided upon after ascertaining a need and then meeting this need. The following list identifies the criteria for deliberative actions: Deliberative actions result from the correct identification of patient needs by validating the nurse’s reaction to patient behavior. The nurse explores the meaning of the action with the patient and its relevance to meeting his need. The nurse validates the action’s effectiveness immediately after completing it. Five Stages of Deliberative Nursing Process Theory Assessment: The nurse assesses the patient's behavior to identify their need for help. Diagnosis: The nurse diagnoses the patient's need for help by interpreting their behavior. Planning: The nurse plans how to meet the patient's need for help. Implementation: The nurse implements the plan to meet the patient's need for help. Evaluation: The nurse evaluates the effectiveness of the intervention and makes adjustments as needed. Five Stages of Deliberative Nursing Process Theory Assessment: The patient is crying, their facial expression is sad, and they are avoiding eye contact. Diagnosis: Based on this assessment, the nurse might diagnose the patient's need for help as "the need for comfort." Planning: plan how to meet the patient's need for comfort. Implementation: The nurse would sit with the patient and hold their hand. The nurse might also offer the patient a tissue or a glass of water. Evaluation: The nurse might ask the patient if they feel better. If the patient is still crying, the nurse might try a different approach. Lydia Hall’s Core, Care, Cure Her theory defined Nursing as “a participation in care, core and cure aspects of patient care, where CARE is the sole function of nurses, whereas the CORE and CURE are shared with other members of the health team.” She worked to involve the community in September 21, 1906 – public health issues. February 27, 1969 Lydia Hall’s Core, Care, Cure Also known as “the Three Cs of Lydia Hall,” it contains three independent but interconnected circles: the core, the care, and the cure. Hall’s theory emphasizes the total patient rather than looking at just one part and depends on all three components of the theory working together. Major Concepts of Lydia Hall’s Core, Care, Cure The patient is a unity composed of the following three overlapping parts: (1) a person (the core aspect), (2) a pathologic condition and treatment (the cure aspect), (3) and a body (the care aspect). the three interlocking circles may change in size and overlap concerning the patient’s phase in the disease process. A nurse functions in all three circles but to different degrees. The Care Circle This circle solely represents the role of nurses and is focused on performing the task of nurturing patients. Nurturing involves using the factors that make up the concept of mothering (care and comfort of the person) and provide for teaching-learning activities. The Care Circle The care circle defines a professional nurse’s primary role, such as: providing bodily care for the patient and helping the patient complete such basic daily biological functions as eating, bathing, elimination, and dressing. When providing this care, the nurse’s goal is the comfort of the patient. educating patients helping a patient meet any needs he or she is unable to meet alone The Core Circle refers to the patient as a person, with their own unique needs, values, and beliefs. is the patient receiving nursing care. The core has goals set by him or herself rather than by any other person and behaves according to their feelings and values. This area emphasizes the patient’s social, emotional, spiritual, and intellectual needs concerning family, institution, community, and the world. The Cure Circle the cure is nursing involves the administration of medications and treatments. nurse shares the cure circle with other health professionals, such as physicians or physical therapists. these are the interventions or actions geared toward treating the patient for whatever illness or disease he or she is suffering from. During this aspect of nursing care, the nurse is an active advocate of the patient. The Cure Circle the cure is nursing involves the administration of medications and treatments. nurse shares the cure circle with other health professionals, such as physicians or physical therapists. these are the interventions or actions geared toward treating the patient for whatever illness or disease he or she is suffering from. During this aspect of nursing care, the nurse is an active advocate of the patient. Px: recovering from surgery core :patient's physical needs, such as the need for pain relief and rest. It might also include the patient's emotional needs, such as the need for support and comfort. care: providing the patient with pain medication, helping them to move around, and listening to their concerns. cure: working with the doctor to develop a treatment plan, administering medications, and providing the patient with information about their illness and treatment. The most important thing to remember about Hall's Care, Cure, Core theory is that nurses play a vital role in all three aspects of nursing care: core, care, and cure. Nurses are responsible for assessing the patient's core needs, providing care that is responsive to those needs, and coordinating the patient's cure. Hall's theory is a valuable tool for nurses who want to provide care that is holistic and patient-centered. It reminds nurses that they are not just treating a disease or injury, but caring for a person. Faye Abdellah’s 21 Nursing Problems Her nursing model was progressive for the time in that it refers to a nursing diagnosis during a time in which nurses were taught that diagnoses were not part of their role in health care. She was the first nurse officer to rank a two- star rear admiral, the first nurse, and the first woman to serve as a Deputy Surgeon March 13, 1919 – present General. Abdellah’s Typology of 21 Nursing Problems She used Henderson’s 14 basic human needs and nursing research to establish the classification of nursing problems. According to Faye Glenn Abdellah’s theory, “Nursing is based on an art and science that molds the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs.” Abdellah’s Typology of 21 Nursing Problems is focused on patient-centered approach to nursing It was formulated to be an instrument for nursing education, The nursing model is intended to guide care in hospital institutions but can also be applied to community health nursing, as well. Major Concepts of Abdellah’s Typology of 21 Nursing Problems Individual She describes nursing recipients as individuals (and families) Health Health, or the achieving of it, is the purpose of nursing services. “total health needs” and “a healthy state of mind and body.” Major Concepts of Abdellah’s Typology of 21 Nursing Problems Society is included in “planning for optimum health on local, state, and international levels.” Nursing Problems The client’s health needs can be viewed as problems, can be obvious or hidden/covert Because covert problems can be emotional, sociological, and interpersonal in nature, they are often missed or misunderstood. Yet, in many instances, solving the covert problems may solve the overt problems as well. Major Concepts of Abdellah’s Typology of 21 Nursing Problems Problem Solving Quality professional nursing care requires that nurses be able to identify and solve overt and covert nursing problems. The problem-solving process can meet these requirements by: identifying the problem, selecting pertinent data, formulating hypotheses, testing hypotheses through collecting data revising hypotheses when necessary based on conclusions obtained from the data. Major Concepts of Abdellah’s Typology of 21 Nursing Problems 1. To maintain good hygiene and physical comfort. 2. To promote optimal activity: exercise, rest, sleep 3. To promote safety by preventing accidents, injuries, or other trauma and preventing the spread of infection. 4. To maintain good body mechanics and prevent and correct the deformity. 5. To facilitate the maintenance of a supply of oxygen to all body cells. 6. To facilitate the maintenance of nutrition for all body cells. 7. To facilitate the maintenance of elimination. Major Concepts of Abdellah’s Typology of 21 Nursing Problems 8. To maintain good hygiene and physical comfort. 9. To promote optimal activity: exercise, rest, sleep 10. To promote safety by preventing accidents, injuries, or other trauma and preventing the spread of infection. 11. To maintain good body mechanics and prevent and correct the deformity. 12. To facilitate the maintenance of a supply of oxygen to all body cells. 13. To facilitate the maintenance of nutrition for all body cells. 14. To facilitate the maintenance of elimination. Major Concepts of Abdellah’s Typology of 21 Nursing Problems 15. To promote the development of productive interpersonal relationships. 16. To facilitate progress toward achievement and personal spiritual goals. 17. To create or maintain a therapeutic environment. 18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs. 19. To accept the optimum possible goals in the light of limitations, physical and emotional. 20. To use community resources as an aid in resolving problems that arise from an illness. 21. To understand the role of social problems as influencing factors in the cause of illness. Four categories of Patients' needs Moreover, patients’ needs are further divided into four categories: basic to all patients, sustenance care needs, remedial care needs, restorative care needs. Basic Needs The basic needs of an individual patient are to maintain good hygiene and physical comfort; promote optimal health through healthy activities, such as exercise, rest, and sleep; promote safety through the prevention of health hazards like accidents, injury, or other trauma the prevention of the spread of infection; maintain good body mechanics and prevent or correct deformity. Sustenal Care Needs facilitate the maintenance of a supply of oxygen to all body cells; facilitate the maintenance of nutrition of all body cells; facilitate the maintenance of elimination; facilitate the maintenance of fluid and electrolyte balance; recognize the physiological responses of the body to disease conditions; facilitate the maintenance of regulatory mechanisms and functions, and facilitate the maintenance of sensory function. Remedial Care Needs identify and accept positive and negative expressions, feelings, and reactions; identify and accept the interrelatedness of emotions and organic illness; facilitate the maintenance of effective verbal and non-verbal communication; promote the development of productive interpersonal relationships; facilitate progress toward achievement of personal spiritual goals; create and maintain a therapeutic environment; facilitate awareness of the self as an individual with varying physical, emotional, and developmental needs.  Restorative Care Needs Restorative care needs include the acceptance of the optimum possible goals in light of limitations, both physical and emotional; the use of community resources as an aid to resolving problems that arise from an illness; the understanding of the role of social problems as influential factors in the case of illness. Ten steps to identify the patient’s problem 1. Learn to know the patient. 2. Sort out relevant and significant data. 3. Make generalizations about available data concerning similar nursing problems presented by other patients. 4. Identify the therapeutic plan. 5. Test generalizations with the patient and make additional generalizations. Ten steps to identify the patient’s problem 6. Validate the patient’s conclusions about his nursing problems. 7. Continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting his or her behavior. 8. Explore the patient and their family’s reactions to the therapeutic plan and involve them in the plan. 9. Identify how the nurses feel about the patient’s nursing problems. 10. Discuss and develop a comprehensive nursing care plan. The 11 nursing skills are: 1. observation of health status 6. use of resource materials 2. skills of communication 7. use of personnel resources 3. application of knowledge 8. problem-solving 4. the teaching of patients and 9. the direction of work of others families 10. therapeutic uses of the self 5. planning and organization of 11. nursing procedure work Conclusion Abdellah’s typology of 21 nursing problems is a conceptual model mainly concerned with patient’s needs and nurses’ role in problem identification using a problem analysis approach. patients are described as having physical, emotional, and sociological needs. People are also the only justification for the existence of nursing. Without people, nursing would not be a profession since they are the recipients of nursing. Abraham Maslow's Hierarchy of Needs Maslow's hierarchy of needs is a motivational theory in psychology comprising a five-tier model of human needs, often depicted as hierarchical levels within a pyramid.  Physiological Needs The physiological needs include those that are vital to survival. Some examples of physiological needs include: Food Water Breathing/air sleep shelter IMaslow included sexual reproduction in this level of the hierarchy as well, since it is essential to the survival and propagation of the species. Security and Safety Needs Pneed for security, stability, and protection from harm. These needs are important for humans to feel safe and secure in their environment: Financial security Health and wellness Safety against accidents and injury Love and Belongingness At this level, the need for emotional relationships drives human behavior. Some of the things that satisfy this need include: Friendships Romantic attachments Family relationships Social groups Community groups Churches and religious organizations it is important for people to feel loved and accepted by others. Personal relationships with friends, family, and lovers play an important role, as does involvement in groups—such as religious groups, sports teams, book clubs, and other group activities. Self-Esteem need for appreciation and respect. People have a need to accomplish things, then have their efforts recognized. Includes, self-esteem and personal worth. People need to sense that they are valued by others and feel that they are making a contribution to the world. achieving good self-esteem and the recognition of others tend to feel confident in their abilities and those who lack self-esteem and the respect of others can develop feelings of inferiority. Self-Actualization Needs Self-actualizing people are self-aware, concerned with personal growth, less concerned with the opinions of others, and interested in fulfilling their potential. are the highest level of needs, and they include the need to reach one's full potential and to live a meaningful and fulfilling life. These needs are important for humans to feel that they are living their best lives. Px: Mina is a homeless person physiological: need for food, water, and shelter. safety: finding a safe place to sleep or avoiding dangerous areas. love and belonging: joining a community support group or making friends with other people who are homeless. esteem: getting a job, going back to school, or volunteering in their community. self-actualization: pursuing their dreams and goals, or sharing her experiences to motivate others The Expanded Hierarchy of Needs In 1970, Maslow built upon his original hierarchy to include three additional needs at the top of his pyramid, for a total of eight: Cognitive needs. This centers on knowledge. People generally want to learn and know things about their world and their places in it. Aesthetic needs. This addresses the appreciation of beauty and form. People might fulfill this need through enjoying or creating music, art, literature, and other creative expressions. Transcendence needs. Maslow believed that humans are driven to look beyond the physical self in search of meaning. Helping others, practicing spirituality, and connecting with nature are a few ways we might meet this need. Erik Erikson's Stages of Psychosocial Development Erikson maintained that personality develops in a predetermined order through eight stages of psychosocial development, from infancy to adulthood. During each stage, the person experiences a psychosocial crisis which could have a positive or negative outcome for personality development. Stages of Psychosocial Development According to the theory, successful completion of each stage results in a healthy personality and the acquisition of basic virtues. Basic virtues are characteristic strengths which the ego can use to resolve subsequent crises Failure to successfully complete a stage can result in a reduced ability to complete further stages and therefore a more unhealthy personality and sense of self. These stages, however, can be resolved successfully at a later time. 1. Trust vs. Mistrust : Infant Trust vs. mistrust is the first stage This stage begins at birth continues to approximately 18 months of age. During this stage, the infant is uncertain about the world in which they live, and looks towards their primary caregiver for stability and consistency of care. 1. Trust vs. Mistrust : Infant If the care the infant receives is consistent, predictable and reliable, they will develop a sense of trust which will carry with them to other relationships, and they will be able to feel secure even when threatened. If these needs are not consistently met, mistrust, suspicion, and anxiety may develop. 1. Trust vs. Mistrust: Success and Failure In Stage One Success in this stage will lead to the virtue of hope. sense of trust Failing to acquire the virtue of hope will lead to the development of fear. anxiety, heightened insecurities, and an over feeling of mistrust in the world around them. 2. Autonomy vs. Shame and Doubt : Toddler Autonomy versus shame and doubt is the second stage This stage occurs between the ages of 18 months to approximately 3 years. focused on developing a sense of personal control over physical skills and a sense of independence. 2. Autonomy vs. Shame and Doubt Toddler Success in this stage will lead to the virtue of WILL. If children in this stage are encouraged and supported in their increased independence, they become more confident and secure in their own ability to survive in the world. If children are criticized, overly controlled, or not given the opportunity to assert themselves, they begin to feel inadequate in their ability to survive, and may then become overly dependent upon others, lack self-esteem, and feel a sense of shame or doubt in their abilities. 2. Autonomy vs. Shame and Doubt Toddler The child is developing physically and becoming more mobile, and discovering that he or she has many skills and abilities, such as putting on clothes and shoes, playing with toys, etc. Such skills illustrate the child's growing sense of independence and autonomy. Erikson states it is critical that parents allow their children to explore the limits of their abilities within an encouraging environment which is tolerant of failure. parents need to encourage the child to become more independent while at the same time protecting the child so that constant failure is avoided. 3. Initiative vs. Guilt : Pre-school 3-5 years old Initiative versus guilt is the third stage children assert themselves more frequently through directing play and other social interaction. During this period the primary feature involves the child regularly interacting with other children at school. Central to this stage is play, as it provides children with the opportunity to explore their interpersonal skills through initiating activities. 3. Initiative vs. Guilt : Pre-school Children begin to plan activities, make up games, and initiate activities with others. If given this opportunity, children develop a sense of initiative and feel secure in their ability to lead others and make decisions. If it fails, through criticism or control, children develop a sense of guilt. The child will often overstep the mark in his forcefulness, and the danger is that the parents will tend to punish the child and restrict his initiatives too much. 3. Initiative vs. Guilt : Pre-school It is at this stage that the child will begin to ask many questions as his thirst for knowledge grows. If the parents treat the child’s questions as trivial, a nuisance or embarrassing or other aspects of their behavior as threatening then the child may have feelings of guilt for “being a nuisance”. Too much guilt can make the child slow to interact with others and may inhibit their creativity. Some guilt is, of course, necessary; otherwise the child would not know how to exercise self-control or have a conscience. A healthy balance between initiative and guilt is important. Success in this stage will lead to the virtue of purpose, while failure results in a sense of guilt. 4. Industry vs. Inferiority : Grade schooler occurs during childhood between the ages 6-11. It is at this stage that the child’s peer group will gain greater significance and will become a major source of the child’s self-esteem. The child now feels the need to win approval by demonstrating specific competencies that are valued by society and begin to develop a sense of pride in their accomplishments. 4. Industry vs. Inferiority : Grade schooler If children are encouraged and reinforced for their initiative, they begin to feel industrious (competent) and feel confident in their ability to achieve goals. If this initiative is not encouraged, if it is restricted by parents or teacher, then the child begins to feel interior, doubting his own abilities and therefore may not reach his or her potential. Some failure may be necessary so that the child can develop some modesty. Again, a balance between competence and modesty is necessary. Success in this stage will lead to the virtue of competence. 5. Identity vs. Role Confusion: Teenager Occurs during adolescence, from about 12-18 years. During this stage, adolescents search for a sense of self and personal identity, through an intense exploration of personal values, beliefs, and goals. During adolescence, the transition from childhood to adulthood is most important. Children are becoming more independent, and begin to look at the future in terms of career, relationships, families, housing, etc. The individual wants to belong to a society and fit in. 5. Identity vs. Role Confusion: Teenager This is a major stage of development where the child has to learn the roles he will occupy as an adult. It is during this stage that the adolescent will re-examine his identity and try to find out exactly who he or she is. Erikson suggests that two identities are involved: the sexual and the occupational. 5. Identity vs. Role Confusion: Teenager Erikson claims that the adolescent may feel uncomfortable about their body for a while until they can adapt and “grow into” the changes. Success in this stage will lead to the virtue of fidelity. Fidelity involves being able to commit one's self to others on the basis of accepting others, even when there may be ideological differences. During this period, they explore possibilities and begin to form their own identity based upon the outcome of their explorations. Failure to establish a sense of identity within society ("I don’t know what I want to be when I grow up") can lead to role confusion. Role confusion involves the individual not being sure about themselves or their place in society. 6. Intimacy vs. Isolation: Young Adult takes place during young adulthood between the ages of approximately 19 to 40 yrs old During this stage, the major conflict centers on forming intimate, loving relationships with other people. During this stage, we begin to share ourselves more intimately with others. We explore relationships leading toward longer-term commitments with someone other than a family member. 6. Intimacy vs. Isolation: Young Adult Successful completion of this stage can result in happy relationships and a sense of commitment, safety, and care within a relationship. Success in this stage will lead to the virtue of love. Avoiding intimacy, fearing commitment and relationships can lead to isolation, loneliness, and sometimes depression. 7. Generativity vs. Stagnation: Middle- Age Adult This stage takes place during during middle adulthood (ages 40 to 65 yrs). generativity refers to "making your mark" on the world through creating or nurturing things that will outlast an individual. We give back to society through raising our children, being productive at work, and becoming involved in community activities and organizations. Through generativity we develop a sense of being a part of the bigger picture. 7. Generativity vs. Stagnation: Middle- Age Adult Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world. By failing to find a way to contribute, we become stagnant and feel unproductive. These individuals may feel disconnected or uninvolved with their community and with society as a whole. Success in this stage will lead to the virtue of care. 8. Ego Integrity vs. Despair: Older Adult This stage begins at approximately age 65 and ends at death. It is during this time that we contemplate our accomplishments and can develop integrity if we see ourselves as leading a successful life. It is during this time that we contemplate our accomplishments and can develop integrity if we see ourselves as leading a successful life. 8. Ego Integrity vs. Despair: Older Adult Success in this stage will lead to the virtue of wisdom. Wisdom enables a person to look back on their life with a sense of closure and completeness, and also accept death without fear. Erik Erikson believed if we see our lives as unproductive, feel guilt about our past, or feel that we did not accomplish our life goals, we become dissatisfied with life and develop despair, often leading to depression and hopelessness. Trust vs. Mistrust (Infancy, 0-1 year old): Success: An infant is consistently comforted and attended to when they cry or express needs. They learn to trust their caregivers to meet their needs, creating a foundation of trust in relationships throughout their life. Failure: An infant is neglected or inconsistently cared for, leading to a lack of trust in caregivers and potential difficulties forming healthy relationships later in life. Autonomy vs. Shame and Doubt (Toddlerhood, 1-3 years old): Success: A toddler is encouraged to feed themselves and make choices in clothing, fostering a sense of independence and autonomy. Failure: A toddler is constantly criticized for their attempts at independence, leading to shame and doubt in their abilities and decisions. Initiative vs. Guilt (Preschool, 3-5 years old): Success: A preschooler is encouraged to explore new activities and ideas, like trying a new hobby or engaging in creative play. They develop a sense of initiative and purpose. Failure: A preschooler is stifled or criticized for their curiosity and exploration, leading to feelings of guilt and a lack of confidence in taking initiatives. Industry vs. Inferiority (School Age, 6-11 years old): Success: A child excels in school or extracurricular activities, receiving praise and recognition. This boosts their confidence and self-esteem, propelling them towards success in future endeavors. Failure: A child constantly receives negative feedback or is compared unfavorably to peers, leading to a sense of inferiority and diminished self-worth. Identity vs. Role Confusion (Adolescence, 12-18 years old): Success: A teenager explores various interests, builds a clear self- identity, and begins to understand their future goals and aspirations. Failure: A teenager struggles with societal pressures and parental expectations, leading to confusion and uncertainty about their identity and life direction. Intimacy vs. Isolation (Young Adulthood, 19-40 years old): Success: A young adult forms meaningful, loving relationships and commits to a partner, experiencing intimacy, connection, and emotional fulfillment. Failure: A young adult struggles to maintain relationships due to fear of vulnerability or commitment, leading to feelings of isolation and loneliness. Generativity vs. Stagnation (Middle Adulthood, 40-65 years old): Success: An adult mentors and supports younger generations, contributes to their community, and finds purpose and fulfillment in their work and relationships. Failure: An adult feels unfulfilled in their career and fails to contribute meaningfully, resulting in stagnation and a sense of purposelessness. Integrity vs. Despair (Late Adulthood, 65+ years old): Success: An older adult reflects on their life, accepts the ups and downs, and finds peace and wisdom, imparting valuable life lessons to younger generations. Failure: An older adult regrets past choices, experiences bitterness, and struggles with unresolved issues, leading to a sense of despair and fear of death. References Peplau, H. E. (1952). Interpersonal relations in nursing. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange. Sills, G. (n.d.). Hildegard Peplau. Nursing Theorist Homepage. Retrieved January 3, 2014, from https://publish.uwo.ca/~cforchuk/peplau/obituary.html Orlando, I. J. (1972). The discipline and teaching of nursing process. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange. Potter, P.A., & Perry, A.G. (2012). Fundamentals of nursing (8th ed.). St. Louis, MO: Mosby Elsevier. Schmieding, N. (1990). An integrative nursing theoretical framework. Journal of Advanced. Nursing, 15(4), 463-467. Hall, L. (1965) Another view of nursing care and quality. Address given at Catholic University Workshop, Washington, D.C. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange. George, J.B.; Nursing Theories: The Base for Professional Nursing Practice; 2000. References Abdellah, F.G. Public policy impacting on nursing care of older adults. In E.M. Baines (Ed.), perspectives on gerontological nursing. Newbury, CA: Sage publications. 1991. Craddock, J. (2013). Encyclopedia of world biography supplement. Detroit, Mich.: Gale. https://www.encyclopedia.com/doc/1G2-3435000010.html Quiz: