Providing Nursing Care Across The Life Span - Term Paper Example

Title: Nursing Care across the Lifespan Name Course Tutor Date: May 22, 2012 Introduction Nursing care is not just a matter of providing services to the patients at the times when they are sick. It also encompasses an ongoing continuum in the delivery of care for the patient across their whole life span (George, 2002). It also focuses on the general wellness of the patient and the overall promotion of the patients’ health throughout their entire life. This is referred to as the foundation of health promotion in the field of nursing. According to Dossey, (2005 p.23) it covers the whole person: physically, spiritually, and psychologically, sexually, socially and even culturally. According to Erik Erikson’s theory of psychological development, a human being undergoes eight different phases of developmental stages (Welchman, 2001, p. 16). Every period of one particular stage is characterized by specific underlying changes. Various characteristics always underlie one specific stage which differentiates it from the preceding one as well as the succeeding one (Vogel-Scibilla et al, 2009). Efficient and effective nursing care is very crucial at any one point in the life of every individual. Notably, each stage has its own opportunities to develop positively as well as negative deficits on one’s character (Welchman, 2001). Therefore, nurses have the big role in society to provide nursing care to the patients across the whole life span which is very essential for the psychological development of the person. The Eight Developmental Stages 1. The Infancy Stage The first of the eight stages of development in Erikson’s theory is known as the infancy stage. Erikson also termed it as the oral sensory stage. It runs from birth to about eighteen months. Here, a person or rather the child develops either trust or mistrust (Vogel-Scibilla et al, 2009). Emphasis is put on the mother’s loving care for the child. This helps the child to develop a positive attitude towards life. If a person successfully passes through this period, they will gain the basic confidence to face the future and also learn to trust the people in their lives (Welchman, 2001). However, if a child is mistreated and isolated from tender love and care, they grow up frustrated and with full of mistrust. At this stage, the most significant aspect of a person’s life is the relationship that they will have with the maternal parent (Marriner & Alligood, 2006, p. 8). All the other caregivers at this stage also play a very significant role in ensuring that the child develops positively in life. The normal vital signs are a pulse of 150+-20, and a respiration rate of 3+-5 (Hoffman et al, 2006). The child also has an automatic grasp. The ADL’s include a generally include feeding and soiling diapers. Moreover, the child communicates via visual, taste and auditory senses. They often respond to stimulation like soft music and phone brightness. They can also hold and cuddle during feeding. There is also considerable daily growth. At the age of three months, they tend to put their hands into the mouth and may communicate through coos, squeals and blow bubbles. They can smile, laugh or cry to show emotion. Nursing care provided at this stage of development encompasses sufficient day care for the children if the parents are work-going (Levin & Munsch, 2011). The child must be well fed and kept in clean and healthy environments that promote the health of the child (George, 2002). Even the nursing theorists support this. According to Fay Adbella, nursing at all stages included three major elements; the physical sociological and emotional needs of the client, interpersonal relationships. Care should also include vital signs, head and chest circumference check up and the immunization status just but to mention a few. (Sitzman & Eichelberger, 2011). Early detection of diseases, immunization and vaccination is a strategy to prevent frequent hospitalization. Moreover, she developed a 21 nursing problem known as a typology that identified the major nursing areas. At the infancy stage, her ideas that could apply include promotion of good hygiene and physical comfort for the child, enough exercise, rest and sleep (Levin & Munsch, 2011, p. 23). Furthermore, the nurse ought to prevent any sort of harm, accident or injury that may happen to the child. In quality nursing care, the nurse must be able to identify any positive or negative reactions of the child in order to ascertain the different feelings and emotion of the child. Good interpersonal relationships between the nurse and the child must also be established (George, 2002). 2. Early Childhood This stage was characterised by Erik Erikson as a stage of autonomy vs. shame. It runs from 18 months of age to three years. The normal vital signs are a pulse of 110, respiration 25 and blood pressure of 99/60 (Hoffman et al, 2006). During this stage, the person learns to master life skills on their own. Our ego will develop either to make us become autonomous or to face life with shame (Levin & Munsch, 2011). The nursing care provided at this stage is a great determinant in the person’s development of self-esteem, self-image and self- independence. Another important factor here is that relationship that the child will have with the parents. It is indeed the biggest determining factor (Marriner & Alligood, 2006). The child learns to talk, walk and feed themselves. They also undergo a finer motor development. The most significant achievement at this stage is usually the toilet training for every individual. The stage is important for building a person’s self esteem (Vogel-Scibilla et al, 2009). The ADL’s at this stage are feeding, walking, toileting and a bit of playing. The child is less fearful of strangers and can hug and kiss (Hoffman et al, 2006). Some are even taught to brush their teeth. According to Erikson, a person develops their first interests at this stage. However, they can easily develop doubt and reluctance towards facing new challenges if they are highly restricted (Welchman, 2001). The care-giving nurse must develop such an environment that promotes the general welfare of the child. Martha Roger’s theory of unitary human beings may apply here. She lays her theory on science and interest in space. She asserts that the patient and their surrounding environment is one and the same thing. Thus a child and the universe are one and the same thing and should not be isolated (Master, 2011). The nurse thus ought to provide toys, dolls, picture books, balls etc. Moreover, mumps, measles and rubella vaccinations will prevent future complications that may bring about hospitalization. They also promote the child’s health. 3. The Play Age This one happens between three to five years. It was termed as the stage of initiative vs. guilt. The vital signs include a pulse of 92, respiration of 25 on average and blood pressure of 99/60 (Hoffman et al, 2006). The individual person develops an inherent desire to copy and emulate the adults around them (Welchman, 2001, p. 17). The child develops a sense of purpose and begins to take major initiative in activities in creating toys and play stations. Mostly, we start to play a lot with toy, miniature cars and take up the mum and dad roles while interacting with other children (Levin & Munsch, 2011). At this stage in time, the child needs professional care and maintenance from the care givers. Paediatric nursing must involve providing resources to the children that promote their health throughout their growth and development. At this stage especially, particular changes occur to the child both physically and biologically which are in need of specialized care. The care given should target to meet the needs of the child. This is in accordance with Patricia Benner’s theory nursing theory (Sitzman & Eichelberger, 2011). The ADL’s include playing with toys, puzzles, painting, drawing and playing with hand puppets. As such, nursing considerations must cover aspects of pre-operative teaching to prevent accidents (Levin & Munsch, 2011, p. 23). It ought to have started from childhood and continue all the way to adolescence and even adulthood. The fourth polio immunization is given at this stage. They also need role models. Care in this aspect should be based on Erickson’s modelling and role modelling theory. This one was developed by Helen C. Erickson who asserted that nurses are supposed to care for their patients by exemplifying good practices that could even be emulated by their patients (Marriner & Alligood, 2006). Persons at this age need role models that they will emulate and copy from. The theory draws from other theories of cognitive development the general adaptation syndrome (George, 2002, p. 45). The mind, body emotion and spirit will usually develop according to the interaction between the child and the care giver. The child can count to five, model, tell the primary colours and understands times of the day such as morning, night and afternoon. Likewise, the basic needs of the child should be met. When the needs of the child are not met, they will perceive the situation as a threat to their well being which will lead to illnesses and distress (Levin & Munsch, 2011). Nursing care from the time of admission of the patient to the time the patient is discharged has five different goals. In this respect, the nurse should first build trust with the patient, then work to build on the positive orientation of the patient (Master, 2011). Next, the nurse is supposed to put the patient under full control of their status. The patient must also be encouraged by the nurse affirming their strengths and promoting their capabilities. In order to achieve and restore the health of their patients, nurses are then meant to set goals that are directed towards the achievement of the best health for the patients (George, 2002). 4. The School Age This developmental stage according to Erikson will normally range from the age of six years to twelve years. It is also known as the stage of latency and is characterised by industry vs. competency (Vogel-Scibilla et al, 2009). The individual person is able to learn and accomplish a number of numerous new skills and other competencies. The vital signs are a pulse of 80 on average, respiration 21 and a blood pressure of 103/60 (Hoffman et al, 2006). Care given to an individual should be such that it nurtures the person in a positive way in which they can be able to develop a sense of industry. This will usually come out of hard work and helps one to achieve accuracy, method and competence (Levin & Munsch, 2011, p. 25). However, if the stage is characterised by social problems and barriers, a person is likely to develop inferiority and inadequacy coupled with feelings of incompleteness (Marriner & Alligood, 2006). The developing individual may start to have self esteem problems and withdrawal symptoms. The ADL’s here are mostly table games, rope jumping, skating on rollers and at times fighting (Hoffman et al, 2006). The nurse should create a friendly environment as school-going children like to take part in their care and treatment. Safety measures may reduce accidents and injury hence less hospitalization. 5. Adolescence According to Erik Erikson’s model of developmental stages, the next stage is the adolescent stage. It is the transition from childhood to adulthood that is marked by several changes. It is also known as the identity vs. role confusion stage (Master, 2011, p. 15). From the adolescent stage onwards, the decisions made depend on the individual and life begins to become more complicated. The normal vital signs are a pulse of 80 on average, respiration of 20 and a blood pressure of 120/78 (Hoffman et al, 2006). Due to the occurring changes, a person tries to find and define their own identity. They struggle with social interactions as they try to find the social groups that they can fit in. Moreover, young teenagers are now grappling with moral issues in their lives because most of their sexuality issues arise at this time (Sitzman & Eichelberger, 2011). The task of the nurse is to help the young teenagers to identify themselves in a positive way that will give them individual identity in the society. Because nursing care is not supposed to be abandoned at any stage in life, the process must still be ongoing even at this stage. The care givers are supposed to help the person identify themselves now as a member of the wider society but not as a member of the family alone. There is usually a tendency that most of the people in this stage will go avoiding responsibilities. Erikson referred to the state of avoiding responsibility as “moratorium” (Welchman, 2001), leading to role confusion and loss of direction in life. A person in charge of providing nursing care for any adolescent must provide quality care that will run all through the lifespan of the person (George, 2002). Hildegard Peplau’s model for nursing, for instance, helps most of the nurse theorists and other clinicians to develop a therapeutic relationship with the patients (Levin & Munsch, 2011, p. 23). ADL’s include sports, school activities, peer activities, reading magazines, riding, driving, shopping, and hanging out. Peplau developed seven nursing roles that can also apply to taking care of the adolescents generally. They are, the stranger role, the resource role, the teaching role, the counselling the surrogate role the active leadership role and finally, the technical expert role whereby the nurse has to provide the necessary physical care and is the sole operator of the equipment (Vogel-Scibilla et al, 2009). Usually teenagers will consider themselves adults. As per the model above, an adolescent under nursing care needs to be informed, to be taught, to be counselled and be represented (Sitzman & Eichelberger, 2011). Moreover the nurse in charge must also see to it that the teen receives exemplified service from which they can emulate the role of leadership. It is based on Peplau’s theory of interpersonal relationships. They also need privacy and can make decisions about care. For instance breast examination for girls may help eliminate some potential diseases (Hoffman et al, 2006). 6. Young Adulthood Young adulthood is a stage of intimacy and solidarity vs. isolation. In essence, a person develops affiliation and love. Nursing care across a life span incorporates also this stage of young adulthood. It runs from eighteen years to thirty five years of age. At this stage a person will seek one or more companions for love and romance. In a way, we strive to find relationships that are mutually satisfying (Marriner & Alligood, 2006). The ADL’s here are basically a career, family and care for parents. The vital signs are similar to the previous stage. If we fail, we tend to shrink back into isolation and we always distance ourselves from the others (Master, 2011). The relationships that play a significant role in our lives here are the ones with our friends and our marital partners (Vogel-Scibilla et al, 2009). For nursing care at this stage, it can be based on Joyce Travelbee’s theory who established the views that nursing was entirely a concept of human to human relationships. The human relationships in a person’s life at this stage are what define him or her (George, 2002, p. 45). The experiences encountered are what define their personal identity. Moreover, the nurse can also incorporate Rosemary Parse’s ideas of the human becoming theory. Here, the human being is a combination of biological, sociological, psychological and spiritual factors all which ought to be met in the nursing care (Sitzman & Eichelberger, 2011). Hospitalization must be avoided as it may be a source of stress to the family, especially if the sick person is the breadwinner. The nurse must provide the necessary interventions to prevent some illnesses. 7. Middle Adulthood This stage runs from 60-65 years and the strengths acquired here include production and care. According to Erikson, this developmental stage is characterised by either work, an occupation or a meaningful piece of creativity (Welchman, 2001, pp. 16-17). A person is now surrounded by his or her own family. They begin to take care of their kids and the big role here is to tame the children in a manner that perpetuates their culture and social norms. If not accomplished, the person becomes meaningless and of no value to the society (Vogel-Scibilla et al, 2009). Nursing care at this stage is still very crucial and needed and the nursing considerations are more the same as for young adulthood. For a nurse to achieve the full role of providing care, it must now run through the entire family. The needs of the whole family must be met, both the medical needs and the physical needs. The communication mode is verbal but not much. The person has also attained some wisdom and can give advice. (Master, 2011) 8. Late Adulthood This is the last stage of development according to Erikson and runs from 55 or65 years to death. He termed it as a stage of recovery from life (Welchman, 2001). If a person’s life was successful, they will often look back in life with a sense of fulfilment, content and happiness. This feeling is called integrity. The person has also developed wisdom from the many things that life has taught him. However, other adults may reach the stage with despair and feelings of incompleteness especially if they did not achieve anything (Marriner & Alligood, 2006, p. 8). Some will even develop fear of death and will struggle to at least achieve a purpose at this stage. The ADL’s are few. They may include a few leisure activities, or voluntary work. For nursing care, feelings of worth and pride for achievements must be maintained. Here, a nurse ought to encompass the fourteen basic needs of Virginia Henderson’s theory of nursing. They include breathing normally, eating and drinking well, eliminating body waste as required, maintaining desirable positions, getting enough sleep and rest and putting on suitable clothes (Marriner & Alligood, 2006). According to her, nursing at this stage in a person’s life span involves assisting the individual who lacks the basic strength to assist themselves. Encourage intake of high fibre foods and a lot of fluids to prevent constipation. A regular exercise must also be recommended plus small doses of medications (Hoffman et al, 2006). Conclusion In conclusion, the nurse is supposed to make the patient whole, complete and independent at any stage in the patient’s life span. Nursing care should run through the all the major developmental stages so as to ensure that the life of an individual is safeguarded (George, 2002, p. 45). The nature of a nursing role was summarised as getting inside the patients skin and supplementing his will and knowledge according to their needs. Moreover, the nurse bears the responsibility to assess the individual needs of the patient and provide a conducive environment in which the patient can perform any activity unaided (Master, 2011). “I say that the nurse does for others what they would do for themselves if they had the strength, the will, and the knowledge. But I go on to say that the nurse makes the patient independent of him or her as soon as possible”. (Sitzman & Eichelberger, 2011, p. 123). This was Virginia Henderson’s classic definition of nursing. As according to Imogene King, the patient has three fundamental needs, the need for health information, the need to care that prevents illness and the need to care when the patient is unable to take care of themselves (Sitzman & Eichelberger, 2011, p. 13). References Dossey, B. M. (2005). Florence Nightingale today: Healing, leadership, global action. Silver Spring, MD: American Nurses Association.pp.23-37 George, J. B. (2002). Nursing theories: The base for professional nursing practice. Upper Saddle River, N.J: Prentice Hall.pp.45-47 Hoffman, T. L., Bennett, M., & Argosy University (Twin Cities). (2006). A descriptive analysis of children with attachment disruptions. Eagan, MN: Minnesota School of Professional Psychology. Levine, L. E., & Munsch, J. (2011). Child development: An active learning approach. Thousand Oaks, Calif: SAGE.pp.23-25 Marriner-Tomey, A., & Alligood, M. R. (2006). Nursing theorists and their work. St. Louis, Mo: Mosby/Elsevier.pp.7-33 Masters, K. (2011). Nursing theories: A framework for professional practice. Sudbury, Mass: Jones & Bartlett Learning.pp. 9-27 Sitzman, K., & Eichelberger, L. W. (2011). Understanding the work of nurse theorists: A creative beginning. Sudbury, Mass: Jones and Bartlett Publishers. Welchman, K. (2000). Erik Erikson: His life, work, and significance. Buckingham: Open University Press. Pp.13-17 Vogel-Scibilia, S. E., McNulty, K. C., Baxter, B., Miller, S., Dine, M., & Frese, F. J. . (January 01, 2009). The recovery process utilizing Erikson's stages of human development. Community Mental Health Journal, 45, 6, pp.405-14. Read More