Health Occupations

Life Stages

Growth & Development

 Begins @ birth, ends @ death  During all stages, individual needs must be met  Need to be aware of the various stages & needs in order to provide quality health care

Life Stages

 Individuals vary, but everyone passes through certain stages of growth & development  Four main types of growth & development in each stage – Physical – body growth, muscle & nerve development, body organ changes – Mental – development of the mind, problem solving, judgment, & coping – Emotional – feelings, love, hate, joy, fear, excitement – Social – interactions & relationships with others

Life Stages

 Each stage has own characteristics & contains specific developmental tasks  Tasks progress from simple to complex  Each stage establishes foundation for next stage  Rate of progress varies (speech development, puberty, etc)

Erikson’s 8 stages of psychosocial development

 A basic conflict or need must be resolved at each stage  If a person does not master conflict during the stage, they will struggle with the conflict later in life  Each life stage creates needs in people  Factors affect life stages & needs – Gender, race, heredity, culture, life experiences, & health status – Injury or illness usually has a negative effect & impairs development or changes needs

Life Stage 1 – Infancy

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Ages – Birth to age 1

Physical – Dramatic & rapid – Newborn – 6-8 lbs, 18-22 inches long – First year – weight triples (21-24 lbs, height now 29-30 inches) – Muscular & nervous systems immature @ birth – Reflexes present @ birth to allow infant to react to environment • Morro – startle due to loud noise or movement • Rooting – touch to cheek causes infant to turn head & mouth to open • Sucking – caused by slight touch on lips • Grasp – response to object placed in hand

Infancy – Physical changes

  Muscle coordination develops in stages – Newborns can lift head slightly – 2 months – roll – 4-5 months – turn body around, hold head up when sitting, accept objects handed to them, grasp stationary objects – 6-7 months – sit unsupported, grasps moving objects, crawl on stomachs – 12 months – freq walk without assistance, grasp objects with thumb & forefinger, throw small objects Born without teeth, 10 –12 by end of 1 st year

Infancy – Physical changes

 Vision – – Poor at birth, limited to black & white, eye movements uncoordinated – By age 1, close vision good, in color, & can readily focus on small objects  Smell, taste, sensitivity to hot & cold, hearing good at birth but become more refined & exact

Infancy – Mental development

 Rapid during first year  Respond to discomfort by crying  Gradually begin to recognize caregivers  Speech – At birth, cannot speak – 6 months – understand words, make sounds – 12 months – understand many words, use many single words in their vocabulary

Infancy – emotional development

  Newborns show excitement 4-6 months – distress, delight, anger, disgust, fear  12 months- elation, affection for adults  Events that occur in the first year of life when these emotions are first exhibited can have a strong influence on their emotional behavior as adults

Infants – Social development

 Self-centered newborns to recognition of others in environment     4 months- recognize caregivers, smile, gaze intently at others 6 months watch others’ activities, are possessive, may have stranger anxiety 12 months sounds – socialize freely with familiar people, mimic & imitate gestures & vocal Dependent on others for all needs – food, cleanliness, rest, love, security, stimulation

Early childhood – 1 – 6 years

 Physical development – Slower than infancy, by age 6, weight is 45 lbs, heights is 46 inches – Skeletal & muscle development helps child to look more adult like • Legs & lower body grow faster than head, arms, chest • Muscle coordination improves & child can run, climb, & move freely • Write, draw, use a knife & fork – By 2-3, have most baby teeth & can eat most food – 2-4 years, develop bladder & bowel control

Early childhood – mental

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development

Advances rapidly – verbal grows from several words @ age 1 to 1500-2500 words at age 6 Age 2 – short attention span but interested in many activities, remember details, begin understanding concepts Age 4 – ask questions, recognize letters & words, make decisions based on logic not trial & error Age 6 – very verbal, want to read & write, memory develops so child can make decisions based on past & present experiences

Early childhood – emotional development

  Age 1-2 – Begin to develop self awareness, accept or defy limits, feel impatient & frustrated when they try to do things beyond their ability, temper tantrums, like routines Age 4-6 – begin to control their emotions, understand right & wrong, more independent, less frustrated, less anxiety when there is a new situation

Early childhood – social development

   Self-centered to social Early years – attached to parents, fear separation, begin to play with others but still are possessive, parallel play Later years – put self aside, take more interest in others, trust others, make more effort to please others, more social & agreeable, like to have friends their own age

Early childhood needs

 Food, rest, shelter, protection, love, security – just as infant does  Routine, order, & consistency  Must be taught responsibility & conformity to rules  Need to make reasonable demands based on their ability to comply

Late childhood (6 – 12 years) – Physical development

 Slow but steady, weight gain 5-7 lbs. per year, height increases 2-3 in/year  Muscle coordination well developed  Physical activities complex  Primary (baby) teeth lost, permanent teeth erupt  Visual acuity at its best  Sexual maturation begins at age 10-12

Late Childhood – mental development

 Life centers around school – increases rapidly  Speech skills develop  Reading & writing skills have been learned  Use information to solve problems   Memory becomes more complex Abstract concepts – loyalty, honesty, values, morals  More adept at making judgments

Late childhood- emotional development

   Achieve greater independence & more distinct personality Age 6 – frightened & uncertain, need reassuring parents & success in school to gain confidence, coping replaces fears, learn to control emotions Age 10-12 –puberty leads to periods of depression followed by joy, emotional changes can cause children to be restless & anxious & difficult to understand

Late childhood – social development

   Age 7 – like activities they can do alone, want approval of others Age 8-10 – more group oriented, form groups with members of own sex, ready to accept others’ opinions, learn to conform to rules & standards of behaviors Age 10-12 – make friends more easily, develop awareness of opposite sex, gradually move away from their parents & dependency upon them

Late childhood needs

 Basic needs of infancy & early childhood  Reassurance, parental approval, & peer acceptance

Adolescence (12-20) – Physical development

  Most dramatic in early period Growth spurt – girls age 11-13, boys age 13 15   Muscle coordination does not occur as quickly, leads to awkwardness or clumsiness Puberty – sexual organs & secondary sexual characteristics develop – Menstruation in girls, sperm/semen in boys – Females – pubic/axillary hair, breast & hip development, body fat distribution – Males – deeper voice, more muscle mass, broader shoulders, pubic/facial/body hair

Adolescence – mental development

 Increase in knowledge & sharpening of skills  Learn to make decisions & accept responsibility for actions  Causes conflict because treated as both children & adults (grow up vs. be a kid)

Adolescence – Emotional development

 Stormy & conflicted  Uncertain, feel inadequate & insecure in trying to establish independence & identity    Worry about appearance, ability, relationships Peer group influences – can change attitudes & values Later years – self-identity established & feel more comfortable with who they are, focus on who they will become, gain more control of feelings, become more mature emotionally

Adolescence – social development

 Move away from family to association with peers  Security with people own age with similar problems & conflicts   If peers help them develop self-confidence, become more secure & satisfied Later years adults – develop more mature attitude & patterns of behavior that identify them as

Adolescence Needs

 Reassurance, support, understanding along with basic needs  Conflict & feelings of inadequacy & insecurity can lead to development of problems – Eating disorders, drug/alcohol abuse, suicide – These occur in other stages, but are frequently associated with adolescents

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Eating Disorders

Often develop from excessive concern about appearance   Anorexia nervosa - psychological disorder where food intake is drastically reduced or nonexistent – Can include excessive exercise – Results in metabolic disturbances, excessive weight loss, weakness, death if untreated Bulimia – psychological disorder where bingeing alternates with fasting or purging – Can result in metabolic disturbances, damage to teeth, weakness, death if untreated  More common in females, but does occur in males

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Chemical abuse

Use of drugs or alcohol to the point of developing a chemical dependence  Frequently begins in adolescence  Reasons for use – Relieving anxiety/stress – Peer pressure – Escape from problems – Experimentation or instant gratification – Heredity or cultural influences  Can lead to physical & mental disorders & disease  Treatment directed toward total rehab

Suicide

 One of leading causes of death in adolescents  Reasons for suicide – Depression – Grief over loss or love affair – Failure in school – Inability to meet expectations – Influence of suicidal friends/parents – Lack of self-esteem

Suicide

 Causes for increased risk – Family history – Major loss or disappointment – Previous suicide attempts – Recent suicide of friends, family, role models  Impulsive nature increases risk

Warning signs of suicide

 Verbal statements – “I’d rather be dead”  Sudden changes in appetite or sleep habits  Withdrawal, depression, moodiness  Excessive fatigue or agitation  Neglect of personal hygiene  Alcohol or drug abuse   Loss of interest in other aspects of life Injuring one’s body  Giving away possessions  Saying goodbye to loved ones

Suicide

 Attempts are a cry for help – Usually person responds to assistance – Should NEVER be ignored  Prevention of suicide – Provide support & understanding – Psychological or psychiatric counseling

Early adulthood (20-40) – Physical development

 Frequently most productive life stage  Development complete  Motor coordination at its peak  Prime childbearing time – Usually produces healthier babies – Male/female sexual development at its peak

Early adulthood – mental development

 Continues through this stage – additional education common  Make many decisions, form judgments – Deal with independence – Make career choices – Determine life style & select marital partner – Start a family – Establish values

Early adulthood – emotional development

  Preserving stability established previously Many emotional stressors – family, careers, marriage  Find satisfaction in achievements  Take responsibility for actions  Learn to accept criticism & profit from mistakes

Early adulthood – social development

 Move away from peer group  Associate with others who have similar ambitions & interests, regardless of age  Own family becomes very important  Do not necessarily accept traditional sex roles & frequently accept nontraditional roles (both male & female nurses, doctors, administrators, teachers, etc)

Middle adulthood (40-65) – Physical development

 Physical changes – Hair grays & thins – Wrinkles appear, muscle tone decreases – Hearing & vision loss – Weight gain occurs – Females -Menopause – end of menstruation – Males have slowing of hormone production, often called male menopause but never lose the ability to reproduce unless due to injury, disease, or surgery

Middle adulthood – mental development

 Mental ability continues to increase  Many seek educational opportunities  Acquired life understanding  Confident decision makers  Excellent at analyzing situations

Middle adulthood – emotional development

 Can be period of contentment & satisfaction or a time of crisis    Emotional status is determined by emotional foundation of previous stages Emotional satisfaction – job stability, financial success, end of child rearing, good health Emotional stress – loss of job, fear of aging/loss of youth, illness, marital problems, problems with children or aging parents  Emotional status varies determined by events occurring during this stage

Middle Adulthood – social development

 Family relationships may see a decline – Children begin lives of own – Parents die  Work relationships may replace family  Marital relationships may become stronger or can end in divorce  Friendships are usually with people who have same interests & lifestyles

Late adulthood (65 and up) – Physical development

 Declining with all body systems affected  Skin dry, wrinkled, thinner with brown or yellow spots  Hair thin, loses shine  Bone brittle & more porous, likely to fx  Cartilage between vertebrae thins leading to stooped posture  Muscle tone decreases  Hearing & vision loss  Decreased tolerance for heat & cold

Late adulthood – physical development

 Heart is less efficient, circulation decreases  Kidney & bladder less efficient  Breathing capacity decreases  These changes occur SLOWLY & many people DO NOT show signs until their seventies or eighties

Late adulthood – mental development

 Varies, people who remain active show less decline    Short term memory first to go Alzheimer’s disease – Irreversible loss of memory – Deterioration of intellectual function – Speech & gait disturbances – Disorientation Arteriosclerosis – thickening & hardening of arterial walls that can decrease blood to brain & cause a decrease in mental acuity

Late adulthood – emotional development

 Some cope well with aging, others become lonely, frustrated, withdrawn, or depressed  Emotional adjustment necessary – Retirement – Death of spouse or friends – Physical disabilities – Financial problems – Loss of independence – Knowing that life must end  Usually people adjust as they have previously

Late adulthood – social development

 Retirement – can lead to loss of self-esteem, especially if identity is closely related to work  More limited circle of friends  Many people start new activities & make new friends while others limit relationships  Changes in social relationships occurs with spouse & friend deaths & moves to new environment  Development of social contacts important – Senior centers, golden age groups, churches

Late adulthood needs

 Same as those of all ages  Sense of belonging  Self-esteem  Financial security  Social acceptance & love

Death & Dying

 Final stage of growth  Experience by everyone, cannot be evaded  Young people tend to ignore it  Elderly often think of own deaths

Terminal disease

 Disease that cannot be cured & will result in death  Some people react in fear – Pain, abandonment, loneliness – Unknown – Anxious about loved ones – Anxious about unfinished work & dreams  Others view death as a final peace – Lived a full life – Strong religious beliefs – Relief from suffering, pain, loneliness

Elisabeth Kubler-Ross

 Extensive research on death & dying  Results of research show – Most HCP believe that pt. should be told of approaching death – Should be left with some hope & reassured that they won’t be left alone – Important to know how much info pt has & how they reacted

5 stages of grieving

 Experienced in preparation for death  Stages may not occur in order & may overlap or be repeated several times  Some patients may not progress through them  May be in more than one stage at the same time  Denial, anger, bargaining, depression, acceptance

DENIAL

 “No, not me!”  Usually occurs when first told   Cannot accept reality of death or feel loved ones cannot accept “The dr. doesn’t know anything”, “Tests must be wrong”  Seek a second opinion, want more tests  Refuse to discuss illness

Dealing with denial

 Help pt. discuss feelings & listen to pt  Provide support without confirming or denying  “It must be hard for you”, “You feel more tests will help?”  Allow pt to express feelings

ANGER

  Pt is no longer able to deny death “Why me?”, “It’s your fault”  May strike out at HCP, are hostile & bitter  Blame themselves, loved ones, or HCP for illness  Understand that anger is not personal attack on HCP but is due to situation  HCP should provide understanding & support by listening to pt & making every attempt to answer demands quickly & kindly

BARGAINING

 Pts accept death but want more time  May turn to religion   Will to live is strong Pt fights hard to achieve goals set family, hold a grandchild – wait to die until child graduates, arrange care for   May make promises to God HCP role – be supportive & listen, help pts achieve goal if possible

DEPRESSION

 Occurs when pt realizes death will come soon – will no longer be with family & are unable to complete goals   May express regrets or become withdrawn & quiet HCP role – let pt. know it’s ok to be depressed, provide understanding, support, touch. Allow pts to cry or express grief

ACCEPTANCE

 Understand & accept the fact that death is going to occur  May complete unfinished business  Try to help loved ones deal with death   Gradually separate selves from world & others HCP role – provide emotional support, realize presence is important

Care of dying patients

 Provide supportive care  HCP need to understand own feelings about death & come to terms  Feelings of fear, frustration, & uncertainty about death can cause HCP to avoid dying pts or provide poor care

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Hospice care

Palliative care – provides support & comfort NOT cure  Usually in pts home, but can be inpatient    Usual life expectancy is 6 months or less Pt may be reluctant to start care – almost at acceptance that death will come Philosophy – DEATH WITH DIGNITY & COMFORT   Provides opportunity for closure Provides comfort – hospital equipment, counseling, free or reduced cost pain meds

Hospice care

 Want pt to have quality of life  Personal care, nursing care, social work, minister, respiratory therapy, volunteers  After death, hospice personnel often maintain close ties with families

Right to die

 Ethical issue  Pts have right to refuse care  Advance directives – living will, durable power of attorney  Euthanasia illegal, but can withhold CPR, ventilators, pacemakers, etc.

Human Needs

 Needs – lack of something that is required or desired  Humans have needs from birth until death  Needs motivate us to behave or act to meet the need  Certain needs have priority over others – Food more important than social status

Maslow’s Hierarchy of Needs

 Abraham Maslow

Maslow’s Hierarchy of Needs

Lower needs must be met first Once lower need is met, then can move up hierarchy

Maslow’s Hierarchy

 1 st level – physiological needs – Physical – required for life – Food, water, oxygen, elimination, sleep, protection from temperature extremes – If some are not met, death occurs (priority needs) – Sensory & motor needs allow us to respond to environment (hearing, sight, touch, smell, taste, mental stimulation) – Many needs are controlled automatically by body – HCP need to be aware of how illness interferes with needs – NPO, anxiety, sleep, meds, age

Maslow’s hierarchy

 2 nd level – Safety – Freedom from anxiety & fear, feeling of security in environment – Need for order, routine, familiar – changes threaten safety – Illness a major threat – pts may not understand illness, tests, meds, etc. HCP needs to explain fully & help pt. adapt to situation

Maslow’s hierarchy

 3 rd level – Love & affection – Social acceptance, friendship, & love – Motivated by need to belong & have relationships with others – Satisfied with friendships, social contacts, acceptance, sexuality – Sexuality continues throughout life – infant through late adulthood, may be threatened by illness

Maslow’s hierarchy

 4 th level – Self Esteem – Feelings of importance & worth – Others show respect, approval, appreciation – Illness can cause lack of self esteem • Dependent upon others for personal cares • May become incontinent • Worry about job or income loss, wellbeing of family, disability or death

Maslow’s hierarchy

 5 th level – Self actualization – Self-realization – person has obtained the full potential, they are what they want to be – Confidence, willing to express beliefs & stick to them, willing to help others

Meeting needs

 Needs met, successful action = happy person   Needs unmet, unsuccessful = tension & frustration Sometimes need to determine priority – for example, food vs. sleep  Feel needs at different intensities, greater need, more motivated to act

Methods of meeting needs

 Direct – Work at meeting need & obtaining satisfaction – Hard work, goal setting, evaluating situation, cooperating – In working to pass test • Can work harder (study longer, listen more) • Set realistic goals (read new material, study every night) • Evaluate situation to see why may be failing (too tired, fall asleep in class = get more sleep) • Can cooperate with others (get help from teacher, study group, tutor)

Methods of meeting needs

 Indirect methods – Work at reducing need or relieving tension produced by unmet need.

– Need is still present, but intensity decreases – Defense mechanisms main method • Unconscious acts helping a person deal with unpleasant situations or unacceptable behavior • Everyone uses them • Maintain self esteem & relieve discomfort • Can be healthy, allows coping • Can be unhealthy if used all of the time & substituted for appropriate ways of dealing with need

Defense Mechanisms

 Rationalization – Using reasonable excuse for behavior to avoid real reason or true motivation – If you need a lab test, avoid it by saying “I can’t get time off of work” rather than admit fear.

Defense Mechanisms

 Projection – Placing blame for your own actions on someone or something else rather than accepting responsibility – “I failed the test because the teacher doesn’t like me” rather than “I failed because I didn’t turn in my work” – “I’m late because the alarm didn’t go off” instead of “I’m late because I didn’t set the alarm clock” – Lets you avoid saying you made a mistake

Defense Mechanisms

 Displacement – Transferring feelings about one person to someone else – Usually occurs because person cannot direct feelings towards person who is responsible – Made at your mom so you hit your sister

Defense Mechanisms

 Compensation – Substitution of one goal for another goal in order to achieve success – Can be healthy if substitute goal meets needs – Can’t sing so you play the guitar – Want to be a dr. but can’t afford med school, so you become a nurse

Defense Mechanisms

 Daydreaming – Dreamlike thought process occurring when person is awake – Means of escape when person is not satisfied with reality – Good if it helps a person establish realistic goals – Bad if it is a substitute for reality – Person dreams about becoming a dr. but doesn’t do any work in school.

Defense Mechanisms

 Repression – Transfer of unacceptable or painful ideas, feelings, & thoughts into unconscious mind – Person not aware this occurs, so it allows them to forget fear or feeling – Feeling does not vanish, but often resurfaces in dreams or affects behavior – Person afraid of heights but doesn’t know why, perhaps something occurred in childhood that they have repressed

Defense Mechanisms

 Suppression – Similar to repression – Aware of unacceptable feelings but refuses to deal with them – May substitute work, hobby, or project to avoid situation – Woman finds breast lump, refuses to go to dr., goes to gym & fills up time with exercise – Ignoring situation causes increased stress – Eventually will have to deal with problem

Defense Mechanisms

 Denial – Disbelief of an event or idea that is too frightening to cope with – Often not aware that you are in denial – Frequently occurs with terminal diagnosis – Dr. is wrong, I want a second opinion – Denial turns into acceptance when person ready to deal with event or idea

Defense Mechanisms

 Withdrawal – Cease to communicate or remove self physically from situation – Can be a satisfactory way to avoid conflict\ – Example – you are working with an unpleasant individual so you ask for a transfer – At times, interpersonal conflict CANNOT be avoided – Need to use open & honest communication in order to improve the relationship