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Chapter
10
Life Cycle
Instructional Approaches
Approach: Basic Concepts of Growth and Development
Because nurses care for clients at all stages of the life cycle, it is important for nurses to understand the
basic concepts of growth and development to provide effective and appropriate care. Ask students to
identify the terminology and basic concepts of growth and development.
DISCUSSION/LECTURE
Growth, the quantitative changes in physical size of the body and its parts, occurs throughout the life cycle.
An individual’s growth rate is not steady but varies from periods of rapid increase, especially during the
prenatal, infant, and adolescent stages, to slower progress, such as during adulthood. Development refers to
behavioral changes in functional abilities and skills that are qualitative in nature. Maturation, the process of
becoming fully grown both physiologically and behaviorally, is based on an individual’s biologic growth,
functional changes, and learning. In each stage of the life cycle, certain developmental goals or tasks must
be achieved; achievement of these tasks is the foundation of future learning, the assimilation of information
that results in a change in behavior. The time of most rapid growth and development in a particular stage in
the life cycle is called the critical period. During this period, an individual is especially vulnerable to any
type of stressor. The processes of growth, development, maturation, and learning are interdependent.
Because it is impossible to predict the exact rate of development for any specific person, nurses should
be familiar with some general principles of human growth and development, summarized here.
Development occurs from head to toe (cephalocaudal), from midline (proximal) to outlying parts (distal),
and in an orderly manner from simple to complex and from general to specific. Growth and development
occur in a continuous, predictable pattern for all individuals but at an inconsistent individual rate; each
developmental stage has specific characteristics, with certain tasks to be achieved during that specific time
period. Each developmental stage forms the foundation for subsequent stages; and some stages of growth
and development are more critical than others.
Approach: Factors that Influence Growth and Development
A variety of factors influence human growth and development. Ask students to identify the major factors
and discuss why they are important for nurses.
DISCUSSION/LECTURE
The interaction of factors such as heredity, life experiences, health status, and cultural expectations affects
an individual’s growth and development, response to daily life situations, and choices about health
behaviors. Heredity—a person’s genetic inheritance from her or his parents—determines physical
characteristics, body structure, and predisposition to certain diseases, and influences a person’s rate of
physical growth and mental development. A nurse should recognize that a client may have inherited health
problems such as cystic fibrosis, hemophilia, or Down syndrome, which may pose significant obstacles to
normal growth and development. Life experiences play an important role in growth and development. The
mental development of babies who are exposed to a variety of objects from an early age generally exceeds
that of babies who lack mental stimulation; likewise, children who grow up in a family environment where
reading is prized generally progress more rapidly in a school setting than those whose families are not
interested in books or cannot afford reading materials. A nurse should take the person’s life experiences
into account when obtaining developmental information. A person’s health status also affects growth and
development; the person who has repeated illnesses or a congenital heart defect may experience delayed
development. A nurse should take into consideration the impact of any health problem on a client’s growth
and developmental status. Cultural expectations establish expected norms for mastery of certain
developmental tasks, which may vary with specific individuals within the cultural group. A nurse should
have some idea of the expectations about growth and development for those cultural groups represented in
a given community.
Approach: Dimensions and Theories of Human Development
A number of developmental theories have been formulated to explain human growth and development in
the physiological, psychosocial, cognitive, moral, and spiritual dimensions. Summarize the important
points of theories in each of these categories and the names of key theorists in each dimension.
DISCUSSION/LECTURE
Physiological growth is affected by the interaction of genetic predisposition, maturation, the central
nervous system, and the endocrine system. Psychosocial growth and development is greatly influenced by
self-concept—the perception of self that includes body image, self-esteem, and ideal self. People who have
a healthy self-concept usually set achievable goals, and this goal achievement reinforces a positive belief
about themselves; they are also more likely to engage in health-promoting behaviors. Two major theories
that explain development of self-concept are intrapsychic (psychodynamic) theories and interpersonal
theories. Intrapsychic theories focus on a person’s individual unconscious processes, such as feelings,
needs, conflicts, and drives, which serve as motivators of behavior, learning, and development.
Interpersonal theories focus on the individual’s relationships with others. Key intrapsychic theorists
include Freud and Erikson; the key interpersonal theorist is Sullivan.
Piaget is the theorist most frequently associated with a developmental theory in the cognitive
dimension—the dimension of the intellectual process of knowing that includes perception, memory, and
judgment. Piaget’s theory identifies four factors that serve as catalysts to intellectual development:
maturation of the endocrine and nervous systems; action-centered experience leading to discovery; social
interaction with opportunities to receive feedback; and a self-regulating mechanism that responds to
environmental stimuli. According to Piaget, there are four major phases of cognitive development:
sensorimotor (birth to 2 years); preoperational (2 to 7 years); concrete operations (7 to 11 years); and
formal operations (11 years and beyond). Individuals vary greatly in their progress through these phases.
As they interact with the environment, individuals use the processes of assimilation (taking in new
experiences or information), accommodation (readjusting the cognitive structure to take in new
information, thereby increasing understanding), and adaptation (changing as a result of assimilation and
accommodation).
Kohlberg is the major theorist in the moral dimension—the personal value system that helps
distinguish between right and wrong. According to Kohlberg, a person’s ability to make moral judgments
and behave in a morally correct manner develops over time and consists of three levels, each building on
the previous one: preconventional (birth to 9 years), conventional (9 to 13 years), and postconventional (13
years and beyond). Each level contains two stages. Kohlberg theorized that few people move through the
stages in Level III.
A sense of personal meaning represents the spiritual dimension. Spirituality refers to relationships with
self, others, and a higher power or divine source—not a specific religious affiliation—and is a lifelong
process. Fowler, the principal theorist in the spiritual dimension, describes a prestage and six distinct stages
of faith development; while there is variation in the age at which individuals experience each stage, the
sequence remains the same.
Approach: Holistic Framework for Nursing
Discuss why it is important for nurses to use a holistic framework to assess clients’ growth and
development.
DISCUSSION/LECTURE
For nursing interventions to be effective, they must be geared to the client’s developmental stage. Nurses’
knowledge of growth and development provides a holistic perspective for assessing individual development
across the life span and for recognizing when developmental progress is not at expected levels in any
dimension. When alterations in a client’s expected developmental patterns are detected, the nurse
recognizes the need for intervention. The nurse’s holistic perspective—that an individual’s physiological,
spiritual, psychosocial, moral, and cognitive dimensions are integrated—maintains focus on caring for the
whole person in a developmentally appropriate way.
Student Learning Activities
1. Small group activity and classroom discussion tool: Assign students to small groups and have each group
prepare a report about one or two of the significant developmental stages in the life cycle and present it
to the class. Students can select the prenatal or neonatal stages, infancy or toddler stages, preschool or
school age stages, preadolescent or adolescent stages, young or middle adult stages, or the older adult
stage. Each report should identify significant developmental characteristics and milestones of the
stage(s) selected and major nursing implications for care of clients in the stage(s), including promotion
of wellness and safety concerns. If possible, ask each group to bring a representative of the stage being
discussed to the class session; if the stage is one in which verbal communication skills have been
developed, the group should ask the individual questions or discuss his or her perception of the
developmental stage. If class time is limited, have each group place its report in the library or other
accessible place for other class members to review.
2. Classroom discussion tool: Based on your knowledge of the health care facilities in which students have
clinical practice experience, identify the developmental stage of clients most frequently encountered in
the facilities and for whom students will be assigned to care. For example, if students are most likely to
be assigned to middle or older adult clients, discuss the special needs of these clients. What types of
health problems are these clients most likely to have? What are their health promotion needs? How can
students use a holistic perspective to anticipate the various needs of these clients?
3. Role play and classroom discussion tool: Assign students to assume the identity of clients of various
developmental stages and to interact with other students who play their nurses. Ask the “client” students
and the “nurse” students to discuss their feelings and any insights they gained about the experience.
4. Classroom discussion tool: Discuss the developmental needs of intergenerational families where
members of various life cycle stages are living together. How can nurses help these family members to
achieve their developmental tasks?
Resources
Diehl, M., Coyle, N., & Labouvie-Vief, G. (1996). Age and sex differences in strategies of coping and
defense across the life span. Psychology of Aging, 11(1), 127–139.
Gabbard, C. (1999). Lifelong motor development. Boston: Allyn & Bacon.
Hoyer, W. J., Rybash, P., Roodin, P. A., & Rybash, J. M. (2003). Adult development and aging (5th ed.).
New York: McGraw-Hill College Division.
Murray, R. B., & Zentner, J. P. (1997). Health assessment and promotion strategies through the life span.
Stamford, CT: Appleton & Lange.
O’Brien-Palmer, M. (1999). Watch me grow: Fun ways to learn about my cells, bones, muscles, and joints.
Chicago: Chicago Review Press.
Pillari, V. (1998). Human behavior in the social environment: The developing person in a holistic context.
Pacific Grove, CA: Brooks/Cole Publishing.
Polan, E., & Taylor, D. (2003). Journey across the life span: Human development and health promotion
(2nd ed.). Philadelphia: F. A. Davis.
Puskar, K. R., & Rohay, J. M. (1999). School relocation and stress in teens. Journal of School Nursing,
15(1), 16–22.
Reed, P. G. (1998). A holistic view of nursing concepts and theories in practice. Journal of Holistic
Nursing, 16(4), 415–419.
Rice, F. P. (2001). Human development: A life-span approach (4th ed.). Englewood Cliffs, NJ: Prentice
Hall.
Scales, P. C. (1999). Reducing risks and building developmental assets: Essential actions for promoting
adolescent health. Journal of School Health, 69(3), 113–119.
Seiffge-Krenke, I. (1998). Chronic disease and perceived developmental progression in adolescence.
Developmental Psychology, 34(5), 1073–1084.
Whitman, T. L, Merluzzi, T. V., & White, R. D. (Eds.). (1998). Life-span perspectives on health and
illness. Hillside, NJ: Lawrence Erlbaum Associates.
Zauszniewski, J. A., & Martin, M. H. (1999). Developmental task achievement and learned resourcefulness
in healthy older adults. Archives of Psychiatric Nursing, 13(1), 41–47.
Web Activities
1. There are several Web sites devoted to child health that are sponsored by government agencies. Select a
Web site such as the National Institute of Child Health and Human Development, a unit of the National
Institutes of Health (NIH) (www.nichd.nih.gov), which offers links to a variety of important
information. The Agency for Health Care Policy and Research, a unit of the Department of Health and
Human Services (www.ahcpr.gov), also has an extensive child health guide. Discuss how some of the
information obtained can be used in client situations.
2. Several Web sites provide parenting tips and information about the growth and development of children;
for example, Parents Place (www.parentsplace.com), KidSource online (www.kidsource.com), the Dr.
Koop section on children’s health (www.drkoop.com), and the LookSmart section on parenting children
of various ages (www.looksmart.com). Compare the information presented on these Web sites for
accessibility, accuracy, and usefulness to parents and family members.
3. Other Web sites provide links to information about adolescents, such as the University of Michigan’s
Child and Adolescent Health site (www.med.umich.edu—use the search feature) and the Family
Education Network (http://familyeducation.com). Parents Place also provides an opportunity to research
ages and stages of development (www.parentsplace.com). Netscape offers a way to search health topics
by age and gender, including teen health: http://channels.netscape.com (click on Health). Assess the
information from these sites and determine how it could be used with clients.
4. Middleage.org (www.middleage.org) is dedicated to information about this stage. Review its definition
of middle age or other links of interest.
5. Netscape provides a source of information about senior health: http://channels.netscape.com (click on
Health). Assess the topic links presented here. Search the Web for additional sites addressing senior
health.
Suggested Responses to the Case Study
Mary Jo, age 32, and her two daughters, Sara, age 14, and Katie, age 8, live with Mary Jo’s grandmother,
age 85. Mary Jo is having difficulty dealing with her daughters and grandmother.
Consider the following:
1. At what stage of psychosocial development is each household member?
Katie: industry versus inferiority
Sara: identity versus role confusion
Mary Jo: generativity versus stagnation
Grandmother: integrity versus despair
2. Compare the cognitive dimensions of these four people.
Katie: Able to cooperate and see others’ views
Sees relationships between objects
Sara: Logical, organized
Thinks in terms of cause and effect
Extremely idealistic
Mary Jo: Realistic
Less egocentric
Grandmother: Slowed reaction time
Decreased capacity for short-term memory
Unchanged long-term memory
3. What should be the focus for enhancing wellness for each person?
Katie: Development of a healthy lifestyle, including immunizations, nutritious meals, personal
hygiene, flossing and brushing teeth, safety precautions, and regular medical and dental checkups
Sara: Health education, including hygiene, nutrition, sex education, developmental changes, and
substance abuse prevention
Mary Jo: Health education, including STDs and breast self-examinations
Grandmother: Maintenance of independence, use of leisure time, regular physical activity,
positive mental attitude
4. What are the safety concerns for each person?
Katie: Safety at play, possible abduction
Know safety rules for activities
Use caution regarding strangers
Sara: Impulsive behavior; e.g., sex = pregnancy or STD; smoking; drugs; alcohol
Mary Jo: Safe driving
Sunbathing
Grandmother: Falls
Answers to the Review Questions
1. The fact that development occurs in a proximodistal manner means that the infant is able to:
c. move his arms before picking up an object with his fingers.
2. The nurse knows that at birth the neonate’s activities are:
a. reflexive.
3. Immunizations are important during:
d. entire life span.
4. The nurse working with preadolescent children should:
b. provide an opportunity for the child to ask questions about health-related concerns.
5. A great many health problems among adolescents are related to:
b. sexual behaviors.