Developmental Stages and Comfort/Rest/Sleep

Erikson’s Psychosocial stages

100

Infancy stage (0-1 year) conflict/virtue/description

Conflict: Trust vs Mistrust

Virtue: Hope

Description: Trust(or mistrust) that basic needs such as nourishment and affection will be met.

200

Early Childhood stage (1-3 years)

conflict/virtue/description

Conflict: Autonomy vs Shame/doubt

Virtue: Will

Description: Develop a sense of independence in many tasks.

300

Play Age stage (3-6 years)

conflict/virtue/description

Conflict: Initiative vs Guilt

Virtue: Purpose

Description: Take initiative on some activities. May develop guilt when unsuccessful or boundaries are overstepped.

400

School Age stage (7-11 years)

conflict/virtue/description

Conflict: Industry vs. Inferiority

Virtues: Competence

Description: Develop self-confidence in abilities when they are competent or sense of inferiority when they are not.

500

Adolescence stage (12-18 years)

conflict/virtue/description

Conflict: Identity vs Confusion

Virtue: Fidelity

Description: Experiment with and develop identity and roles.

Erikson’s Psychosocial stages Continued

100

Early Adulthood Stage (19-29 years)

conflict/virtue/description

Conflict: Intimacy vs. Isolation

Virtue: Love

Description: Establish intimacy and relationships with others.

200

Middle Age stage (30-64 years)

conflict/virtue/description

Conflict: Generativity vs Stagnation 

Virtue: Care

Description: Contribute to society and be part of a family.

300

Old Age stage (65 onward)

conflict/virtue/description

Conflict: Integrity vs. Despair

Virtue: Wisdom

Description: Assess and make sense of life and meaning of contributions.

400

Growth

Growth takes place during the first 20 years of life.

500

Psychosocial Development

Divides the lifespan into eight stages

Different psychosocial tasks to complete at each stage 

Piagets Stages of Cognitive Development

100

Sensorimotor

Age/What happens?

Age: 0-2 years

What happens?: Coordination of senses with motor responses and sensory curiosity about the world. Language used for demands and cataloguing. Object permanence is developed.

200

Preoperational

Age/What happens?

Age: 2-7 years old

What happens?: Symbolic thinking, use of proper syntax and grammar to express concepts. Imagination and intuition are strong, but complex abstract thoughts are still difficult. Conservation is developed.

300

Concrete Operational

Age/What happens?

Age: 7-11 years old

What happens?: Concepts attached to concrete situations. Time, space, and quantity are understood and can be applied, but not as independent concepts.

400

Formal Operational

Age/What happens?

Age: 11 years and older

What happens?: Theoretical, hypothetical, and counter factual thinking. Abstract logic and reasoning. Strategy and planning become possible. Concepts learned in one context can be applied to another.

500

Cognitive Development 

4 stages

Theory of cognitive development that begins at birth and continues until adulthood. Uses experience to move from stage to stage.

Comfort Rest and Sleep

100

Stages of sleep:

Stage 1

• Non-rapid eye movement (REM) sleep
• Breathing remains regular, and muscle tone is present
• Body temperature starts to decrease
• 5% of a person’s total sleeping time
• 
  

200

Stages of sleep:

Stage 2

• Non-REM sleep
• No eye movements detected, heart rate and breathing decrease, and muscles relax
• 50% of a person’s total sleeping time

300

Stages of sleep:

Stage 3

• Non-REM sleep
• The brain activity, through an EEG, shows the delta wave
• Body’s short-term hibernation period
• Immune system strengthens
• Muscles and tissues relax
• 15% of a person’s total sleeping time
• 
  

400

Stages of sleep:

Stage 4

• REM sleep
• The heart rate and blood pressure increase
• Muscle mobility and body temperature decrease further
• Brain activity, as noted in an EEG, increases
• 20% to 25% of a person’s total sleeping time
• 
  

500

Recommended hours of sleep for each age

• Newborns (birth to 3 months): 14 to 17 hours
• Infants (4 months to 1 year): 12 to 16 hours
• Toddlers (1 to 2 years): 11 to 14 hours
• Preschool (3 to 5 years): 10 to 13 hours
• School-age children (6 to 12 years): 9 to 12 hours
• Adolescents (12 to 18 years): 8 to 10 hours
• Adults (18 to 60 years): 7 or more hours
• Adults (61 to 64 years): 7 to 9 hours
• Adults (65 years or older): 7 to 8 hours

Comfort Rest And Sleep Continued

100

Effects of sleep deprivation

• Negatively affects higher-order cognitive processes.
• Impairs judgment.
• Decreases response time.
• Can trigger seizure disorders, migraines, and tension headaches.
• Places clients at increased risk for accidents, depression, stroke, mood swings, and other sleep disorder conditions.
• Worsening cognitive effects can lead to obesity and poorly controlled blood sugars in clients with type 2 diabetes.

200

Pharmacologic methods used to promote sleep

• A sleep study is usually performed prior to any pharmacologic therapies.
• Nonbenzodiazepine hypnotics (zolpidem, zaleplon, and eszopiclone)
• Melatonin
• OTC medications (doxylamine, succinate, and diphenhydramine)

300

Nonpharmacologic interventions to improve sleep

• Therapies such as acupuncture, thermotherapy, and massage.
• Avoid stimulants, such as caffeine, alcohol, and nicotine, at least 4 to 6 hours before bedtime.
• Remove any unnecessary light and noise; substitute calming white noise if necessary.
• Establish a bedtime routine (e.g., taking a warm shower or bath before bedtime).
• Keep the room dark, quiet, and at a comfortable, cold temperature.
• Only go to bed when tired. 
• 
  
  • If the client feels restless while attempting to sleep, they should go to another room and do a simple activity like reading or listening to preferred music.
• Keep a consistent sleep–wake cycle by going to bed and waking at the same time (allows the body to fall into a biological rhythm).
• Keep naps short, less than 30 minutes.
• Engage in a regular exercise routine, along with healthy eating; complete exercising at least 3 hours before going to bed.
• Remove all work items and TVs from the bedroom when possible. The bedroom should be associated with sleep and sexual activity only.

400

Sensory overload

• Receiving stimuli at a rate and intensity beyond the brain's ability to process the stimuli in a meaningful way.
• Can be very common in a hospital setting due to various lights, noises, procedures, etc.
• Nurses should be especially aware of sensory overload when in an acute care setting. Evidence-based data show that this population of clients generally has a lower quality of sleep (pain and discomfort, disturbed frequently, subject to increased noise levels, given pharmacologic agents that may influence sleep)

500

How to decrease sensory overload 

• Lowering noise levels, lowering alarm volumes, establishing a “quiet time”
• Dimming lights at night
• Providing clients with blindfolds and earplugs when appropriate
• Coordinating and organizing care to minimize interruptions (combining tasks).
• Controlling patients’ pain and monitoring the effects of all medications