Presentation on theme: "Life Span Developmental Crisis"— Presentation transcript:
1Life Span Developmental Crisis Prof.Dr.Zeinab A.HalimProfessor of Psychiatric Mental Health NursingFaculty of Nursing-Cairo University
2Learning Objectives Define the term life span Describe the specific situational and maturational crises of child, adolescent, adult and old age.Describe the common responses associated with each developmental stage.Plan general and specific psychosocial interventions for each group of populations.
3DefinitionsLifespan is potential maximum number of years a person can live ( years)Life expectancy is the average number of years one can expect to live (72 years for men & 79 years for women)Centenarian is a word used to denote a person who has reached 100 years of age
4Developmental theory Interpersonal views of development regarding Erick EricksonDevelopmental tasksPhase(approximate age span)Trust versus mistrustInfancyAutonomy vs. shame and doubtToddlerInitiative vs. guiltPreschoolIndustry vs. inferioritySchool ageIdentity vs. identity diffusionAdolescentIntimacy vs. isolationAdultGenerativity vs. stagnationLate adulthoodIntegrity vs. despairOld age
5Life Span Development Problems of disturbed attachment Childhood periodCommon situational and maturational crises may be due impaired parent child attachmentProblems of disturbed attachmentThe disruption and separations have been linked to:Development of grief, anger,Denial, and despair, that may lead topsychopathology.
6Life Span Development cont’d. Adolescent's crisisAdolescent's needs:Needs to find and confirm his/her identity.Needs to accept his own bodyNeeds to develop his own bodyNeeds to develop positive self awareness, insight.Needs to be independent from adult dominantNeeds to develop effective coping skills to handle the normal changes going on his life.
7Life Span Development cont’d Maturational crisisNegative sexual body imageNegative self conceptAnxiety, tension, guiltLow self-esteemHelplessness
8Life Span Development cont’d Situational crisisPhysical illnessSubstance abuse
9Life Span Development cont’d Psychosocial interventionfor adolescent's crisesThe psychosocial aspects of primary care adolescent are best incorporated into the overall care of the adolescent. Not just after specific behavioral problems arise.The therapists must be acquainted with adolescent, as well as theadolescent's family, peers, and school. So the intervention will bedivided into two main aspects:Providing individual care for adolescent.Providing community care (family based care, and school-basedstrategies) for adolescent.
10Psychosocial intervention for adolescent's crises cont’d. Providing individual care for adolescent :a- Building self-esteemBy maintaining eye contact, address the individual by her name, actively listening to her which make adolescent feels more acceptance and valued.Do not lecture or give advice, because adolescents heat lectures and advices.Direct them toward problem solving and assuming responsibility for their own feelings. Convey respect by requesting rather than ordering and by thanking them for their help .Praise each small effort toward success, and point out the adolescent's progress.
11Psychosocial intervention for adolescent's crises cont’d. b- Skill developmentApplying the problem=solving process to actualproblems.Help them in practicing appropriate social skills.Working cooperatively within group, learning how to listen to others, and exploring new methods for controlling anger and aggression.
12Psychosocial intervention for adolescent's crises cont’d. Providing community care(family based care, and school-based strategiesSullivan (1991) cited research that gives us important informationabout what works best:One-to-one individual attention. A responsible, invested adult in every young person's life is essential. This can be a parent, teacher, counselor, or health care provider, or another adult who is able to care what happens.Involvement of parents with adolescents' problems.
13Psychosocial intervention for adolescent's crises cont’d. Providing community care(family based care, and school-based strategies cont’d.Comprehensive programs that include social and mental health services, after school child care, and primary health care should be developed.Community involvement in developing comprehensive solutions to complex problems. Multiple agencies need to develop collaborative goals and plans, and pool resources where appropriate.
14Life Span Development Adult’s needs Adulthood’s period Needs to be more satisfied in his employment.Needs to be more sociable with other sex.Needs to be more independent .Needs to form a new family unit.Needs to be more confidence in himself.Needs to maintain a real intimacy with others.
15Life Span Development cont’d. Adulthood’s period cont’d.Adult’s crisis
16Adulthood’s period cont’d. Adult’s crisisA- Maturational crisisDecision crisisUnplanned pregnancyOccupational changeDependency problemsParenthood issue problems.Lack of meaningful work.
17Adulthood’s period cont’d. Adult’s crisisExamplesB- Situational crisisPhysical disorders.Death and dying,Tasks of mourning,Divorce and separationSubstance abuseSexual abuse.InfertilityDivorce
18Adult’s crisis cont’d. Eight Typical Phases of Emotional Reaction:
19Psychosocial intervention for adult's crises To give appropriate support of the client in one of these crisis situation the helper must understand the following:The stages of grief when a loss is experienced.The experience of normal grief.The principles and procedures for loss interventions
20Psychosocial theories of aging Life Span DevelopmentElderly PopulationPsychosocial theories of agingPsychological theories of aging explore the mental process, behavior and feelings of persons throughout the life span along with some the mechanisms people use to meet the challenges they face in old age. Sociological theories address the impact of society and the elderly on each other.
21Elderly Population cont’d. Examples Psychosocial theories of aging1-Disengagement TheoryIt views aging as a process in which society and the individual gradually withdraw or disengage, from each other, to the mutual satisfaction and benefits of both.The benefit to individuals is that they can reflect and be centered on themselves, having been freed from social roles.The value of disengagement to society is that some orderly means is established for the transfer of power from the old to the young making it possible to society to continue functioning after its individual members die
22Elderly Population cont’d. Examples Psychosocial theories of aging2- Developmental tasks theory (Erik Erickson, 1963):It proposes that healthy psychological aging is the result of the successful fulfillment of developmental tasks.The challenge or tasks of old age is to accept and find meaning in life; this gives ego integrity that aids in adjusting and coping with the reality of aging & mortalityFeeling of anger, bitterness, depression, & inadequacy can result in inadequate ego integrity.
23Elderly Population cont’d. Examples Psychosocial theories of agingCohort- based, Context, Maturity, Specific Challenge (CCMSC) modelA geronto- psychotherapeutic life span approach by (Knight, 1996). It outlines 4 factors to be considered in psychotherapy
24Cohort- based, Context, Maturity, Specific Challenge (CCMSC) model FactorConsideration1. Cohort factorsIndividual cognitive performance, verbal fluency, education, normative course of life, life experience from a social historical view point2. Context effectsCurrent environmental characteristics such as age – adapted accommodations, residential facilities, & spare time options. General & social health & long time care provision3. MaturityPerson’s cognitive & emotional complexities, areas of expertise & competencies, including experience in family life & person’s accumulated interpersonal competencies4.Specific challengesChronic diseases, disabilities, & grieving while experiencing deaths of relatives & friends, as well as the person dealing with their own end- of- life, including preparation for death.
25Elderly Population cont’d. Psychosocial NeedsIn general they are six psychosocial needsFor autonomy and independenceFor dignity, credibility, and respectFor identity and individualityFor communicationFor belongingFor touch
26Elderly Population cont’d. Common psychosocial problems of elderly population:1- Loss (personal losses, social losses status or prestige change).Multiple losses compel older persons to expend enormous amounts of physical and emotional energy in grieving, adapting to the changes that result from loss, and recovering from stress inherent in these processes.2- Life crises (widowhood, marital problems, sexual problems, retirement, financial worries, sensory loss).3- Rejection.4- Powerlessness
27Elderly Population cont’d. Common emotional reactions as expressed in old age:Grief & mourningGrief & mourning reaction scenario:1- Loss2-Inability to accept the loss3-Shock of reality4-Physical feelings of emptiness, weakness, perhaps a feelingof suffocation, shortness of breath, & a tendency to deep sighing5-Experience of great distress6-There may be a sense of unreality, including delusions &obsessive preoccupations with the image of the lost person
28Elderly Population cont’d. Common emotional reactions as expressed in old age:Grief & mourning reaction scenario cont’d. :7- Experience of disorganization, anger, irritability, eventoward friends & relatives.8-Anxiety alternate with depression & despair9-Acute grief ordinarily lasts a month or2 and then begins tolessen; on the average, it may be largely over in 6 to 12months.10-Exaggerated grief reaction may occur11-Morbid grief reactions are distortions or prolongations oftypical grief (months or years)
29Elderly Population cont’d. Common emotional reactions as expressed in old age cont’d. :
30Elderly Population cont’d. Common Emotional Problems of AgingLossesLoss of relationships with peopleLoss of significant others and confidantsLoss of peer group and collegial relationshipsFinancial lossesLoss of possessionsAwareness of declining healthDeterioration of own healthDiscomforts and painConfinement and immobilityPhysical changesMonotony of daily encountersAbsence of personal privacyEnforced idleness
31Common Emotional Problems of Aging cont’d. PowerlessnessPowerlessness against others and the worldVulnerability: being a spectatorUnreliability of othersUnpredictability of others and "the fates"Indignities and dependenceBeing exposed to propagandaBeing "talked into" accepting something That isnot wontedHaving information withheldNot receiving accurate information
32Common Emotional Problems of Aging cont’d. Powerlessness against timeNot knowing the duration of confinementSensing a meaningless existenceSensing threats to life and healthAwareness of deathDeterioration of significant others' healthConfinementBurden of caring for othersRefectionFeeling forgottenBeing forgottenFeeling unworthy or unacceptable
33Common Problems of Aging Comparison of Dementia and DepressionDEMENTIADEPRESSIONRapidInsidious, indeterminateOnsetShortLongDurationConsistently depressedMood/behaviorFluctuatesProvides a close, but usuallyincorrect answer to question"Do not know"ResponseHighlightConcealedDisabilitiesCognitionRelatively stableFluctuates greatly
34Specific interventions related to Elderly Population 1- Assessment of psychosocial statusThree interrelated dimensions are usually considered in gathering information for a psycho-social assessment of an elderly person- These include:(1) psychological state(2) developmental satisfaction(3) social effectiveness.
35Assessment of psychosocial status cont’d. Psychological StatePsychological state can be thought of as being composed of five separate facets:(l) The client's view of self(2) His thought content(3) Affect and mood(4) Stress management and coping styles(5) Behavior
36Assessment of psychosocial status cont’d. Psychological State cont’d.The questions and statements presented below may be helpful in determining an overall assessment of the client's view of self1. Tell me what it's like for you to be 72 (or whatever his age).2. Tell me about what aging is like.3. Tell me about what your aging has been like.4. What is the ideal old person like? Tell me what most old peopleare like.5. How are you like the ideal old person? How are you different?6. If you had to describe yourself in three words, what would theybe?7. How do you feel about growing older?
37Assessment of psychosocial status cont’d. Psychological State cont’d.Tell me about the periods when you felt most successful. Do you think you were different then, or much as you are now?2. Tell me about your greatest strengths3. Tell ire about your happiest times. What about you makes you happy?4. What was the most important thing you have done in your life? What personal characteristics of yours made it happen?
38Assessment of psychosocial status cont’d. Social EffectivenessThe last facet of the psychosocial assessment of an older adult involves gathering data that can be used to determine the elderly individual's social effectiveness. The socially effective elderly person is one who is able to establish, maintain, and use social networks and interpersonal relationships to meet basic human needs
39Specific interventions related to Elderly Population cont’d. Life review therapyThis is a nursing intervention that assists the older adult in an individual basis to positively resolve Erickson’s major developmental tasks for the older adult & gain integrity). The older adult examines his life critically & reviews all aspects.Technique of life reviewA structured approach is taken with specific time allowed to focus on a review of the different life periods, such as 1 to 2 weeks on childhood, 1 or 2 weeks on the teenage years & so forth.
40Specific interventions related to Elderly Population cont’d. ReminiscenceThis is a nursing intervention that encourages the elderly person to recall or remember past events with the purpose of attaining specific goal. It may be formal (1 or twice a week) or informal with individuals or group E.g., the nurse use reminiscence to increase self- esteem or life satisfaction.Technique of Reminiscence1- Encourage the elderly person to reminisce or discuss memories &past experiences (successes & pleasurable events)2- Or in a group setting with the nurse acting as a facilitator;participants discuss different topics from their past (significantevents, birth of their children, travel, places they have lived, &holidays)
41Specific interventions related to Elderly Population cont’d Remotivation TherapyGoalsHelp achieve sense of belongingIncrease feelings of self-worth, self-reliance, and personal valueAssist individuals to maximize their potential through other-directed communication and stimulating interest in surrounding environment and peopleProceduresWelcomingCreate a bridge to realitySharing the world we live inThe work of the worldAppreciation
42Specific interventions related to Elderly Population cont’d Sensory stimulation and trainingGoalsHelp put the regressed person back in touch with surroundingsImprove sensitivity and responsiveness to the environmentIncrease discrimination abilityProceduresStructured experiences involving the five senses; e.g. visual, looking in the mirror; auditory, listening to tapes; tactile, touching textured objects, olfactory, smelling fragrant, spicy aromas, gustatory, tasting sweet, sour, bitter foods; kinesthetic, moving and dancing
43Specific interventions related to Elderly Population cont’d Behavior modification and habit trainingGoalsGive maximum support to appropriate behavior and compensatefor behavioral deficitsIncrease functional levels of the elderly and also their sense ofself-controlReduce anxietyProceduresProvide an environmental cue (stimulus) that targets, signals, or in some way helps the resident focus on the appropriate, expected behaviorProvide a positive reinforcement (reward) for achievement of the expected behavior
44Specific interventions related to Elderly Population cont’d Pet therapyGoalsAlleviate depressionEnhance self-image and identityHelp fulfill need to be loved and to love in returnHelp restore emotional equilibriumProceduresAnimals (such as dogs, cats, fish, and birds) are used as therapeutic catalysts
45Learning Activities Form groups of three students: 1- Choose a target group of adolescents, parents, teachers, or other significant caregivers.2- With this target group identify an area of need that could be dealt with through planning a program of anticipatory guidance.3- Plan and implement this program
46Learning ActivitiesIdentify the local community resources that provide supportive or mental health services to the elderly and their families. Visit oneagency and observe the types of services provided, the ages and types of clients served, the prevailing treatment focus of the agency (primary, secondary, tertiary prevention, palliation, and so on) and the prevailing attitudes of the health care providers toward the elderly.Select one client over the age of 65 who is in a general hospital for treatment, of an acute or a chronic physical illness. Perform a comprehensive mental health assessment and then plan an intervention program with the client, the focus of which is primary prevention. Include consideration of personal resources, strengths, family and social networks, and community resources as you both plan the intervention program. Evaluate the plan of care.