Developmental Stages Actually Are Practical
Whenever we have a crop of nursing students around, I hear a lot of things like “you can use that book as a doorstop as soon as you’re out of school,” in addition to “here’s how you answer this for boards, and here’s how you do it in real life.” Unfortunately, I agree that nursing education is a lot of busywork that has little application to the way we truly do our jobs. We learn a lot of theory in school, including spending months of our lives on NANDA diagnoses and care plans. The only time I look at NANDA diagnoses as a practicing RN is to make fun of them (“Denial, Ineffective”…I don’t even know what that is). I knew this when I was in school, but I overgeneralized and glossed over things that I find myself actually needing. One example is developmental stages.
I have learned these developmental stages half a dozen times throughout my two college careers, one of which at some point included a minor in psychology, and it has finally dawned on me that these things are useful clinically. By developmental stages, I speak of those theories by Freud, Erikson, and Piaget—the three most often touted. Last I heard, parts or most of all of them have been discredited, but they are still taught because there is just something useful there.
What practical application do these stages have? Nurses can use them to facilitate communication with our patients. We do this without formally thinking about it, most likely, but deliberately reflecting on the theory behind our communication helps. It helps even more with pediatric patients. For example, I have a seeming knack for quieting screaming children, but it isn’t a knack. I paid attention in peds class on the day we discussed how these theories apply to children, and I use them. Is this 4-year-old screaming because she is pain or because she doesn’t know what the strange equipment is I am using? Is my 13-year-old only toughing it out because his friend is there and he wants to look cool? If so, and I miss that, I might also miss an injury. Talking to children to figure out where they are developmentally solves a lot of problems. Even young children can explain their fears if you ask. A 5-year-old boy I cared for recently was turning a blood draw into a rodeo until I figured out he was just concerned about what we were going to do with his blood after we took it. After I explained this to him, he still didn’t like it, but four nurses didn’t need to hold him down.
Similarly, older patients can benefit from our consideration of their life stage. Patients who are “frequent fliers” or who have vague physical complaints may simply be lonely or depressed and getting attention through the medical contact. Elderly patients may be depressed because they are engaged in their life review and not liking what they see.
Using theories like this is sort of black-belt nursing, particularly in the current environment when nurses have to get in and get out and don’t have a lot of time to engage in holistic care the way we might prefer. However, as much as I tend to agree that theory doesn’t get us very far in day-to-day nursing, I would argue that these are worth revisiting because they facilitate care—practically and not just in theory.
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