When It Comes To the NCLEX It’s All About Erikson

April 5th, 2012

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By , BSN, RN

I lay awake last night thinking about the NCLEX. I know it doesn’t say much for my personal life but the test has been consuming my work hours all this past week. I felt like I was missing one big topic, one issue that stands out; that you should know well as you prepare for your licensing exam. So, I called a few friends.

It didn’t take long to find the missing piece—growth and development. Every nurse I talked to mentioned some question about toddlers or school children or the differences between young and middle adulthood (where most of us are now). Growth and development theory is a key factor in critically thinking through many of the NCLEX questions. And, it’s all about Erikson.

Erik H. Erikson adapted and expanded Freud’s theory of development to include the entire lifespan; believing people continue to develop throughout life. He envisioned life as a series of levels of achievement. He believed that the greater the task achievement, the healthier the personality of the individual; failure to achieve on one level then impacts the ability to achieve on the next.

Erikson’s eight stages reflect both positive and negative aspects of each life period and they are aspects nurses must be aware of at each stage. He emphasized that people must change and adapt their behavior to maintain control over their lives. When individuals don’t satisfactorily accomplish some tasks they will often regress to an earlier stage when stressed by an illness. And, I will make no bones about it—NCLEX examiners love Erikson. That is something most of the big testing prep companies agree on.

So, with no further ado, Erickson’s Eight Stages of Development:

  1. Infancy – Birth to 18 months. This is the “trust vs. mistrust” phase. Children develop their sense of trust when their caregivers provide reliability, care, and affection. The main event at this stage of life is feeding. Trust is achieved when the infant will let the caregiver out of site without undue distress. The key is constant, consistent caregiving.
  2. Early Childhood – 18 months to 3 years. Known as the “autonomy vs. shame and doubt” stage, children at this age are developing control over their physical skills and starting to have a sense of independence. Yep, it’s the “no” age. It’s all about toilet training and walking and feeding themselves. This newfound independence is the result of maturation and imitation. success leads to feelings of autonomy; limiting choices and/or harsh punishment can lead to feelings of shame and doubt.
  3. Late Childhood – 3 to 5 years. This is the age of exploration, where kids face conflict between “initiative vs. guilt.” Success at this stage of development gives children a sense of purpose. These are the ages where they begin asserting control and power over their own environment. Children like to pretend and try out new roles. Fantasy and imagination allow them to explore their environment. Those who try to exert too much power experience disapproval and this can result in strong feelings of guilt. This is the time for parents to be teaching about impulse control and cooperative behaviors.
  4. School Age – 6 to 11 years. This stage is known for “industry vs. inferiority.” It’s off to school and learning to cope with new social and academic demands. Kids at this age thrive on accomplishments and praise. Without proper support for learning of new skills or if skills are too difficult, children may develop a sense of inadequacy and inferiority. Erikson believed the adult attitude toward work can be traced to successful achievement in this stage.
  5. Adolescence – 12 to 18 years. Being a teen is all about the friends. “Identity vs. role confusion” is the basic conflict at this age and everything is built around social relationships. There are new social demands, opportunities, and conflicts that relate to the emergent identity and separation from family. Teens need to develop a sense of self and personal identity. Success leads to the ability to stay true to what the individual believes and failure often leads to role confusion. From a nursing perspective this is a time for allowing teens to make many of their own decisions about their health and treatment plans.
  6. Young Adulthood – 19 to 40 years. This is the age of “intimacy vs. isolation.” Young adults are forming intimate, loving, relationships, if all goes well. Failure often results in loneliness and isolation from others. These are the marrying years and the beginnings of young adults ‘own families.
  7. Middle Adulthood – 40 to 65 years. Work and parenthood define this stage of life and the conflict most often seen is “generativity vs. stagnation.” Adults at this stage of life need to create or nurture things that will outlast them. This is most exemplified by raising children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world around them.
  8. Maturity – 65 years to death. This is a time of reflection. It is “ego integrity vs. despair.” Older adults will look back on life and either feel a sense of fulfillment or a sense of failure. Success at this stage leads to feelings of wisdom, while failure tends to result in regrets, bitterness, and despair. Erikson said, “Healthy children will not fear life, if their parents have integrity enough not to fear death.”

There are many other growth and development theories and as you prepare to take the NCLEX you should at least be passingly familiar with Freud and Piaget and others. But, Erikson is the man when it comes to the NCLEX. Dig out those notes from your nursing school growth and development class (family health or whatever it’s called) and know your stages.

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