Psychiatric Mental Health Nursing by Videbeck

136 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP

Nursing philosophies often describe the person or in-
dividual as a biopsychosocial being, who possesses
unique characteristics and responds to others and
the world in various and diverse ways. This view of
the individual as unique requires nurses to assess
each person and his or her responses to plan and
provide nursing care that is personally meaningful.
This uniqueness of response may partially explain
why some people become ill while others do not.
Understanding why two people raised in a stressful
environment (e.g., one with neglect or abuse) turn
out differently is difficult: one person becomes rea-
sonably successful and maintains a satisfying mar-
riage and family, while the other feels isolated, de-
pressed, and lonely; is divorced; and abuses alcohol.
Although we do not know exactly what makes the dif-
ference, studies have begun to show that certain per-
sonal, interpersonal, and cultural factors influence a
person’s response.
Cultureis all the socially learned behaviors, val-
ues, beliefs, customs, and ways of thinking of a pop-
ulation that guide its members’ views of themselves
and the world. This view affects all aspects of the per-
son’s being including health, illness, and treatment.
Cultural diversity refers to the vast array of differ-
ences that exist among populations.
This chapter examines some of the personal,
interpersonal, and cultural factors that create the
unique individual response to both illness and treat-
ment. In determining how a person copes with illness,
we cannot single out one or two of these factors. Rather
we must consider each person as a combination of all
these overlapping and interacting factors.

INDIVIDUAL FACTORS

Age, Growth, and Development

A person’s age seems to affect how he or she copes
with illness. For instance, the age of onset of schizo-
phrenia is a strong predictor of the prognosis of the
disease (Buchanan & Carpenter, 2000). People with
a younger age of onset have poorer outcomes, such as
more negative signs (apathy, social isolation, lack
of volition) and less effective coping skills, than do
people with a later age of onset. A possible reason for
this difference is that younger clients have not had
experiences of successful independent living or the
opportunity to work and be self-sufficient and have a
less well-developed sense of personal identity than
older clients.
A client’s age also can influence how he or she
expresses illness. A young child with attention deficit
hyperactivity disorder (ADHD) may lack the under-
standing and ability to describe his or her feelings,
which may make management of the disorder more

challenging. Nurses must be aware of the child’s level

of language and work to understand the experience as

he or she describes it.

Erik Erikson described psychosocial development

across the life span in terms of developmental tasks

to accomplish in each stage (Table 7-1). Each stage of

development depends on the successful completion of

the previous stage. In each stage, the person must

complete a critical life task that is essential to well-

being and mental health. Failure to complete the crit-

ical task results in a negative outcome for that stage of

development and impedes completion of future tasks.

For example, the infancy stage (birth to 18 months) is

the stage of “trust versus mistrust,” when babies

must learn to develop basic trust that their parents

or guardians will take care of them, feed them, change

their diapers, love them, and keep them safe. If the

infant does not develop trust in this stage, he or she

may be unable to love and trust others later in life,

because the ability to trust others is essential to es-

tablishing good relationships. Specific developmental

tasks for adults are summarized in Table 7-2.

According to Erikson’s theory, people may get

“stuck” at any stage of development. For example, a

person who never completed the developmental task

ERIKSON’SSTAGES OFPSYCHOSOCIALDEVELOPMENT

Stage Tasks

Trust vs. mistrust

(infant)

Autonomy vs. shame

and doubt

(toddler)

Initiative vs. guilt

(preschool)

Industry vs. inferiority

(school age)

Identity vs. role

diffusion

(adolescence)

Intimacy vs. isolation

(young adult)

Generativity vs.

stagnation

(middle adult)

Ego integrity vs.

despair (maturity)

Table 7-1

Viewing the world as safe

and reliable

Viewing relationships as

nurturing, stable, and

dependable

Achieving a sense of

control and free will

Beginning to develop a

conscience

Learning to manage

conflict and anxiety

Building confidence in own

abilities

Taking pleasure in accom-

plishments

Formulating a sense of self

and belonging

Forming adult, loving rela-

tionships and meaningful

attachment to others

Being creative and

productive

Establishing the next

generation

Accepting responsibility for

one’s self and life