Theories Relevant To Nursing Practice

Theories relevant
NURSING PRACTICE
to
INSTRUCTIONAL MATERIALS 7
Learning Objectives:
Given relevant questions, the students will be able to:
1. Ensure a working relationship utilizing relevant

concepts/theories of effective communication and
interpersonal relationship in nursing practice.
2. Discuss relevant concepts of collaboration with

interpersonal, cultural, and related theories.
THEORETICAL FOUNDATION IN NURSING | Theories relevant to Nursing Practice 195

Theories relevant
NURSING PRACTICE
to
1. Abraham Maslow
Human Needs Theory
2. Harry Stack Sullivan
Transactional Analysis
3. Von Bertalanffy
General Systems Theory
4. Kurt Lewin
Change Theory
5. Erik Erikson
Psychosocial Development
6. Lawrence Kohlberg
Moral Development Theory
THEORETICAL FOUNDATION IN NURSING | Theories relevant to Nursing Practice 196

1. ABRAHAM MASLOW’S
HUMAN NEEDS THEORY
In a 1943 paper titled "A Theory of Human Motivation," American
psychologist Abraham Maslow theorized that human decision-making is
undergirded by a hierarchy of psychological needs. In his initial paper and a
subsequent 1954 book titled Motivation and Personality, Maslow proposed that
five core needs form the basis for human behavioral motivation.
I. BACKGROUND OF THE THEORIST
On April 1, 1908, Samuel and

Rose Maslow happily gave birth to
their first of seven children, Abraham
Harold Maslow. As a teenage
Abraham was pushed by his parents
for academic success. He studied law
at the City College of New York for
three semesters before transferring to
Cornell. He then returned to CCNY.
He married his first cousin, Bertha
Goodman and had two daughters.
Maslow and his family moved to
Wisconsin so he could attend a local
university (University of Wisconsin) to
pursue his newly found interest in
psychology. He received a BA in 1930, an MA in 1931, and PhD in 1934 all in
psychology. After receiving his diplomas, he went on to study human sexuality. He
taught full time at Brooklyn College. Abraham Maslow met Kurt Goldstein while
serving as the chair of the psychology department. Kurt Goldstein the author of
The Organism, inspired Maslow to his crusade for a humanistic psychology.
THEORETICAL FOUNDATION IN NURSING | Theories

Abrahamrelevant
Maslowto Nursing Practice 197
II. MAJOR ASSUMPTIONS, CONCEPTS
AND RELATIONSHIPS
I.
Maslow's hierarchy of needs is a theory of motivation which states that five

categories of human needs dictate an individual’s behavior. Those needs are
physiological needs, safety needs, love and belonging needs, esteem needs,
and self-actualization needs.
Maslow's theory presents his hierarchy of needs in a pyramid shape, with

basic needs at the bottom of the pyramid and more high-level, intangible needs
at the top. A person can only move on to addressing the higher-level needs when
their basic needs are adequately fulfilled.
1. PHYSIOLOGICAL NEEDS: The first of

the id-driven lower needs on Maslow's
hierarchy are physiological needs. These most
basic human survival needs include food and
water, sufficient rest, clothing and shelter,
overall health, and reproduction. Maslow states
that these basic physiological needs must be
addressed before humans move on to the next
level of fulfillment.
2. SAFETY NEEDS: Next among the lower-level

needs is safety. Safety needs include protection
from violence and theft, emotional stability and
well-being, health security, and financial security.
3. LOVE AND BELONGING NEEDS: The social

needs on the third level of Maslow’s hierarchy
relate to human interaction and are the last of the
so-called lower needs. Among these needs are
friendships and family bonds—both with biological
family (parents, siblings, children) and chosen family (spouses and

Abrahamrelevant
partners). Physical and emotional intimacy ranging from sexual
relationships to intimate emotional bonds are important to achieving a
feeling of elevated kinship. Additionally, membership in social groups
contributes to meeting this need, from belonging to a team of coworkers
to forging an identity in a union, club, or group of hobbyists.
4. ESTEEM NEEDS: The higher needs, beginning

with esteem, are ego-driven needs. The primary
elements of esteem are self-respect (the belief
that you are valuable and deserving of dignity)
and self-esteem (confidence in your potential for
personal growth and accomplishments). Maslow
specifically notes that self-esteem can be broken
into two types: esteem which is based on respect
and acknowledgment from others, and esteem which is based on your
own self-assessment. Self-confidence and independence stem from this
latter type of self-esteem.
5. SELF-ACTUALIZATION NEEDS: Self-

actualization describes the fulfillment of your full
potential as a person. Sometimes called self-
fulfillment needs, self-actualization needs occupy
the highest spot on Maslow's pyramid. Self-
actualization needs include education, skill
development—the refining of talents in areas such
as music, athletics, design, cooking, and
gardening—caring for others, and broader goals like
learning a new language, traveling to new places, and winning awards.
According to Maslow, individuals are motivated by unsatisfied needs. As

each of these needs is significantly satisfied, it drives and forces the next need to
emerge. Maslow grouped the five needs into two categories - Higher-order
needs and Lower-order needs. The physiological and the safety needs
constituted the lower-order needs. These lower-order needs are mainly satisfied
externally. The social, esteem, and self-actualization needs constituted the higher-
order needs. These higher-order needs are generally satisfied internally, i.e., within
an individual. Thus, we can conclude that during boom period, the employees
lower-order needs are significantly met.

Abrahamrelevant
ACTIVITY
PART 1.
Directions: Identify the following statements below and write PN if it
is PHYSIOLOGICAL NEEDS, SN for SAFETY NEEDS, LB for LOVE
AND BELONGINGNESS, SE for SELF ESTEEM and SA for SELF
ACTUALIZATION.
_____ 1. Protection from violence and theft

_____ 2. Education, skill development—the refining of talents in
areas such as music, athletics, design, cooking, and
gardening—caring for others
_____ 3. Last of the so-called lower needs
_____ 4. Reproduction
_____ 5. Biological needs.
_____ 6. Fulfillment of your full potential as a person
_____ 7. Oxygen, food, water, shelter, clothing and sleep
_____ 8. Friendships and family bonds—both with biological
family (parents, siblings, children) and chosen family
(spouses and partners).
_____ 9. Give us stability, protection and safe circumstances
_____ 10. Self-fulfillment needs
_____ 11. Ego-driven needs
_____ 12. Broader goals like learning a new language, traveling
to new places, and winning awards
_____ 13. Physical and emotional intimacy ranging from sexual
relationships to intimate emotional bonds
_____ 14. Respect and acknowledgment from others
_____ 15. Having a good retirement pension, and insurance.

Abrahamrelevant
PART II.
Directions: Read the questions carefully. Choose the best answer
for each question. Write your answer on the blank provided.
_____ 1. Which of the following is the correct order of Maslow’s Hierarchy of

Needs from bottom to top?
a. physiological needs, love and belonging needs, self-actualization,

self-esteem needs, safety needs,
b. physiological needs, safety needs, self-esteem needs, self-
actualization, love and belonging needs
c. physiological needs, love and belonging needs, self-esteem needs,
safety needs, self-actualization
d. physiological needs, safety needs, love and belonging needs, self-
esteem needs, self-actualization
_____ 2. Abraham Maslow described the physiologic needs as
a. a need to be and do what we were meant to do.

b. those needs that give us stability, protection and safe circumstances.
c. a need for belongingness and personal confidence
d. biological needs.
____ 3. Abraham Maslow’s theory consists of five levels of basic needs. The most
important of which is
a. Safety needs c. Self esteem
b. Self -actualization d. Physiological needs
_____ 4. All of the following is true about safety needs as described by Maslow,
except:
a. children's safety needs include protection from their parents and to
feel safe in their home.
b. this need gives stability, protection and safe circumstances.
c. these are the most important among all needs
d. adult’s safety needs include knowing that their family is safe, having
a good retirement pension, and insurance.
____ 5. If somebody is naturally talented at athletics, and enjoys these activities,

this level of needs describes that the person is meant to play sports.
a. Safety needs c. Self esteem
b. Self -actualization d. Physiological needs

Abrahamrelevant
IV. MODEL/DIAGRAM/PARADIGM
Directions: Complete the Hierarchy of Needs below. Using the words

on the box, locate in the correct position.
SELF-
LACK OF PROBLEM
FULFILLMENT CONFIDENCE
PREJUDICE SOLVING
NEEDS
RESPECT OF
BASIC NEEDS FOOD FAMILY
OTHERS
PSYCHOLOGICAL SEXUAL HEALTH

BREATHING
NEEDS INTIMACY PROTECTION
CREATIVITY FRIENDSHIP PENSION EXCRETION

Abrahamrelevant
V. USEFULNESS, TESTABILITY, PARSIMONY &
VALUE IN EXTENDING NURSING SCIENCE
Abraham Maslow's iconic pyramid of needs is one of the most famous

images in the history of management studies. At the base of the pyramid are
physiological needs, and at the top is self-actualization, the full realization of one's
unique potential. Along the way are the needs for safety, belonging, love, and
esteem.
However, many people may not realize that during the last few years of his
life Maslow believed self-transcendence, not self-actualization, was the pinnacle
of human needs. What's more, it's difficult to find any evidence that he ever actually
represented his theory as a pyramid. On the contrary, it's clear from his writings
that he did not view his hierarchy of needs like a video game-- as though you reach
one level and then unlock the next level, never again returning to the "lower" levels.
He made it quite clear that we are always going back and forth in the hierarchy,
and we can target multiple needs at the same time.
2. HARRY STACK SULLIVAN’S

TRANSACTIONAL ANALYSIS
People develop their personality within a social context
Without other people, humans would have no personality.
Development rests on the individual’s ability to establish intimacy with
another person.
Anxiety can interfere with satisfying interpersonal relations.
Healthy development entails experiencing intimacy and lust toward another
same person.
THEORETICAL FOUNDATION IN NURSING | Theories relevant

Harry Stack to Nursing Practice
Sullivan 203
Harry Stack
Sullivan, (born February 21,
1892, Norwich, New York,
U.S.—died January 14,
1949, Paris), American
psychiatrist who developed a
theory of psychiatry based
on interpersonal
relationships.
He believed that
anxiety and other psychiatric
symptoms arise in
fundamental conflicts
between individuals and their
human environments and
that personality development
also takes place by a series
of interactions with other
people.
He made substantial contributions to clinical psychiatry, especially

the psychotherapy of schizophrenia, and suggested that the mental functions of
schizophrenics, though impaired, are not damaged past repair and can be
recovered through therapy. Possessing an extraordinary ability to communicate
with schizophrenic patients, he described their behavior with clarity and insight
unrivalled at that time.
Stack-Sullivan is known for his Interpersonal Theory. He is considered the

father of interpersonal psychiatry or interpersonal psychoanalysis. He proposed
the interpersonal theory of personality. He explained the role of interpersonal
relationships and social experiences in shaping personality. He also explained the
importance of current life events to psychopathology. The theory further states that
the purpose of all behavior is to get needs met through interpersonal interactions
and to decrease or avoid anxiety.

Sullivan 204
AND RELATIONSHIPS
III.
1. PERSONALITY
Personality is an energy system.

¡ Tension – potentiality for action
¡ Energy Transformations – actions themselves
TENSION
Anxiety, premonitions,
drowsiness, hunger, sexual excitement.
Not always on a conscious level
Partial distortions of reality
Two Types:
¡ Needs
¡ Anxiety
§ NEEDS
Tensions brought
about by a biological
imbalance between
the person and
environment.
Episodic
Biological component
and interpersonal relations.
¡ Zonal Needs – arises from a specific body part.
¡ General Needs – over all well-being of a person.

Sullivan 205
¡ Tenderness is a basic interpersonal need
§ ANXIETY
Disjunctive, diffuse and

vague, call forth no
consistent action for
relief.
Transferred through
empathy.
Chief disruptive force
blocking the
development of healthy
interpersonal relations.
¡ Prevents people from learning from mistakes
¡ Persisting pursuance of childish wish for security
¡ Ensures people will not learn from experience.
¡ Its presence is worse than its absence.
Stems from complex interpersonal relations. Vaguely

represented in awareness. No positive value. Blocks
satisfaction of needs.
ENERGY TRANSFORMATIONS
transformed into either overt or covert actions.

Behaviors that satisfy our needs and reduce anxiety.
May be observable or hidden from other people (emotions,
thoughts)
Evolves into dynamisms

Sullivan 206
2. DYNAMISMS
Traits or habit patterns

Major Classes:
¡ Related to specific ¡ Disjunctive

zones of the body (Malevolence)
¡ Mouth, anus, genitals ¡ Isolating (Lust)
¡ Those related to ¡ Conjunctive
tensions (Intimacy and Self-
System)
MALEVOLENCE
Disjunctive dynamism between evil and hatred.

Feeling of living
among one’s
enemies
2-3 yrs, when
child is rebuffed,
ignored, or
punished.
Adoption of
malevolent
attitude for protection.
Timidity, Mischievousness, Cruelty, anti-social behavior.
LUST
Assumes an isolating
tendency.
Auto-erotic behavior
Hinders an intimate
relationship.
Increases anxiety and
decreases self- worth.

Sullivan 207
INTIMACY
Close interpersonal relationship
between 2 people of equal status.
Equal partnership
Integrating dynamism that draws out
loving reactions from people.
Decreases loneliness and anxiety
Rewarding experiences most healthy
people desire.
SELF-SYSTEM
Most complex and inclusive of all dynamisms.

Consistent pattern of behavior that maintains people’s
interpersonal security by protecting them from anxiety.
Principal stumbling block to favorable changes in personality.
Security Operations
§ SECURITY OPERATIONS
Reduces feelings of anxiety or insecurity.
Two kinds:
¡ Dissociation = includes impulses, desires, and needs

that a person refuses to allow into awareness. (dreams)
¡ Selective Inattention = refusal to see things that one

does not wish to see. (conscious)

Sullivan 208
3. PERSONIFICATIONS
People’s images of themselves or others

Mental images that we acquire during development to help us
understand ourselves and the world.
Personifications help maintain emotional equilibrium and reduce
anxiety.
• Separation of the good vs. bad
THE BAD ME
- Grows from experiences of punishment and disapproval
- Represents those aspects of the self that are considered
negative and hidden from others and possibly the self.
- Anxiety results from recognition of the bad me.
• Recalling an embarrassing moment
• Guilt about a past action
THE GOOD ME
- results from experiences with reward and approval
• Experiences associated with tenderness and intimacy
- Everything we like about ourselves
- The part of us we share with others and prefer to focus on
because it produces no anxiety
THE NOT ME
- anxiety provoking experiences that invoke security operations
may become dissociated from self to form the not-me.
• Security operations = Sullivan’s concept of defense
mechanisms
- Experiences that are denied

Sullivan 209
- Experiences that are kept out of awareness and repressed
• Acknowledging not-me experiences creates high
anxiety/ negative emotion.
Eidetic Personifications – imaginary friends, projection traits to other
people
LEVELS OF COGNITION
Refers to ways of perceiving, imagining, and conceiving.

Prototaxic – undifferentiated experiences which are highly personal.
Parataxic – communicated to others in a distorted fashion.
Syntaxic – consensually validated and symbolically communicated.
7 DEVELOPMENTAL STAGES
Each stage involves specific interpersonal challenges or tasks, and specific

types of interpersonal relationships. Personality change is most likely during the
transitions between stages. Personality continues to evolve from infancy through
adulthood.
1. INFANCY (Birth – 18 months)

GRATIFICATION NEEDS
- During the beginning stage, the

major developmental task for the
child is gratification of needs. This
is accomplished through activity
associated with the mouth such as
crying, thumb sucking, tenderness
from mothering one and learns
anxiety from the mother through
empathy.
2. CHILDHOOD (18 months – 6 years old)

Sullivan 210
DELAYED GRATIFICATION
- At ages 18 month to 6 years, the

child learns that interference with
fulfillment of personal wishes and
desires may result in the delayed
gratification. Imaginary playmate
(i.e., eidetic personification)
§ Practice social
relations/ rehearsal
§ Safe, secure
relationships to practice with no threat of negative
consequences
3. JUVENILE ERA (6 – 9 years old)

FORMATION OF PEER GROUP
- The major task of

juvenile stage is
formation of satisfactory
relationships within peer
groups. This is
accomplished through
the use of competition,
co-operation, and compromise. Need for peers of equal
status. Children learn how to compete, compromise, and
cooperate.
4. PREADOLESCENCE (9 – 12 years old)

DEVELOPING RELATIONSHIPS WITHIN SAME GENDER
- The task at the Preadolescence

stage focus on developing
relationships with persons of the same
sex. One’s ability to collaborate with
and show love and affection for another
person begins at this stage.

Sullivan 211
5. EARLY ADOLESCENCE (12 -14 years old)
IDENTITY
- During early adolescence, the child is struggling with developing a

sense of identity that is separate and independent from the parents.
The major task is the formation of satisfactory relationships with
members of the opposite sex.
6. LATE ADOLESCENCE (14 – 21 years)

FORMING LASTING, INTIMATE RELATIONSHIP
- The late adolescence period is characterized by tasks associated

with the attempt to achieve interdependence with the society and the
formation of a lasting, intimate relationship with a selected member
of opposite sex.
- Feel both intimacy and lust toward the same person; Learn how to
live in the adult world; Discovery of self
7. SENESCENCE
Senescence stage is also called the Late Adulthood

stage. As we grow older (65 years and over) and become
senior citizens, we tend to slow down our productivity, and
explore life as a retired person. It is during this time that we
contemplate our accomplishments and are able to develop
integrity if we see ourselves as leading a successful life.
Erik Erikson believed if we see our lives as
unproductive, feel guilty about our past, or feel that we did
not accomplish our life goals, we become dissatisfied with
life and develop despair, often leading to depression and
hopelessness. Success in this stage will lead to the virtue of
wisdom. Wisdom enables a person to look back on their life
with a sense of closure and completeness, and also accept
death without fear.

Sullivan 212
PSYCHOLOGICAL DISORDERS
All psychological disorders have an interpersonal origin and must be

understood with reference to social environment
Deficiencies found in psychiatric patients are found in every person to a
lesser degree
Psychological difficulties are not unique, but come from same interpersonal
difficulties we all face
Two broad classes of schizophrenia
¡ Organic
¡ Situational
PSYCHOTHERAPY
Therapist is a participant observer who establishes an interpersonal

relationship with the patient and provides opportunity for syntaxic
communication
Sullivanian therapists attempt to help patients develop foresight, discover
difficulties in interpersonal relations, and restore their ability to participate in
consensually validated experiences
PART I.
Directions: Read the questions carefully.
ACTIVITY Choose the best answer for each question.
Write your answer on the blank provided.
_____ 1. According to Sullivan, are tensions brought about by a biological

imbalance between the person and environment.
a. Personality c. Needs
b. Tension d. Anxiety

Sullivan 213
_____ 2. Based on Sullivan’s theory, this is considered as the most complex and
inclusive of all dynamisms.
a. Lust c. Malevolence
b. Intimacy d. Self-system
_____ 3. Sullivan identified the different levels of cognition that refers to ways of
perceiving, imagining, ang conceiving. Which of the following pertains
to that which is communicated to others in a distorted fashion?
a. Parataxic c. Syntxic
b. Prototaxic d. Pretaxic
______ 4. Reduces feelings of anxiety or insecurity
a. Security Options c. Intimacy

b. Personifications d. Self-system
_____ 5. Auto-erotic behavior
a. Lust c. Malevolence
b. Intimacy d. Self-system
_____ 6. Mental images that we acquire during development to help us

understand ourselves and the world.
a. Security Options c. Intimacy

b. Personifications d. Self-system
_____ 7. Two types of Tension

a. Intimacy and Self- c. Needs and Anxiety
System d. Selective Attention and
b. Lust and Malevolence Dissociation
_____ 8. Feeling of living among one’s enemies

a. Intimacy c. Lust
b. Self- System d. Malevolence
_____ 9. All of the following except one are the major classes of Dynamisms
a. Malevolence b. Lust

Sullivan 214
c. Needs d. Intimacy
______ 10. According to Sullivan this is also known as forming lasting, intimate
relationship
a. Juvenile Era c. Preadolescence

b. Late Adolescence d. Early Adolescence
PART II. Directions: Complete the Stages of Development

according to Harry Stacks Sullivan. Write your answer on the space
provided.
STAGES OF DEVELOPMENT
STAGE AGE SIGNIFICANT INTERPERSONAL LEARNINGS
OTHER PROCESS
Infancy 1 Mother Tenderness Good/Bad

Childhood 2-6 2 Imaginary Syntaxic
Playmates Language
Juvenile Era 6–9 3 4 Competition,

Compromise,
Cooperation
5 9– 6 Intimacy Affection &

12 Respect
7 8 Several Intimacy & Lust Balance,

Chums Security
Operations
Late 9 Lover 10 Discovery of

Adolescence self & world

Sullivan 215
3. VON BERTALANFFY’S
GENERAL SYSTEMS THEORY
General system theory, therefore, is a general science of wholeness... The

meaning of the somewhat mystical expression, “The whole is more than the sum
of its parts” is simply that constitutive characteristics are not explainable from the
characteristics of the isolated parts. The characteristics of the complex, therefore,
appear as new or emergent...
- Ludwig von Bertalanffy
Ludwig von Bertalanffy was an

Austrian-born biologist who developed
the idea of General Systems Theory,
arguing that systems as a whole had
properties and perhaps even laws, that
were different from, and could not be
reduced to, the properties and laws of
their components. Others had
recognized systems in various ways,
often claiming that they are "more than
the sum of their parts." Bertalanffy
promoted the idea of "organicism," that
systems of many kinds should be
treated as organisms with multiple
hierarchical levels. Like Ernst Mayr,
Bertalanffy believed that holist
biological models might be better models for systems than
mechanistic reductionist models.

Ludwig Von to Nursing Practice
Bertalanffy 216
II. PHILOSOPHICAL UNDERPINNINGS
OF THEORY
The system theory is the transdisciplinary study of the abstract organization

of phenomena, independent of their substance, type, or spatial or temporal scale
of existence. It is also a management methodology as it is a way of analyzing and
thinking about organizations and also an alternative approach Simpler definition
says, A theory that sees an organization as a set of interrelated and interdependent
parts.
The systems theory focuses on understanding the organization as an open
system that transforms inputs into outputs. This theory is based on the work of a
biologist, Ludwig von Bertalanffy, who believed that a general systems model could
be used to unite science. Early contributors to this theory included Kenneth
Boulding, Richard Johnson, Fremont Kast, and James Rosenzweig. The systems
theory began to have a strong impact on management thought in the 1960s as a
way of thinking about managing techniques that would allow managers to relate
different specialties and parts of the company to one another, as well as to external
environmental factors. The systems theory focuses on the organization as a whole,
its interaction with the environment, and its need to achieve equilibrium.
III. MAJOR ASSUMPTIONS, CONCEPTS

AND RELATIONSHIPS
IV.
CHARACTERISTICS OF SYSTEMS THEORY
1. COMMUNICATION
- Communication mechanisms must be in place for
organizational systems to exchange relevant information with
its environment. Provides for the flow of information among
the subsystems.
2. SYSTEMS, SUBSYSTEMS AND SUPERSYSTEM

- Systems: set interrelated parts that turn inputs into outputs
through processing
- Subsystems: do the processing

Bertalanffy 217
- Super systems: are other systems in the environment
3. BOUNDARIES
- Separates system from its environment
- Four types:
i. Physical Boundary - prevents access (security system)

ii. Linguistic Boundary - specialized language (jargon)
iii. Systemic Boundary - rules that regulate interaction
(titles)
iv. Psychological Boundary
4. GOAL-DIRECTEDNESS
- Systems are goal oriented and engage in feedback in order to
meet the goals of the organization.
5. HOLISTIC VIEW
- Systems theory focuses on the arrangement of and relations
between the parts that connect them into a whole
- The mutual interaction of the parts makes the whole bigger
than the parts themselves
BASIC ELEMENTS OF A SYSTEM
1. Input
- Maintenance Inputs (energic imports that sustain system)
- Production Inputs (energic imports which are processed to
yield a productive outcome).
2. Throughput
- Work done on those resources used to produce a product.
3. Output
- Exit or change exiting the system. System returns the product
to the environment.
4. Process
- Provides a series of mechanical or chemical operations on
something in order to change or preserve it.

Bertalanffy 218
5. Feedback
- Information about a reaction to a product; Used as basis for
improvement
- Can be:
• Positive Feedback - move from status quo
• Negative Feedback - return to status quo
TYPES OF A SYSTEM
1. OPEN SYSTEM
Continuously interacts with the environment
There is exchange of materials, energies and information with the
environment
2. CLOSED SYSTEM
Theoretical systems that do not interact with the environment; Not
influenced by surroundings
Ludwig Von Bertalanffy (1969, 1976) developed general systems theory,

which has the following assumptions:
a. All systems must be goal directed.
b. A system is more than the sum of its parts.
c. A system is ever changing and any change in one part affects the
whole.

Bertalanffy 219
d. d. Boundaries are implicit and human systems are open and
dynamic.
These concepts may be applied to different kinds of systems, e.g.

Molecules in chemistry, cultures in sociology, and organs in Anatomy & Health in
Nursing.
ACTIVITY
Choose the best answer for each question.
_____ 1. Ludwig Von Bertalanffy developed the general systems theory which has
the following assumptions except;
a. boundaries are implicit and human systems are open and dynamic.
b. all systems must be goal directed.
c. a phenomenon that occurs continuously in all living systems
d. a system is more than the sum of its parts.
_____ 2. In the general systems theory, this refers to the process through which

Bertalanffy 220
the output is returned to the system.
a. Output c. Input
b. Feedback d. Process
_____ 3. In the general systems theory, this refers to the information that enters
the system.
a. Process c. Feedback
b. Output d. Input
Directions: Match Column A with corresponding items on Column B.

Write your answer on the space provided.
COLUMN A COLUMN B
_____ 1. Communication a. rules that regulate interaction
(titles)
_____ 2. Holistic View b. Systems are goal oriented and
engage in feedback in order to
meet the goals of the
organization
_____ 3. Systemic Boundary c. Systems theory focuses on the
arrangement of and relations
between the parts that connect
them into a whole
_____ 4. Throughput d. Work done on those resources
used to produce a product
_____ 5. Goal Directness e. Provides for the flow of
information among the
subsystems.
_____ 6. Open System f. Theoretical systems that do not
interact with the environment;
Not influenced by surroundings
_____ 7. Closed System g. Continuously interacts with the
environment

Bertalanffy 221
4. KURT LEWIN’S
CHANGE THEORY
“a dynamic balance of forces working in opposing directions.”
German-American
psychologist. Known as the
modern pioneers of social,
organizational, and applied
psychology. Recognized as the
"founder of social psychology”.
First to study group dynamics
and organizational
development. Kurt Lewin left
Germany as the Nazis
consolidated their power. He
adapted and applied the
Gestalt perspective to
personality theory and social
dynamics and called it "Field
Theory." He was also responsible for the founding of the National Training
Laboratories in Bethel Maine, best known for "sensitivity training" for corporate
leaders.
In 1909, he entered the University of Freiburg to study medicine, transferred

to University of Munich to study biology. He became involved with the socialist
movement and women's rights. He served in the German army when World
War I began. Due to a war wound, he returned to the University of Berlin to
complete his Ph.D.
THEORETICAL FOUNDATION IN NURSING | Theories relevant to Nursing Practice

Kurt Lewin 222
Famous Works: Lewin coined the notion of genidentity. (Two objects are
not identical because they have the same properties in common, but because
one has developed from the other. He also proposed a perspective as an
alternative to the nature versus nurture debate. Lewin suggested that neither
nature (inborn tendencies) nor nurture (how experiences in life shape
individuals) alone can account for individuals' behavior and personalities, but
rather both nature and nurture interact to shape each person.

AND RELATIONSHIPS
V.
Change is an inevitable occurrence in any organization, and successful change
must be managed. Learn about Lewin's three step model for change management
that includes unfreezing, changing and refreezing to transform new behaviors into
an organization's new norms.
1. People grow and change throughout their lives. This growth and change are
evident in the dynamic nature of basic human needs and how they are met.
2. Change happiness daily. It is subtle, continuous and manifested in both
everyday occurrences and more disruptive life events.
It is a phenomenon that occurs continuously in all living systems, it means

alteration in the status Quo.
Kurt Lewin (1962) developed the change theory, which identifies the following six
components:
1. Recognition of the area where change is needed.

2. Analysis of a situation to determine what forces exist to maintain the
situation and what forces are working to change it.
3. Identification of methods by which change can occur.
4. Recognition of the influence of group mores or customs on change.
5. Identification of the methods that the reference group uses to
bring about change.
6. The actual process of change.

Kurt Lewin 223
If you have a large cube of ice but realize that what you want is a cone of
ice, what do you do? First you must melt the ice to make it amenable to change
(unfreeze). Then you must mold the iced water into the shape you want (change).
Finally, you must solidify the new shape (refreeze).
By looking at change as a process with distinct stages, you can prepare

yourself for what is coming and make a plan to manage the transition – looking
before you leap, so to speak. All too often, people go into change blindly, causing
much unnecessary turmoil and chaos.
To begin any successful change process, you must first start by

understanding why the change must take place. As Lewin put it, "Motivation for
change must be generated before change can occur. One must be helped to re-
examine many cherished assumptions about oneself and one's relations to
others." This is the unfreezing stage from which change begins.
CHANGE PROCESS/ CHANGE MANAGEMENT PROCESS
Lewin described change as a three-stage process.
STAGE 1 - "UNFREEZING"
- The Unfreezing stage is probably one of the most important stages
to understand the world of change we live in today. This stage is
about getting ready to change. It involves getting to a point of
understanding that change is necessary, and getting ready to move
away from our current comfort zone. This first stage is about
preparing ourselves, or others, before the change. Unfreezing and
getting motivated for the change is all about weighing up the 'pro's'
and 'con's' and deciding if the 'pro's' outnumber the 'con's' before
you take any action. This is the basis of what Kurt Lewin called the
Force Field Analysis.

Kurt Lewin 224
FORCE FIELD ANALYSIS
There are lots of different

factors (forces) for and
against making change that
we need to be aware of. If
the factors for change
outweigh the factors against
change we'll make the
change. If not, then there is
low motivation to change.
STAGE 2: CHANGE - OR TRANSITION

- According to him change is not an event, but rather a process. He
called that process a transition. Transition is the inner movement or
journey we make in reaction to a change. This second stage occurs
as we make the changes that are needed.
- Example- Imagine bungee jumping or parachuting. You may have
convinced yourself that there is a great benefit for you to make the
jump, but now you find yourself on the edge and get scared. But
when you do it you may learn a lot about yourself. Using role models
and allowing people to develop their own solutions also help to
make the changes.
STAGE 3: FREEZING
- This stage is about establishing stability once the changes have
been made. The changes are accepted and become the new norm.
People form new relationships and become comfortable with their
routines.

Kurt Lewin 225
ACTIVITY Choose the best answer for each question.
_____ 1. Nurse Vince is conducting health teaching about Covid 19 Vaccination at

Brgy. Madawon, Nabua. Initially, the residents were unreceptive and
hostile about it but then after thorough information dissemination
including the pros and cons, majority now agreed to submit for
vaccination once it is readily available. Based on Kurt Lewin’s theory, this
is a clear manifestation of which state of change?
a. Unfreezing c. Refreezing
b. Movement d. Defrosting
_____ 2. A week after the vaccine was offered, majority of the clients who availed
it at various vaccination centers identified by Nabua LGU are from Brgy.
Madawon, Nabua. Based on Kurt Lewin’s theory, this is a clear
manifestation of which state of change?

Kurt Lewin 226
_____ 3. One of the recipients of the Covid 19 vaccine is Mr. and Mrs. Dela Cruz,
residents of Brgy. Madawon, Nabua. So far, they are glad getting the
vaccine and even reported no adverse reactions or side effects from it.
They now encourage their family members and other relatives from other
barangays to follow suit.
_____ 4. What are Lewin's 3 stages of change?
a. Unfreeze, change, refreeze

b. change, unfreeze, refreeze
c. Refreeze, Change, Unfreeze
d. Unfreeze, Refreeze, Change
_____ 5. What does Lewin's model relate to in business?
a. How businesses manage change and how successful they are

at it
b. How businesses get people to do what the company wants them
to do
c. How businesses trick their employees into doing new stuff
d. How a business manages to trick you
_____ 6. Which of the following is not part of the practical steps in the Unfreeze
stage?
a. Ensure there is strong support from senior management

b. Determine what needs to change
c. Create the need for change
d. Manage and understand the doubts and concerns
e. Dispel rumors
_____ 7. Which of the following is not part of the practical steps in the Change
stage?
a. Communicate often
b. Dispel rumours
c. Empower action
d. involve people in the process
e. Anchor the changes into the culture

Kurt Lewin 227
_____8. 'Communicate Often' belongs to which stage?
b. Change d. Defrosting
_____ 9. Empower action' belongs to which stage?
_____ 10. Anchor the changes into the culture' belongs to which stage?
_____ 11. Develop ways to sustain the change' belongs to which stage?
_____ 12. Manage & understand the doubts and concerns' belongs to which stage?
_____13. Involve people in the process' belongs to which stage?
_____ 14. Celebrate success!' belongs to which stage?
_____15. Return the organization to a sense of stability

Kurt Lewin 228
5. ERIK ERICKSON’S
PSYCHOSOCIAL DEVELOPMENT
Erik Erikson, in full Erik

Homburger Erikson, also called Erik H.
Erikson, (born June 15, 1902, Frankfurt
am Main, Germany—died May 12,
1994, Harwich, Massachusetts, U.S.),
German-born American psychoanalyst
whose writings on social psychology,
individual identity, and the interactions
of psychology with history, politics,
and culture influenced professional
approaches to psychosocial problems
and attracted much popular interest.
As a young man, Erikson attended

art school and traveled around Europe. In
1927, when he was invited by the
psychoanalyst Anna Freud to teach art,
history, and geography at a small private
school in Vienna, he
entered psychoanalysis with her and
underwent training to become a
psychoanalyst himself. He became interested in the treatment of children and
published his first paper in 1930, before completing psychoanalytic training and
being elected to the Vienna Psychoanalytic Institute in 1933. The same year, he
emigrated to the United States, where he practiced child psychoanalysis
in Boston and joined the faculty of the Harvard Medical School. He became
interested in studying the way the ego, or consciousness, operates creatively in
sane, well-ordered individuals.

Erik Erikson 229
OF THEORY
Erikson’s psychosocial development theory emphasizes the social

nature of our development rather than its sexual nature. While Freud believed that
personality is shaped only in childhood, Erikson proposed that personality
development takes place all through the lifespan. Erikson suggested that how we
interact with others is what affects our sense of self, or what he called the ego
identity.
Erikson proposed that we are motivated by a need to achieve competence

in certain areas of our lives. According to psychosocial theory, we experience eight
stages of development over our lifespan, from infancy through late adulthood. At
each stage there is a conflict, or task, that we need to resolve. Successful
completion of each developmental task results in a sense of competence and a
healthy personality. Failure to master these tasks leads to feelings of inadequacy.
Another major contribution of Erikson’s work is the notion that personality is

shaped over the life span, which implies that experiences later in life can heal or
ameliorate problems in early childhood.
Finally, Erikson powerfully advocated for a “new education of children”
based on self-knowledge and a complex world view that scorned “immediate
diagnoses of health or sickness, judgments of goodness or badness, or advice on
‘how to’.” Erikson’s beliefs in the complexity and resilience of children and in the
importance of mutuality in helping relationships led Institute founders Maria Piers,
Barbara Bowman, and Lorraine Wallach to name the Institute in his honor.
III.MAJOR ASSUMPTIONS, CONCEPTS

AND RELATIONSHIPS
VI.
Erik Erikson was an ego psychologist who developed one of the most
popular and influential theories of development. While his theory was impacted by
psychoanalyst Sigmund Freud's work, Erikson's theory centered on psychosocial
development rather than psychosexual development.
The stages that make up his theory are as follows:

Erik Erikson 230
STAGE 1: TRUST VS. MISTRUST (0-1 year old)
ORAL SENSORY
The important event is

feeding and the important
relationship is with the mother.
The infant must develop a loving,
trusting relationship with the
mother/caregiver through
feeding, teething and comforting;
failure to resolve this conflict can
lead to sensory distortion, and
withdrawal.
This stage is all about
fulfilling needs. The baby needs
to trust the world around them to
take care of their needs. If they are hungry, they need to develop trust that they
will be fed. If they are not fed, or their diaper is left dirty, they may develop a
mistrust in the outside world. This sense of trust of mistrust can affect us
throughout the rest of our lives.
STAGE 2: AUTONOMY VS. SHAME AND DOUBT (1 to 3 years old)

MUSCULAR-ANAL

toilet training and the important
relationship is with the parents.
The child’s energy is directed
towards mastering physical
skills such as walking, grasping
and muscular control. The child
learns self-control but may
develop shame, doubt,
impulsivity or compulsion if not
handled well.
Autonomy vs. Shame & Doubt Autonomy means being your own boss. Here
a toddler tries to control their own bodies by toilet training and their environment,

Erik Erikson 231
by always saying "NO!!!!". Sometimes they do poopy in their pants or get yelled at
by their parents, causing shame and doubt in their own abilities. If we learn how to
control ourselves in reasonable ways, we develop a healthy will. We are then able
to face the later challenges of life.
STAGE 3: INITIATIVE VS. GUILT (3 to 6 years old)

LOCOMOTOR

independence and the important
relationship is family. The child
continues to become more
assertive in exploration,
discovery, adventure and play.
The child may show too much
force in this stage causing
feelings of guilt; failure to resolve
this conflict can lead to
ruthlessness and inhibition
Initiative vs. Guilt Here the key word in a child's life changes from "No!" to
why?". In this stage children want to understand the world and they ask too many
darn questions!!!! If their initiative in questioning the world is encouraged, then they
will feel comfortable with expressing their curiosity throughout the rest of their life.
If we discourage them and tell them to shut up, then they will feel guilty about their
questioning and avoid being inquisitive later.
STAGE 4: INDUSTRY VS. INFERIORITY (6 to 12 years old)

LATENCY
Age (school age). The important

event is school and the important
relationships are teachers, friends and
neighborhood. The child must learn to deal
with new skills and develop a sense of
achievement and accomplishment. Failure
to do so can create a sense of inferiority,
failure and incompetence.

Erik Erikson 232
Industry vs. Inferiority This is where most children begin formal education
(what we call school). For the first time children are being formally evaluated. If a
child raises their hand in class and answers a question correctly, then he/she will
feel industrious (competent). If he/she tries to answer a question but stutters to get
out the wrong answer, and other students all start making fun of his/her speech
impediment, then the child will feel inferior.
STAGE 5: IDENTITY VS. CONFUSION (12 – 20 years old)
The important event is development

of peer relationships and the important
relationships are peers, groups and social
influences. The teenager must achieve a
sense of identity in occupation, sex roles,
politics and religion. In addition, they must
resolve their identity and direction. Failure to
make these resolutions can lead to the
repression of aspects of the individual for the
sake of others (fanaticism).
Identity vs. Role Confusion In adolescence, Erikson believed that a

teenager’s main social need is to discover his or her social identity. While
searching for your identity, you may try out different roles, like trying to fit into
various social groups, experimenting with drugs or sex, or just changing your
wardrobe. You should be trying to find a stable sense of self now, or Erikson
believed you may have an identity crisis later.
STAGE 6: INTIMACY VS. ISOLATION (20 – 40 years old)
The important event is parenting

and the important relationships are lovers,
friends and work connections. In this
stage, the individual must develop intimate
relationships through work and social life.
Failure to make such connections can
lead to promiscuity, exclusivity and
isolation.
Intimacy vs. Isolation Young adults
(early 20s into early 30s) are trying to

Erik Erikson 233
balance their career efforts (work, school or self- improvement) with the need to
be in an intimate relationship with another person. How much time should I spend
looking for a relationship? What if I don't find anybody? What if I am all alone for
the rest of my life?
STAGE 7: GENERATIVITY VS. STAGNATION (40 to 65 years old)

parenting and the important
relationships are with children
and the community. This stage is
based on the idea that each adult
must find a way to satisfy,
support and contribute to the
next generation; it is often
thought of as giving back. Failure
to resolve this stage can lead to
overextension or rejectivity.
Generativity vs. Stagnation Erikson believed that by the time we reach our
mid 30s to mid 50s we start to really examine our lives and see if it is going the
way we planned it or did it take a drastic turn. This is where some people take
drastic steps and change their lives. You could see a lot of late divorces or extreme
changes in clothes or cars- we call this experience a mid-life crisis.
STAGE 8: INTEGRITY VS. DESPAIR (65 years old to death)
The important event is reflection on and

acceptance of the individual’s life. The
individual is creating meaning and purpose of
one’s life and reflecting on life achievements.
Failure to resolve this conflict can create
feelings of disdain & despair.
Integrity vs. Despair Towards the end of
our lives we look back and evaluate ourselves.
Did we live a good life? Leave behind a legacy

Erik Erikson 234
of friends or family? Or did we waste our time playing Madden 2023 on Playstation
7? If we feel like there were many lost opportunities along the way we may fall into
despair. I like to use this stage to try to shape my life now- you should too.
One of the strengths of psychosocial theory is that it provides a broad

framework from which to view development throughout the entire lifespan. It also
allows us to emphasize the social nature of human beings and the important
influence that social relationships have on development.
Researchers have found evidence supporting Erikson's ideas about identity

and have further identified different sub-stages of identity formation. Some
research also suggests that people who form strong personal identities during
adolescence are better capable of forming intimate relationships during early
adulthood. Other research suggests, however, that identity formation and
development continues well into adulthood.

Choose the best answer for each question.
ACTIVITY
_____ 1. According to Erikson's Psychosocial Stages of Development, the stage in
which a child needs to learn important academic skills and compare
favorably with peers in school to achieve competence is the ____ stage.
a. Trust vs. Mistrust

b. Identity vs. Role Confusion
c. Initiative vs. Guilt
d. Industry vs. Inferiority
_____ 2. Mary and Fred have one child and want to adopt a second. Since their first
child's infancy had been extremely difficult on Mary, she was excited at the
possibility of adopting an older child, perhaps a well-behaved, toilet-trained
3 year-old, and skipping the infancy period entirely. Fred, on the other
hand, had serious misgivings not knowing about the quality of care giving
and relationships in this child's early life. In a 3 year-old's case, he felt that
inadequate care and improper resolution of what Ericksonian stage could

Erik Erikson 235
lead to irreparable damage in later development?
a. Intimacy vs. Isolation

c. Trust vs. Mistrust
d. Autonomy vs. Shame and Doubt
_____ 3. A 38-year-old woman quits her high-paying marketing job to focus on her
children and become a school counselor. What stage would Erikson
consider this to be:
a. Identity vs. Role Confusion

b. Generativity vs. Stagnation
c. Integrity vs. Despair
d. Industry vs. Inferiority
_____ 4. Which is an example of the initiative vs. guilt stage?
a. An infant chewing on a teething ring

b. A preschooler insisting on picking out her own clothes, no matter
how mismatched they are
c. A middle-schooler completing a challenging math assignment
d. A teenager trying out new fashions and hairstyles
_____ 5. The stage that occurs between birth and one year of age is concerned
with:
a. Intimacy vs. Isolation

c. Trust vs. Mistrust
d. Autonomy vs. Shame and Doubt
_____ 6. How many stages of psychosocial development did Erikson describe?
a. 4 c. 8
b. 10 d. 12
_____ 7. The crisis that arises in young adulthood is concerned with:
a. Trust vs. Mistrust

b. Integrity vs. Despair
c. Industry vs. Inferiority
d. Intimacy vs. Isolation
_____ 8. If a child struggles to do well in school, what problem might emerge?

Erik Erikson 236
a. Struggle with feelings of inferiority
b. Experience a sense of guilt
c. Develop a poor self-identity
d. Begin to mistrust the people around him
_____ 9. Successfully completing the eighth stage of psychosocial development

leads to the emergence of what quality?
a. Hope c. Fidelity
b. Purpose d. Wisdom
_____ 10. The person I did my project on
a. Sigmund Freud c. Erik Erikson

b. B.F Skinner d. Jean Piaget
_____ 11. This person I did my project on created
a. Electricity
b. 8 stages of human development
c. The first rail line
d. Psycho sexual stages
_____ 12. Which of these are on the 8 stages of human development
a. Trust vs Mistrust c. Intimacy vs isolation

b. Industry vs inferiority d. all of the above
_____ 13. Erikson stages of human development is the same for everyone
a. True b. False
_____ 14. When a child is constantly told by their parents that they cannot do
something, this is a negative outcome of which stage of development
a. Stage 1 - Trust vs. Mistrust

b. Stage 2 - Autonomy vs. Doubt
c. Stage 3 - Initiative vs. Guilt
d. Stage 4. Industry v Inferiority
_____ 15. Preschoolers (ages 3-6) go through what stage?
a. Shame vs Doubt d. Initiative vs Guilt

b. Industry vs Inferiority e. Ego vs Identity
c. Trust vs Mistrust

Erik Erikson 237
Directions: Complete the Stages of Psychosocial Development
according to Erik Erikson.
ERIKSON’S STAGES OF PSYCHOSOCIAL DEVELOPMENT
STAGE
Issue Description of Task
(Approx Age)
1
Trust vs. If needs are dependently met, infants
Mistrust develop a sense of basic trust
2
TODDLERHOOD Toddlers learn to exercise their will and
do things for themselves, or they doubt
(1-3 years old)
their abilities
3
PRESCHOOL Initiative vs.
(3-6 years) Guilt
4 5
Industry vs.
Inferiority
6
ADOLESCENCE Teenagers work at refining a sense of
(Teen years – self by testing roles and then integrating
them to form a single identity, or they
20s) become confused about who they are.
YOUNG 7
ADULTHOOD Intimacy vs.

Isolation
(20s – early 40s)
8 In middle age, people discover a sense
Generativity of contributing to the world, usually
vs. Stagnation through family and work, or they may
feel a lack of purpose
9 10 Reflecting on his or her life, an older
adult may feel a sense of satisfaction or
failure.

Erik Erikson 238
6. LAWRENCE KOHLBERG’S
MORAL DEVELOPMENT THEORY
Kohlberg's theory of moral development is a theory that focuses on how

children develop morality and moral reasoning. Kohlberg's theory suggests that
moral development occurs in a series of six stages. The theory also suggests
that moral logic is primarily focused on seeking and maintaining justice.
Lawrence Kohlberg,
(born October 25, 1927,
Bronxville, New York, U.S.—
died January 17, 1987, Boston,
Massachusetts), American
psychologist and educator
known for his theory of moral
development.
Kohlberg was the

youngest of four children of
Alfred Kohlberg, a successful
silk merchant of Jewish
ancestry, and Charlotte
Albrecht Kohlberg, a Protestant
and a skilled amateur chemist.
When the couple divorced in
1932 after 11 years of marriage,
each of the children was
required by a court order to choose which parent he or she would live with. The
two younger children chose their father and the older ones chose their mother.

Lawrencerelevant to Nursing Practice
Kohlberg 239
Kohlberg graduated from Phillips Academy in Andover, Massachusetts, in
1945. After serving in the U.S. merchant marine, he worked on a ship that had
been hired by Haganah, the Zionist military organization, to smuggle Jewish war
refugees into Palestine, past the British blockade. The ship was intercepted,
however, and Kohlberg was imprisoned in a British internment camp in Cyprus.
Returning to the U.S. in 1948, he enrolled at the University of Chicago, where he
completed a B.A. in psychology in one year and a Ph.D. in psychology in 1958. He
subsequently held teaching positions at various institutions before settling
at Harvard University in 1968.

OF THEORY
How do people develop morality? This question has fascinated parents,

religious leaders, and philosophers for ages, but moral development has also
become a hot-button issue in psychology and education. Do parental or societal
influences play a greater role in moral development? Do all kids develop morality
in similar ways?
Kohlberg based his theory on a series of moral dilemmas presented to his

study subjects. Participants were also interviewed to determine the reasoning
behind their judgments in each scenario.
One example was "Heinz Steals the Drug." In this scenario, a woman has
cancer and her doctors believe only one drug might save her. This drug had been
discovered by a local pharmacist and he was able to make it for $200 per dose
and sell it for $2,000 per dose. The woman's husband, Heinz, could only raise
$1,000 to buy the drug.
He tried to negotiate with the pharmacist for a lower price or to be extended

credit to pay for it over time. But the pharmacist refused to sell it for any less or to
accept partial payments. Rebuffed, Heinz instead broke into the pharmacy and
stole the drug to save his wife. Kohlberg asked, "Should the husband have done
that?"
Kohlberg was not interested so much in the answer to whether Heinz was
wrong or right but in the reasoning for each participant's decision. He then

Kohlberg 240
classified their reasoning into the stages of his theory of moral development.
III.MAJOR ASSUMPTIONS, CONCEPTS

AND RELATIONSHIPS
VII.
STAGES OF MORAL DEVELOPMENT
Kohlberg's theory is broken down into three primary levels. At each level of
moral development, there are two stages. Similar to how Piaget believed that not
all people reach the highest levels of cognitive development, Kohlberg believed
not everyone progresses to the highest stages of moral development.
LEVEL 1. PRECONVENTIONAL MORALITY
Preconventional morality is the earliest period of moral development. It lasts

until around the age of 9. At this age, children's decisions are primarily shaped by
the expectations of adults and the consequences for breaking the rules. There are
two stages within this level:
Stage 1 (Obedience and Punishment): The earliest stages of moral

development, obedience and punishment are especially common in

Kohlberg 241
young children, but adults are also capable of expressing this type of
reasoning. According to Kohlberg, people at this stage see rules as fixed
and absolute. Obeying the rules is important because it is a way to avoid
punishment.
Stage 2 (Individualism and Exchange): At the individualism and

exchange stage of moral development, children account for individual
points of view and judge actions based on how they serve individual
needs. In the Heinz dilemma, children argued that the best course of
action was the choice that best served Heinz’s needs. Reciprocity is
possible at this point in moral development, but only if it serves one's
own interests.
LEVEL 2. CONVENTIONAL MORALITY
The next period of moral development is marked by the acceptance of social

rules regarding what is good and moral. During this time, adolescents and adults
internalize the moral standards they have learned from their role models and from
society.
This period also focuses on the acceptance of authority and conforming to the
norms of the group. There are two stages at this level of morality:
Stage 3 (Developing Good Interpersonal Relationships): Often
referred to as the "good boy-good girl" orientation, this stage of the
interpersonal relationship of moral development is focused on living up
to social expectations and roles.7 There is an emphasis on conformity,
being "nice," and consideration of how choices influence relationships.
Stage 4 (Maintaining Social Order): This stage is focused on ensuring

that social order is maintained. At this stage of moral development,
people begin to consider society as a whole when making judgments.
The focus is on maintaining law and order by following the rules, doing
one’s duty, and respecting authority.
LEVEL 3. POSTCONVENTIONAL MORALITY
At this level of moral development, people develop an understanding of

abstract principles of morality. The two stages at this level are:

Kohlberg 242
Stage 5 (Social Contract and Individual Rights): The ideas of a social
contract and individual rights cause people in the next stage to begin to
account for the differing values, opinions, and beliefs of other
people. Rules of law are important for maintaining a society, but
members of the society should agree upon these standards.
Stage 6 (Universal Principles): Kohlberg’s final level of moral

reasoning is based on universal ethical principles and abstract
reasoning. At this stage, people follow these internalized principles of
justice, even if they conflict with laws and rules.
Directions: Read the questions
ACTIVITY carefully. Choose the best answer for

each question. Write your answer on the
blank provided.
_____ 1. How many main stages of moral development are there?
a. 1 c. 5
b. 3 d. 7
_____ 2. How many levels of moral development are there in each stage?
a. 2 c. 6
b. 4 d. 8
_____ 3. Does everyone achieve the last stage of moral development?
a. No b. Yes
_____ 4. In this stage, children are good so that they can be seen as good to other
people.
a. Preconventional/ b. Conventional
Premoral c. Post Conventional
_____ 5. If a child is good because they do not want to avoid punishment, which

Kohlberg 243
stage are the students in?
Premoral c. Post Conventional
_____ 6. In this stage, individual judgment is based on individual rights and justice
for the greater good.
a. Preconventional or b. Conventional
Premoral c. Post-Conventional
_____ 7. In this stage, the child is aware of wider rules of society. At this point, a
student is good because of what society says.
_____ 8. A child at this stage children begin to understand that different individuals
have different viewpoints. In other words, they may understand that what
"dad" thinks is right may be different from what his/her teacher may think
is right.
a. Pre-conventional/ b. Conventional
Premoral c. post-conventional
_____ 9. People at this stage develop their own set of moral guidelines that may or
not fit into the law. Things like human rights, justice, and equality are most
important even if they have to go against society and have to face
consequences.
_____ 10. According to Kohlberg, most people will reach the highest stage of moral
development.
a. True b. False

Kohlberg 244
Directions: Complete the Stages of Moral Development according to
Lawrence Kohlberg.
LEVEL/ STAGE AGE RANGE DESCRIPTION

1 No difference between
INFANCY doing the right thing and
avoiding punishment
I. 2 Interest shifts to rewards
rather than punishment-
SELF-INTEREST
effort is made to secure
greatest benefit for oneself
3 4 5
6 Orientation toward fixed

II.
rules. The purpose of
morality is maintaining the
social order. Interpersonal
accord is expanded to
include the entire society.
7 8 Mutual benefit, reciprocity.
Morally right and legally
right are not always the
same. Utilitarian rules that
III. make life better for
everyone.
9 10
UNIVERSAL
PRINCIPLES
REFERENCES:
1. McEwen, M., & Wills, E. M. (2018). Theoretical basis for nursing (5th
ed.). Lippincott Williams and Wilkins.
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https://nurseslabs.com/psychosocial-theories/

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Theories Relevant To Nursing Practice

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Theories relevant

1. Ensure a working relationship utilizing relevant

2. Discuss relevant concepts of collaboration with

THEORETICAL FOUNDATION IN NURSING | Theories relevant to Nursing Practice 195

THEORETICAL FOUNDATION IN NURSING | Theories relevant to Nursing Practice 196

I. BACKGROUND OF THE THEORIST

On April 1, 1908, Samuel and

THEORETICAL FOUNDATION IN NURSING | Theories

Maslow's hierarchy of needs is a theory of motivation which states that five

Maslow's theory presents his hierarchy of needs in a pyramid shape, with

1. PHYSIOLOGICAL NEEDS: The first of

2. SAFETY NEEDS: Next among the lower-level

3. LOVE AND BELONGING NEEDS: The social

THEORETICAL FOUNDATION IN NURSING | Theories

4. ESTEEM NEEDS: The higher needs, beginning

5. SELF-ACTUALIZATION NEEDS: Self-

According to Maslow, individuals are motivated by unsatisfied needs. As

THEORETICAL FOUNDATION IN NURSING | Theories

_____ 1. Protection from violence and theft

THEORETICAL FOUNDATION IN NURSING | Theories

_____ 1. Which of the following is the correct order of Maslow’s Hierarchy of

a. physiological needs, love and belonging needs, self-actualization,

_____ 2. Abraham Maslow described the physiologic needs as

a. a need to be and do what we were meant to do.

____ 5. If somebody is naturally talented at athletics, and enjoys these activities,

THEORETICAL FOUNDATION IN NURSING | Theories

Directions: Complete the Hierarchy of Needs below. Using the words

PSYCHOLOGICAL SEXUAL HEALTH

CREATIVITY FRIENDSHIP PENSION EXCRETION

THEORETICAL FOUNDATION IN NURSING | Theories

Abraham Maslow's iconic pyramid of needs is one of the most famous

2. HARRY STACK SULLIVAN’S

THEORETICAL FOUNDATION IN NURSING | Theories relevant

He made substantial contributions to clinical psychiatry, especially

Stack-Sullivan is known for his Interpersonal Theory. He is considered the

THEORETICAL FOUNDATION IN NURSING | Theories relevant

 Personality is an energy system.

THEORETICAL FOUNDATION IN NURSING | Theories relevant

 Disjunctive, diffuse and

 Stems from complex interpersonal relations. Vaguely

 transformed into either overt or covert actions.

THEORETICAL FOUNDATION IN NURSING | Theories relevant

 Traits or habit patterns

¡ Related to specific ¡ Disjunctive

 Disjunctive dynamism between evil and hatred.

THEORETICAL FOUNDATION IN NURSING | Theories relevant

 Most complex and inclusive of all dynamisms.

¡ Dissociation = includes impulses, desires, and needs

¡ Selective Inattention = refusal to see things that one

THEORETICAL FOUNDATION IN NURSING | Theories relevant

 People’s images of themselves or others

THEORETICAL FOUNDATION IN NURSING | Theories relevant

 Refers to ways of perceiving, imagining, and conceiving.

Each stage involves specific interpersonal challenges or tasks, and specific

1. INFANCY (Birth – 18 months)

- During the beginning stage, the

2. CHILDHOOD (18 months – 6 years old)

THEORETICAL FOUNDATION IN NURSING | Theories relevant

- At ages 18 month to 6 years, the

Personality is an energy system.

Disjunctive, diffuse and

Stems from complex interpersonal relations. Vaguely

transformed into either overt or covert actions.

Traits or habit patterns

Disjunctive dynamism between evil and hatred.

Most complex and inclusive of all dynamisms.

People’s images of themselves or others

Refers to ways of perceiving, imagining, and conceiving.

All psychological disorders have an interpersonal origin and must be

Therapist is a participant observer who establishes an interpersonal