Nursing Theories

Cognitive Development Nursing Theories

Piaget’s Theory of Cognitive Development: Critical analysis

Background. Jean Piaget was a Swiss clinical psychologist who is known best for his pioneering work in child development (Lillard et al., 2013). Piaget was an enthusiast of children’s education and devoted much of his time trying to understand the child’s understanding capabilities. Notably, Piaget worked at Binet Institute in the 1920s where his job was generally to develop French versions on English intelligence tests. More often, he was intrigued with the reasoning of the children when they gave the wrong answers for the questions that required logical thinking. According to Piaget, he believes that, the different and wrong answers given by the children demonstrated the differences of thinking between children and adults. He observed the behavior in his children who formed the first test subjects in formulation of his theory in 1936 (Jehan & Butt, 2015).

Theory description.

Piaget’s theory of cognitive development is purely based on the reasoning based on innovation. He was not influenced by works of the other people when he formulated his nursing theory (Barrouillet, 2015). Neither did he follow certain natural laws. He was the first to conduct such a study that was primarily focused on child development. Piaget’s Cognitive Theory has four stages of development. The first stage is the sensorimotor stage (0-2 years) that mostly involves infants and toddlers who acquire knowledge through sensory activities and experiences. Also they obtain knowledge by manipulating objects. This observation was mostly made on his daughter and nephew. The next stage is the preoperational stage (2-7 years) where children learn by playing, but still struggle with understanding logical things. At this stage, children are yet to fully obtain abilities to differentiate some of the logical elements like choosing between two equal things but with slight distortions. The third stage is referred to as the concrete operation stage (7-11 years). At this stage, children’s mental development is a bit flexible; they begin to think more logically and can differentiate between a few things. They mind is still rigid in this stage meaning, they take time to understand something. The fourth and final stage is the formal operational stage (11 years and above). At this phase, people have the ability to use deductive reasoning, develop logical understanding of ideas and are able to see the world in larger scope.

Nursing theory Evaluation.

In regard to Piaget theory of cognitive development, the basic assumption is that children are slow thinkers unlike the adults who are logical and first thinkers (Siegler, 2016). Before the nursing theory, there was a general assumption that, children are less competent in thinking compared to adults who are quicker thinkers. Piaget in his study showed that, children are not less thinkers but they have different ways of viewing the world compared to the adults. According to Piaget, children are born with a genetically inherited basic mental structure that forms the foundation of all subsequent learning and knowledge (Kose & Arslan, 2015).

The nursing theory has been applicable in many settings and hence making it evidence based. The stages described by the nursing theory are practical and can be observed in children throughout growth and development. On many occasions, scholars have criticized the Piaget model on data collection because he heavily relied on a sample of children from the same society background, which could not offer a sample size population that would have included all the children with different characteristics. They also argue that, the child’s environment influences the level of their thinking. According to Bryant (date), the tasks given to the children were not hard to do for the children and hence the Piaget data was biased and not a true reflection of the matter.

Nursing theory Application.

Nurses in their line of work have to face and experience the wrath of dealing with so many types of people. Logical thinking among the patients varies with some having the capability to instantly grasping the information in the right way while others take long to process. Piaget’s cognitive development theory becomes an important tool in nursing especially when dealing with children. By using the nursing theory, the nurse gets to identify the stage of the child according to the stages defined by Piaget (Kose & Arslan, 2015). With that knowledge, the nurse will understand the ability of the child to understand and hence knowing how to communicate to the patient effectively in getting critical information that may be relevant in her/his diagnosis.

Erikson Theory: Critical Analysis


Erik Erikson, born in 1902 in Frankfurt, Germany and moved to the United States around 1930s. At his youth age, he used to serve as a tutor of the children of Sigmund Freud’s associates. He received training in psychoanalysis and he did a lot of investigations in that field. His nursing theory was based on his own life experiences and he based his work on Sigmund Freud’s theory (Stroebe, et Al., 2012). He analyzed Freud’s theory and to make it more effective he decided to investigate the emotional aspect of what resulted in the development of his psychological theory.

Nursing Theory description.

Notably, Erik Erikson’s theory used deductive reasoning in its development. According to Erikson’s Theory of 8 development stages, researchers are able to understand the changes of an individual throughout his or her life. Every successful stage leads to another developmental stage and if the challenges of a certain stage are not completed then they are likely to reoccur in the future (Heckhausen, Wrosch & Schulz, 2010). If a researcher wants to determine certain aspects, then he must start by hypothesizing with general statements then determine the possibilities to reach a certain logical conclusion. Erikson proposed a model which takes up stages of life and during every stage, a person experiences a psychosocial crisis which may have a positive or negative outcome on personality (Csikszentmihalyi & Rathunde, 2014). The theory consists of eight stages, five stages up to 18 years with three further beyond as discussed below.

The first stage is trust vs mistrust which occurs from birth to 12 months and infants learn that adults can be trusted. This is because they receive their needs and the caregivers who do not give their children’s needs endanger feelings of anxiety, fear, and mistrust .

The second stage is autonomy vs shame which occurs between 1 and 3 years. Children learn they can control their actions and they can get results when they act on the environment. They start to get preference over things such as toys, food and clothing (Ungar, Ghazinour & Richter, 2013).

The third stage is initiative vs guilt which occurs between age 3 and 6. Children start asserting control over their world by playing and social interactions. They develop a sense of self-confidence and they feel the sense of belonging.

The fourth stage is industry vs inferiority which occurs between age 6 and 12. They start comparing themselves with other children then they develop sense of pride and achievement in sports, social activities and school work (Lillard et. al, 2013).

The fifth stage is identity vs role confusion occurring between 12 and 18 years. Adolescents start asking questions such as “what do I want in my life”, “who am ?”. The successful ones develop strong sense of identity while the rest feel unsure of their identity and they feel confused.

The sixth stage is intimacy vs isolation which occurs between 20 and 40 years. After the person identifies him/herself, he/she is ready to share their lives with another person. At this stage the person starts setting their own goals of life and their behavior at this stage largely determines their lives.

The seventh stage is generatively vs stagnation which occurs when people reach 40s and it involves people finding their life’s work and how they contribute to other people’s life for instance raising children, mentoring and volunteering.

The last stage is integrity vs despair which occurs from mid-60’s to the rest of their lives. In this stage people feel the sense of satisfaction or failure with respect to their lives. The person feels tired of life and their behavior do not affect any aspect of their lives.

The eight stages as outlined by Erikson derive their ideas from Freud’s theory as they hold some tenets which include. The ego is an essential aspect in human development. The stages are independent and part of the ego is a powerful agent which promotes mental health. With this regard, Freud’s ego psychology states that social and sexual factors play a very important role in the development of personality (Jeong Shin & Cooney, 2012). However, Erikson’s theory is more detailed as compared to Freud’s and it gives information about neurotics as well as the normal personality.


There is an explicit assumption that human development follows a predictable pattern as Erikson assumed that physical, cognitive, as well as psychological processes tend to follow a certain pattern (Hoare, 2011). This means that one can be able to determine the psychological characteristics for a person in a certain age bracket (Martin, Ruble & Szkrybalo, 2010). Additionally, Erikson’s theory has an implicit assumption in the sense that Erikson assumes that there is a crisis which occurs at each stage of development. He says that these crises are psychosocial in nature since it involves the psychological needs of a person (i.e. psycho) and conflicting with the needs of the society (i.e. social) (Lillard et al., 2013). Erikson’s theory has been praised due to its use of scientific techniques to support its arguments. Psychosocial theory puts a great emphasis on whatever happens in the society and it shows how this influences the identity of an individual (Bussey & Bandura, 2012). Therefore, the theory is evidence-based since it investigates the effects of one stage to another. This is because one is able to concept of whatever happens in a certain stage before moving to the next stage. Additionally, you can be able to make reference of one stage with respect to another. According to Erikson, a successful completion of one stage leads to a healthy person since he or she acquires the basic virtues. These virtues are the characteristics strengths which the ego can use so as to resolve subsequent crises (Elo et al. 2013).

The validity of Erikson’s theory can easily be determined by the application of the secondary analysis which evaluates the internal-consistency which is how useful the data is in the research in question as well as the construct validity which is how useful the data can be used for other research. According to Villar (2012), development of Erikson’s research on psychoanalytical studies has been credited due to its consistence. To test the validity of Erikson’s theory he used children, young adults, and older adults and special attention was given across the age groups. Findings showed that the theory was useful in operationalizing and testing development in the individuals. This is because it was possible to determine the psycho behavior of a person in a certain age group. Also one can relate thinking of a person with the Erikson’s stages of development (Beyers & Seiffge-Krenke, 2010).


There is need for the nurses to understand Erikson’s theory and it can be greatly used when practicing nursing. For instance, understanding the concepts of the theory will help in analyzing the patients’ symptomatic behavior in the context of traumatic past experiences as well as the struggles with the current developmental tasks (Sacco, 2013). Based on the past experiences of the patients, nurses would be able to identify the inpatient’s faulty behavior hence they will help them seek psychological assistance such as counseling. Additionally, they can help a patient who may be having difficulty with developmental phases through the provision of care directed to a specific stage (Kolb & Kolb, 2012).

When the patient’s resolution of previous psychosocial stages have been found to be faulty in the manner that they compromise the development, patients have the opportunity of reworking early development through the relationship of a therapist. This means that the patient would have a chance of opening up about any challenge that they experienced at early stages of their lives which could be affecting them. Erikson’s theory has also been applied in the psychology discipline (Elo et al., 2013). In nursing, they must study the psychology of a human being as this will help them in understanding the techniques that they will use to approach patient. Erikson’s theory can be used in training the nurses as it lays the foundation for the succession of every stage of a person’s development (Belsky & Pluess, 2013). Generally, cognitive psychologists note that every developmental stage of a human being is associated with the complex social issues (Stark, Chase, & DeYoung, 2010). However, nurses must be careful in order to ensure they apply the theory in the most appropriate manner. They should use it for social related health issues hence it can only be used to diagnose conditions such as depression which are psychosocial related.

Freud’s Theory: Critical Analysis


Sigmund Freud was born on May 6th 1856, in Příbor, Czech Republic. He earned his medical degree between 1873 to 1881 at University of Vienna. On reading about the treatment of hysteria in 1884 by Breuer, he turned to psychology and developed theories where he met some opposition before other scholars accepted his views. The psychosexual development theory is one of the most famous theories put forward by Sigmund Freud (Kline, 2014).

Theory description.

Sigmund Freud postulated that children move through a series of stages centered on erogenous zones. He argued that successful completion of the stages results in healthy adult individuals while fixation at any of the stages results in complications during adulthood (Kline, 2014). Though the reasoning is still used in modern day psychoanalysis, there is application of the new modern theories too. The theory employs the use of deductive reasoning (Usher & Bryant, 2014).  Deductive reasoning starts with a general rule then proceeds to a specific conclusion.

The main concepts of Freud’s theory is based on the idea that parents play crucial role in the development of their children. Freud postulated that personality consists of the id, ego and superego. He also proposed five stages of development: oral, anal, phallic, latency and genital stages. According to Freud, each stage of development has to be completed for the successful development of an individual (Usher & Bryant, 2014).

The theory explains that at the oral stage (0-1 year), the mouth is the pleasure center for development and this is why children are born with the sucking reflex. If the oral needs are not successfully met at the stage, the child develops negative habits like thumb sucking, smoking and drinking. During the anal stage (1-3 years), children experiment with stool and urine. Poor resolution at this stage especially by toilet training may make a child to be obsessed with order. During the phallic stage (3-6 years), children take pleasure in their genitals, and begin to struggle with sexual desire towards the opposite sex. This is when the boy child demands the mother’s attention and the girl child demands father’s attention. This is also referred to as the Oedipal complex in boys and the Electra complex in girls. During the latency stage (6-12 years), children lose the sexual instincts and begin to develop the superego or conscience. This is when the children begin moral behavior. At the genital stage (12 years and older ), the sexual feelings reemerge. With the successful completion of the other stages, the adolescents may have appropriate behavior which may lead to marriage and child birth (Ahmed, 2012).


Freud’s theory of psychosexual development explains the behavior of children and adults. Observed behavior in an individual, depends on whether the individual completed the stages of development successfully or not. Patients observed by nurses may exhibit certain traits depending on their stage of development. Depending on what is observed by the nurse, he or she may conclude that the patient is fine or has complications. It is believed that children exhibit behavior which is related to what was observed by Freud at the various stages of development. The theory is based on observations made on developing children and adults who were fixated at certain stages in their development circle. This theory has sufficient clarity and consistency. It has been used successfully to explain various forms of behavior observed among adults as well as children.

In some areas, the theory did not meet the standard. This is because the theory has explanatory power but lacks scientific validity. The psychodynamic model is able to provide good explanations for the causes of abnormality, but lacks empirical research evidence needed to support the theory. Freud’s theory was based on his own observation of the population that he interacted with. The psychoanalysis conducted by Freud depends on his own subjective interpretation. Additionally, the sample used by Freud in making his conclusions was not representative. He used a sample that included middle class Viennese women aged between 20 and 44 years all of whom had emotional problems. This makes the sample non representative of the actual population. The theory is over focused on sexual issues yet there are many issues in life.


Human behavior is affected significantly by our subconscious. However, the expression of the subconscious is affected by various experiences during childhood (Ewen, 2014). For example, an individual who had very little given to him when growing up is possible to become self-reliant and vice versa. It is important for psychiatrists to determine past environmental for individuals before making the right diagnosis on patients who exhibit anomalies in their life. In dealing with patients, it is important to consider that the individual person has to deal with the id, the ego and the superego (Ahmed, 2012). The id is pleasure seeking and can result to a chaotic society if not regulated by the ego and the superego. The super ego is the regulator, and mostly borrows from religious and culture where gentility is taught and practiced.



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