Fundamentals - Principles, part 5: Theoretical Foundations - Kohlberg, Maslow, Erikson, and Piaget

July 12, 2021 Updated: August 09, 2021 13 min read

When you were little, did you have an imaginary friend or a stuffed animal with magic powers? Read on to find out why, and how understanding human perception, needs and motives can make you a better nurse. In this article, we've outlined the key theoretical frameworks in nursing that you will need to know for your nursing school exams—Kohlberg, Maslow, Erikson, and Piaget. These are the frameworks which are most commonly found on exams and can give you a good theoretical foundation.

The Fundamentals of Nursing video series follows along with our Fundamentals of Nursing flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Why do nurses need to know theoretical foundations?

The theoretical foundations that you will need to know for your nursing exams explain different methods of understanding human thinking, reasoning, decision-making, types of needs, internal conflict, perception and cognition. Considering these frameworks in the context of patient behavior will help nurses better understand their patients, and oftentimes themselves, which can lead to better caregiving. Knowing Maslow's hierarchy can also help with determining nursing priorities.

Understanding patients motives, needs and perceptions can enhance nursing communication and the nurse/patient relationship.

What is psychosocial?

Throughout this article, we will use the term psychosocial when referring to different aspects of each framework. Psychosocial simply means involving both psychological and social aspects, or the interrelation of mental health and the social environment.

Kohlberg's Theory of Moral Development

Kohlberg’s Theory of Moral Development is a theory that focuses on thinking, reasoning, and decision-making across the lifespan. The three stages in Kohlberg's Theory are preconventional, conventional, and postconventional.

Preconventional stage

Kohlberg's Theory says that from birth to age 5, children are in the preconventional stage, when actions are taken with the goal of avoiding consequences or to get a reward. If you are familiar with the metaphor for "carrot vs. stick," where the carrot is a reward and the stick is a punishment, you can think of that for Kohlberg's preconventional stage.

Kohlberg's Theory about the preconventional stage can help explain why sticker charts are effective for very young children, as the sticker functions as a reward for good behavior.

Conventional stage

Kohlberg's Theory defines the conventional stage from age 6 to 12 when children start to think about how their actions affect other people, and that can influence their decision making. Children in this stage begin to understand and follow social norms and desire the approval of others.

Postconventional stage

Kohlberg's Theory says that the postconventional stage begins around age 13, and that this is when abstract ideas and other perspectives begin to impact decision making.

Maslow's Hierarchy of Needs

Maslow's Hierarchy of Needs is the most popularly known example of these theoretical frameworks, so you may already know about it! Maslow defined human needs and organized them hierarchically by how important they are. Maslow's Hierarchy is often shown in the form of a pyramid, indicating which needs are the most basic and important, as the foundation that the other needs are built on.

The key takeaway from Maslow's Hierarchy is that our psychosocial, higher-level needs can't be met until our basic and physiological needs are met. As a nurse, you will want your patients to fulfill their self-actualization needs, but per Maslow's Hierarchy, they can't do that if they are in severe pain or don't know where their next meal is coming from.

Maslow's Hierarchy can be used to help determine your priority nursing actions. For example, when prioritizing a nursing diagnosis for a patient with an eating disorder, inadequate nutrition (a physiological need) takes priority over working on body image (a psychosocial need).

If you encounter a test question where you need to establish your nursing priorities, and there are both physiological and psychosocial options, you can usually eliminate the psychosocial options first.

Physiological Needs

Physiological needs are the base of Maslow's Hierarchy. This means that our biological survival needs are the most important: water, food, and shelter.

Safety

Second from the bottom in Maslow's Hierarchy is safety, which includes security, employment and access to resources.

Love and Belonging

Third from the bottom in Maslow's Hierarchy is love and belonging, which includes relationships with friends, family, and significant others.

Self-Esteem

Fourth from the bottom in Maslow's Hierarchy is self esteem, which includes achievement and respect. We desire to be respected by others and ourselves (self-respect).

Self-Actualization

Near the top of Maslow's hierarchy is self actualization, which includes pursuing inner talents and fulfillment (e.g., hobbies) and achieving personal goals.

Erikson’s Stages of Psychosocial Development

Erikson’s Stages of Psychosocial Development is the name for a theory that describes key stages in human development and the "psychosocial crisis" encountered during each stage. A psychosocial crisis in this context is a conflict that can involve mental health and the social environment. For each stage of human development, Erikson posited that people have a main conflict that they are concerned with, whether they are aware of it or not.

Infancy: Trust vs. Mistrust

Erikson theorized that from birth to 1 year of age, we are learning what we can trust and what we cannot. For example, if you (a baby) cry, does someone attend to your needs?

Toddler: Autonomy vs. Shame and Doubt

Erikson theorized that from 1 to 3 years of age, we are learning our own autonomy in the world and that we can act on the world around us, but we can also internalize shame and doubt if our autonomy is suppressed. For example, if a three year old wants to dress herself, she is exhibiting autonomy, but if she were prevented from doing so by a strict parent or authority figure, she might learn to doubt her abilities.

Preschooler: Initiative vs. Guilt

Erikson theorized that from 3 to 6 years of age, children take initiative in the world and assert themselves through their social and physical interactions on the environment. However, if a child is prevented from doing so, they may internalize guilt.

School Age: Industry vs. Inferiority

Erikson theorized that from 6 to 12 years of age, we become more part of "industry" by attending school, making crafts, learning, participating in sports, and competing with peers. However, this can also have the effect of stack ranking us against our peers, and inferiority complexes can develop.

If a child was hospitalized during this time, they are away from their peers and the learning environment. Nurses can remember this Erikson stage (and its related needs) and give the child some crafts to do, or ensure they get their homework and other projects sent to them from their school.

Adolescence: Identity vs. Role Confusion

Erikson posited that from 12 to 18 years of age, we are forming our own identity in the world with our beliefs, actions, values, and choices (e.g., what clothes to wear). However, at this time we may also become confused about our place in the world. Teens may ask themselves, "What do I want to do with my life?"

Young Adulthood: Intimacy vs. Isolation

Erikson theorized that once we arrive at adulthood at age 18, all the way to age 40, we seek intimacy with others through friendships, acquaintances, family, and romantic relationships. However, we are also susceptible to isolation if we do not succeed (or think we don't) in these intimate relationship efforts.

Adulthood: Generativity vs. Stagnation

Erikson suggests that between the ages of 40 and 65 years old, our new task becomes generativity — to find our life's work and live into its purpose (e.g., career, raising a family, etc.). However, if we do not master this task we risk stagnation — feeling stuck or like we are not having an impact on the world around us.

During this time, life changes may be occurring — kids are grown and leave the home, some people become grandparents. This is a big shift and can be a crisis for some. People in this stage may either try to hold onto their youth, or part ways with it freely.

Older Age: Integrity vs. Despair

Erikson's theory states that once we reach old age (65 years old and older), we might reflect on our lives and feel pride and integrity at what we've accomplished. Alternatively, if we don't believe we have accomplished our life's goals, we may feel despair.

Piaget's Theory of Cognitive Development

Piaget’s Theory of Cognitive Development is a theory that describes perception and cognition across the lifespan. Piaget's Theory is made up of stages of how children perceive and explore the world before entering adulthood.

Sensorimotor stage

Piaget's theory states that during the sensorimotor stage, which is from birth to 2 years old, humans learn through senses and movement. During this stage, we also develop object permanence.

When children are born, they do not have object permanence, which means when something disappears from their sight, it ceases to exist to them. That's why peekaboo is such a fun game for babies and young toddlers— when you cover your face, they think you have completely disappeared...only to—SURPRISE!—come right back!

Preoperational stage

Piaget's theory defines the preoperational stage between ages 2 and 7 as the time when magical thinking occurs. Magical thinking is defined as thinking that magic is real, and that things can happen in the child's environment because of magic.

The preoperational stage also features animism, which means that we attribute human-like characteristics to inanimate objects. This could be anything from a stuffed animal to a decoration in the house. Children might be afraid of these things, or really like these things, because they believe the things are alive. If a child has an imaginary friend, that is also an example of animism.

Concrete operational stage

Piaget states that in the concrete operational stage, from ages 7 through 11, children gain an increased understanding of cause and effect, and the concept of conservatism starts to be understood. Conservatism is the understanding that matter does not change when its form is altered.

As an example, if you have 100ml of liquid and pour it into a short, fat glass, then pour it into a tall, skinny glass, a child who had not mastered conservatism would think that those were different amounts of liquid. An understanding of conservatism is evident when the child knows the volume of liquid didn't change.

Formal operational stage

Piaget's formal operational stage begins at age 11 and continues beyond, and this is where children develop abstract thinking, deductive reasoning, and logic-based problem solving. Abstract thinking is the ability to think of concepts (e.g., "dogs" in general as opposed to the child's actual, specific pet dog) and abstract ideas (things that exist but you can't touch, e.g. love, freedom, or poverty).


Full Transcript

Hi. I'm Meris, and today we're going to be talking about theoretical foundations such as Kohlberg, Erikson, Maslow and Piaget. These are very important for Fundamentals of Nursing classes, so I'm going to be following along with our Fundamentals of Nursing flashcards. These are available on LevelUpRN.com. If you have a set, you can follow along with me. I recommend that. We're going to be starting on card number 12, and I'll be sure to point out, just like I'm sure you know, the bold and red text is very important. Anything called out with a key point is very important as well, so be sure to focus on that when you're looking at your cards.

Alright. Let's get started. Okay, so first up we're going to be talking about Kohlberg.

Kohlberg's theory of moral development talks about thinking, reasoning and decision-making across the lifespan. So there's three big components to this. There's preconventional, which is for children less than 5 years old, and it kind of means I'm doing things, I'm making decisions to either get a reward or to avoid a consequence. This is why sticker charts work really well, because those little kids love that reward.

Then from 6 to 12 years we're in the conventional phase. This is where I'm starting to think about how my actions are affecting other people and that's going to play into my decision-making.

And then from 13 years on, now we are in postconventional, and this is where some more abstract thinking is able to come into my decision-making process and I'm starting to think about the world more complexly. So that is Kohlberg's Theory of Moral Development.

Okay, so up next we're talking about Maslow, and I love this card because we have this beautiful, beautiful image here on the back of the card for us to use. I think of this as just a really, really nice drawing, a nice illustration of Maslow's hierarchy of needs.

So Maslow's hierarchy of needs is essentially saying that there are lots of needs for a human being.

Some of them are physiological, like food and water. Some of them have more to do with love and belonging, and then at the highest is self-actualization. This is where we pursue who we really are, our inner talents. We feel fulfilled, but we can't do the higher level things unless all of the needs are being met at the lower levels.

So for instance, I can't be worried about love and belonging if I don't have food, water, shelter, things like that. It's just not possible, right? I need to meet my most basic needs before moving on to the higher psychosocial concerns. So Maslow's hierarchy of needs is incredibly important in nursing school, and you will see this comes into play when we answer test questions also, because yes, sometimes I want my patients to be achieving their self-actualization needs, but they can't do that because they are in severe pain or hungry or having concerns about where their next meal is going to come from when they get discharged. So definitely keep Maslow's in mind at all times.

Okay, moving right along to Erikson with card number 14. Now Erikson talks about key stages in human development, and has this idea that at each stage of development, there's a psychosocial crisis. So I'm not going to go through all of these, because as you can see, pretty extensive here. There's a lot of stages, but it is important to familiarize yourself with these because this comes up basically in every class.

So when you are an infant, the stage for Erikson is trust versus mistrust, which essentially means, when I cry, does somebody come? So this is the first psychosocial crisis for Erikson, is going to be learning to trust that when I have a need, somebody responds to it.

Then we can skip ahead to school age. School age we have industry versus inferiority. This is where kids are really industrious. They may be focused on things like crafts. They may be really into school and to being with their peers and learning.

So for instance, if they were to be hospitalized, then they're away from their peers. They're away from that learning environment, and we need to help them to meet that Erikson need by maybe giving them crafts to do, or ensuring that they get homework and other projects sent to them from their school.

Moving on, a big one that we see here in adulthood, from 40 to 65 years old is generativity versus stagnation. So basically, do I have some sort of thing that I feel comfortable? My children are going off to college. I am retiring. I'm starting to live my life in a different way. That's a big crisis for some people.

Either, I really lean into that role. I love seeing my children go off and become their own people. I love getting to be a grandparent. I love getting to spend my retirement time doing fun things. Or, does that cause me a crisis emotionally? Do I try to hold onto that youth? So these are some very important ones. And keep in mind, I just went over three, but there are a bunch here.

So Erikson stages are incredibly important for most of your nursing classes. Be sure to familiarize yourself with these concepts.

Okay, next we are talking about Piaget, on card number 15. Piaget had a theory about perception and cognition through the lifespan, and this really has to do with how children explore the world and learn about the world.

After about age 11 on, it's pretty much the same, but kids see the world and experience it in a much different way.

So you will see that on this card, we have a lot of bold red text, and that means it's really important. So I'm not going to go through all of this because there is a lot on here, but I am going to call out some key things.

One of the biggest things is that from age zero to two, children explore the world through the sensorimotor stage. So sensorimotor means with my senses and by moving. So this means that kids touch everything. They crawl. They're at eye level. They're experiencing the world in that way. They put things in their mouths, right? This experience of taste and feeling things. Tell me in the comments what you think that children in the sensorimotor stage are at risk for.

Another thing about the sensorimotor stage is that these children are experiencing something called object permanence. When kids are born, they don't have object permanence, meaning if I have an object and I move it out of sight, that child does not think that that thing continues to exist. That is why peekaboo is so much fun for them. But in this stage, they are starting to learn object permanence, which is very exciting.

Preoperational is from two to seven years, and a big thing here—and you probably have seen this in children in that age range—is something called magical thinking. So this is where we think that magic is real, and things can really happen because of magic.

We also have something called animism, which means that we attribute characteristics to inanimate things. So we treat inanimate things as though they are alive, so maybe that is a stuffed animal or maybe some sort of decoration in the house. Children might be afraid of these things or really like these things because they feel as though they are alive.

Concrete, operational, that's from age 7 to 11, and this is where a concept known as conservatism comes into play. This means that when an object transfers containers, it does not change the amount. So for instance if it's going from—if I have one container of liquid and I pour it into another but I have half and half, children in this stage learn that the amount doesn't change just because the form has changed.

And then from formal operational is from age 11 on, and this is where we really see children develop abstract thinking, and that is a type of thinking that persists into adulthood.

So you can see that Piaget is really talking about, "how do I see the world? How do I perceive it? And how do I explore the world?"

Okay, so that is it for theoretical foundations such as Kohlberg, Maslow, Erikson and Piaget. I hope that review was helpful. If it was, please like this video. I would love to hear your comments. Let me know about what you had as a child that you thought was alive or that you attributed characteristics to. I would love to hear that. Be sure to subscribe to the channel so that you can be kept up-to-date with all of the new content that we push out, and speaking of which, in the next video I will be covering the health belief model and the transtheoretical model, so I hope I'll see you there. Thanks so much, and happy studying!


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