can you help with the erikson stage- ego vs despair?

[starrys]

i had a 69 yo pt with sepsis, uti, and lung cancer. she's completely bed rest, needs total help. she also has paranoid psychosis personality so she's confused, agitated at times. in my nursing care plan it says to put the development stage. according to her age, she's in the ego vs. despair stage. however, do i put what her mental state is in? she wouldn't be in the despair stage nor the ego stage because of her psychosis. i found the first stage which was the trust vs. mistrust stage where the person depends on the mother or caregiver. is this correct for the patient?

[ParkerBC,MSN,RN, PhD, RN]

Yes. You are correct. Each stage is where a person should be in their lives, but as always, there are exceptions. I would be certain to document that your patient is not in the appropriate Erickson’s developmental stage, give rationale to your assessment like you did in your post, then state the stage in which you have determined your patient to be.

Good job !

[Double-Helix, BSN, RN]

I don't agree with saying that a 69 year old is in the trust vs mistrust stage. Yes, she may be dependant on others for her needs, but that's not what the stage is about. Erickson's theory was that each stage existed as a continuoum, and where you fell along that continuoum depended on your upbringing during that stage. So during the 0-1 age, the extend to which the baby's needs are met determines how trustful or mistrustful they will be for the rest of their lives. So a 69 year old cannot return to the trust vs mistrust stage.

Ego integrity vs despair refers to how the person feels when they reflect back on their life and how they behave based on their reflection. A person that feels their life has been meaningful and important will be on the ego integrity side of the continuom and continue to be a productive person. This means having hobbies, socializing, caring for grandchildren, etc. They continue to feel that their life is important. If the person feels they have done nothing or little of value in their life they will head toward the despair side: withdrawing and depression.

You can assess this person if they are able to make some lucid statements. Ask about their past, if they have children, what they did for hobbies before they were hospitalized. Ask family members these questions or see what information you can get from the socal portion of the H and P. If the patient is not lucid at all you can document that the patient is in the ego vs despair stage based on their age but you are not able to assess them further due to their mental status.

[elkpark]

When I taught nursing, it used to drive me crazy when students turned in a care plan or case study that said, "This person is X years old, therefore s/he is in Erikson's X stage of development." The individual's chronological age is the least important piece of information when determining what Eriksonian stage a person is in -- the classical age ranges for the stages are based on a "normal," healthy, high-functioning person. A person who has had significant chronic stressors in life, or is in a crisis state at present (as most acutely hospitalized individuals are) can be functioning in any of the earlier stages, and often is (whether that is a chronic state, or an acute, temporary reaction to the stress of the hospitalization and whatever caused it). You need to look at all the data you can gather about how the person is interacting with the world and relating to others, look at the detailed descriptions/definitions of the stages, and identify the one that best describes your client, regardless of chronological age. People with schizophrenia or other psychotic processes or disorders are often functioning at the trust-vs.-mistrust level, but each person is an individual and must be considered and assessed individually.

I agree with Parker, good job!

[Double-Helix, BSN, RN]

When I taught nursing, it used to drive me crazy when students turned in a care plan or case study that said, "This person is X years old, therefore s/he is in Erikson's X stage of development." The individual's chronological age is the least important piece of information when determining what Eriksonian stage a person is in -- the classical age ranges for the stages are based on a "normal," healthy, high-functioning person. A person who has had significant chronic stressors in life, or is in a crisis state at present (as most acutely hospitalized individuals are) can be functioning in any of the earlier stages, and often is (whether that is a chronic state, or an acute, temporary reaction to the stress of the hospitalization and whatever caused it). You need to look at all the data you can gather about how the person is interacting with the world and relating to others, look at the detailed descriptions/definitions of the stages, and identify the one that best describes your client, regardless of chronological age. People with schizophrenia or other psychotic processes or disorders are often functioning at the trust-vs.-mistrust level, but each person is an individual and must be considered and assessed individually.

I agree with Parker, good job!

It's fine that you feel that way, but that's not Erikson's theory. Erikson's theory allows for foreward progression through the stages. He states that the point where you complete one stage affects your future behavior and development. His theory doesn't leave room for regression through the stages. He believed that once a stage was completed, it couldn't be repeated.

I understand that age isn't the determining factor in determining the psychosocial stage. A person can become stagnated in a stage, such as a person with severe MR never progressing beyond trust v mistrust or autonomy v shame. It is possible for people with dementia or other psychiatric conditions to regress to a previous level of functioning. However the question was to assess the development from Erikson's perspective. Since Erikson didn't incorporate that into his theory, neither can we.

[ParkerBC,MSN,RN, PhD, RN]

i don't agree with saying that a 69 year old is in the trust vs mistrust stage. yes, she may be dependant on others for her needs, but that's not what the stage is about. erickson's theory was that each stage existed as a continuoum, and where you fell along that continuoum depended on your upbringing during that stage. so during the 0-1 age, the extend to which the baby's needs are met determines how trustful or mistrustful they will be for the rest of their lives. so a 69 year old cannot return to the trust vs mistrust stage.

ego integrity vs despair refers to how the person feels when they reflect back on their life and how they behave based on their reflection. a person that feels their life has been meaningful and important will be on the ego integrity side of the continuom and continue to be a productive person. this means having hobbies, socializing, caring for grandchildren, etc. they continue to feel that their life is important. if the person feels they have done nothing or little of value in their life they will head toward the despair side: withdrawing and depression.

you can assess this person if they are able to make some lucid statements. ask about their past, if they have children, what they did for hobbies before they were hospitalized. ask family members these questions or see what information you can get from the socal portion of the h and p. if the patient is not lucid at all you can document that the patient is in the ego vs despair stage based on their age but you are not able to assess them further due to their mental status.

i understand and respect your position. in a healthy person, i agree 100% with what you're saying. however, it is a theory of development. people develop differently. a person who is 69 years old and who is developmentally delayed does not have the cognitive ability to enter the stage of ego integrity vs despair. in other words, the person doesn't have the ability to reflect as their cognitive abilities do not allow for it. regression occurs as a natural protective mechanism for the brain. if a person who has been traumatized regresses back to infancy, then that is their developmental stage. i could not comfortably chart that the patient is in their appropriate developmental stage when they exhibit objective signs and symptoms that demonstrate differently.

if we assigned a developmental stage to patient based upon their age, then it wouldn't be a developmental theory. i personally think erikson's theory is flawed, but that's my personal opinion.

[JersE.Joe]

"It can be argued Crane (2005) that Erikson's theory qualifies as astage theory in the same way that Piaget's or Kohlberg's theories dobecause once again the stages refer to qualitatively different behaviorpatterns; they concern general issues; they unfold in an invariantsequence; and they are thought to be culturally universal. This maywork as a generality, but one must also consider that life's difficulties,such as divorce or loss of a job or loved one, can set a person back(regression)."

http://swppr.org/textbook/ch%209%20erikson.pdf