Applying Piaget's developmental stages to pediatric nursing education

Teaching -- Piaget

Teaching through nursing and the use of Piaget's developmental stages to convey information

Quite often, a nurse must act as a teacher to her young patients. Other than the child's parents, teachers are likely to be the other major adult presence in most young person's frame of familiarity. Also, one of the nurse practitioner's functions in pediatric care is making the procedures and ailments of the child comprehensible within the limits of the child's cognitive faculties.

Sensorimotor Stage (ages 0-2)

During this preverbal stage, a nurse should attempt to communicate with the infant in a kinesthetic fashion. For example, a child who is experiencing his or her first trip to the doctor might be introduced to something frightening, like a cold stethoscope, by first placing a warm hand or a familiar plastic toy upon the area. This stage is characterized initially by the development of the infant's reflexes, like sucking, then by the development of habits, and then by passive reactions like moving away from a hand. Only later in this stage does the infant have a sense of object permanence, followed by the development of a sense of causality and finally creative engagement with the world. In deference to these different stages of the sensorimotor stage, if at all possible, it might be a good idea to allow a very young child's mother to be in view during an uncomfortable procedure, or, if this is not possible, to illustrate the concept of 'here' and 'away' and 'back again' with a stuffed animal to show that the child's mother will come back. Allowing the child to touch the examining implements if at all possible, allows a framework of physical comfort to be established through the child's empowering action of grasping. If this is not possible, the child may be allowed suck on his or her familiar pacifier, to establish a sense of physical comfort during a procedure.

Concrete Operational Stage (ages 7-11)

During this stage, children can understand the concept of multiple stages or aspects of a problem, the concept of transferable size and volume, and also reversibility of things like numbers or steps of an action. A child at this stage can understand, for example, that a large plate of fries and a small plate of fries have the same amount of food, even though the portion looks smaller on the large plate. Also, the child at this stage is no longer egocentric. The child can understand that he or she must undergo a difficult treatment, even though it hurts, because the family wants the child to get well, or that he or she may need to do things differently than others in his or her peer group. For example, a child who is a diabetic can understand that he or she cannot eat the same candy as his or her peers and suffer no adverse consequences, even though most of the peer group does not need to check their blood sugar. Children are still operating in the realm of the concrete at this stage, however, so rather than stress the moral rightness or wrongness of actions on an abstract level it is better to focus on physical consequences and results.

Formal Operational State (ages 11+)

After puberty, during the formal operational state, children begin to acquire the ability to think on an abstract level. A teenage affected with cancer might have questions to the philosophical question of 'why me,' or a teenager contemplating using birth control can weigh the pros and cons or long-term consequences of engaging in sexual behavior, or at least the different side effects of different methods of birth control. At this stage, children are no longer functioning on a purely egocentric and literal level, and can understand that he or she may have different perceptions and feelings about different issues than his or her parents, for example.

Conclusion

Piaget believed that the final transition into the formal operational stage usually coincided with puberty, although not all individuals made a full transition into the ability to think rationally, logically, and on an abstract level. It is up to the nurse's discretion when dealing with teenagers to judge, based upon the individual, whether the patient is interested or capable of formal operational logic. Also, all of the transitions to the different phases happen at different ages for different persons.