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36 LAYING THE FOUNDATION
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UNIT 1
Giving approval
During the health assessment interview, nurses can feel pressured to comment
judgementally on a consumer’s statements, feelings or behaviours, especially if
these contradict the nurse’s personal beliefs or feelings. Telling a consumer what is
right or wrong is moralising. This may limit the consumer’s freedom to verbalise
or behave in certain ways that might not please the nurse. Comments such as
‘What a good idea,’ ‘You shouldn’t feel that way,’ or ‘That is bad,’ hinder the
nurse’s attempts to establish rapport, support consumer competence and facilitate
communication. When there is concern that the consumer’s expressed beliefs
or personal behaviours are ill-informed, harmful or destructive, the nurse might
more effectively explore the source of the belief or the impact of the consumer’s
behaviour on others.
EXAMPLES OF EFFECTIVE APPROVAL RESPONSES
> ‘What made you come to that conclusion?’
> ‘What do you think the consequences will be if you continue to keep your illness from your wife?’
Defending
Occasionally, consumers who have had previous stressful or unpleasant experiences
(or seen relatives have these) with doctors, specialists or other agents in the
healthcare setting will engage in criticism or verbal attack. It is not helpful for the
nurse to defend the object of the attack. Defending implies that the consumer has
neither the right to hold such opinions or feelings nor the right to express them,
especially if they are hostile or angry. The nurse will not be able to change the
consumer’s opinions or feelings by defending the individual or the object attacked.
Rather, deection or criticism of consumer feelings more often either blocks
expression of these feelings or reinforces them. Defending is not therapeutic because
it requires the nurse to speak not just for themselves but for others, something that
nurses truthfully and realistically are not able to do.
EXAMPLES OF INAPPROPRIATE DEFENDING RESPONSES
> ‘This hospital has an excellent reputation. I’m sure that if you were kept waiting as long as you say,
there was a good reason.’
> ‘No one here would hide the truth from you.’
It is more respectful and useful to accept and support consumers’ rights to feel
as they do and to express those feelings. The nurse can do this without agreeing
with the expressed feelings. This empathetic behaviour defuses any antagonism and
minimises consumer resistance to the continued interaction.
EXAMPLES OF APPROPRIATE DEFENDING RESPONSES
> Nurse: You sound pretty angry about your previous experiences in this hospital.
> Consumer: Of course I am. Wouldn’t you be upset if no one ever told you what was going on and no
one answered your call bell?
> Nurse: I guess I’d be pretty upset if I thought people were not treating me respectfully.
Advising
Consistently telling a consumer what to do does not foster competence. Advising
encourages consumers to look to others for answers, deprives them of the
opportunity to learn from past mistakes, and discourages independent judgement.
As some consumers may resort to dependent, passive behaviour when faced with
illness, it is important that the nurse does not reinforce this dependence, but rather
supports the consumer’s healthy functioning as much as possible.
THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 37
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
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EXAMPLE OF INEFFECTIVE ADVISING RESPONSES
> Consumer: Do you think that I should have an abortion?
> Nurse: Well, if I were you, I’d certainly think long and hard before I’d have another child. Or No, I
think you should continue the pregnancy. Abortion is never the answer.
A more helpful response would be for the nurse to support the consumer’s
own problem-solving ability using therapeutic communication techniques such as
exploring or reection.
EXAMPLES OF EXPLORING
> ‘Tell me more about what made you consider an abortion.’
> ‘What other alternatives have you considered?’
EXAMPLES OF REFLECTION
> ‘Do you think you should?’
> ‘How would you feel about having the abortion?’
Questioning techniques which may be problematic
Experienced nurses as well as beginners will nd themselves occasionally feeling
nervous and perhaps unsure of how to proceed during the health assessment
interview. This anxiety can lead to the use of questioning techniques and
interviewing responses that, although not specically identied as nontherapeutic,
are potentially problematic. Such techniques increase consumer anxiety, decrease
the ow of needed information and have the potential to provide the nurse with
irrelevant data. The following are several examples of problematic interviewing
techniques the nurse should keep in mind and work hard to avoid. It is a good
idea to practise interview questioning with a peer or friend and note areas that you
should work on to improve in the future.
CHAPTER 2
Posing leading questions
Leading questions may indicate to the consumer that the nurse already has a certain
answer in mind. Their use can be intimidating to the consumer and curtail further
communication. This is especially true if these leading questions concern topics that
the consumer perceives as sensitive or as possible sources of anxiety.
EXAMPLES OF POSING LEADING QUESTIONS
> ‘You’ve never had any type of sexually transmitted infections, have you, Miss Jenkins?’
> ‘Of course, you’ve told your daughter that her smoking really bothers you, Mr Talbott, isn’t that
correct?’
Interrupting the consumer
Changing the subject or interrupting the consumer prevents completion of a
thought or idea and introduces a new focus. Such behaviour may ease the nurse’s
discomfort, but it shows a lack of respect, and often just confuses or irritates the
consumer. Questions should focus on one topic until all relevant data has been
collected and the consumer feels nished. Changing the subject or interrupting cuts
off the ow of ideas and communicates the message that whatever the consumer
was addressing is not as important as what the nurse wants to discuss next.
Neglecting to ask pertinent questions
It is easy to become complacent when conducting consumer interviews. Do not let a
consumer’s outward physical appearance, personality or social standing distract you
from ascertaining pertinent information. Do not assume that, because an individual
is well dressed and talks about a luxury car, he or she is well off. Likewise, do not
presume that a poorly dressed and ill-mannered person is poor and uneducated. All
consumers deserve to be treated respectfully during the consumer interview.
38 LAYING THE FOUNDATION
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UNIT 1
Using multiple questions
Consumers can become confused if a nurse asks several questions at once. Too
many questions may put consumers on the defensive, minimising an individual’s
participation and impeding the ow of necessary information.
REFLECTION IN PRACTICE
Asking essential information
A 15-year-old female presents to the emergency department with acute abdominal
pain. You are asked by the nurse manager to conduct a health assessment with the
consumer and her parents. Later you discover that the consumer is experiencing
a miscarriage. You tell your nurse manager that you did not inquire about the
consumer’s sexual activity. What variables in this scenario do you think led you to
neglect this part of the interview?
Using medical jargon
The use of medical jargon or slang can make a consumer quite anxious or
confused. Nurses who are part of the wider healthcare system, which has its
own culture and language, frequently use medical jargon. Consumers who may
feel frightened and powerless in this unfamiliar environment may be further
disadvantaged by their lack of comprehension and any perceived language
barrier. The use of medical jargon can be seen by the consumer as unwillingness
to share or attempts to hide information. It can also give the impression that the
nurse feels superior to the consumer and is unwilling to engage in collaboration
or mutual problem solving. Conduct the health assessment interview in a
language that is common to both participants, and check periodically with
the consumer as to clarity. This will indicate an interest in the consumer’s
perspective and a desire to work collaboratively. It may require the nurse to call
on an authorised interpreter.
Being authoritative
The use of authority as a healthcare professional can be a problematic technique. It
reinforces a patriarchal nurse–consumer relationship and can limit the cooperation
of the consumer.
EXAMPLE OF NEGATIVE USE OF AUTHORIT Y
> ‘I’ve been a nurse, Mr McMahon, for over 15 years, and I think I know what is best for you.’
In a few situations, the use of authority can be an effective communication
technique.
EXAMPLE OF POSITIVE USE OF AUTHORITY
> ‘As your healthcare provider, knowing about your previous heart attack, history of high blood pressure,
and family history of stroke, I would suggest you consider what options you have to assist you to stop
smoking.’
Having hidden agendas
Frequently, consumers seek health care for one problem but are concerned
about other problems. The consumer may believe that the overriding concern
is embarrassing, private or insignicant. Once in the presence of a healthcare
provider, the consumer may open up and discuss concerns. For example, a
consumer may seek care for a sore throat, then ask for blood tests for HIV. The
nurse should deal with the consumer’s concerns in the best way possible, then
follow up when indicated.
THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 39
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INTERVIEWING THE CONSUMER WITH SPECIAL NEEDS
Consumers with special needs require more consideration by the nurse during
the interview. Although the goal of the interview and the specic interviewing
techniques remain the same, the process differs according to the consumer’s special
needs. Conducting a successful assessment interview with the consumer with special
needs may require more time and effort than usual, and often requires the help of
an intermediary, such as a family member or a friend of the consumer. Remember
that consumer privacy and condentiality laws require consumer consent when an
interpreter or other assisting individual is used.
The consumer with impaired hearing
Often, consumers with impaired hearing will read lips, so it is important to remain
within sight of the consumer and face the individual when talking. When working
with such a consumer, ensure that the hearing aid is in working order and turned
on. Background noise should be at a minimum, because noise can be distracting
to the consumer with a hearing aid. Even if an
is a liaison between the consumer and a member of the healthcare team) is with
the consumer to assist in communication, always face the consumer and direct all
communication to that individual (Figure 2.10). It is common for those speaking
to a consumer with impaired hearing to speak loudly or slowly; however, though
well intentioned, such acts detract from the consumer’s ability to read lips. Tone
and inection of voice are lost to the consumer with impaired hearing. However,
other nonverbal cues such as facial expression and body movements can be used to
convey the meaning of what is said.
intermediary (an individual who
CHAPTER 2
FIGURE 2.10 When working with a consumer with impaired hearing, the interpreter needs to direct questions
to the consumer.
Consumers who have never had the ability to hear and those who have not
heard for a long time may have speech that is difcult to understand. Often, the
best approach to interviewing these consumers is to allow additional time, and to
use a written form for gathering data if applicable. When communicating through
writing, always remain with the consumer to clarify questions and answers.
Information can be reinforced with written instructions.
The consumer with impaired vision
When interviewing a consumer with a visual impairment, always look directly
at the consumer as if the individual were sighted. Because they cannot rely on
visual cues, voice intonation, volume and inection are important to the visually
impaired. It is common for those speaking to a visually impaired consumer to speak
loudly; this is insulting and can hinder communication.
40 LAYING THE FOUNDATION
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UNIT 1
ALA MY STOCK P HOTO/H ERO IMAGE S INC.
FIGURE 2.11 The nurse needs to inform
the consumer with impaired vision when a
touch is to occur and ask permission.
Touch is especially important to those with impaired vision; however, an
unanticipated touch can be frightening. Before touching the consumer, be certain
to inform the consumer and ask permission to touch (
consumer when you are entering or leaving the room and orientate the individual
to the immediate environment. Use clock hours to indicate the position of items in
relation to the consumer. Those consumers who are partially sighted may cling to
the independence that their limited vision allows; offer assistance to the partially
sighted and follow their cues or responses.
Figure 2.11). Advise the
The consumer with impaired speech or aphasia
When interviewing the consumer who has impaired speech, ask simple questions
that require ‘yes’ and ‘no’ answers and allow additional time for consumer responses.
Using this technique, it is often necessary to convert open-ended questions such as
‘How are you today?’ to closed questions such as ‘Are you feeling well now?’ You may
need to repeat or rephrase the question if the consumer did not understand. If you
are unable to understand the consumer’s responses, use a written interview format,
letter boards or ‘yes’ and ‘no’ cards. Health settings have technologies with adaptive
mechanisms that can aid communication. Also pay close attention to the consumer’s
nonverbal cues, such as blinking, clicking, or other gestures.
Even when all questions in the interview are asked and answered using closed
questions, allow the consumer the opportunity to contribute to the information
gathering; for example, ‘I have asked all the questions I have to ask you for now, would
you like to tell me anything related to any of the questions I have asked?’ then continue
with, ‘Would you like to say anything else before we conclude the interview?’
When someone else is speaking for the consumer, the nurse should speak and
direct questions to the consumer, not to the intermediary. If you ask a consumer
with aphasia to complete a written format of the interview, remain with the
consumer to clarify questions and to explain data requirements.
The consumer with a low literacy level
The consumer who has a low level of literacy is unable to complete or verify written
data. Thus, this must be done verbally or with the assistance of a trusted friend or
family member. In addition, alternative strategies are used to ensure that appropriate
treatment and follow-up are clear. For example, technology and appropriate software
programs or illustrated charts can be used to describe procedures and treatments. A
picture of a clock can be used to illustrate time for procedures such as blood glucose
monitoring. Medications can be colour coded for simplicity in administration.
Consumers should be able to repeat all instructions to verify accuracy. Home
healthcare clinicians can follow a consumer with a low level of literacy in the
consumer’s home environment to assess treatment adherence and accuracy.
REFLECTION IN PRACTICE
Caring for the consumer with low literacy
The 22-year-old consumer has just moved to your community and has told you he has
trouble with reading and writing and is not able to write more than his name and address.
How will you provide education for his follow-up care required after discharge?
The consumer with low literacy is unable to complete or verify written assessment data.
Therefore, alternative strategies are used when caring for them to ensure that education on
treatment and follow-up is simple and clear. Some strategies to use include:
> illustrated charts to describe procedures and treatments
> technology and software programs
> a picture of a clock to illustrate time
> colour-coded medications
> consumer recall on instructions to double-check accuracy
> follow-up with home healthcare agency when indicated to ensure appropriate care.
THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 41
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
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The consumer who is culturally or linguistically diverse
Interviewing consumers from diverse cultural or linguistic backgrounds may
require the assistance of an interpreter. Most healthcare agencies have a register
of interpreters available. Sometimes the consumer will bring a translator to the
interview. Often this translator is a friend or family member. The nurse should not
assume that the translator can answer questions for the consumer. It is important to
direct interview questions to the consumer and not to the interpreter.
Remember that pure translation from one language to another does not consider
dialects or
which have the potential to offend someone. For example, the question ‘Are you
pregnant?’ when translated without considering colloquialisms may mean ‘Do you
have intercourse outside marriage?’
CLINICAL REASONING
Practice tip: Using an interpreter
One of the most common difculties with communication is when the consumer has English
as a second language. The use of an interpreter is an excellent way to overcome these
difculties. The following are some tips to consider when you are using an interpreter to
improve communication outcomes.
1. Use a trained medical interpreter whenever possible.
2.
3.
4.
5.
6.
7.
8. When available, use pre-printed questions and healthcare instructions in the consumer’s
colloquialisms (words and phrases particular to a community),
When possible, allow the interpreter and consumer a few minutes to converse before
initiating the interview.
Instruct the interpreter to translate the consumer’s replies sentence by sentence, thus
avoiding summarisation. This will ensure that important information is not omitted.
Keep your questions brief. Inform the interpreter what information you are trying to
obtain.
Maintain eye contact with the consumer, not the interpreter, during the questioning and
translating.
Observe the consumer’s nonverbal communication, being sensitive to cultural inuences.
Be patient! Extra time needs to be allotted for this interview exchange.
native language.
CHAPTER 2
Pay special attention to the consumer’s nonverbal cues, especially facial
expressions and body movements. Often, information that is lost in the translation
to English can be gained through nonverbal cues. The use of signs, such as pointing,
can be helpful in an emergency situation; however, a more complete interview
should be deferred until an interpreter is present.
The consumer who has a low level of understanding
Interviewing the consumer with a low IQ requires time and patience because the
consumer may require time to process questions and to formulate answers, and
may need clarication of the meaning or intent of questions. Hurrying may cause
the consumer to become confused, lose concentration or to refuse to answer. It
may be necessary to interview the consumer’s family or caregiver for supplemental
information. Request permission from the consumer to speak to someone else and
respect the consumer’s right to be present during all phases of the interview. Always
direct interview questions to the consumer and allow the consumer to request
assistance from family members or a caregiver. Observe the interaction between
the consumer and the family or caregiver, because nonverbal communication can
provide valuable information about the consumer’s present health or illness state
as well as about the relationship between the consumer and the family member or
primary caregiver.
42 LAYING THE FOUNDATION
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UNIT 1
The consumer who is emotional and upset
Consumers may cry during the interview. On some occasions crying can be
anticipated, such as when parents relate events that led to their child’s death.
At other times a consumer may cry unexpectedly. The latter example affords an
opportunity for you to gain information about something of importance to the
consumer by gently asking what is causing the emotional response. It is important
to show empathy and to allow the consumer to cry. Offering tissues indicates to the
consumer that it is OK to cry and conveys a message of thoughtfulness. When the
consumer has regained composure, proceed with the interview.
Consumers and those who are speaking on behalf of individuals in healthcare
settings can become emotionally upset. For example, the parent of a sick child
may be overwhelmed by events that led to the child’s hospitalisation. Emotional
outbursts and crying are often the result of such stress. Allow the consumer, family
member or signicant other to express emotions. If it is obvious that the person
being interviewed is holding back tears, give permission to express emotion with a
simple statement such as, ‘I can see that you are upset; it’s OK to cry.’
When interviewing an obviously angry person, recognise and acknowledge the
emotion. A natural instinct is to personalise the anger and become angry in return
(Stein-Parbury, 2021); instead, recognise the emotion and bring it to the consumer’s
attention. ‘You appear very angry about something. Before we continue with the
interview, please tell me about your feelings.’ Avoid statements such as ‘Take a
moment to get hold of yourself,’ because this directive implies that the consumer’s
feelings are not appropriate and should not be expressed. Acknowledging an
individual’s emotions and giving them permission to express feelings will convey
respect and enhance genuine communication and enacts person-centred care.
Behaviour that may be sexually inappropriate or threatening
A consumer who displays sexually inappropriate behaviour may act out during the
interview. For example, the consumer may stand very close to the nurse and say,
‘You have been so nice to me, I would like the chance to be nice to you.’ The nurse
may counter this behaviour by dening appropriate boundaries, sharing personal
reactions and refocusing the consumer; for example, stating, ‘It makes me feel very
uncomfortable when you stand this close to me. Let’s get back to getting information
to assist in your healthcare needs.’ It is important to set limits and to focus on tasks
when dealing with a consumer who is behaving in a sexually inappropriate manner.
Healthcare professionals need to be cognisant of the power imbalance between them
and consumers and employ de-escalation strategies in these situations.
Before they begin the interview, it is important that nurses recognise that they are
required to work within their scope of practice, code of conduct and the healthcare
organisation’s national safety and quality health service standards (NSQHSS, 2017).
This includes following policy to ensure your personal safety. In some situations,
there may be a history of a consumer’s inappropriate behaviour, such as violence or
poor impulse control, and the nurse should follow policy to ensure their safety. Keep
in mind that sometimes consumers may use hostile behaviour because it may get
them what they want. Take care not to respond with anger and hostility, rather focus
on what the consumer is communicating (Stein-Parbury, 2020).
You can minimise the risk of aggression through nonthreatening interventions
such as limit setting and refocusing. Position yourself near an easily accessible exit.
Do not turn your back on the consumer and never allow the consumer to walk
behind you or come between you and the exit. Watch for signs of increasing tension
in the consumer (e.g. clenched sts, loud voice, angry tone of voice, narrowed
eyes). Alert a colleague and security if the consumer makes you nervous or anxious.
Always follow your institution’s health and safety policies. Trust your instincts
and remove yourself from potentially threatening and dangerous situations when
necessary.
THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 43
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REFLECTION IN PRACTICE
Inappropriate behaviour
You are undertaking a health assessment on a female consumer just admitted to your
ward. She is dressed in a very short skirt and a low-cut, see-through blouse. During the
assessment she leans over and exposes her breasts to you. She asks you if you have a
partner and says you have sexy eyes. What would you say to this consumer? How would
you be sure that your non-verbal communication matches your verbal response?
The consumer who is under the inuence of alcohol or drugs
The consumer who is under the inuence of alcohol or drugs presents a challenge
to the nurse. Depending on the quantity of alcohol consumed and the type of drugs
ingested, the consumer can have central nervous system (CNS) depression, or the
individual can be very disruptive with CNS stimulation. The consumer’s judgement
may be impaired, which can lead to physical harm to those in the immediate
environment. For this reason, when you have a violent or agitated consumer,
security personnel should be alerted and stationed nearby. Always follow your
institution’s health and safety policies.
Consumers under the inuence of some drugs have been known to exhibit
profound strength and are capable of inicting serious physical harm on themselves
and others. To care for this person, place yourself at a safe distance, remain calm,
and provide care in a nonthreatening manner.
CHAPTER 2
CLINICAL REASONING
Assessing alcohol withdrawal
Regular excessive alcohol consumption is a prominent health issue. Alcohol and drug
misuse in consumers presenting to healthcare settings, particularly to emergency
departments, is an ongoing issue with only a slight decline reported (AIHW, 2020). To
assist in prevention and minimise alcohol-related harm within Australian communities, a
national alcohol strategy 2019–2028 was released in 2019 with the aim of reducing harmful
alcoholconsumption by 10% (Commonwealth of Australia, 2019). Assessing alcohol
withdrawal is essential for consumers newly admitted to a healthcare setting, not only for
the consumer’s outcome but to assist the healthcare provider to ensure consumer safely. A
well-known assessment tool is the Clinical Institute Withdrawal Assessment for Alcohol–
Revised (CIWA-Ar), which is sensitive to a person experiencing alcohol withdrawal. Reoux
and Miller revised the CIWA-Ar in 2000 (Knight & Lappalainen, 2017). The tool contains 10
symptom criteria that the health practitioner uses to calculate an overall score to guide
consumer management. Policies will vary among individual healthcare agencies; however,
interventions are usually based on the nal score calculated for the consumer.
For further information about assessing and managing alcohol withdrawal, refer to
Quigley, Connolly, Palmer and Helfgott (2015), who provide a brief guide to the assessment
and treatment of alcohol dependence.
DEVELOPMENTAL THEORIES
While the basic interview techniques give you a general understanding of how to
undertake a health assessment, you will need to consider the developmental age
and stage of the consumer prior to commencing any data collection. Having this
fundamental knowledge and understanding of the consumer will enable you to
adapt your interview techniques to ensure the consumer is safe, and feels safe and
understood during the assessment. It will also help you gather accurate and relevant
data for your health assessment.
44 LAYING THE FOUNDATION
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UNIT 1
A variety of theories have been developed that depict and predict growth and
development. The theories most widely used for clinical assessment of consumers
are the ‘ages and stages’ theories of Piaget (1952), Freud (1946), Erikson (1974)
and Kohlberg (1981). The
based on the premise that individuals experience similar sequential physical,
cognitive, psychosocial and moral changes during the same age periods, each of
which is termed a
there are specic physical and psychosocial skills known as
tasks/milestones
developmental task is generally considered to be dependent on success in achieving
prior developmental tasks and is also known to be inuenced by the presence
of environmental opportunities in which to develop the new skills. If prior
developmental tasks have been delayed, or have occurred in a defective way, the
individual’s capacity to successfully adapt to their environment can be impacted.
A key nursing role in assessment is to identify areas of differentiation or decit and
then develop a plan of care in collaboration with the patient to address their needs.
developmental stage. During each developmental stage,
ages and stages developmental theories are
developmental
that are expected. An individual’s readiness for each new
Transitional developmental theories
A second group of theories include life events or transitional developmental
theories
response to specic events such as new roles (e.g. parenthood) and life transitions
(e.g. career changes). Life events and transitions require adaptive coping behaviour
as well as signicant changes in an individual’s life patterns. Each of these events,
which can occur singly or together and may be positively or negatively stressful,
is not tied to a specic time or stage in the life span. Each event, however, does
have certain tasks associated with it that must be achieved. The degree of success
or failure with these tasks inuences the individual’s potential for success with
concurrent and subsequent developmental tasks that occur in response to any
other life events. A variety of factors have been found to affect how an individual
responds to life events (Kozlowska, Scher & Helgeland, 2020). These factors
include biological status, personality, cultural orientation, socioeconomic status,
interpersonal support systems, number and intensity of life events, and orientation
to life (Kozlowska, Scher & Helgeland, 2020). Although the stress associated with
each life event or transition can serve as an impetus for growth, excessive stress
can disrupt the individual’s equilibrium and lead to a variety of physical and
psychological health problems (Kozlowska, Scher & Helgeland, 2020; Saxon, Etten
& Perkins, 2015). In identifying life events and stressors, nurses can play a critical
role in helping consumers maintain health and control stress.
, which are based on the premise that a change in development occurs in
Ages and stages developmental theories
There are many developmental theories that describe human development across
the entire life span. By categorising development into specic stages/ages, the
healthcare professional is then provided with a predictable range of expected
developmental changes. This predictability allows for an anticipated preparation
for the changes and for the healthcare professional to be alert when development
may be delayed or interrupted. For the purposes of this text, information about
developmental events or tasks is provided in stages for chronological (increasing)
age. A summary of the work of four of the most inuential developmental theorists
(Piaget, Freud, Erikson and Kohlberg) can be accessed from the online resource
section of this text.
DEVELOPMENTAL STAGES, TASKS AND LIFE EVENTS
Developmental stages and milestones can be inuenced by many factors. These
include inherited factors such as physical height and chromosomal anomalies,
constitutional factors such as illness, levels of intelligence and the ability to learn,
THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 45
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as well as a person’s ability to engage socially and emotionally with others (Hayes,
2020). Also, factors such as improved
nutrition, medical advances and healthier
lifestyles can inuence growth rates and longevity and hence developmental
expectations in Australia and New Zealand. Although there may be developmental
changes in the future, for this text the human developmental stages will use the
following chronological developmental terms of reference:
> Stage 1 Infancy (birth to 1 year)
> Stage 2 Toddler (1 to 3 years)
> Stage 3 Pre-schooler (3 to 5 years)
> Stage 4 School-age child (5 to 12 years)
> Stage 5 Adolescence (12 to 18 years)
> Stage 6 Young adulthood (18 to 30 years)
> Stage 7 Early middle adulthood (30 to 50 years)
> Stage 8 Late middle adulthood (50 to 70 years)
> Stage 9 Late adulthood (70 years to death).
To enable a holistic view of development, the following section will combine
the developmental tasks, life events and transitions from each major theory of
development. Although the lists of tasks for each stage are not exhaustive, and
do not reect all the tasks facing the full range of normal human conditions
and circumstances, they do provide an overview of parameters with which the
healthcare professional can gauge their assessment data. Generally, ask yourself
whether the individual’s overall development seems consistent with the tasks
usually associated with their chronological age. Remember that failure to meet tasks
in one area does not always indicate abnormal development. Information presented
should therefore form a general approach on which you can base your assessment
of an individual’s growth and development. If you would like further information
about developmental stages of the paediatric consumer, refer to a current paediatric
textbook (e.g. Lissauer & Carroll, 2022).
CHAPTER 2
Developmental tasks of infants (birth to 1 year)
Infancy is a period of dramatic and rapid physical, motor, cognitive, emotional and
social growth. It is a time of critical growth and development. During the rst year of
life, infants change from being dependent on others for all levels of activities of daily
living to an individual who can interact with their environment and form meaningful
relationships with signicant others. A list of key gross and ne motor, language and
sensory milestones associated with this period can be found in
TABLE 2.1 Growth and development during infancy
AGE GROSS MOTOR FINE MOTOR LANGUAGE SENSORY
Birth to 2 months > Assumes tonic neck
posture
> When prone, lifts and
turns head
2 to 4 months > Can raise head and
shoulders when prone to
45°–90°; supports self on
forearms
> Rolls from front to back
> Rooting reex to feed
> Grasp reex (not sted)
> Draws arms and legs to
body
ngers
> Grasps and tries to reach
objects
> Bats objects with their
hand
Table 2.1.
> Vocalises as cry > Comforts with touch, being
held and swaddling
> Looks at faces (6 weeks)
> Follows objects when in line
of vision
> Responds to high-pitched
voices
> Smiles
> Vocalises when talked to;
coos, babbles
> Squeals
> Smiles
> Follows objects 180°
> Turns head when hears voices
or sounds (12 weeks)
>>
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