Communicating with the Child and Family

1
Communicating with the Child and Family

• Ricci, ch 30, pp. 1043-1048 ch 32, pp. 1086-1091

2
Understanding Pediatric Patients

• Hospitalization and illness are major stressors
  because of the change in usual routines and a
  childs limited coping mechanisms.

3
Reactions to Hospitalization

• Reactions are affected by
• Developmental age
• Previous experiences with illness
• Available support systems and coping abilities
• Seriousness of the illness

4
Stressors of Hospitalization

• Separation
• Loss of control
• Physical stressors, specifically fear of bodily
  injury and pain

5
Risk Factors for Stressors

• Difficult temperament
• Lack of fit between child and parent or poor
  parental support
• Age (6 mos to 5 yrs)
• Males
• Below average intelligence
• Multiple and continuing stresses as in frequent
  hospitalizations

6
Behaviors R/T Stressors

• Crying
• Clinging
• Fear/anxiety
• Refusal to eat
• Difficulty sleeping
• Anger
• Negativism, uncooperativeness
• Aggression, depression, regression
• Loneliness
• Boredom
• Withdrawal

7
Parental Responses

• Disbelief
• Anger
• Guilt
• Fear, anxiety
• Frustration
• Depression

8
Sibling Reactions

• Loneliness
• Fear
• Worry
• Anger
• Resentment
• Jealousy
• Guilt

9
Interventions to Minimize Stressors

• See Table 30.1
• Use play to provide diversion, increase security,
  decrease anxiety, and allow expression of
  feelings
• Playrooms offer distancing
• Familiar toys are comforting
• Use large muscles, dramatic play, drawing,
  puppets, books

10
Communicating with Children

• Make developmentally appropriate
• Rely on nonverbal behavior more than verbal
• Get on childs eye level but avoid staring at
  child
• Avoid sudden or rapid advances, broad smiles
• Always be truthful
• Give child choices as appropriate
• Allow children to express feelings and fears
• Offer praise, encouragement, and rewards

11
Communicating contd

• Avoid analogies and metaphors
• Give instructions clearly
• Give instructions in positive manner
• Use interpreter when needed
• Avoid long sentences, medical jargon,
  colloquialisms think about scary words
• (Table 30.2, p. 1042)

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Creative Techniques

• I messages
• 3rd person
• Storytelling
• Bibliotherapy
• Dreams
• What if questions
• 3 wishes

• Rating (not just pain)
• Word association
• Sentence completion
• Pro and con list
• Writing and drawing
• Magic
• Play

13
Developmentally Appropriate CommunicationInfants
(0-12 mos)

• Non-verbal
• Crying as communication
• Pick up adults non-verbal behaviors
• If under 6 months, will usually respond to
  anyone.
• If over 6 months, stranger anxiety exists

14
Early Childhood (Toddler Preschool) 1-6 yrs

• Focus on CHILD in your communication
• Need warm-up time. May be uncooperative
• Use words child will recognize use short,
  familiar, and concrete terms
• Be consistent dont smile when doing painful
  things
• Allow child to handle most equipment
• Keep fearful equipment out of sight until it is
  needed.

15
School Age (6-12 yrs)

• High level of curiosity likes to help
• Give explanations and reasons
• Explain how things work allow handling of most
  equipment
• Allow to express feelings
• Respect privacy
• Generally behave well and communicate effectively

16
Adolescent (12-18 yrs)

• Be honest with them
• Aware of privacy needs
• Think about developmental regression
• Importance of peers
• Listen to them and respect their views
• Avoid judging or criticizing tolerate
  differences
• Pick your battles
• Avoid the third degree

17
Play

• Childrens work
• Childs developmental workshop
• As therapeutic intervention
• As stress reliever for child/family
• As pain reliever/distracter
• As barometer of illness

18
Therapeutic Art

• Can tell about childs situation both from seeing
  what he draws and what he says about it.
  Important points
• first figure
• size of figures
• order
• position
• exclusion
• accentuated parts
• absence of parts
• size and place of drawing
• stroke type
• erasures
• cross-hatching

19
Communicating with Parents

• Most information comes from them
• If parent sees a problem, pay attention
• Listen actively listen for information directed
  over the childs head.
• Try to be a facilitator in arriving at a solution
  to the problem rather than always giving your
  ideas
• Remember to use open-ended questions that start
  with what how tell me about

20
The Health History

• Pediatric health history has similar and
  different components from adult history.
• Past hx includes birth hx, immunizations, GD,
  and habits in addition to the usual questions.
• Review of systems is somewhat different than
  adults especially in areas that require
  evaluation of behavior (eyes or ears for
  instance) and in sexual development.

21
Functional Assessment

• Determines childs daily routines
• Includes meals, activity, habits, sleep
  behaviors, elimination routines, hygiene, day
  care
• Also determines health care issues including
  routine visits to doctors and dentists, use of
  assistive devices, sexual practices, sun
  exposure, piercings, tattoos.
• Also includes cultural/religious practices, for
  instance, cupping and coining.

22
Complete Family Assessment

• Family composition
• Home environment
• Occupation and education of members
• Cultural and religious elements
• Family interactions including who makes
  decisions, how members communicate, how they
  solve problems, disciplinary methods, and support
  for each other