Chapter 8: Atraumatic Care of Children and Families

What is the term used to describe therapeutic care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system?

Atraumatic Care

How can a nurse provide atraumatic care? (4 ways)

- prevents/minimize pain and bodily injury

- minimize separation of the child from the family

- utilize techniques of communication

- provide teaching that promotes sense of control

How can family centered approach aid in providing atraumatic care? (what does it promote)

- promotes family roles

- fostering family support of the child

- providing appropriate information

How can the nurse help children cope with care?

- using age appropriate interventions

- using child specific interventions

What is a Child Life Specialist (CLS)?

a specially trained individual who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful

What are some services provided by the CLS?

- non-medical preparation of for tests, surgery, and other medical procedures

- support during medical procedures

- therapeutic play

- activities to support normal growth/development

- sibling support

- advocacy for the child and family

- Grief and bereavement support

- ER interventions for children and families

- Hospital readmission tours and information programs

- Outpatient consultation with family

What is the goal of CLS?

- decrease the child's anxiety and fear

- improving and encouraging the child's understand and cooperation

What is the term used to describe the holding position that promotes close physical contact between a child a parent (or caregiver) that may be used for certain procedures or treatments where the child must remain still?

therapeutic hugging

What are some methods of distraction?

- have the child paint toes inward and wiggle them

- ask the child to squeeze our hand

- encourage the child to count aloud

- sing a song and have the child sing along

- point out the pictures on the ceiling

- have the child blow bubbles

- play music appealing to the child

What are some nursing interventions prior to the procedure

- use age appropriate terminology

- provide a description of and the reason for the procedure

- describe where the procedure will occur

- introduce strange equipment

- describe length of procedure

- identify unusual sensations that may occur ding the procedure

- inform if pain may occur

- Tell child it is OK to cry

- ID special care required after procedure (ie. lie down for 10 minutes)

- discuss relaxation techniques

- therapeutic play

(T/F) invasive procedures can be preformed in the child's room?

false, in treatment room or room other than child's room. Child's room is a safe haven

What should the nurse take into consideration when preparing patient teaching?

- consider child's temperament

- coping strategies

- previous experiences

- developmental needs/ cognitive abilities

What are some post procedure nursing interventions?

- cuddle and soothe infants

- hold and comfort child

- encourage children to expressing feelings through play (dramatic play or puppets)

- provide older children with opportunities to express themselves

What are some positive outcomes of family-centered approach to healthcare?

- anxiety is decreased

- children are calmer

- pain management is enhanced

- recovery time is shortened

- family confidence and problem solving are improved

- communication between team and family are improved leading to greater satisfaction

- decreased cost of healthcare

What are the guidelines for appropriate verbal communication?

- Use open-ended questions

- Redirect conversations to maintain focus

- Use reflection to clarify the parent's feelings

- Paraphrase the child's or parent's feelings to demonstrate empathy

-Acknowledge emotions

- demonstrate active listening by using the child's or family's own words

What are guidelines for appropriate nonverbal communication?

- relax, maintain an open posture, arms uncrossed

- sit opposite the family and lean forward slightly

- maintain eye contact

- nod dead to demonstrate interest

- note the child's or parent's posture, eye contact and facial expression

What are the steps to communicate with a ped's patient?

Introduce yourself and explain your role.

Position yourself at the child's level.

Allow the child to remain near the parent if needed, so the child can remain comfortable and relaxed.

Smile and make eye contact with the child if culturally appropriate.

Direct your questions and explanations to the child.

Listen attentively and pause to allow time for the child to formulate his or her thoughts.

Use the child's or family's terms for body parts and medical care when possible.

Speak in a calm, quiet, confident, and unhurried voice.

Use positive, rather than negative, statements and directions.

Encourage the child to express his or her feelings and ask questions.

Observe for nonverbal cues.

Ask for permission if you need to approach the child to avoid appearing threatening.

What are the techniques to communicating effectively with an infant?

• Respond to crying in a timely fashion.

• Allow the infant time to warm up to you.

• Use a soothing and calming tone when speaking to the infant.

• Talk to the infant directly.

• Communication through play may be helpful with older infants.

• Watch for signs of over-stimulation such as closing eyes, turning away, yawning, and irritability.

What are the techniques to communicating effectively with an Toddler ?

• Approach toddlers carefully; they are often not only fearful but also quite resistant.

• Use the toddler's preferred words for objects or actions so he or she is better able to understand.

• Toddlers enjoy stories, dolls, and books.

• Participate in parallel play to help start communication.

• Prepare toddlers for procedures just before they are about to occur.

What are the techniques to communicating effectively with an Preschooler?

• Use play, puppets, or storytelling via a third-party approach.

• Speak honestly.

• Use simple, concrete terms.

• Ask specific questions.

• Allow the child to have choices as appropriate.

• Participate in imaginative play to help open communication.

• Prepare preschoolers about 1 hour prior to a procedure.

What are the techniques to communicating effectively with an School Age Children?

• Use diagrams, illustrations, books, and videos.

• Allow the child to honestly express feelings.

• Use third-party stories to elicit desired information (such as "some children feel anxious about....").

• Allow the child to ask questions related to care and treatment. Give the child adequate time for all of the questions to be answered.

• Prepare the child a few days in advance for a procedure.

What are the techniques to communicating effectively with an Adolescents?

• Always respect the teenager's need for privacy.

• Ensure confidentiality.

• Remain nonjudgemental.

• Listen attentively and speak respectfully.

• Use appropriate medical terminology, defining words as necessary.

• Use creativity and humor.

• Do not force the adolescent to talk as this may shut down communication.

• Prepare the teen up to 1 week prior to a procedure.

What are some tips to working with an interpreter?

- Build rapport with interpreter(est. goals)

- the interpreter is the communication bridge

- ensure enough time is allotted

- speak slowly and clearly

- pause every few sentences so the interpreter can translate

- talk directly to the child and family (not to the interpreter)

- give the family and the interpreter a break

- express the information in two or three ways if needed

- use an interpreter to help ensure the family can

- avoid side conversations during session

(T/F) Children or someone who is bilingual can be used as an interpreter?

false

What are the red flags that indicate poor literacy skills?

- difficulty filling out registration forms

- frequently missed appointments

- noncompliance/lack of follow up

- hx of medication errors

- avoids reading in office (or makes excuses)

- inability to answer common questions about their treatment or medications

- avoid asking questions for fear of looking stupid

(T/F) appearance, verbal ability, employment status and education level can be used to judge literacy level

false, cannot detect persons who do not read well

How can the nurse enhance the learning experience for a child or adult with a literacy problem?

-draw pictures or use medical illustrations

- use videos

- color code medications or the steps of a procedure

- record an audiotape

- repeat verbal information often and group it into small amounts

- teach a "back up" family member

How should a nurse teach a school age child?

- they have the need to cooperate and achieve

- school age children want to participate in their care

- teach school age child an parent together

What are ways that the nurse an evaluate if the teaching is effective?

- demonstrate the skill (return demonstration)

- repeat back or teach back the information in own words

- anser open ended questions

During what phase of care do Child Life Specialist intervene?

- before procedure

- during procedure

- post procedure