Exam 1 Flashcards
Atraumatic Care
therapeutic care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system
Principles of Atraumatic Care
- Prevent or minimize physical stressors, including pain, discomfort, immobility, sleep deprivation, inability to eat or drink, and changes in elimination.
- Avoid or reduce intrusive and painful procedures, such as injections, multiple punctures, and urethral catheterization.
- Avoid or reduce other kinds of physical distress, such as noise, smells, shivering, nausea and vomiting, sleeplessness, restraints, and skin trauma.
- Control pain via frequent assessments and use of pharmacologic and nonpharmacologic interventions.
- Prevent or minimize parent–child separation.
- Promote family-centered care, treating the family as the patient.
- Use core primary nursing.
- Consider research findings related to preferences of parents and children and whether or not to be together.
- Promote a sense of control.
- Elicit the family’s knowledge about the child and his or her health condition, promoting partnerships, empowerment, and enabling.
- Reduce fear of the unknown through education, familiar articles, and decreasing the threat of the environment.
- Provide opportunities for control, such as participating in care, attempting to normalize daily schedule, and providing direct suggestions.
Child Life Specialist (CLS)
individual specially trained in the developmental impact of illness, injury, and trauma and who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful or distressing
Services provided by CLS
- Nonmedical preparation for tests, surgeries, and other medical procedures
- Support during medical procedures
- Therapeutic play
- Activities to support normal growth and development
- Educate child and family about health conditions
- Teach and support coping and pain management strategies
- Sibling support
- Advocacy for the child and family
- Grief and bereavement support
- Emergency room interventions for children and families
- Hospital preadmission tours and information programs
- Outpatient consultation with families (American Academy of Pediatrics,
Preventing or minimizing physical stressors
- For painful injections, blood draws, or IV insertion, use numbing techniques
- During painful or invasive procedures, avoid traditional restraint or “holding down” of the child. Use alternative positioning such as “therapeutic hugging.”
- If the above-mentioned positions are not an option, have the parent stand near the child’s head to provide comfort.
- Insert a saline lock if the child requires multiple doses of parenteral medications.
- Advocate for minimal laboratory blood draws.
- Minimize intramuscular or subcutaneous injections.
- Provide appropriate pain management
Preventing or minimizing child and family separation
- Promote family-centered care.
- In the hospital, provide comfortable accommodations for the parent.
- Allow the family the choice about whether to stay for an invasive procedure, and support them in their decision.
Promoting a sense of control
- Maintain the child’s home routine related to activities of daily living.
- In the hospital, use primary nursing.
- Encourage the child to have a security item present, if desired.
- Involve the child and family in planning care from the moment of the first encounter.
- Empower the family and child by providing knowledge.
- Allow the child and family choices when they are available.
- Make the environment more inviting and less intimidating
Therapeutic Hugging
(a holding position that promotes close physical contact between the child and a parent or caregiver) may be used for certain procedures or treatments where the child must remain still.
Distraction Methods
- Have the child point toes inward and wiggle them.
- Ask the child to squeeze your 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.
Family-Centered Care
partnership between the child, family, and health care providers in planning, providing, and evaluating care
Alternatives for confusing or misunderstood terms
Table 8.2 page 207
Types of communication
- Verbal
- Nonverbal
- Written
Basics for Communicating with children
- 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
Communicating with infants
- 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 overstimulation such as closing eyes, turning away, yawning, and irritability.
Communicating with toddlers
- 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.
Communicating with preschoolers
- 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
Communicating with 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.
Communicating with adolescents
- Always respect the teenager’s need for privacy.
- Ensure confidentiality.
- Remain nonjudgmental.
- 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.
Tips for working with an interpreter
- Help the interpreter prepare and understand what needs to be done ahead of time.
- the interpreter is the “communication bridge”, not a content expert
- Ensure enough time is alloted.
- Speak slowly and clearly
- Pause every few sentences so the interpreter can translate
- talk to the child and family not the interpreter.
- Give the family and the interpreter a break.
- Express info in two to three different ways if needed.
- ensure the family can read and understand the translated written materials.
- avoid side conversations during a session.
- children should not be used as an interpreter.
- if the interpreter isn’t good, replace them.
Techniques to improve learining
- slow down and repeat
- speak in conversation style using plain language
- group info and teach in small amounts using logical steps.
- Prioritize info: survival skills first
- use visuals
- hands-on approach
- retern demonstrations, teach backs.
Teaching tips for young children
- simple language
- honesty
- time explanations to decrease anxiety: avoid bad news close to bedtime.
- Parents know their child best
- Childs wishes must be respected when they verbalize or demonstrate to stop giving them info.
- Praise the child and let them know their appreciated.
What is important to adolescents.
- self-image
- self-concept
- privacy
Peers are critically important.
Teaching school age children
- Allow child some control and involvement in the decisions
- children can relate present-day happenings to past experiences
- achievement and accomplishment is important
- children are able to understand time, sequence and cause and effect.
- provide info 3-7 days in advance to mentally prepare them.
- praise child.
Teaching Adolescents
- allow teens to be in control and involved in decisions
- adolecents can process abstract info and how their actions affect long-term outcomes.
- they are concerned with how they look and their peer’s view of them
- they strive for independence and can have view that are different from their parents or medical staff.
Preparing for the health history
1: gather materials
2: Approach parent or caregiver
3: Approach the child
4: communicate with child during health history
5:Observe the parent-child interaction
6: Determine the type of history needed.
Performing a health history
- Demographics: name, age, DOB, ethnicity, sex, insured
- Chief Complain (reason for the visit)
- History of present illness
- Past Health History
- Family Health History
- Review of Systems: G&D, skin, head neck, cardio, GI, Neuro, etc..
- developmental history (gross motor)
- Functional history (daily routine)
- Family composition, resources, and home environment.
Questions for G&D
Weight loss or gain, appropriate energy and activity levels, fatigue, behavioral changes such as irritability, nervousness, anger, or increased crying
Questions for skin
Easy bruising or bleeding, rash, lesion, skin disease, pruritus, birthmarks, or change in mole, pigment, hair, or nails
Questions for head and neck
Head injury, headache, dizziness, syncope
Preferred IV sights
