HPHD 3 - Child development + communication, Motivational Interviewing, Pain, Bad News

Question 1

At what age can infants distinguish strangers from non-strangers?

Answer 1

~ 3 months

Question 2

At what age do children form specific attachments, and miss key people?

Answer 2

~ 7/8 months

Question 3

What is the critical period requiring secure attachment with a carer, for a child’s normal development?

Answer 3

During the first year

Question 4

What are the 3 phases of behaviour shown by hospitalised children?

Answer 4

1) Protest ~ hrs/days: distressed, look for carer
2) Despair: helplessness, withdrawn, cry intermittently
3) Detachment: Interested in surroundings, sociable, remote and pathetic when carer returns

Question 5

What are the effects of separation from main carer on a child?

Answer 5

Behavioural: Anxiety, aggression, clingy, bed wetting, detachment
Physical: Depressed, slower, less play, less sleep, changes in HR and body temp

Question 6

Why does hospitalisation of children aged 6 months to 3 yrs have more adverse effects than at other ages?

Answer 6

• Child cannot keep image of carer in mind
• Limited language
• Cannot understand abstract concepts
• Perceived abandonment due to own failure (punishment)

Question 7

What can be done to reduce stress in a hospitalised child?

Answer 7

• Allow carers access
• Allow attachment objects
• Reassurance
• Make setting homely
• Toys/activities
• High quality substitute care
• Continuity of staff

Question 8

What are Piaget’s 4 stages of childhood cognitive development?

Answer 8

0-2 yrs = Sensori-motor
2-7 yrs = Pre-operational
7-12 yrs = Concrete operational
12+ yrs = Formal operational

Question 9

At what age do children understand permanence - ie objects exist when out of sight?

Answer 9

~ 8 months

Question 10

At which stage of development (Piaget’s) do children develop language, imagination and symbolic thought?

Answer 10

2-7 yrs = Pre-operational

Question 11

At which stage of development (Piaget’s) do children begin to see from others perspectives?

Answer 11

7-12 yrs = Concrete operational

Question 12

At which stage of development (Piaget’s) do children develop abstract logic?

Answer 12

12+ yrs = Formal operational

Question 13

What does ‘young children lack theory of mind’ mean?

Answer 13

Young children think others know how they feel

Question 14

What is Vygotsky’s theory of social development?

Answer 14

Cognitive development requires social interaction. Carers should focus on the zone of proximal development, teaching children skills they can do with assistance (rather than skills they can do themselves, or skills they cannot do at all)

Question 15

Define motivational interviewing:

Answer 15

Collaborative, person-centred form of guiding, to elicit and strengthen motivation for change

Question 16

At what point of the stages of change model is motivational interviewing most effective?

Answer 16

Contemplation

Question 17

Define pain:

Answer 17

Unpleasant sensory and emotional experience associated with actual or potential tissue damage

Question 18

What is the biomedical model of pain?

Answer 18

Pain is solely caused by physical damage

Question 19

Give some examples of pain which challenge the biomedical model of pain:

Answer 19

• Mental pain
• Phantom limb pain
• Placebo effect

Question 20

What is the main function of acute pain?

Answer 20

• Attracts attention

- Warns of damage

Question 21

Define chronic pain:

Answer 21

Pain experienced for > 3 months without ongoing tissue damage, which doesn’t go away with prolonged rest + medication

Question 22

Outline the gate control theory of pain:

Answer 22

• Synaptic gate between peripheral nerves and neurons in spinal cord
• Gate is open or closed by physical or psychological factors

Question 23

List some factors which tend to ‘open’ the pain gate:

Answer 23

• Physical injury
• Inactivity/poor fitness
• Poor sleep
• Anxiety
• Depression
• Stress/distress
• Focusing on pain
• Wishing it would go away

Question 24

List some factors which tend to ‘close’ the pain gate:

Answer 24

• Medication
• Heat/cold
• Massage
• Exercise
• Relaxation/meditation
• Laughter/humour
• Love/pleasure/happiness
• Distraction

Question 25

Define nociception:

Answer 25

The ability to feel pain

- the stimulation of peripheral pain receptors which send impulses to CNS

Question 26

Define pain threshold:

How much does this vary between people?

Answer 26

The point at which a stimulus becomes painful.

Similar in most people

Question 27

Define pain tolerance:

How much can this vary?

Answer 27

The degree to which a painful stimulus can be tolerated
Varies widely (individuals/cultures/contexts)

Question 28

How does humour affect someones pain tolerance?

Answer 28

It increases their tolerance

Question 29

How does anxiety affect someones pain tolerance?

Answer 29

It reduces their tolerance

Question 30

How does fear affect someones pain tolerance?

Answer 30

It increases their tolerance

Question 31

How do pain management programmes successfully help a patient manage their pain?

Answer 31

• Improve fitness
• Develop coping strategies
• Set goals to work towards
• Teach to accept pain

Question 32

What are the 5 stages of grief?

Answer 32

1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance

Question 33

What percentage of people have readjusted within 2 yrs after experiencing grief?

Answer 33

85%

Question 34

What factors may cause someone to experience grief for a prolonged time?

Answer 34

• Prior bereavements
• Mental health issues
• Type of loss: young, caring status
• Lack of social support
• Discouraged expression of grief
• Discouraged ending of grief

Question 35

Name the model used for breaking bad news:

Answer 35

SPIKES model

Question 36

Explain the SPIKES model:

Answer 36

S- Setting + listening Skills
P- Patients Perception
I- Invitation from patient to give Information
K- Knowledge
E- Empathy
S- Strategy + Summary