HPHD 3 - Child development + communication, Motivational Interviewing, Pain, Bad News Flashcards
At what age can infants distinguish strangers from non-strangers?
~ 3 months
At what age do children form specific attachments, and miss key people?
~ 7/8 months
What is the critical period requiring secure attachment with a carer, for a child’s normal development?
During the first year
What are the 3 phases of behaviour shown by hospitalised children?
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2) Despair: helplessness, withdrawn, cry intermittently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
What are the effects of separation from main carer on a child?
Behavioural: Anxiety, aggression, clingy, bed wetting, detachment
Physical: Depressed, slower, less play, less sleep, changes in HR and body temp
Why does hospitalisation of children aged 6 months to 3 yrs have more adverse effects than at other ages?
- Child cannot keep image of carer in mind
- Limited language
- Cannot understand abstract concepts
- Perceived abandonment due to own failure (punishment)
What can be done to reduce stress in a hospitalised child?
- Allow carers access
- Allow attachment objects
- Reassurance
- Make setting homely
- Toys/activities
- High quality substitute care
- Continuity of staff
What are Piaget’s 4 stages of childhood cognitive development?
0-2 yrs = Sensori-motor
2-7 yrs = Pre-operational
7-12 yrs = Concrete operational
12+ yrs = Formal operational
At what age do children understand permanence - ie objects exist when out of sight?
~ 8 months
At which stage of development (Piaget’s) do children develop language, imagination and symbolic thought?
2-7 yrs = Pre-operational
At which stage of development (Piaget’s) do children begin to see from others perspectives?
7-12 yrs = Concrete operational
At which stage of development (Piaget’s) do children develop abstract logic?
12+ yrs = Formal operational
What does ‘young children lack theory of mind’ mean?
Young children think others know how they feel
What is Vygotsky’s theory of social development?
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)
Define motivational interviewing:
Collaborative, person-centred form of guiding, to elicit and strengthen motivation for change
At what point of the stages of change model is motivational interviewing most effective?
Contemplation
Define pain:
Unpleasant sensory and emotional experience associated with actual or potential tissue damage
What is the biomedical model of pain?
Pain is solely caused by physical damage
Give some examples of pain which challenge the biomedical model of pain:
- Mental pain
- Phantom limb pain
- Placebo effect
What is the main function of acute pain?
- Attracts attention
- Warns of damage
Define chronic pain:
Pain experienced for > 3 months without ongoing tissue damage, which doesn’t go away with prolonged rest + medication
Outline the gate control theory of pain:
- Synaptic gate between peripheral nerves and neurons in spinal cord
- Gate is open or closed by physical or psychological factors
List some factors which tend to ‘open’ the pain gate:
- Physical injury
- Inactivity/poor fitness
- Poor sleep
- Anxiety
- Depression
- Stress/distress
- Focusing on pain
- Wishing it would go away
List some factors which tend to ‘close’ the pain gate:
- Medication
- Heat/cold
- Massage
- Exercise
- Relaxation/meditation
- Laughter/humour
- Love/pleasure/happiness
- Distraction
Define nociception:
The ability to feel pain
- the stimulation of peripheral pain receptors which send impulses to CNS
Define pain threshold:
How much does this vary between people?
The point at which a stimulus becomes painful.
Similar in most people
Define pain tolerance:
How much can this vary?
The degree to which a painful stimulus can be tolerated Varies widely (individuals/cultures/contexts)
How does humour affect someones pain tolerance?
It increases their tolerance
How does anxiety affect someones pain tolerance?
It reduces their tolerance
How does fear affect someones pain tolerance?
It increases their tolerance
How do pain management programmes successfully help a patient manage their pain?
- Improve fitness
- Develop coping strategies
- Set goals to work towards
- Teach to accept pain
What are the 5 stages of grief?
1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance
What percentage of people have readjusted within 2 yrs after experiencing grief?
85%
What factors may cause someone to experience grief for a prolonged time?
- Prior bereavements
- Mental health issues
- Type of loss: young, caring status
- Lack of social support
- Discouraged expression of grief
- Discouraged ending of grief
Name the model used for breaking bad news:
SPIKES model
Explain the SPIKES model:
S- Setting + listening Skills P- Patients Perception I- Invitation from patient to give Information K- Knowledge E- Empathy S- Strategy + Summary
