M2: Conversations with Parents and Children Flashcards
a skill we all need to learn and develop
Communication
The most likely sources of difficult conversations are occasions that may be…..
uncomfortable, disagreeable, problematic, emotionally-charged or stressful situations
8 OCCASSIONS THAT MAY BE PROBLEMATIC, EMOTIVE, OR STRESSFUL (G2K)
- Prior to surgical or medical intervention
- Dealing with serious or acute illness
- Dealing with disability
- Following the death of someone close
- When family and medical team disagree on the best interest of the child
- Information and involvement in treatment
- Appropriate medical treatment
- This may involve sex, sexual orientation, or sexual
abuse.
To protect the child from distressing news/burden of
knowing: loss of innocence, hopelessness and despair
Involvement in Treatment discussions or decisions
This is most especially seen when outcome of the treatment is uncertain.
Disagreements
3 PREPARING TO ENGAGE IN A DIFFICULT SITUATION
- KNOW what to say
- SET the scene
- ESTABLISH the objectives
restate what you just heard using “I” statements. This allows you to clarify what the other person is actually saying, not what you think
Reiterate
Count to 10 before saying anything. (Compose how you respond and think) of possible consequences as a result of what you are going to do.
Contemplate
Take a (deep breath) to check in, settle your thoughts, emotions and give yourself some time to compose yourself.
Respire
(Speak with compassion and thoughtfulness). Assume the good intentions of your conversation partner or partners and seek to educate rather than defend your point of view.
Communicate
Two important ways in communicating complex
information to children are as follows
- Make it simple
2. Explain complex procedures easily
is based in predictions and probabilities rather than absolute certainties
Prognosis
What will a 3 to 5 year old most likely ask if it is the first time that the patient will encounter this feeling or illness
What is happening to
me?”
What will a 6 to 8 year old most likely ask?
“Why do I have a fever?”;
What will a 9 to12 year old most likely ask?
“What sort of illness do I have?”
Before a child undergoes amputation, allow the child to ______. This is to make the child less anxious about the
procedure.
play with their doll/toy or ask her what happened with the doll
most important skill in communicating
effectively
Listening
Principles in communicating with children and adolescents are as follows
- Listen with full attention
- Hold off giving advice as this deprives children of the experience of finding their own solutions
- Children have to come to terms with their problems
in their own individual ways. - No one can make a decision about a problem for a child.
- ## Giving distressing information is not a single event
- Listen attentively
- Hold off advice
- Children have to come to terms on their own
- Don’t make decision for child
- Don’t give distressing info at one go
Children’s communication abilities vary with their age and experience
(master SIFU)
- Subtle nonverbal communication
- Idiosyncratic use of language
- Frame of reference
- Unfamiliar experience
15 GIVING EMOTIVE AND SENSITIVE INFORMATION (G2K)
- Introduce yourself.
- One person needs to be designated to lead in giving
information otherwise, the child will be overwhelmed. - Find out what the child likes to be called. Be as
thoughtful as you can. - Be aware of levels and stages of development.
- Avoid rushing the child, and allow them time to get to know you.
- Let them dictate the pace.
- Firmly establish what the child’s understanding is of the issue in question.
- Respond to the child as an individual, and do not
assume that all children are the same. - Talk to children normally. Comfortably audible.
- Try to keep speech clear and sentences short.
- Do not try to copy children’s slang or adopt their
mannerisms. - Be aware of what might for the child, constitute a
threat. - Believe. Trust must be the basis of any relationship and is particularly important among children.
- Children exist as an integral part of a family system, so try to work in partnership with the parents.
- It is not advisable to just challenge or override the
parents, especially in front of the child.
METHODS COMMONLY USED BY ADULTS TO GET
CHILDREN AND ADOLESCENTS TO COOPERATE (G2K)
- Blaming and accusing
- Name-calling
- Threats
- Commands
- Lecturing and moralizing
- Warnings
- Martyrdom statements
- Comparisons
- Sarcasm
- Prophecy
The rights of children include
- Right to information
- Right to express
- Right of expression to influence.
- Right to decision making
The following are necessary things to do when parents do not want to inform or involve their children in medical discussions:
(UREA)
- Understand
- Respect .
- Educate.
- Allow sufficient time.
How to Discuss the options and strategies to parents
(2 Whos and 2 Whats)
- Who tells child.
- Who should be present.
- What is given after
- What is the best way of presenting information.
Emphasize to parents that giving information to children is not an all-or-nothing event but a process hence _____
It must be planned
Results of disagreements about treatment include
- Process involves multidisciplinary team second opinion courts.
- Medical team needs to be clear about what they feel is in the child’s best interest
- —————————————————————– - Second opinion courts
- Best interest of the child
Who will be involved, where will you meet, how will you manage the conversation? is an example of
Setting the scene
Explaining slowly that based on studies in the past, the prognosis is 6 months to 1 year, but also indicate that it is of no guarantee that that will also happen to the patient.
Is an example of
Prognosis
To relay the bad news to a child ask them following 5 first
A. What happened? B. What does he/she knows? C. What did he/she expect? D. What are his/her thoughts? E. What do you remember?
(Ouchy, booboo) are examples of
Idiosyncratic use of language
A child may call his/her
grandmother as “Nanay” or his/her aunt as “Mama” is an example of
Idiosyncratic use of language
mother raises an eyebrow which
would indicate something which is an example of
Subtle nonverbal communication
Using 1-10 as a pain scale is an example of using a Child’s….
frame of reference
Children act differently when either the
physician is around or not is an example of
Children’s interpersonal responses on the context of a situation
