Pediatric ch 3 pg 37-39 Flashcards
Communicating With Families: Nurse’s Role
When communicating with children and their families, the pediatric nurse should:
Identify his or her role.
Provide appropriate introductions for the nurse, caregivers, and family members. Identify the stakeholders and the caregivers, including the child in the process.
Record all telephone calls during office hours and after, and log all incoming and outgoing calls, advice given, and questions answered. Include date, time, and who was involved in the communication process (Bell & Condren, 2016; Institute for Healthcare Communication, 2017).
Establish an appropriate setting to communicate information.
Ensure privacy.
Provide anticipatory guidance, a critical communication strategy that improves care and supports competence in caregiving by offering information, guidance, and education for family caregivers.
Health Insurance Portability and Accountability Act
to protect the privacy of patients’ health records and information. The law protects “individually identifiable health information” (U.S. Department of Health & Human Services, 2017). It also limits access to health information in any format (e.g., written, oral, facsimile, social media) to authorized individuals who have a “right to know.” “Right to know” includes disclosure of a person’s health information to individuals who have a direct need to know on a specific date in which that health-care provider is caring for the client. For example, if a coworker has had a baby in your institution and as a nurse you are caring for newborns on that particular floor but not this patient, it is unlawful for that nurse to look up his or her coworker’s baby information. Deviations from this federal law have resulted in imprisonment and fines for the offending individuals or institutions. Recent updates to HIPAA are related to increases in transmission security, cybersecurity, auditing, workforce screening, and the encouragement of reports of abuse
Communication With Family Members During Emergencies
When families are under stress during emergencies, communication can be challenging. Nurses can help ensure their message is received in trying times with these strategies:
Provide a quiet environment for conversation.
Communicate slowly.
Avoid medical jargon.
Sit down and face caregivers at eye level.
Allow plenty of time for questions.
Avoid giving false hope.
Allow for repetition of what caregivers have heard to ensure understanding.
Be empathetic and sincere
CRITICAL COMPONENT
Emergencies
Critical components and interventions during emergencies include:
Provide clear and concise information.
Do not make promises.
Inform family members that the physician will speak with them as soon as possible.
If possible, give them a private environment.
Call clergy, child life specialists, and social workers if available to offer support.
Barriers to Effective Communication
The pediatric nurse can facilitate effective communication by identifying potential barriers to client/family communication and removing them when possible. Barriers to effective communication may include:
Physical abnormalities such as cleft lip or cleft palate
Physiological alterations such as hearing or visual impairment (Fig. 3–2)
Cognitive barriers may affect perceptions, expression, concrete or abstract thinking; for example, this may include the use of jargon, sarcasm, or irony
Avoidance or distancing language, for example, acting out, denial, projection, rationalization, or trivializing (Vertino, 2014)
Environmental noise
Cultural differences, particularly when the message sender does not focus on the beliefs, values, goals, and outcomes of the child and family (see Chapter 4 for further cultural factors).
Language barriers, hearing or speech difficulties
Psychological alterations: children with disabilities have communication rights that must be met by the health-care practitioner (Brady et al., 2016; Limiñana-Gras, Sánchez-López, Calvo-Llena, & Corbalán, 2015)
Sender and receiver biases
Closed-ended, yes-or-no questions: use only when the nurse needs focused information
Ignoring family and psychosocial issues
Protection for Individuals With Hearing Disabilities
Title III of the Americans with Disabilities Act (ADA) prohibits discrimination against individuals with disabilities by places of public accommodation” (42 U.S.C. §§ 12181–12189). Private health-care providers are considered places of public accommodation. As noted by the National Association of the Deaf (2017), “the U.S. Department of Justice issued regulations under Title III of the ADA at 28 C.F.R. Part 36. Health care providers have a duty to provide appropriate auxiliary aids and services when necessary to ensure that communication with people who are deaf or hard of hearing is as effective as communication with others.
Hearing Screenings
Hearing screenings are performed before discharge on all infants born in the hospital. This evaluation detects deviations in hearing that may prevent the child from reaching developmental milestones such as turning the head toward a sound, being soothed by the voice of a caregiver, mimicking sounds heard, and learning to talk. These primary skills of communication must be obtained before the development of the communication process. Infections passed from the mother and the antibiotics used to treat such infections may cause ototoxicity and alter hearing. In addition, chronic ear infections or infections transmitted in utero can cause limitations in hearing.
Communication
To facilitate communication with children and families from other cultures, the nurse should:
Include family members in interactions.
Be an active listener.
Observe verbal and nonverbal cues.
Understand that family responses to wellness and illness strongly influence behaviors.
Learn culturally appropriate interactions, such as whether to use eye contact and whether shaking hands is welcomed in the client’s culture. Be mindful of pauses and personal space.
Repeat important information more than once, and speak slowly.
Avoid medical jargon, instead using terms family members can understand.
Allow time for questions.
Give information in the family’s native language, with the use of certified interpreters as necessary.
Address intergenerational needs.
Legal Requirements for Interpretation
The 1964 Civil Rights Act states that no person should be denied the benefits of or experience discrimination in any program receiving federal assistance based on his or her race, color, gender, or natural origin. The Supreme Court determined that discrimination based on language amounts to discrimination based on natural origin. This legally requires health-care institutions to provide language accessibility for their patients. Many states, such as California, New Jersey, and Washington, have enacted health-care interpreter certification as directed by the National Council on Interpreting in Healthcare, which advocates for the development and implementation of national standards of practice for interpreters in health care (Chen, Youdelman, & Brooks, 2007; Friedman, 2014; National Conference of State Legislators, 2016). Facilities not covered by federal funds may still be subject to individual state laws (National Conference of State Legislators, 2016). The lack of trained medical interpreters in a health-care setting puts children and families at risk and is a form of discrimination.
BARRIERS TO COMMUNICATION WITH CHILDREN AND FAMILIES INCLUDE:
- Closed-ended questions with yes-or-no answers
- Prejudiced or preconceived messages based on race, age, ethnicity, culture, gender, lifestyle, wealth, appearance, or status
- Preconceived messages based on the practitioner’s beliefs of what constitutes correct family structure, function, or roles
- Unaddressed fears of the child or the caregiver
- Child, family, or caregiver not being treated with respect
- Insufficient information
- Not answering minor questions, such as those related to diet
- Failure to include parents in the care plan
- Parents not being treated as partners in their child’s care
- Failure of nurses to understand parent–child relationships
- Failure to meet the developmental needs of the child
- Failure to consider cultural aspects or speaking in nuanced language that is specifically culturally based
DEFINITION OF A FAMILY
A family consists of two or more members who interact and are dependent on one another socially, financially, and emotionally. Until the early 1960s, nuclear families consisting of a husband, wife, and children were the norm in the United States (Fig. 3–3). The exception was during the Great Depression, when multiple generations living together as extended families became more common because of economic necessity (Fig. 3–4). Nuclear families were portrayed by the media in television by The Adventures of Ozzie and Harriet and Leave It to Beaver. Single widowed parents were also shown with television shows such as The Andy Griffith Show.
Family cont…
The 1960s saw tremendous turmoil caused by political, social, and cultural changes resulting from the Vietnam War and the emergence of civil rights for women and minorities. Social attitudes began to shift during this time and were reflected in television and movies. Single parenthood, women’s changing roles, birth control, and divorce were now shown in the media (Angier, 2013). Blended families, those consisting of remarried parents and the children of their former marriages, first appeared in the media during the 1960s; that included single-parent and same-sex-partner families. Over the decades, sitcoms like Roseanne and Modern Family reflected the nation’s changing demographics.
family cont..
Although divorce rates have essentially remained unchanged since the 1990s, changes in family structure continue to occur. Children are more likely to live in a single-parent family or a cohabitating family (consisting of unmarried adults and the children of one or both adults) at some time in their lives. According to the Pew Research Center (2015), two-parent families represented 69% of all families, compared with 73% in 2000 and 87% in 1960. Fifteen percent of children live with parents who are remarried, 7% of children live with a parent who is cohabitating with a partner (Pew Research Center, 2015). In 2015, one-parent families constituted 26% of all families, compared with 22% in 2000 and 9% in 1960 (Pew Research Center, 2015). The Pew Research Center (2015) notes that 78% of the children in white households, two-thirds of Hispanic children, and 84% of Asian children lived in a two-parent household. Conversely, 54% of black children lived with a single parent, with 38% living in a two-parent household. Children in households with a college-educated parent were more likely to be living in a two-parent household (Pew Research Center, 2015).
Regardless of family structure, the available resources such as goods, services, information, and influences impact a child’s health, development, and ability to adapt to disease and illness. Race, ethnicity, and immigrant status also affect families and children through cultural influences (see Chapter 4 for details). Nurses must be aware of these influences and assist in strengthening the family structure to maintain and support the parenting and family process. Referring the family unit to social service within the institution will assist in helping to identify resources.
Diversity of Families
Family is also defined as the structure or the relationship between individuals that provides the financial and emotional support needed for social functioning (Friedemann, 1989). Nurses should not be judgmental when caring for children and families. We must remember that every family acts as a unique unit.
Types of Family Units
The family unit of today varies. Family members do not have to be related by blood to be considered a unit. Families of today can be nuclear, extended, single-parent, blended, foster, and adoptive. Parents can be of different sexes or the same sex. One family unit is not better than another. The most important thing is for children to be in a positive, supportive environment so that they can grow and develop to their highest potential.
