Transcript Communication with hospitalized children

Communication with
hospitalized children
General principle
Communication related to development of
thought processes
–Infancy
–Toddler
–Preschooler
–School age
–Adolescent
 Creative Communication with children
Therapeutic Play
General principle
 An atmosphere of acceptance and
comfortable
 Respect for the individuality
 Culture-parent-child-nurse relationship
 Empathy: one can see the world through
the children’s eyes.
 Sensitivity: nonverbal and verbal
communication
Infancy
 Thought processes of infancy
– Sensorimotor
– Trust v.s. mistrust
 Patterns of infant communication
– Verbal P47 table 2-14
• Smile, coo, cry
– Nonverbal P46
• Comfort is expressed by soft sounds, cuddling, and
eye contact. 第1段
• Discomfort is expressed by thrashing the extremities,
arching the back, and crying vigorously.
• Normal infants understand more words than they
can speak. P47第2段
– Providing a stimulating environment
– Use the infant’s known words.
 Communication strategies
Communication strategies– infant
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P46
Hold for feeding.
Hold, rock, and talk to infant often.
Talk and sing frequently during care.
Tell names of objects.
Use high-pitched voice with newborns.
When the infant is upset, swaddle and hold
securely.
Toddler
 Thought processes of Toddler
P50
– Preoperational
– Autonomy v.s. shame and doubt
– Dealing with egocentric thinking
– Able to communicate effectively with their hands to
transmit ideas
 Patterns of toddler communication
 Communication strategies
Patterns of toddler communication
P50
 Verbal :
– May use four to six words in addition to “mama” and
“dada”. 第二段
– Receptive speech far outpaces expressive speech
– 3y/o almost 1000 words and uses short sentences.
 Nonverbal P50第三段
– Pointing, pulling an adult over to a room or to object.
– Speaking in expressive jargon.
– Cry, pounds feet, displays a temper tantrum, or uses
other means to illustrate dismay.
handling them
holding, rocking, and stroking
verbalize the feeling shown by the toddler
Communication strategies -- Toddler P52
Give short, clear instructions.
Do not give choices if none exist.
Offer a choice of two alternatives when possible.
Approach positively.
Tell toddler what you are doing, names of objects.
Hold, rock, and stroke.
Repeat words that are familiar to the child
Concrete explanation.
Nonverbal message are consistent with words and
actions.
Table 2-19
Preschool
P56
 Thought processes of preschool
– Preoperational
– Autonomy v.s. shame and doubt
– Everything is direct and concrete
– Unable to separate fact from fantasy
 Patterns of preschool communication
– Verbal 第一段
P56
• Language skills blossom
• Over 2000 words
• Complete sentences of several words and use all parts
of speech.
• But grasp of meaning is usually literal and may not
match that of adults
 Communication strategies
Communication strategies– Preschool
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P57
Allow time for child to integrate explanations.
Verbalize frequently to the child.
Use drawings and stories to explain care.
Use accurate names for bodily functions.
Allow choices.
Concrete visual P57此部分最後一段
Medical equipment
Several short sessions rather than one long session
Keep unfamiliar equipment out of view until it is
needed.
School-age
〈 P62 〉
 Thought processes of School-age
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Concrete operation
Industry v.s. inferiority
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Rely less on what they see and more on what they
know when faced with new problems.
– Becomes an enthusiastic participant
– Heightened concern about body integrity
 Patterns of School-age communication P62
– Learn how to correct any lingering pronunciation
or grammatical errors.
– Writing（encourage to keep a journal）
 Communication strategies
Communication strategies-- School-age P62
Provide concrete examples of pictures or
materials to accompany verbal descriptions.
Assess knowledge before planning teaching.
Allow child to select rewards following
procedures.
Teach techniques such as counting or
visualization to manage difficult situations.
Include child in discussions and history with
parent.
Responding to “Why?” .
Adolescent
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Thought processes of adolescent
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Formal operation
Identity v.s. role confusion
Willing to discuss their concerns with an adult
outside the family
Patterns of adolescent communication
P65
Verbal communication P65第1段
- All parts of speech are used and understood by
the adolescent.
- Colloquialisms and slang
- Foreign language
- Understand and analyze grammar and sentences
structure
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Communication strategies
Communication strategies:
P65
 Provide written as well as verbal explanations.
 Direct history and explanations to teen alone” then
include parent.
 Allow for safe exploration of topics by suggesting
that the teen is similar to other teens.
 Arrange meetings for discussions with other teens.
 Provide positive models and a variety of experiences.
第2段倒數第2行
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Privacy & respect.第4段第1行
Teen room.第5段第1行
Allow choices.第5段第3行
Use of contracts may increase compliance. 第6行
Creative Communication with children
Whaley & Wong’s Nursing care of the infant and children. P151 BOX6-4
Verbal techniques
 “I”messages
 Third-person technique
 Facilitative responding
 Storytelling
 Mutual Storytelling
 Bibliotherapy
 Dreams
 “What if ”questions
 Three Wishes
 Rating Game
 Word association game
 Sentence Completion
 Pros and cons
Nonverbal techniques
 Writing
 Drawing
 Magic
 Play
Therapeutic Play
各年齡層兒童的遊戲發展
 The definition of Therapeutic Play
治療性遊戲在醫院中的功能
Therapeutic Play Techniques
–Stories
–Drawings
–Music
–Puppets
–Dramatic play
–Pets
適用於各年齡層兒的治療性遊戲
Play activities for specific Procedures
各年齡層兒童的遊戲發展
 Infant
P44
– Solitary play
 Toddler
P48
– Parallel play
 Preschool
P54
– Associative play
 School age
P59
– Cooperative play.
 Therapeutic recreation（Adolescent） P63
The definition of Therapeutic Play
 Play therapy
 Therapeutic play
P175
– Play sessions can provide a means for the
child to learn about health care, to express
anxieties, to work through feelings, and to
achieve a sense of mastery or control over
frightening or little-understood situations. 第1
段第2行後面
– Play that presents an opportunity to deal with
the fears and concerns of health experiences is
called therapeutic play. 第1段倒數第3行
治療性遊戲在醫院中的功能 –補
 Provides diversion and brings about relaxation
 Helps the children feel more secure in a strange
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environment
Helps to lessen stress of separation and the feeling of
homesickness
Provides a means for release of tension and expression of
feelings
Encourages interaction and development of positive
attitudes toward others
Provides an expressive outlet for creative ideas and
interests
Provides a means for accomplishing therapeutic goal
Places child in active role and provides opportunity to
make choices and be in control
Assess the child’s knowledge of his or her
illness or injury. P175第2段
 Outline drawing of the body or stories.第2行 fig5-8
 Goodenough Draw-A-Person test (table5-5) .第5行
後面
– Cognitive level(3-13 years)
 Gellert Index：the child’s knowledge of the body.
(table5-6)倒數第5行
適用於各年齡層兒的治療性遊戲
P175
 Toddler
– Initial approach should be made in their parents’
presence.第2段第1行
– Peek-a-boo or hide-and-seek.第3行
– Use familiar objects.最後1行
– Repetition familiar stories. P176第1段第2行
– Doll. P176第2段
– Others：familiar objects from home.第2段第3行
– Hospital equipment.第2段第5行
各年齡層兒的治療性遊戲--Preschool
 Simple outline of the body or a doll.第1段第2行
 Hospital equipment.第3行 & Fig. 5-9
 Like crayons and coloring books, puppets,
felt and magnetic boards…. 第2段
 Pet therapy.第2段第2行後面 & Fig. 5-10
P177
各年齡層兒的治療性遊戲--School age
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P177
Play begins to lose its importance in the school-age years.
第1段第1行
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Often regress developmentally.第1段第3行
Outline of the body and dolls.第1段倒數第3行
Terms for body parts that are suitable.倒數第2行
Drawing.倒數第1行
Enjoy collecting and organizing objects and often ask
to keep disposable equipment. 第2段第2行
 Games, book, schoolwork, crafts, tape recording, and
computers.第3行
promote a sense of mastery and achievement.最後1行
各年齡層兒的治療性遊戲
-- Therapeutic recreation（Adolescent） P178
 Telephone contact with other teenagers and visits
from friends. 第1段第4行
 Interactions with other teenagers at a pizza
party…（Fig.5-11）第5行
 Physical activities.第1段倒數第2行
 Provide choices.第2段第1行
Play activities for specific Procedures
Whaley & Wong’s Nursing care of the infant and children. P1111 Box 27-1
 Fluid intake
 Deep breathing
 Range of motion and use of extremities
 Soaks
 Injections
 Ambulation
 Extending environment