Transcript Chapter 6

Communication and
Health Assessment of
the Child and Family
Chapter 6
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Principles of Communication
• Make communication developmentally
appropriate
• Rely on nonverbal behavior more than verbal
• Get on child’s eye level but avoid staring at child
• Approach child gently/quietly. Give them time to
warm up to you. Use transition objects or play
techniques.
• Always be truthful
• Give child choices as appropriate
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Involve Child in
Communication
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Principles of Communication
(cont’d)
• Avoid analogies and metaphors
• Give instructions clearly
• Give instructions in positive manner
• Avoid long sentences, medical jargon,
colloquialisms; think about “scary words” See
handout on choosing language.
• Allow younger children to be close to parent
• Give older child opportunity to talk without
parents present
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Principles of Communication
cont’d
• Allow children to express feelings and
fears
• Offer praise, encouragement, and
rewards
• Use a variety of communication
techniques—see pp. 115-116.
• Be culturally sensitive—see p. 109
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Developmentally Appropriate
Communication
• Infants
– Non-verbal
– Crying as communication
– Pick up adults non-verbal behaviors
– If under 6 months, will usually respond
to anyone.
– If over 6 months, stranger anxiety
exists
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Developmentally Appropriate
Communication
• Early childhood
– Focus on CHILD in your communication
– Need “warm-up” time. May be
uncooperative
– Use words he will recognize; use short,
familiar, and concrete terms
– Be consistent: don’t smile when doing painful
things
– Allow child to handle most equipment
– Keep fearful equipment out of sight until it is
needed.
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Developmentally Appropriate
Communication (cont’d)
• School-age years
– High level of curiosity; likes to help
– Give explanations and reasons
– Explain how things work; allow handling of
most equipment
– Allow to express feelings
– Respect privacy
– Generally behave well and communicate
effectively
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Developmentally Appropriate
Communication (cont’d)
• Adolescent
– Be honest with them
– Aware of privacy needs
– Think about developmental regression
– Importance of peers
– Listen to them and respect their views
– Avoid judging or criticizing; tolerate
differences
– Pick your battles
– Avoid the third degree
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Play
• Children’s “work”
• Child’s “developmental workshop”
• As therapeutic intervention
• As stress reliever for child/family
• As pain reliever/distracter
• As barometer of illness
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Therapeutic Art
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Therapeutic Art
• One of the most valuable forms of
communication
• Can tell about child’s situation both from seeing
what he draws and what he says about it.
Remember to take into account other information
about family.
• Important points: first figure, size of figures,
order, position, exclusion, accentuated parts,
absence of parts, size and place of drawing,
stroke type, erasures, cross-hatching (p. 116)
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Communicating with Parents
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Communicating with Parents
• Most information comes from them
• If parent sees a problem, pay attention
• Listen actively; listen for information
directed “over the child’s head.”
• Try to be a facilitator in arriving at a
solution to the problem rather than always
giving your ideas
• Remember to use open-ended questions
that start with “what” “how” “tell me about”
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The Health History
• Pediatric health history has similar and different
components from adult history (p. 117 and 119)
• If pain is part of chief complaint, see p. 116
• Complete family assessments are indicated in
the following instances:
– Comprehensive checkups
– Developmental delays
– Child abuse/behavioral or emotional probs
– Children with stressful events and major life
changes
– New home care patients
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The Health History (cont’d)
• Family Assessments gather information about:
– Family composition
– Home environment
– Occupation and education of members
– Cultural and religious elements
– Family interactions including who makes
decisions, how members communicate, how
they solve problems, disciplinary methods,
and support for each other
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The Health History (cont’d)
• Nutritional Assessment
– Especially important for patients with
evidence of nutritional problems (p. 128-129)
– Dietary recalls are frequently unreliable
– Most common is 24h but is only useful if day
is typical; 3 day diaries are more helpful
– May also use specific history questions as
seen on p. 126 or a food frequency record on
p. 127.
– Other methods for assessing nutritional
status include anthropometrics and labs
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