What are the 10 principles of communicating with children?
Make communication developmentally
appropriate
Get on child’s eye level
Approach child gently/quietly
Always be truthful
Give child choices as appropriate
Avoid analogies and metaphors
Give instructions clearly
Give instructions in positive manner
Avoid long sentences, medical jargon; think
about “scary” words
Give older child opportunity to talk without
parents present
What is distance language?
– Use of “it” or “others"
– Know “someone” vs. their child
– Shield themselves from the painful reality of the
situation
What is paralanguage?
Pitch, pause, intonation, rate, volume, and stress
apparent in speech
What are some principles for talking to parents?
Encouraging the parent to talk
– Utilize “what”, “how” or “tell me about”
– Avoid “did”, “is”, “does”
• Directing the Focus
– One of the most difficult skills
• Listening and Cultural Awareness
• Be aware that parent may wish to share
information that they do not want the child
to hear or understand
• Being Empathic (not sympathetic), but stay away from stuff like, "I know exactly how you feel" and don't bring your own experiences into the conversation. Make it about them, not you.
• Using Silence
– Permits the interviewee to sort out thoughts and
feelings and search for responses
• Defining the Problem
• Solving the Problem
• Providing Anticipatory Guidance, ie, anticipate foreseable problems and provide guidance on how to mitigate or avoid them.
What are some blocks to effective communication?
• Socializing
• Giving unrestricted and unsolicited advice
• Using stereotyped comments or clichés
• Interrupting and finishing sentences
• Forming prejudged conclusions
• Talking more than the interviewee
What level of communication do children understand most?
nonverbal
Strageies for communicating with an infant
– Primarily use and understand nonverbal communication
– Crying, cooing
– Crying as communication
• Types of cries
Strageies for communicating with a young (2-4yrs) child
– Children under 5 years old are egocentric!
– Focus of communication should be on them!
– Cannot relate to experiences of others
– Explain what, how, and why
– Literal meanings attached to words
– Utilize play and allow them to handle equipment
– Be Consistent –verbal vs nonverbal
Strageies for communicating with a school-aged child
– Interested in the functional aspect of all procedures, objects and activities
– Allow manipulation of equipment
– Have a heightened concern about body integrity
– Require relatively simple explanations
Strategies for communicating with an adolecent (if that's even possible)
– Be honest with them
– Be aware of privacy/confidentiality needs
– Think about developmental regression
– Importance of peers and self-concept
What are some creative verbal strategies for talking with children?
– “I” messages
– Third-Person Technique
– Facilitative Reasoning
– Storytelling, mutual storytelling
– Bibliotherapy
– Dreams
– Three wishes (be careful. child may say something you become responsible for, ie, "I wish daddy would stop hitting mommy), Rating Game, Word Association
– Sentence completion, Pros and Cons
What are some nonverbal techniques for talking with children?
Nonverbal Techniques
– Writing
– Drawing
– Magic
– Play
T/F: Play can be used in children as a form of pain relief, stress relief, and a measure of severity of illness/condition?
True.
It's therapeutic, it's children's work, and is what drives a child's developement.
When taking Hx, what are the four components of "present illness"
– The details of onset
– A complete interval history
– The present status
– The reason for seeking help now
What are some components of a child's Hx that differ in nature or emphasis from an adult's?
– Birth history
– Allergies
– Immunizations
– Growth & development
– Habits, ie nail chewing, bed wetting for fun, thumb sucking, etc.
What is the basic idea of collecting a family medical Hx?
Trying to determine risks to child based on genetic, social, or environmental living conditions.
What is involved in obtaining a psych/social Hx?
To elicit information about the child’s self-
concept
School success/issues
Friendships
Unusual habits
Family and home environment
What are you looking for in taking a child's sexual Hx?
• To elicit information concerning the child’s
sexual concerns or activities
Alerts the nurse to circumstances that may
indicate screening for STI or testing for
pregnancy
Provides information related to the need for
sexual counseling, such as safe sex practices
What is Anthropometry?
Measurement of ht, wt, head circumference,
proportions, skinfold thickness and arm
circumference.
Taken during a nutritional Hx assessment (best indicator of mental/physical developement.)
What does a physical assessment tell you about a child's nutrition by system or location?
Abnormal if:
– General growth= <5th or >95th%
– Skin, Hair, Neck: scaley, thick, edema, dry, etc. Think vit or e-lyte deficiency
– Eyes, Ears, Nose, Mouth: vit A, C, D or riboflavin imbalances
– Chest, CV system, abdomen: vit C,D, or e-lyte imbalance
– Musculoskeletal: vit A,C,D, e-lyte, or protien/amino acid imbalance.
– Behavior: Vit A, C, D, E, or e-lyte, or amino acid (thiamine, pyridoxine) imbalance.
