Child Life in Hospitals Exam 1

  1. Children's fears and fantasies
    • fear of punishment -90%
    • fear of abandonment
    • fear of physical limitations
    • fear of death
  2. Reason for child life interventions
    minimize stress and anxiety experienced by children to assure optimal growth and development
  3. History of CL
    • as early as 1917
    • Emma Plank and Mary Brooks during 50s and 60s
  4. Primary objectives of CL
    • to help child cope with stress and anxiety of hospital experience
    • promote child's normal growth and development while in health care setting and after returning home
  5. Helping to cope
    • provide materials and guidance for play
    • prepare children for hospitalization
    • lending emotional support for siblings and family
    • advocating child's point of view
    • maintaining a receptive environment for children and their families
  6. Play is a mechanism in which children
    • learn
    • socialize
    • express concerns
    • test growing bodies
    • cope
  7. Overt or active responses to hospital stimulation
    • crying
    • screaming
    • whining
    • clinging to parents
    • resisting meds/treatment
    • being self-destructive
    • being destructive of environment
    • fighting
  8. passive responses to hospital stimulation
    • excessive sleeping
    • decreased communication
    • decreased activity
    • decreased eating
  9. Regressive behavior to hospital stimulation
    • alterations in sleeping patterns
    • eating too much or too little
    • being tense, anxious, restless
    • manifesting fears
    • being overly concerned with one's body
    • displaying compulsive behavior
  10. Elements related to degree of psychological upset
    • unfamiliarity of hospital setting
    • separation from parents
    • age
    • pre-hospital personality
  11. Physical and procedural unfamiliarity
    • physical: when they see all of the hospital things, machines, unfamiliar faces, etc
    • procedural: vital signs, blood tests, dressing changes
  12. *****Three stages of children's response to separation***
    • Protest
    • Despair
    • Detachment
  13. Protest
    • Initial phase may last few hours-week or more
    • overt/active behavior
    • acute distress, crying, screaming, kicking
    • suggests strong expectation that mother will return
    • rejects all alternative figures, though some cling to nurses
  14. Despair
    • if parents don't return during period of protest
    • increasing hopelessness
    • quiet and withdrawn, crying intermittently
    • superficial calm
    • presumed to be a decrease in stress
  15. Detachment
    • appear to be making recovery
    • become active and interested in surroundings
    • problem noted at return of parents
    • respond with indifference upon parents' return
  16. Three stage process helps explain
    • upset of a previously calm child upon arrival of parents
    • child's greater interest in presents and material goods than in the parents upon visitation
    • "highly social" child who has suffered a prolonged separation
    • reluctance of a child to leave hospital with parents upon discharge
  17. upset child
    • visit of parents brings to surface feelings of intense grief/anger.
    • protest is positive; child hasn't entered despair or detachment
  18. child's interest in material goods
    • clue that he/she might be in the detachment stage
    • when left without parents, children become self-centered and tend to develop some preoccupations
  19. "Highly social" child
    • allows anyone in and out
    • "socially superficial and promiscuous"
    • may be in detachment phase
  20. Child reluctant to leave
    • protests leaving hospital
    • detachment
    • comfort zone is the hospital
  21. Most susceptible to rigors of hospitalization
    7 months-3-4 years
  22. Infants
    older infants cry more, feeding issues, negative responses to observers
  23. Toddlers/preschoolers
    • aware of separation, incapable of accepting explanations
    • concept of time
    • need for parents
    • fantasies
  24. school-age
    • better equipped
    • develop relationships
    • better able to test reality
  25. adolescents
    • struggle for independence
    • becoming dependent
    • cut off from social activities
    • how will it affect their appearance
    • sexual identity
  26. Importance of parental involvement
    • source of strength and familiarity in a strange
    • environment
    • can interpret new experiences to child
    • defuse fantasies of abandonment
    • provide info to staff of child’s likes/dislikes
  27. Sibling involvement
    • Siblings are not immune to the difficulties
    • experienced by parent and hospitalized child
    • Siblings suffer pain of separation
    • Endure increased parental irritability
    • Temporary neglect of siblings
  28. sibling reactions: normal
    • resentment
    • jealousy
  29. conspiracy of silence
    no one is talking, it must be bad
  30. Information and support needed by all parents
    • Less than peak of their capacities of understanding
    • things
    • Parents inability to voice complaints
    • Afraid nurses will retaliate
    • Parents need an ally among hospital staff who
    • can provide info concerning available services and give emo support. (social worker)
  31. What causes most stress for families?
    lack of information
  32. two mechanisms for providing info
    • Pre-admission preparation booklet
    • Pre-admission familiarization program or hospital
    • tour
  33. Topics of pre-admission booklet
    • What to tell their child
    • What to wear, bring
    • Whom to turn to (and when) for accurate info and
    • support
    • How to behave on the unit
    • How to help one’s child (parenting plans)
    • What are parents expect to do? What are they
    • allowed to do?
  34. Child life's role of imparting info to parents
    • Continually remind colleagues of parents’ need
    • for open communication
    • Concern expressed by parents can be reported to
    • the appropriate parties
    • When child life specialist senses a parent is
    • reluctant to ask questions of people, offer support
  35. Guidelines to supportive listening
    • Keep the focus of conversation on the parent
    • Look directly at speaker
    • Nod your head and give affirmative signals
    • Don’t be afraid of silence
    • Draw out the parent with questions. Ask open
    • ended questions
    • If you disagree with parent, avoid using
    • questions that lead them to your way of thinking
    • Restate what you have heard (perception check)
    • Respond to feeling messages
  36. ultimate goal in involving parents
    parent-child relationships
  37. Child life considerations regarding parents' roles
    • Be aware of their discomfort and their
    • insecurities as they attempt to become “parents in the hospital”
    • Encourage family involvement in preparation or
    • play sessions
    • Avoid usurping parents’ role as a provider of
    • play
    • Teach parents new ways of playing with children
    • –quadriplegic
    • Serve as a role model for parents who may feel
    • uncomfortable with play activities
    • Teaching these skills will hopefully follow the
    • family home from the hospital
  38. Play facilitates
    • Child’s self-expression
    • Provides mechanism for coping with difficulties
    • Active participant (vs. passive one)
    • Normal growth and development
  39. Characteristics of play
    • Play is pleasurable
    • Play has no extrinsic goals. Motivations are
    • intrinsic and serve no other objectives
    • Spontaneous and voluntary
    • Involves some active engagement on part of the
    • player
    • Play has certain systematic relations to what is
    • not play (things you gain…cognitive development, etc)
  40. Role of play in CL
    • Play and physical development
    • Play and intellectual development
    • Play and social development
    • Play and emotional development
  41. Play and physical development
    • provides motivation necessary to exercise body
    • and facilitate development
    • child does not play in order to develop but
    • rather for pure pleasure inherent in the play…just a bi-product
  42. Play and intellectual development
    • Piaget states: children learn about the world
    • around them through their own actions and explorations
  43. two process that take place in play
    • Assimilation- taking in new information
    • Accommodation- altering patters of thinking
  44. Piaget
    • Sensorimotor stage
    • Pre-operational
    • Concrete-operational
    • Formal-operational
  45. Sensorimotor
    • Birth-2
    • Children move from dominances of reflex
    • mechanisms to deliberate manipulation of objects
    • Object permanence is developed
    • Connection between his or her actions and their
    • effects on objects: cause and effect
  46. Pre operational
    • 2-7
    • has greater ability to hold and recall image of
    • objects
    • symbolization –dramatic play, etc
    • egocentric
  47. Concrete-operational
    • 7-12
    • conservation
    • increasingly able to think logically but only in
    • the concrete realm
    • better able to understand a thorough prep for
    • surgery
    • able to understand sequencing- large to small,
    • etc
  48. formal operational
    • 12- adulthood
    • no longer rely on presence of physical objects
    • to demonstrate logical though
    • abstract thought
    • unoccupied
    • onlooker
    • solitary independent
    • parallel
    • associative
    • cooperative or organized supplementary
  50. onlooker
    • not actively involved, but watching more and
    • focused on play activities of others. Remain close to a group
  51. solitary independent
    • No effort to interact with others.
    • Play alone
  52. parallel activity
    • Play in same area with like materials, but with
    • each using material in an independent manner.
  53. associative play
    • Children interact with each other while engaged
    • in common activity
    • Play is not organized
  54. cooperative and organized
    • Group goal is developed
    • Usually directed by one or two of the players
    • Characterized by differentiated roles
  55. Staff response to play
    • Monitor regression
    • Understanding fears and feelings
    • Enhancing communication
    • Education and preparation
  56. 3 types of play beneficial to stress reduction
    • recreational play
    • therapeutic play
    • play therapy
  57. Recreational play
    • spontaneous, unstructured
    • occurs naturally, its content and form are affected by developmental level of child
  58. Therapeutic play
    • occurs when an adult structures activity for specific purpose
    • CLS
  59. Play therapy
    • interpreting child's play and recommending appropriate interventions
    • skilled therapists use play to help children understand their own behavior and change those behaviors that are inapproproate
  60. Types of medical play
    • role rehearsal/role reversal
    • medical fantasy play
    • indirect medical play
    • medical art
  61. role rehearsal/role reversal
    • real medical equipment or play equipment
    • introduce child to equipment to create sense of safety
    • encourage to play
    • assess reactions or feelings
    • ask open ended questions giving them control-master
  62. medical fantasy play
    • no props of medical equipment is used
    • need medical oriented theme
  63. indirect medical play
    • more structure, more at risk to overwhelm the child
    • dolls
    • play function should be pleasurable and positive, not as structured
  64. medical art
    use of medical supplies into art work
Card Set
Child Life in Hospitals Exam 1
Questions from Child life in Hospitals book