Communication with hospitalized children

1
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

2
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
  childrens eyes.
• Sensitivity nonverbal and verbal communication

3
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. ?1?
• Discomfort is expressed by thrashing the
  extremities, arching the back, and crying
  vigorously.
• Normal infants understand more words than they
  can speak. P47?2?
• Providing a stimulating environment
• Use the infants known words.
• Communication strategies

4

• Communication strategies infant 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.

5
P50
Toddler

• Thought processes of Toddler
• 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

6
Patterns of toddler communication P50

• Verbal
• May use four to six words in addition to mama
  and dada. ???
• Receptive speech far outpaces expressive speech
• 3y/o almost 1000 words and uses short sentences.
• Nonverbal P50???
• 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

7
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

8

• 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 P56
• Verbal ???
• 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

9
Communication strategies Preschool 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???????
• Medical equipment
• Several short sessions rather than one long
  session
• Keep unfamiliar equipment out of view until it is
  needed.

10
School-age lt P62 gt

• Thought processes of School-age
• Concrete operation
• Industry v.s. inferiority
• 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

11
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? .

12
Adolescent

• Thought processes of adolescent
• 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?1?
• All parts of speech are used and understood by
  the adolescent.
• Colloquialisms and slang
• Foreign language
• Understand and analyze grammar and sentences
  structure
• Communication strategies

13
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. ?2????2?
• Privacy respect.?4??1?
• Teen room.?5??1?
• Allow choices.?5??3?
• Use of contracts may increase compliance. ?6?

14
Creative Communication with children Whaley
Wongs Nursing care of the infant and children.
P151 BOX6-4

• Verbal techniques
• Imessages
• 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

15
Therapeutic Play

• ???????????
•  The definition of Therapeutic Play
• ????????????
• Therapeutic Play Techniques
• Stories
• Drawings
• Music
• Puppets
• Dramatic play
• Pets
• ??????????????
• Play activities for specific Procedures

16
???????????

• Infant P44
• Solitary play
• Toddler P48
• Parallel play
• Preschool P54
• Associative play
• School age P59
• Cooperative play.
• Therapeutic recreation(Adolescent) P63

17
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. ?1??2???
• Play that presents an opportunity to deal with
  the fears and concerns of health experiences is
  called therapeutic play. ?1????3?

18
???????????? ?

• Provides diversion and brings about relaxation
• Helps the children feel more secure in a strange
  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

19
Assess the childs knowledge of his or her
illness or injury. P175?2?

• Outline drawing of the body or stories.?2? fig5-8
• Goodenough Draw-A-Person test (table5-5) .?5???
• Cognitive level(3-13 years)
• Gellert Indexthe childs knowledge of the body.
  (table5-6)???5?

20
?????????????? P175

• Toddler
• Initial approach should be made in their parents
  presence.?2??1?
• Peek-a-boo or hide-and-seek.?3?
• Use familiar objects.??1?
• Repetition familiar stories. P176?1??2?
• Doll. P176?2?
• Othersfamiliar objects from home.?2??3?
• Hospital equipment.?2??5?

21
???????????--Preschool P177

• Simple outline of the body or a doll.?1??2?
• Hospital equipment.?3? Fig. 5-9
• Like crayons and coloring books, puppets, felt
  and magnetic boards. ?2?
• Pet therapy.?2??2??? Fig. 5-10

22
???????????--School age P177

• n      Play begins to lose its importance in the
  school-age years.?1??1?
• n      Often regress developmentally.?1??3?
• Outline of the body and dolls.?1????3?
• Terms for body parts that are suitable.???2?
• Drawing.???1?
• Enjoy collecting and organizing objects and often
  ask to keep disposable equipment. ?2??2?
• Games, book, schoolwork, crafts, tape recording,
  and computers.?3?
• ?promote a sense of mastery and
  achievement.??1?

23
??????????? -- Therapeutic
recreation(Adolescent) P178

• Telephone contact with other teenagers and visits
  from friends. ?1??4?
• Interactions with other teenagers at a pizza
  party(Fig.5-11)?5?
• Physical activities.?1????2?
• Provide choices.?2??1?

24
Play activities for specific Procedures Whaley
Wongs 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