Atraumatic Care Teaching and Techniques

TABLE 30.3 COMMUNICATING EFFECTIVELY WITH CHILDREN Age Techniques Infants •Respond to crying in a timely fashion. •Allow the infant time to warm up to you. •Use a soothing and calming tone when speaking to the infant. •Talk to the infant directly. •Communication through play may be helpful with older infants. •Watch for signs of overstimulation such as closing eyes, turning away, yawning, and irritability. Toddlers •Approach toddlers carefully; they are often not only fearful but also quite resistant. •Use the toddler’s preferred words for objects or actions so he or she is better able to understand. •Toddlers enjoy stories, dolls, and books. •Participate in parallel play to help start communication. •Prepare toddlers for procedures just before they are about to occur. Preschoolers School-age children •Use play, puppets, or storytelling via a third-party approach. •Speak honestly. •Use simple, concrete terms. •Ask specific questions. •Allow the child to have choices as appropriate. •Participate in imaginative play to help open communication. •Prepare preschoolers about 1 hour prior to a procedure. •Use diagrams, illustrations, books, and videos. •Allow the child to honestly express feelings. •Use third-party stories to elicit desired information (such as “some children feel anxious about….”). •Allow the child to ask questions related to care and treatment. Give the child adequate time for all of the questions to be answered. •Prepare the child a few days in advance for a procedure. Adolescents •Always respect the teenager’s need for privacy. •Ensure confidentiality. •Remain nonjudgmental. •Listen attentively and speak respectfully. •Use appropriate medical terminology, defining words as necessary. •Use creativity and humor. •Do not force the adolescent to talk as this may shut down communication. •Prepare the teen up to 1 week prior to a procedure. TABLE 30.4 GENERAL TEACHING TIPS FOR YOUNG CHILDREN Teaching Tips Practical Application Offer simple, concise, concrete explanations based Use a child’s senses and relate what a procedure will on the assessed needs, questions, and look, sound, smell, taste, or feel like (“The MRI developmental level of the child. machine will sound very loud, like a big train”). Be honest, even when the information you need to Use the family’s words that the child understands; convey is not positive. This helps the child to form use “soft words” (“This will feel warm” instead of a bond of trust and confidence with caregivers. “This will burn”). Time explanations to decrease anxiety and excess worry before the event. Avoid telling unpleasant news close to bedtime. Parents know their child best. Eliciting information from them about their child’s past behaviors and coping skills can often mean the difference between a positive and negative experience for their child. As a general rule, give toddlers information about procedures, medicines, and other interventions immediately beforehand; give 4- to 7-year-olds information 1 or 2 days in advance. Teach parents how to coach their child with pain management, visualization, or other methods of distraction when appropriate (“Remember when we went to the beach …”). Provide an active role for the child. This helps to Allow the child to help with simple self-care activities foster a child’s sense of self-confidence and control such as holding a dressing or piece of tape. Provide over the situation. props and dolls to touch and feel as much as possible (“Your job is to keep your hands still”). Children’s wishes must be respected when they verbalize or demonstrate that they do not want more information. Keep explanations short and simple; know when to stop teaching. Praise the child and let him or her know how much you appreciate his or her help and cooperation. Use “please” and “thank you” often (“Thank you. I like the way you held still for me”). Teaching Preschool Children. When teaching young children, the nurse or family assumes part or all of the responsibility for what is learned, how it is learned, and when it is learned. Because they have vivid imaginations, young children often attempt to invent pieces of information, or they pick up bits and pieces of misinformation that can lead to false assumptions. Skillfully delivered and timed information can promote trust, calmness, and control in an otherwise apprehensive and uncooperative preschooler. Table 30.4 presents some general guidelines for teaching young children. Teaching School-Age Children. Unless they are quite ill, school-age children usually want to participate in their care. They have a need to cooperate and achieve. When teaching, speak directly to them and include them in the education plan. Teach the school-age child and parent together, as parents can often learn by observing the care being given and taught to their child. Table 30.5 provides some general guidelines to keep in mind when teaching school-age children. Teaching Adolescents. Adolescents are particularly sensitive about maintaining body image and feelings of control and autonomy. This is especially important with health care processes and decisions that affect them. Table 30.6 gives guidelines to use when teaching adolescents. Refer to chapter 2 for information on evaluating learning and documenting education. Consider This! Elsa is a 5-year-old girl on your unit who was recently diagnosed with diabetes. She is getting ready to be discharged home at the end of the week. Her grandparents are her primary care givers. What concerns regarding learning would you take into consideration during your assessment? Describe different teaching strategies you would utilize with Elsa and her family. How would you evaluate learning with Elsa and her family? p. 1121 p. 1122 TABLE 30.5 GENERAL GUIDELINES WHEN TEACHING SCHOOL-AGE CHILDREN Teaching Tips Practical Application Allow the child some control and involvement in Offer choices whenever possible (taking the medicine the decision-making process. with juice or milk), but don’t offer choices when there are no alternatives (taking the medicine). Children can relate present-day happenings to past experiences. Use examples and past experiences that are familiar to the child (“Remember when you were first learning to swim …”). Achievement and accomplishment are very important to children at this age, so anything they can be actively involved in will help them adjust and learn. Provide an active role and allow the child to do as much of his or her care as possible. Use props, dolls, games, and computers to enhance learning. At this age, most children are able to sequence, Teach children the steps involved and how long it will understand cause and effect, and make sense take (“Today I’m going to teach you how to change of time. your dressing. This will help keep your cut clean. First, wash your hands …”). Gaining control over the situation and preparing Provide information 3 to 7 days in advance, depending mentally are important for their self-confidence. on the child’s age and developmental level. Praise the child and let him or her know how much you appreciate his or her help and cooperation. Use “please” and “thank you” often (“Thanks! You did a great job using your inhaler”). TABLE 30.6 GENERAL GUIDELINES WHEN TEACHING ADOLESCENTS Teaching Tips Practical Application Allow teens to be in control and involved in Speak directly to teens; consider their input in all decisions the decision-making process. about their care and education. Adolescents can process abstract information and understand how their actions affect long-term outcomes. Provide reasons why something is important and discuss how their lives will be affected by their decision to take care of their health needs (“If you take your asthma medicine, you’ll be better able to play tennis”). Adolescents are very concerned about how Collaborate with the teen to develop acceptable solutions they look and how they fit in with peers. and strategies for dealing with health issues that affect personal appearance and peer acceptance (e.g., wig vs. head scarves for hair loss from chemotherapy). Adolescents strive for independence and Expect some noncompliance with care, despite your best have personal values and ideologies that educational efforts. Work together to achieve win–win may conflict with those of parents and the outcomes of educational goals. medical community.