Communication with hospitalized children

General principleCommunication related to development of thought processes

–Infancy–Toddler–Preschooler–School age–Adolescent

Creative Communication with children Therapeutic Play

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 children’s eyes. Sensitivity: nonverbal and verbal

communication

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. 第 1 段

• Discomfort is expressed by thrashing the extremities, arching the back, and crying vigorously.

• Normal infants understand more words than they can speak. P47 第 2 段

– Providing a stimulating environment– Use the infant’s known words.

Communication strategies

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.

P50 Thought processes of Toddler– Preoperational– Autonomy v.s. shame and doubtAutonomy 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

Toddler

Patterns of toddler communication P50

Verbal :– May use four to six words in addition to “mama” and

“dada”. 第二段– Receptive speech far outpaces expressive speech– 3y/o almost 1000 words and uses short sentences.

Nonverbal P50 第三段– Pointing, pulling an adult over to a room or to object.– Speaking in expressive jargon.– Cry, pounds feet, displays a temper tantrum, or uses o

ther means to illustrate dismay.

handling them holding, rocking, and stroking verbalize the feeling shown by the toddler

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 childConcrete explanation.Nonverbal message are consistent with words and

actions.Table 2-19

Preschool P56

Thought processes of preschool – Preoperational– Autonomy v.s. shame and doubtAutonomy v.s. shame and doubt– Everything is direct and concrete– Unable to separate fact from fantasy

Patterns of preschool communication P56

– Verbal 第一段• Language skills blossom• Over 2000 words• Complete sentences of several words and use all parts o

f speech.• But grasp of meaning is usually literal and may not mat

ch that of adults

Communication strategies

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 此部分最後一段 Medical equipment Several short sessions rather than one long session Keep unfamiliar equipment out of view until it is n

eeded.

School-age 〈 P62 〉 Thought processes of School-age

• Concrete operation

• Industry v.s. inferiorityIndustry 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

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?” .

Adolescent

Thought processes of adolescent- Formal operation - Identity v.s. role confusion dentity v.s. role confusion - Willing to discuss their concerns with an adult out

side the family Patterns of adolescent communication P65

Verbal communication P65 第 1 段- All parts of speech are used and understood by th

e adolescent.- Colloquialisms and slang- Foreign language- Understand and analyze grammar and sentences s

tructure Communication strategies

Communication strategies: P65

Provide written as well as verbal explanations. Direct history and explanations to teen alone” then in

clude parent. Allow for safe exploration of topics by suggesting tha

t the teen is similar to other teens. Arrange meetings for discussions with other teens. Provide positive models and a variety of experiences.

第 2 段倒數第 2 行 Privacy & respect. 第 4 段第 1 行 Teen room. 第 5 段第 1 行 Allow choices. 第 5 段第 3 行 Use of contracts may increase compliance. 第 6 行

Creative Communication with children Whaley & Wong’s Nursing care of the infant and children. P151 BOX6-4

Verbal techniques “I”messages 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

Therapeutic Play

各年齡層兒童的遊戲發展  The definition of Therapeutic Play

治療性遊戲在醫院中的功能Therapeutic Play Techniques

–Stories–Drawings–Music–Puppets–Dramatic play–Pets

適用於各年齡層兒的治療性遊戲 Play activities for specific Procedures

各年齡層兒童的遊戲發展

Infant P44

– Solitary play Toddler P48

– Parallel play Preschool P54

– Associative play School age P59

– Cooperative play. Therapeutic recreation（ Adolescent）

P63

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. 第 1 段第 2 行後面

– Play that presents an opportunity to deal with the fears and concerns of health experiences is called therapeutic play. 第 1 段倒數第 3 行

治療性遊戲在醫院中的功能 –補 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

Assess the child’s knowledge of his or her illness or injury. P175 第 2 段

Outline drawing of the body or stories. 第 2 行 fig5-8

Goodenough Draw-A-Person test (table5-5) . 第 5行後面– Cognitive level(3-13 years)

Gellert Index ： the child’s knowledge of the body. (table5-6) 倒數第 5 行

適用於各年齡層兒的治療性遊戲 P175

Toddler – Initial approach should be made in their parents’ p

resence. 第 2 段第 1 行– Peek-a-boo or hide-and-seek. 第 3 行– Use familiar objects. 最後 1 行– Repetition familiar stories. P176 第 1 段第 2 行– Doll. P176 第 2 段– Others ： familiar objects from home. 第 2 段第 3

行– Hospital equipment. 第 2 段第 5 行

Simple outline of the body or a doll. 第 1 段第2 行

Hospital equipment. 第 3 行 & Fig. 5-9

Like crayons and coloring books, puppets, felt and magnetic boards…. 第 2 段

Pet therapy. 第 2 段第 2 行後面 & Fig. 5-10

各年齡層兒的治療性遊戲 --Preschool P17

7

      Play begins to lose its importance in the school-age years.第 1 段第 1 行

      Often regress developmentally. 第 1 段第 3 行 Outline of the body and dolls. 第 1 段倒數第 3 行 Terms for body parts that are suitable. 倒數第 2 行 Drawing. 倒數第 1 行 Enjoy collecting and organizing objects and often ask

to keep disposable equipment. 第 2 段第 2 行 Games, book, schoolwork, crafts, tape recording, and

computers. 第 3 行

promote a sense of mastery and achievement. 最後 1行

各年齡層兒的治療性遊戲 --School age P177

各年齡層兒的治療性遊戲 -- Therapeutic recreation （ Adolescent ） P178

Telephone contact with other teenagers and visits from friends. 第 1 段第 4 行

Interactions with other teenagers at a pizza party… （ Fig.5-11 ）第 5 行

Physical activities. 第 1 段倒數第 2 行 Provide choices. 第 2 段第 1 行

Play activities for specific Procedures Whaley & Wong’s 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