Presented by Marlene Meador RN, MSN, CNE
Therapeutic CommunicationHow does a nurse communicate with a patient who does
not use words?
Physical Proximity and environmentTouchListening Visual CommunicationTone of VoiceBody LanguageTiming
Considerations and strategies for cooperation:Remember developmental age (why is this crucial to
success?) p 60 & 61 table 4.3Honesty Involve child- speak directly to the childInvolve parents when appropriate
Developmental milestones and approach to communicationInfants (0-12 mo)
Toddlers(1-2 yr)
Preschoolers(3-5 yrs)
School-age(6-11)
Use of calm voice; respond to cries, mimic baby sounds, talk and read regularly, use a slow approach and allow time to get to know you
Learn the toddler’s words for common items, picture books, respond to their receptiveness, preparation should occur immediately before event
Offer choices, use play or “storytelling” for explanations,simple sentences, picture books, puppets, be concise; limit length of explanations
Photos, books videos, diagrams, establishlimits, use play, introduce preparatory materials 1-5 days in advance of the event
Barriers to Communication
LanguageCultural differencesDistractionStress/conflict
Quick Question?What is the best way to ruin the relationship between the nurse and child/family/patient?
How is the assessment of a child different
than the assessment ofan adult?
Adapting the physical assessment to children:Physical proximity to the
child/patientPhysical contact Sequence of assessment
Examination of InfantsAllow parents to hold and participateAuscultate when quiteWarm equipmentInvasive procedures last
Rectal temperatures Lab draws)
Examination of ToddlersEncourage parents to participateIntroduce equipmentPlayChoices/controlSecurity object
Examination of Pre-School AgeDemonstrate and introduce
equipmentSequence Games and playDistraction
Examination of School Age and AdolescentProvide privacy (parental presence or
absence/chaperone)Choices of exam sequenceExplanation of body parts and functionsReassurance of normalcy
Beginning the ExaminationVerify patient- National Patient Safety Goal Introduce self- explain purpose of assessmentUtilize therapeutic communication (open-
ended questions) Address the child (direct questions, make eye
contact- WHY?)Obtain feedback from parents when
necessary
Why is an accurate history the single most important component of the physical examination? Page 807 Box 33-3
Substantive dataObjective data
Three types of health historyComplete or initial
Conception to current statusWell or interim
Previous well visit to current visitProblem-oriented or episodic
Information related to current problem
Obtaining a history:Open-ended questioningRe-phrase rather than repeatListen actively (reflective reply)Cultural differencesAvoid judgmental questionsPsychosocial data is critical to health
promotion
Problem-Oriented HistoryCharacteristics Defining Variables
Chief complaint and onset
Body Location
QualityQuantityAggravating and alleviating
Previous & current treatment
Use the child’s own words to describe when & how began
Anatomic location general or localized
Burning/stabbing/dull/achingIntensity of pain or problemWhat increases or relieves the
pain or problemMedications, thermo therapy,
responses to treatment
Obtaining a Health HistoryBirth History
Prenatal care (onset and duration)Mother’s age and health at time of birthMother’s history of illness, injuriesMother’s impression of pregnancy (also
significant other’s impression)
Obtaining a Health History cont…Familial or Inherited Disorders
Chromosomal disorders in other family members
Height and weightDiabetesCardiovascular diseaseAsthma/ reactive airway diseaseAllergies
Prioritizing Care
Primary- ABCDE’sAirway, breathing, circulation, LOC (disability, &
exposure) A temperature too low is as serious as too high
Adaptations in Emergency Assessment S- signs and symptomsA-allergiesM-medications and immunizations (OTC and
herbal)P- prior illness or injuryL- last meal and eating habitsE- events surrounding illness/injury
Prioritizing Care cont…Secondary
VS, pain, history and head-to-toe assessment and inspection
Height/weight, diagnostic testingPsychological problemsRisk of infectionNutritional problems
Prioritizing Care cont…Tertiary
Health concerns that do no immedicately threaten the physiologic status of the child:Knowledge deficit / Patient teachingCopingHealth maintenanceActivityRest
Assessment Findings: head to toe (chapter 33)
Head (eyes, ears, hair, shape, FOC)Chest- cardiac, respiratory, excursion- shapeAbdomen- size, shape, tone Musculoskeletal- posture, tone, symmetryNeuro- reflexesSkin- including hairGenitalia- age appropriate
Quick Review:Why is it important for the nurse to
know the normal range of vital signs specific to the age of patients?
Table 33-1 page 808
How does the nurse prioritize assessment findings?Stay alert to what would cause harm…Is this an acute need? Or at risk for?How does the nurse select the
intervention?How do you evaluate the effectiveness of
the intervention?
What physical and psychosocial findings suggest abuse or neglect?
DressGrooming and personal hygienePosture and movementsBody imageSpeech and communicationFacial characteristics and expressionsPsychological state
When would the nurse notify CPS?
What are the nurse’s legal obligations
What are the nurse’s ethical obligations?
Recognize your own limitations and protect yourself. The Health Science Programs of Austin Community College
recognize the additional stressors associated with becoming a nurse.
We offer free counseling services to all students through the Student Services Department
These counselors offer confidential assistance to any student as well as test taking skills and tips
EVC- Sandra Elizondo (512) 223-5810 [email protected] RRC- Julie Reck (512) 223-0235 [email protected]
Please contact Marlene Meador RN, MSN if you have any questions or concerns
regarding this information.