Presented by Marlene Meador RN, MSN, CNE

Therapeutic Communication How does a nurse communicate with a patient who does not use words? Physical Proximity and environment Touch Listening Visual Communication Tone of Voice Body Language Timing

Considerations and strategies for cooperation: Remember developmental age (why is this crucial to success?) p 60 & 61 table 4.3 Honesty Involve child- speak directly to the child Involve parents when appropriate

Developmental milestones and approach to communication Infants (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, establish limits, use play, introduce preparatory materials 1-5 days in advance of the event

Barriers to Communication Language Cultural differences Distraction Stress/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 of an adult?

Adapting the physical assessment to children: Physical proximity to the child/patient Physical contact Sequence of assessment

Examination of Infants Allow parents to hold and participate Auscultate when quite Warm equipment Invasive procedures last Rectal temperatures Lab draws)

Examination of Toddlers Encourage parents to participate Introduce equipment Play Choices/control Security object

Examination of Pre-School Age Demonstrate and introduce equipment Sequence Games and play Distraction

Examination of School Age and Adolescent Provide privacy (parental presence or absence/chaperone) Choices of exam sequence Explanation of body parts and functions Reassurance of normalcy

Beginning the Examination Verify patient- National Patient Safety Goal Introduce self- explain purpose of assessment Utilize 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 data Objective data

Three types of health history Complete or initial Conception to current status Well or interim Previous well visit to current visit Problem-oriented or episodic Information related to current problem

Obtaining a history: Open-ended questioning Re-phrase rather than repeat Listen actively (reflective reply) Cultural differences Avoid judgmental questions Psychosocial data is critical to health promotion

Problem-Oriented History Characteristics Defining Variables Chief complaint and onset Body Location Quality Quantity Aggravating and alleviating Previous & current treatment Use the child’s own words to describe when & how began Anatomic location general or localized Burning/stabbing/dull/aching Intensity of pain or problem What increases or relieves the pain or problem Medications, thermo therapy, responses to treatment

Obtaining a Health History Birth History Prenatal care (onset and duration) Mother’s age and health at time of birth Mother’s history of illness, injuries Mother’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 weight Diabetes Cardiovascular disease Asthma/ reactive airway disease Allergies

Prioritizing Care Primary- ABCDE’s Airway, breathing, circulation, LOC (disability, & exposure) A temperature too low is as serious as too high

Adaptations in Emergency Assessment S- signs and symptoms A-allergies M-medications and immunizations (OTC and herbal) P- prior illness or injury L- last meal and eating habits E- events surrounding illness/injury

Prioritizing Care cont… Secondary VS, pain, history and head-to-toe assessment and inspection Height/weight, diagnostic testing Psychological problems Risk of infection Nutritional problems

Prioritizing Care cont… Tertiary Health concerns that do no immedicately threaten the physiologic status of the child: Knowledge deficit / Patient teaching Coping Health maintenance Activity Rest

Assessment Findings: head to toe (chapter 33) Head (eyes, ears, hair, shape, FOC) Chest- cardiac, respiratory, excursion- shape Abdomen- size, shape, tone Musculoskeletal- posture, tone, symmetry Neuro- reflexes Skin- including hair Genitalia- 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? Dress Grooming and personal hygiene Posture and movements Body image Speech and communication Facial characteristics and expressions Psychological 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) RRC- Julie Reck (512)

Please contact Marlene Meador RN, MSN if you have any questions or concerns regarding this information