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 children’s 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. 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

4. Communication strategies– infantP46 • 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”. 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 other means to illustrate dismay. handling them holding, rocking, and stroking verbalize the feeling shown by the toddler

7. Communication strategies --ToddlerP52 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 第一段 • 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– PreschoolP57 • Allowtime 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 needed.

10. School-age 〈 P62〉 • 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-ageP62 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第1段 • 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. 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

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

15. 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

16. 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

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.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

18. 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

19. 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

20. 適用於各年齡層兒的治療性遊戲P175 • Toddler • Initial approach should be made in their parents’ presence.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

21. 各年齡層兒的治療性遊戲--PreschoolP177 • 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

22. 各年齡層兒的治療性遊戲--School ageP177 nPlay begins to lose its importance in the school-age years.第1段第1行 nOften 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

23. 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

24. 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