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Frequently Asked Questions
As a new nurse working on a pediatric unit, you are unsure of communication
principles that are unique to children. What are some pointers that you can
remember to help facilitate communication with children and their families?
Remember that effective communication, whether it is with a child or with an adult,
requires sensitivity and a thoughtful plan of how to proceed. A high priority is to first
establish a trusting relationship. To develop this, you must be willing to talk, listen, take
the time, and provide honest answers. Be sure to follow through on promises, to carefully
explain and reinforce information, and to respect cultural, ethnic, and traditional factors.
Other key ideas include to address the child by name; create a quiet open environment
that promotes talking; consider family feelings, cultural views, and values; actively listen
(requires attention and effort); be attentive; be empathetic; avoid preset judgments; be
sure your message is clear; clarify when necessary; provide feedback; and be sure to
maintain professional boundaries.
What is the most important factor that influences the ability of the child to
communicate with the nurse?
The ability of the child to communicate effectively is mostly influenced by the
developmental level of the child. Communication for and with an infant occurs through
nonverbal cues. The tone, pitch, and speed of speaking accompanied by touch and body
movements generate meaning and communication. A toddler communicates by using
simple one- to two-word sentences. The toddler may use gestures or simple language to
convey wants and desires (e.g., “drink,” “potty,” “bye-bye”). The ability to communicate
becomes easier as the child develops cognitively and expressively. The pediatric nurse
should consider developmental stages when communicating with children, and adapt his
or her language and nonverbal techniques as necessary (e.g., using play, storytelling, or
puppets to convey information to the preschooler or using appropriate medical
terminology when working with the adolescent).
You have recently begun work in a busy inner-city pediatric hospital. One of your
new experiences is working with families from many different cultures. How will
your communication with these families differ from your communication with the
Caucasian families you largely worked with before?
It is important to be caring, supportive, and respectful, regardless of the client’s culture or
ethnic background. It is very important that nurses learn about cultural perspectives that
may impact communication styles and patterns. In some cultures, the oldest family
member may be the one you will focus your client teaching on, rather than the child or
child’s parents. Other considerations might include being aware of communication styles.
For example, in a Chinese culture silence is valued, nonverbal and contextual cues are
considered important, asking questions may be difficult, and touch by a nonfamily
member may be frowned upon. An African-American child or family may be distrustful
and cautious. They use nonverbal expressions a great deal and value direct eye contact.
Most important, you will need to remember that someone’s physical appearance (e.g.,
looks Vietnamese) may not mean that the person is most comfortable with the traditional
cultural methods of communication. You will need to assess the child’s and family’s
communication preferences, while at the same time acknowledging that there may be
cultural or traditional preferences.
You are working with Amelia, a 5-year-old from the Sudan. Neither Amelia, her
parents, nor her older brother speak English. Amelia has just been diagnosed with
pneumonia and will need to have a peripherally inserted central catheter (PICC)
and chest tube placed. How should you proceed in beginning to prepare Amelia and
her family for the procedures?
Working with clients who do not speak English is challenging, particularly when invasive
procedures must be performed. Legally, clients or their guardians are required to receive
education and information in their own language in order to make an informed consent.
Most facilities have certified translators who are able to translate essential information to
the client and family and provide their responses to members of the health care team. If a
translator is not available to speak the language of the client(s) you are working with, the
facility will have the phone number of a language translation service available nationally.
While beginning to organize this service, you may also begin orienting the family to the
environment and basic aspects of care in simple English and sign language.
Margaret was a client on your unit for 4 months. As her primary nurse, you cared
for her 3 to 4 times a week. In the process of discharge, her mother handed you a
lovely wrapped box. Inside was an expensive crystal vase. What is the best method
of handling this situation?
While caring for children and their families, it is important to create and maintain a
professional therapeutic relationship. Therapeutic relationships should be caring and
empathetic while avoiding emotional overinvolvement. This is often difficult when the
child and family are in your care for extended periods of time. Remember to begin your
relationship with the client and family by explaining your role in the child’s care, how
and when it will be provided, and how they can assist in the care. It can be a challenge to
not interfere with the parent-child relationship, but it is important that you as the nurse
assist the caregiver to care for and nurture the child. Also be mindful not to share
personal information. Although difficult, you will need to return the vase to Margaret’s
mother and explain that although you are unable to keep the gift, the thoughtfulness
behind it will be remembered.
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