Download Age Specific Pediatric

HealthStream Regulatory Script
[Developmentally Appropriate Care of the Pediatric Patient]
Version: [12.02.04]
Lesson 1:
Lesson 2:
Lesson 3:
Lesson 4:
Lesson 5:
Lesson 6:
Lesson 7:
Introduction
Infants
Toddlers
Preschoolers
Schoolchildren
Adolescents
Development and Assessment of Competencies
Lesson 1: Introduction
1001
Introduction
Welcome to the introductory lesson on developmentally
appropriate care of the pediatric patient.
IMAGE: 1001.JPG
As a healthcare professional, you are committed to providing
quality patient care.
One aspect of quality care is developmentally appropriate care:
treating patients with special consideration to their particular stage
of life, and the developmental challenges and milestones
associated with that stage of life.
As your partner, HealthStream strives to provide its customers with excellence in
regulatory learning solutions. As new guidelines are continually issued by regulatory
agencies, we work to update courses, as needed, in a timely manner. Since
responsibility for complying with new guidelines remains with your organization,
HealthStream encourages you to routinely check all relevant regulatory agencies
directly for the latest updates for clinical/organizational guidelines.
Point 1 of 11
2
1002
Course Rationale
This course has been designed to help ensure the age-appropriate
care of children, by providing you with information on the needs,
characteristics, and related medical care practices specific to
different stages of childhood.
IMAGE: 1002.JPG
Point 2 of 11
1003
Course Goals
After completing this course, you should be able to:
•
•
•
NO IMAGE
Define the term “competency” and explain the relationship
between age-specific competencies and developmentally
appropriate care.
Discuss needs, characteristics, and related medical care
practices for the:
• Infant
• Toddler
• Preschooler
• Schoolchild
• Adolescent
Describe how age-specific competencies are acquired and
assessed.
Point 3 of 11
1004
Course Outline
The remainder of this introductory lesson provides additional
background information on competencies, in general, and agespecific competencies, in particular. This information includes a
closer look at the importance of age-specific competencies and
developmentally appropriate care, from both a patient-care
standpoint and an accreditation standpoint.
FLASH ANIMATION: 1004.SWF/FLA
Lessons 2, 3, 4, 5, and 6 discuss the needs, characteristics, and
related medical care practices for infants, toddlers, preschoolers,
schoolchildren, and adolescents, respectively.
Finally, lesson 7 describes how age-specific competencies are
developed and assessed.
Point 4 of 11
1005
What Is a Competency?
The term “competency” refers to a set of knowledge, skills, and
abilities that allow a person to perform a specific task.
IMAGE: 1005.JPG
Employees of all sorts must develop the competencies necessary
to succeed at their jobs.
Healthcare employees, for example, must develop and
demonstrate competencies related to providing patient care.
Point 5 of 11
1006
What Are Age-Specific Competencies?
Age-specific competencies are one type of healthcare
competency.
IMAGE: 1006.JPG
When healthcare professionals develop age-specific
competencies, they are able to provide medical care appropriate
to a patient’s:
•
•
•
Chronological age
Developmental age
Maturity level
Point 6 of 11
1007
Why Develop Age-Specific Competencies?
Age-specific competencies are important:
•
•
IMAGE: 1007.JPG
To enhance your ability to provide quality patient care
To enable your facility to meet certain accreditation
requirements
Let’s take a closer look at each of these goals on the following
screens.
Point 7 of 11
1008
Importance of Age-Specific Competencies: Quality Patient Care
At each stage of life, human beings tend to exhibit certain
predictable characteristics and needs, as well as specific
developmental challenges and milestones.
IMAGE: 1008.JPG
By understanding the age-specific challenges and characteristics
of your patients, you learn to provide developmentally appropriate
care --- care more likely to meet your patients’ needs.
Important note:
Remember that each patient is an individual, with individual needs
and characteristics. Developmentally appropriate care uses age as
a guideline, but other factors should be taken into account, on a
case-by-case basis. For example, the developmentally appropriate
care of an adolescent with Downs syndrome differs from the
developmentally appropriate care of an adolescent without Downs
syndrome.
Point 8 of 11
1009
Importance of Age-Specific Competencies: JCAHO Standards
Because of the strong relationship between age-specific
competencies and quality patient care, the Joint Commission on
the Accreditation of Healthcare Organizations (JCAHO) requires
that all accredited institutions ensure the competency of staff
members.
IMAGE: 1009.JPG
Specifically, for all employees who provide patient care, the ability
to provide developmentally appropriate care must be:
•
•
Developed through education and training
Assessed [glossary] on an ongoing basis
Point 9 of 11
1010
JCAHO Standards: Assessment of Age-Specific Competencies
To be considered competent under JCAHO standards, an
employee must demonstrate knowledge of how human beings
grow and develop at different stages of life.
IMAGE: 1010.JPG
Employees also must demonstrate the following skills and abilities:
•
•
•
How to determine a patient’s status by assessing
appropriate patient data
How to identify a patient’s needs by interpreting
appropriate patient information
How to provide care appropriate to a patient’s age and
developmental needs
Note: Assessment of competencies will be discussed in greater
detail in lesson 7.
Point 10 of 11
1011
Pediatric Age Groups
As an introduction to age-specific competencies, the next five
lessons provide an overview of the characteristics, needs, and
age-specific care of pediatric patients in five groups (see table to
the right).
IMAGE: 1011.JPG
As you review the characteristics and needs of each age group in
the following lessons, keep in mind that there are no absolute rules
when it comes to age-specific information. Exceptions can and do
occur. (Remember the example of the patients with and without
Downs syndrome, presented earlier in the lesson.)
Moreover, your facility may use slightly different age groups.
Therefore, use the framework presented in this course as a
general guide to developmentally appropriate care, and consult
your supervisor for facility-specific differences.
Point 11 of 11
Lesson 2: Infants
2001
Introduction
Welcome to the lesson on the infant (birth to one year).
FLASH ANIMATION: 2001.SWF/FLA
After completing this lesson, you should be able to:
•
•
Describe the infant with respect to age-specific:
• Physical characteristics and changes
• Nutritional needs
• Psychosocial[glossary] and developmental
characteristics
• Cognitive[glossary] abilities
• Safety needs
• Pharmacological [glossary] considerations
Discuss care practices appropriate for the infant, based on
age-specific developmental challenges and milestones,
characteristics, and needs.
Point 1 of 17
2002
Physical Characteristics and Changes: Neonatal
In the hours and days immediately following birth, the infant’s
physical health is evaluated by looking for:
•
•
•
IMAGE: 2002.JPG
The presence of normal reflexes (startle, grasp, and gag
reflexes)
Good APGAR scores[glossary]
Appropriate vital signs
Point 2 of 17
2003
Physical Characteristics and Changes: Year One
Over the course of the first year of life, infants establish patterns
for physical body functions (digestion, temperature regulation,
sleeping).
IMAGE: 2003.JPG
They also develop the following physical skills and abilities:
•
•
•
•
•
•
•
•
Respond to light and sounds.
Respond to familiar faces and voices.
Raise head.
Roll over.
Bring hand to mouth.
Crawl.
Stand.
Walk alone or with help.
Point 3 of 17
2004
Physical Characteristics and Changes: Developmentally Appropriate Care
As a healthcare worker, you can help attend to the physical needs
of infants by educating parents regarding proper childcare
techniques.
IMAGE: 2004.JPG
For example, teach parents:
• How to help the infant establish regular sleeping patterns
and positions
• How to keep the infant appropriately warm
Also be sure to ask parents:
• Whether the infant’s motor skills appear to be developing
normally
• Whether they have noticed any signs of hearing or vision
problems in the infant
For infants hospitalized for extended periods, provide safe, ageappropriate toys to promote motor skills.
Point 4 of 17
2005
Nutritional Needs and Related Care
Infants grow at a rapid rate. Adequate intake of calories and
nutrients must be maintained.
IMAGE: 2005.JPG
During the first several months of life, infants should receive breast
milk or iron-fortified formula. Fluoride supplements may be
necessary.
At four to six months, strained foods may be introduced. It is best
to try one new food each week, monitoring the infant’s tolerance to
each new item.
After an infant begins to cut teeth, tooth decay can result if formula
or juice remains in contact with teeth for extended periods of time
(such as, when an infant is put to bed with a bottle).
Be certain to educate parents regarding these nutritional needs
and issues.
Point 5 of 17
2006
Psychosocial and Developmental Characteristics
Infants are entirely dependent on others for care.
IMAGE: 2006.JPG
Psychosocially, therefore, the infant faces the primary task of
developing trust in his or her caregiver and the environment.
An infant who fails to develop trust may demonstrate failure to
thrive[glossary].
Additional psychosocial and developmental characteristics of the
infant are summarized in the table on the next screen.
Point 6 of 17
2007
Psychosocial and Developmental Characteristics: Table
CUDDLING AND TOUCHING
ACTIVITIES
FINGER-SUCKING
EXPLORING WORLD THROUGH TASTE AND TOUCH
CHANGES
AND
DEVELOPMENTS
ABILITY TO DIFFERENTIATE PRIMARY CAREGIVER FROM OTHERS
(LEADING TO “STRANGER ANXIETY” [GLOSSARY])
CAREGIVERS
IMPORTANT
RELATIONSHIPS
SIBLINGS
OTHER FAMILY MEMBERS
FEARS
SEPARATION FROM PRIMARY CAREGIVER(S)
Point 7 of 17
2008
Psychosocial and Developmental Challenges: Developmentally Appropriate Care
Promote trust and healthy infant-parent bonds by encouraging
parents to hug, cuddle, and touch their infants.
IMAGE: 2008.JPG
Staff members, also, should meet the needs of infants promptly by
providing close contact.
Minimize the infant’s fear of separation by:
• Encouraging the primary caregiver(s) to participate in the
examination and treatment of the infant, as appropriate
and safe
• Keeping the primary caregiver(s) in the infant’s line of sight
at all times during examination/treatment, as appropriate
and safe
To minimize stranger anxiety, limit the number of staff members
involved in the care of each infant.
For infants hospitalized for extended periods, be certain to provide
safe, age-appropriate toys for touching and tasting.
Point 8 of 17
2009
Cognitive Abilities
Infants have limited verbal skills.
IMAGE: 2009.JPG
Initially, communication is limited to crying out of hunger or pain.
Over the course of the first year, however, most infants learn to:
•
•
Mimic sounds and/or speak a few words.
Follow simple commands.
Infants also learn to manipulate and move objects.
Learning is by imitation.
Point 9 of 17
2010
Cognitive Abilities: Developmentally Appropriate Care
Because of the limited verbal skills and cognitive abilities of the
infant, all teaching should be directed to the primary caregiver(s).
IMAGE: 2010.JPG
When educating parents, be sure to provide information on:
•
•
•
•
Preventive healthcare, including immunizations
Proper infant nutrition
The importance of caregiver-infant bonding
Safety issues for the infant, including childproofing a home
Allow caregivers time to ask questions and return-demonstrate
childcare procedures.
Point 10 of 17
2011
Safety Needs
Safety is a significant issue for infants because they:
•
•
IMAGE: 2011.JPG
Lack the mental and physical skills to keep themselves safe
Are eager to explore the world through taste and touch,
without awareness of potential consequences
Point 11 of 17
2012
Safety Needs: Developmentally Appropriate Care
Ensuring safety requires attention to the infant as well as his or her
environment:
•
•
•
•
•
•
IMAGE: 2012.JPG
Infants should be supervised at all times, unless in their crib
with the rails up or in their playpen.
Medications, small objects, and other unsafe items should
be kept out of the reach of infants at all times.
All medical equipment should be removed from the infant’s
reach after being used.
Appropriate infant car seats should be used.
For sleeping, infants should be placed on their backs and
kept warm with blankets.
Other safety precautions should be taken, such as covering
electrical outlets, removing access to cords, installing infant
gates, locking toilets, etc.
Point 12 of 17
2013
Pharmacology and Related Care
For infants, oral administration of medication is preferred.
IMAGE: 2013.JPG
Medication dosage is based on body weight.
Absorption and metabolism of medication are unpredictable.
Therefore, monitor infants closely after the administration of
medication.
Point 13 of 17
2014
Other Care Considerations
When caring for an infant, always use appropriately sized items
(blood pressure cuffs, electrodes, catheters, etc.).
IMAGE: 2014.JPG
Protect infants from infection, as the immune system is still
developing at this stage.
Allow for religious and cultural beliefs (as expressed by the infant’s
primary caregivers).
Report suspected child abuse or neglect to your supervisor
immediately.
Point 14 of 17
2015
Review
If an infant is slow to roll over, crawl, or reach other milestones of
physical development, this is a sign of a serious problem.
a. True
b. False
TRUE / FALSE INTERACTION
Correct answer: B
Feedback for A: Incorrect. Children develop at different
speeds. If an infant is slow to reach milestones of physical
development, this may not be anything to worry about.
Feedback for A: Correct. Children develop at different
speeds. If an infant is slow to reach milestones of physical
development, this may not be anything to worry about.
Point 15 of 17
2016
Review
Infants enjoy which of the following activities?
a.
b.
c.
d.
e.
Finger-sucking
Cuddling and touching
Exploring through taste and touch
All of these
None of these
MULTIPLE CHOICE INTERACTION
Correct answer: D
Feedback for A: Not quite. The correct answer is D.
Infants enjoy all of these activities.
Feedback for B: Not quite. The correct answer is D.
Infants enjoy all of these activities.
Feedback for C: Not quite. The correct answer is D.
Infants enjoy all of these activities.
Feedback for D: Correct. Infants enjoy all of these
activities.
Feedback for E: Incorrect. The correct answer is D.
Infants enjoy all of these activities.
Point 16 of 17
2017
Summary
You have completed the lesson on infants.
NO IMAGE
Remember:
•
•
•
•
•
•
•
Over the course of the first year of life, infants establish
body functions, and develop physical skills and abilities
such as responding to light and sound, rolling over,
crawling, and standing.
Infants grow at a rapid rate. Adequate intake of calories
and nutrients must be maintained.
Infants are entirely dependent on others for care and face
the primary psychosocial challenge of developing trust.
Infants have limited verbal skills, and learn by imitation.
Infants tend to put themselves in unsafe situations
because they are eager to explore, and unable to
recognize danger.
Absorption and metabolism of medication are
unpredictable in infants.
Provide developmentally appropriate care to the infant with
consideration for these age-specific characteristics.
Point 17 of 17
Lesson 3: Toddlers
3001
Introduction
Welcome to the lesson on the toddler (ages one to three).
FLASH ANIMATION: 3001.SWF/FLA
After completing this lesson, you should be able to:
•
•
Discuss the toddler with respect to age-specific:
• Physical characteristics and changes
• Nutritional needs
• Psychosocial and developmental characteristics
• Cognitive abilities
• Safety needs
• Pharmacology considerations
Describe care practices appropriate for the toddler, based
on age-specific developmental challenges and milestones,
characteristics, and needs.
Point 1 of 14
3002
Physical Characteristics, Changes, and Related Care
Toddlers develop many physical skills. Over the course of two
years, they learn to:
•
•
•
•
•
•
IMAGE: 3002.JPG
Walk, run, and climb.
Throw and drop toys.
Stack blocks.
Scribble.
Use certain fine motor skills.
Control the bladder and bowel.
Because toddlers are so active and energetic, they must be
monitored closely to ensure safety.
Point 2 of 14
3003
Nutrition Needs and Related Care
Toddlers develop tolerance for a variety of foods. They tend to like
finger foods, though they may continue to bottle/breastfeed and/or
begin to use utensils for eating.
IMAGE: 3003.JPG
As compared to infants, they require fewer calories, but more
protein. They should drink whole milk (not low-fat or nonfat) until
the age of two.
Risk of cavities increases in toddlers.
Be sure to educate primary caregivers regarding:
o
Nutritional needs of toddlers
o
Importance of dental hygiene in toddlers
Point 3 of 14
3004
Psychosocial and Developmental Characteristics
Psychosocially and developmentally, toddlers face the primary
challenge of autonomy[glossary] vs. shame and doubt.
IMAGE: 3004.JPG
As a toddler develops autonomy, he or she begins to:
• Establish a core identity.
• Depend less on the primary caregiver(s).
• Tolerate brief separation from the primary caregiver(s).
If the toddler struggles with autonomy, shame and doubt may
develop and appear in the form of:
• Low tolerance for frustration
• Lack of self-confidence
Additional psychosocial and developmental characteristics of the
toddler are summarized in the table on the following screen.
Point 4 of 14
3005
Psychosocial and Developmental Characteristics: Table
FRUSTRATION
ANGER
EMOTIONS
AND
BEHAVIORS
JEALOUSY
AFFECTION
AGGRESSION/NEGATIVITY (“TERRIBLE TWOS”)
IMPULSIVITY
IMPORTANT
RELATIONSHIPS
FEARS
PRIMARY CAREGIVER(S)
SEPARATION FROM PRIMARY CAREGIVER(S)
Point 5 of 14
3006
Psychosocial and Developmental Characteristics: Developmentally Appropriate Care
As with infants, encourage close contact between toddlers and
caregivers.
IMAGE: 3006.JPG
Also encourage caregivers to set safe rules, limits, and
boundaries, to counter the toddler’s impulsivity and lack of selfcontrol.
At the same time, support and promote the toddler’s developing
autonomy:
•
•
Whenever safe and possible, allow the toddler to make
choices related to medical procedures and examinations.
Explain all medical procedures before starting, using a
firm, direct approach, and emphasizing the aspects of the
procedure that will require the toddler’s cooperation.
To decrease separation anxiety, encourage caregivers to
participate in examination/treatment of the toddler, as safe and
appropriate.
Point 6 of 14
3007
Cognitive Abilities
Toddlers are eager learners, exploring the world through tasting,
touching, looking, listening, and smelling, and learning through
discovery and imitation.
IMAGE: 3007.JPG
Verbal skills improve, with increased vocabulary.
Toddlers understand concrete explanations and follow simple
commands, though they have short attention spans.
Time for the toddler does not extend beyond the immediate, and
space does not extend beyond what is within sight.
The toddler is able to differentiate between familiar people and
strangers.
Point 7 of 14
3008
Cognitive Abilities: Developmentally Appropriate Care
As with the infant, education of caregivers is important for the
toddler. Unlike infants, however, toddlers are able to learn about
and participate in certain aspects of their own care.
IMAGE: 3008.JPG
When educating caregivers:
• Emphasize preventive healthcare, nutrition, and safety.
• Allow time for questions and return-demonstration of
childcare procedures.
When teaching or instructing the toddler:
• Keep all explanations short, simple, and concrete.
• Give one direction at a time, using vocabulary that the
toddler can understand.
• Use puppets, dolls, and storybooks to help explain medical
procedures, and decrease anxiety.
• Use praise to encourage correct behavior.
Point 8 of 14
3009
Safety Needs and Related Care
Toddlers are exploratory, impulsive, and energetic. Like infants,
they are unable to recognize danger. For all these reasons, they
are likely to end up in unsafe situations, if not monitored closely.
IMAGE: 3009.JPG
Even with careful monitoring, accidents and injuries may occur as
autonomy increases.
Because toddlers explore through taste, choking and poisoning are
threats. All of the following should be kept out of reach:
• Medications
• Small objects
• Chemicals
• Cleansers
Point 9 of 14
3010
Pharmacology and Related Care
As with infants, absorption and metabolism of medication can be
unpredictable in toddlers. Therefore, carefully monitor the effects of
all medications.
IMAGE: 3010.JPG
Oral medication is preferable.
Medication dosage is based on body weight.
Point 10 of 14
3011
Other Care Considerations
When caring for a toddler, use distraction to take the focus off of
pain or medical procedures.
IMAGE: 3011.JPG
Use an appropriate pediatric pain assessment scale if the toddler
is in pain.
Plan procedures in advance to minimize the toddler’s waiting time.
Other care considerations are similar to those seen with the infant:
• Use medical items/accessories of an appropriate size.
• Report suspected abuse or neglect to your supervisor
immediately.
• Allow for religious and cultural beliefs (as expressed by the
toddler’s primary caregivers).
Point 11 of 14
3012
Review
Regarding psychosocial development of the toddler, which of the
following statements is (are) true?
MULTIPLE CHOICE INTERACTION
Correct answer: D
a. Healthcare workers should support and promote the
toddler’s developing autonomy.
b. Caregivers must set safe rules, limits, and boundaries for
the toddler, to counter the toddler’s impulsivity and lack of
self-control.
c. Whenever possible and appropriate, the toddler should be
allowed to make choices related to medical procedures
and examinations.
d. All of these are true.
e. None of these is true.
Feedback for A: Not quite. The correct answer is D. All of these
are true. Rules, limits, and boundaries are necessary to counter
the toddler’s impulsivity and lack of self-control. At the same time,
however, it is important to support and promote the toddler’s
developing autonomy -- for example, by allowing the toddler to
make choices whenever possible and appropriate.
Feedback for B: Not quite. The correct answer is D. All of these
are true. Rules, limits, and boundaries are necessary to counter
the toddler’s impulsivity and lack of self-control. At the same time,
however, it is important to support and promote the toddler’s
developing autonomy -- for example, by allowing the toddler to
make choices whenever possible and appropriate.
Feedback for C: Not quite. The correct answer is D. All of these
are true. Rules, limits, and boundaries are necessary to counter
the toddler’s impulsivity and lack of self-control. At the same time,
however, it is important to support and promote the toddler’s
developing autonomy -- for example, by allowing the toddler to
make choices whenever possible and appropriate.
Feedback for D: Correct. All of these are true. Rules, limits, and
boundaries are necessary to counter the toddler’s impulsivity and
lack of self-control. At the same time, however, it is important to
support and promote the toddler’s developing autonomy -- for
example, by allowing the toddler to make choices whenever
possible and appropriate.
Feedback for E: Incorrect. The correct answer is D. All of these
are true. Rules, limits, and boundaries are necessary to counter
the toddler’s impulsivity and lack of self-control. At the same time,
however, it is important to support and promote the toddler’s
developing autonomy -- for example, by allowing the toddler to
make choices whenever possible and appropriate.
Point 12 of 14
3013
Review
FLASH INTERACTION: 3013.SWF/FLA
When caring for a toddler, it is important to educate his or her
primary caregiver(s). At the same time, however, toddlers are able
to learn about and participate in certain aspects of their own care.
Feedback:
When teaching or instructing a toddler:
What are some of the guidelines for communication that can help
you teach a toddler most effectively?
•
•
Type your thoughts in the box below, then click Submit to compare
your answer to ours.
•
•
Keep all explanations short, simple, and concrete.
Give one direction at a time, using vocabulary that
the toddler can understand.
Use puppets, dolls, and storybooks to help explain
medical procedures, and decrease anxiety.
Use praise to encourage correct behavior.
Point 13 of 14
3014
Summary
You have completed the lesson on toddlers.
NO IMAGE
Remember:
•
•
•
•
•
•
•
Toddlers develop many physical skills, such as the ability
to walk, run, climb, stack blocks, and scribble.
Toddlers develop tolerance for a variety of foods, though
they tend to prefer finger foods.
The toddler faces the primary psychosocial challenge of
autonomy vs. shame and doubt.
Toddlers are eager learners, though they have short
attention spans.
Safety issues for toddlers arise because children in this
age group are exploratory, impulsive, energetic, and
unable to recognize danger.
Absorption and metabolism of medication can be
unpredictable in toddlers.
Provide developmentally appropriate care to toddlers with
consideration for these age-specific characteristics.
Point 14 of 14
Lesson 4: Preschoolers
4001
Introduction
Welcome to the lesson on the preschooler (ages three to five).
FLASH ANIMATION: 4001.SWF/FLA
After completing this lesson, you should be able to:
•
•
Discuss the preschool patient with respect to age-specific:
• Physical characteristics and changes
• Nutritional needs
• Psychosocial and developmental characteristics
• Cognitive abilities
• Safety needs
• Pharmacological considerations
Describe care practices appropriate for the preschooler,
based on age-specific developmental challenges and
milestones, characteristics, and needs.
Point 1 of 15
4002
Physical Characteristics, Changes, and Related Care
Preschoolers gain in fine motor skills and coordination.
IMAGE: 4002.JPG
They develop the ability to:
•
•
•
•
•
Walk on tiptoe.
Stand on one foot.
Hop.
Dress themselves.
Feed themselves.
Recognize and encourage the physical accomplishments of the
preschooler.
Point 2 of 15
4003
Nutritional Needs and Related Care
Preschoolers begin to develop food likes and dislikes, and may be
allowed to make some food choices.
IMAGE: 4003.JPG
Promote good nutrition by encouraging healthy choices.
Point 3 of 15
4004
Psychosocial and Developmental Characteristics
Psychosocially and developmentally, preschoolers face the
primary challenge of initiative [glossary] vs. guilt.
IMAGE: 4004.JPG
Preschoolers who develop initiative gain in:
• Self-confidence
• The ability to act with direction and purpose
Guilt may appear in the form of:
• Fear of punishment
• Limited ability to act with purpose and direction
Additional psychosocial and developmental characteristics of the
preschooler are summarized in the table on the following screen.
Point 4 of 15
4005
Psychosocial and Developmental Characteristics: Table
TOLERANCE FOR SEPARATION FROM PRIMARY CAREGIVER(S)
CHANGES
AND
DEVELOPMENTS
INCREASED INDEPENDENCE
INCREASED AWARENESS OF SELF VS. OTHERS
INCREASED AWARENESS OF OTHERS’ FEELINGS
BETTER IMPULSE CONTROL
PEER-GROUP SOCIALIZATION AND PLAY
ACTIVITIES
AND
INTERESTS
IMPORTANT
RELATIONSHIPS
RITUALS AND ROUTINES
INTEREST IN SEXUAL DIFFERENCES
FAMILY
UNKNOWN
DARK
FEARS
BEING ALONE
NIGHTMARES
INJURY
Point 5 of 15
4006
Psychosocial and Developmental Challenges: Developmentally Appropriate Care (1)
Because of the fear of bodily injury and mutilation, injury and
disease can be very upsetting to a preschool child.
IMAGE: 4006.JPG
To help decrease fear and anxiety, provide accurate, ageappropriate information to the preschooler:
•
•
•
•
Explain healthcare issues clearly.
Before starting any procedure, explain what you are going
to do, firmly and directly.
Be honest if a procedure will hurt, but explain that it will not
hurt for long.
Use toys, games, puppets, dolls, and/or storybooks to help
teach and reassure the child.
Also, use talking, singing, and other distractions to divert attention
from frightening procedures.
Point 6 of 15
4007
Psychosocial and Developmental Challenges: Developmentally Appropriate Care (2)
Although the preschooler has better impulse control than the
toddler, caregivers and healthcare workers still must establish
clear boundaries, limits, and rules for the preschooler. Appropriate
behavior should be rewarded with praise.
IMAGE: 4007.JPG
Within safe limits, promote the preschooler’s growing
independence and initiative by allowing choices. Allow the
preschooler to control his or her hospital environment as much as
possible.
Encourage preschoolers to:
•
•
•
Ask questions and communicate openly.
Talk about their feelings and fears.
Play with other children, to continue to develop social skills
and independence.
To the extent possible in the hospital environment, allow the
preschooler to maintain comforting routines.
Point 7 of 15
4008
Cognitive Abilities
Preschoolers learn through exploration, discovery, and asking
questions (the “why” phase).
IMAGE: 4008.JPG
Verbal skills improve dramatically:
• Speech becomes more intelligible.
• Vocabulary increases to approximately 1000 words.
• Sentences of four to six words are common.
Other cognitive advances for the preschooler include the ability to:
• Reason logically.
• Use abstract thought.
• Distinguish between right and wrong.
• Maintain attention for longer periods.
• Learn from and tell stories.
• Learn and remember home address and phone number.
Imagination also increases during this stage.
Point 8 of 15
4009
Cognitive Abilities: Developmentally Appropriate Care
As the level of cognition increases, it is possible to provide the
preschooler with increasingly detailed healthcare information:
• Explain unfamiliar objects.
• Use correct terminology.
IMAGE: 4009.JPG
Although the preschooler understands more and more, caregiver
education also remains important. When teaching caregivers,
continue to emphasize:
• Preventive care, such as regular checkup and
immunizations
• Nutrition
• Parenting skills
• Safety issues
Allow time for both preschoolers and their caregivers to ask
questions and return-demonstrate procedures.
Point 9 of 15
4010
Safety Needs and Related Care
Preschoolers grow increasingly active and independent, but still
have a limited ability to recognize danger.
IMAGE: 4010.JPG
Therefore, preschoolers, like toddlers, require close supervision.
Both preschoolers and their caregivers should be reminded of
safety issues and safety habits. Encourage caregivers to promote
good safety habits.
Important safety issues and habits to discuss include:
• Use of safety equipment such as bike helmets and
skateboarding pads
• Match and fire safety
• Pool safety
• Car safety (e.g., looking both ways before crossing a
street)
• Use of car safety seats or seatbelts
Point 10 of 15
4011
Pharmacological Needs and Related Care
For preschoolers, the oral route of administration is preferred.
IMAGE: 4011.JPG
Medication dosage is based on body weight.
Keep all medications out of the reach of preschoolers.
Point 11 of 15
4012
Other Care Considerations
Additional considerations for the care of the preschooler are similar
to those seen with the infant and toddler:
•
•
•
•
•
•
IMAGE: 4012.JPG
Promote close contact between the preschooler and his or
her primary caregiver(s).
Promote caregiver participation in medical procedures and
examinations.
Plan procedures in advance to minimize the preschooler’s
waiting time.
Use medical items/accessories of an appropriate size.
Reported suspected abuse or neglect to your supervisor
immediately.
Allow for religious and cultural beliefs (as expressed by the
preschooler’s primary caregivers).
Point 12 of 15
4013
Review
The preschooler’s greatest fear is separation from his or her
primary caregiver(s).
a. True
b. False
TRUE / FALSE INTERACTION
Correct answer: B
Feedback for A: Incorrect. Separation from the primary
caregiver is the greatest fear for infants and toddlers. The
preschooler’s greatest fears are: the unknown, the dark,
being alone, nightmares, and bodily injury/mutilation.
Feedback for B: Correct. Separation from the primary
caregiver is the greatest fear for infants and toddlers. The
preschooler’s greatest fears are: the unknown, the dark,
being alone, nightmares, and bodily injury/mutilation.
Point 13 of 15
4014
Review
When educating the preschool patient, all of the following are best
practices EXCEPT:
a.
b.
c.
d.
Explain unfamiliar objects.
Allow time for the preschooler to ask questions.
Have the preschooler return-demonstrate procedures.
Use easily understood “nicknames” for body parts, medical
equipment, and procedures.
MULTIPLE CHOICE INTERACTION
Correct answer: B
Feedback for A: Incorrect. A, C, and D all are best
practices. The correct answer is B. When educating a
preschooler, use correct terminology.
Feedback for B: Incorrect. A, C, and D all are best
practices. The correct answer is B. When educating a
preschooler, use correct terminology.
Feedback for C: Incorrect. A, C, and D all are best
practices. The correct answer is B. When educating a
preschooler, use correct terminology.
Feedback for D: Correct. When educating a preschooler,
use correct terminology.
Point 14 of 15
4015
Summary
You have completed the lesson on preschoolers.
NO IMAGE
Remember:
•
•
•
•
•
•
Preschoolers gain in fine motor skills and coordination,
developing the ability to walk on tiptoe, stand on one foot,
hop, and dress and feed themselves.
Preschoolers begin to develop food likes and dislikes.
Preschoolers face the primary psychosocial challenge of
initiative vs. guilt.
Preschoolers learn through exploration, discovery, and
asking questions. Cognitive advances include the ability to
reason logically and use abstract thought.
Safety is an issue for preschoolers, as they grow
increasingly active and independent, but still have a limited
ability to recognize danger.
Provide developmentally appropriate care to the
preschooler with consideration for these age-specific
characteristics.
Point 15 of 15
Lesson 5: Schoolchildren
5001
Introduction
Welcome to the lesson on schoolchildren (ages five to twelve).
FLASH ANIMATION: 5001.SWF/FLA
After completing this lesson, you should be able to:
•
•
Describe the schoolchild with respect to age-specific:
• Physical characteristics and changes
• Nutritional needs
• Psychosocial and developmental characteristics
• Cognitive abilities
• Safety needs
• Pharmacological considerations
Discuss care practices appropriate for the schoolchild,
based on age-specific developmental challenges and
milestones, characteristics, and needs.
Point 1 of 16
5002
Physical Characteristics and Changes
Schoolchildren grow relatively slowly until a spurt at puberty.
Note: The onset of puberty varies widely and, in many pediatric
patients, may not occur until the adolescent stage.
IMAGE: 5002.JPG
Schoolchildren are very active, and increase in:
•
•
•
Neuromuscular [glossary] skills
Balance
Muscular strength
Point 2 of 16
5003
Physical Characteristics and Changes: Developmentally Appropriate Care
For schoolchildren who enter puberty, provide reassurance that:
•
•
IMAGE: 5003.JPG
The physical changes they are experiencing are normal.
Clumsy and awkward sensations will resolve when growth
slows.
Respond honestly to any questions about secondary sexual
characteristics.
Point 3 of 16
5004
Nutritional Needs and Related Care
Schoolchildren tend to prefer fast food and eating with friends.
IMAGE: 5004.JPG
Remind schoolchildren of the principles of proper nutrition, and
encourage healthy food choices.
Point 4 of 16
5005
Psychosocial and Developmental Characteristics
Psychosocially, the schoolchild faces the primary developmental
task of industry[glossary] vs. inferiority.
IMAGE: 5005.JPG
Children who succeed in developing industry tend to display:
• Competency
• Achievement
• Self-confidence
Those who fail to develop industry display signs of inferiority:
• Feelings of inadequacy
• Fear of not meeting the expectations of others
Additional psychosocial and developmental characteristics of the
schoolchild are summarized in the table on the following screen.
Point 5 of 16
5006
Psychosocial and Developmental Characteristics: Table
HOUSEHOLD CHORES
ACTIVITIES
SCHOOLWORK
AND
BEHAVIORS
MORAL AND ETHICAL BEHAVIOR
GENDER-SPECIFIC THOUGHT AND ACTION
INDEPENDENCE FROM PARENTS
CHALLENGES
DEPENDENCE ON SELF
IMPORTANT
RELATIONSHIPS
PEERS
LOSING CONTROL
FEARS
NOT MEETING EXPECTATIONS
Point 6 of 16
5007
Psychosocial and Developmental Challenges: Developmentally Appropriate Care
Help promote the schoolchild’s growing independence, selfesteem, and sense of control and competence by:
• Providing opportunities for decision-making and self-care
• Encouraging questions and verbalization of feelings
• Recognizing the need for privacy (while also supporting
the family unit)
• Recognizing the child’s achievements
IMAGE: 5007.JPG
Especially during long periods of hospitalization:
• Provide for schooling.
• Encourage peer contact.
Point 7 of 16
5008
Cognitive Abilities
Schoolchildren are avid learners who love to share their
knowledge.
IMAGE: 5008.JPG
Cognitive developments include the ability to:
•
•
•
•
•
•
Use logic and deductive reasoning to arrive at
conclusions.
Understand cause-and-effect.
Recognize the existence of past and future.
Understand death and its finality.
Read and write.
Use math skills.
Schoolchildren still have limited understanding of anatomy, bodily
functions, and illness.
Point 8 of 16
5009
Cognitive Abilities: Developmentally Appropriate Care
As level of cognition increases, provide the schoolchild with more
detailed healthcare information:
• Explain medical procedures in straightforward terms, using
correct terminology.
• Allow the schoolchild to explore medical equipment ahead
of time.
IMAGE: 5009.JPG
When educating schoolchildren:
• Consider the child’s attention span.
• Use rewards and praise.
• Provide privacy, if necessary.
Point 9 of 16
5010
Safety Needs
Safety issues for the schoolchild are related to:
•
•
•
•
•
IMAGE: 5010.JPG
Peer pressure
Substance abuse
Sexuality
Conflict resolution
Preventive healthcare
Point 10 of 16
5011
Safety Needs: Developmentally Appropriate Care
Be aware that peer pressure may lead to poor choices for
schoolchildren.
IMAGE: 5011.JPG
Guide the schoolchild toward healthy choices by discussing and
providing accurate information regarding:
• Exercise
• Nutrition
• Safety habits such as wearing a seatbelt
• Smoking
• Drug and alcohol use
• Sexuality
Help caregivers learn to discuss these issues with their children, as
well.
Help schoolchildren learn to resolve conflict peacefully.
Finally, emphasize the importance of ongoing preventive
healthcare:
• Regular checkups
• Immunizations on schedule
Point 11 of 16
5012
Pharmacology and Related Care
For schoolchildren, oral administration of medication is preferred.
IMAGE: 5012.JPG
Adult dosages based on body weight are used.
Keep all medications and medical equipment out of the reach of
schoolchildren.
Point 12 of 16
5013
Other Care Considerations
Additional considerations for the care of the schoolchild include:
•
•
•
IMAGE: 5013.JPG
Plan procedures in advance to minimize the child’s waiting
time.
Reported suspected abuse or neglect to your supervisor
immediately.
Allow for expression of religious and cultural beliefs.
Point 13 of 16
5014
Review
FLASH INTERACTION: 5014.SWF/FLA
As avid learners who love to share their knowledge, schoolchildren
make many cognitive advances.
What are some of these advances? Type your thoughts in the box
below, then click Submit to compare your answer to ours.
Feedback:
Cognitive developments of the schoolchild include the
ability to:
• Use logic and deductive reasoning to arrive at
conclusions.
• Understand cause-and-effect.
• Recognize the existence of past and future.
• Understand death and its finality.
• Read and write.
• Use math skills.
Point 14 of 16
5015
Review
Safety issues for the schoolchild are related to:
a.
b.
c.
d.
e.
Impulsivity
Peer pressure
Inability to recognize danger
All of these
None of these
MULTIPLE CHOICE INTERACTION
Correct answer: C
Feedback for A: Incorrect. Inability to recognize danger
contributes to safety issues for infants, toddlers, and
preschoolers. Impulsivity is a concern for toddlers and
preschoolers. For the schoolchild, safety issues are related to
peer pressure, as well as substance abuse, sexuality, conflict
resolution, and preventive healthcare.
Feedback for B: Correct. Inability to recognize danger contributes
to safety issues for infants, toddlers, and preschoolers. Impulsivity
is a concern for toddlers and preschoolers. For the schoolchild,
safety issues are related to peer pressure, as well as substance
abuse, sexuality, conflict resolution, and preventive healthcare.
Feedback for C: Incorrect. Inability to recognize danger
contributes to safety issues for infants, toddlers, and
preschoolers. Impulsivity is a concern for toddlers and
preschoolers. For the schoolchild, safety issues are related to
peer pressure, as well as substance abuse, sexuality, conflict
resolution, and preventive healthcare.
Feedback for D: Incorrect. Inability to recognize danger
contributes to safety issues for infants, toddlers, and
preschoolers. Impulsivity is a concern for toddlers and
preschoolers. For the schoolchild, safety issues are related to
peer pressure, as well as substance abuse, sexuality, conflict
resolution, and preventive healthcare.
Feedback for E: Incorrect. Inability to recognize danger
contributes to safety issues for infants, toddlers, and
preschoolers. Impulsivity is a concern for toddlers and
preschoolers. For the schoolchild, safety issues are related to
peer pressure, as well as substance abuse, sexuality, conflict
resolution, and preventive healthcare.
Point 15 of 16
5016
Summary
You have completed the lesson on schoolchildren.
NO IMAGE
Remember:
•
•
•
•
•
•
•
Schoolchildren grow relatively slowly until a spurt at
puberty.
Schoolchildren are very active, and make gains in
neuromuscular skills, balance, and muscular strength.
Schoolchildren tend to prefer fast food and eating with
friends.
The schoolchild faces the primary psychosocial task of
industry vs. inferiority.
Schoolchildren are avid learners who love to share their
knowledge.
Safety issues for the schoolchild are related to peer
pressure, substance abuse, sexuality, conflict resolution,
and preventive healthcare.
Provide developmentally appropriate care to the
schoolchild with consideration for these age-specific
characteristics.
Point 16 of 16
Lesson 6: Adolescents
6001
Introduction
Welcome to the lesson on the adolescent (ages 12 to 18).
FLASH ANIMATION: 6001.SWF/FLA
After completing this lesson, you should be able to:
•
•
Describe the adolescent with respect to age-specific:
• Physical characteristics and changes
• Nutritional needs
• Psychosocial and developmental characteristics
• Cognitive abilities
• Safety needs
Discuss care practices appropriate for the adolescent,
based on age-specific developmental challenges and
milestones, characteristics, and needs.
Point 1 of 16
6002
Physical Characteristics and Changes
Adolescents experience dramatic physical change:
•
•
•
IMAGE: 6002.JPG
Rapid increase in height
Development of primary and secondary sexual
characteristics
Development of body hair and facial blemishes
Point 2 of 16
6003
Physical Characteristics and Changes: Developmentally Appropriate Care
Adolescents are often critical, self-conscious, and confused about
their physical appearance and bodily changes.
NO IMAGE
Be sensitive to this issue when caring for the adolescent patient:
• Reassure patients regarding the normality of physical
changes and the variability in timing of these changes.
• Allow for privacy.
Teach:
• Breast self-exam for adolescent females.
• Testicular self-exam for adolescent males.
Point 3 of 16
6004
Nutritional Needs
Because of their rapid growth and physical/sexual development,
adolescents have increased need for:
• Calories
• Protein
• Calcium
• Iodine
• Iron
• B-complex vitamins
IMAGE: 6004.JPG
Many teens, however, do not get the nutrients they need, due to
factors such as:
• Eating a lot of fast food
• Dieting
• Snacking rather than eating balanced meals
Point 4 of 16
6005
Nutritional Needs: Developmentally Appropriate Care
To help improve the nutritional status of adolescent patients in your
care:
• Provide accurate information about nutrition.
• Encourage healthy food choices.
• Discourage food fads and fad diets.
IMAGE: 6005.GIF
In addition, be sure to screen adolescents for nutritional disorders:
• Obesity
• Anorexia
• Bulimia
Point 5 of 16
6006
Psychosocial and Developmental Characteristics
Psychosocially, the adolescent faces the primary challenge of
identity formation vs. role confusion.
IMAGE: 6006.JPG
Adolescents who achieve identity formation display:
• A strong sense of self
• Devotion to their duties and obligations
• A tendency to keep their word
Adolescents who struggle to form an identity may display role
confusion:
• Poor sense of self
• Poor concept of their sexuality
Additional psychosocial and developmental characteristics of the
adolescent are summarized in the table on the following screen.
Point 6 of 16
6007
Psychosocial and Developmental Characteristics: Table
INTERNAL: DESIRE FOR BOTH INDEPENDENCE AND DEPENDENCE
CONFLICTS
EXTERNAL: REBELLION AGAINST AUTHORITY
MOOD SWINGS
EMOTIONS
AND
BEHAVIOR
ANGER
OUTBURSTS
PEERS
IMPORTANT
RELATIONSHIPS
OPPOSITE SEX
PERSONAL APPEARANCE
FEARS
NOT BEING ACCEPTED
POOR SCHOOL PERFORMANCE
Point 7 of 16
6008
Psychosocial and Developmental Challenges: Developmentally Appropriate Care (1)
When caring for an adolescent, recognize and respect the need for
independence and self-determination:
•
•
•
•
•
IMAGE: 6008.JPG
Treat the adolescent patient as an adult and avoid
authoritarian[glossary] approaches.
Communicate directly with the adolescent. Avoid
communicating through the adolescent’s parents.
Encourage self-care and decision-making on the part of
the patient.
Demonstrate acceptance, allowing for personal values and
any religious or cultural beliefs.
Be prepared to deal with resistance and rebellion that may
affect the patient’s compliance with the recommended
medical regimen.
Point 8 of 16
6009
Psychosocial and Developmental Challenges: Developmentally Appropriate Care (2)
Be aware that the adolescent patient may find
hospitalization/treatment threatening:
• Hospitalization may threaten the patient’s evolving selfidentity.
• Separation from peers may cause concern.
• The patient may fear that treatment will affect his or her
appearance and relationships --- very sensitive issues at
this age.
IMAGE: 6009.JPG
To help reassure the patient:
• Encourage peer contact during hospitalization.
• Encourage questions and verbalization of fears.
Point 9 of 16
6010
Cognitive Abilities and Related Care
Adolescents have fully developed cognitive abilities, including:
• Logical thought
• Abstract thought
• Deductive reasoning
• Analytical reasoning
IMAGE: 6010.JPG
Adolescents:
• Consider many options when solving problems.
• Understand hypothetical situations.
• Form independent decisions.
Respect the cognitive abilities of adolescents by explaining all
medical procedures, including the reason for each.
Point 10 of 16
6011
Safety Needs
Safety issues for adolescents are related to:
•
•
•
•
•
IMAGE: 6011.JPG
Peer pressure
Risk-taking behaviors
Substance abuse
Sexual activity
Relatively high rates of depression and suicide
Point 11 of 16
6012
Safety Needs: Developmentally Appropriate Care (1)
Be aware that peer pressure may lead to poor choices for
adolescents.
IMAGE: 6012.JPG
Guide the adolescent toward healthy choices by discussing and
providing accurate information regarding:
• Risk-taking (for example, reckless driving or participating in
risky sports)
• Smoking
• Drug and alcohol use
• Sexuality
With regard to sexuality, in particular:
• Correct any misinformation from peers.
• Teach and encourage sexual responsibility.
• Monitor for sexually transmitted diseases and pregnancy.
Point 12 of 16
6013
Safety Needs: Developmentally Appropriate Care (2)
To help guard against the dangers of depression:
•
•
IMAGE: 6013.JPG
Screen adolescent patients for depression.
Encourage the use of stress-reduction techniques.
Point 13 of 16
6014
Review
With regard to their physical appearance and bodily changes,
adolescents tend to be:
a.
b.
c.
d.
Unaware
Indifferent
Pleased and proud
Critical and self-conscious
MULTIPLE CHOICE INTERACTION
Correct answer: C
Feedback for A: Incorrect. Adolescents tend to be critical,
self-conscious, and confused about their physical
appearance and bodily changes. It is important to be
sensitive to this issue when caring for the adolescent
patient.
Feedback for B: Incorrect. Adolescents tend to be critical,
self-conscious, and confused about their physical
appearance and bodily changes. It is important to be
sensitive to this issue when caring for the adolescent
patient.
Feedback for C: Incorrect. Adolescents tend to be critical,
self-conscious, and confused about their physical
appearance and bodily changes. It is important to be
sensitive to this issue when caring for the adolescent
patient.
Feedback for D: Correct. Adolescents tend to be critical,
self-conscious, and confused about their physical
appearance and bodily changes. It is important to be
sensitive to this issue when caring for the adolescent
patient.
Point 14 of 16
6015
Review
When caring for an adolescent patient, treat the patient as an adult
and avoid authoritarian approaches.
a. True
b. False
TRUE / FALSE INTERACTION
Correct answer: A
Feedback for A: Correct. When caring for an adolescent, it
is important to recognize and respect the need for
independence and self-determination. One way of doing
this is to treat the patient as an adult and avoid
authoritarian approaches.
Feedback for B: Incorrect. When caring for an adolescent,
it is important to recognize and respect the need for
independence and self-determination. One way of doing
this is to treat the patient as an adult and avoid
authoritarian approaches.
Point 15 of 16
6016
Summary
You have completed the lesson on adolescents.
NO IMAGE
Remember:
•
•
•
•
•
•
Adolescents experience dramatic physical and sexual
change and development.
Adolescents have an increased need for calories and
nutrients, but often do not meet this need, for a variety of
reasons.
The adolescent faces the primary psychosocial challenge
of identity formation vs. role confusion.
Adolescents have fully developed cognitive abilities.
Safety issues for adolescents are related to peer pressure,
risk-taking behaviors, substance abuse, sexual activity,
and relatively high rates of depression and suicide.
Provide developmentally appropriate care to the
adolescent with consideration for these age-specific
characteristics.
Point 16 of 16
Lesson 7: Development and Assessment of Competencies
7001
Introduction
Welcome to the lesson on development and assessment of agespecific competencies.
FLASH ANIMATION: 7001.SWF/FLA
After completing this lesson, you should be able to:
•
•
•
List the responsibilities of your facility with regard to agespecific competencies.
Find documentation of the age-specific competencies used
in your facility.
Describe various methods used to assess age-specific
competencies.
Point 1 of 9
7002
Facility Responsibilities
Your facility has three primary responsibilities for helping
employees develop age-specific competencies:
FLASH ANIMATION: 7002.SWF/FLA
1. Defining relevant competencies
2. Educating and training staff members in relevant
competencies
3. Assessing employee competencies
Let’s take a closer look at each responsibility.
Point 2 of 9
7003
Defining Age-Specific Competencies
Each healthcare facility is responsible for defining the exact
competencies to be achieved by its employees.
FLASH ANIMATION: 7003.SWF/FLA
Exact definitions are important so that all employees have a clear
idea of the knowledge and skills they need to provide quality,
developmentally appropriate care.
With regard to exact definitions, remember that the age-specific
needs and characteristics presented in this course provide a useful
framework and general guidelines for treating patients in a
developmentally appropriate manner.
The competencies defined by your facility, however, may differ
slightly from those presented in the previous five lessons.
Point 3 of 9
7004
Defining Age-Specific Competencies: Documentation
You are likely to find the age-specific competencies for your facility
documented in one or more of the following places:
•
•
•
•
•
•
FLASH ANIMATION: 7003.SWF/FLA
Position or job descriptions
Addenda to position or job descriptions
Unit or departmental policies
Departmental scope-of-service documents
Peer review standards
Contracts between employer and provider groups
If necessary, ask your supervisor where to find documentation of
the age-specific competencies that have been established by your
department or facility.
Point 4 of 9
7005
Education
Defining competencies is not enough.
FLASH ANIMATION: 7005.SWF/FLA
To help you acquire necessary competencies, your facility should
offer some or all of the following:
•
•
•
•
•
Orientation programs
In-services
Videos and other self-learning materials
Computer-based programs
Hospital-wide education programs
All education should be appropriately documented in your
employee record.
Point 5 of 9
7006
Assessment
In addition to educating and training employees, your facility is
responsible for assessing age-specific competencies, using
specific, measurable criteria.
FLASH ANIMATION: 7006.SWF/FLA
Point 6 of 9
7007
Assessment: Methods
Assessment methods may include:
•
•
•
•
•
Direct observation
Return demonstration
Medical record review
Peer evaluation
Patient satisfaction survey
Click on each method to learn more.
CLICK TO REVEAL
In direct observation, a supervisor watches as a staff
member provides care or services to a patient of a
particular age group. The supervisor then documents
whether or not care was provided in a manner appropriate
for the patient’s age.
In return demonstration, a staff member first observes as
a supervisor teaches the proper way to care for a patient in
a particular age group. The staff member then “returndemonstrates” the care procedure, showing that he or she
has acquired the relevant age-specific competency.
In medical record review, a supervisor checks the
medical records of various patients, taking note of whether
or not care was provided in a manner appropriate for each
patient’s age.
In peer evaluation, coworkers assess the knowledge and
ability of a staff member. Peer evaluation can provide
valuable assessment data, as coworkers are in the best
position to view one another’s performance on an ongoing
basis.
Surveys can provide information regarding patient
perceptions of the quality of age-specific care.
Point 7 of 9
7008
Review
When assessing age-specific competencies using the direct
observation method, a supervisor watches as a staff member
provides care or services to a patient of a particular age group.
a. True
b. False
TRUE / FALSE INTERACTION
Correct answer: A
Feedback for A: Correct. In direct observation, a supervisor
watches as a staff member provides care or services to a
patient of a particular age group. The supervisor then
documents whether or not care was provided in a manner
appropriate for the patient’s age.
Feedback for B: Incorrect. This statement is true. In direct
observation, a supervisor watches as a staff member
provides care or services to a patient of a particular age
group. The supervisor then documents whether or not care
was provided in a manner appropriate for the patient’s age.
Point 8 of 9
7009
Summary
You have completed the lesson on development of age-specific
competencies.
NO IMAGE
Remember:
•
•
•
•
Your facility is responsible for defining age-specific
competencies, so that all employees have a clear idea of
the knowledge and skills they need to provide ageappropriate care.
Age-specific competencies may be documented in a
variety of places. Ask your supervisor for more information.
Your facility is responsible for providing education and
training in age-specific competencies, and for documenting
that training.
Your facility is responsible for assessing age-specific
competencies, using methods such as direct observation,
return demonstration, medical record review, peer
evaluation, or patient satisfaction surveys.
Point 9 of 9
[Developmentally Appropriate Care of the Pediatric Patient]
Course Glossary
#
Term
assess
Definition
to judge
psychosocial
cognitive
APGAR score
failure to thrive
involving both psychological and social aspects
relating to mental processes
autonomy
initiative
industry
pharmacological
neuromuscular
independence or freedom
numbered score used to assess a baby's physical state at the time of birth
description applied to children whose current weight or rate of weight gain is significantly
below that of other children of similar age and sex
ability or readiness to begin a series of behaviors directed toward a goal
determination to perform a task
related to or involving the use of drugs
pertaining to the nerves and muscles
[Developmentally Appropriate Care of the Pediatric Patient]
Pre-Assessment
1. The term “competency” refers to a set of knowledge, skills, and abilities that allow a person to perform a specific task.
a. True
b. False
Correct answer: A
Rationale: This is an accurate definition of competency.
2. When age-specific competencies are assessed for JCAHO purposes, employees must demonstrate the ability to:
a. Determine a patient’s status by assessing appropriate patient data.
b. Identify an individual patient’s needs by interpreting appropriate patient information.
c. Provide care appropriate to a patient’s age and developmental needs.
d. All of these abilities must be demonstrated.
e. None of these abilities must be demonstrated.
Correct answer: D
Rationale: To be considered competent under JCAHO standards, an employee must demonstrate all of these abilities, plus knowledge of how
human beings grow and develop at different stages of life.
3. All children within a given age group have identical needs and characteristics.
a. True
b. False
Correct answer: B
Rationale: At each stage of life, human beings tend to exhibit certain predictable characteristics and needs. Age-specific characteristics, however,
are never absolutes. They are simply reliable guidelines to consider when providing care to patients of different ages.
4. An infant fails to gain weight at an age-appropriate rate. Possible reasons for this include:
a. The infant and his mother are having trouble with breastfeeding.
b. The infant’s primary caregivers do not provide enough physical contact (i.e., hugging and cuddling).
c. The infant has not learned to trust his environment.
d. All of these are possible reasons.
e. None of these is a possible reason.
Correct answer: D
Rationale: Inadequate weight gain can be indicative of poor feeding, but also can occur with failure to thrive --- a condition sometimes associated
with an infant’s failure to develop trust in his or her primary caregiver(s) and environment. Trust and healthy infant-parent bonds develop in part
through physical contact --- hugging, cuddling, and touching.
5. Which of the following statements is accurate with regard to significant people in the lives of pediatric patients?
a. For infants and toddlers, siblings are most significant.
b. For preschoolers, playmates are most significant.
c. For schoolchildren, teachers are most significant.
d. For adolescents, peers are most significant.
Correct answer: D
Rationale: For infants and toddlers, the primary caregiver is most significant. For preschoolers, family members are most significant. For
schoolchildren and adolescent, peers are most significant.
6. Infants and toddlers should be monitored closely after the administration of medication because:
a. Medication is generally administered to infants and toddlers intramuscularly, which can cause discomfort.
b. Dosage of medication in infants and toddler is based on how the patient responds to the initial age-specific dose.
c. Because absorption and metabolism of medication are unpredictable in infants and toddlers, unexpected adverse events may occur.
d. All of these are reasons for monitoring.
e. None of these is a reason for monitoring.
Correct answer: C
Rationale: Oral administration of medication is preferred in both infants and toddlers, and dosage is based on body weight. Absorption and
metabolism of medication are unpredictable in patients of both age groups, necessitating careful monitoring after the administration of medication.
7. You are caring for a pediatric patient. The patient is very affectionate, but also quick to show frustration, anger, and jealousy. When educating
the patient about medical care, you use a firm, direct approach, keeping all explanations short, simple, and concrete, and emphasizing the aspects
of procedures that will require her cooperation. You include the patient’s caregivers in all education, emphasizing preventive healthcare, nutrition,
and age-specific safety issues. Your patient is:
a.
b.
c.
d.
An infant
A toddler
A schoolchild
An adolescent
Correct answer: A toddler
Rationale: These care practices and characteristics are most appropriate for and best describe a toddler.
8. As children demand greater and greater independence, ensure safety by limiting their ability to make choices.
a. True
b. False
Correct answer: False
Rationale: It is important to encourage and promote independence by allowing for choice, when possible and appropriate. Provide for safety in
other, age-appropriate ways.
9. Regarding safety issues for pediatric patients, all of the following statements are true EXCEPT:
a. Safety issues for infants and toddlers are related to oral and tactile exploration, combined with an inability to recognize danger.
b. Safety issues for preschoolers are related to increasing independence and physical activity, combined with a somewhat limited ability to
recognize danger.
c. Safety issues for schoolchildren are related to risk-taking behaviors, combined with the inability to understand cause-and-effect.
d. Safety issues for adolescents are related to peer pressure, substance abuse, sexual activity, and depression.
Correct answer: C
Rationale: Safety issues for schoolchildren are similar to those of adolescents: peer pressure, substance abuse, and sexuality.
10. Which of the following care practices is (are) important for ALL pediatric patients, regardless of age group?
a. Report suspected abuse or neglect of pediatric patients to your supervisor immediately.
b. Use toys, games, and puppet to reassure pediatric patients about medical procedures.
c. Direct all healthcare education toward the pediatric patient’s primary caregiver(s).
d. All of these are care practices appropriate for all pediatric patients.
e. None of these care practices is appropriate for all pediatric patients.
Correct answer: A
Rationale: You are required to report suspected abuse or neglect of any pediatric patient, regardless of age. Toys, games, and puppets are
appropriate for toddlers and schoolchildren, but not for other pediatric patients. In most cases, the primary caregiver should be included in the
pediatric patient’s education. Only for the infant, however, should all education be directed to the caregiver. As a pediatric patient grows and
matures, more and more education should be provided directly to the patient.
11. Jane is a 16-year-old patient in your care. She has confided to you that she and her boyfriend are sexually active. She is not taking oral
contraceptives or using any form of barrier contraception. You should:
a. Tell Jane that she is too young to be having sex.
b. Tell Jane’s parents that she needs to start using birth control.
c. Provide Jane with accurate information regarding birth control and sexually transmitted diseases.
d. Encourage Jane’s parents to keep closer tabs on their daughter.
Correct answer: C
Rationale: When caring for adolescent patients, avoid authoritarian approaches, and communicate directly with the patient (rather than through the
parents). Promote safe and healthy choices by discussing and providing accurate information on subjects such as sexuality and substance abuse.
12. You are caring for a ten-year-old girl. Which of the following is LEAST likely to be true of this patient?
a. One of her most significant fears is failure to meet the expectations of others.
b. She is an avid learner who loves to share her knowledge.
c. She enjoys receiving praise from her parents, teachers, and other authority figures.
d. She has a thorough understanding of anatomy, bodily functions, and illness.
Correct answer: D
Rationale: Schoolchildren have limited understanding of anatomy, bodily functions, and illness.
13. Adolescents tend to have excellent nutritional status.
a. True
b. False
Correct answer: False
Rationale: The nutritional status of adolescents is often compromised by factors such as eating a lot of fast foods, dieting, and snacking rather
than eating balanced meals.
14. Each healthcare facility is responsible for defining and describing the exact competencies to be achieved by its employees. Regarding these
definitions and descriptions, all of the following statements are true EXCEPT:
a. Exact definitions are important so that all employees have a clear idea of the knowledge and skills they need to provide quality, ageappropriate care.
b. Descriptions of age-specific competencies are often documented in job descriptions or unit/departmental policies.
c. Once a facility has defined and documented its competency expectations, it has no further responsibilities with regard to the age-specific
competencies of its employees.
d. Clear definitions and descriptions provide reliable guidelines for patient care, but do not give hard-and-fast rules.
Correct answer: C
Rationale: In addition to defining age-specific competencies, facilities are responsible for training and assessing their employees with regard to
established competencies.
15. Your coworkers provide written feedback on your age-specific competencies. This method of assessment is known as:
a. Direct observation
b. Return demonstration
c. Peer evaluation
d. Medical record review
Correct answer: C
Rationale: In the peer evaluation method of assessment, coworkers assess the knowledge and ability of a staff member.
Final Exam
Question Title: Question 1
Question: Monitoring for sexually transmitted diseases is an important care practice for the adolescent patient.
Answer 1: True
Answer 2: False
Answer 3:
Answer 4:
Answer 5:
Correct Answer: True
Answer Rationale: This statement is true.
Question Title: Question 2
Question: Rapid growth and development create high caloric demands in:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Infants and toddlers
Infants and adolescents
Infants and preschoolers
Toddlers and schoolchildren
Correct Answer: Infants and adolescents
Answer Rationale: Rapid growth and development occur in both the infant and adolescent stages. Therefore, patients in these two pediatric age
groups have relatively high caloric needs.
Question Title: Question 3
Question: The primary psychosocial challenge for the schoolchild is:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Autonomy vs. shame
Industry vs. inferiority
Identity formation vs. role confusion
Initiative vs. guilt
Correct Answer: Industry vs. inferiority
Answer Rationale: Schoolchildren strive to achieve industry, and the related feelings of competency and self-confidence. Those who fail to
achieve industry will demonstrate signs of inferiority: feelings of inadequacy and fear of not meeting the expectations of others.
Question Title: Question 4
Question: Whole milk is best for:
Answer 1: Toddlers
Answer 2: Preschoolers
Answer 3: Adolescents
Answer 4: All of these
Answer 5: None of these
Correct Answer: Toddlers
Answer Rationale: The fat contained in whole milk is important to meet the toddler’s nutritional needs. After the age of two, nonfat or low-fat milk
is best.
Question Title: Question 5
Question: All teaching should be directed to the patient’s primary caregiver when caring for:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
An infant
A schoolchild
An adolescent
A toddler
Answer 5:
Correct Answer: An infant
Answer Rationale: Because of the limited verbal skills and cognitive abilities of the infant, all teaching should be directed to the primary
caregiver(s). Some or most teaching should be directed to the patient when caring for toddlers, preschoolers, schoolchildren, or adolescents.
Question Title: Question 6
Question: Frustration, anger, and jealousy are common emotions for the toddler.
Answer 1: True
Answer 2: False
Answer 3:
Answer 4:
Answer 5:
Correct Answer: True
Answer Rationale: Frustration, anger, and jealousy, as well as affection, aggression/negativity, and impulsivity are common in toddlers.
Question Title: Question 7
Question: Children develop the ability to distinguish between right and wrong during the:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Infant stage
Preschool stage
Schoolchild stage
Adolescent stage
Correct Answer: Preschool stage
Answer Rationale: Preschoolers develop the ability to distinguish between right and wrong.
Question Title: Question 8
Question: Loss of control is a common fear among:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Toddlers
Preschoolers
Schoolchildren
Adolescents
Correct Answer: Schoolchildren
Answer Rationale: Schoolchildren tend to fear loss of control and failure to meet the expectations of others.
Question Title: Question 9
Question: An adolescent may resist complying with a recommended medical regimen because of:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Fear of bodily injury or mutilation
Feelings of rebellion
Inability to think about healthcare options analytically
All of these
None of these
Correct Answer: Feelings of rebellion
Answer Rationale: Adolescents are most likely to resist complying because of feelings of rebellion.
Question Title: Question 10
Question: Peer pressure may lead to poor choices for schoolchildren. Guide the schoolchild toward healthy choices by discussing and providing
accurate information regarding:
Answer 1: Smoking
Answer 2: Drug and alcohol use
Answer 3: Sexuality and sexual activity
Answer 4: All of these
Answer 5: None of these
Correct Answer: All of these
Answer Rationale: Schoolchildren need accurate information on all of these subjects.