HDFS 4500: Final, HDFS 4500: Test 4, HDFS 4500 TEST 3, HDFS 4500 Test 1, HDFS 4500 TEST 2

Custodial Grandparents

- Need to reclaim their own lives, learn how to take care of themselves, and find resources and support groups - May be particularly in need of mental health services

Toddlers

Common issues in hospitals: - Separation - Fear of injury/pain - Fantasy - Immobility/restriction - Forced regression - Loss of routine - Believe they are being punished

Preschoolers

Common issues in hospitals: - Separation - Fear of loss of control or power - Fear of bodily mutilation or penetration

School Agers

Common issues in hospitals: - Separation - Fear of loss of control, mastery, bodily mutilation, bodily injury, illness, disability, death

Infants

Common issues in hospitals: - Separation from parents - Unable to build trust and attachment with the mom (primary caregiver) - Lack of stimulation - Pain

Normative Stressors

Common, developmental stressors of daily life

Sensorimotor

According to Piaget's theory, the primary mode of play in the first two years of life occurs in __________ exploration and interaction with the world around them

4-7

Child life intervention reduces stress in children aged _______ to _______ years, particularly during anticipatory and preparatory phases of the ER experience

G. Stanley Hall (1921)

Developed his recapitalization theory, in which every persons development reflected human evolutionary progression. A child's play framed and present experiences might be imitating behaviors of prehistoric ancestors

Secure Relationship

Development promotes exploration of the social and physical environment as the child experiences the caregiver's ability to be sensitive to and respond to his/her needs in a contingent manner

Advanced

Developmentally (advanced/delayed) children typically do better in the hospital

Feeling

Explain how you are _________.

Familiarization Activities

Exploration and manipulation Plaster finger casts, finger puppets, and bracelets Surgical mask creations I.V. pole decorating Collages Painting with sponge tooth cleaners Band-aid ornaments and necklaces Mobiles Water play

Brain Structure Neurochemistry

Exposure to traumatic and repeated painful procedures leads to actual changes in _______ _______and _______

Expressive Therapy

Expressive therapists interpret children's activities and prescribe specific activities for healing

Nurse

Historically, the role of the ________ has been characterized by the provision of physical care under the control of the doctor, while at the same time remaining professionally detached from the patient

Sickle Cell Disease (SCD)

Children with ________ ________ ________ (_______) are at an increasedrisk of developing ischemic brain injury, including overtstrokes and silent infarcts

Emotional Disturbances

Children with ______________ ____________ tend to distort perceptions about illness or injury.

Supportive

Children with a (supportive/unsupportive) hospital staff typically do better in the hospital

Sensitive

Children with prior experience in hospitals may be more _______ to medical events and the nature of their experience may affect their responses to preparation

Postoperative

Children's anxiety in the preoperative environment is associated with impaired _______________ behavior and clinical recovery

Activities Environment

Children's best experiences in the hospital were mostly related to ____________ and the ______________

Decreases

Children's distress (increases/decreases) when the physician interacts directly with the child and when parents use simple distraction and focused coping skills to help the child

Family

For play in preparation for broader issues, anything that can be grouped as having the characteristics of a _______ can be used

False

True or False: Legacy making should only be done when the patient is near death.

True

True/False: Child Life professionals are diverse, eclectic, and flexible

Dimensions of Healing Environments

Universal qualities of spatial existence that, when appropriately administered, contribute to the therapeutic process.

Emotional Fragility

Unstructured, child-initiated play provides children with opportunities to experience and work through challenges, discomfort, and disappointments. Lacking these experiences can impair the ability to develop coping skills and the inner resolve necessary to thrive in a changing world

Open Ended

Use ______ _______ questions when assessing what children know

More Adult Teaching Tools

Use photographs of the procedure instead of, or in addition to, dolls and drawings, according to the teen's cognitive and emotional abilities

Language

Use simple, direct ________ that your child can understand.

Biofilia

Used by Dr. Edward O. Wilson to describe the innate affiliation humans have with other living things

Emotional Distress

__________ ___________ was common in 1965 both during the period of hospitalization and after discharge

Auxilary Programs

__________ ___________, often used in conjunction with child life services, provide additional outlets for patients of all ages and their families

Straightforward

__________ approaches don't always work with children

Education

__________ of all health care providers is the first step to reducing pain in pediatric patients.

Parental

__________ opinions of pediatric nursing care substitutes for children's perspectives

Partnerships

__________ should be encouraged between families and professionals to ensure family- centered care

Anticipating

___________ a painful procedure in a pediatric patient is the key to adequately treating pain.

Interpreter

___________ services are used as appropriate to ensure understanding in patients or families who do not speak English or for whom English is a second language

Caregivers

____________ And their programs will always be the primary source of psychosocial support of children in the healthcare continuum

Uncertainty

____________ about any aspect of the elements involved in an invasive procedure can limit the child's ability to develop any effective control and thereby increase feelings of helplessness and stress

Working Phase

The second phase of therapeutic relationships identified by Stuart and Sundeen (1995) At this point the professional work stored achievement of goals as established in the initiation phase

Sensorimotor

In Piaget's theory, the stage (from birth to about 1 year of age) during which infants know the world mostly in terms of their sensory impressions and motor activities Object Permanence

Concrete Operational

In Piaget's theory, the stage of cognitive development (from about 4 to 5 years of age) during which children gain the mental operations that enable them to think logically about concrete events Conservation (liquid is the same amount regardless of the size of the cup)

Formal Operational

In Piaget's theory, the stage of cognitive development (from about 6-12 years of age) during which people begin to think logically about abstract concepts Abstract Reasoning

Perception Physical Movement

Restricted in both discriminating _________ and __________ _________, the response of young infants is limited to crying, muscle tension, and diffuse movements

Appraisals

The degree of distress one experiences in the face of potentially disrupting events is the product of a pair of __________ made by the individual

Match

The demeanor of the people preparing the child and performing the procedure must _______ the emotions the child is likely to be feeling.

Constructive Play

The second stage of play for Piaget. Characterized by goal directed activities, and play during which children create products. Children also exhibit new manipulations of objects in this stage. When in this stage of play, children can also be observed independently developing simple dramatic play themes. Most often observed in children 2 to 4 years of age

Nursing Staff

The single most important part of successful home care is the ________ ________

Guiding Children

The skill of _________ _____ comes with playing with children, sometimes *for* children, and always using careful observation and assessment to determine the next steps to take

Instructional

According to the EBP Play Statement: Therapeutic play typically consists of at least one of the following types of activities: 1) the encouragement of emotional expression 2) __________ play to educate children about medical experiences 3) physiologically enhancing play

Play

According to the EBP Play Statement: ________ is not only universal but essential to human development

Well-Being

According to the EBP Play Statement: A central goal in pediatric health care is to facilitate the emotional and physical ___________ of children in the hospital

Play

According to the EBP Play Statement: Can be broadly defined as any activity in which children spontaneously engage and find pleasurable

Hospital Fears

According to the EBP Play Statement: Results showed that children who engaged in therapeutic, non-directive play showed a significant reduction in self-reported ________ _______ in comparison with children from other groups

Stress-Point Preparation

Addresses both primary and secondary appraisal Each of a series of stress points is identified. Children and their families are prepared for each stress point using a combination of interventions

Tutored

Adequately ________ parents provide more cost-effective care because they avoid prolonged hospitalization

Complex

Adolescents need more _______ information about what to expect before, during, and after the procedure

Co-Player

Adults actually join in and take an active role in children's play while following the lead of the child

American Academy of Pediatrics Statement on Child Life

Child life services should be delivered as part of an integrated patient and family centered model of care and included as a quality indicator in the delivery of services for children and families in health care settings

Evidence-Based Practice

Child life specialists recognized that clinical care and decision-making must be grounded in _______________-_________ ____________ Represents an integration of clinical experience , the best available research, and patient preference or needs

Intensity

Children who are calm react with less ____________ to negative stimulation than do children who are already upset for other reasons Lessen the chance that the procedure will fail

Less

Children who asked questions and expressed concerns were (more/less) distressed and spent significantly (more/less) time seeking information during the procedure.

Lower

Children who play have a (lower/higher) heart rate

Autonomy

In the medical field, the supreme ethical rule is _______

Empowerment Outcomes

Include belief in one's self and one's ability to have control over important life events and situations

Distinguished Service Award

Include professional experience, integrity, leadership, vision, and overall contributions to the child life profession and child life council.

Intimate Relationships

Involve a partnership with an emotional commitment to one another Interaction between these individuals is personal and intimate, on social, emotional and or physical levels

School

Involvement in child life programming and hospital school programs are critical for a child in ________ to normalize the medical setting, provide structure and routine, as well as offer opportunities for peer group interaction

Care

Involvement, caring, and interpersonal connection form the basis from which _________ is delivered.

The New Nursing

Involves a clear redefinition of nursing care to include administering to the sick body and addressing wider, related psychological, emotional, social, and spiritual needs of the patient

Caring Orientation

Involves a host of behaviors that ensures competent and compassionate practice

Montessori Method

Involves children playing and manipulating materials in ways that have true meaning in their lives.

School-Age Children

Less vulnerable to the anxieties of hospitalization due to a number of developmental achievements. More social, able to be separated from parents for longer periods of time, incapable of cognitive reasoning. They are able to form trusting relationships with other adults and peers. They are able to process information and understand relationships between events and experiences.

Licensed Vocational Nurse

Licensure Experience preferred

Siblings

Likely to feel distress about family separations and disruptions, lack of attention, focus of the family on ill children, negative feelings about themselves and family members, cancer treatments and effects, and fear of death

Restricted Activity

Limitation of normal or desired activity due to illness or hospital rules

Teachable

Look for __________ moments, or everyday opportunities to talk about what your child is thinking and feeling

Play

Main theorist: Parten (1932) Categorized depending on the amount of social interaction children partake in - Solitary - Onlooker - Parallel - Associative - Cooperative

Directive Roles

Making decisions and providing information

Pain

Management of _______ in pediatric patients is both a moral and ethical obligation for healthcare providers.

Caring Behavior

Manifested through attributes

Nonverbal

Many children communicate best through ________ means

Before

Many healthcare professionals intervene (before/after) families find themselves in crisis with sick family members

Hyper-parenting Hothousing

Marano (2008) and Sigel (1987) identify ____________ and ____________techniques as two ways that parents attempt to create a perfect childhood and provide the optimal environment for their children to grow and develop.

Gardebd

Marcus and Barnes (1995) found that people who use ________ use them frequently and reported positive mood

PICC line

Materials: ______ _______ - IV start kit - Lidocaine - Tourniquet - Alcohol swap - Xray machine Procedure: - Lidocaine injection - Start an IV - Use gauging device to stretch IV Start hole - Thread ______ _______ with wire up arm, under collar bone, over to a few inches from heart - Remove wire, leaving flexible tubing - Wrap and tape - Send to xray to check placement

Want

Most parents surveyed would (want/not want) to be present when invasive procedures are performed on their children.

Sentence Completion Technique

Most widely used projective technique with sentence stems designed to elicit responses towards some event which the researcher is interested in Advantage of decreasing any tendency to lead or bias children's responses Provides the children a possibility to express their own thoughts

Information

The patient's best recourse, given the current healthcare environment

Privacy

During hospitalization, respect for the ________ of the child's bedroom and the family's only personal space must be observed

Culture

Each family has its own _________

Single-Room NICUs

Enable customize light levels and control noise. Provide more privacy in the possibility of sleeping near one's child.

1982 Katie Beckett Home and Community Based Medicaid Waiver

Enabled those with chronic conditions and disabilities to be cared for in the home rather than the hospital or other care facilities

Peer Group Contact

Encourage teens to keep in touch with their _______ _______

United Nations Declaration of Human Rights in 1948

Encouraged laws that considered the best interest of the child in custody proceedings and other legal procedures

Home

Encouraging simple medical play at _______ as part of usual play activities with attention to the positive aspects of medical care also may prepare children for future healthcare experiences in inpatient or outpatient settings

Stressors

External and/or internal demands that are appraised as taxing or exceeding the resources of the person May be social, cultural, psychologic, physiologic, or a combination of stimuli impinging on the individual

Assessment and Collaboration

Facilitates decision-making regarding for whom and how intervention will be provided most meaninfully

Dynamic Interactions

Facilitating flow experiences via play helps children to engage in _________ _________ with the body, mind and spirit that can re-balance the symmetry created between illness, disability and health.

Wholeness

Facilitating playful flow experiences that lead to feelings of __________ can promote a connection with children's healthy parts once again

Mutual Relationships

Fall into 4 broad types, and depend upon certain circumstances: -- Length of time the nurse and patient have together -- Needs and desires of the nurse and the patient -- Personality factors

Alliance

Family-centered care benefits for pediatric healthcare providers: - Stronger __________ with the family

Means

Play involves attention to ______ rather than ends Goals are flexible, self-imposed, and changeable

Competitiveness

Family-centered care has shown increased satisfaction among families and patients which leads to increased ___________ for hospitals in the marketplace

Learning

Family-centered care has shown more effective ___________ environments for professionals-in-training

Mastery

Preparation for toddlers: - Introduction/rapport building with child and parent - Exploration - Demonstration - ____________

Collaboration

Principle of family-centered care - __________ with families at all levels of healthcare

Work Responsibilities

Priority that families use to cope with the disruption in family routine caused by hospitalization Again, mothers usually take more time off from work than fathers do, and her work seems to take a lower priority than his

Left

Speaking is a (left/right) brain function

Meaning

The ________ that a person attaches to the pain experience, whether it be known or hidden from awareness, influences perception of symptoms, processing of pain-related and other information, and ability to cope

Communication

The foundation of any therapeutic relationship is dependent on the _________ skills of the therapist

Accommodative Learning

The play of elementary age children moves from the central role of assimilative learning of early childhood to the less central role of ____________ ____________

Reinforce

The positive effects of involving parents in the preparation of their children allows them to _______ information and practice coping apart from the preparation session, a practice that may be especially useful when there is a long lag time between contact with the family and the planned procedure, when a child will be receiving home care, and when repeated procedures are expected

Information

The primary material for making an assessment of potentially threatening circumstances is the _________ one has about them.

Exploratory Sensorimotor

The primary motive play for infants and early toddlers Play will center on visual in motor actions, on objects and on people, as infants and young toddlers actively explore the world, and their own capabilities, through simple non-go oriented and repetitious play

Separation Anxiety

The primary threat to the age group of older infants (6 months-1 year)

Nonfunctionality

The realization that when a living thing dies, all aspects of a living body cease to function

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

The recommendation was made that "patients and families should be given the opportunity to be fully engaged participants at all levels

Professional

The relationship a child life specialist has with a child or adult is a __________ relationship, regardless of other relationship possibilities

Fear

The relationship between an estimation of an individual's personal power in comparison to the power of the unknown, with lower estimates of personal power leading to greater levels of _____.

Chronobiology

The relationship of light to biologic and physical patterns of life. Diurnal and seasonal fluctuations are believed to affect the healing process, and a variety of studies confirm that adjusting light levels in nurseries to reflect diurnal variation has a positive affect on infants. When the days are very short, some individuals are described as experiencing seasonal affective disorder

Resilience

The result of exposure to harmful situations, rather than ignoring or avoiding those risks. An is able to "manipulate their environment" and guard them from the negative aspects in their life

Parents

The role of child life is to support _______, whenever possible, as leaders in the delivery of support to their children

Communication Stressors

Too much or too little information provided to parents Few opportunities to ask questions Inability to interpret staff behaviors

Language

Using _________ to express pain not only states its existence and describes its nature but most often also becomes a part of the pain experience itself

Interventions

Using therapeutic play, expressive modalities, and psychological preparation as primary tools, in collaboration with the entire healthcare team and family, child life _____________ facilitate coping and adjustment at times and under circumstances that might otherwise prove overwhelming for the child

Therapeutic Relationships

Usually reactive, and focus on healing or problem-solving Usually a supportive relationship Have a beginning middle and end

Reassurance

Verbal __________ by parents results in increasing the child's distress

Psychological Upset

Vernon, Foley, Sipowits, and Schulman (1965) claim that "_______ _______" observed in children during or after hospitalization or medical care is due in part to the unexpectedness and unfamiliarity of events they encountered

Basic

Very young children may only need _______ information, but the opportunity to explore the equipment and environment with a supportive adult is reassuring

Unsettling

When a child looks to an adult to gain a better understanding of death but no one is able to provide honest or clear responses, it is ________ for the child.

Stress

When a older infants cues of emotional expressions are missed and the infant is unable to elicit nurturing responses, a feeling of distress and decreased sense of control may increase the infants ______ levels

Positive

When a preparation program included information regarding coping techniques, behavioral outcomes were more __________ for children undergoing surgery.

Emotional Development

When provided with frequent opportunities to play, children develop self determination, self-esteem, and the ability to self regulate; all vital elements of ____________ _____________

Anxiety

When the opportunities for action are perceived to overwhelm the player's capabilities, the resulting stress is experienced as ______

Regress

When toddlers experience severe restrictions and changes of routine, feelings of unpredictability and loss of control may cause them to ______ to earlier and more secure developmental levels. While this may appear to provide comfort to the toddler, Giving up newly acquired skills is difficult and may make toddlers more susceptible to negative responses to hospitalization

In-services

Whenever possible, child life staff should request formal or informal _______ about the procedures that children will experience Ideal to arrange _______ as techniques and equipment are newly developed

Skilled Professionals

Whenever possible, ensure that a child life specialist or another pediatric healthcare professional skilled in preparation and coaching is present to assist with the procedure

Proportion

Whenever possible, equipment should be in _______ to their doll

Fantasy Imagination

With these tools, play opens windows through which children can process their experiences, present and past, and grasp new meaning

Manipulations

Within months of their first year, infants will gradually move practice play and to purposeful ____________ of materials

Negatively-Loaded Statements

"This is going to hurt" "This will sting" "Hold still/don't move"

Neutral Statements

"This is the numbing medicine" "I'm putting the IV in your hand now"

Positive Statements

"This will feel cool/tingly" "Your hand should start to feel numb now"

Secondary Appraisal

"What, if anything, can I do about this?" "What options do I have to cope with this event or circumstance and what is the likelihood that these efforts will be effective?

Complicated

(Normal/Complicated) grief experiences for teenagers

Red Flags

- Do I do anything for this patient that I would not do for every patient? - Who needs the interaction more, me or the patient? - Do I choose to see this patient over others who are of higher priority?

Encouragement, Empowerment, and Partnership

- Patient/family-centered communication - Bedside shift report - Patient/family-centered multidisciplinary rounds. - Ability of the nurse to communicate in a patient-centered way. - Immediacy describes a behavior in which the nurse is fully present at the moment with the patient and not distracted. - The use of humor as a PCC behavior by nurses can enhance relationships with patients and families and reduce uncertainty and anxiety during interactions.

Issues with Siblings

- Personality changes - "Selfish" behavior

Step-Down Grant

100% grant funded the first year 50% the second year 25% the third year

Formal Operational

12+ years Thoughts of death consistent with mature adult Difficult to recognize their own death as an ever-present possibility

Visitor

1950s Family is a _______ and restrictions are imposed

Humanize

1965 ACCH is created to "_________ healthcare for children"

Education for All Handicapped Children Act

1976 federal law mandating publicly supported education for all children in the least restrictive environment - Stipulated that children have an individualized educational plan developed by a team that includes the child's parents

Family-Centered Care

1987 ACCH publishes a document regarding ________ ______ ________ for children

Families

2001 Government institutes multi-million dollar project to measure the effectiveness of partnerships between patients, healthcare professionals, and __________

Kat Davitt

2014 Mary Barkey Award Recipient Participated in the first major strategic planning program from the CLC in 1996 called "Vision to Action" Do not be afraid to take care of yourself Recognize the blessings of our work, as it is a privilege Don't be afraid to keep learning

Negative

29 of the 30 studies concluded that children who were prepared for surgery experienced fewer ________ symptoms than did children in control groups who did not receive preparation

Temperament

3 categories based on 9 dimensions Easy Difficult Slow to warm

Sensory Cognitive Behavioral

3 primary coping strategies

Preoperational Stage

3-6 years May not realize that being alive and being dead are mutually exclusive Death is temporary and reversible Death is associated with older age Unable to envision their own deaths Don't understand why people die Vulnerable to believing they can cause death with their thoughts and actions

Inability to Attend and Poor Task Completion

4.5 million children between the ages of 3 and 17 are diagnosed with attention deficit hyperactivity disorder. Marano (2008) attributes the high incidence to an early childhood curriculum that requires children to sit idle for extended periods of time. There has also been a corresponding increase in the number of children being medicated to enhance their attention, with over 21 million prescriptions each year; a 400% increase over a decade.

Resilience

5 things child life specialists can do to build _________ - Play - Schedule - Communicate/Talk it out - Create - Grow

Concrete Operational

6-12 years Dead people cannot function

Conversation

A ________ could ensure parents know more about children's final wishes

Play

A arena in healthcare settings were children can exert power, create a sense of comfort, familiarity, and safety, expressed thoughts and feelings, and make choices

Bronfenbrenner

A balance between the individual and systems in the environment serves to support positive developmental outcomes

Causality

A belief of what brought about the state of death, whether from internal causes, or a combination of the two

Playing in the Hospital

A child's fundamental tool for mastering challenging experiences, providing opportunities to "play out" emotionally-laden hospital experiences and come to terms with them

Brief

A child's life can be complete, even if it is _______

Ratios

A combination of psychosocial risk assessment, medical or treatment variables , and the time requirements associated with particular interventions directly affect operational staff to patient _________ in both inpatient and outpatient settings

Infectious Disease

A common reason for hospitalization throughout childhood

Ethical Responsibility

A company's social responsibility not to violate accepted principles of right and wrong when conducting its business

Insensitivity

A consideration of mental and sensory functions

Less

A conversation could help children who are brooding silently suffer (more/less) as they approach death

Stressful

A discriminating signal used whenever staff enter the room for a pending unpleasant event helps the child separate safe from _______ visits.

Caring

A dynamic, multidimensional, and universal concept that enhances the preservation of human dignity - Composed of nurturing activities, processes, and peaceful death

Diagnostic/Acute Phase

A family may face feelings of stress that are as significant as in the terminal phase or at the time of death

Improv

A form of engagement that is invigorating, adaptive, self-caring, and relational for people of all walks of life

Play

A healing modality through which child practitioners promote growth and development of infant, children, and youth Requires an understanding of the elements of play and the intentional integration of these elements to support the achievement of educational or therapeutic goals

Concentration

A high degree of ______ is the chief characteristic of flow

Living Wills

A legal document stating a person's desires on what measures should or should not be taken to prolong life when his or her condition is terminal.

Distraction

A non-pharmacologic technique that can refocus the child's thinking by directing his or her attention away from the pain related to the procedure.

Mourning

A painful process that requires people to adjust their ties to the person who has died - An essential first step in this process is understanding and, at some level, accepting that the loss is permanent.

Time

A power issue Has special meaning for people who are dying Double standards

External

A preschoolers concept of the cause of illness is complicated by their inability to separate themselves from the _________ world

Information

A primary goal of the process of preparation is to enhance the child and family's understanding of the procedures through the presentation of _______ about the circumstances they face.

Child Life

A primary method of achieving the goals of health-care play and activities programs

Grant Proposal

A proposed contract to complete the project if selected for funding

Imaginations

A quality infant and toddler toy allows children to use their __________. Look for stuffed animals or dolls that aren't from a TV show, or other media, to allow your child to create her own play ideas. Developing creativity and problem-solving skills is important for lifelong learning.

Many

A quality infant and toddler toy can be used in _______ and will grow with your child.

Senses

A quality infant and toddler toy engages the _______. Young babies learn by using all of their _______. They like play that involves materials with a variety of textures, as well as lots of physical contact, singing, and dancing. For older toddlers, play with sand, finger paint and shaving cream provides opportunities for learning using touch, smell, sight, and sound.

Decisions

A quality infant and toddler toy lets children make __________ about their play. A quality toy does not do something for the child. Instead, the child finds pleasure and satisfaction from doing something to the toy.

Advanced Practice Nurse

A registered nurse having education beyond the basic nursing education and certified by a nationally recognized professional organization in a nursing specialty, or meeting other criteria established by a Board of Nursing. Masters in Nursing 3 years of clinical nursing experience

Easy Street

A rehabilitative environment designed to stimulate real life experiences Developed by David Guynes in 1985 The environment is used by adults who are attempting to re-integrate themselves into the main stream by practicing on environments that more closely approximate what they will encounter in the real world. These environments include portions of checkout stands, cars and buses, turn styles, restaurants, and mailboxes. Although it was created for adults, it was also developed as an alternative for children. The alternative, it was designed around a game board concept that, use the environment to support rehabilitation

McGill Pain Questionnaire

A self-report instrument for assessing people's pain Includes 20 descriptor word groups measuring four dimensions of pain (sensory, affective, evaluative, and miscellaneous), along with a rating scale of present pain intensity.

HIPAA

A set of rules to be followed by doctors, hospitals, and other healthcare providers - Ensures that all medical records, medical billing, and patient accounts meet certain consistent standards with regard to documentation, handling and privacy

Ethical Dilemma

A situation in which you have to decide whether to pursue a course of action that may benefit you or your organization but that is unethical or even illegal

Therapeutic Relationship

A state of mutual interest or involvement that has to do with healing or curing This healing may be purely physical or it may be psychological or developmental healing

Hospitalism

A term used by Rene Spitz to describe the syndrome found in infants who have been separated from their mothers or other primary caregiver His solution was the anti- thesis of the accepted hospital practice of scrupulous asepsis Fostered the opening of Pediatrics to the idea that social and environmental factors influence a child's response to treatment

Hospitalism

A term used by Rene Spitz to describe the syndrome found in infants who have been separated from their mothers or other primary caregiver. - His solution was the anti thesis of the accepted hospital practice of scrupulous asepsis - Fostered the opening of Pediatrics to the idea that social and environmental factors influence a child's response to treatment

Therapy Process

A therapeutic relationship either always is, or can be, part of the _______ _______

Professional

A therapeutic relationship is almost always a _______ relationship because it has codes of ethics and standards of practice and consequences if not followed

Psychoneuroimmunology

A transdisciplinary scientific field concerned with interactions among behavior, the immune system, and the nervous system. Proponent suggest that stress can compromise immune system, therefore interfering with healing. Supports the need for stress reduction in healthcare settings. Studies are becoming more common place in traditional medical journals.

Stages of Grief

A variety of reactions that may surface as an individual makes sense of how a loss affects him or her

Design

A very broad base discipline focused on issues of problem-solving.

Contamination

A way a territory may be disturbed. In which something inappropriate is left behind in a territory

Invasion

A way a territory may be disturbed. When a territory is physically entered by an outsider

Violation

A way a territory may be disturbed. When a territory is purposely modified by an outsider

Efficacy

ACLP has funded two major research projects investigating the clinical and economic _________ of child life services in health care - The effectiveness of the child life in MRI studies at children's National Health system in Washington DC - Value of play at Saint Jude children's research hospital in Memphis TN

Games with Rules

Acceptance of prearranged rules and adjustments to these rules

Games with Rules

Acceptances of prearranged rules and adjustments to these rules

Light

Access to this has been beneficial to academic performance, behavior, and preference in workplace

Privacy

According to Altman (1975), __________ is directly related to control issues in that it can be defined as the selective control of social interactions

Incidence of Anxiety and Depression

According to Gray (2013), as opportunities for children's play have declined, mental disorders among children have increased. To highlight, anxiety disorder and major depression in young people are five to eight times what they were in the 1950s. Panksepp (2002) argues that play serves as the deepest wellspring of joy in human experience, which buffers us from anxiety and depression.

Social Competence

According to Pellegrini (2009), different types of play foster ____________ _____________ (respect for rules, self discipline, aggression control, problem solving skills, leadership development, conflict resolution, and playing by the rules)

Play

According to Piaget, this is a simulation where children assimilate or solidify their present knowledge through play activities

Preparing a Memory

According to Solnit (!984), it is important for a child to be supported in "_______ _______ _______"

Coping

According to the stress-coping framework: Cognitive and behavioral efforts to manage specific external and or internal demands that are appraised as taxing or exceeding the resources of the person.

Psychoanalytic Theory

According to this theory, play allows children to explore unwelcome feelings or socially unacceptable thoughts via a familiar and comfortable medium, without the fear of adult disapproval.

Validate

Acknowledge and _______ the child's feelings

Education Communicate

Acknowledging team goals to normalize the transition process an address patient and family anxieties or questions, CCLSs can assist in this transition by providing ____________ and helping patients to ___________ their needs, fears, hopes, and expectations

Association for the care of Children's Health

Added the impact of many voices from nursing, social work, pediatric medicine and psychiatry to help sustain in focus the ongoing work of child life specialists

Home Care

Additional factors particularly pertinent to pediatric home care that might be considered our accommodations for siblings, location of the child's room near the entry to accommodate visitors, opportunities for stimulation, access to nature, and extension of home environment to school and day care.

Chronically Ill

Additional support for well siblings have a ________________ _____ child may include professional constantly and support group involvement with peers in similar situations

20-40

Age Group Can be devastated by the death of a loved one during a disaster or crisis event.

Decreases

All forms of social play with peers become more evident as play with adults ____________

Boundary Problems

All of these can alert the professional to ________ ________

Respond

Allow the child time to respond.

Communicate

Allow younger children to _________ through play or art.

Rooming In

Alternative Caregiving Environment In addition to sufficient space for sleeping and caregiving activities of families, space should be provided for a parent lounge, food preparation area, laundry, library, and consultation and teaching space. Another element of support would be a communications outlet that could be linked via modem to a computer. Parents should have ready access to respite spaces

Cooperative Care

Alternative Caregiving Environment Non-medical care partner. Not located in a full-fledged medical unit. Patient must require acute hospitalization, but not need continuous care. The unique characteristics are the separation between residential and support spaces, the hospitality ambience of the design, in the absence of nursing stations. The rarity of existing units for children may be the result of physician concern that children should be kept in acute care settings until they can go home. Benefits of remaining in an acute care setting maybe I'll wait by the stress of being in a institutional setting

Topical

Although _________ analgesics have been shown to reduce pediatric procedural pain with venous access, they are underutilized

Therapeutic

Although child life specialist use play to achieve a number of very goals, using play in a true ____________ manner includes three main objectives: to establish rapport, to promote observation and collect useful data, and to interpret behaviors and understand how children are making sense of their healthcare situation

Emotional

Although physical boundaries of care are taken away, it is expected that _________ boundaries remain clear

EMLA

An emulsion that can be applied to skin to deaden pain - useful for little children

Past

An important part of medical data collection is information about the child's ______ experience with painful procedures and pain control approaches

Parents

An important source of information to the child about the potential threat of circumstances

Perception

An individual's response to a stressful event is largely dependent on their __________ of the event or stressor.

Planetree

Angela Thieriot founded ___________ in response to her own unpleasant hospital experiences. Reacting and part to what she recognized as a need of patients to become educated about their illness, she began by developing a health resource center where patients could access information. _____________ environments are typically fully accessible and homelike, and include a variety of elements to support patients and their families

Honestly

Answer the child's questions completely and ________.

Being Hurt

Anxiety surrounding _______ _______ has been identified as one of the greatest fears of children

Open

Anxiety, anticipation, and overexcitement (open/close) the gate in the gate control theory

Therapeutic Intervention

Any activity relating to treating or assessing the physical status of the child

Intrusive Events

Any event involving entry into the body through the skin or a natural body orifice

Separation

Any expression of concern due to separation from family, friends, or pets due to hospitalization

Environment

Any physical or interpersonal aspect of the child's environment

Physical Symptoms

Any physical symptoms or sensation relating to the illness or treatment

Pointer Extension

Any type of this operates as a symbol of authority

Family

Anyone who the patient says it is

Supportive

Anytime the interaction between therapist and client goes beyond technical, mechanical, rehearsed tasks, there is potential to make use of a _________ component in the relationship

Theories

Applied as frameworks directing the attention of the child life practitioner to extend beyond children in isolation and focus on children in the context of family relations in the social environment

Culturally-sensitive

Applying ________-______ care principles to child life practice means developing the skills to engage thee patient or sibling in appropriate anticipatory grief work within the norms for any culture.

Efficacy

Appropriate healing environments in Hanst feelings of ___________ rather than compromise them

Anxiety

Approximately 60% of all pediatric patients suffer from severe __________ immediately before their anesthesia induction

No

Are coping strategies rigid?

Adult World

Aries argued that medieval children who survived the nursery. Were simply incorporated into the ribaldry, games and work of the ________ _______ The latency part of childhood was missing

Normalization

Art means creating ___________ for the child - Coloring, cutting, and gluing for preschoolers and school age - Step by step projects for school age - Interesting, intricate coloring pages for teens - Make your own items for teens

Formal Operstions

As adolescence and, ultimately, adults move from concrete operations to thinking in ____________ ____________, play's outward manifestations change and become miniaturized, socialized, and abstracted

Child Life Mission

As child life professionals, we help infants, children, youth, and families cope with the stress and uncertainty of illness, injury, and treatment We provide evidence based, developmentally appropriate interventions including therapeutic play, preparation, and education to reduce fear, anxiety, and pain

Manageable

As children become engaged in verbal, physical or imaginative play , their feelings are shaped and expressed, via play activities and behaviors, and thus made ____________

Adaptation

As children play, they build images and products that stimulate reality. Piaget calls this ____________ This process enables children to construct their own knowledge and present time

Questions

Ask if the child or parent has any _______

Territory

Associated with a particular physical environment

Increased Distress

Associated with the appraisal of uncontrol ability, confrontive coping, and escape avoidant coping by the parent

Decreased Distress

Associated with the coping strategy of excepting responsibility by the parent

Association for the Care of Children's Health

Association for the Well-Being of Hospitalized Children and their Families -> Association for the Care of Children in Hospitals (ACCH) -> _________ ______ _______ ________ ______ ________ ________

Less

At discharge, children are (less/more) likely to receive home health care services or long-term care than adults

One Day

At the earliest, how far in advance are you supposed to prep children for a procedure?

Away

Because the child's bed should be the ultimate safe place, all invasive procedure should be done in a treatment room _______ from the child's bedside

Stressful

Because toddlers have not yet developed a sense of body image or boundaries, intrusive procedures may be highly __________ regardless of whether pain is actual or perceived

Value-Neutral Roles

Being a family supporter and advocate Focused on the emotional, environmental, relational, and informational family needs in a nondirective way Encompasses providing for family's environmental needs

PICC Line

Better than IV or central line because --- Needle doesn't stay in --- Wire doesn't stay in --- Lidocaine --- Kids job --- Amount of ________ --- PPE important due to sterile nature of procedure

4 11

Between what ages are the most negative reactions of siblings

Contamination

Bibace and Walsh Concrete Operational 5-7 years External object or event causes illness; do not understand how

Internalization

Bibace and Walsh Concrete Operational 7-11 years Illness occurs inside the body, caused by an outside source

Physiological

Bibace and Walsh Formal Operational 12-14 years There can be multiple causes of illness; more sophisticated understanding of internal systems & processes

Psychophysiological

Bibace and Walsh Formal Operational ~14 years+ Capable of understanding internal processes and the impact of psychological processes on health

Avoidant Attachment

Bowlby and Ainsworth Caregiver is unresponsive, uncaring, and dismissive

Ecological Systems Theory

Bronfenbrenner Microsystem Mesosystem Exosystem Macrosystem

Ecological Theory

Bronfenbrenner (1979) Contributes to the study of families to the examination of development in the context of both immediate and distal systems Explains the interdependence of the systems Encourages one to look beyond the immediate contacts of the developing child, observing the child within the larger context of society, drawing attention to environmental interconnections in their impact on growth and development It is the perceptions of, and transactions with, the environment that influence development

Family

Can be as temporary as a few weeks or as permanent as forever - Enter through birth, adoption, marriage, or from a desire for mutual support - Joint Commission (TJC) expanded its definition to include individuals who serve as the patient's support person

Mobile Devices

Can be effective in minimizing patient perceptions of pain and anxiety during distressing medical procedures

Emotional Readiness

Can be fostered by: - helping individuals more accurately understand the circumstances and experiences they face - helping them understand, identify, practice - implement options and strategies they may use to better proceed through the experience, and helping individuals organize their emotional experience to make meaning of the events

Parallel Play

Can be used to build rapport Based on the developmental stage that toddlers must master before they are ready to play cooperatively with peers Involves the comofrt of companionship, but does not require them to share or converse

Uncooperativeness

Can ead to concerns of safety, time, cost efficiency for staff, and psychological stress for both the child and parent

Preparation Programs

Can provide the context in which children can develop trusting relationships with their health care team

Relevant

Child life specialists must gather information that is _______ It will ideally guide the content of the care to follow

Culture

Children play in every human _____

Play

Children's most powerful tool. It helps children make sense if their world, develop new concepts, increase social skills, gain emotional support, and take responsibility for their actions through meaningful experiences

Shorter

Children's stays in the hospital or 29% (shorter /longer) than adult stays

Slide

Children's thinking is more like a _______ (where they look at one frame at a time), than like a movie.

Vygotsky

Children's thinking...reflect[s] a combination of maturation and learning from the social and cultural context

Softer

Choose "softer" language (but still honest language) when preparing a child for a procedure

Privacy

Choose an environment where there is ________

Stroke

Chronic blood transfusion therapy is con-sidered the standard of care in children with SCD who areknown to be at high risk for _______

Countertransference

Circumstances in which a psychoanalyst develops personal feelings about a client because of perceived similarity of the client to significant people in the therapist's life.

Everything That Is Alive Eventually Dies

Concept about Death If children do not understand that death is an inevitable part of life, they will have misunderstandings while trying to figure out why this particular death occurred. Many children do not want to talk about the death because it will expose these terrible feelings of guilt and shame.

All Life Functions End Completely at the Time of Death

Concept about Death When children can correctly identify what living functions are, they can also understand this concept

Death Is Caused by Physical Reasons

Concept about Death When children experience the death of a family member or friend, they must understand why the person died. They can watch for cues from the children and allow them to ask for further explanations. Graphic details are not necessary and should be avoided, especially if the death was violent.

Imaginative

Conceptually, developmental psychologists Jean Piaget (1962) and Erik Erikson (1976) contend that young children engage in __________ play to illustrate mastery over experiences, including those that have affective significance

Collaboration

Core concept of family-centered care - Patients and families are also included on an institution-wide basis - Health care leaders collaborate with patients and families in policy and program development, implementation, and evaluation; in health care facility design; and in professional education, as well as in the delivery of care

Participation

Core concept of family-centered care - Patients and families are encouraged and supported in participating in care and decision-making at the level they choose

Tear Soup: A Recipe for Healing After Loss by Pat Schwiebert and Chuck DeKlyen (1999)

Creates a metaphor for the bereavement process, comparing grief to making soup Appropriate for adults and adolescents, as well as some older school-aged children

Public Health Insurance

Critical to ensure adequate healthcare access and utilization among children of less educated mothers, regardless of family structure

The Baby Doe Case

Decided: April 1982 Baby was born with severe down-syndrome & a hole between the baby's trachea and esophagus. Case ruled that parents have the right to refuse medical treatment to their newborn children which allowed the baby to die (from starvation).

Preparations

Decisions made regarding _________ should be based on clinical experience in light of the best theoretical and empirical evidence that is available

Professional Wellbeing

Declines in ______ ______ are correlated with Decreased quality of care for patients Higher labor costs for medical corporations

Beliefs

Discuss your family's ________ bout death and what happens after death.

Professional Relationships

Discussions of __________ _______ tend to focus on those activities by the professional that are expected behavior, in those that may be dangerous or harmful to the client

Treatment

Distraction toys should be used only in the ________ room. This ensures their availability for procedures and helps to maintain the child's interest in the toys' novelty

Close

Distraction, relaxation, and guided imagery (open/close) the gate in the gate control theory

Geomancy Feng Shui

Divination by means of figures, lines, or geographic features. Purpose is to enhance energy flows and create a positive space Many of their suggestions are compatible with the requirements of the western technology, particularly with regard to structure and safety

Yes

Do Japanese people believe child life is important?

No

Do adolescents want to be the ultimate decision maker regarding their care?

Yes

Do children grow to accept death even though they do not understand it?

No

Do features such as "sociology of play, elaboration of language, and imagination" tend to differ across cultures?

Yes

Do infants remember traumatic experiences?

No

Do most North Americans believe child life is important?

Supplemented

Education for parents regarding normal growth and development must be _______________ with resources to address risk areas for each developmental stage

Coping

Effective ______ techniques have been found to include visual and auditory distraction, tactile stimulation, counting and singing, and verbal interaction

Problem Emotion

Efforts to cope may be _______ focused, _______ focused, or a combination

"Working with Children in Hospitals"

Emma Plank Describes the work of the child life and education Department at Cleveland Metropolitan hospital § Depends on the anecdote to show what the childcare worker can do § Notes individual differences of children's responses to illness and hospitalization and stresses initial and ongoing assessments of these responses

Bodrova and Leong (2015)

Emphasize play is not as a reflection of past experience but as an actual essential for the development of the future child

Autonomy vs. Doubt

Erik Erikson 1-3 years ISSUE: Reduced autonomy // Lack of opportunities for self-control // Separation anxiety CHILD LIFE INTERVENTION: Encourage normalization through play and exploration of environment and materials

Play Director

Facilitated the development of a school program for kindergarten in early elementary grades; Built in staff to library; Invited special volunteers to visit with nature projects, handicraft projects, and entertainments Engaged children immediately following being admitted and again when waiting to be taken to the OR

Empowered Families

Feel a sense of control and mastery over their situation as opposed to relying on professionals to meet their needs

Flow

Felt when the opportunities for action are in a balance with the players ability or skills.

Escape

Flow can be considered a form of _________

Creating Opportunities for Parent Empowerment (COPE)

Focused on increasing: - Parents' knowledge and understanding of the range of behaviors and emotions that young children typically display during and after hospitalization - Direct parent participation in their children's emotional and physical care

Movement

For swaddling and snuggling, minimize _________: lay side by side; cover the child's feet and arm with a blanket

Contact

For swaddling and snuggling, the caregiver laying by the side of the child maintains ________ with each other

Individual

For the _________, beliefs are influenced by such things as: - Past experiences with the healthcare system - Family members' and influential others' experiences - Thoughts and cognition - Biochemical/structural strengths and weaknesses - Culture - Socioeconomic statis

Back

For the kangaroo hug, chest to back contact allows the child to be hugged by the caregiver from the _______

Thigh

For the kangaroo hug, stabilize the holder's elbow and hand using the bed or the caregiver's _______

Philippe Aries

French Medievalist Published "Centuries of Childhood: A social History of Family Life" in 1962 - Perhaps the cause of this disinterest was that ephemeral nature of children, their vulnerabilities, their fragile lives before the modern era - Childbirth and infancy were perilous in the human story until modern times, and his rendering of the nursery lives of children is harrowing

Transference

Freud theorized that when people enter therapy, the way that they see and respond to their therapist will be influenced by two factors: - They will see the relationship in light of their earlier ones, especially very early childhood relationships - They will have a tendency to replay those earlier situations . It applies not only to clients of psychotherapist, but to all of us in many of our relationships

Permission

Give your child "________" to die, if you believe that will help.

Refocusing Attention/Choosing an Alternate Focus

Gives the patient credit for being engaged in planning and implementing their coping strategy Patient consciously chooses an alternate focus

Active Role

Giving parents and _______ _______ to play in assisting their child through a difficult medical procedure may be especially useful - Seems to counter the helplessness, distress, and anxiety that may come from observing one's child's discomfort and resistance

Postoperative Care

Giving parents information and education about __________ _________ appears to be related to less pain and postoperative vomiting in children

Hospitalization

Goal of a child life and education program -- Plank § Arrange specific opportunities for play under direction of a skilled worker where fantasies or traumatic experience in relation to ________________ can be played out and worked through

Social Distance

Hall — type of distance Expressed frequently and healthcare settings. The distance at which informal business takes place Thought to be between four and 12 feet

Personal Distance

Hall — type of distance Kept between individuals who know one another, or in private information must be shared Ranges from 18 inches to four feet

Intimate Dustance

Hall — type of distance Less than 18 inches Direct contact is not unusual

Public Distance

Hall — type of distance The speaker generally stands at least 12 feet from an audience

Preoperative Anxiety

Has been linked to increased incidence of separation anxiety, eating disorders, nightmares and fear of physicians approximately two weeks post-operatively

Music

Has been used in healthcare settings to cover up unwanted noise and to act as a stress reducer Parkin (1981) found that this reduced the stress of children prior to examination and a dental clinic

Creative Play

Has enormous power in promoting children's development and learning.

Touch

Has power implications If a student/employee were to return the gesture, it may be considered disrespectful

Height

Has power implications Still opportunities to be on the same level

Irrevocability

Has to do with the child's idea of death as permanent and irreversible, or temporary and reversible

Immobility

Has to do with the child's notions concerning the movement of the dead. The dead may be seen as totally inactive or partially or completely active

Vygotsky's Theory of Cognitive Development

He outlined features that he viewed critical and defining make believe play. One of these characteristics is the creation of imaginary situations that permit children to grapple with wishes that are not yet realized. Research exploring his assertions supports that claim that young children are able to consider numerous potential possibilities in a theoretical manner

Behavioral Coping Strategies

Humor Imagery Hypnotherapy Relaxation Techniques Muscle Relaxation Desensitization Modeling

Parten (1932)

Identified participation of children with others as criteria for her for levels of play Non-social activity Unoccupied Onlooker Behavior Solitary Play

Overwhelming Impossible

If a desired behavior change seems _________ or ______ to implement, patients or learners will not be likely to attempt to change their behavior

Help

If a family member is too distraught or needs help, bring in ________

Family Spaces

If spaces are not provided for family members, conflicts can occur with staff and opportunities for parents to care for their children may be curtailed. Adequate space for guest within the patient room is essential, and the basic needs of a parent who might be confined to the hospital for an undetermined period of time must be taken into account.

Level of _________ During the Event

If the child will be sedated, talk about what will happen while they're asleep If they will be sedated, talk about how they will wake up

Yes

If the gate it open in the gate control theory, are the patients in pain?

Model of Functional Emotional Development Levels

In Stanley Greenspan's ________ ________ ________ ________ ________ ________ (Greenspan, 1999), the first stage specifically identifies the importance of regulation of state and emotion as it relates to infants' abilities to focus on and attend to the sights, sounds, touches, tastes, and smells around them. In describing this stage, Greenspan also highlights the significance of infants' relationships with caring adults in the process of becoming interested and engaged with the world around them and in learning to regulate their reactions and states of arousal.

Zone of Proximal Development

In Vygotsky's theory, the difference between what a child can do with no help and what a child has the potential to do with guidance

Zone of Proximal Development (ZPD)

In Vygotsky's theory, the difference between what a child can do with no help and what a child has the potential to do with guidance

Public Territory

In a hospital, this would be the dining room

Dr. Roger Ulrich

Included the provision of a sense of control as one of his for primary health facility design guidelines

Causality

Includes both abstract and realistic causes of death, or internal and external factors

Professional Practice

Includes continued education through ongoing reading of the current literature, participation in professional workshops, and clinical supervision that includes self-awareness and personal reflection, all of which promote integration of personal and professional responses.

Nursing Practices

Inconsistent _______ _______ created nurse-patient boundary issues on a cardiac step-down unit related to confidentiality, limit setting, and professionalism with children awaiting organ transplantation and their families

Distances

Increased stress associated with hospitalization was correlated with increased _____________ from nurses, doctors, and male strangers

Prolonging Life

Increasing the length Preventive care, exercise, surgery, etc

Protest

Initial stage of separation anxiety for older infants An active and aggressive response to the absence of the parent, and is characterized by crying, screaming, or kicking while constantly watching for signs of the parents return. The child refuses the attention of anyone else, and seems inconsolable. May last from several hours to as long as a week

13-17

Injuries, including leg injuries, medication poisoning, and head injuries, are among the top reasons for hospital stays for ____ to _____-year-olds

Proxemic Behavior

Integral to the concept of personal space

Choromotherapy

Intention is to cure illness by exposure to specific colors or color palettes.

Cognitive Understandings

Interactive, exploratory experiences, both features of play in unstructured social environments, enhance ____________ _____________

Collaboration

Interdisciplinary communication and understanding enhances _______

School Ager (6-12 years)

Interventions Maximize parental involvement Maximize parental information Encourage education and teacher involvement Facilitate medical play and information Promote therapeutic play

No

Is preparation a linear process?

Rapport

Key strategies for building _________ included asking the child questions about topics such as age, grade in school, pets, or the number of siblings.

Transtheoretical Model

Key tool for changing behavior at the individual level STRATEGIES TO EFFECT CHANGE - Political action - Planning, needs analysis, and evaluation - Grassroots movements DISCRETE STAGES - Precontemplation - Contemplation - Preparation - Action - Maintenance

Technical Interactional

Knafl, Breitmayer, Gallo and Zoeller (1992) documented this development of an alliance and described it as a blend of ________ and _______ competences. The study emphasized that although parents valued and needed providers' expertise, it was the compassion and respect that were consistent components when describing outstanding health care encounters

Importance

Knowledge about play helps child life specialist to articulate the _______ of play to those who do not have this information, but we must also value play because it belongs to the children and because it is enjoyable

Content of Play

Largely the result of a transaction between children and the environment

Transactional Model

Lazarus and Folkman's (1984) _______ _______ developed for adults is the model most commonly applied to children After judging the stimulus as stressful, the individual performs a secondary appraisal to determine what can or might be done to address it. After appraisal, the individual uses some form of cognitive or behavioral coping effort

Process

Lazarus's work (1966) began to shift the emphasis of study from a stimulus-response perspective to a _______ orientation of psychologically coping with stress

Teaching

Learning from others is as important as _______ for chiild life care

Research Nurse

Licensure 2 years' nursing experience

Not Play

Literal, with intense, neutral (or intense) effect, inflexible or predictable

Interactive

Live, ______________ programming can be a particularly effective way to engage patients restricted to their rooms for infection control or medical reasons

Hidden Meanings

Look for ______ _______ in your child's questions or comments.

Signs

Look for ______ that your child is ready to talk

Done

Look for signs that your child is _______ talking

Psychological Preparation

May contribute to the optimal emotional adjustment of children and families to hospitalization, health care, illness, or other potentially stressful events.

Prevention

May provide ample opportunity to define at-risk individuals and intervene before symptoms become severe

Eclectic

More often child life specialists are _______, knowing a little about several approaches to clinical work This _______ nature of child life does not allow for the tight, theoretical parameters that are a condition of almost all therapies

Clinical Relationship

Mutual Relationship Type

Consistency of Care Giving

NIDCAP Developmental Care Environment Each infant is assigned a primary multidisciplinary care team that includes the family to create an individualized care plan

Supports During Transitions

NIDCAP Developmental Care Environment Infants often need increased support between caregiving activities in between sleep and wakeful periods

Opportunities for Skin-to-Skin Holding

NIDCAP Developmental Care Environment Kangaroo care encourages respiratory stability and more restful sleep for infants, while helping parents to feel less anxious and more fulfilled

Newborns Neonates

Nearly 2/3 of all childhood hospital stays are for ___________ and ____________

Stress Coping Framework

Not all people respond to the same set of potentially stressful circumstances in the same manner, with some experiencing extreme distress, while others are relatively undisturbed. Explained by the complex relationship that occurs between the potential stressor and the individuals perceptions of, or appraisals about, the stressor

Hugging

One of the comforts of childhood that is not abandoned in adulthood and that benefits nearly everyone during stressful times. Limits the child's movement, is a positive and comforting act, and offers a serendipitous advantage - that both arms stiffen in order to _______.

Play

One of the few places of comfort that children can return to on a regular basis during times of stress. Provides children a place where they can restore themselves, a place that has healing potential, a place of safety

Child Life

One of the most progressive, useful, and humane programs to be initiated in recent years.

Creative Play

Painting with syringes Messy activities Body tracings Graffiti posters Drawing/stories Progressives stories (mad libs) and drawings Hospital books

Philosophy

Palliative Care is both a _______ and a program

Do not

Parental evaluations of the care received by their children (do/do not) accurately represent children's views

Positive

Parental involvement in children's play in medical settings may have a (positive/negative) effect on children

Assent

Part of autonomy is ______

Interdisciplinary

Patient and family satisfaction data an ________________ team member feedback further confirmed the positive effects of child life programs on children, families, and staff

Adverse

Patients who expect negative outcomes are more likely to have ________ outcomes

Child Life Specialist

Pediatric patients who interactively played with a ________ ________ _________ exhibited less preoperative anxiety than the children who did not receive play opportunities with a specialist.

Harder

Pediatric specialists say the failure to discuss death — with children who are old enough to understand the concept and who wish to have the conversation — can make it (easier/harder) for all involved

Accommodation

Piaget Brought about by disequilibrium, information is adapted or organized in a new way

Play by Proxy

Playing next to someone who may be unable to play will give them the same benefits as if they were playing themselves

Rubin

Pointed out the eclectic nature of the staffing programs made it hard to find a name inclusive enough to take into account all the child life does

Sensory Coping Strategies

Positioning Movement Soothing Touch Massage

Parents

Preparation activities must fully incorporate _______

Strengths

Principle of family-centered care - Recognize and build on _________ of child and family

Empowering

Principle of family-centered care - ________ each child and family

Respect

Principle of family-centered care - _________ for child and family

Choice

Principle of family-centered care - _________ for the child and family on healthcare options

Flexibility

Principle of family-centered care - __________ in organizational policies

Healing

Process of becoming physically and psychologically whole again

Procemic Theory

Proponents of ____________ ________ suggest that different cultures have different spatial behaviors. Awareness of these cultural differences is critical in contemporary health settings. Caregivers are serving multicultural communities, so awareness of differences between groups will enable them to increase their effectiveness

Melanie Klein (1932)

Proposed using play as a direct substitute for verbalizations during children's therapy sessions. Whether children were emotionally disturbed or not, they felt that play was a natural medium of expression for young clients. From their point of you, play was the childhood equivalent of free association

Language

Quality play promotes ________- Talking with your baby and toddler about what is happening around him while playing and responding to his sounds, words, and gestures lays the foundation for healthy brain development, as well as future success learning how to read and write at school.

Thinking

Quality play promotes _________ skills. The kind of play described in this guide, gives your child the opportunity to learn concepts and problem-solving strategies which are critical for future academic learning in science, math and literacy.

Thinking

Quality play promotes _________ skills. The kind of play described in this guide, gives your child the opportunity to learn concepts and problem-solving strategies which are critical for future academic learning in science, math and literacy.

Patient + Family-Centered Care

Recognizes the family as the constant in a child's life and seeks to empower patient and family members at every opportunity- Fosters collaboration with families in the care of individual children and in planning and program development for hospitals and other healthcare settings- Evident in mutually respectful parent and professional partnerships

Predictability

Recognizing the outcome Allows siblings the ability to experience first hand the inevitability of an impending death

Patient-Centered Outcomes Research Institute (PCORI)

Reduces the confusion in the wide range of complex and often-perplexing choices in healthcare

Respect for Autonomy

Refers to respecting patients' rights to make decisions about their own healthcare

Insecure Attachment

Reflect the child's experience of a pattern of inconsistent or dismissive responses to his/her bouts for attention during times of discomfort, distress, or pain

Clinical Relationships

Reflect the simple fact that a professional and a client are in a relationship in which some sort of clinical services provided by the professional to the client. There is no implication of interpersonal trust, integrity, or empowerment in the reality of a clinical relationship. Hierarchical and assumes that some knowledge or ability of the clinician is being transferred to the client or patient.

Attachment

Reflects the relationship between the quality of care provided by a caregiver (parent or surrogate) as it affects the child's confidence in the availability of the caregiver

Distraction

Refocusing attention Implies that the CLS is active in choosing an item for __________ the patient's attention while things happen behind the patient's back Implies little respect for the profession and for the patient's active participation.

Emotional Based Coping

Regulating emotion and response Behavior aimed to regulate the emotion responses

Therapeutic

Relating to or dealing with healing, especially with remedies for disease Providing or assisting in a cure

Mutual Unilateral

Relationships can be _______ or _______

Psychological Safety Freedom

Reported to be essential elements in home environments that produced creative potential in adolescents. In order to be creative, children need free, uninterrupted time to think and engage in reflective abstraction

Adolescents

Require space that is comfortable and not located in the same waiting area as younger children

Coping Facilitation

Research demonstrates that preparation in ________ ___________ interventions decrease the need for sedation and procedures such as MRIs, resulting in lower risks for the child and cost savings in personnel, anesthesia, and throughput related expenses

High

Research documenting the importance of developmental care principles for newborn intensive care unit to have demonstrated that (high/low)-risk infants have improved medical outcomes, including decreased intercranial hemorrhage is, reduce severity of chronic lung disease, improved growth, and earlier discharge

Sociodramatic Play

Research found that children who engage in complex forms of this type of play, compared to those who do not, displayed greater language skills, better social skills, more empathy, greater imagination, and a stronger understanding of the communication of others

Personal Space

Robert Sommer (1969) defined this as an area with invisible boundary surrounding a persons body into which intruders may not come Thought of as the imaginary bubble around oneself that defines one's relationship with others

Emotional Readiness

Sense of being as prepared as possible to face impending situations

Culturally Competent Care

Sensitive to individual family values and avoids stereotypical models of communication or the assumption that one's own background is the norm and the patient and family's background is diverse

6-8 months

Sequence of language acquisition: - Babbles - Attends to their own name

4-6 weeks

Sequence of language acquisition: - Coos

Newborn

Sequence of language acquisition: - Cries as first means of oral communication

36 months

Sequence of language acquisition: - Has receptive language of about 800 words - Understand simple prepositions

"Yes, and"

Shows a willingness to follow the child's lead and participate playfully without knowing exactly what will happen next

Present

Siblings who are ________ with the family and extended family are better able to cope with a stressful event

Type of Admission

Source of stress for parents during a child's acute illness Expected — with time for planning Unexpected — from Clinic with need to change family routines quickly Emergency — most stressful due to suddenness of illness or injury

Length of Stay

Source of stress for parents during a child's acute illness How long the child is in the hospital

Arousal-Seeking Theory

States that children need to be continually involved in information processing, but that play is the way children mediate the amount of stimulation to achieve an optimal level of arousal

Positioning for Comfort

Stephens, Barley, and Hall (1999) Model for working with children and parents The positioning of children supported by their caregiver during invasive procedures also addresses psychosocial issues around trust and autonomy during the early years Have become an indicator of quality in healthcare practices to encourage the active engagement of parents and children during stressful events

Positioning for Comfort

Stephens, Berkeley, Hall (1999) Presents a model of working with children and parents Positioning of children supported by their caregiver during invasive procedures address of psychosocial issues around trust and autonomy during the early years Has become a indicator of quality in healthcare practices to encourage the active engagement of parents and children during stressful events

Ethical Dilemma

Steps for Resolving an ______ ______: - Identify the problem - Consult a respected peer, supervisor or ethical review board - Is the conflict a matter of knowledge, emotion, or personal needs? - Decide on a course of action

Nature

Steve and Rachel Kaplan (1989) suggested that her preference for the outdoors as a result of the critical contribution to our survival that is provided by an understanding of ________. According to the research, the nature scenes that have the most appeal to those that balance interest with understandability.

Lazarus

Stress and coping Individual appraisal Cognitive and behavioral attempts to manage stressful situations Behavior is affected by the level of understanding

New

Stress levels for siblings are higher with a ______ diagnosis of progressive illness as opposed to a previously diagnosed condition

Lewandowski, Good, and Draucker, 2005

Studied the effects of guided imagery on the level of pain and chronic pain sufferers over time Participants used a 7-minute tape of guided imagery exercises three times a day over four days Pain is never-ending Pain is relative Pain is explainable Pain is torment Pain is restrictive Pain is changeable Massive changes in pain perception

Control

Studies have shown that the negative aspects of environmental stress can be mitigated when individuals feel they can control their space

Pain

Subjective Can be relieved by guided imagery

Symbolic Play Dramatic Play

Substitution of an imaginary situation to satisfy child's personal needs and wishes

Role of Change

Successful work with families is strongly related to the extent to which healthcare professionals adopt the ______ _____ ______ agent

Vygotsky

Suggested that even young children are capable of reasoning in a theoretical manner, particularly when engaged in fantasy play. He maintained that entering the pretend play mode enables young children to approach to situations in a "as if" fashion and to consider experiences not only in the here and now but to entertain the theoretical ideas.

Erik Erikson

Suggested that play provide young children with a way of safely processing difficult experiences and restoring a sense of mastery over these situations

Groos (1914)

Suggested that play was the body's natural way of preparing for the task of adult life

5

Supervisor support is the most important for those who have practiced less than ___ years

Distress

Support children in healthcare experiences at any time of ________ related to medical procedures

Procedures

Support during _________... - minimizes stress - reduces pain - increases feelings of control for the patient minimizes long-term coping difficulties - minimizes anxiety and depression - encourages compliance with medical treatment - makes the job of healthcare professionals easier

Medical Staff

Support from ______ _____ is the strongest predictor of burnout

Supervisors

Support from ______ is the strongest predictor of turn-over intentions and a strong predictor of job dissatisfaction

Parents

Supporting __________ in the NICU helps reduce stress and positively affect the parent infant relationship over time

Healthy Self

Supporting and facilitating flow experiences with children can also enhance the awareness of the "______ ______," which is essential for children who are sick, injured, disabled or traumatized

Brain

Supporting and protecting the infants developing nervous system improves _______ functioning

Sociopetal Seating

Supports conversation

Beliefs

Systemic conditions that have the potential to make healthcare provision for families more or less effective: - Adherence to scientific and biomedical ________ about healthcare

Alternative Practice

Systemic conditions that have the potential to make healthcare provision for families more or less effective: - Home care and other ________ ________ settings

Access

Systemic conditions that have the potential to make healthcare provision for families more or less effective: - Poverty and inadequate ________ to healthcare resources

Sensory

Techniques categorized as _______ rely on sound, touch, or movement to enhance the child's coping capacities

Positioning

Teens have more positive results when they are given a choice of __________

Timing

Tell other children about events at least a week in advance to allow them to acclimate to the information and to plan and rehearse their preferred coping strategies

Easy Child

Temperament Type Adaptability and positive mood May show anxious behavior at times that can be addressed by interventions

Honesty

The Golden Rule

Guide

The ability to ______ children through multiple dimensions and processes of play, according to their developmental and environmental needs, is a competency core to the practice of child life

Resiliency

The ability to return rapidly to a previous psychologic or physiologic state Protective factors that encourage this and children focus on involvement in action and the ability to give directions More likely to develop in children if they are helped to perceive experiences constructively, are supported with policies that lessen separation from family members, and are encouraged to express their feelings

Threat

The absence of a parent during a critical period may signal a greater _______ to the child

Sociodrama

The action of ___________ can facilitate the creation of previously unconceived possibilities, which can lead to the expression and containment of feelings, more effective problem-solving and coping, the reduction of stress, and the development of more hopeful future images

Self-Awareness

The adolescent's quest for acquisition of skills and development of individual talents reflect this growth of ____________ and need for identity clarification

Indian Vastu

The art of correct setting in order to optimize field surrounding the earth Five components: orientation, theory, proportions, cannons of Hindu architecture, and character Hospitals fall into the category of public buildings: 105 categories of architecture established an ancient texts

Verbal First Aid: Help Your Kids Heal from Fear and Pain--and Come Out Strong

The authors explain the connection between the mind and the body, and how words can promote healing during times of pain and crisis. Protocol for communication that encourages healing and recovering physically and emotionally from a crisis. It is based on the idea that the specific language used when talking about an illness, procedure, or traumatic situation will impact the way that the event is processed by the patient, and in turn, the way the next crisis is approached.

Realization

The awareness of death, of the state of being deceased, or an event which happens Death can happen to someone, or it can be something which makes the living die

Play Partnerships

The challenge for child life specialist is linking the elements of play, imagination, and attention on one hand with motivated feelings on the other hand. The essence of this cannot be systematically described in existing research, but evolves as each individual, ongoing relationship progresses

Goodness of Fit

The challenge for childlike professionals involves providing a supportive environment that matches the needs of the child with the demands of the healthcare setting

Distress

The challenge to the child life specialist is to recognize and understand these differences between children and members of their families and attempt to tailor interventions to support coping and ultimately reduce the degree of _______ experienced

Physician

The child feels feels comfortable and safe in a waiting area designed especially for children may more easily adapt to being treated by more than one familiar and trusted ____________

Self-generated Play

The child initiates and controls actions

Autonomous

The child life program should be ________, have a budget for staff and supplies, be given adequate space for activities and storage, and assume responsibility for training and supervising volunteers in its service

Strategies

The child life specialist may influence the secondary appraisal. This can be done by helping the child to identify, practice and implement _______ that are compatible with the demands of the situation and that are perceived by the child as effective

Sensory

The child's understanding of explanations, and in turn the nature of one's primary appraisals, may also be enhanced through incorporation of "_______" information -- the conveying to children through descriptions and descriptions of the sensations

Preparation Social Support

The combination of _______ and _______ _______ results in lower anxiety for parents and children

Play

The comfortable environment in which children learn to solve different kinds of problems. When they are faced with the more complex reality of the world, they are able to reapply the learning that took place during this period

Rubric

The concept of stress, according to Lazarus (1966), is not a variable but a _______ consisting of many variables and processes

Shuttle Diplomacy

The concept that all parties will be listened to, but ultimately it is the responsibility of the parent to make the decision

Inclusive

The definition of family is more _________ than mother, father, and child

Access

The entry and reception to the hospital she provided support of experience for children and their families by being welcoming, accessible, clearly designated, and of the appropriate scale. The side of the facility should be designed to be psychologically supportive by clearly indicating destinations locations, by supporting convenient access to buildings, and by being safe.

Chronic Pain

The experience of _______ _______ is also associated with patterns of disengagement and isolation Participants viewed pain as a physical problem that was invisible to people around them and believed it isolated them both physically and emotionally. They often hid their condition Many perceived others to hold disapproving views of the pain Pain closed up communication with family members, and patients were often concerned over the effects it had on the family system. It was common for participants to perceive that their pain was not believed.

Boredom

The experience of flow has a feeling of purpose and self-control period when one's skills or abilities are greater than the opportunities for using them, a state of _________ results, which can fade into anxiety when the ratio between skills and opportunities becomes too large

Limbic

The extreme sense of danger, combined with the perceived inability to escape or cope in PTSD leads to a sudden shift of thinking from the higher order cortical areas to the primitive, lifesaving responses in the brain's _______ system

Included

The factor that may have the greatest impact upon a child's ability to cope with the critical illness and potential death of a sibling is the degree to which he or she has been _______ in the illness and death experience

Supportive Relationship

The factors of trust, warmth, interpersonal positive regard and focus on empowerment of the client or patient are all more definition of a ________ _______

Do-able

The goal of preparation is to influence the individual's stress appraisal so that they feel it is "____________"

Compassion Fatigue

The gradual decline of compassion over time as a result of caregivers being exposed to events that have traumatized their patients.

Sensitive

The healthcare professional must be ________ to the family's readiness for specific messages

Nonjudgmental

The healthcare professional must convey acceptance and warmth by being __________ and must develop a high level of immunity to being embarrassed, shocked, dismayed, or overwhelmed by the child or family member's thoughts or behaviors

Receptive

The healthcare professional must exhibit a ________ attitude that demonstrates value for feelings, opinions, individuality, and uniqueness

Commitment

The healthcare professional must show a high level of _________ to understanding through a willingness to explore subjects that are important to the family

Farther Away

The higher the mental age of the children, The (farther away from/closer to) themselves they would place a silhouette of someone they disliked

Middle Knowledge

The idea that terminally ill people can know that they are dying yet at the same time not completely grasp or come to terms emotionally with that fact

Autism Spectrum

The increase in patients diagnosed with _________ ____________ disorders has presented opportunities for childlife specialization in supporting this population in the medical setting

Attachment Relationships

The influence of the quality of parent-child relationships on the healthcare experience of both the child and the parent can be informed through an understanding of __________ ___________-

Increasing

The influence of the social world on children's thinking coincides with ____________ knowledge in the development of functional structures

Observations

The information children take in about an event is not always didactic in nature and may be influenced by their _______ of people and activities in their environment, either through incidental events or deliberate presentation

Control

The interpersonal aspect of play allows children to engage in activities and behaviors that they can _______, which is essential for children feeling overwhelmed by emotions and events

Recall

The language used in play and discussion is also likely to become the language used to _______ the event

Siblings

The least prepared members of the family to except a medically frail child as part of the family unit

Worst

The majority of the ________ experiences of children in hospitals were related to physical care, treatment and symptoms

Cognitive Appraisal

The mental judgement about a stressor An evaluative process that determines why and to what extent a particular transaction or series of transactions between the person and environment is stressful Intervene between the encounter with the stressor and the resulting reaction

Supportive Relationships

The more technical and concrete the activities of the therapist, the less need there is for, or the less use there is of, _______ _______

Child Life Program

The most common _______ ______ ______ consists of a team of child life specialists working together, often within a children's hospital

Appraisal

The most commonly used definitions of stress, stressors, or stressful situations today considers both external and internal factors and includes the additional feature of _______

Needle Stick

The most frightening procedure for children in the hospital setting because it often results in pain and distress.

Lazure Painting

The multi layered, semi transparent technique varies intent from blue to rose depending on the health status of the patient

Staff Spaces

The native the staff are often overlooked in hospital design. When staff needs are not considered, staff morale may be low in existing patient spaces may have to be usurped for staff functions. Environment support support privacy and staff collaboration will indirectly benefit patients by supporting the psychologic State of caregivers

Seasonal Affective Disorder (SAD)

The negative psychologic state associated with the lack of exposure to daylight during winter months.

Appearance

The notion of the way the dead look

Playroom

The only truly safe place should be the _________ where children may safely engage in play activities without the fear of intrusive examinations or procedural tasks being completed

Imaginative Play

The opportunities for patients ________ _______ experiences need to be maximized by child life professionals to support children and establishing hope and developing resilience as they cope with illness, injury, health care, and other life stresses

Adaptive Maladaptive

The outcome or results of coping efforts is either _______ or _______

Symbolic Themes

The preschool years, termed by Singer and Singer (1979) as "the golden age of social-dramatic and make-believe play," are characterized by the gradual expansion of children's play in to very complex ____________ ____________

Family Members

The presence and participation of _________ __________ is a fundamental component of patient and family centered care and has a significant positive effect on a child adjustment to the health care experience

Social Support

The presence of ______ ______ during waiting periods can decrease fear and anxiety

Common Goal

The presence of a _______ _______ that supersedes individual goals is a distinguishing characteristic of collaborative relationships

Threat

The presence of a parent who is uniformed, unwelcomed, uninvolved, or anxious may also increase a sense of _______

Successfully

The presence of parents who are confident, knowledgeable, and supportive can positively influence this appraisal and may also contribute to the child's secondary appraisal that a challenge can be _______ met

Parents

The presence or absence of _______, as well as _______' own levels of comfort and understanding, can affect the appraisals children make regarding their circumstances

Stressful

The primary appraisal can be further influenced by providing the child with information about the potentially _________ circumstances

Environment Policies

The primary appraisal may be threatened, which may involve alterations in the ________ or modification of _______.

Play

The primary communication tool for children, and intrinsic motivator that allows for the natural integration of meaning, process, and mastery for a developing child

Preparation

The primary goal of _________ is to reduce the fear and anxiety experienced by a child who is undergoing a medical procedure and to promote his or her long-term coping and adjustment to future health care challenges

Psychological Preparation

The process of providing or enhancing psychological preparation can be initiated at varying times in context with children and families. It may begin as soon as one knows an event is to happen -- *advance preparation* -- during the actual event -- *emotional support and facilitation of coping* -- and may even be continued *after* the event has concluded.

Grieving

The process of responding to the loss and adapting to the loss. Normal, healthy response. Not something to "get over" One does not need to "recover from" this

Coping

The process through which the individual manages the demands of the person-environment relationship that are appraised as stressful and the emotions they generate

Psychological Stress

The product of a relationship between the person and the environment that is appraised as taxing or exceeding his or her resources and endangering his or her well-being

Systemic Conditions

The provision of healthcare services to families is affected by a number of ________ _______ that describe the environment within which the healthcare professional must operate

Therapeutic Supportive

The psychotherapist probably utilizes both __________ relationships and __________ relationships most of the time in clinical practice

Coping Strategies

The specific efforts to manage stressful demands May be external, observable behaviors or internal processes

Relation

The state of being mutually interested or involved

Relationship

The state of being related

Ecstasy

The state of flow creates a compelling, highly motivating feeling of mild ______ that seems to be a by product of the heightened focus that is a requisite of flow

Bereavement

The state of having experienced a loss

Unexpected Menstruation

The stress of having a procedure or surgery may bring on _______ _______

Role Ambiguity

The strongest predictor of burnout and job dissatisfaction

PTSD

The strongly engraved pathways in _______ include more details than memories of more typical and manageable situations. Any component of these highly developed pathways that recur, even isolated and in another context, can easily trigger re-entry into the state of high alarm and sense of danger

Carl Rogers

The theories behind the work of _______ _______ led to a therapy that required warmth, genuineness, a positive regard from the therapist toward the patient. Overtime, in an effort to equalize the power in the client therapist relationship, the therapist moved to an even more open relationship with patients , offering loving support, the sharing of feelings, and sometimes confrontation

Need

The therapeutic relationship moves through several stages, but it is goal is to prepare the client and or family for the time when they no longer _______ the professional

Termination Phase

The third and final phase of therapeutic relationships identified by Stuart and Sundeen (1995) During this phase, the focus is on ending the relationship, not on establishing new material. Closure for both the client in the professional is important here and is usually achieved by summarizing the previous interactions and accomplishments

Dramatic and Sociodramatic Play

The third stage of play for Piaget. In this stage children create imaginary roles and interactions and use objects, actions or words to represent items or situations. This form of play is similar to the second stage, except that the dramatic play increases in frequency, the play themes tend to be more sophisticated, and the play is much more social. Characteristics reflect those exhibited in Parton's fourth stage, cooperative play. Children can be observed sharing play themes, mutually determining dramatic play roles in negotiating scripts and actions. Children in the stage must use considerable intellectual skill to imagine the sequence they will play out with their peers and negotiate their desired roles

Prevention Restoration Cure

The three primary purposes of play in health-care settings

Certification Membership

The top two-rated features when asking members to rate usefulness of the CLC's q6 programs and services, were online _________ and _________ management

Play

The vehicle through which children can best internalize new information

Coping Style

The way an individual routinely uses certain types of strategies to manage his or her world Does not describe the specific actions an individual will use in a particular situation

Power

The way in which professionals and patients interact depends in part on how they use their ________

Lawton and Nahemow

Their theory, the press competence model, suggest at the more compromised patients are with regard to their physical or emotional health the more susceptible they may be to negative aspects of the physical environment Environments with a high level of *press* (very challenging) are appropriate when the competence level of an individual is high When competence is low, and overtaxing environment is not suitable

Patrick (1916)

Theorized the purpose of play is a renewal of energy where in children used to play to avoid boredom while they waited for their energy levels to be restored

Jean Piaget

Theory of the development of intelligence Taught us to listen to children in a new way, to observe their language and play and you tease out the internal logic of the imaginative constructs

Clinical Nonclinical

Therapeutic relationships provide both _____ and ______ services

Explore the Available Resources

There are an abundance of credible resources that examine play across various disciplines and from various perspectives

Clinical Treatment

Thinking of families as systems embedded in larger ecological systems may yield critical intervention points and opportunities to reinforce and enhance _______ ______

Psychoanalytic

This interpretation of place suggest that young children use play as a medium for self-expression that can reduce anxiety caused by internal conflict. It has been suggested by many theories that place serves as a neutralizing medium by which young children manipulate Traumatic or anxiety inducing situations in an attempt to gain mastery over the event

Mid Adolescence

This period ranges from age 14 to 18 and is described is the most difficult time for an adolescent to be hospitalized it is during this time when the peer group is especially important to developing self image and independence, and doubts about sexual functioning are of greatest concern

Boundaries

Those limitations or barriers that keep some things in and keep other things out

Adult Intervention

To be effective, this must allow opportunities for children to be emotionally involved in the play and facilitate resolutions to the issues children demonstrate in the play This requires knowledge of child development in the impact of psychic stressors faced by children in traumatic and unfamiliar situations. This does not negate the value of families, medical pushing out, and others playing with children in healthcare settings. It does say that the role of child life specialist, in assessing anxiety, determining coping capabilities, and planning therapeutic play opportunities, becomes more demanding

Loss

To be separated from and deprived of a valued person, object, status, or relationship

Information

To prepare for invasive procedures, parents and children need ________ about a procedure's importance to the health or diagnosis of the child

Emotional Based Problem Based

Two types of coping

Clinical Referral Specialist

Two years oncology experience RN

Context Content

Type and forms of play are a result of _____ and _____

Modeling Interventions

Typically develops using delivery modes that capture the attention of the target audience

Child Life Assistants

Typically required to have core college coursework and experience with children and group settings Generally focus on normalization, play activities, coordinating special events, and maintaining the playroom Actively participate in the orientation, training, and supervision of volunteers Enables the CCLS to conduct an assessment in delegate as appropriate

Landscaped

Ulrich found that driving through landscaped areas resulted in lower blood pressure and higher preference than bill boarded, urban areas.

Parental Needs

Usually revolve around: - Knowing the expected outcome of medical treatment - Being given honest answers - Being assured that the best care is given - Seeing and visiting children frequently - Being notified of any changed in the condition of their children

Hospice Care

Usually used when a person has 6 months or less to live

Playing with Hope

Vandenberg (1986) suggests that an additional way of looking at fantasy players to view it as children "________ _______ ______." He posits that perhaps children are constructing a basis for hope that may change their lives just as adults do via mental fantasy play. Fantasy play, whether merely imagined, or eventually played out, is the very stuff of life for both children and adults

Friendship

Varcarolis (1994) delineates three types of relationships: - friendship (social) - intimate - therapeutic (professional) He defines _________ as when "mutual needs are met during social interaction

Stabisimus Repair

Vaughn (1957) described an experimental condition in which two groups of children were admitted to the hospital for _______ _______ The experimental group met for 15-25 minutes with a psychiatrist who reassured and supported each child and provided a brief, developmentally appropriate explanation of the surgery planned for the following day. The control group demonstrated more severe and persistent emotional disturbance

Psychosocial

Was Erickson a cognitive or psychosocial theorist?

Negative

Well-conceived and evaluated prevention programs have the potential to reduce _________ health outcomes

Stressful

What a child finds _______ is closely related to his or her age, gender, and developmental level

6 months 3-4 years

What age groups are the most vulnerable?

Public Social Personal Intimate

What are the four types of psychologic distance identified by Hall?

Invasion Violation Contamination

What are the three ways that Lyman and Scott (1967) said a territory may be disturbed

Fear of the unknown Loss of control Fear of pain

What are three things that children in healthcare experience?

Parent Training Spaces Single-room NICUs

What are two trends in hospital design?

Social Ambiance

What do philosophies on healing environments generally address over physical space?

Privacy Social Interaction

What do you opportunities should healthcare environments provide? Can be accommodated through seating and furniture configuration, furniture and casework design, room configuration, and floor plan layout

Humanize Death

What does "demedicalizing death" mean?

Acceptance by Peers

What is of great importance to school aged children. Play often reflects this

Chin

What is the most powerful part of the body? When in the air, considered superior, condescending, or confrontational

1:15

What is the recommended ratio for child life specialist to inpatients?

End

What part of the stay in a hospital does beauty and aesthetic experiences in sensory integrity become more prevalent?

Comfort

When child life specialists facilitate opportunities for play, they are creating places of _______ with children that support them in sharing and containing feelings of worry, despair and anxiety.

Words Actions

When children are ill, their parents are in crisis, making them vulnerable to the healthcare provider's _______ and _______-

Optimal Capacity

When children experience flow, they are living at ______ ______, they are actively engaged in the present and they are facing life with feelings of control and opportunity

Cooperative

When children experience intimidating medical interventions, such as an anesthesia mask induction, the children who are least ____________ are those who lack preparation for what to expect

Finders Solvers

When children see themselves as problem _________ and problem _______, they develop curiosity about their world and confidence in their ability to figure things out for them-selves.

Non-pharmacologic

When combined with preparation inappropriate pharmacologic interventions, ___________________ strategies for pain and distress management have proven successful in terms of patient and family experience, staff experience, and cost effectiveness

In Progress

When events are imminent or _______ ________, efforts to provide brief explanations of components of the events as they unfold into facilitate coping maybe more prominent

Postvention

When it is too late for preparation: - Post procedural play or _________ --- Recovery and reframing --- Replay the event through play, art, etc --- Medical play --- Planning for future events

Symptom

When mentioning medicine, link it, if possible, to treating a specific _______ in the child.

Direct Communication

When parents are able to have _________ ________ with providers, the result is increased parent and staff satisfaction, and nurses report decreased time in mediating family communication with the medical team

Actively Rehearsed

When playing through stressful events with children, it is important that the ideal coping behaviors be _______ _______

Exploration

While explaining procedures to the parents, offer the child an opportunity to _______ the various medical equipment that will be used during his or her surgical experience Show the child and parents where they will be on the day of the surgery

John Locke

While he did not actually condemn play, he was clear that in a Puritan culture of the times, work, rationality, and discipline were the primary ingredient needed for a child's development

Consolidating

While play is not synonymous with learning and Piaget's cognitive theory, it can facilitate learning by ____________ newly learned behaviors

Family

Who has the greatest impact on a babies health and well-being?

Siblings

Why are ________ of hospitalized children susceptible to stress and coping concerns in the event of hospitalization? - Limited concepts of illness - Limited bodily understanding - Still developing socio-emotional skills, coping skills

Boundaries

Why do we need __________

Liminal Spaces

Wilson argues that children need to experience ____________ _____________—places of ill-defined purpose—for it is in these that children enjoy the wonders of play most fully

Distraction

With _______, there is the implication that the caregiver is active in choosing a device for distracting and in controlling the child's attention while events unfold before the child's back

Chronic Illness

With ________ _______, the opportunity exists for professionals and patients to come to know each other over a long period of time, and therefore for the possibility of a connected relationship to develop Both parties come to understand and appreciate each other as people, and often share on a personal level the pain of loss and the joy of successful adaptation that accompanies living with _________ _______

Decreased

With increasing procedural invasiveness, parental desire to be present (increased/decreased)

Proposal

_______ Checklist

Family Members

________ ________ should tell the child about the death

Maladaptive

____________ behaviors observed in the child are believed to result from a lack of sensitivity to the child and an increase in stress

Observations

_____________ i've play allow child life specialist to consider the social patterns of interaction and activity level that are informative of a child's prior experiences with play, social skill development, peer relationships, cognitive and physical strengths and limitations, as well as competence with social or healthcare related situations

Therapeutic

_____________ properties of play are utilized by child life specialist as a means to allow children to become active participants in the environment, expressed thoughts and feelings and practice emotional control over difficult issues

Parental Participation

______________ ____________ in toddler interventions is important, both to provide security for the toddler during new experiences, but also to lessen a parents anxiety by allowing the parent to engage in anticipatory coping

Expressive

______________ therapies can be offered to complement child life programs and to provide support for particularly vulnerable patients

Physical

__________awareness is only a minute portion of the entirety of human awareness.

Pediatric

child life services should be included in the hospital operating budget as an essential part of hospital based __________ care

Sibling

n 2010, the American Academy of Pediatrics (AAP) released a policy statement to protect ________ donors by recommending a donor advocate meet with minor donors prior to donation.

Instructors in Child Life

§ Minimum of a master's degree or post-baccalaureate advanced training in child life, child development or closely related field § Credential as a Certified Child Life Specialist (CCLS)

Powerful Professionals

(Powerful/Powerless) (Patients/Professionals)

Powerless Patients

(Powerful/Powerless) (Patients/Professionals)

Placebo

No-specific positive outcomes in a treatment setting

Staff

Think of yourself not only as a family service but also as a ______ service

Developmental

Those who enjoy family-centered care have improvement in both medical and _________ outcomes

Empathy

- Involves active participation and understanding of the individual's and family member's feelings or ideas - The healthcare professional must sense, share, and accept the client's feelings

Stressors Siblings Face

- Long separations from the patient or a parent - Visits to an unfamiliar hospital - Changes in routine

Emma Plank

"Working with Children in Hospitals" Applauds hospitals that provide rooming in for mothers with small children Applauds lengthening visiting hours and notes the comforting attention staff members give to children who cry when the time is up States goals of a child life and education program

Pain

"_____ is whatever the experiencing person says it is, existing whenever the experiencing person says it does"

Before

(Before/After) Child Life: - Hospital physicians and administrators discovered that institutionalized children developed subsequent psychiatric disturbances and became asocial, delinquent, feeble-minded, psychotic, problem children

Normal

(Normal/Complicated) grief experiences for teenagers

Powerful Patients

(Powerful/Powerless) (Patients/Professionals)

Powerless Professionals

(Powerful/Powerless) (Patients/Professionals)

True

(True/False)

Old

(Young/Old) siblings May feel guilty if I contagious illness or intentional injury is the reason for hospitalization, and they may have a perceived or actual believe that their actions had a role in the cause of the illness or injury. They may experience more feelings of anxiety as they become increasingly able to conceptualize the impact of future outcomes. They may feel anger toward the sick sibling, or toward parents replacing more responsibilities on them at home, either in caring for other siblings or performing household tasks

Young

(Young/Old) siblings may experience guilt, imagining that they caused the illness or injury. They may also worry about developing the same illness or injury. More vulnerable to separation from parents

Older

(Younger/older) children typically do better in the hospital

Birthing Project

- A successful grassroots program - Provides pregnant women with a role model who acts as an advocate to help them navigate the maze of healthcare options and determine where to receive necessary prenatal care during their pregnancies - Advocates are there from prenatal care through the first year of the child's life

TEACCH

- A well research program used with individuals with autism. The program emphasizes language development and uses a variety of visual cues to facilitate language development.

Empowering Role of the Parents

- Active learner - Parent-professional partnership - Parents are the expert on their child

Freire's Train-the-trainer Program

- An effective, culturally sensitive, healthcare strategy that works well to empower diverse individuals, families, and local communities - An important philosophy is having the participants themselves choose the content of their education rather than having experts develop curricula for them - Provides care to those who have minimal access to healthcare delivery systems - Helps families transcend themselves and their limitation by drawing from their internal capacities as well as referencing a reality that is greater, outside of, and beyond themselves

Child Life Professionals

- Assist children, adolescents, and their families in coping with hospitalization, illness, trauma, or disability - Support the normal developmental tasks of independence, continuation in schooling, and the development of individuality - Support families and their relationship with their children and with the healthcare team

Empathy

- Awareness and acceptance of the self as a feeling person - Listening to messages and identifying the patient's or family members' feelings - Responding to feelings exhibited in specific messages

Leukemia

- Cancer of the white blood cells - Cancer cells overtake white blood cells and keep them from doing their job - There's nothing you did wrong to get cancer - You may have been tired, had no appetite, gotten lots of bruises, or had lots of fevers before we found out -- it'll go away when we fix the cancer - 90% remission rate in children

Political Action Policy Development

- Decision making through both private and public mechanisms occurring in city councils, hospitals, small businesses, community organizations, universities, courts and state legislatures - Might be also thought to compass neighborhood advocacy, media campaigns, and judicial policy making - Usually directed toward changing social conditions through a variety of tactics

Information and Knowledge Sharing Shared Decision Making

- Exemplified when the nurse shares knowledge of health and illness and the patient shares personal experiences of their illness, family relationships, values, and beliefs. - Leads to the development of mutual agreeable goals - Critical to the development of a strong partnership. - Requires purposeful action by the nurse. Unfortunately, such purposeful action infrequently occurs in acute care hospitals that are not committed to a patient- and-family-centered approach to care delivery.

Same-day Surgery Satellite Healthcare Sites

- Families become important partners with the healthcare team in the provision of care - Parents often are with their children during the preoperative and the postoperative phases - Seem to be environmentally friendly and are frequently owned by small groups of physicians who have a vested interest in keeping their customers happy

Optimal Healthcare

- Family-centered care is commonly used to describe _________ ________ as experienced by families

Feelings Siblings Experience

- Fear - Guilt - Sadness - Worry - Left out - Anger or jealousy

Bedside Shift Report

- Fosters patient/family partnership in that the patient/family provides input and actively participates in the shift-to-shift hand-off. - In addition, patient/families as partners in care is reflected most robustly in their engagement in multidisciplinary bedside family centered rounds.

Classic Medical Play

- Free use of medical tools, even if it is not the intended use - Not directive - Not goal oriented - Useful for familiarization and feeling mastery over environment

Child Life Specialist

- Has an impetus for change and improvement in the healthcare setting - Has the opportunity to advocate for patient and family partnership - Role may also involve encouraging colleagues to reconsider and amend their beliefs about patient and family empowerment, to progress toward a mentality of encouraging parent participation rather than allowing parents to participate, and to trust that the family is a valuable informational resource and collaborator in the development of effective, responsive care plans

Caring Professionals

- Have control over their emotions and the clinical situation - Self-reliant - Anticipate problems and provide the highest quality care

Child Life Professionals

- Ideally positioned to support patients and families in their caregiving roles and to build on parent knowledge and skills about child development - They prepare patients and families and support their presence in critical care, anesthesia induction, painful procedures, and other new and anxiety-provoking experiences - Have opportunities to foster independence and supportive relationships among children and adolescents and their families

Child and Adolescent Service System Program

- In the early 1980s - Improved services for children with serious emotional, behavioral, or mental disorders

Empowering Teaching

- Interactive - Emphasis on behavior change - Individualization and application of theory about each topic to own situation through use of common scenarios - Emphasis on shared problem-solving and learning from each other - Repetition and review - Monthly follow-up phone calls to family

Questions Siblings Have

- Not understanding what is wrong with the patient or why the patient cannot come home - Wondering if they or the patient did something wrong to cause the illness - Worrying that they might catch the illness - Wondering who will take care of them if parent or another caregiver are at the hospital

Respect & Dignity

- Nurses purposively demonstrate respect for the patient/family and work to maintain their dignity during the hospitalization. - Although this purposive action may take many forms, such action should include openly listen to and honor

Therapeutic Medical Play

- Offer the child a doll or stuffed animal as the "patient," and medical supplies, and allow the child to manipulate the materials while caring for the "patient" - Use open-ended questions to encourage verbalizations about the play - Correct any medical misconceptions the child either verbalizes or expresses through play

Diabetes

- Pancreas makes a special magic juice called insulin - Magic juice takes the sugar in your food and makes it into energy so you can run and play - Body got confused and told it to stop making the magic juice, so now you can't get any energy from your food -- the energy is just floating around in your body with nowhere to go - When the energy in your body has nowhere to go, there's too much energy floating around in your blood, which makes you feel bad - We're going to give you insulin to make those bad feelings go away

Ecological View

- People and contexts are interdependent -- individual actions are influenced by the characteristics of the settings that people occupy - Individuals are subjected to multiple contextual influences - Beliefs, values, and norms define what is acceptable in the various settings people occupy

Pre-Procedural Preparation

- Planning - Implementation - Delivery of information - Timing

Cognitive Strategies

- Rehearsal - Intellectualization (talking through the procedure) - Encouragement - Positive self-talk - Humor - Refocusing attention

Systemic Conditions

- Represent social statuses, social states, or organizational practices and policies - Might be perceived as those key features of the environment that are likely to influence the character of health care in the U.S. in the next decade

Palliative Care

- Respect for the dignity of patients and families - Access to competent and compassionate ________ ______ - Support for the caregivers - Improved professional and social support for pediatric _______ _______

Genuineness

- Sharing of self exhibited by behaving in a natural, spontaneous, and nondefensive manner

Child Life Support for Siblings

- SibzOnly - Sibling support groups or play rooms - Medical play and therapeutic outlets - Parental education on sibling reactions

Family-centered care

- Some medical professionals feel it takes too long - Some think it is too expensive - IT'S HARD - Some medical professionals feel they "know more" and should be trusted

Traditional Role of the Professional

- Teach from the class - Teacher is the expert

Empowering Role of the Professional

- Teach from within the semicircle - Teacher facilitates with emphasis on relationships

Caring, Trust, and Leveling of Power

- The nurse must 1st acknowledge the power differential and then level power and control to become an equal partner with the patient; without the leveling of power differentials, partnership cannot be realized

Child Life Vision Statement

- The profession of child life will continue to meet the needs of infants, children, youth, and families as they cope with the stress and uncertainty of illness, injury, and treatment - Philosophy and practice will be applicable to any health care setting and transferable to other community settings or situations in which the potential for infants, children, and youth to cope, learn, and master is placed at risk - Services provided will be evidence based, developmentally appropriate interventions that include therapeutic play, preparation and education to reduce fear, anxiety, and pain

Causes of PSDD

- The replacement of free time and free play activities with media - Highly structured toys that tell children what and how to play and that help them imitate the scripts they see on the screen - The growing emphasis on academic, skill-based curricula in early childhood settings that undermine children's creative play and problem solving. - An increasingly commercial culture that teaches young children "I want it" rather than "I can do it"

Tools needed for a procedure preparation for an IV start

- Tourniquet - Alcohol wipes - ____ needle - ____ tubing - Gauze - Band-aid

Health Planning Enterprise

- Usually consists of several distinct steps that lead to desired actions

Sickle Cell Anemia

- Your blood is made of three types of cells (or three things are in your blood for small kids): white blood cells, red blood cells, and platelets. - See, the red ones look like dinner plates! - RBC job is to bring oxygen to your body when you breathe so that you have the energy to run and play. - They do that by carrying oxygen on the middle of the "plate" - You may feel tired or have lots of pain in your arms/legs - Your RBC aren't shaped like plates. - They're shaped like moons! - The moons look cooler than the plates, but they're not as good at carrying oxygen. - When you aren't feeling good, we can give you some medicine and blood with plate shaped RBC at the hospital to help with the pain. - That's why you're here.

Sickle Cell Anemia

- Your blood is made of three types of cells (or three things are in your blood for small kids): white blood cells, red blood cells, and platelets. - See, the red ones look like dinner plates! - RBC job is to bring oxygen to your body when you breathe so that you have the energy to run and play. - They do that by carrying oxygen on the middle of the "plate" - You may feel tired or have lots of pain in your arms/legs - Your RBC aren't shaped like plates. - They're shaped like moons! - The moons look cooler than the plates, but they're not as good at carrying oxygen. - When you aren't feeling good, we can give you some medicine and blood with plate shaped RBC at the hospital to help with the pain. - That's why you're here.

Having their parent

99% of children state that "________ ______ _______" present provides the most comfort when in pain

Mother

99.1% of school-aged children stated they found the presence of their ________ most helpful when in pain

Symbolic Play

According to Piaget, this is an indication that children are developing the ability to transform direct sensory data into abstract mental images. Children at play actively do things that represent personal images of their own experiences. This action is based on similarity between the available play object in the unavailable object that it represents. Piaget links this with general intellectual growth. He states that real ____________ ____________ develops rapidly when the child learns language, and is characteristic of the period between two and four years

Piaget

According to _____ (1962), play is the way younger children abstract or assimilate experiences into their existing schema or internal cognitive structures

Therapeutic Play

According to the EBP Play Statement: (Therapeutic Play/Play Therapy) focuses on the process of play as a mechanism for mastering developmental milestones and critical events

Cognitive Social

According to the EBP Play Statement: *Play was found to significantly promote ____________ and _________ aspects of development and these effects were magnified when adults participated in play with children.*

Emotional Expression

According to the EBP Play Statement: A defining feature of therapeutic play is its ability to elicit __________ ____________ leading to greater psychological well-being for a child in the hospital

Play Therapy

According to the EBP Play Statement: Addresses basic and persistent psychological issues associated with how a child may interact with his or her world

Therapeutic Play

According to the EBP Play Statement: Children are encouraged to ask questions to clarify misconceptions and express feelings related to their fears and concerns Acts as a vehicle for eliciting information from children while also sharing information about what to expect from medical procedures and what sensations may be experienced.

Emotions

According to the EBP Play Statement: Children spontaneously described themselves through their art by expressing _________

Physiological

According to the EBP Play Statement: In addition to relieving psychological stress, therapeutic play is also effective in reducing apprehensive _____________ responses

Related

According to the EBP Play Statement: In one study, Schwartz, Albino and Tedesco found that medically (related/unrelated) therapeutic play was more effective

Cooperation

According to the EBP Play Statement: In studies where children were offered therapeutic play, they exhibited greater _____________ during stressful procedures and were more willing to return to the hospital for further treatment

Anxiety Fears

According to the EBP Play Statement: Several studies have shown that therapeutic play is effective in decreasing ________ and ________ for children from the time of admission to immediately after surgery and to the time of discharge

Therapeutic Play

According to the EBP Play Statement: Specialized activities that are *developmentally supportive* and facilitate the emotional well-being of a pediatric patient. Focus is on the promotion of continuing *'normal development'* while enabling children to respond more effectively to difficult situations

Child Life Specialist (CLS)

According to the EBP Play Statement: The _______ _______ _______ (_____) ensures that the play is developmentally appropriate while using language that is understandable to the child

With

According to the EBP Play Statement: The paucity of research (*with/on*) children is recognized as problematic by those working in the field 18-21

Emotional

According to the EBP Play Statement: Therapeutic play typically consists of at least one of the following types of activities: 1) the encouragement of __________ expression 2) instructional play to educate children about medical experiences 3) physiologically enhancing play

Physiologically

According to the EBP Play Statement: Therapeutic play typically consists of at least one of the following types of activities: 1) the encouragement of emotional expression 2) instructional play to educate children about medical experiences 3) ____________ enhancing play

Cost Effectiveness

Additional research should be conducted to evaluate the effects of child life services on patient care outcomes, including patient and family experience and satisfaction, staffing ratios, throughput, in ________ _________________

Outdoors

Adults identify the most significant experiences of their childhood as being located (indoors/outdoors) Fosters all aspects of a child's development Associated with reduce stress in the resultant healing effects

Play Leader

Adults participate in children's play; includes making deliberate attempts to enrich and extend the play episode

Cognitive Theories

Advance of our knowledge three perspectives on how changes and thinking occur relative to the role of the child life specialist as an agent of change facilitating the continued growth and development of children

Financing

Advocacy for ___________ of child life services should occur at the facility, community, state, and federal levels

Turner (2005)

Advocated for the inclusion of attachment-informed assessment as a way to strengthen the selection of interventions to meet the needs of individual parent-child dyads

Pharmacological

Advocating for ________ intervention: - EMLA, LMX, Synera - Vapo-coolant spray - Oral sucrose - LET - Sedation/Anesthesia

3-5

Age Group They focus on the details of death and may also personalize the experience Being dead can mean living under changed circumstances Death is equated with punishment but it is also seen as reversible Apt to be sad, angry, scared or worried and communicate these feelings in their: tantrums, fighting crying clinging separation fears regression to earlier behaviors magical thinking that the person can reappear acting and talking as if the person is still alive

Post-procedural Play

After an event, a sort of debriefing, often called _______ _______, might be the only option for a child already in a state of crisis; however, it is ideal for all children to process events that may have tax their coping resources and to prepare a memory that may serve them well in subsequent situations. Support and coping options can be introduced during times of crisis, even if prior preparation has not been an option.

9

Age - Children understood the biological aspects of death and that it was inevitable even though the sense that death was a punishment persisted

5-9

Age Group - Children commonly reified death, believed that it came from the outside, perhaps was visible, and possibly could be avoided - Tended to believe in a death that was walking around, trying to catch people

3-5

Age Group - Death was a departure, a gradual or temporary sleep, neither definite nor irreversible; they attributed life and consciousness to the dead

40-60

Age Group Can be badly impacted by the sudden loss of a loved one during a disaster or crisis event. They might feel guilty for not having been able to protect the deceased Might grieve future plans for retiring together.

40-60

Age Group Can be badly impacted by the sudden loss of a loved one during a disaster or crisis event. They might feel guilty for not having been able to protect the deceased Might grieve future plans for retiring together.

0-3

Age Group Have little understanding of the cause or finality of death Most likely to react to separation from a significant person and to the changes in their immediate world. Their distress at the changes in their environment following a loss are displayed by: crying searching change in sleep and eating habits

0-3

Age Group Have little understanding of the cause or finality of death Most likely to react to separation from a significant person and to the changes in their immediate world. Their distress at the changes in their environment following a loss are displayed by: crying searching change in sleep and eating habits

60+

Age Group Loss is often expected Unexpected losses of during a disaster or crisis event can be detrimental Often they lack the social support needed, which can be detrimental

60+

Age Group Loss is often expected Unexpected losses of during a disaster or crisis event can be detrimental Often they lack the social support needed, which can be detrimental

Early Teens & Adolescents

Age Group Responses are directly related to developmental tasks. Common reactions include: numbing anger resentment anxiety guilt sense of increased responsibility self-involvement risk-taking and acting-out behaviors avoidance of feelings distance fear of death appetite and sleep changes physical complaint academic decline or apathy

Early Teens & Adolescents

Age Group Responses are directly related to developmental tasks. Common reactions include: numbing anger resentment anxiety guilt sense of increased responsibility self-involvement risk-taking and acting-out behaviors avoidance of feelings distance fear of death appetite and sleep changes physical complaint academic decline or apathy

3-5

Age Group They focus on the details of death and may also personalize the experience Being dead can mean living under changed circumstances Death is equated with punishment but it is also seen as reversible Apt to be sad, angry, scared or worried and communicate these feelings in their: tantrums, fighting crying clinging separation fears regression to earlier behaviors magical thinking that the person can reappear acting and talking as if the person is still alive

6-9

Age Group They have a sense of the importance of, and contributing factors to, personal health and safety. Emotions and understanding can be incongruent. Less sophisticated beliefs They also personify death They are most likely to display: anger denial irritability self-blame fluctuating moods withdrawal earlier behaviors school problems

6-9

Age Group They have a sense of the importance of, and contributing factors to, personal health and safety. Emotions and understanding can be incongruent. Less sophisticated beliefs They also personify death They are most likely to display: anger denial irritability self-blame fluctuating moods withdrawal earlier behaviors school problems

9-12

Age Group They know that death: (1) is a permanent state; (2) cannot be reversed; (3) once you have died your body is no longer able to function; (4) it will happen to everyone at some time; (5) it will happen to them. This understanding can be accompanied by adult-like responses The most common reactions are: crying aggression longing resentment isolation, withdrawal sleep disturbance suppressed emotions concern about physical health academic problems or decline

9-12

Age Group They know that death: (1) is a permanent state; (2) cannot be reversed; (3) once you have died your body is no longer able to function; (4) it will happen to everyone at some time; (5) it will happen to them. This understanding can be accompanied by adult-like responses The most common reactions are: crying aggression longing resentment isolation, withdrawal sleep disturbance suppressed emotions concern about physical health academic problems or decline

Preschool & Young School-Age Children

Age-specific considerations - Avoid quick approaches - Broad smiles and other facial contortions may appear threatening - Avoid extended eye contact until the child is comfortable - Position yourself at child's eye level - May be more responsive when remaining close to parents - Be direct and concrete

Adolescents

Age-specific considerations - Be prepared to deal with a wide range of emotions and behaviors - Exchange information without coercive questions - Ask broad, open-ended questions before specific questions

Infants

Age-specific considerations - Consider body language - Nonverbal behaviors work especially well - Maintain a calm voice and avoid sudden, loud noises - Best approach for handling is to pick them up without gestures - Usually more at ease when upright, and in visual contact with and close proximity to their parents

Older School-Age Children

Age-specific considerations - Use relatively simple explanations - Use concrete explanations and reasons

Organ Transplantation

Although the average length of hospital stay for children remain short, the increase in the number of children undergoing _______ __________ means very long stays for a growing number of children

Pain

Always subjective and can only be viewed in terms of the person's experience.

Flow

Always voluntary and very individually defined. It can be one of many kinds of experiences: social, kinesthetic, imagining, reading or observing. Hence, the same activity for one person can be play in yet not be play for another

Do Something

An additional value of the interpersonal aspect of play, is that it needs a basic need to "________ _________"

Patient + Family-Centered Care

An approach to healthcare that is based on mutually beneficial partnerships among patients, families, and healthcare professionals - Integral to the care and support of individual children and their families - Extend beyond the caregiving process - Based on the recognition that the family is the constant in an individual's life and that it has significant influence over an individual's health and well-being

Child Life Specialists

Are especially trained to work with children and provide a valuable resource to the health care team in preparing parents and children for invasive procedures. These specialists are skilled in translating hospital jargon into ordinary language and in giving explanations at the developmental level of a child.

Nonnormative Stressors

Arise from unusual or traumatic experiences

Modeling

Arising out of the work of behavioral psychologists was the use of "_______" techniques. - Children are presented with a model who is facing stressful situations comparable to that of the child. - Holds that the viewing of a model who encounters and manages stressful circumstances is likely to increase the probability that the target child will adopt the same behaviors, and more successfully handle the event.

Trust

Arnold Gesell (1952) theorized that positive, trusting relationships would develop best when the parent consistently follows the queues of the baby. Theorists agree that if _______ is not established in the first year of life, it will be very difficult to establish later, and will always be more fragile than it might have been if integrated in the child's first few months

Healing

Can take place even when the body is dying or weakening Sometimes it is the most successful when a cure is no longer a possibility and death is impending

Joy

Art can be a way of showing ______

Escape

Art can be an __________ for adults and children - Take yourself to a safe, painless place

Therapy

Art can be used as ________ - Memorial balloons - Therapeutic activities

Pain

Art can be used as ________ management

Distraction

Art can be used as _________ from emotional "digestion" and procedures

Developmental

Art can be used as a __________ growth tool - Eye-hand coordination Dancing - Gross motor development - Fine motor development - Language development

Misconceptions

Art can be used as a way of correcting ____________

Emotional

Art can be used as an __________ expression

Wong-Baker FACES Pain Scale

Asks children to compare their pain to a series of faces ranging from a broad smile to a tearful grimace

Communication

Aspect of Child Life Value Statement - Infants, children, and youth communicate their needs through words, play, and behavior. - We are committed to enabling all forms of this - We accomplished this by observing, listening, and facilitating this with those who may be misunderstood or who need support in order to be heard - Written documentation of child life assessments, interventions, and evaluation of outcomes is an essential aspect of our practice

Theoretical Foundations of Practice

Aspect of Child Life Value Statement - Knowledge and application of this are the basis for our professional practices

Professional Collaboration

Aspect of Child Life Value Statement - Shared and reciprocal efforts of individuals, disciplines, organizations, and communities are an effective means of meeting the diverse needs of infants, children, youth, and families - Child life practice includes this, as well as commitment to the education, supervision, and mentoring of novice child life professionals

Professional Standards of Practice

Aspect of Child Life Value Statement - The commitment to excellence and integrity involves lifelong learning, adherence to our code of ethics, and the development and support of educational and training programs based upon defined clinical competencies

Therapeutic Relationships

Aspect of Child Life Value Statement - We are committed to relationships built on trust, respect, and professional competence that contribute to the development of confidence, resilience, and problem-solving skills that enable individuals and families to deal effectively with challenges to development, health , and well-being

Infants, Children, Youth, and Families

Aspect of Child Life Value Statement - We recognize the diversity of individual and family strengths and needs, acknowledging the importance of their support systems in community links - We promote individual and family integrity, development, and well-being by embracing the concept of patient and family centered care

Observational Learning

Aspect of social learning theory Explains the transmission of information resulting in a change in behavior as a consequence of experience or modeling

Post-Procedural Follow-Up

Aspects of the past events are discussed as a form of preparation for similarly stressful experiences

One day

At the earliest, how far in advance are you supposed to prep children for a procedure?

Active Rehearsal

At the heart of psychological preparation The goal is to influence the child and family's confidence in their ability to manage the situation

Protective

Attachment behaviors elicit a ___________ response in the caregiver whose role is to identify and respond to the threat and return the infant to a state of comfort

David Lancy

Attention is shifted from focus on the needs of societies oldest members to those of the child

Privacy Confidentiality

Attention to ____________ and _____________ is also essential for adolescence to feel trusting and able to participate in their own treatment planning. Respecting wishes and honoring confidences are essential principles to build trust and acceptance

Efficacy

Attention to additional demands in the environment influencing children's ability to process information during medical play should be recognized for the potential to interact in ways that inhibit or enhance the _________ of the intervention

Language

Attention to the use of _______ is critical so that it is non-threatening and age-appropriate

Family Preservation and Family Support Act of 1993 (P.L. 103-66) Families of Children with Disabilities Act of 1994 (P.L. 103-82)

Authorized a range of family support services, many of which are offered in the home, that build on family strengths and are planned in collaboration with families

Euphemisms

Avoid _________ i.e.,"passing away" or "going to sleep."

You

Avoid negative "_______-messages"

Sedation

Avoidance of _________ while obtaining adequate diagnostic imaging results is a desirable outcome for young children with SCD.

Temperament Theory

Child by professionals can apply this theory as an organizing framework to describe individual characteristics of a child observed in relation to specific characteristics in the environment

Parallel

Child imitates others who are playing

Nurse Auditor

BSN or related field 5 years of research or clinical trials management PC proficient

Child Life Specialist Education

Bachelor's degree Supervised experience in a healthcare setting Knowledge of medical terminology Supervisory skills and competencies in growth and development, family dynamics, play and activities, interpersonal communication, developmental observation and assessment, the learning process, group process, behavior management and the reactions of children to hospitalization and illness

Overprotection

Barrier impeding opportunities for children's unstructured play. Generally speaking, in the early part of the twentieth century parents focused more on protecting childhood innocence and less on risks to physical well-being

Privacy Issues

Be especially mindful of _______ _______

Conversation

Be receptive if children initiate a ________

Explanations

Be specific and literal in _________ of death

Soft

Be sure that "________" terms are easily understood and not confusing when preparing a child for a procedure

Pain

Because _______ s a private, internal event that cannot be directly observed, assessment of the _______ experience is often built on a person's self-report

Distinct Needs

Because children process information from the world around them much differently than adults, they have__________ ________ for managing the effects of stress and trauma without the assistance of a professional who understands their unique perspective

Philanthropic

Child life and ancillary services often attract a segment of the population that may otherwise not be inclined to provide ____________ support to a hospital

Phenominism

Bibace and Walsh Preoperational 3-4 years Illness caused by bad behavior or thought, magic, or object is far away from the child

Contagion

Bibace and Walsh Preoperational 4-5 years Illness caused by proximity to another person or thing, magic

Sensorimotor Stage

Birth-3 years Children go through a separation phase Unable to differentiate death from temporary separation or abandonment

Consuming

Can work like a drug, diverting children from working on their own internal needs. It teaches them to associate happiness and a sense of well-being with getting what they want rather than with interacting meaningfully with objects and people and mastering and learning how to have an influence

Does not

Blood draw or IV Key points - Child's job - Blood amount - Needle (does/does not) stay in for IV - Only thing in arm is a mouse straw - You'll get it removed before going home - Why we use IVs

Professional

Boundaries are developed by the implied definitional assumption that professional relationships are to be kept ________ As long as there is clarity about what type of relationship one has with one's client, boundaries can be maintained. Personal information should not be a part of the interactions between child and specialist. When the sharing of a personal piece of information is being considered, very careful thought should be put into the advantages versus the risks It is possible for a child life specialist to be just as effective without revealing specific personal information

Privacy

Child Life Specialists should provide _________ when adolescents are in the hospital

Stimulation

Child Life Specialists should provide appropriate ___________ when an infant is in the hospital

Choices

Child Life Specialists should respect independence and teen's __________ when adolescents are in the hospital

Disorganized Attachment

Bowlby and Ainsworth Caregiver is usually abusive or neglectful Caregiver responds in frightening or frightened ways

Secure Attachment

Bowlby and Ainsworth Caregiver reacts quickly and positive to child's needs Caregiver is responsive to child's needs

Ambivalent Attachment

Bowlby and Ainsworth Caregiver responds to the child inconsistently

Ambivalent Attachment

Bowlby and Ainsworth Child is distressed when caregiver leaves Child is not comforted by the return of their caregiver

Avoidant Attachment

Bowlby and Ainsworth Child is not distressed when the caregiver leaves Child does not acknowledge the return of the caregiver Child does not seek or make contact with the caregiver

Secure Attachment

Bowlby and Ainsworth Distressed when caregiver leaves Happy when caregiver returns Seeks comfort from caregiver when scared or sad

Disorganized Attachment

Bowlby and Ainsworth No attaching behaviors Often the child appears dazed, confused, or apprehensive in presence of caregiver

Curing

Bringing about recovery from a disease

Microsystem

Bronfenbrenner's term for a setting in which a child interacts with others on an everyday, face-to-face basis.

Mesosystem

Bronfenbrenner's term for linkages between two or more microsystems

Exosystem

Bronfenbrenner's term for linkages between two or more settings, one of which does not contain the child.

Playmates

Burgess and McMurphy (1982) observe the behavior of children six months to five years old and found that distance from adults increased with age for distance to ____________ decrease

Supportive

By being a _________ individual in a child's life, one may help build skills such as problem solving, decision making, assertiveness, communicating effectively, managing emotions, conflict resolution, resisting peer pressure, and developing personal relationships

Positively

By entering into the all consuming state of flow, children can lose their self consciousness, enjoy being one entity in body, mind and spirit, and experience a sense of overall well-being . This provides children with an increased awareness of their capacity to respond _________ to others, their environment, and themselves to create, relax and find joy in their beings

Reduced

By providing children with information about procedures, it was posited that this psychological upset can be _______

Protection

By the time children are 3 or 4 years old, they are able to perceive a need for protection and respond through eliciting attachment behaviors

3 4

By the time children are ____ or ____ years old, they are able to use the cognitive capacity to predict, plan, influence, communication, and negotiate with the caregiver

Family Member

Can be anyone who is willing and able to assume the responsibility and reap the rewards that the role entails

Social Contextual Influences

Can introduce stress or emotional responses that may interfere with the ability of the individual to assimilate new information, apply previously successful skills or strategies to normal situation; basically to learn

Conventional

Child life expertise has applications beyond ________________ hospital care

Comfort Holds

CCLSs are often involved in facilitating the use of __________ ______ Techniques for positioning children in a parent or caregivers lap or other comforting position Generally require fewer staff to be present in the room, facilitate safe and effective accomplishment of the medical procedure, decrease parent anxiety and increase Parent satisfaction

Grief Support Legacy

CCLSs are often involved in providing ________ _________ or __________ activities in the event of the death of pediatric or adult patients

Patient Family Centered

CCLSs are part of an interdisciplinary, __________ and _________ __________ model of care, collaborating with the family, physicians, advanced practice providers, nurses, social workers, and other members of the health care team to develop a comprehensive plan of care

Welcoming

CCLSs can advocate for a more __________ environment in treatment and examination rooms on pediatric units as well as outpatient settings Their background and training are helpful in designing settings that are appropriately stimulating, nonthreatening, and interactive

Comfort Kits

CCLSs may develop _________ _________ for use in treatment areas to include age appropriate distraction items

Priti Desai

CLC 2013 Distinguished Service Award Child Development Specialist for CHETNA in India Initiated child life internship at Egleston Second master's degree in public health Teaching at East Carolina University Doctorate Degree in 2008 Child Life Specialty Council for Operation Smile Child Life Advisor for The Priyanka Foundation Treasurer of the CLC Board of Directors 2001-2003 Chaired Diversity Committee 1997-2001

Fetal Concerns Program

CLS is often called upon to assist families with young children, when the prenatal diagnosis of a lethal anomaly changes the excited family's prepartions for the birth of a new baby

Terminal Phase

CLS may help a child prepare for death by preserving self-concepts, maintaining relationships with family and friends, and expressing feelings and fears

Tangible Tools

Can assist in the task of conveying information about sensory experience and sequence of events

Parental Grief

Can be a long-lasting and powerful experience, and is influenced by the developmental task expected. They might blame themselves for not protecting the one who died better during the disaster or crisis event. Their emotions might range greatly and include such things as: - loneliness - sadness - disbelief - anger - anxiety - etc

Parental Grief

Can be a long-lasting and powerful experience, and is influenced by the developmental task expected. They might blame themselves for not protecting the one who died better during the disaster or crisis event. Their emotions might range greatly and include such things as: - loneliness - sadness - disbelief - anger - anxiety - etc

Advance

Children and parents are helped if they actively acquaint themselves in _______ with the unfamiliar equipment

Infant

Care in the neonatal intensive care unit (NICU) is required to be family centered as much as ________ centered

Therapeutic Art

Caring adults facilitate children's engagement in expressive activities that may be therapeutic

Heal

Carl Jung maintained that children have within themselves the ability to ______, and play provided an appropriate template to do so

Personal Space

Carried around with an individual as he or she moves

Case/Sparks Debate

Cassandra, 18, did not want to undergo chemo for Hodgkin's lymphoma even though there was an 85% chance of survival Cassandra wanted to look at other options for treatment Cassandra was removed from her home after missing treatment appointments The court decided Cassandra was not mature enough to make the decision and was put under temporary state custody

Industrial Revolution

Caused a crisis in the cities o Men, women, and children were paid small wages for long hours of work o Families lived in hovels without access to clean food or water and often without even a semblance of sanitation o Disease epidemics were common, and large numbers of babies succumbed to the lethal "summer diarrhea" every year

Counter

Certain responses, whether considered coping strategies or stress responses, run _______ to the demand of the situation and to the goals one has for managing the perceived threat.

Problem Based Coping

Change the situation or solve the problem

Rational Planning

Characterized by a comprehensive review of possible solutions and the selection of the best possible alternative

Adolescent (12-18 years)

Erikson Identity and repudiation versus identity diffusion To be oneself To share being oneself

Family Involvement

Child Life Specialists establish therapeutic relationships with children and parents to support ___________ __________ in each child's care

Developmentally Appropriate

Child Life Specialists provide ___________ ___________ information about events and procedures

Peer Group

Child Life Specialists should encourage _____ and _______ activities when adolescents are in the hospital

Education Teacher

Child Life Specialists should encourage ___________/_________ involvement when a school ager is in the hospital

Education

Child Life Specialists should encourage ____________ when adolescents are in the hospital

Medical Prep

Child Life Specialists should facilitate _________ ______ when adolescents are in the hospital

Medical Play Information

Child Life Specialists should facilitate _________ _______ and ____________ when a school ager is in the hosptial

Medical Play

Child Life Specialists should facilitate __________ _______ when a toddler is in the hospital

Medical Therapeutic

Child Life Specialists should facilitate __________ and __________ play when a preschooler is in the hospital

Friends

Child Life Specialists should facilitate involvement with ___________ when adolescents are in the hospital

Parental Involvement Information

Child Life Specialists should maximize _________ ________ and _____________

Therapeutic Play

Child Life Specialists should promote ____________ __________ when a toddler and school ager is in the hospital

Distraction Mood

Child life interventions offering appropriate play materials and instruction to caregivers on ways to play with their child post-surgery allow play to be used as a resource that provides ____________, improves _______, and supports the parent-child relationship during a demanding important phase of recovery

Care Experience

Child life interventions play a major role in calming children's fears and result in higher patient satisfaction ratings of the entire __________ _________

Physical

Child life interventions resulted in less emotional distress, better overall coping during the hospital stay , a clearer understanding of procedures, and a more positive ___________ recovery as well as post hospital adjustment for children enrolled

Psychosocial

Child life programs are an important component of pediatric hospital based care to address the ___________ concerns that accompany hospitalization and other health care experiences

Customer Satisfaction

Child life programs are recognized as contributing to a culture of patient and family centered care as well as to __________ ____________ measures, increasingly important from an incentive based reimbursement an accreditation standpoint as well as marketing and public reporting of outcomes

Committees

Child life representation is often incorporated into hospital _________________

Joint Commission

Child life services contribute to an organization's efforts to meet the standards set forth by the _________ ____________ with regard to affective communication, patient and family centered care, age specific competencies, and cultural competence

Quality Outcomes

Child life services improve _____________ and ______________ in pediatric care as well as the patient and family experience

7

Child life services should be available to meet identified patient or family needs __________ days a week

Quality Indicator

Child life services should be delivered as part of an integrated patient and family centered model of care and included as a ___________ __________ in the delivery of services for children and families in health care settings

Directly

Child life services should be provided ___________ by certified child life specialists in pediatric inpatient units, emergency department's, chronic care centers, and other diagnostic or treatment areas to the extent appropriate for the population served

Individualized

Child life services staffing should be ______________ to address the needs of specific inpatient and outpatient areas

Adverse

Child life specialists focus on the optimal development and well being of infants, children, adolescents, and young adults while promoting coping skills and minimizing the _________ effects of hospitalization, health care, and or other potentially stressful experiences

Assessment Skills Teamwork

Child life specialists must rely on _______ _______ and _______ for integrating the multiple factors that converge in the experiences of children and families

Trust

Child life specialists played an integral role in establishment of ________ with the child

Donor Advocates

Child life specialists, as ________ ________, ensure siblings receive developmentally appropriate education prior to donation, empower siblings to make informed consent, and recognize siblings as autonomous patients.

Association for the Care of Children's Health (ACCH)

Child life was formative in the creation of the multidisciplinary organization ultimately known as the ________________ _________ _______ ________ ________ __________ _________ (_________) whose members were dedicated to promoting and providing developmentally-based psychosocial care to children in hospitals

Psychosocial Vulnerability

Child variables, family variables, and diagnosis and treatment variables are known to affect _______________ _____________ and thus influence the child's particular child life intervention needs

Onlooker

Child watches two individuals play but plays alone

Associative

Child works together with other children

Grow

Childhood is a time of such rapid development that not a day should go by without attention to the basic imperative to ______

5

Children 1 to 17 years account for ____% of all hospital stays

More information

Children ages 6 years+ are increasingly curious about how body systems work

1-5

Children ages ______ to ______ years are the age group most vulnerable to experiencing perioperative anxiety

Beetter

Children and families who received any form of preparation and supportive care expressed significantly (better/worse) satisfaction with their hospital experience when compared with children and families in other groups.

Risk Aversion

Children are "bubble wrapped" by their parents and deprived of opportunities to assess and manage risk. In this type of environment, children are incapable of adapting to a fluid world, making them risk-adverse and psychologically fragile.

Stimulation

Children are not just sick, they are growing. They need ___________ in addition to healthcare, medication, and feeding

Vulnerable

Children are particularly ________, and parents or other responsible adults may feel unsure of their ability to help children to successfully understand and manage these experiences

Difficult

Children assigned a _________ composite score on a measure of temperament were more likely to receive healthcare play interventions to help them express feelings, develop coping skills, and address misunderstandings

Serious

Children engaged in play's flow appear free of the problems that had so recently haunted them, even though the context or theme of their play is quite ______

Concrete Salient

Children focus on the most ________ and _________ aspects of an item.

Lower

Children from (higher/lower) socioeconomic backgrounds engage in less complex, less frequent, and less sophisticated make-believe play

Less Lower

Children from (less/more) technologically advanced cultures and from (lower/more) socioeconomic backgrounds engage in less complex, less frequent, and less sophisticated make-believe play

Technology

Children from cultures that are less technologically advanced in those from lower socioeconomic class is playing ways that reflects the lack of ____________

Advocate for Play at Home and at School

Children have the right to relax and play and to join in a wide range of cultural, artistic, and other recreational activities. Play is a child rights and social justice issue, as under-resourced children have fewer opportunities for play than their adequately resourced counterparts

Low

Children in (high/low) income areas are 25% more likely to enter through the emergency department

Pain

Children in healthcare experience: fear of _____

Unknown

Children in healthcare experience: fear of the ________

Control

Children in healthcare experience: loss of _______

Open Communication

Children involved in ______ _______ about their own or a family member's impending death are less likely to experience anxiety, withdrawal, and isolation than those who are "protected" from such knowledge

Cues

Children may remain fearful unless they know when a task is complete

Flow

Children may sometimes play simply to immerse themselves in the experience of ______

Symbolic Dramatic Make-Believe Play

Children of this age project in an act behaviors that are for bidden to them in real life. Children reconstruct frightening or painful situations, unbearable to them in reality, and put them into manageable form.

Invasive

Children on a general ward in a hospital receive just as many _________ procedures as children in the pediatric ICU

See

Children pay attention to how things look, not the logic that underlies them. They tend to believe what they ______.

Intrinsic Motivation

Children tend to find serious play experiences rewarding and pursue them on a voluntary basis prompted by _______ ________

Do

Children who (do/do not) play often tend to be more emotional and suffer from physical distress

Do Not Play Often

Children who _____ _____ _____ _____ are under extreme emotional or physical distress or have cognitive or emotional limitations

Resilient

Children who adapt to the experience of being hospitalized without negative sequelae Tend to respond more quickly and appropriately to major life events or to adapt more positively to chronic and ongoing stressors. They may cope better with the isolation and immobility required during treatment for a limited period of time if they are able to rely on the strength and ability to develop supportive relationships

Psychologically

Children who are _______________ prepared for surgery experienced fewer negative symptoms than did children who did not receive formal preparation

Problem Solving Deficit Disorder (PSDD)

Children who say they're bored a lot. They have trouble becoming deeply engaged in unstructured activities. They lack creativity and imagination and experience difficulty in playing cooperatively with others or resolving conflicts without aggression. They do better when they're told what to do. They prefer structured activities They ask for new things all the time but quickly become bored once they have them. When they're able, parents often enroll their children in organized after-school activities

Younger

Children who were (older/younger), more severely ill, and to endured more invasive procedures had significantly more medical fears, a lower sense of control over their health, and ongoing post traumatic stress responses six months post discharge

Adjustment

Children who were hospitalized as young children demonstrated ___________ difficulties as adolescents, especially children who were hospitalized for longer than 1 week or had multiple admissions before the age of 5 years

Puppets

Children will often express thoughts and feelings through _______ that they might not express directly

General Care

Children with (a more invasive procedure/general care) typically do better in the hospital

Increases

Children's distress during a procedure (increases/decreases) in several situations: - When developmentally inappropriate amounts of control over the procedure are given to the child - When the physician distracts a parent with social talk - When parents don't focus their attention on the child - When the parent is either a "cheeleader" or is "overinvolved"

Medical Day Care

Children's medical needs, therapies, and socialization are provided in a group setting. The centers feel a unique role in allowing parents to work and maintain activities of daily living. They provide the children with an environment that emphasizes individual growth and development within an appropriate social setting rather than in the isolated environment of home. Many children make extraordinary psychosocial and physical progress within this developmentally appropriate and engaging setting. The challenges of frequent hospitalizations for these children may be more easily manage due to familiar staff and smoother transition from one setting to another

Coping Strategies

Clearly defined _______ _______ can influence the child and family's appraisals of their ability to manage impending events As soon as potential stress points have been identified, it is imperative to ensure that children and families have _______ _______ available to them that will minimize their distress

Active Control Behaviors

Clinging Following

Piaget

Cognitive Theorist Sensorimotor Preoperational Concrete Operational Formal Operational

Adolescents

Common issues in hospitals: - Dependence on adults - Separation from family and peers - Fear of bodily injury and pain - Fear of loss of identity - Body image/sexuality - Concern over peer group status

Can

Communication techniques in preparation: - Give the child the opportunity to express thoughts/feelings/concerns - Acknowledge and validate child's feelings - Focus on what child ________ do; coping strategies - Avoid negative you messages

Patient

Communication that is ________-centered has been shown to facilitate a positive nurse-patient relationship

Infant Mortality

Complications at birth, family poverty leading to neglect or abandonment, inadequate or inappropriate food, accident and poor hygiene were common factors in __________ _________

Depersonalization

Component of Burnout - Impersonal response to patients

Emotional Exhaustion

Component of Burnout - Lack of energy or interest in one's job

Accomplishment

Component of Burnout - Reduced feelings of peresonal _______

Death is Irreversible

Concept about Death - Children who do not fully understand this concept may view death as a kind of temporary separation. - They often think of people who have died as being far away, perhaps on a trip. - Children who have had a family member or friend die may feel angry when the person does not call or return for important occasions. If children do not understand this, they have little reason to begin to mourn.

Sustain

Conditions of consistency, comfort, and predictability are provided in pediatric healthcare settings in part through promotion of child life services designed to __________ relationships between the parent and child.

Anticipatory Discussions

Conducting _________ _______ before a physical examination is performed can reduce fears and misunderstandings and lead to enhanced professional, child, and family comfort

Erikson

Consider the social and cultural environment of the developing individual as the influential factor in the development of personality across the lifespan View development as a dynamic and continuous process whereby the individuals strives to adjust issues that arise at key interaction points These social conflicts identified within the stages are applied as a framework from which caregivers approach age-appropriate activities and instructions across the lifespan

Copp Typology

Consisted of five categories: the victim, the combatant,the responder, the reactor, and the interactor. Eachcategory contained pain language commonly used andthe coping style associated with pain descriptions.

Coping

Constantly changing cognitive and behavioral efforts to manage specific external and or internal demands that are appraised as a taxing or exceeding the resources of the person Frequently stated as a desired outcome of many child life interventions

Coping Style

Copp (1985) found that words used to describe pain could be categorized by the meaning that pain held for the person and the coping style that he or she brought to it.

Solitary

Current characteristic of doctor-patient relationships - Physicians face financial disincentives to refer patients or prescribe an off-formulary medication

Information Sharing

Core concept of family-centered care - Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. - Patients and families receive timely, complete, and accurate information in order to effectively participate in care and decision-making

Respect & Dignity

Core concept of family-centered care - Health care practitioners listen to and honor patient and family perspectives and choices. - Patient and family knowledge, values, beliefs, and cultural backgrounds are incorporated into the planning and delivery of care

Play

Creates an environment where stress and anxiety are reduced Helps the child regain confidence and self-esteem Provides an outlet for feelings of anger and frustration Helps the child understand treatment and illness Aids in assessment and diagnosis Speeds recovery and rehabilitation

Void of Creativity and Imagination

Creative thinking among American children is declining. Over the last two decades "children have become less emotionally expressive, less energetic, less talkative and verbally expressive, less humorous, less imaginative, less unconventional, less lively and passionate, less perceptive, less apt to connect seemingly irrelevant things, less synthesizing, and less likely to see things from a different angle"

Parent Training Spaces

Critical to the psychological comfort of parents. The spaces are provided with the equipment that the child will be using at home, most typically ventilators, oxygen, or infusion therapy. Equipment and supplies should be in place at home prior to the child's arrival

Does

Csikszentmihalyi argues that play is too often thought of as something a person ______, rather than something a person feels or experiences

Population-based

Current characteristic of doctor-patient relationships - Focus is on the health of the public

Wide Open

Current characteristic of doctor-patient relationships - In 1996, approximately 210 physicians, nurses, managers, trainees, and students had access to a hospitalized patient's chart

Contract

Current characteristic of doctor-patient relationships - Neither doctor nor patient truly has free choice - Patients as a whole are increasingly wary of physicians as a group - Relationship typically begins with selection from a list

Episodic

Current characteristic of doctor-patient relationships - Physicians couple and uncouple in group arrangement - Physicians are selected and deselected by managed care plans - Patients change doctors because of change in insurance

Art

Dancing Drawing Painting Coloring Writing Creating Music

Universality

Deals with the child's ideas of mortality

Dysfunctionality

Deals with the ideas about bodily functions other than the senses.

Separation

Deals with the location of the dead and is concerned with the child's idea of where the dead are

Four Concepts about Death

Death is irreversible All life functions end completely at the time of death Everything that is alive eventually dies Death is caused by physical reasons

7

Death is irreversible Everyone will die Dead don't function People die from both internal and external causes Specific details of death Envision their own deaths Death associated with old age

Sibling Donors

Decrease the risks of transplant related complications compared to unrelated donors

Trust

Defined as having confidence in another person, or accepting another person as being true and reliable without being able to or seeing the need to verify it. ______ in a professional means that one should be able to expect certain knowledge in certain professional behavior. ______ is the very core of positive human interactions, and is an absolutely necessary component of a supportive relationship. It becomes a component of a therapeutic relationship in that, if ______ is lacking, the client may well terminate the relationship and select an individual with equivalent abilities who does provide the trust factor

Competence

Demonstrated in the face of a known risk such as the presence of a disability, natural disaster, or a life threatening chronic illness

Responses to Grief

Depend on the people's ability to understand the situation, their concern about other people's well-being, their desire to protect others, what the changes in their home life include, how their roles and expectations change, how supported they feel, what stage of grief they are in, and what their concerns about the future are.

Piaget

Depicts the development of cognitive skills in relation to the interaction of maturational processes and experience over a predictable sequence of stages, from the sensory motor. Through the formal operational stage initiated in early adolescence. Focusing on the individual child as an active agent experience in the world, he describes learning as taking place as children encounter new experiences

Piaget (1962)

Described for general status of play based on how children utilize play materials

Social Learning Theory

Describes a child as an active participant in learning within the environment and larger systems Attention Retention Imitation Reinforcement

Temperament Theory

Describes individual characteristics of the child observed in relation to specific characteristics of the environment

Leo Vygotsky (1962)

Describes play as a valuable component of young children's cognitive development and as the leading facilitator of children's ability to think abstractly within the social cultural and historical settings of children's worlds. Suggested that Piaget's theory sometimes ignored the larger social context and was limited to his "special child milieu", and, therefore, it was not a universal phenomenon

Underutilized

Despite the availability of pharmacologic and non-pharmacologic methods that reduce procedure-related pain, they are ________

Building Systems

Detail such as lighting, acoustics, and ambience are important in hospital environments.

Needs Analysis

Determining a customer's needs by acquiring information, processing and evaluating the information, then creating a plan of action to address the needs.

Newborn Individualized Developmental Care and Assessment Program ( NIDCAP)

Developed as a foundation for the provision of developmentally supportive care in the neonatal intensive care unit The plan begins with detailed observations of infant behavior and builds on the infants unique strategies in creating a plan of care, including the infants autonomic, motor, and state systems These observations help those professionals and parents to respond to the infant mini cues and providing supportive care

No

Did family structure influence physician visits or having a usual source of care?

D.W. Winnicott

Did not like parents visiting children in hospitals - Undermines nurses' selflessness - Take forever to leave - Criticize the nurses

End-of-Life Care

Dimensions for _____-_____-_____ _____ - Respect for the family's role in caring for their child - Comfort-managing pain while still able to interact or play - Spiritual care - Access to care and resources - Communication-sensitive and compassionate sharing of information for parent and child - Support for parental decision making - Caring and humanism

Sociofugal Seating

Discourages social interaction

Yes

Do nearly all parents want to participate in the decision about their presence?

Non-maleficence

Do no harm

Immigrant Populations

Documented and undocumented immigrants and refugees

Yes and No - More time on the front end for relationship building - Less time on the back end fixing problems, putting out fires, and dispelling misconceptions, etc

Does family-centered care take longer?

Beneficence

Doing good or causing good to be done; kindly action

Communication

Don't force _________

Trisomy 21

Down Syndrome

Right

Drawing is a (left/right) brain function

Interpersonal

During play, children connect with themselves finding comfort not only in the process of play but, also, in the grounding of self in a familiar, safe activity. This ____________ function of spontaneous play can enable children to explore, resolve conflicts, master situations, and understand mind, body and a world on their own

Flow

During this experience, there is a general feeling of control; a feeling of influencing whatever is happening, and a merging with the environment or process Can be momentary or long-lasting The brain "quiets down" in the sense that there is a lessening of cortical arousal

Concrete Operational

During this stage of cognitive development, children's thinking becomes more orderly, more structured, and more logical. As a consequence, the play of school age children will be more realistic in rule oriented and will reflect a developing need for order.

School Ager (6-12 years)

Erikson Industry versus inferiority To make things To make things together

Preschooler (3-6 years)

Erikson Initiative versus guilt To go after To play

Trust v. Mistrust

Erik Erikson Birth-1 year ISSUE: Separation from caregivers // Unfamiliar environment, routines, and people CHILD LIFE INTERVENTION: Prompt consistent care // Encourage parent involvement to meet both physical and emotional needs

Theory of Psychosocial Development

Erik Erikson Stages applied as a framework from which caregivers approach age-appropriate activities and instruction across the lifespan

Still

Emphasize that the child will have one job, which in most procedures is to hold _______. Repeat the job several times in such a way that the child will be certain that the job applies to the whole procedure.

2001 Crossing the Quality Chasm

Emphasized the importance of patients and families being involved in their healthcare decisions, of healthcare becoming more transparent with improved access to information, and of care that is focused on the individual needs

Erikson's Theory

Emphasizes a healthy personality as opposed to a pathological approach Specific changes are assumed to take place during eight predictable age related stages Individuals face a unique conflict at each stage, which has two aspects: favorable and unfavorable The individual must adequately resolve each conflict before progressing to the next stage

The Research is on Your Side

Empirical, scientific evidence documents the benefits of play on whole child development and challenges the growing trend to reduce opportunities for play at home and school

The Children's Health Insurance Program of 1997 (CHIPP)

Enacted to help provide healthcare coverage for children in families unable to afford private insurance with incomes too high to be covered through Medicaid - Federal funds were available to states covering children up to 200% of the Federal Poverty Level

Designers

Encompass a variety of professionals, including architects, interior designers, furniture in fabric designers, landscape architects, and urban designers Conscientious ______________ Attempt to provide spaces that will support the endeavors of the caregivers in the healthcare fields Aspire to create environments that will directly support the well-being of children and their families

Active Participation in Care

Encourage teens to _______ _______ _______ _______

Question List

Encourage teens to come to the session with a _______ _______

Recreational

Engaging in _______ activities and entertainment, as well as therapeutic sibling group programming, made theme feel welcomed and enhanced their feelings of inclusion

Infant (0-1 years)

Erickson Trust v. Mistrust To get To give in return

Initiative v. Guilt

Erik Erikson 4-5 years ISSUE: Limitations on sense of control and independence // Magical thinking and egocentric thought resulting in misunderstanding and fear CHILD LIFE INTERVENTION: Increase opportunities for control // maintain routines // assess understanding // provide age-appropriate explanations

Industry v. Inferiority

Erik Erikson 6-12 years ISSUE: Separation from normal activities associated with home, school, and peers // Concrete literal thought resulting in misunderstanding, reduced self-esteem CHILD LIFE INTERVENTION: Promote opportunities for choice, control, self-expression, and relationship building // Allow for privacy but also promote peer interactions

Toddler (1-3 years)

Erikson Autonomy versus shame and doubt To hold on To let go

Trust v. Mistrust

Erikson believed that this stage is the most crucial to a human beings development, as it allows the child to establish a sense of hope and the expectation that the world is a good place. It was acknowledged by Erikson that experiences in _______ _______ _______ could and should occur during that first year, but that a baby should emerge from this stage with a favorable balance of _______ over ______

You

Especially for young babies, _____ are their best toy!

Child Life Council

Established in 1982

Federalization for Children's Mental Health

Established in 1990 as a consumer-led organization to assist in building family-centered systems of care

Trust

Establishment of ______ is critical in a supportive relationship and nontherapeutic relationship

Imagination

Ethologists maintained that the __________ is important in the healing process, and that one's fantasies positively add to the quality of life.

Understand

Even if children don't ___________ death, they can still grieve.

Imagination

Even though children want toys that are based on characters from TV shows or movies, these toys encourage consumerism, unhealthy food choices, and limit your child's ___________.

Direct Communication

Every child's cognitive development is unique and can be assessed only by engaging in _______ _______

Quality of Practice

Evidence-based practice is intended to provide child life professionals with the evidence they need to continually advance __________ _______ __________ and to communicate with others about child life work

Children in Stage Three

Evidenced formal operations thinking; they could abstract, hypothesize, be logical, and consider three aspects of a situation

Patient Protection and Affordable Care Act of 2010 "Affordable Care Act"

Expanded insurance coverage to millions of uninsured individuals through Medicaid reformations and subsidized private insurance for people with lower and middle incomes

Negative

Expecting a negative experience leads to a (positive/negative) experience

Chronic Pain

Experience continuous awareness of their bodies Tend to b e less engaged and more isolated Have sleep, mobility, work, travel, and more issues because of this

12

Experiences in mistrust are less damaging and foster growth and balance better when they occur after the first _____ months

Home Health Care

Factors that affect both parents and siblings within the hospital may be exacerbated in the home environment. The ongoing responsibility of understanding the operation and functions of medical equipment without the back up of readily available professionals create additional stress. Siblings may feel less recognize or supported you to additional time devoted to the care of the sick child at home. They may also feel more conspicuous or different in the community and may be reluctant to have their peers visit

Satisfaction

Families of children who are engaged in meaningful activities expressed greater satisfaction with care, even in settings where lengthy weights are the norm

Control

Family-centered care benefits for children: - Children have a say in their treatment and care: increases feelings of ________ and compliance

Independence

Family-centered care benefits for children: - Eases transition to _________ and adult care for teens and young adults

Anxiety

Family-centered care benefits for children: - Increased presence of parent decreases child _________

Individualized

Family-centered care benefits for children: - Medical care is ___________ for each patient: children feel like they really do matter

Mental Health

Family-centered care benefits for families: - Family to family support can be beneficial to parents' _______ _______

Communication

Family-centered care benefits for families: - Open and honest ________: listening, respecting, and valuing the family and child's opinion

Support

Family-centered care benefits for families: - Parents are able to provide better _________ for their children -- provision for increased parent presence in the hospital and during invasive procedures

Parents

Family-centered care benefits for families: - Parents are recognized and valued... allowed to be _________ throughout the medical care

Integral

Family-centered care benefits for families: - Siblings and other family members are recognized as an ________ part of the child's life

Capacity

Family-centered care benefits for pediatric healthcare providers: - Better understanding of the family's care giving _________

Comprehensive

Family-centered care benefits for pediatric healthcare providers: - It feels good to provide __________ care that involves the patient and family in a meaningful way

Accurate

Family-centered care benefits for pediatric healthcare providers: - More ________ information about the child's family: their needs, concerns, issues, and expectations

Feedback Forms

Family-centered care benefits for pediatric healthcare providers: - New JCC and government regulations which may pay hospitals federal funds based on patient and family ________ ________, not other stats

Collaboratively

Family-centered care benefits for pediatric healthcare providers: - Plan of care developed __________ with family: better adherence and follow through with treatment

Empowerment

Family-centered care improves families' feelings of __________ in the care of the patient

Well being

Family-centered care is based on the understanding that families have significant influence over the _______ of a patient

Constant Transient

Family-centered care is based on the understanding that family is a ________ in the patient's life, whereas medical communities are ________

Pain

Fear, anxiety, and tension can heighten the response to ______ in a child no less than in adults

Detachment

Final stage of separation anxiety for older infants Appears after a long period of parental absence and is characterized by the child's reinvestment in his or her surroundings in normal activity. The child copes with the pain of the parents absence by forming superficial attachments to others, becoming increasingly self-centered, and becoming more interested in material objects. While the child appears to be recovering, the return of the parents is met with apathy and the child's inability to reattach. This is the most serious stage, and that the adverse effects are less likely to be reversed

Consultation Service

For hospitals or other health care settings considering the initiation or expansion of child life services, the child life council offers a __________ _________ to support existing program review and development, new program startup, interdisciplinary education, and written standards of care

Stress and Coping Theory

Focuses on the individual viewpoint or appraisal of a stressful situation recognizing that individuals use different coping responses in different situations

Evidence Based Practice

Following the principles of _________ ________ ________, child life specialists should make use of resources from ACLP, as well as other sources, to keep abreast of new theory and research and to apply it accordingly

Hug

For bear hugging, chest to chest contact allows the child and the caregiver to _____ eachother

Upper Body Hips

For bear hugging, hug the child's _______ _______ and _______. Minimize the child's arm movement by placing the caregiver's arm over the child's arm. The child straddles the caregiver to minimize movement of legs

Elbow Hand

For bear hugging, stabilize the holder's _________ and ________ using bed

Analgesia

For children to cope effectively with painful experiences, adequate ________ is required.

Significant Others

For children to cope effectively with painful experiences, supportive _______ _______ is crucial

Soothing Action

For children, _______ _______ usually takes the form of play because it is children's most familiar, comfortable medium. Play is often the only place of comfort that children are able to bring into health care settings, and keep with them on a continual basis to confront the stresses of everyday life when in a hospital

Relaxation

For comfort touch, all the child and the caregiver to focus on breathing and _________ techniques. Be sure to create relaxing posture for the child.

Hand Arm

For comfort touch, contact on the ______ and ______. The caregiver can gently pat, rub, or massage the child's body

Hand

For comfort touch, the staff performing IV will hold the child's ______ on the bed. Use the holder as needed.

Chair

For comfort touch, when the child is sitting up in a _______ and hand is on the bed, the child's feet will be out of the way

Efficacy

For hospitalized children, the efficacy of play is enhanced through the use of familiar, developmentally appropriate toys and activities to foster security, control and emotional support, as well as toys that are relevant to children's medical conditions and aid in the "work of worrying"

Immobilization

For swaddling and snuggling, have sufficient _________ - Secure the child's lower body by using a blanket and the holder's arm. Hold the child's shoulder and extremity of the IV area and stabilize the holder's hand using bed

Upper Body Waist

For the kangaroo hug, hug the child's ________ _______ and below the ______. Cross caregiver's legs over the child's feet, or wrap a blanket around the child's legs

Adolescense

For this age group in the emergency room, Communicate honestly Involve patient in care and decision Discuss potential psychological changes and physical responses Address long-term issues in followup Provide opportunity for follow up discussion and guidance as needed

School Age

For this age group in the emergency room, Ensure preparation for and involvement in procedures Encourage choices among options if possible Involve patient in care Teach planned coping strategies that encourage mastery Provide age-appropriate activities Help children recognize aspects of their effective coping

Preschool

For this age group in the emergency room, Parental involvement in noninvasive cares should be encouraged The parent should be able to remain with the child to provide emotional support There should be accurate preparatory information There should be psychological preparation prior to and following procedures You should ask questions and model honest communication Teach planned coping strategies Provide age-appropriate activities and play

Toddler

For this age group in the emergency room, Parents should be involved in noninvasive cares The parent should be able to remain with the child to provide emotional support Choices should be provided in age-appropriate activities The number of caregivers should be minimized The child should be actively involved in treatment if possible The child should be prepared for procedures There should be age-appropriate activities when waiting The use of excessive restraint should be minimized

Infancy

For this age group in the emergency room, parents should be able to remain with the child to provide emotional support the number of caregivers should be minimized the number of intrusive procedures should be minimized The presence of parents should be enabled to comfort the child

Security

For young infants, early threats to a sense of _________ are loss of support, loud noises, and sudden movement

Locomotion Play

Forges connections between neurons

Collaborative

Forming supportive __________ relationships with parents of children with a chronic illness should be an early intervention - Such partnerships increase the chances that parents will be open in sharing the stresses and hassles experienced in the daily care of their children

Child Life Programs

Fostering collaborative dialogue with families, promoting communication throughout the experience, and continuously acknowledging the family as an integral part of the healthcare team are strong foundations in family ________ ______ ______-

Eden Alternative

Founded by Dr. W.H. Thomas Focuses on the psychosocial needs of patience and addresses these needs to the physical environment 10 beliefs Considers a supportive physical environment to be essential to its success. Although the program is focused on seniors and adults, the general philosophy can be readily applied to children and their families. Loneliness, helplessness, and boredom or chronic problems for long-term care patients of all ages. Architecture that facilitate social interaction, empowers children to control their physical environment, and stimulates imagination imagination is highly desirable in long-term pediatric settings

Anthroposophy

Founded by Rudolph Steiner in 1924 Supportive philosophy focusing on opening up to the various spatial realms connected with human life through our conscious understanding. The intent of this facility is to provide a sense of living order. The philosophy reflected in the building assumes an evolution on the part of the healing patient from containment to exploration.

Clinical Therapeutic Connected Overinvolved

Four broad types of mutual relationships

Burnout

Four predictor variables of _______: - Individual characteristics - Workload - Role Stress - Social Support

Future Minds

Fredrick Froebel stated that play needs to be cherished and encourage for it is in free play that children reveal their ____________ ____________

Grassroots Movement

Freire's train-the-trainer program

Comforting

It is vital that during every stressful procedure someone is assigned the job of __________ the child.

Family Systems Theory

Friedman Individual family members make up a whole family unit Interactions between individuals represent countless complex interactions All interactions between individuals are interdependent When a change occurs in any member, it affects the whole system Family units interact with other units

Early Play Theories

From the end of the 19th century and the first of the 20th century, they often described play as an instinctive mechanism that led to a number of different outcomes depending on various theorist perspectives

Modeling

From the stress-coping perspective, _______ may affect both appraisals, by providing the patient with additional information about the nature of the experience to be encountered (primary) and by demonstrating how a "model" child successfully encounters and impeding threat, in the process introducing effective strategies the child may adopt (secondary)

Preparation

Further attention to the manner of presentation, language used, and types of information conveyed, would enhance _______ efforts

Cure

GOALS - To cure imbalance as a result of a situation and temperament or personality problems POPULATION - Children who do not respond to restorative play or identified as having emotional problems FORMS OF PLAY - Structured - Distinctive FUNCTIONS OF PLAY - To express fantasies, anxieties, and defenses through repetition and by developing a relationship with therapist through situation/objects specific to the individual

Prevention

GOALS - To prevent deterioration, diffusion, regression - To maintain internal sense of control/efficacy POPULATION - All children and groups FORMS OF PLAY - Nondirective - Unstructured FUNCTIONS OF PLAY - To maintain a sense of control To encourage interaction with peers in a familiar setting with objects and materials for age range and individual interests

Restoration

GOALS - To restore after situational distress/imbalance - To assess rapidity of return to previous state POPULATION - All children - Small groups - Individuals FORMS OF PLAY - Structured - Guided FUNCTIONS OF PLAY - To express feelings - To obtain mastery through play with objects and roles associated with health-care encounters

Cure

GOALS To cure imbalance as a result of a situation and temperament or personality problems POPULATION - Children who do not respond to restorative play or identified as having emotional problems FORMS OF PLAY - Structured - Distinctive FUNCTIONS OF PLAY - To express fantasies, anxieties, and defenses through repetition and by developing a relationship with therapist through situation/objects specific to the individual

Fiduciary Contract

Gary Schoener (1998) describes the relationship between therapist and client as a ________ ______ -- an agreement between unequals in which one person has more power and more responsibility

Stress Potential Assessment Process

Gay bars et al. (1990) apply a systems framework for the assessment of the child's vulnerability to stress relative to the context of the healthcare system Draws the attention of the child practitioner towards the interaction of child variables, family variables and healthcare variables during the dynamic and ongoing process of assessment

Proactive

General playing in a playroom or at bedside to maintain normal development is a _________ intervention

Proactive Preventative

General preparation for procedure is a ________ or __________ intervention

Family Income

Generally has an impact on the availability of resources and supports, an important variable for siblings

Simpler

Generally, the (simpler/more complex) the toy is, the better it is for your child's developing mind.

Goodness of Fit

Genetic qualities of temperament account for some individual differences in behavior but environmental factors are considered to influence the expression of those traits Challenge for child life professionals involves providing a supportive environment that matches the needs of the child with the demands of the healthcare setting

Territoriality

Gifford Defined this as a pattern of behavior and attributes based on perceived, attempted, or actual control of a quantifiable physical space. Can be differentiated from privacy and that address is domain and ownership rather than sense of personal separation. As with privacy, there are multiple rounds of this ranging from primary to public.

System Community

Healthcare providers must intervene at the _______ and _______ levels to effectively prevent many negative health outcomes

Express

Give children an opportunity to _______ their thoughts, concerns, and feelings

Conversation Informality

Goal of a child life and education program -- Plank § Help children at meal times to accept hospital food or limiting diets, by providing food groupings at mealtimes with the chance for ________________ and __________

Ongoing Program

Goal of a child life and education program -- Plank § Provide an area where parents can visit and play with their child as part of an ____________ ____________. At the time when parents have to leave, the child finds himself with others and can be more easily reassured

Activity of the Growing Child

Goal of a child life and education program -- Plank § provide a setting for children of all ages where they can find play and activities that interest and absorb them, counteract their loneliness and anxiety, and help to turn the passivity of the patient into the __________ ______ _______ ________ ________

PTSD

Goleman (1995) summarizes the components and process leading to _______ to include heightened sensitivity for fear responses at the neural level, or, in the language of the stress-coping model, sudden primary appraisal of extreme threat The person feels overwhelmed, powerless and helpless, and feels unable to escape, change, or cope with the event

Diverse

Healthcare settings are more _______ than hospitals

Younger

Good books for (younger/older) toddlers include ones that focus on topics that interest them, like animals, foods, and faces with different expressions etc

Older

Good books for (younger/older) toddlers include ones with repetitive text that allows them to "read" a story themselves as well as books that tell stories about familiar experiences. Other helpful books encourage skills like potty training, dressing and sharing. Make story time a part of every day. Engage your child with the story by asking questions about what happens next or how are the characters feeling. Encourage them to say familiar words and phrases that appear in the book.

Infants

Good books for _______ include ones with one or two clear images per page, and simple rhyming stories. Show your baby pictures, and read stories and allow him to watch your mouth and facial expressions as you read. Name and point to objects on a page for her, but don't worry about finishing a whole story.

Quality of Life

Good outweighing bad

Nurse Anesthetist

Graduate of approved anesthetist program Licensure CRNA and APN credentiials

Impaired Social Cognitive Competence

Gray (2013) documents declining opportunities to play with a corresponding decline in empathy and rise in narcissism among children with few opportunities to play socially. Depriving children of child-initiated outdoor play impedes the development of social-emotional learning and the ability to self regulate.

Primary

Historically, prevention was conceptualized in terms of _______ interventions practiced before an organism experienced biological disease

Survival

Groos (1914) Play of young animals mimics the _______ strategies of adult animals

Nature

Growth, maturation, and expansion of environmental influences that occur with increasing age change the _______ of stressful experiences

Fire in My Heart, Ice in My Veins by Enid Samuel-Traisman (1992)

Guided journal for teenagers experiencing a loss Journal encourages activities that promote emotional expression

When Someone Very Special Dies: Children Can Learn to Cope with Grief by Marge Heegaard (1988)

Guided journal geared toward children ages 6-12 who have experienced a death Blends the exploration and validation of feelings of grief with explanations of basic concepts of death and the variety of beliefs about death that exist in different cultures and religions

Proxemics

Hall (1969) describe this as the interrelatedrelated observations and theories of man's use of space as a specialized elaboration of culture

Social Planners Community Organizers

Have developed a wide variety of strategies to effect social change that range from formal planning with community representatives to highly confrontational tactics designed to disrupt social activities

Nursing Schools Social Welfare Agencies

Have their roots int he middle to late 19th century and were agents of change in promoting the well-being of children

Older Adolescents

Having a tainted a confident level of independence, they develop improved parent relationships and may approach the stresses of hospitalization with adult like coping skills

James Robertson

He and his wife, Joyce, found children's experiences to brief separations from parents under a variety of circumstances "A Two Year Old Goes to the Hospital"

Prevention Services

Health-care professionals must continuously seek opportunities to provide effective _______ _______

Healing Wellness

Health-care professionals who work with families during illness have unique opportunities to implement effective teaching that may enhance ________ and _______

Zone of Helpfulness

Healthy relationship area in which most patient contact should occur If one moves too far to the left, there is potential for under involvement in the neglected professional responsibilities. Too far to the right, in the relationship becomes over involved, with the need to maintain the relationship taking priority over the needs of the client. This template does not require that the professional embrace a particular style or even theory, but rather be aware of one's place on a relationship continuum.

Puzzles

Help toddlers learn to solve problems, think flexibly and stick with a task, as well as develop fine motor skills.

Information

Helps in predicting potential stress points

Educational Intervention

Helps to facilitate children's recovery time and to decrease the number of days in the hospital setting

Secondary

Historically, prevention was conceptualized in terms of _________ prevention practiced after a disease had developed but before significant suffering

Tertiary

Historically, prevention was conceptualized in terms of __________ prevention practiced after suffering or deterioration had occurred

Negative

Historically, the _________ aspects of children's reactions to healthcare have been documented

Reinforce

Higher levels of developmentally appropriate symbolic by and may be fostered when parents and other caregivers ____________ imitation by teaching a step wise, versus a global, approach to mastering independent activities, offer explanations of rationale supporting parental behaviors and roles, and institute active listening and responding

Grants

Highly competitive Typically given for one-time needs

Dr. F.C. Robbins

Hired Plank to organize the Child Life and Education Department at Cleveland Metropolitan Hospital One of his goals was to change the drab, stark spaces in which the children stayed

Role Strain

Holds that as society becomes more complicated, so do the social roles of its members.

Reaction

Honor whatever ________ the child has

Preoperational

In Piaget's theory, the stage (from about 1 to 3 years of age) during which a child learns to use language but does not yet comprehend the mental operations of concrete logic Egocentrism

Adolescent (12-18 years)

Hospitalization issues Dependence on adults Separation from family and peers Fear of bodily injury and pain Fear of loss of identity Body image and sexuality Concern about peer group status after hospitalization

Toddler (1-3 years)

Hospitalization issues Separation Fear of bodily injury and pain Frightening fantasies Immobility of restriction Forced regression Loss of routine and rituals

School Ager (6-12 years)

Hospitalization issues Separation Fear of loss of control Fear of loss of mastery Fear of bodily mutilation Fear of bodily injury and pain Fear of illness itself, disability, and death

Preschooler (3-6 years)

Hospitalization issues Separation Fear of loss of control and sense of own power Fear of bodily mutilation or penetration by surgery or injections, castration

Infant (0-1 years)

Hospitalization issues Separation Lack of stimulation Pain

Life-space

Hospitalize children participating in a program of planned play demonstrate more positive feelings in __________ drawings than those without a planned program

Higher

Hospitalized children ages eight through 11 years rated being away from family (higher/lower) than any other fears associated with hospitalization

Guided Imagery

If you say you can do it, you will Can be used for pain relief

The Next Place by Warren Hanson (1997)

Illustrated poem that explores the possibilities of where a person goes after they die

Turner (2005)

Illustrated scenarios to draw distinctions among secure, avoidant and resistant relationships. Advocated for the inclusion of attachment informed assessment as a way to strengthen the selection of interventions to meet the needs of an individual parent child dyad

Collaborative Relationships

Important steps in building ________ ________: - Good communication with clarity of vision and a foundation for active involvement of all in goal setting - Use of educational materials and strategies that account for the psychologic needs of the learner - Development of relationships that build on the strength of individuals and families

Chronic Pain

Imposed diverse restrictions on daily living and role performance It affected sleep, mobility, work, finances, travel, recreation, and simple activities. Participants searched for the cause and meaning of their pain. Not knowing the cause of their pain left them feeling helpless; many described how the pain controlled their lives. They indicated they were prepared to try anything that might help with pain relief.

Gene Stanford

In 1980, he challenged the fledgling organization to enter adulthood by achieving three things: § A clearly defined role § Clearly defined qualifications § Control of who can enter the profession

Supportive

In 1984, as study by chess and Thomas documented that for school children, psychologic development sometimes includes stress, but that within a _____________ environment with opportunities for mastery, hospitalization may result in psychology Jake benefits

Free-standing

In 1992 the Child Life Council (CLC) became incorporated as a ___________-_________ organization

Macrosystem

In Bronfenbrenner's bioecological model, the outermost environmental level, consisting of the child's culture and society.

Practice Play

In Piaget's theory, children use this to consolidate and re-organize behaviors into symbolic play. This pretend play truly emerges during the second year of life

Scaffolding

In Vygotsky's theory, the use of appropriate guidance techniques that allows for enough challenge to advance the child to the next level (while recognizing and adapting to characteristics of an environment to promote learning)

Emergency

In _______ situation, sometimes preparation is not possible. Coaching a child through the procedure and offer ideas for coping strategies is the next best thing

General

In _________ Studies in settings other than healthcare facilities on children's personal space, the methodology most frequently used involves asking the child to position a figure relative to a figure of himself or herself in the context of a given situation

Primary Territory

In a hospital, this would be the patient's room

Pain Management

In addition to advocating for the appropriate use of analgesics, CCLSs are often directly involved in the utilization of non-pharmacologic _______ _____________ techniques in coaching or supporting patients and families before and or during distressing medical procedures

Anxious

In addition to play's developmentally supportive benefits and as a normalizing activity for children and youth of all ages, it is particularly valuable for children who are ________ or struggling to cope with stressful circumstances

Safe

In addressing the needs of the older infant, toddler, and preschool age child, it is important to clearly establish ______ places for children

Younger Adolescents

In general they are less vulnerable to these inherent risks about loss of independence and control because they have yet to develop strong emancipatory drives and more easily handle the increase dependency precipitated by the hospital experience

Frank McCourt

In his memoir Angela's Ashes, he describes his childhood as miserable, immersed in poverty , neglect, the death of siblings, drunkenness, living conditions of almost unimaginable squalor

Turn your Neighborhood into a Place for Play

In his play advocacy manifesto, Lanza (2012) identifies challenges to free play, offers practical strategies for fostering free play in neighborhoods across the country, and shares inspiring stories of innovative communities that are making free play a priority for children.

Leadership

In many cases, child life professionals provide _____________ for activities such as patient and or family advisory councils and hospital wide staff education

Difficult

In order to be play, an activity must ordinarily be ______ enough to be interesting, but not so ______ that it is impossible

Experience

In terms of the loss of a family member, children should be able to ________ it

Elective Social Skills Training

In the case of _______ _______ ______ _______, the intervention occurs after symptoms have developed but before any major negative outcomes occur

Therapy

In the case of _______, the intervention occurs after the disease or negative health outcome is present

Common Childhood

In the era of enlightenment __________ __________ began to enjoy a status in the human story that would increase in the late 18th and early 19th centuries when children were thought to possess a primal innocence that could be instructive to adults and needed to be protected and cherished

Physical Reason Why

In the event that a dying is not the child, discuss the _________ _______ for the death and then describe ______ this is not going to happen to the child.

More Opportunities to Participate in Care

Indicate those areas in which the child might like to participate during the procedure

Children in Stage Two

Indicated concrete operations thinking; they could consider two aspects of a situation at the same time, and the ideas which they held could conflict or be congruent; the children tended to think in terms of specifics

Stress Theory (Lazarus)

Individual appraisal Cognitive and behavioral attempts to manage stressful situations Behavior is affected by the level of understanding

Pain Expression

Inextricably linked to language, and the meaning of the language used is crucial to understand a person's _______ _________

More

Infants who have undergone painful procedures within the first few days of life have been shown to react with (more/less) crying to subsequent procedures

Child Life Value Statement

Infants, Children, Youth, and Families Play Therapeutic Relationships Communication Theoretical Foundations of Practice Professional Collaboration Professional Standards of Practice Research

Adult

Influences the organization of the attachment relationship as it develops over time and across situations

The Child's Role

Inform the child of the "jobs" he or she needs to do related to the procedure

Specific

Information about a medical procedure should be as _________ as possible as this can lead to a greater reduction in anxiety than when children receive only standard or more generalized forms of information

Anticipatory Coping

Information and preparation will lessen teen fears and anxiety while enhancing this

Deliberate

Information may be given directly to children through deliberate explanations of upcoming events.

What Why

Information should include both _______ will happen during the upcoming medical procedure as well as ______ it will happen

Family Systems Theory

Informs child life practice by providing a perspective on the socialization of the child and drawing attention to many aspects of the context of family as a socializing agent When change occurs the whole system is affected and reacts in a manner that serves to sustain balance Provides a framework for childlike professionals to observe the transactional nature of family responses to situational events and plan events to meet the unique needs of individual families

John Bowlby

Interested in the theoretical aspects of the observed reactions of young children to brief separations from their mothers or mother surrogates Human attachment situated a primary and singular component of human life independent of other needs or gratifications

Erik Erikson

Interpreted psychosocial development Took the ancient "ages of man" models are constructed epigenetic theory of psychosocial development from birth to death Considered the social and cultural environment of the developing individual as the influential factor in the development of personality across the lifespan Development is dynamic and a continuous process whereby the individual strives to adjust to issues that arise at key interaction points

Adolescent (12-18 years)

Interventions Encourage peer group activities Provide privacy Respect independence Encourage self-expression Address body image, sexual image, and future concerns Facilitate medical preparation Encourage education and teacher involvement Facilitate visits with peers

Toddler & Preschooler (1-6 years)

Interventions Maximize parental involvement Maximize parental information Facilitate medical play Promote therapeutic play

Infant (0-1 years)

Interventions Maximize parental involvement Maximize parental information Provide stimulation

Peer Group Support

Interventions for adolescent should focus on this

Jean-Jacques Rousseau

Introduced the radical idea that children might actually need to play. He wrote in Emilie that children have their own unique way of seeing, thinking, and feeling, and adult should allow children the innocence and freedom of childhood by not restricting them to adult ways

Professional Caring

Involves a self-donation and self-transcendence that is, caring arises out of a concern for and response to the patient or family

Directly

Involving siblings _______ may mean encouraging their presence in the hospital setting and allowing them to participate in developmentally appropriate cares or bedside activities

Degree of Distress

It is the combination of primary and secondary appraisals that results in the ________ ______ ________ one experiences

Child Life Professionals

It is the job of ________ _________ to provide care and guidance in these negotiations, to serve as culture brokers, interpreters of the health care apparatus to family and child and the child to medical professionals

It's worth the extra cost - Failed communication and trust are much more expensive

Is family-centered care more expensive

Strain

It is assumed that psychologically healthy children are able to use play to organize, articulate, and master those aspects of life that would otherwise cause ____________, and that play is the medium through which children's inner world can be seen and better understood

Reason

It is important for school-age children to know the implications of disease or treatment and hospitalization for the present and also the future, as they are able to ________ and cognitively process events and consequences

Departmental Process

It is important to facilitate a _______ _______ -- groups of solo practitioners -- who can provide respectful clinical supervision and integration of new learning and theory

Least

It is in the course of serious play that children are apt to be entirely focused on the activity, and ______ aware of the environment and activities taking place outside of the play experience

Stressful

It is particularly important the children have opportunities for play when they are in _________ situations

Guided Imagery

It is proposed that ________ _________ helps people experiencing chronic pain gain awareness of this underlying process and explore alternative ways of experiencing pain for greater consistency with well-being.

Education

It is speculated that with more ____________ may come in increased sensitivity to the effects of hospitalization on siblings and a greater sense of responsibility to provide support and information

Fair Standards Act

It was not until 1938 that the _________ _________ ________ set limits on the age at which children could be employed, 14, and the number of hours per day they could work, 10. o Children of any age could be required to work without restrictions if employed by their parents or parents substitutes

Rene Spitz

Made careful observation of studies of infants in a foundling home in order to test the hypothesis that it was precisely the absence of mothering and environmental stimulation that led to the alarming susceptibility to disease, physical wasting, and emotional withdrawal o Babies raised in the fondling hospital were emaciated, listless, unsmiling, scarcely able to move o His studies were carried out on babies institutionalized for conditions other than sickness

System

Jason, Anes, and Birkhead (1991) suggested that ________-level variables must be addressed in treating chronic fatigue syndrome

Psychoanalytic Theory

Justified at practice that was supposedly devoid of relationship. Freud himself did not practice a non-responsive therapy, but was actually quite active with his patients. It was the followers of Freud who tried to implement his theories and stay completely invisible, physically and personally, to their patients

Despair

Middle stage of separation anxiety for older infants The child starts crying and appears depressed. One of increasing hopelessness. The child may continue to cry intermittently, but more often appears withdrawn and quiet

Asking Questions

Keeps you in control and may block a moment of imaginative play from developing

Effective Programs

Key elements of _______ _______: - Conveying information to the child in a developmentally appropriate manner - Encouraging the expression of feelings about the information or event - Including the participation of parents or other significant family members - Establishing a trusting therapeutic relationship with staff members

Coping Healing

Play is a central experience in the hospital lives of children. It is a means of _________ and _________

Toddlers

Learn by moving, exploring, playing, and engaging and socializing activities. They make their needs known and demonstrated ways, often reacting with frustration to restrictions of movement or changes in routine. They may perceive the hospital as punishment and if they experience pain for the first time, they may feel more confused when the parent does not rescue them from painful procedures. They need to master experiences and gain autonomy is met through play. The presence of child life programming and opportunities to play at the bedside or in a playroom or crucial to ensure ongoing development.

Hands-on

Learning is enhanced with _______-_______ methods versus exclusively verbal explanations

Aggregation

Legislative and policy strategies are typically directed to higher levels of ________ then individual clients

Preschoolers

More secure than toddlers if they have had opportunities to develop trusting relationships through life experiences. Still very vulnerable to the stresses of hospitalization and medical care Suffer most from physical restrictions and loss of control. They may continue to view the hospital as punishment but now also engage in magical thinking

Psychosocial State

Play is viewed as a primary method of determining children's _____ _____, especially among nursing staff

Playfulness

Many theorists suggest that ____________, and the ability to play, is a critically important characteristic of humans that promote rapid adaptation to change the environment, allows us to psychologically cope with past and present concerns, and prepares us for our future roles as adults

Hopeless

Many times, the problems children confront leave them feeling _______. They may not be able to think of possible solutions to problems can be enacted using physical movements, prompts, mental actions in mind body interactions. This can be observed as child life specialist support children reenacting healthcare experiences during which children have previously been the passive recipients.

Intense

Play for preschoolers often includes the simple imitation of adults and moves into more ____________ themes reflecting real life roles, home relationships, expression of physical and emotional needs, for bidden impulses, and the reversal of roles

Protection

Maximizing parental presence and participation in cares provides the greatest _____________ for the older infants successful developmental growth and minimize the disruptive effects of hospitalization

Siblings

May experience a wide range of feelings and concerns, and may be forced to identify and deal with these concerns in the absence of the parent who is either physically separated or emotionally unavailable to them when a child is hospitalized

Empowerment

McCarthy and colleagues (2002) reported significantly higher scores on measures of sense of control, ability to make decisions, and ability to provide care, for parents who participated in an __________ approach to asthma education.

Age Experiences

Play frequency, complexity, and category changes with _____ and _____

Easy

McLeod and McClowry (1990) Characterized by adaptability and positive mood, may show anxious behavior at times that could be addressed by interventions

Slow-to-warm

McLeod and McClowry (1990) May need extra time and attention in order to adjust to new situations

Difficult

McLeod and McClowry (1990) Perhaps described as manipulative, demanding, highly active and or loud, can be facilitated through interventions related to increasing choices and control, positive feedback and activities designed to increase the child's self-esteem

Compassionate Empathic

Medical curricula place increasing emphasis on teaching and assessment of __________, ___________ behavior

Intervention

Medical play is often used as __________ in Japan

Psychosocial

Melnyk et. al found that an experimental program designed to enhance maternal coping during and after their child's hospitalization did result in more positive _______ outcomes -- their children had more positive behavioral outcomes

Bedside Manner

Michael Kahn (1991) Describe Freud's early dismissal of the relationship, referred to as "________ ______," stating that it was relevant in the therapeutic process

Age Experiences

Play frequency, complexity, and category changes with _______ and _________

Flow

Mihaly Csikszentmihalyi (1997) found that those individuals who get the most pleasure from play enter into a mental stay called "______" People are fully in the moment, totally consumed with their playful pursuits and intrinsically rewarded by spontaneous joyful feelings that accompany these experiences A state of self-forgetfulness, the opposite of rumination and worry, people are so absorbed in the experience at hand that they lose all self-consciousness

Core Competencies

Minimal level of acceptable practice as defined by the Association of Child Life Professionals, and are a guide for individuals or organizations who may wish to further define this as specific to their situation

Association for the Care of Children's Health (ACCH)

Mission in 1965 was to provide leadership for "humanizing healthcare for children" - Parents could become members in 1978 - First organization to advocate for the professionalism of child life - 1987: Articulated 8 key elements for family-centered care

Preparation Process

More than 50 years of research and experience support three key elements of the ___________ ____________: o Provision of developmentally appropriate information o Encouragement of questions and emotional expression o Formation of a trusting relationship with a health care professional

Fantasy

Montessori's motives in stating that play is a child's work are often misinterpreted and miss understood. Her writing emphasize that children's way is a kind of ________ preparation for adult life, not a substitute for work

Strategic Planning

More focused on defining two or three critical success factors and implementing strategies to achieve specific objectives

Alternative Focus

More respect is implied about the child's active participation in selecting and implementing the strategy Distraction

Trauma or Emergency

Most likely no end of life plan in place Loss of logic and objectivity Allow parents to fill their role in parenting Facilitate memory making and time spent with child Offer outside grief support and counseling

Funding

Most often, ______ constitutes the greatest roadblock to launching a child life program

Would

Most parents (would/would not) want to be in attendance if their child were likely to die

Comprehensive

Most parents have a strong desire for ___________- information about their child's care and should be included in the preparation process

Impact

Mothers of children who are hospitalized state that they often feel stressed and out of control because of the _______ of disease and treatment

Sociodramatic Play

Motivated by the native children to model adults in their environment in their thoughts, feelings, actions, and reactions, interview themselves as other persons and act accordingly.

Institution

Multifaceted ____________ - wide protocols incorporate the standard utilization of both pharmacologic and nonpharmacologic techniques, preparation of patient and family, environmental considerations, and training of all health care team members

Prevention

Play has an important role in _____, providing for integrating experience, emotion, and cognition as experiences are occurring, so that intervention is necessary

Pediatric Ambulatory Care

Must be provided in ways that Enhance the strengths of families Support the child's development Promote multidisciplinary communication and cooperation Build partnerships with community-based health, early intervention, education, social services, and other human service organizations and agencies

Play

Must be: - voluntary - internally motivated - pleasurable, relaxed - "as if" or pretense present - organism rather than object dominated - unique, unpredictable - active

Connected Relationship

Mutual Relationship Type

Over-involved Relationship

Mutual Relationship Type

Connected

Mutual Relationship Type - May develop when the patient and professional have either been together long enough for the relationship to have evolved beyond a clinical or therapeutic relationship, or the process is accelerated because of the patient's extreme need - Ex. Oncology - Developing reciprocal trust is the basic social process that enables professionals and children to reach the goal of being ________

Therapeutic Relationship

Mutual Relationship Type - Most common - Ideal

Overinvolved Relationship

Mutual Relationship Type - Usually develops when the patient has extraordinary needs and the professional chooses to meet them, or when the patient and the professional have spent an extensive length of time together and mutually respect, trust, and care for each other

Knowledge

Never assume a child holds any level of knowledge.

Questions

Never diminish or belittle a child's _________-

Cognitive Emotional

Play in the hospital has _________ and _________ limitations

Swallow

NG tube procedure preparation - Materials ---- NG tube ---- Jelly ---- Procedure doll - Key Points ---- We know its uncomfortable ---- Job is to ________ ---- When it's in you'll stop feeling it ---- Soreness/scratchiness ---- Why they need it

Collaborative Care

NIDCAP Developmental Care Environment All exams, procedures, and test should be planned with the infants primary caregiver and parents present to provide comfort inn lesson stress

Individualized Feeding Support

NIDCAP Developmental Care Environment Both method and schedule of feeding need to be based on each infants individual needs and competencies, so that feeding is perceived as pleasurable

Structuring the Infant's 24 Hour Day

NIDCAP Developmental Care Environment Cares should be cluster to respect the infants sleep wake cycles and to promote growth

Quiet, Soothing Environment

NIDCAP Developmental Care Environment Measures like rocking chairs or recliner's at the bedside for parents, home like family spaces, and the ability to personalize the infants bedside with family photos, soft music, clothing, and blankets help decrease family stress. Subtle lighting to reflect day and night sequencing and reduction of noise levels in special care nursery's are also important to reduce potentially harmful stimuli

Appropriate Positioning

NIDCAP Developmental Care Environment Placing the infant in special positions for cares and rest enhances the infants ability to seek comfort and encourages stability

Developmental Support

NIDCAP Developmental Care Environment The caregiving team should include developmental care specialists as well as other disciplines to provide psychosocial care including social work, pastoral care, and child life

Pacing of Care Giving

NIDCAP Developmental Care Environment The family is in integral part of caregiving as the infant begins to recognize parents voice, touch, and feel and receives comfort in more physiological measures with family presence and participation

Adolescence

Naturally seeking to separate from parents and family, they develop a heightened dependence on peers and social groups The hospital experience becomes threatening as it separates the child from normal group activities, disrupts future plans, and increases insecurities about appearance and self-worth

Primary Appraisal

Nature of the threat "Am I in trouble" The individual might appraise the potential threat as irrelevant, as benign or positive, or as in some way stressful

Anxiety

Nearly all parents share a generalized feeling of __________

Caring About

Necessitates emotional involvement and commitment to the patient

Adult Understanding

Observing children's play leads to ____________ ____________

Job Dissatisfaction

Negative affective response regarding certain aspects of ones job and work experiences (job-centered)

Negative

Negatively-valenced priming results in more ___________ evaluations of ambiguous stimuli than does positive priming

Analgesia

Neonates who undergo painful procedures with inadequate ___________ demonstrate detrimental long-term effects in their perception and response to painful events.

Problem-Solving

Nesting blocks and shape sorters can be used independently now as your toddler's _________ skills develop.

Lie

Never _______ to a child about death

Nocebo

Non-specific negative outcomes Clinical outcomes which arenot attributable to the actual pharmacological or physiother-apeutic intervention and are susceptible to attention,expectation, suggestion, and conditioning

Affective Expression

Normal grief behavior

Behavioral Expression

Normal grief behavior

Cognitive Expression

Normal grief behavior

Physical Expression

Normal grief behavior

Guided Imagery

Not about me putting a patient in the image of a more comfortable place from my point of view,but rather my teaching patients how to attain a state of comfort based on their own images.

Chronic Pain

Not an isolated event. It is a manifestation of the whole; therefore, getting well entails resolving issues that are present in all aspects of one's life.

Inexperience

Not defined as play "because it suspend or evade the rules of reality but because the players freely accept the goals and rules that constrain the actions, knowing full well that he or she need not play"

Understandable Language

Not only do parents need information, but also they need to receive it in a _____________ _________ with the opportunity to ask questions for clarification

Personification

Notion of death as concretized and reified as a person or thing

Home Care

Numbers are increasing rapidly due to the development of ventilators and other sophisticated equipment for home use, the recognition that hospitalization is stressful for children, and the reimbursement structure. It stands on firmer financial ground. Concerned about the susceptibility of children to nosocomial infections while in the hospital Pediatric services have increased to supporting nurturing environment in which families need for medical assistance in normal lifestyles combined to meet a comprehensive care needs of the medically fragile child.

Doctor-Nurse Game

Nurses must play the role of inferior in subtle ways to maintain cordial relations with the doctor as their superior

Social Learning

Observational learning Attention Retention Imitation Reinforcement

Positive ending

Offer stickers or other rewards to help the child have a concrete, positive representation of the preparation session

Appropriate Choices

Offer the child _______ _______ at every juncture

Behavioral Limits

Offer the child some _______ _______ as well as choices

Medical Play

Offers children an opportunity to experience some mastery over things that have been used on them in the medical setting

Female Doctors

Often find that they are met with less respect and confidence and are given less help

Nontherapeutic Relationships

Often proactive but may be specifically aimed at providing for a need or desire of the other person May be a supportive relationship but not necessarily May or may not be professional relationship because it may not have standards or codes, or may not follow them Usually do not provide clinical services Have a starting point but can continue indefinitely until one party decides to end the relationship

Rest Relaxation

Oksala and Merenmies (1989) found that the need for _______ and ______________ was strongly essential during the entire stay in a pediatric ICU, while the need for beauty and aesthetic experiences became more important during the latter portion of the stay. The ladder need is probably similar to what might be appropriate for the home care experience

One Week

Older child need to know about impending procedures about ________ in advance to mentally prepare and practice their coping strategies, and acclimate themselves to new information

One week

Older child need to know about impending procedures about ________ in advance to mentally prepare and practice their coping strategies, and acclimate themselves to new information

Art

Older toddlers are ready to explore and express themselves through ______

Advance hospital's ranking

One way your hospital can benefit from patient-centered care: - Tactics like implementing communication strategies based on the patient-centered model of care offer the opportunity for hospitals to improve CAHPS (Consumer Assessment of Healthcare Providers and Systems) scores, leading to overall higher rankings

Improve patient health outcomes

One way your hospital can benefit from patient-centered care: - The best reason for implementing a patient- and family-centered model is that it is the right thing to do - Experience, expertise and scientific knowledge all support this model because it has consistently demonstrated improved patient health outcomes

Play

Research shows that adolescent's moods are most positive when they are engaged in ____________ then at any other time

Favorably

On most measures, the children receiving child life interventions responded more ____________ than did children who did not have access to child life

Predictable Realistically

Once a child and family's needs for preparation have been assessed, the task of the CLS is to provide information that will make events seem as _______ as possible, and _______ influence children's and families' appraisal so that they have adequate coping resources to manage the impeding events

Irreversibility

Once a physical body dies, it cannot come alive again

Behavioral Tendencies

Once individuals have insight into their _______ ______, they can be assisted in making changes in their interactions with children and families

Negotiations

Once it is time for the procedure, begin on time and do not allow "_______" for changes in rules to be used as a delaying tactic

Tension Boredom

One can often observe a fine balance between ________ and ________ in children's play experiences

Future Volunteer Leaders

One compelling reason for leadership development within a professional association is to develop _______ _______ ________

Coping Skills

One element of the preparation process specifically targeted toward the child's secondary appraisal is instruction in "_______ _______". Uses cognitive strategies to alter behavioral reactions and patterns, helping the child identify and practice techniques for coping with specific procedures and events

Consuming

One factor that can undermine children's interest in finding and working on problems of their own making

Developmental

One of the roles of child life specialist is to think of play as a __________________ process that proceeds through stages that are linked to, yet separate from, the areas of cognitive, social, emotional, physical, language and gender role development

Unilateral Relationships

One person is unwilling or unable to develop the relationship to the level desired by the other

Interpersonal

One reason children display the irrepressible need to play, even in the face of extreme adversity, is the _________ aspect of play that compels children to return to a place of safety and comfort where they can regroup and heal themselves

Increase employee satisfaction

One way your hospital can benefit from patient-centered care: - By enhancing patient/family-caretaker interactions, efficient hospital systems decrease employee burnout, improve staff relationships, and enhance patient/family-caretaker interactions

Improve market share

One way your hospital can benefit from patient-centered care: - Consumers are no longer satisfied with the status quo for their healthcare - With much access to hospital performance and service excellence information, health systems that place patients and families in the center of care, gain competitive advantage over those which stick to using traditional methods

Attain better financial performance

One way your hospital can benefit from patient-centered care: - Improving processes for care coordination, reducing waste both in materials and labor resources, and effective patient and family-centered philosophy of care which can improve hospital performance and business outcomes

Family Centered Care

Open in 24 hour visiting, family advocacy, family to family support, and a view of parents as participating in care

Beneficial

Opportunities for parents to engage in play activities with their young children are ____________ to both patient and family, alleviating some feelings of helplessness in parents and assisting in the child hospital adjustment

Working Models

Organization of expectancies and patterns Facilitated through cognitive advances Dydadic relationship itself becomes represented internally through the child's capacity to believe in the existence of the caregiver without the physical presence of that caregiver

Locus of Control

Originated in personality theory and generally refers to the perceived seat of social control When an individuals health or the health of a family member is compromised, the resultant mindset is one of disempowerment or lack of control A physical environment that prohibits individuals from managing their space can contribute to this disempowerment

Fantasy Play

Others have suggested that children engage in ________ _______ because it is broadening the range of potential behaviors, enhances the possibility of survival in an ever changing environment, and provides the behavioral flexibility essential for insightful problem solving.

Culture Background

Our ethics are valued differently depending on our ______ and our _______

Fear Pain

Our understanding of the relationship between ______ and ______ is one of the foundations for psychological preparation.

Safety

Physical and psychological __________ is essential for play to occur

Guided Imagery

Pain becomes changeable for many in the treatment group Pain stops being "never-ending" for all participants Participants who were in the treatment group reported less "torment" due to pain over the course of the study

Gate Control Theory

Pain impulses are moderated by a gating mechanism that opens to allow nerve impulses to reach the brain or closes to decrease or prevent impulse transmission

Anesthesia

Parental presence for _______ induction is important for reducing stress in children and enhancing recovery

Uncertainty

Parental stress over the ________ of a child's prognosis may interfere with family coping and child management

Invasive Procedures

Parents also cite _______ _______ as traumatic events

Terminal/Chronic Illness

Parents and children can have a "feeling" of something being "not right" Evaluate the understanding of the child and family "The family's not ready" Validate feelings Help them put into place an end of life plan

Comfort

Parents hold their children in familiar positions of ________. In these positions, children can cooperate and maintain a sense of control.

Role

Parents need a clearly defined ____ as part of a team

Prepared

Parents who are _________ for a procedure provide information about it to their own child and so reduce fears and uncertainty.

Understanding

Parents who are given adequate information and support can play an instrumental role in enhancing their child's _______ of events and coping activities

Calmer

Parents who are paid little attention and have less input, remain more anxious and, focusing on the procedure, tend to ignore their child, while parents who interact with their child during a procedure are ________

Anxiety

Parents who receive adequate counseling about their role in the OR during their child's anesthesia induction were shown to be more helpful in decreasing the child's _______ than parents who were not prepared for how to help

Supportive Care

Parents' perceptions of issues and needs ideally guide the nature of _______ _______

Associative Play

Parten Children interacting by exchanging toys in conversation Third stage of play. Children interact, but there's no organization to the play or among peers, and each child played independently within the group. Most often observed in young preschool children when the interactions among children are more important to them than the play activity itself. Children often move quickly from one activity to another, interacting, talking about their play, learning materials and sharing props, but no cooperation or negotiation is observed

Cooperative Play

Parten Fourth stage of play. Children truly play together, take turns, assign roles, and organize pretend play seems in script. The most social stage. Children are able to demonstrate a focus on group projects, a division of roles, sustained placing and cooperation to attain a simple group goal. Most often observed in older preschool and young elementary age children

Solitary Play

Parten Most often exhibited by infants and very young children Varying levels of sophistication can be observed in this stage of play Some of this should be encouraged for all children since those who have learned to be comfortable in playing alone are likely to succeed in working independently later in life

Parallel Play

Parten The second stage of play for young children. Characterized by children playing near others, but not with others. Children continue to play independently, but often do so with similar toys of their peers around them. There is an increased awareness of the children nearby, but little direct interaction, although toddlers often dislike pleasure and having peers who are engaging in similar activities close to them. Frequently utilized by three-year-old as an effective way to enter groups. Older toddlers first plane next to others, and then with their peers, as they play their way into a group activity

Humanizing Healthcare

Passionately · embraced by child life practitioners, but the success of such a revolutionary undertaking depended on validation of its presuppositions by others

Traditional Role of the Parents

Passive learner

Covenant

Past characteristic of doctor-patient relationships - Fidelity and altruism govern relationship - Doctors put patients' interests before their own - Relationship typically begins through recommendation from a trusted source

Personal

Past characteristic of doctor-patient relationships - Focus is on the individual

Collegial

Past characteristic of doctor-patient relationships - Gaining the wisdom of another colleague or financial rewards provide incentives for referrals

Confidential

Past characteristic of doctor-patient relationships - In 1976 approximately 70 physicians, nurses, managers, trainees, and students had access to a hospitalized patient's chart

Continuous

Past characteristic of doctor-patient relationships - Physician may care for several generations of the same family

Harry Bakwin

Pediatrician in hospital practice working with sick children Shared spitz's bias toward humanizing care and was to initiate unlimited parental visits to infants o Encouraged house staff to develop friendly relationships with the children they treated o TLC (tender loving care) o Hospitalization was "looked on as a result of repeated infections" o Questioned whether infection control precautions might not be harmful to the child

Abraham Jacobi

Pediatrics' academic status began with the appointment in 1860 of _______ _______ as professor of infantile pathology and therapeutics at New York Medical College o He had an unusual interest in and knowledge about the diseases of children and was a great advocate in the field of Children's Health and welfare o His interests were wide-ranging o He began a tradition of concern for Children's Health that has had a profound and enduring effect on the well-being of children

Active

Pelander and Leino-Kilpi suggest that patients considered themselves "_______" participants in healthcare

Should

Pelander and Leino-Kipli say that children (should/should not) take part in and make decisions about their own healthcare

Clinical Nurse

Perioperative inpatient and outpatient Full-time and per diem positions One year of oncology or ambulatory care experience

Psychoanalytic Theory

Persisted in influencing beliefs that play is *cathartic* -- allowing children to express what they can not handle rationally -- and that through play children can come to *master* situations or come to grips with pain in reality

Stressors

Personal emotions and communication problems with the healthcare team are predominant _________-

Chronic Pain

Persons with _______ _______ revealed that they experienced a continuous awareness of their bodies, in contrast with the relative lack of consciousness of the physical self that is found in healthy individuals. Their bodies became the primary focus of their existence Pain often overtook the mind, blocking all other sensation or thought, and patients believed that their personalities were greatly influenced by the pain. Some participants expressed losing sight of what it was like to feel healthy. They viewed the body as an obstacle rather than an enabler to action, and they expressed sadness about the loss of physical abilities and power

Prevention

Perspective that might be useful to healthcare professionals who work with families - Adopting _________ as a guiding principle

Caring

Perspective that might be useful to healthcare professionals who work with families - Using principles of _______ practice

Unique

Perspective that might be useful to healthcare professionals who work with families - Viewing families as _________ systems

Licensure

Peterson and Soloman (1998) describe three ways in which boundaries are established for professionals. First there is a ________. When given official sanctioned by society or by a governing body, the professional receives societies permission to engage in activities that might not usually be allowed but are for the good of the client

Ethical Standards

Peterson and Soloman (1998) describe three ways in which boundaries are established for professionals. Second, is the development of _______ _______ for each profession.

Interpersonal Boundaries

Peterson and Soloman (1998) point out that those ________ ________ operate on a continuum. When they're too tight, individuals are prevented from engaging in open in giving relationships. When they are too loose, an individual is robbed of the sense of being a unique person whose needs and wants are separated from others

Advocacy

Phase in a Parent's Coping As parents become more comfortable with the environment and information, they often become strong advocate for their child treatment, reaffirming their roles as parents who best know their child's needs and responses

Information Seeking

Phase in a Parent's Coping Parents gather information from many different professionals, analyze literature, and develop a personal understanding of the diagnosis and management

Initial

Phase in a Parent's Coping Parents may be passive and acquiesce two recommendations of professionals

Well Siblings

Physical separation from parents and the sick sibling is a major source of stress for _______ ________. They may feel physically or emotionally abandoned, interpreting these events as a loss of love, or they may feel they are being punished Changes in caregivers and routines may be difficult, especially if they are care for outside security of their own home

Therapeutic

Physicians, psychologists, social workers, child life specialists, attorneys, physical therapists, and play therapists are all types of (therapeutic/nontherapeutic) relationships

Assimilation

Piaget Children exposed to new information transform it to fit their existing way of thinking

School Ager (6-12 years)

Piaget Concrete operations Increasing ability to think logically in the physically concrete realm Understands the meaning of series of actions, of order and sequencing

Information Processing Theory

Piaget Developed using the analogy of a computer system, with concepts such as in coding, generalization, itemization and strategy construction key to the process of learning for children and adults A search that children's thinking is greater than we generally assume relative to adult thinking. The processes are the same as abilities develop with maturation and experience, with variation reflecting differences in degree rather than kind Considers children to be active agents, striving to develop strategies for problem-solving by processing information and learning ways to reach goals based on successful strategies Focuses on small, precise steps involved in problem-solving

Information Processing Theory

Piaget Developed using the analogy of a computer system, with concepts such as in coding, generalization, itemization and strategy construction key to the process of learning for children and adults A search that children's thinking is greater than we generally assume relative to adult thinking. The processes are the same as abilities develop with maturation and experience, with variation reflecting differences in degree rather than kind Considers children to be active agents, striving to develop strategies for problem-solving by processing information and learning ways to reach goals based on successful strategies Focuses on small, precise steps involved in problem-solving

Adolescent (12-18 years)

Piaget Formal operations Deductive and abstract reasoning Can't can't imagine the conditions of a problem and develop hypotheses about what might logically occur under different combinations of factors

Preschooler (3-6 years)

Piaget Preoperational Transition. Depending solely on perception and depending on truly logical thinking Better able to see more than one factor at a time that influences a event

Toddler (1-3 years)

Piaget Sensorimotor Preoperational Can hold and recall images Increasing use of symbolization Highly egocentric perception of world

Disequilibrium

Piaget When a child realizes that his thinking doesn't match new information As long as this exists, the opportunity for growth and learning is halted

Equilibrium

Piaget When the child changes his way of thinking to include new information Learning and the opportunity for growth exist

Infant (0-1 years)

Piaget Sensorimotor Exploration of physical self and environment Object constancy Cause and effect

Assimilative

Piaget characterized the ages of 2 to 5 as the preoperational stage, with play serving a ____________ function, allowing children to consolidate their experiences As a result, adaptation constantly takes place through the medium of play

Maturational Process of Development

Piaget's characterization of the Waze children think reflects this

I Miss You: A First Look at Death by Pat Thomas (2001)

Picture book designed for preschool and young school-aged children Offers a very concrete explanation of death and dying and can be used after a death occurs, in anticipation of someone close to a child dying, or with a child who is dying

When Dinosaurs Die: A Guide to Understanding Death by Laurie Krasny Brown (1998)

Picture book designed for young school-aged children who have experienced or are preparing for a loved one's death

Agency for Healthcare Research and Quality (AHRQ)

Places more emphasis on the patient's experience of care and on effective partnerships among clinicians, patients, and families, there is recognition that having patients and families informed and actively engaged in healthcare leads to better health, quality, and safety outcomes

Alternative Focus

Planning and rehearsing an _______ _______ may provide a benefit for many children and families

IV

Planning preparation for a ______ - Tourniquet - Alcohol wipes - ____ needle - ____ tubing - Gauze - Band-aid

Blood Draw

Planning preparation for a _______ _______ - Tourniquet - Alcohol wipes - Butterfly needs with syringe attached the tube - Gauze - Band-aid

Surgery

Planning procedure preparation for ________ - Pictures of suite - Anesthesia mask and pulse-ox - Flavored chap sticks - Procedural doll - Gauze/band-aid - Gown - Pictures of staff in bunny suits

Intrinsically Motivated

Play is __________ ________ This encompasses notions of self-directed activity and freely chosen explorations that lead to self satisfaction, inherent attraction and a desire for continuation even when adult guided

Anesthesiologist's Urinate

Planning procedure preparation for surgery - Asleep before, during, and wake up after - __________ job - Mom and dad will be there when you go to sleep and when you wake up (or, if not, why?) - How throat may feel scratchy - Where procedure takes place - Masks and outfits of medical personnel - Child's job upon waking (_______, eat, don't touch surgery site, tell us how their pain is)

Threatened

Play allows adults to enter the world of children with mutual recognition, acceptance, and temporary power sharing. There is less reason for children to feel ____________ by an adult

Release Feelings

Play allows children to ____________ ____________ that might be otherwise difficult to express openly. It allows them to use play materials in aggressive, hostile ways without fear of reprisal's

Communicate

Play allows children to ____________ feelings effectively and naturally

Social Skills

Play allows children to develop ____________ ____________ that might be useful in other situations

Problem-Solving

Play allows children to try out new roles and experiment in a safe environment using a variety of ____________ approaches

Fantasy

Play as _______: Imagination, creativity, and flexibility Seen as "higher order" and has been found to be related to reading and other academic areas of ability

Self

Play as _______: Play is optimal experience or peak experience Subjective experience that integrates all of learning and capacities of the individual

Power

Play as _______: Psychologists often deal with this in terms of intrinsic motivation, autotelia, stimulus arousal, and free choice or free will

Progress

Play as _______: The specific focus has shifted from physical skills, to emotional, to cognitive, depending upon prevalent theories

Adaptation

Play as _______: Those children who do not get to play with others because they are too withdrawn or aggressive generally also perform badly at school

Therapeutic Modality

Play as a ___________ ____________ has been found to reduce children's emotional stress and help them cope with medical experiences

Developmental Psychosocial

Play can be adapted to address the _________________ and _______________ needs of patients in every pediatric age group

Predictable Orderly

Play development is ________ and ________, yet unique to the situation and the individual

Change of Perspective

Play does not ignore reality. It is always about things that exist in reality, although it usually involves a ________ ______ ________ on the part of the participant to affect a temporary transformation of some form.

1st Hospital Play Programs

Play leaders were asked to respond to the distress of children admitted in large groups for a tonsillectomy's into individual children undergoing major surgeries; To provide daily activities for children on the wards; To help with parent visiting by setting up toy displays to educate parents on what is suitable to bring to their chill ; To set up a program for outpatients receiving bronchoscopies

External Rules

Play may be free from __________ _______ There may be rules within the imaginary contacts, but there is freedom to spontaneously create and change the rules, a differentiation between play and games, where rules are externally imposed

Active Engagement

Play requires _______ ________ Just may be seen in the concentration, enthusiasm, and joy of children when playing, in the sense of mastery that can emerge from Clay, in the diminished consciousness of self, and in the sense of freedom from time

Inflexibility

Play serves as training for the unexpected. Bekoff and Pierce (2009) identified a 'flexibility hypothesis' in wolves that allows them to improvise behaviors more effectively through play. Further, they highlight the importance of play in developing children who are creative, flexible, and able to adapt to new environments.

Reactive

Play session specifically designed to help a child who has regressed language or motor skills is a _________ intervention

Tension

Play that focuses on "serious," real life themes has inherent in it some degree of ________, yet lacks the "worry" since "it is just pretend."

Solitary

Play where the child is alone and not aware of anything around them

Competence Motivation Theory

Posits that children receive satisfaction in developing competency via play, regardless of whether there are any external rewards

Infant (0-1 years)

Possible troublesome responses Failure to bond Distrust Anxiety Delayed skills development

Preschooler (3-6 years)

Possible troublesome responses Regression Angry toward primary caregiver Acting out Protest Despair and detachment Physical and verbal aggression Dependency Withdrawal

School Ager (6-12 years)

Possible troublesome responses Regression Inability to complete some tasks Uncooperativeness Withdrawal Depression Displaced anger and hostility Frustration

Toddler (1-3 years)

Possible troublesome responses Regression Uncooperativeness Protest Despair Negativism Temper tantrums Resistance

Adolescent (12-18 years)

Possible troublesome responses Uncooperativeness Withdrawal Anxiety Depression

Needs of the Siblings

Priority that families use to cope with the disruption in family routine caused by hospitalization Caring for the siblings at home is an area that most parents will except outside help to manage

Space

Power consideration The more you use, the more you are regarded as powerful

Self-motivated

Practitioners should be _______ in seeking sources of new information and seeking feedback about areas of future clinical growth.

Individual Characteristics

Predictor Variable of Burnout: - Age - Previous experience - Education level - Training - Grief experience/education - Religious affiliation

Role Stress

Predictor Variable of Burnout: - Role ambiguity - Role conflict

Social Support

Predictor Variable of Burnout: - Supervisor - Family and friends - Other CLS - Other medical staff - Human service personnel

School-Agers

Preparation for __________ - Steps stay the same, but... ---- Provide more information ---- Suggest and implement more complex coping strategies ---- Provide more opportunities for child to participate in their care

Negative

Preparation had a (positive/negative) effect on young children with a history of previous hospitalization, suggesting that these children require specialized methods and alternate timing

Single

Preparation is ideally conducted by a _______ individual who may also be present during a given stress point to provide support

Before

Preparing a child ________ the procedure is a valuable intervention

Coping

Preparing children and families for medical experiences creates a ________ plan

Emotionally

Preparing children and families for medical experiences help __________ process the experience

Understanding

Preparing children and families for medical experiences increases ___________

Rehearsing

Preschool and school-age children benefit from _______ expected behaviors and participating in choices about which coping strategies are most useful to them

Bodily Injury

Preschoolers are particularly vulnerable to threats of __________ ________, as their concept of body integrity is not yet fully developed

Magical Thinking

Preschoolers believe that they have the ability to wish things to happen

McLeod and McClowry (1990)

Present and effective demonstration of the application of temperament theory and research in an explanatory model supporting child life practice

Traditional Teaching

Primarily lectures

Diversity

Principle of family-centered care - Honor ________ and its impact on the family's experience and perception of care

Information Sharing

Principle of family-centered care - Ongoing _________ _______ with child and family in a way that is useful and affirming

Course of Care

Principle of family-centered care - Providing/ensuring support to the child and family throughout their ______ _____ _____

Does not

Prior experience or familiarity with the healthcare system (does/does not) lessen children's fears

Spatial Distancing

Researchers propose that one's sense of _____________ ____________ may vary depending on cultural or ethnic background.

Needs of the Hospitalized Child

Priority that families use to cope with the disruption in family routine caused by hospitalization Most parents believe that they should be with the child as much as possible, and mothers generally spend more time in hospital than fathers. As the child's condition of improves, less time may be spent at the bedside

Home Responsibilities

Priority that families use to cope with the disruption in family routine caused by hospitalization Other caretakers or older siblings may help with essential tasks like preparing meals, while other home tasks may be ignored. Whether a parent rooms in the hospital or visits, a parents personal needs for exercise, socialization, and time with spouse may all be difficult

Sedation

Procedural _______ can expose children with SCD to dehydration, hypoperfusion, hypothermia, acidosis, hypotensionand hypoxia, all of which could trigger a sickle-cell-related adverse event

Toddlers

Procedure Preparation for __________: - Introduction/rapport building with child and parent - Exploration - Demonstration - Mastery

Teens

Procedure preparation for ______: - Encourage them to come prepared with a list of questions - More adult teaching ________ - Coping strategies should be discussed for every step of the process - Privacy issues -- who and when examination - Peer group contact

School-Agers

Procedure preparation for __________ - Steps stay the same, but... ---- Provide more information ---- Suggest and implement more complex coping strategies ---- Provide more opportunities for child to participate in their care

Teens

Procedure preparation for teens: - Encourage them to come prepared with a list of questions - More adult teaching ________ - Coping strategies should be discussed for every step of the process - Privacy issues -- who and when examination - Peer group contact

Comfort Hold

Process of a _________ _______: - Feedback and questions from family - Staff communication - Explanation & Preparation - Rapport building and rehearsal - Positioning - Procedure - Post-procedural support and processing - Feedback and questions from family

Medicalizing

Prolonging life "Being kept alive on machines" Extraordinary measures Impersonal care/questions Different specialized doctors, looking at different specialized systems

Play

Promotes freedom of expression and creativity while facilitating physical, cognitive, social, and emotional development

Family

Promoting _______-centered care allows a parent to be present with the child and empowers both of them to cope with the experience.

Vygotsky's Theory of Cognitive Development

Proposes that children learn through hands-on activities and social interaction

Evaluation Procedures

Provide a structured means to answer questions, which provide a basis for changing interventions in ways that more effectively address identified needs

Perspectives

Provide a system of values that guide professional practice

Address the Societal Factors Devaluing Play

Provide research-based solutions to the prominent factors in America restricting opportunities for children to play.

End of Life Plan

Provide the family with choices Every child's life has meaning, celebrate it with the family Memory making, even while dying, is important Routine while dying is important Play

Justice

Respecting the rights of others and giving them what is rightfully theirs

Play in Clinical Practice

Provides a thorough overview of the necessity of play, including its origins, types, and effects, as well as information on how to conduct play assessments and interventions Reviews child therapies that incorporate play—and describes how play can be effectively used to treat children and adolescents with various psychiatric conditions

Play

Provides a context for children to practice newly acquired skills and also to function on the edge of their developing capacities to take on new social roles, attempt novel or challenging tasks, and solve complex problems that they would not (or could not) otherwise do.

Attachment Theory

Provides a perspective to child life specialists from which to clarify the central role of the parent-child relationship to the well-being fo the developing child

Imaginative Play

Provides health-care professionals with self-care and stress reduction, but also makes them more present for, vulnerable with, and supportive of their colleagues, their patients, and their patients' families.

Medical Information

Providing accurate _________ _________ to children lessens negative behavior and promotes faster recovery post-operatively while also attenuating fear and anxiety

Erikson

Psychosocial theorist Stages of psychosocial development Challenges arise at certain developmental points

Verbal

Purely _______ descriptions are less likely to be effective when providing information

Procedures

Research has indicated that periods of wait before _________ provide opportunities for patients to obsess over every possible complication

Psychological Nourishment

Qualities of competence, autonomy, and relatedness

Social

Quality play promotes ______ skills. Through play, your child will learn how to get along with others. Although your young child may not be developmentally ready to "play" with other children, interactive experiences will help set the foundation for future friendships.

Social

Quality play promotes ______ skills. Through play, your child will learn how to get along with others.Although your young child may not be developmentally ready to "play" with other children, interactive experiences will help set the foundation for future friendships.

Language

Quality play promotes ________ - Talking with your baby and toddler about what is happening around him while playing and responding to his sounds, words, and gestures lays the foundation for healthy brain development, as well as future success learning how to read and write at school.

Physical

Quality play promotes ________ development. It's important that you provide time for active play in a safe, open space with materials that allow children to move their bodies and use their senses. Limit time spent in car seats, swings, and other restricted spaces.

Physical

Quality play promotes ________ development. It's important that you provide time for active play in a safe, open space with materials that allow children to move their bodies and use their senses.Limit time spent in car seats, swings, and other restricted spaces.

Creativity

Quality play promotes _________. Experiences come from your child's interests and abilities. It's the process that's important - what they do, not the product they make in the end. Current brain research shows that children learn best when they experiment and discover for themselves rather than being shown by adults.

Creativity

Quality play promotes _________. Experiences come from your child's interests and abilities.It's the process that's important - what they do, not the product they make in the end.Current brain research shows that children learn best when they experiment and discover for themselves rather than being shown by adults.

Relationships

Quality play promotes close _________ The most important part of your child's healthy development is safe, trusting _________ with you and the other caregivers in her life. Interacting with your child through positive, supportive play experiences will help her gain the confidence she needs to build loving and healthy _________.

Relationships

Quality play promotes close _________ The most important part of your child's healthy development is safe, trusting _________ with you and the other caregivers in her life. Interacting with your child through positive, supportive play experiences will help her gain the confidence she needs to build loving and healthy _________.

Physiological Responses

Research has shown that _____________ _____________ can be reduced with therapeutic play interventions

Interpersonal Entanglements

Raise at least two serious questions: - Can a patient or family member make clear and free choices to accept or reject affections, especially sexual, in the context of the unavoidably unequal physician-patient-family relationship? - Once such intimacy develops, can the parties maintain a proper and effective therapeutic relationship?

Fathers

Ranked assurance and information is less important than their partner

Child Life Position Statement (1979)

Rationale for child life interventions Essential components of child life programs A child's hospital experience could be positive Staffing standards and job descriptions for child life

Hope

Research indicates that there are a variety of internal and external characteristics common to resilient children, and one of the factors that most of these children and youth share is a sense of _______

Complex Sociodramatic Play

Research indicates that this type of play can be facilitated through education that includes active, hands-on activities, open ended creative play, caring human relationships and teachers who set the stage for play in a way that encourages children to stretch beyond their comfort zones

Burnout

Reaction to job stress in which the focus is on the physical, mental, and emotional exhaustion caused by long-term involvement in emotionally demanding situations (client-centered)

Goes Away

Reassure your child that all pain and suffering ______ ______- after death

Alone

Reassure your child that he or she will not be _____

Develop

Recent studies have documented: how play helps the children and adults to ________; The kinds of activities that can best fit play environment; the tools that are needed for play; and what play can tell us about the children's needs, challenges, satisfactions, and strengths

Activities

Recent studies have documented: how play helps the children and adults to develop; The kinds of _________ that can best fit play environment; the tools that are needed for play; and what play can tell us about the children's needs, challenges, satisfactions, and strengths

Tools

Recent studies have documented: how play helps the children and adults to develop; The kinds of activities that can best fit play environment; the ________ that are needed for play; and what play can tell us about the children's needs, challenges, satisfactions, and strengths

Satisfactions

Recent studies have documented: how play helps the children and adults to develop; The kinds of activities that can best fit play environment; the tools that are needed for play; and what play can tell us about the children's needs, challenges, ____________, and strengths

P.L. 99-457 Education of the Handicapped Act Amendments of 1986 Part H: Early Intervention Programs for Handicapped Infants and Toddlers

Recognized the importance of collaborating with families in maximizing the health and development of these children and coordinating services across agencies

Patient- and Family-centered care

Recognizes the family as the constant in a child's life and seeks to empower patient and family members at every opportunity - Fosters collaboration with families in the care of individual children and in planning and program development for hospitals and other healthcare settings - Evident in mutually respectful parent and professional partnerships

Distraction

Relaxation techniques Selection and concentration on an alternate focus Comforting self-talk Typically, more than one method is presented so that children have control of their preference

Special Things

Remind your child of the ________ _______ he or she has done and the teachers, friends, nurses, and others who will always remember him or her

Sitting

Research has demonstrated that children are less fearful and distressed when positioned for medical procedures in a _________ position

Explore the Great Outdoors

Richard Louv (2008) identified a disconnect with nature affecting the current generation of children. Examining research across multiple disciplines, Louv argues that direct contact with nature is essential for the development of emotional and physical health in childhood and across the lifespan

Security Rule

Rule of HIPAA: Defines standards, procedures and methods for protecting electronic PHI with attention to how PHI is stored, accessed, transmitted, and audited"

Enforcement Rule

Rule of HIPAA: Ensures that all facilities are responsible to all rules of HIPAA and have equal punishment for equal HIPAA violations

School-Age

The _______ years are characterized by an increasing ability to understand rules, a concept of fairness, and cooperation with others

Alternative Caregiving Environments

Rooming in Cooperative care Home care Gaining importance in children's healthcare

Educational Background

Rosemary Bolig (!983) Listed 5 basic approaches to child life programming, including: - diversion - activity and recreation - child life development - therapeutic - comprehensive. She stated that the child life program elements and strategies offered are typically related to the ________ _______ of program staff and administrators

Social

Rough-and-tumble play always has a ____________ component

Mock Aggression

Rough-and-tumble play usually contains elements of ____________ ____________, but vigorous activity does not

Play

Rubin, Fein, and Vandenberg (1983) found six recurring criteria of _____: - intrinsic motivation - orientation toward means rather than ends - internal rather than external locus of control - noninstrumental rather than instrumental action - freedom from externally imposed rules and expectations - active engagement

Stress

Rudolph, Dennig, and Weisz (1995) say that any response that reflects a spontaneous internal or behavioral reaction to stress, rather than a deliberate attempt to cope, is referred to as a _______ response

Identifiers Rule

Rule of HIPAA: "As part of the HIPAA Administrative Simplification regulation, there are currently three unique identifiers used for covered entities in HIPAA administrative and financial transactions. The use of these unique identifiers will promote standardization, efficiency and consistency."

Position

The ________ of the child can play a significant role in the child's stress during a procedure.

Privacy Rule

Rule of HIPAA: Gives patient the right to access all their medical records and request corrections be made to them. Protects individuals private information and sets limits and conditions on uses and disclosures on information not released with patient permission

Transactions Rule

Rule of HIPAA: Requires that medical terms, abbreviations, procedures, equipment, and diagnoses comply with regulated set of codes, so that all data is uniformly charted across all care facilities

Cooperative

Rules and roles exist Inventing own games

Delivered Outcomes

Significant changes in pediatric healthcare in the last 25 years, especially the institution of principles of family centered care, have affected both the way that healthcare is ___________ to children in the psychosocial ___________

Morhers

Sandilippo (1994) focused on the personal space in coping behaviors of terminally and chronically sick children with HIV and cancer. He concluded that all sick children reported greater distancing of parents than that perceived by their __________

Nature

The ________ of the illness itself is concerning to siblings who may worry about the outcome, fearing that their brother or sister might die

Spencer (1873)

Saw play as a way to release surplus energy. He argued that humans have a specific amount of energy needed for survival and, as survival needs diminished, this built-up energy must be released; children did this through play

Buffer

Schoffstall concluded that personal space serves as a __________ to protect individuals from a perceived threat

Relationships

School age children and adolescents benefit from activities that allow them to maintain ______________ with peers and establish new connections

Mastery Achievement

School age children and adolescents seek play that contributes to feelings of _________ and _____________, which is one reason video games are so popular with this age group

Real

School children exhibit a growing concern with having things appear ____________ during their dramatic play. Often, the group work and social interaction involved in planning play become The focus rather than the play itself. This shift forms the basis on which a competitive spirit and play, apparent and competitive flight and games with rules, develops during the elementary school years. The regular development of social interaction experience by children age 7 and older brings a gradual decrease in, and, finally an end to symbolic play. This decrease in children symbolic play is linked to general development in active participation in other areas to which play activity is transferred

More Complex Coping Strategies

School-age children may wish to use creative visualization, listen to favorite music or inspirational tapes, choose whether to watch and participate in appropriate aspects of care, or identify other ways to help them feel more control in the situation

Collaborative Process

Significant in influencing the ________ _______: - Excellent communication skills - Respect for the value of colleague's roles - Ability to share points of view - Trust

Empowering Setting

Seats arranged in a semicircle

Traditional Setting

Seats arranged in rows

24 months

Sequence of language acquisition: - Has a vocabulary of around 50 words - Aquires one or more words per day - Uses two-word sentences - Should be able to follow simple two-step commands

5 months

Sequence of language acquisition: - Makes monosyllabic sounds

12 months

Sequence of language acquisition: - Uses 1-2 words other than "mama/dada" - Increases vocabulary at an average of one word/week - Comprehends simple commands

18-20 months

Sequence of language acquisition: - Uses an average of 20 words

10 months

Sequence of language acquisition: - Uses first specific words with appropriate reference - Should comprehend "no"

4 years

Sequence of language acquisition: - Uses intelligible speech most of the time

24-30

Sequence of language acquisition: - Uses telegraphic speech as 3-5 word sentences with subject, object, and verb

Mutual Pretense

Significant obstacle in parent-child interactions The knowledge of the poor prognosis by both parent and child, but admitted or addressed by neither

Systems

The CCLS's psychosocial and developmental expertise and their keen awareness of the benefits of patient and family centered care provide a useful perspective at the _______ level

Boundaries

Serve to help people to take control of themselves and prevent abuses

Affective Reactions

Set in motion and then become relatively independent ofcognitive processing

Child Life Care

Should reflect respect and understanding of the experience, knowledge and beliefs of other members of the team. Avoid making promises that others will have to keep Be certain to offer only those coping options that will truly be available to children and families

Mastery

Show parents and the child around the environment, introduce them to the staff.

Explanation

Show the preoperative area where the child will get ready for surgery, and emphasize that the parents will be with the child during this time Describe admission procedures Use dolls and medical equipment

Children in Stage One

Showed preoperational thinking; they were tied to the perceptual and could consider only one aspect of a situation at a time

Explanations

Siblings who are supported with developmentally appropriate explanations of the causes of illness or injury participate by being present with the sick Brother or sister, and are provided with opportunities to express their feelings and demonstrate few were adverse responses

Grasping

Simple rattles and soft toys are perfect. Babies love the satisfying feeling of shaking toys and making noise. When babies shake or touch a toy and then feel and hear the reaction, they learn cause and effect. Other good toys include objects to hang overhead for _______, noise making toys to kick with feet, teethers, and toys with a variety of textures.

Practice Play Functional Play

Simple, repetitive muscle movements with or without objects

Prevention Message

Simply providing a _________ _______ is unlikely to be effective without significant involvement of the healthcare professional and explicit intervention designed to change behavior

Sustaining Hope and Effort

Singer (1994) describes the fantasies of adults in the imaginative play of children as a process for "__________ ________ ________ ______," and maintains that make believe play of children can be regarded as a fundamental precursor of the full blown adult imagination. Through imaginary plane, children take on an attitude toward the possible, explorer range of potential futures, or in effect, and travel through time and space to direct a better, more hopeful childhood

Better

Single mothers appeared to be (better/worse) off at accessing care for their children than those mothers with low levels of education in two-parent families

Advocate a Slow Parenting Approach

Skenazy (2009) advocates adopting a slow parenting approach in raising children, characterized by few organized activities and an environment where children are free to explore the world at their own pace.

Parental Anxiety

Skipper and Leonard (1968) demonstrated that an intervention with mothers that involved both preparation and support reduced _______ _______ Children scored lower on both physiologic and psychologic measures of distress

Hierarchical

Smilanksy (1968) and Parten (1932) assumed a developmental, _____ sequence to their types of play

Functional Play

Smilanksy (1968) elaborated by renaming practice play as "_____ _____" Simple, repetitive muscle movements with or without objects

Symbolic Play

Smilanksy named _____ _____ "dramatic" Substitution of an imaginary situation to satisfy child's personal needs and wishes

Play

Smith and Vollstedt (!985) found that trained observers characterize an activity as _____ when there is a combination of non-literality, positive effect, and flexibility

Experience

Solnit (1984) notes that a child's "past" or _______ serves as preparation for the present and the future

Psychologically Vulnerable

Some children, regardless of age or developmental level, have been described as psychologically vulnerable. Despite the advances in meeting the unique needs of children through child life, play preparation, and family presence, these vulnerable children need individualized approaches to meet their needs. This group may include young children and previously hospitalized children who may have misconceptions are overwhelming fears about past hospitalizations and treatments.

Fears

Some parents who doubt their ability to cope with the procedure are often able to participate and can effectively comfort their child when they have had a chance to express their _______, are prepared for the procedure, and receive support and encouragement from the staff.

Avoidant

Someone who is more likely to engage in efforts to postpone or avoid acknowledging the event for as long as possible At greater risk for responding with difficulty to medical procedures

Vigilant

Someone who may articulate anticipatory anxiety, ask questions, and tend to make emotional or task-oriented plans to deal with stressful situations

Environmental Stressors

Sounds of monitors, alarms, equipment Visual stimulation of equipment, procedures, lighting Observation of other patients Procedures and surgical interventions conducted at bedside

Changes in Routine

Source of stress for parents during a child's acute illness Changes especially in rooming, arrangements for childcare, and work responsibilities

Child's Illness

Source of stress for parents during a child's acute illness Diagnosis decisions about management of illness including consents for painful treatment for procedures perceived severity of the illness

Changes in Child's Behavior

Source of stress for parents during a child's acute illness Loss of developmental milestones Changes in child's emotional responses Physical changes due to illness or injury including pain, altered appearance, ability to communicate, loss of mobility or strengthc

Hospital Environment

Source of stress for parents during a child's acute illness Unfamiliar equipment, routines, policies Uncertainty about parental roles and participation in cares Personnel roles, number of caregivers Unknown expectations of parents by staff

Industry

The Eriksonian need for this can also be seen in play of school age children as they demonstrate to themselves and others that they are competent, have talents and skills, and abilities.

Child Spaces

Space is occupied by pediatric patient should be located near the services that hospital staff members are trying to provide. Psychologic support can be communicated by the inclusion of spaces that allow for social interaction, privacy, and access to nature. The environment should reflect child centered care by providing areas such as play rooms or teen rooms for age-appropriate activities, adequately skilled furniture, and light controls, and choices and types of space

Heal

Speak to develop mental or psychosocial issues in the management of challenges, and might be more appropriately referred to as a "psychotherapeutic relationship"

Healing

Speak to develop mental or psychosocial issues in the management of challenges, and might be more appropriately referred to as a "psychotherapeutic relationship"

Boundary Violations

Specific violations of the standards of a professional relationship

Lazarus

Specifically excludes in his stress-coping framework reactions and responses that are common to use his term, *automatized* and, therefore, required no effort and do not represent attempts to manage the situation

Nurse Manager

The RN leader responsible for the care delivery, personnel supervision, and operating budget of a unit, area, or facility.

Crisis

The U.S. healthcare system is _______ oriented

Peggy Jessee

Spring 2014 Distinguished Service Award recipient MS, PhD, CCLS Read "Parade Magazine" in 1978 Child life connected hands-on learning, child development, and the health care of children

One

Stage (One/Two/Three)

Three

Stage (One/Two/Three)

Two

Stage (One/Two/Three)

Bargaining

Stage of Grief An attempt to postpone acceptance of the loss you have encountered. Expressed when you try and make a deal with God or your Higher Power for the exchange of one thing or person for another.

Bargaining

Stage of Grief An attempt to postpone acceptance of the loss you have encountered. Expressed when you try and make a deal with God or your Higher Power for the exchange of one thing or person for another.

Anger

Stage of Grief Occurs for individuals usually when they can no longer live in the make-believe world of denial. The reality that the unexpected news is most probably true results in ________. This _________ can be directed in many ways.

Anger

Stage of Grief Occurs for individuals usually when they can no longer live in the make-believe world of denial. The reality that the unexpected news is most probably true results in ________. This _________ can be directed in many ways.

Acceptance

Stage of Grief The individual may be spending more time sleeping, in quiet thought, or in turning his or her focus inward. You begin to realize that you are not responsible for the loss that has occurred in your life or that your part in the loss was not the ultimate result of the loss. An ___________ of the reality that life brings things and people into our lives and that life takes things and people out of our lives.

Acceptance

Stage of Grief The individual may be spending more time sleeping, in quiet thought, or in turning his or her focus inward. You begin to realize that you are not responsible for the loss that has occurred in your life or that your part in the loss was not the ultimate result of the loss. An ___________ of the reality that life brings things and people into our lives and that life takes things and people out of our lives.

Denial & Isolation

Stage of Grief The onset is usually triggered by the shock of some unexpected news. This stage allows you to collect yourself and, with adequate time, to mobilize other, less radical defenses.

Denial and Isolation

Stage of Grief The onset is usually triggered by the shock of some unexpected news. This stage allows you to collect yourself and, with adequate time, to mobilize other, less radical defenses.

Depression

Stage of Grief This is used to help individuals prepare for truth concerning the loss they have experienced. At this stage, reassurance and encouragement by others is no longer as meaningful to the individual. In this stage, you may begin to feel the weight of the fact that the loss did actually occur, that you were powerless to prevent it, and that you feel hopeless in your life recovering from the loss.

Depression

Stage of Grief This is used to help individuals prepare for truth concerning the loss they have experienced. At this stage, reassurance and encouragement by others is no longer as meaningful to the individual. In this stage, you may begin to feel the weight of the fact that the loss did actually occur, that you were powerless to prevent it, and that you feel hopeless in your life recovering from the loss.

Bibace and Walsh

Stages of illness understanding Align with Piaget's cognitive stages

Social Change

Steps in effecting _______ ______: - Being educated about various issues that influence the political agenda - Developing specific plans for change - Defining and prioritizing needs - Developing a power base

Departmental Process

Steps include: - collaborating with members of the team - gathering basic information - assessing the demands of the situation - assessing individual variables - determining the focus of care - influencing appraisal through a variety of means - facilitating coping strategies - reevaluating appraisal and coping

Negative Affective Priming

Suggestions can produce the suggested affective effect even when the suggestive input is minimal

Technology

Systemic conditions that have the potential to make healthcare provision for families more or less effective: - The proliferation of ________ and broad access to healthcare information

Adopting Prevention as a Guiding Principle

Systemic conditions that have the potential to make healthcare provision for families more or less effective: - Viewing families as uni

Palliative Care

The _______ ______ team can support the parents' efforts by providing information about normal cognitive development and how this affects a child's understanding of death

Ending

Taking the responsibility for _________ the relationship is one of the expectations for professional relationship within nursing, and thus impacts the establishment in course of the therapeutic relationship

Expressive Play

Target shooting with syringes Throwing wet sponges Paper "fights" Velcro "dart" boards Punching activities Pounding/banging activities Cooking activities Throwing activities

Indicated Interventions

Targeted to "high-risk" individuals with some detectable symptoms

Universal Interventions

Targeted to entire populations

Selective Interventions

Targeted to subgroups of the population at higher than average risk of developing a disorder

Coping Strategies

Teach the child _______ _______ Focus on these at every step of the process

Nontherapeutic

Teachers, electricians, car sales persons, business partners, beauticians, friends, and family members are (therapeutic/nontherapeutic) relationships

Diagnosis Education

Teaching a child about their diagnosis in a way that they can understand and without (unexplained) medical terms - Used any time a child receives a diagnosis - Increases understanding - Increases compliance - Decreases anxiety - Opens doors for questions - Dispels misconceptions - Builds rapports with kids, parents, and medical staff

Prevention

Teaching is a primary _________ tool

Slow-to-warm-up Child

Temperament Type May need extra time and attention in order to adjust to new situations

Difficult Child

Temperament Type // Manipulative // Demanding // Highly active and/or loud Can be facilitated through interventions related to increased choices and control, positive feedback, and activities designed to increase child's self-esteem

Therapeutic Play

Term associated with play in healthcare settings Play that is used to prevent psychologic injury and aims to: - meet children's ongoing developmental needs - help children cope with the unfamiliar hospital environment - increase children's understanding of their hospitalization and treatment - promote a sense of control, mastery, and positive self-concept - facilitate self-expression - meet children's needs to cope with separation and deprivation

Family-Centered Care (FCC)

The "approach to healthcare that is based on mutually beneficial partnerships between patients, families, and healthcare professionals."

Family Centered Care

The "approach to healthcare that is based on mutually beneficial partnerships between patients, families, and healthcare professionals." - Some medical professionals feel it takes too long- Some think it is too expensive - IT'S HARD - Some medical professionals feel they "know more" and should be trusted

Grief

The "whole person" response to loss and includes feelings, thinking, physical symptoms, social changes, and spirituality

Communication

The Accreditation Council for Graduate Medical Education (ACGME) requires that doctors be taught effective _____________ skills.

Electronic

The American Academy of Pediatrics recommends no _________ media before age 2. These toys interfere with a young child's developing brain.

Pleasure

The ____________ of play allows children to relax and, therefore, anxiety and defensiveness are reduced

7

The ability of a sibling to understand and cognitively perceive events may cause children under the age of ____ to be the most vulnerable

Wayfinding

The behavior in individual exhibits when attempting to locate or arrive at a destination. When the design of a building results in poor _________, that individual maybe come frustrated and lost. Adults have been lost as children recount their experiences among the most frightening of childhood, and can find this experience very intimidating as adults. With regard to healthcare settings, and individual may enter into a frustrating _____________ situation in an already distractive state because of poor health or concerned about the poor health of a friend or family member. The unpleasantness of this disorientation is exasperated by the stresses The objective is to allow the viewer to guess how the interior is organize simply by looking at the exterior envelope

Noncorporeal Continuation

The belief in an afterlife or some kind of communication that goes on after the death of the physical body

Ask them

The best method for understanding children's experiences is to ______ _______

Ethics

The branch of philosophy that deals with values pertaining to human conduct, considering the rightness and wrongness of actions and the goodness or badness of the motives and ends of such actions The rules, standards or moral principles adopted by an individual or group to govern conduct

Scientific/Biomedical Health Paradigm

The dominant health belief system for the majority of families in the U.S. - Determinism (cause and effect relationships exist for all natural phenomena) - Mechanism (life is compared to the structure and function of machines) - Reductionism (all life can be reduced or divided into smaller parts) - Dualism (mind and body are separated into two distinct entities

Ecological

The family systems perspective is based on the notion that the person or patient is embedded in a family system that, in turn, is embedded in a larger _________ system

Games With Rules

The final stage of play for Piaget. Children recognize and follow preset rules according to the goals of a group or game. Children in the early elementary grades begin to enjoy games with rules Piaget maintains that skills gained an earlier stages of play lead to the development of more sophisticated behaviors, demanded in the stage. The value of this stage cannot be stressed enough. Through gameplaying, children learn how to most fully cooperate, resolve conflicts, and express themselves to others

Initation/Orientation Phase

The first phase of therapeutic relationships identified by Stuart and Sundeen (1995) The most important goal for this phase is that trust is established. This phase usually includes some sort of introduction, the establishment of the purpose of the interaction, and a mutual decision about the plans and logistics for continuing interaction. Some theorists divide this first phase into two subsections, an introduction section and a beginning or contractual section

Functional Play

The first stage of play for Piaget. In the first two years of life, children play by engaging and simple manipulation of objects, and by imitating movement and utterances of others. Sometimes referred to as "practice" play because children are often observed consolidating skills via repetitive actions and finding pleasure in these repetitions. It will continue to be demonstrated throughout a child's behavior, in differing forms, even into the teen years

Play

The focus of The Walt Disney Company grant is _____. The grant includes funding for up to $50,000 to underwrite a rigorous study demonstrating the impact of ______ interventions on outcome measures in a hospital.

Psychological Preparation

The goal is to increase children and family members sense of predictability and control over potentially overwhelming life experiences, allowing them to proceed in these situations with a resulting sense of mastery and with the lowest possible level of distress.

Increase

The overall goal of preparing children and families for medical experiences is to _________ feelings of control and predictability in order to foster a sense of mastery and minimize distress.

Symbolic

The parental role in the system of social intercourse inside the family have an impact on children's abilities to engage and increasingly complex ____________ play

Sensory Exploration

The primary way that infants and toddlers learn about their world

Preparation

The process of ____________ includes support at all phases of an event in which a child and family may be challenged: before, during and after.

Effort

The process of coping does not imply success, only _______

Appraisals Coping

The process of making ________ and of _______ is dynamic, constantly changing, and may be influenced by one's past experiences, positive or negative, as well as changing circumstances within the environment

Play

The purpose of The EBP Play Statement is to present empirical findings regarding the value of play for children in the hospital and to assert that _______ constitutes an integral component of evidence-based practice in child life.

Experience Intuition

The range and depth of a practiyioner's interventions are enhanced by _______ and _______

Secondary

The reality that a therapeutic relationship does not allow for any _________ relationship to be safely pursued with the client is a major challenge to the establishing identity of child life

Environmental Psychology

The study of transactions between individuals and their physical settings Gifford said " in these transactions, individuals change the environment and their behavior and experiences are changed by the environment Includes research and practice aimed at using and improving the process by which human settings are designed Deals with control, privacy and social interaction, personal space, territoriality, and comfort and safety

Hope Theory

The successful pursuit of goals elicits positive emotions, and the failure to attain a goal results in negative emotions and ineffective coping behavior

Chronic Phase

The time between the diagnostic or acute phase and the terminal phase of the illness Families realize the illness and treatment will be a continuing part of their family life Families may feel less supported by others and more isolated from social activities

Troublesome

The traditional belief is that children cared for on intensive care units will have more ______________ responses than with children cared for in general pediatric wards

Illness

The type of _______ is a significant factor in the characteristics of the roles and resulting relationships

Universality

The understanding that all things must eventually die

Sensory Informational

The use of _______ _______ approaches is now routinely incorporated into preparation activities with positive effect

Equipment

The use of _______ is intended for familiarization, active rehearsal of coping strategies, and appraisal of the situation as manageable

Parent Pagers

The use of this is an innovative program that has helped parents take time for personal, family, and business needs. Allows the parent to be readily available as needed at the bedside, helps them to feel a measure of control, and enhances they are participation in their child's care

Mainfested

The usefulness of guided imagery with persons experiencing chronic pain is built on the premise that there is an underlying and enduring process that accounts for how pain is _________ in a person's life.

Gender

There are distinct differences in the play of children related to _____

Gender

There are distinct differences in the play of children related to _______

Themes

There are gender difference, as well as age differences, in the _____ in which children most frequently engage

Join with Like Minded Individuals

There are many professional organizations and advocacy groups advancing the importance of play in whole child development

Pain Suffering

There is a general consensus that a crucial obligation of health care professionals, particularly those treating children, is the management of ______ and the relief of _________

Psychological

There is a prevalence of ___________ upset following discharge from the hospital

Trust

There is an importance of security, protection, and intimacy for a level of ______ to develop between infant and family. When these needs are not met, infants may become depressed, develop failure to thrive, or show signs of hospitalism

Length of Stay

There is evidence that child life services help to contain costs by reducing the _________ _______ ________ in decreasing the need for sedation and analgesics

Preparation

There is evidence that developmentally appropriate _________ programs can lead to significant changes in children's behavior and less anxiety following surgery and procedures

Cognitive Coping Strategies

Thermal regulation Music Conscious choice of alternate focus (distraction) Thoughts stopping self-instruction Therapeutic storytelling Intellectualization Reframing Spirituality or prayer

Play in Hospitals

These are all reasons why children should ______ ______ ______: - Prevention - Cope with fears and anxiety - React and understand in their own time - Provides observation of coping skills for care providers - Assists those who cannot verbally express themselves

Non-directive

This relationship approach to therapeutic play emphasizes the therapist role in providing an environment in which children feel accepted The therapist communicates feelings of warmth and reflects children's feelings, giving them the time and permission to lead the way through therapy Basic to this approach is the assumption that children have within themselves the motivation and ability to initiate positive changes in their lives

Guarded Alliance

Thorne and Robinson (1989) recognize three phases, with the development of a _______ ________ between family members and professionals being the final step in an ongoing relationship

Information Processing

Thought is a process Level of information process depends on maturity of thought Impact of stress

Competency

Three Steps for Developing _____________: - Having a self-awareness of one's own beliefs, values, and biases - Understanding the client's worldview and valuing the diverse heritage of others - Having the intervention skills to feel effective in communicating and developing relationships that enable families from different cultures and life experiences to feel positive about their interactions

During

Three chances for psychological preparation: 1. Prior to the procedure 2. __________ the procedure 3. After the procedure

Stress

Three classical definitional orientations have been used to describe _______: - Stimulus definitions - Response definitions - Relational definitions

Easy Difficult Slow-to-warm-up

Three commonly referred to temperament types

Descriptive Casual Inferential

Three levels in understanding of death

Natural Play

Through ________ _______ children obtain recommended amounts of exercise, prepare for future sports, choose their favorite play activities, assess and manage risk, and develop social relationships with a wide variety of children.

Health Concerns

Throughout the world children are facing an obesity epidemic, and during the past forty years in the US, the obesity rate for children aged 6 to 11 has more than quadrupled. Today over twenty-three million young people in the US are overweight or obese

1940s-early 1960s

Time Period - New medical modalities became available for children and adolescents - Healthcare experiences, particularly hospitalization, was often traumatic for children - Hospitals considered parents and other family members as visitors, and many visitation restrictions were imposed - Few supportive and expressive play programs - Little attention was paid to preparing children and families for procedures - Parents were not encouraged to participate in their child's care

1950s-early 1960s

Time period - Enlightened healthcare professionals began to realize that play, preparation, and 24 hour access to their children for families would improve clinical and developmental outcomes - Association for the Care of Children's Health (ACCH) was founded

Direct Care

Timing, availability of child life staff and ability of parents and staff of other disciplines to provide support may influence the amount of ________ ________ offered to an individual child and family

Assent

To express agreement Requires: - Helping the patient achieve a developmentally appropriate awareness of the nature of his or here condition - Telling the patient what he or she can expect with tests and treatment - Making a clinical assessment of the patient's understanding of the situation and the factors influencing how he or she is responding - Soliciting an expression of the patient's willingness to accept the proposed care

Certification Program Maintenance

To help ensure patients and families receive high quality care from certified child life specialists, the Association of child life professional's Commission administers the examination based ______________ ___________ and ongoing certification ___________________

Roles

To prepare for invasive procedures, parents and children need to know what to expect during the procedure and what their differing individual _______ will be.

Overprogramming

Today's parents feel pressured to help their children develop at an accelerated pace

Preparation

Toddlers are often able to understand far more than they are able to express in words, and subsequently they benefit from ____________ for procedures

Greatest

Toddlers require the (least/greatest) attention to minimizing these differences in the hospital environment and the home environment.

Fewer

Toy companies say that watching Baby Einstein, Brainy Baby and similar DVDs helps babies get smarter sooner. But University of Washington researchers found that for every hour spent watching baby DVDs, infants learned 6 to 8 _______ new words than babies who never watched. This is because as babies watch TV they are spending less time interacting with parents or engaging in creative play -two activities that promote learning.

Think For Themselves

Toys that encourage girls to focus primarily on taking care of others and thinking about their appearance and boys to build and be aggressive don't allow children to learn to _______ ______ _________ and define their own interests.

Child Life Specialists

Trained professionals with expertise in helping children and their families overcome life's most challenging events Educated and clinically trained in the developmental impact of illness and injury Their role helps improve patient and family care, satisfaction, and overall experience

Action

Transtheoretical Model - Individuals are performing the desired behavior change at the designated criterion level

Preparation

Transtheoretical Model - Individuals tend to take action to change their behavior in the next 30 days

Contemplation

Transtheoretical Model - Recognize a problem and are seriously considering changing the behavior

Maintenance

Transtheoretical Model - Represents continuous, long-term change wherein the person works to consolidate behavioral and cognitive/experiential gains made while transitioning through the previous stages to avoid relapse

Precontemplation

Transtheoretical Model - Resistance to recognizing and modifying problem behaviors - Have no intention of changing their behavior in the next 6 months

Palliative Care

Treats uncomfortable symptoms to improve quality of life.

Normative Nonnormative

Two categories of stressors in children

Hypoplastic Left Heart Syndrome (HLHS)

Underdevelopment of the aorta, aortic valve, left ventricle, and mitral valve; this defect involves the entire left side of the heart.

Collaborative

Understanding the roles, tasks and beliefs of others is an important foundation of _______ work Promotes an environment in which the goals of psychological preparation, optimal coping and sensitivity to individual needs can be built

Play Developmentally Appropriate Communication

Used to: o Promote optimal development o Educate children and families about health conditions o Prepared children and families for medical events or procedures o Plan and rehearse useful coping and pain management strategies o Help children work through feelings about past or impending experiences o Establish therapeutic relationships with patients, siblings, and parents to support family involvement in each child's care

Real Equipment

Using this for preparation helps preschoolers understand and communicate

Merits

Voicing negatively-loaded suggestions is more likely a habit of some providers who believe in its ________ rather than something all providers do when it is solicited by the patient.

Social Cultural Theory

Vygotsky Children's thinking is said to reflect a combination of maturation and learning that takes place within a social and cultural context The social and cultural context is seen as influencing what children learn and how they learn it Acknowledges the influence of context on children's developing knowledge of the world Children's thinking is described as reflecting the integration of where children are cognitively with the demands of the given context

Zone of Proximal Development (ZPD)

Vygotsky believes that play moves children into the ____________ ____________ ____________ ____________ which takes them along in oscillating continuum into higher levels of thinking. This is his term for the distance between what children can do without help and what children can do through interaction with skilled helpers. It is within this that children's potential for new learning is strongest

Scientific/Biomedical Health Paradigm

WEAKNESSES - Fragmentation of healthcare services - Lack of research and treatment that are holistic or preventive in nature - Lack of healthcare that considers the mind-body connection - Symptomatic treatment of diseases vs. determining causation - "Prescriptionism" -- heavy reliance on pharmaceutical interventions

Anxiety

Warning the patient with negatively-loaded statements was associated with subsequent greater reported _________

Did not

Warnings and commiserations that referred to painful sensations or unpleasant emotions (did/did not) help our patients reduce pain and anxiety

Anita Olds (1986)

Warns that primary colors can become strident if overused in the assumption that "that's what children like."

Cognitive

Was Piaget a cognitive or psychosocial theorist?

Family Members

We can become ________ ________ with someone through birth, adoption, marriage, or our own personal choice

Inner Fantasy

What is the motivation of play during the years between two and seven? Reaches its peak when symbolic play almost totally consists of personal, real life experiences, which are channeled into children's own subjective purposes. This constitutes children's efforts to re-create experiences so they can best be coached with, and she repeat past experiences in order to enjoy or reframe them in acceptable and understandable ways.

Piaget

What theorist is responsible for cognitive development?

Previous Sedation

What to include in pre-procedural preparation: - Developmental level - Appraisal of the events - _________ experience - Level of __________ during the event

Coping Cooperation

What two things will increase when an adolescent unit features in environment and policies specifically designed for adolescence

9 months - 4 years

What years are children the most vulnerable to the negative affects of hospitalization

Children

When _______ are dying they need: - Goals - Rules - Friends - Leisure - Play - Pain Management

Family

When a child is the patient, the patient is the ________

Theories

Without __________, it would be difficult to determine and articulate why and how things happen the way they do - Validate - Guide - Contribute to Evidence -Based Processes - Help CLS maintain objectivity Applied as frameworks directing the attention of the child life practitioner to extend beyond children in isolation and focus on children in the context of family relations in the social environment

Theory

Without __________, it would be difficult to determine and articulate why and how things happen the way they do - Validate - Guide - Contribute to Evidence-Based Processes - Help CLS maintain objectivity

Hand-over-Hand Method

You use your body and/or technical adaptations to scaffold the child's physical abilities

Stress-Point Supportive Care

Wolfer and Visintainer (1975) Included role rehearsal, and reported that the experimental group demonstrated less upset on both psychologic and physiologic measures Participants in the experimental group had better post-hospital adjustment scores

Supportive

Wolfer, Gaynard, Goldberger, Laidley, and Thompson (1998) defined child life relationships with children and families as "_______" rather than "therapeutic". These relationships involved expressions of positive effect, affirmation in the provision of aid or assistance.

Reactive

Working with a child who is referred or identified because of noncompliance or high anxiety is a __________ intervention

Stage Manager

Works with the child to prepare for play and responds to children's requests

Academic

Workshop at the summit · Assure that _____________ programs are of the highest quality, are comprehensive and facilitate professional skill development and assessment

Training

Workshop at the summit · Move towards a standardized curriculum that teaches child life skills essential in all clinical settings; increase training possibilities for field supervisors

Scholarship

Workshop at the summit · Strengthen the evidence-based research and scholarship skills of child life specialists and foster professional dialogue about evidence-based practice

Education Training Scholarship

Workshops at the summit included recommendations in what three areas

Play Development

You want to provide your little one with experiences that will enhance healthy ______ and ______.

Social Emotional

You can also make a book with photos of your toddler to encourage language and ______/______ development.

Losing a Spouse/Partner

Young adults might feel emptiness and isolation and their social connections might change as they are no longer a couple but an individual. Means not only grieving, but assuming the (often unfamiliar) responsibilities and roles of the deceased and may include helping children through grief.

Sensory

Young children are _________ oriented and best able to comprehend what will happen in a perioperative setting if the explanations are concretely presented with hands-on materials

Involvement

Young children learn best when given opportunities for active _______ with the material presented

Baskets Buckets

Young toddlers enjoy _______ and _________ for filling and carrying small toys.

Individualization of Care

Younger, less mobile patients who have more complex medical conditions may need greater _____________ _____ _________ from the CCLS

Mimic

Your toddler will enjoy pots, pans, spoons, brooms and other adult objects that are safe for ______ play. Imitating the actions of adults around them is an important way that they try on various roles. Almost any safe object can become a toy for ______ play.

Therapeutic Play

Zahr (1998) evaluated _______ _______ as a surgivsal preparation method for preschoolers in Lebanon The intervention group has less anxiety and more cooperation The intervention group had lower mean blood pressure and pulse rates during a preoperative injection. _______ _______ is an effective way to reduce stress responses among preschoolers in Lebanon

Coping Efforts/Strategies

Zeitlin and Williamson (1994) define _______ _______ or _______ as the specific cognitive or behavioral actions taken to manage tension-generating events

90

____% of babies with trisomy 13 or 18 die within one year of life

Push and Pull Toys

______ ______ ______ _______ are great ways to develop large motor coordination and strength in toddlers.

Sand Water

______ and _______ play for toddlers provides opportunities for imaginative play as well as motor development. You can encourage this play by adding small toys such as vehicles, animals, plastic containers, bowls and spoons.

MRIs

______ requires the child to lie motionless for 30-60 min, thus sedation/anesthesia might be used to facilitate successful completion

50 75

______ to ________% of children develop significant fear and anxiety before surgery, with recognized risk factors

Physical Contact

_______ ______ at time of death helps parents express their sense of continuing bonds with their child

Blank Cloth

_______ _______ dolls as described by Gaynard, Golberger, and Laidley (1991), are ideal for preparing children for healthcare procedures, as they allow the use of real needles and can be used to rehearse positions that the child will need to assume

Optimal Care

_______ _______ is delivered when parents or other caregivers are primary members of the child's caregiving team

Past Experiences

_______ _______ may affect current appraisals, and in turn, children's responses to care

Close-Ended

_______ _______ questions could put words in the child's mouth

Open-ended Toys

_______ _______ such as boxes or blocks can become houses, roads, castles and caves for toddlers Provide props such as fabric, animals and vehicles to support your child's different play ideas. Such materials allow babies, toddlers and children of many ages to play together with the same things!

Preparation Implementation

_______ and _______ of coping strategies is ideally a collaborative effort

Music Songs

_______ and _______ that encourage repetition, rhythm, movement and clapping bring joy and build motor and language skills for toddlers

Cognitive

_______ approaches include those that help reframe or refocus thoughts from negative to positive

Behavioral

_______ approaches introduce behaviors that are compatible with the successful completion of the threatening event

Vinyl

_______ dolls with appropriate anatomic features are typically most useful for play about healthcare with toddlers and very young preschool children

Constraints

_______ for children may include developmental age or limited life experiences.

Action

_______ in itself is soothing and can be a stress reducer for all individuals regardless of age. It gives one something to do rather than merely waiting passively for events to happen; it feels more effective in soothing than random, uncontrolled behaviors or thoughts, and is a more effective coping mechanism

Demonstration

_______ its use on yourself, then the parents Ask the children to imitate this behavior

Visual

_______ materials can be invaluable in helping children and families gain a sense of an unfamiliar setting

Survival

_______ mode in PTSD leads the brain to secrete neurochemicals that construct more vivid, powerful, and pervasive memories and responses

Introductions

_______ yourself to the parents State your name and your role on staff Clearly state what will and will not occur on this occasion

Nurses

_______' lack of time and heavy workload impeded their use of nonpharmacologic pain management techniques

Disease

_______-related pain is the most common source of pain in pediatric patients, pain from placement of intravenous lines is second

Creative Play

________ _______ is being challenged because: - Infants and toddlers are spending many hours in front of a screen. - Many toys are marketed as educational when in fact there is no evidence to prove it. - The increasing number of electronic toys, games and DVDs often turns our infants and toddlers into passive players whose. main activity becomes pushing a button. - Toys are often linked to popular media characters. Branding toys for the very young means that when they are older they often want an item simply because it is linked to a familiar character, not because of the quality of the toy.

Counseling Sessions

________ _______ with families are effective in preventing exposure to "environmental tobacco smoke" among asthmatic children

Fantasy

________ activity of children has a positive effect on reducing distress and recommended the incorporation of imaginary activities into the therapeutic interventions of health care professionals

Asthma Pneumonia

________ and _______ remain among the top 10 reasons for hospitalizations among all pediatric age groups

Resilient

________ individuals possess the ability to spring back, rebound, successfully adapt in the face of adversity. They develop social competence despite the occurrence of stressful experiences and major assaults on the developmental process.

Hope

________ is about possibility, about the future, about expectations and often coexist with uncertainty. It is a potent and positive human faculty that assures us that the future is open. ________ provides a passion for the possible and is considered by many to be the strongest driving force of humans in regards to bringing about change in igniting the spirit within us to continue in spite of overwhelming challenges.

Siblings

________ need: - Room to grieve - Safe environment for asking questions - Opportunities for dispelling misconceptions - Therapeutic play outlets - A reprieve from stress

Sensory

________ strategies: - swaddling infants - sucking - comfort positions - positive touch - one voice - music

Empower

_________ children as much as possible in circumstances concerning their own death

Financial

_________ pressures and many health care settings have threatened the growth and sustainability of CCLS services

Parents

_________ should be permitted to remain with their child during this stressful experience but be allowed to leave during the procedure if desired.

Behavioral

_________ strategies: - Deep breaths/blowing - Desensitization

Social Interaction

·Activities that enable __________ __________ are particularly helpful for patients who are isolated for infection control or confined for monitoring reasons