Chapter 35: Communication and Teaching with Children and Families

A 9-year-old arrives in the clinic for a venipuncture. The child says to the nurse, "You better know what you are doing, because you only get one chance at this!" What is the best response by the nurse?

*"I can understand that you are concerned about having your blood drawn. I will try and make this as comfortable as possible."* In the same way that children who request health care do not enjoy being criticized, neither does the average health care provider. If a child makes a critical remark, therefore, it is easy to respond with a defensive or protective comment rather than a therapeutic one. The nurse should try to respond instead with a supportive comment. When making this statement the child may not be angry but rather frightened. Telling the child it may take a couple of tries only increases the anxiety and fear.

A child who is scheduled for an x-ray repeatedly talks about how she is not worried about the procedure. What is the priority action by the nurse?

*Ask the child if she is concerned or worried, or has any questions about the x-ray.* The child may be repeatedly discussing how she is not concerned because she is concerned. It is important for the nurse to recognize this and check the child's perception of the procedure. Giving the child praise is positive reinforcement, but the timing of the praise needs to be appropriate. The child's behaviors can be documented but this not the priority action by the nurse. Reflection requires restating the word or phrase stated by the child to give assurance that the nurse is listening, but may not allow for the child to fully express her emotions in this situation.

A 9-year-old child with rheumatoid arthritis has difficulty moving the hands as well as other joints due to pain. The child refuses to participate in the prescribed physical therapy. What would be the best way for the nurse to make sure the child continues to exercise the joints?

*Play a game like "Simon Says" to introduce exercises.* School-aged children love to play games. By playing "Simon Says" and introducing different exercises to help with movement, the nurse may help stimulate the client to want to be active. Reading about exercises and seeing them demonstrated by a person or in a video will not increase the child's desire, especially since the child is in pain. Exercise for this child should be a pleasant experience and playing a game will help accomplish that goal.

A 15-year-old client with type 1 diabetes has been noncompliant with the dietary regimen. When educating the adolescent, what is the most important thing the nurse can do to allow the adolescent to be in control and involved in the decision-making process?

*Speak directly to the adolescent and consider the client's input in the decisions about care and education.* A teaching tip for adolescents that will allow them control and involvement in the decision-making process is to speak directly to them and consider their input in all decisions about their care and education. Adolescents are particularly sensitive about maintaining body image and the feelings of control and autonomy. Reasons as to why things are important should be conveyed to them. The nurse should collaborate with the teen to develop an acceptable solution to being compliant. The nurse should also expect some noncompliance from adolescents. Even with noncompliance in some areas, there some things the adolescent does well—and the adolescent should be praised for these accomplishments. Choices can be offered whenever possible but for a client with diabetes these choices are often limited.

An 8-year-old child is scheduled to have a tonsillectomy and adenoidectomy in 2 weeks. What intervention can the nurse provide to help the child and family adjust to the hospitalization?

*Take the child on a tour of the facility and surgical suite and explain what to expect preoperatively and postoperatively.* Nurses can help children cope with the experience by using age-appropriate and child-specific interventions. Preparation can help children and their families to adjust to illness and hospitalization. Preparing the child reduces stress and fear. As much as possible, the nurse or child life specialist can show the child the areas where the child will have surgery, play with age-appropriate dolls to learn such things as IV insertion, and answer all the child's questions. Telling the child the parents will not be able to see him or her increases fear and anxiety. Being able to have a popsicle after surgery is the truth, but it is not the entire truth nor does it prepare the child for unknown places. The purpose of prehospital preparation is not to interview the child but to prepare the child.

An adolescent comes to the clinic exploring options for birth control. In addition to instruction on birth control, the nurse provides a pamphlet about sexually transmitted infections (STIs). As the nurse is documenting the interactions of the visit, which documentation best identifies that the teaching has been effective?

*The client demonstrates effective use of a condom and names two methods to reduce the risk of STIs.* It is important for the nurse to evaluate that the instruction has been effective, particularly with the topic of birth control and sexually transmitted infections (STIs). Actual demonstration and specific information about the topic provide the best evaluation that the teaching was effective. All the other observations are generalized statements that do not demonstrate learning. It is good to identify what was taught and that there were no questions but this does not demonstrate learning. Stating an understanding without specifics does not demonstrate learning. It is good to provide actual statements by the client, but the given response does not demonstrate learning.

The nurse is caring for a 7-year-old client who is newly diagnosed with diabetes. Which teaching strategy will be effective when teaching this client to check blood glucose levels?

*Use the demonstration/re-demonstration strategy.* The nurse must develop appropriate strategies for learning depending upon the developmental level of the client. Active participation, particularly for a 7-year-old client, facilitates learning. Checking blood glucose levels is a psychomotor skill that is best learned through demonstration by the nurse followed by re-demonstration by the client. Due to shorter attention spans for young children, lectures would have to remain brief; this is not the best option. Reading books or pamphlets is not appropriate as the client has a limited reading ability. Although role modeling is always completed, it would not be most effective for learning. Further instruction and demonstration are necessary.

Which best demonstrates the teaching principle of providing a conducive environment for learning?

*a 10-minute puppet show after mealtime* A puppet show lasting no longer than 10 minutes without the distractions of meals, animals, or toys would best demonstrate this teaching principle.

When caring for hospitalized teens, nurses should choose their words and actions carefully since adolescents typically are concerned about:

*appearing out of control of the situation and/or themselves* Adolescents are concerned about how others view them. They wish not to do or say "dumb" things or appear babyish. This concern may cause them to worry about postanesthesia behavior or about how they might react to a procedure. Independence is desired yet a concern. Mobility restrictions, mutilation, and separation are more common fears and anxieties in preschool-age children and school-age children.

Take the child on a tour of the facility and surgical suite and explain what to expect preoperatively and postoperatively.

*demonstration* The purpose of demonstration is to show how the procedure actually is done. Having to imagine steps is little different than reading about them. School-aged children, because of their stage of cognitive development (concrete operations), learn best by demonstration. Watching a video is a good teaching strategy to show the process but it does not have the "real" syringe and vial the child can see and touch. Once the demonstration is complete the child should be allowed to return the demonstration and/or have time to practice with the nurse's assistance.

A 5-year-old girl tenses up when the nurse approaches to examine her. "Are you afraid?" the nurse asks her. The girl shakes her head in denial. As the nurse lifts the stethoscope to auscultate the girl's chest, however, the nurse notices that the girl tenses up again and grips the edge of the examination table tightly. "Oh—you are afraid of the stethoscope, aren't you?" the nurse replies. "It's okay—it doesn't hurt; see—reach out and touch it." Which communication technique is the nurse demonstrating here?

*empathy* Empathy is the ability to put yourself in another person's place and experience a feeling the same as that person is experiencing. People who are capable of empathy are the best support people because they can anticipate a child's reactions or fears. Genuineness is a quality of projecting sincerity or being yourself. Warmth is an innate quality some people manifest more spontaneously than others. Basic ways in which warmth is demonstrated are direct eye contact, use of a gentle tone of voice, listening attentively, approaching a child within a comfortable space of 1 to 4 feet, and using touch appropriately. No one likes to talk to someone who does not appear to be listening or responding. Good listening, therefore, like speaking, is not passive but active.

A student nurse walks into a client's room and states, "I am a student nurse who is going to take care of you today." Which level of communication is the student using?

*first level* The first level of communication is cliché conversation. It is pleasant chatting or comments. When the student tells his or her function and position, it leads the family and client to move the conversation from the cliché level to a more meaningful one.

A nurse is talking to a mother concerned about her 5-year-old son. She informs the nurse that he eats only cereal and peanut butter every day and fears that he is not getting proper nutrition. The nurse reassures the mother that even though he is eating a limited variety of foods, he is likely getting enough nutrition. Which type of teaching is this nurse practicing?

*informal teaching* Health teaching may be offered to an individual or to a group and can be both formal or informal. Teaching a group of children about hospitalization would be formal. Assuring this mother about adequate nutrition for her child would be informal teaching. Structured and systematic are two types of formal teaching.

A 4-year-old child is scheduled for major abdominal surgery. Prior to the procedure, which teaching will the nurse provide regarding pain?

*information on expected pain and ways to alleviate pain* Honest communication is needed to acquire the child's trust. Knowing what to expect and how the nurse can help with the pain is important during the preoperative stage. It is not appropriate to not discuss pain management. Deep breathing and coughing will increase pain after abdominal surgery. Alternative therapies may be used in conjunction with traditional methods. A lot of instruction at one time may increase fear and overwhelm a 4-year-old child.

The nurse is teaching a 6-year-old girl and her mother about home care for an eye infection. Which communication technique would be least effective with this child?

*standing beside the child when doing the teaching* Standing above a 6-year-old may create the feeling of being dominated. Sitting at her level promotes equality and a more comfortable teaching-learning setting. Listening with patience to the child when she speaks or questions allows her time to completely formulate and express her thought or question. It is respectful. Talking to the child as well as the mother during health teaching keeps the child a participant in her care. Asking permission to touch the child reduces threat.

A child who has had several surgeries to correct a congenital defect is found crying after receiving the news another surgery will be needed. The nurse could best assist this child through what form of communication?

*touch* Touch is the most intimate and meaningful form of nonverbal techniques. When words are inadequate touch rarely is. Touch can be used to accompany reassuring words or in place of words as a strong support signal (e.g. I'm here; I understand; it is all right to be afraid). Staying with the child and touching them while they cry allows the child to be upset with no condemnation, but also says the nurse cares. Silence is used after asking a question and giving the child time to respond. Supportive statements let children know you accept their behavior. Reassurance would only be false in this situation.