Ch 35 PrepU: Communication and Teaching with Children and Families

A nursing student is learning about teaching and how to evaluate is effectiveness. Which of the following statements made by the student identifies a need for further instruction?

"Evaluation is done as a final step of teaching only." Evaluation is the process of assessing whether teaching has been effective. It is the final step in teaching but occurs also throughout the entire learning process. This evaluation process helps both teacher and learner to better meet changing needs.

Nursing students are learning about the importance of therapeutic communication in their pediatric course. The nursing instructor identifies a need for further teaching when a student makes which statement?

"It is best to stand when listening to a child to demonstrate knowledge." Good listening is not passive but active. Posture reveals greatly whether one is listening. Sitting, not standing, means the nurse is actively listening and interested in what the child has to say. Leaning forward, not backward, displays interest in the child and conveys an openness. The nurse can convey good listening habits by pulling up a chair to the bedside or to a table when the child is sitting and engaging with the child at the same level.

A 16-year-old girl confides in the nurse that her parents are difficult to deal with and that it stresses her out. The nurse responds by saying, "You think that's stressful, you should see some of the clients I have to deal with in here!" Which barrier to communication is this nurse demonstrating?

"Topping up" is minimizing a child's views by telling a better story. A child tells you, for example, she has a problem; you say, "You want to know what problems really are? Come and work here." Clichéd advice (advice given from a formula, not individualized to the situation) is meaningless because it is too general to be helpful. In the same way 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 comment or disapproving remark rather than a therapeutic one. Parents and children do not come for health care to be criticized; they come to learn more about how to stay well or recover from illness. If you criticize them, they may not reveal any further information to you because they do not want you to react in the same way you did to their preliminary statements.

Which statement by the nurse is most appropriate when preparing a 6-year-old child for a surgical procedure under general anesthesia?

"When special medicine is given, it will cause a very good and different type of sleep." When providing teaching to a 6-year-old child, the nurse must consider the developmental level and cognitive stage of the child. In this case, the child needs to be able to differentiate the sleep and that there is special medicine used for that purpose. If the child thinks the sleep is the same as every other night, the child may become concerned about people hurting him/her when sleeping at home. "Putting the child to sleep" may indicate to the child that he/she will not wake up, or will go away like a pet. Using the terms "anesthesia" and "appendectomy" is too detailed for a 6-year-old child.

The nurse asks a 2-year-old client, "How are you feeling?" Which verbal response is anticipated for a child at this age and developmental level?

"me hurt" When speaking to a 2-year-old child, the nurse anticipates that the verbal response by the child will include 2 words, typically a noun and a verb. This is most common for the age and developmental level. The child should be able to form appropriate words, not nonsense words. The child should put up to 2 appropriate words together, not 1. A full sentence is not anticipated at this age and developmental level.

The nurse is caring for a 7-year-old child scheduled for a tonsillectomy the next day. The client states, "I really wish I was not having surgery tomorrow. I am not excited about this. Maybe I will be better by tomorrow." Which response by the nurse is most appropriate?

"you sound worried, let's talk about tomorrow" Therapeutic communication is an interaction between two people that is planned (deliberately intending to determine the true way a child feels), has structure (use specific wording techniques that will encourage the response you expect to elicit), and is helpful and constructive (at the end of the exchange the nurse will know more about the child than at the beginning, and the child, ideally, also knows more about a particular problem or concern). The child seems worried; therefore, the nurse would discuss the child's feelings with the child to determine the best course of action. It is not appropriate for the nurse to state "hope you are better" or "everything was fine" as these are not therapeutic. If possible, it would be appropriate for the child to tour the operating room prior to surgery, after discussion the child's feelings. Seeing the location may help alleviate some fears.

The nurse is having trouble communicating with a hospitalized child. Which communication technique would be the most beneficial for the nurse to offer the child?

A useful nonverbal technique to learn how children feel about a frightening experience is to ask them to draw a picture of what happened or a picture of themselves. A child's use of color may be a clue as to their mood (happy children will use bright colors; depressed children will use black or dark colors). The child's age would matter if the child were to keep a diary. This would have to be an older school age child or adolescent. If the child is not communicative, attending a group discussion might tend to increase the anxiety because more pressure would be exerted to participate in the group. Playing video games is a single activity and requires the child to focus on the game and not the problem.

The school-age child with a new colostomy will require teaching by the nurse to learn to care for the ostomy. In order for the nurse to teach the child effectively, what is most important for the nurse to know about the child?

An assessment of the child's learning style needs to be completed prior to conducting the teaching session. Assessing individual learning styles helps to meet each child's best way of learning. The reason for the colostomy is not necessary; care of the colostomy is the focus of the teaching. Manual dexterity may be important for the child to be able to handle equipment safely, but it is not the most important fact to know. The procedure can be adjusted to take into consideration manual dexterity. The parent may or may not be present for the teaching session if the goal is to teach the child self-care skills.

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 nursing student learning pediatrics and the development of language correctly identifies the age when children are able to put together two-word (noun-verb) sentences to be:

By age 2 years, children have mastered language well enough to be able to put together two-word sentences (noun and verb).

What should be the first step in developing a teaching plan for a 9-year-old child who needs education about a gluten-free diet for the treatment of celiac disease?

Client education occurs when nurses share information, knowledge, and skills with children and their families. For this to be effective, the nurse would first have to assess the child's and family's current level of understanding, the child's cognitive level, the child's physical ability and any psychosocial concerns. The child learns best when the child's input is valued and the child is actively involved in the learning process. Giving the child a video to watch or a pamphlet to read does not allow interaction for learning or the ability to ask questions or voice concerns. If the child is to be on a gluten-free diet, the parents responsible for purchasing the food should also be included in the teaching. Collecting facts about the child's likes and dislikes would be important to know, because gluten-free substitutions may be available. These, however, are not the primary actions. The assessment comes first.

The nurse is trying to understand how a 10-year-old child feels about the treatment plan. Which nursing technique may be most beneficial?

Drawings can be a useful nonverbal technique to learn how a child feels about an experience such as a treatment or procedure. A child's use of color may provide clues into the child's mood. Writing a song requires thought and verbalization of feelings. The child may have a difficult time verbalizing their feelings. Having the parent ask for information or listening to interactions with siblings may not reveal the child's true feelings. The child may state what someone else wants them to say or hopes that they will say.

An emergency department nurse is caring for an 8-year-old client with a hearing impairment. The child is scared and having pain from a forearm burn. What is the best way for the nurse to communicate with the child?

Face directly in front of the child when speaking to allow following of lip movement. There are several strategies that can be tried when communicating with a hearing-impaired child. The nurse must determine which is most successful. When a child is in pain, it makes communication more difficult. When communicating with hearing-impaired children, check whether they use a hearing aid; if so, be certain it is turned on. Next, it is best to face the child when you speak—not stand above—so the child can follow your lip movements. There is no need to use exaggerated lip movements, which may cause confusion. To supplement, use hand gestures as necessary to convey your message, or write out instructions. If you have difficulty understanding what they are trying to say, ask them to write it down if they are old enough.

The nurse is educating an adolescent, newly diagnosed with diabetes, on how to follow a diabetic diet. Which approach would be most effective?

Give choices and then allow the client to plan meals for the next couple days. The nurse is most correct to identify that the adolescent is going to need information as well as evaluation of understanding. Allowing the teen to make food choices for a few days will enhance their ability to follow the required diet. Using a finite number of days is not overwhelming and will allow for instruction throughout the time frame. Having preplanned meal plans limits the application of understanding. Quizzing the teen does not enhance teaching and learning about diabetic nutrition. There is no nursing instruction or evaluation when the adolescent is using a website.

A nurse is working with a 13-year-old girl who continually demands cups of water or juice, specific foods, and constant changes to her bed position. How should the nurse respond to this client?

Graciously meeting all of her requests, within reason Demanding behavior generally stems from insecurity or fear. Give more of yourself, not less, to counteract this response. When you have proven you are dependably there for them, children do not feel so insecure, and the need to be demanding usually fades. Withdrawing from them has the opposite effect if it increases the child's insecurity and the demanding behavior. Ask, "Is there anything else I can do for you?" not, "Haven't I already done enough?" Scolding the girl or informing her mother will not address the girl's underlying insecurity.

A 12-year-old girl nervously asks the nurse several questions about menstruation and then expresses a concern in a stammering, roundabout way. When she is finished talking, the nurse replies by saying, "So, you are telling me that you are afraid of getting your period while at school and it showing through your clothing, is that correct?" Which communication technique is the nurse using?

Perception checking documents a feeling or emotion reported to you. This makes it a step deeper than paraphrasing. In paraphrasing, you document a statement or fact; in perception checking, you document a feeling or emotion. Clarifying consists of repeating statements others have made so both of you can be certain you understood them. Reflecting is restating the last word or phrase a child has said when there is a pause in the communication.

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.

The nurse is caring for a 8-year-old client scheduled for a computed tomography (CT) scan. The client is anxious about the procedure. Which action by the nurse is appropriate?

Take the child to see the CT equipment and answer any questions. School-age clients best understand when they can see and, if possible, touch things they are unfamiliar with. It can help to make an intrusive or invasive procedure seem less frightening for a school-age client when he or she is prepared for what is to happen. Teaching with dolls and toys is a way to teach preschoolers. A brochure is not appropriate as the child will not be able to comprehend what he or she has not personally experienced at this age. Showing a video to a child can help, but showing the actual equipment is best when possible. The nurse has better knowledge of the procedure so should educate the child.

A nurse is providing teaching on the medication regimen for beta-thalassemia to an adolescent. What is the best way for the nurse to determine if the teaching was successful?

The best way for the nurse to determine if teaching has been successful is to ask the client to "teach back" the information taught. Using this method, the nurse can correct any misconceptions. Providing written materials to reinforce teaching, having the client verbalize understanding the instructions, and providing an opportunity to ask questions are all appropriate client education strategies, but they do not evaluate the effectiveness of the teaching.

When teaching children, the nurse will need to establish expected outcomes with which characteristic(s)? Select all that apply.

When teaching, a plan should be devised that includes mutually agreed-upon outcomes. They should be realistic, measurable, and specific. They should be agreed upon by the nurse, client, and family.

A nurse is visiting a first grade class to provide basic teaching on nutrition. She begins by briefly explaining how our bodies need food to perform all of the activities that we do. In the cafeteria at lunch time, she shows how to select healthy and diverse foods from the buffet line. She then has the children perform this same task to make sure they understand the principles. Which teaching strategies are used in this scenario? Select all that apply.

The nurse uses lecture (explaining how our bodies need food as fuel), demonstration (actually selecting foods from a buffet line), and redemonstration (having the children imitate her by selecting foods from the buffet line) in her teaching. Discussion, positive reinforcement, and behavior modification are not indicated in this scenario.

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 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.

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.

A nurse is preparing to teach an 8-year-old child recently diagnosed with diabetes how to give an insulin injection. Which is the best technique for the nurse to use?

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.

The nurse is preparing a 4-year-old to go visit an older sibling in the pediatric intensive care unit (PICU). What teaching method would best help in this child's preparation?

dolls Preschool-age children tend to be frightened of intrusive procedures. Explaining to preschool-age children what the sibling may look like or what the environment may look like is difficult for them to comprehend. Explaining to children why the tubes are necessary, why the sibling cannot talk, and what the sibling will look like is best taught with dolls or puppets. Using dolls or puppets help children visualize details. Pointing to a place on a doll's body is not as intrusive as pointing to the child's own body. Visualizing the tubes coming out of the doll helps the child visualize details. Explaining to children why the tubes and the machines are necessary calls for clear understanding and praise for learning. Pictures, videos, and stories do not allow the child to actively participate in the learning process.

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 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.

When developing a teaching plan for a child, what must the nurse assess first?

level of knowledge, ability to complete task, and motivation to learn The nurse prepares the teaching session based on essential factors for the ability to comprehend the teaching. Level of knowledge, ability to complete tasks, and motivation to learn must be assessed before a teaching plan can be developed. By doing so, the content can be established with strategies to successfully complete the task. Both parental and peer support may be helpful but are not essential for the nurse to know before the plan is created. Interest and the ability to stay focused can be established during the teaching session.

When the nurse is caring for various pediatric clients, which one may benefit the most from the use of drawings to elicit their feelings?

pre school age child No matter the diagnosis, all clients may use art therapy to express their feelings. However, a preschool-aged child is not able to verbalize internal feelings but can draw pictures to show meaning. This difference is what makes art therapy most helpful for this age group. Infants are too young to draw pictures, and adolescents have the ability to verbalize internal feelings.

The nurse is preparing a preschool-aged child for a planned hospitalization. Which teaching strategy will be most effective in preparing the child for the experience?

puppet show with doctor and nurse puppets A puppet show that presents a story about hospitalization would be more effective than all the other options listed. The puppet show will engage the preschool-aged child and will make a "game" out of the story. A DVD will not engage a preschool-aged child because the staff is not known to the child. Passive activities such as coloring and looking at pictures while the pamphlet is being read are less effective.

A preschool-age child will require the placement of a peripherally inserted central catheter (PICC) for extended antibiotic treatment. Based on the child's developmental age, what methods of teaching could the nurse best utilize to help the child understand care for the PICC? Select all that apply.

puppets, dolls, handling the equipment Preschool-age children are interested in learning because developing a sense of initiative is the main developmental task. Instructions need to be geared to their limited vocabularies. Preschoolers can watch a demonstration eagerly and freely demonstrate the skill. They ask many questions about equipment and procedures, so handling the tape, the dressings, and syringes, etc., helps them to visualize and understand. Dolls and puppets help children visualize details about intrusive procedures to the body. Pictures and videos are good teaching tools, but they do not provide the ability for the preschool-age child to interact during the learning process.

The child states, "I never want to be a nurse or a doctor." The nurse recognizes this statement as reflecting what level of communication?

shared personal ideas and judgement The child is making a judgment about his future. This is the third level of communication. Cliché conversation and fact reporting are lower levels of communication; sharing feelings requires a higher level of trust.

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.

The nurse is planning a teaching session for a group of 12-year-old girls and has determined personal hygiene is a subject that would be of benefit to all. Which method of teaching would be most appropriate for this group?

videos Cognitive learning involves a change in the individual's level of understanding or knowledge. It can be gained through exposure to any teaching technique but is usually learned through lecture, reading, and audiovisual aids. Psychomotor learning requires a change in a person's ability to perform a skill. It is best mastered through demonstration and redemonstration. Affective learning involves a change in a person's attitude. It is best gained through role modeling, role-playing, or shared-experience discussion.