Education and communication competencies for student nurses to

improve communication with special needs children with minimal to

non-existent verballanguage abilities: How to speak without

saying a wordMelinda M. Grisham RN, BS, BSNChamberlain College of Nursing

NR660 CapstoneFebruary 21, 2015

Nursing Concern Special Needs Children as Patients

Autism Spectrum Disorder (ASD)

Down’s Syndrome

Cerebral Palsy

Mental Retardation/Impaired Cognitive Abilities

Developmental Delays (Drake, Johnson, Stonek, Martinez, and Massey, 2012)

Language and Communication Skills

Minimal to Non-Existent

Age Appropriate

Cognitively Delayed (Brown and Elder, 2014)

Nursing Curriculum Lacking Components

Education

Co-morbidities

Congenital

Reasons for Developmental Delays

Communication

Student Uncertainty

Alternative Methods

Time Factor

Literature Review

Harris, Abbott and Jukes (2012) discussed UK health care professionals must adhere to the Equality Act of 2010.. "The hospital passports developed by the South West London Access to Acute Group (2010), for example, conveys information through a traffic-lights system, where red indicates things staff must know about the client, amber indicates things that are important to the client, and green indicates the client's likes and dislikes" (Harris, Abbott and Jukes, 2012, p. 29).

Davis-Evans (2013) shared education and interventions when caring for surgical patients. Surgery is a major stress source for patients that stimulate panic attacks and anxiety. Patients with non-verbal skills cannot express their anxiety verbally, but they can display physical behaviors that can cause injury to themselves or to staff.

Drake, Johnson, Stoneck, Martinez, and Massey (2012), conducted a study using a cross-sectional post-test survey to evaluate nurse's perceptions utilizing a coping kit intervention for hospitalized children with developmental disabilities. The coping kits consisted "of simple communication cards, a social script book about going to the hospital, distraction items (toys), a pad of paper and a pencil, a picture communication card set on a ring, and a piece of theta-tubing to play with or chew" (Drake, Johnson, Stoneck, Martinez, and Massey, 2012. p. 217).

Literature Review

Dreyfus (2012) is a systemic functional linguist from Australia, who conducted research on her 17-year-old intellectually disabled son who does not communicate with speech. During her 10-year research observations, Dreyfus found her son communicated using gestures, vocalizations, artifact actions, certain behaviors and eye gazes in varying combinations.

Phillips (2012) performed a literature search that reflected themes that special needs patients experienced in general hospitals. Identified themes were: effect on the patient in the hospital, staff attitude and knowledge, hospital environment, role of family, and improvement recommendations.

Singer (2012) discussed how school nurses in the UK feel that their jobs are challenging as more learning disabled students enter into the school system.. Singer’s intent was to explore challenges that nurses face that prevent provision of high-quality nursing and health care with these school aged students.

Collins, Golembeski, Selgas, Sparger, Burke and Vaugh (2007) discuss a model to guide practice change called the Clinical Excellence Through Evidence-Based Practice (CETEP). The model is a continuous cycle of inquiry where the process is an assessment of evidence-based factors, patient factors, and clinical setting factors. Once the assessment has been formulated then a planning, implementation, evaluation process begins. The cycle completes and if new information is derived after the evaluation, then the inquiry cycle begins again.

Literature Review Pinto and Gardner (2014) brought awareness with augmentative

and alternative communication (AAC) systems used by children with no oral communication skills. Tablets and smartphone technology are used as a form of AAC. Data from a female child with CCN and cerebral palsy using an iPad facilitated conversation between the child and the mother.

Temple and Mordoch (2012) looked at how Canadian nursing students perceived disability and their preparedness to care for disabled patients. The study reported majority of second and fourth year students did not receive education during nursing courses on how to interact and care the intellectually disabled.

Ely, Chen-Lim, Zarnowsky, Green, Shaffer and Holtzer (2012) discuss how children with cognitive impairment and physical limitations are not medicated adequately for post-surgical pain when there is communication gap.

Fan, Wang, Chao, Jane, and Hsu (2015) researched competency-based education reported increased academic performance in a medical-surgical course and practicum that those that were in a traditional course

How can nurses provide nursing care and communicate with a non-verbal or

cognitively impaired child?

Project Details: Expected Results

Resolution:Alternative

Communication Aides

Resolution: Toys, distractors and communication boards

Reinforce positive behavior with age appropriate reward

Resolution:Nursing Outcomes

for Improved

CommunicationPrepared pre-licensure students

Competencies

Achieved and Met

Education

Communication

Simulation

Role Playing

Resolution: New Modalities of Scholarship

Implement Curriculum Changes

Simulated Scenarios

With Non-Verbal Child

Student Role Play with Sign Language

Clinical Rotation

Special Needs Classroom

Typical Classroom

Early Childhood Intervention Programs

Evaluation of Outcomes

EBP-research on communications competency

Better patient outcomes for Special Needs children

Prepared nurses to manage complexcommunications needs

Adept to simple sign language, PECS, and AAC

Met needs for child and family

Contributions to Nursing Profession

Dissemination of Project

Power Point Presentations Professional Nursing Groups (Local and State) Schools of Nursing Parent-Based School Organizations (PTAs)

Webinars Acute Care Facilities Pediatric Nursing Units Special Needs Families Support Groups

Scholarly Publications

YouTube.com

References Billings, D. M. & Halstead, J. A. (2012). Teaching in Nursing A Guide for

Faculty. (4th Ed.), St. Louis, Missouri: Elsevier.

Brown, A. B. & Elder, J. H. (2014). Communication in autism spectrum disorders: A guide for pediatric nurses. Pediatric Nursing, 40(5), 219-225.

Collins, P., Golembeski, S., Selgas, M., Sparger, K., Burke, N., & Vaughn, B. (2007). Clinical excellence through evidence-based practice—A model to guide practice changes. Topics in Advanced Practice Nursing eJournal, 7(4).

Commission on Collegiate Nursing Education. (2013). Standards of accreditation of baccalaureate and graduate nursing guidelines.Retrieved from http://www.aacn.nche.edu/ccne-accreditation/standards-

procedures-resources/baccalaureate-graduate/standards.

References cont’d

Davis-Evans, C. (2013). Special needs populations: Alleviating and preventing panic attacks in the surgical patient. AORN Journal, 97(3),

354-364. doi: 10.1016/j.aorn.2012.12.012

Drake, J., Johnson, N., Stoneck, A.V., Martinez, D. M., & Massey, M. (2012). Evaluation of a coping kit for children with challenging behaviors in a pediatric hospital. Pediatric Nursing, 38(4), 215-21.

Dreyfus, S. (2012). Life's a bonding experience: A framework for the communication of a non-verbal intellectually disabled teenager. Journal of Interactional Research in Communication Disorders, 4(2), 249-

271. doi: 10.1558/jircd.v4i2.249

Ely, E., Chen-Lim, M. L., Zarnowsky, C., Green, R., Shaffer, S., & Holtzer, B. (2012). Finding the evidence to change practice for assessing pain in children who are cognitively impaired. Journal of Pediatric Nursing,

27, 402-410. doi: 10.1016.j.pedn.2011.05.009

References cont’dFan, J. Y., Wang, Y. H., Chao, L. F., Jane, S. W., & Hsu, L.L. (2015). Performance

evaluation of nursing students following competency-based education. Nurse Education Today, 35, 97-103. doi: 10.1016/j.nedt.2014.07.002

Gaylord, N., Chyka, D., & Lawley, G. (2012). Developmental evaluation of preschool children: A service-learning experience for nursing students. Journal of Nursing Education, 51(12), 710-713. doi: 10.3928/0184834-20121030-03

Harris, J., Abbott, L., & Jukes, M. (2012). Improving care for children with Down's syndrome. Learning Disability Practice, 15(6), 25-29.

Hemsley, B., Balandin, S., & Worrall, L. (2012). Nursing the patient with complex communication needs: Time as a barrier and a facilitator to successful communication in the hospital. Journal of Advanced Nursing, 68(1), 116-126. doi: 10.111/j.1365-2648.2011.05722.x

References cont’dKyle, G. (2012). Caring for a child with Down's syndrome in the acute care

setting. Nursing Children and Young People, 24(4), 18-22.

Nielson, S. (2014). Patients and staff have benefited from our sign language initiative.Nursing Standard, 28(30), 35-35. doi: 10.7748/ns2014.03.28.30.35.s45

Obrecht, J. A., Van Hulle Vincent, C., & Ryan, C. S. (2014). Implementation of evidence-based practice for pediatric pain assessment instrument. Clinical Nurse Specialist, 28(2), 97-104. doi: 10.1097/NUR.0000000000000032

Phillips, L. (2012). Improving care for people with learning disabilities in hospital. Nursing Standard, 26(23), 42-48.

Pinto, M. & Gardner, H. (2014). Communicative interaction between a non-speaking child with cerebral palsy and her mother using an iPad. Child Language Teaching and Therapy, 30(2), 207-220. doi: 10.1177/0265659013518338

References cont’dShewan, J. (2014). Starting out-learning signing was so rewarding for me

when nursing a deaf student. Nursing Standard, 29(1), 29-29. doi:10.7748/ns.29.1.29.s35

Singer, B. (2012). Perceptions of school nurses in the care of students with disabilities. The Journal of School Nursing, 29(5), 329-336. doi: 10.1177/1059840512462402

Temple, B. & Mordoch, E. (2012). Nursing student perceptions of disability and preparation to care for people with intellectual disabilities. Journal of Nursing Education, 51(7), 407-410. doi: 10.3928/01484834-20120515-01

Weldon, J. M., Langan, K., Miedema, F., Myers, J., Oakie, A., & Walter, E. (2014). Special needs populations: Overcoming language barriers for pediatric surgical patients and their family members. AORN Journal, 99(5), 616-629. doi: 10.1016/j.aorn.2014.02.005