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Professional Resources Committee as a resource for use by professionals in the field.

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Please refer to the speaker notes included with each slide, these are rich in detail!

Our Thanks to:The Child Life Council’s Professional Resources Committee, who provided the template to help in the creation of this presentation for our audience.

Communicating with Patients and Families in the Medical

Setting

Communication: Why is it Important?

Communicating with children can present significant challenges. It is always important to be honest with children and provide accurate information, but health care workers need to

remember that children’s cognitive abilities and communication skills are developing.

Gaynard, L., Wolfer, J., Golberger, J., Thompson, R., Redburn, L., & Laidley, L. (1998) Psychosocial Care of Children In Hospitals: a Clinical Practice Manual from the ACCH Child Life Research Project. Rockville, MD: Child Life Council.

It Takes Two to Communicate

• Communication is an interaction between at least two people.

• Both verbal and nonverbal cues can contribute to the overall understanding of the message.

• Context, symbolic language, and confusion can also affect understanding.

Klinzing, D. G., & Klinzing, D. R. (2009) Communication and Child Life. In Thompson, R. H. (E.D.) The handbook of child life: A guide for pediatric psychosocial care (pp 80-84). Springfield, Ill: Charles C. Thomas.

“Health team members need to take the time , and have the skills, to talk with children and

family members in an effective and supportive manner. They need to try to understand how

children are receiving, interpreting, and applying new information.”

Gaynard, L., Wolfer, J., Golberger, J., Thompson, R., Redburn, L., & Laidley, L. (1998) Psychosocial Care of Children In Hospitals: a Clinical Practice Manual from the ACCH Child Life Research Project. Rockville, MD: Child Life Council.

Important Factors for Communicating in the Health Care Setting

• Use language that conveys respect and enhances integrity and self-worth.

• Non-verbal communication can unintentionally alter the impact of the message.

• Offer a choice only when a choice is possible.• Message delivery greatly impacts how it is received.• Use pronouns accurately.

Gaynard, L., Wolfer, J., Golberger, J., Thompson, R., Redburn, L., & Laidley, L. (1998) Psychosocial Care of Children In Hospitals: a Clinical Practice Manual from the ACCH Child Life Research Project. Rockville, MD: Child Life Council.

Klinzing, D. G., & Klinzing, D. R. (2009) Communication and Child Life. In Thompson, R. H. (E.D.) The handbook of child life: A guide for pediatric psychosocial care (pp. 85-93). Springfield, Ill: Charles C. Thomas.

Important Factors in Communicating in the Health Care Setting

• Be responsive and follow the lead of children and family members.

• Use positive directions whenever possible.• Consider developmental level.• Use minimally threatening language.

Gaynard, L., Wolfer, J., Golberger, J., Thompson, R., Redburn, L., & Laidley, L. (1998) Psychosocial Care of Children In Hospitals: a Clinical Practice Manual from the ACCH Child Life Research Project. Rockville, MD: Child Life Council.

Person First Language

• Person first language stresses the importance of not using a diagnosis to define a person, as a diagnosis is just one characteristic of his or her identity.

• It is important, as professionals, to show patients and families that we value them, not the diagnosis.

Missouri Department of Mental Health. (2007, June 1). Philosophy & values: People first language – disability etiquette. Retrieved from http://dmh.mo.gov/docs/dd/A05PeopleFirstLang.pdf.

Examples of Person First Language

Say…– “The girl has diabetes”– “The boy has down

syndrome”– “The child who uses a

wheelchair”

Rather than…–“The diabetic girl”–“The down syndrome

boy”–“The handicapped

child”

Choosing Words for Effective Communication

• Many words can have different meanings.– This is especially true of medical jargon. Most

patients and families are not “fluent” in hospital speak.

• Words that the patient and/or family might understand differently should be explained.– Dye (contrast) or Die– Stool collection– CAT scan

Terminology to be mindful of…“Red Blood Count”

Count Dracula

“Benign”

What every 8 year old wants to be…

Terminology to be mindful of…

“CAT Scan” “Stool Sample”

Developmental Considerations for Effective Communication

Infants in the HospitalBirth – 12months

In the hospital environment, infant patients might experience: • Separation• Lack of stimulation• Pain

Some responses infants might display are:• Failure to bond• Distrust• Anxiety• Delayed skill development

Rollins, J. A. (2005). Children’s Hospitalization and Other Health-Care Encounters. J. A. Rollins, R. Bolig, & C.C. Mahan (Eds.), Meeting Children’s Psychosocial Needs Across the Health Care Continuum. Austin, TX: Pro-Ed, Inc.

Communicating with Infants & Parents

• Maximize parental involvement and information.

• Speak directly facing, and close to, infant.• Respond to infant’s non-verbal and verbal

cues.

Rollins, J. A. (2005). Children’s Hospitalization and Other Health-Care Encounters. J. A. Rollins, R. Bolig, & C.C. Mahan (Eds.), Meeting Children’s Psychosocial Needs Across the Health Care Continuum. Austin, TX: Pro-Ed, Inc.

Toddlers in the Hospital12 months – 36 months

Rollins, J. A. (2005). Children’s Hospitalization and Other Health-Care Encounters. J. A. Rollins, R. Bolig, & C.C. Mahan (Eds.), Meeting Children’s Psychosocial Needs Across the Health Care Continuum. Austin, TX: Pro-Ed, Inc.

Toddler patients might experience:

• Separation• Forced regression• Loss of routine and rituals

Some reposes toddlers might display are:• Uncooperativeness• Protest• Despair

Communicating with Toddlers

• Use simple, concrete language.

• Use sensory information the child can relate to.

• Preparation should be hands on, including play and medical equipment.

• Provide choices whenever possible.

Rollins, J. A. (2005). Children’s Hospitalization and Other Health-Care Encounters. J. A. Rollins, R. Bolig, & C.C. Mahan (Eds.), Meeting Children’s Psychosocial Needs Across the Health Care Continuum. Austin, TX: Pro-Ed, Inc.

Preschoolers in the Hospital3 years – 5 years

Rollins, J. A. (2005). Children’s Hospitalization and Other Health-Care Encounters. J. A. Rollins, R. Bolig, & C.C. Mahan (Eds.), Meeting Children’s Psychosocial Needs Across the Health Care Continuum. Austin, TX: Pro-Ed, Inc.

Preschool patients might experience:

• Separation• Fear of loss of control, sense of own power• Dependency

Some responses preschoolers might display are:

• Regression• Despair and detachment• Physical and verbal aggression

Communicating with Preschoolers

• Use the “tell, show, do” bedside approach.• Recognize understanding of time is still developing.• Sequence of events• Model honest communication• “Magical thinking”- e.g. thoughts caused illness

Rollins, J. A. (2005). Children’s Hospitalization and Other Health-Care Encounters. J. A. Rollins, R. Bolig, & C.C. Mahan (Eds.), Meeting Children’s Psychosocial Needs Across the Health Care Continuum. Austin, TX: Pro-Ed, Inc.

School-Aged Children in the Hospital5 years – 12 years

Rollins, J. A. (2005). Children’s Hospitalization and Other Health-Care Encounters. J. A. Rollins, R. Bolig, & C.C. Mahan (Eds.), Meeting Children’s Psychosocial Needs Across the Health Care Continuum. Austin, TX: Pro-Ed, Inc.

School-aged children might experience:

• Fear of loss of control• Fear of loss of mastery• Fear of bodily mutilation

Some responses school-aged children might display are:

• Regression• Withdrawal • Depression• Frustration

Communication with School-Aged Children

• Ensure preparation for, and involvement in, procedures.

• Help children recognize aspects of their effective coping.

• Be sure to define unfamiliar hospital terminology.

Rollins, J. A. (2005). Children’s Hospitalization and Other Health-Care Encounters. J. A. Rollins, R. Bolig, & C.C. Mahan (Eds.), Meeting Children’s Psychosocial Needs Across the Health Care Continuum. Austin, TX: Pro-Ed, Inc. (Chapter 1).

Adolescents in the Hospital12 years – 18 years

Rollins, J. A. (2005). Children’s Hospitalization and Other Health-Care Encounters. J. A. Rollins, R. Bolig, & C.C. Mahan (Eds.), Meeting Children’s Psychosocial Needs Across the Health Care Continuum. Austin, TX: Pro-Ed, Inc.

Some responses adolescent patients might display are:

• Uncooperativeness• Withdrawal• Anxiety• Depression

Adolescent patients might experience:

• Dependence on adults• Separation from family and peers• Fear of bodily injury and pain

Communicating with Adolescents

• Communicate honestly.

• Provide privacy during intimate conversations.

• Involve patient in care and decisions.

• Address long-term issues.

Rollins, J. A. (2005). Children’s Hospitalization and Other Health-Care Encounters. J. A. Rollins, R. Bolig, & C.C. Mahan (Eds.), Meeting Children’s Psychosocial Needs Across the Health Care Continuum. Austin, TX: Pro-Ed, Inc. (Chapter 1).

Communicating with Patients and Families During Health care Encounters

“More than 50 years of research and experience support 3 key elements of the preparation

process: (1) the provision of developmentally appropriate

information; (2) the encouragement

of questions and emotional expression; and (3) the formation of a trusting relationship with

a health care professional.”American Academy of Pediatrics Committee on Hospital Care & Child Life Council. (2014). Child Life Services. Pediatrics, 133, e1471-e1478.

Language During Preparation

• Honesty • Clarification of words that the child might not

understand• Appropriate Choices• Adaptability

Klinzing, D. G., & Klinzing, D. R. (2009) Communication and Child Life. In Thompson, R. H. (E.D.) The handbook of child life: A guide for pediatric psychosocial care (pp 80). Springfield, Ill: Charles C. Thomas.

Language During Procedures

• Use behavior-specific verbal praise.• Limit number of voices.• Remember to offer appropriate choices.• Avoid using the word “sorry.”

Language Throughout the Day

• Be mindful to clarify words that the child might not understand.

• Always incorporate choices built into the day to empower the child.

• Continue to assess the child’s understanding.

Communicating Across Cultures

• It is imporant to remember that different cultures have different styles and norms around communication.– Always remember when using an interpreter to

look at the family.– Siblings should not be expected to translate.– Educate yourself on different cultures that are

often served at your facility

Child Life Department

• Insert contact information/unit information

What questions do you have?