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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”
“Benign”
Count Dracula
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 Hospital
Birth – 12months
In the hospital environment, Some responses infants might
infant patients might
display are:
• Failure to bond
experience:
• Separation
• Lack of stimulation
• Pain
• 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 Hospital
12 months – 36 months
Toddler patients might
experience:
Some reposes toddlers
might display are:
• Separation
• Forced regression
• Loss of routine and rituals
• Uncooperativeness
• Protest
• Despair
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 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 Hospital
3 years – 5 years
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
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 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 Hospital
5 years – 12 years
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
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.
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 Hospital
12 years – 18 years
Adolescent patients might
experience:
Some responses adolescent
patients might display are:
• Dependence on adults
• Separation from family and
peers
• Fear of bodily injury and
pain
• Uncooperativeness
• Withdrawal
• Anxiety
• Depression
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 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?