Chapter 8: Priniciples of Atraumatic Care

Principles of Atraumatic Care

Atraumatic care- Therapeutic care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system

.Techniques for Providing Atraumatic Care

• Therapeutic communication– Goal directed– Focused and purposeful

• Therapeutic play– Provides emotional outlet or coping devices

• Child education– Helps child understand the reason for the hospitalization/procedures

Preventing/Minimizing Physical Stressors• Utilize a child life specialist.

– Specially trained individual who provides programs to prepare children for hospitalization and painful procedures

• Minimize physical distress during procedures.– Use positions that are comfortable to the child.

• Therapeutic hugging: a holding position that promotes close physical contact between the child and parent caregiver may be useful when the child must remain still

– Use distraction methods.Distraction Methods- box 8.2

• Have the child point toes inward and wiggle them.• Ask the child to squeeze your hand.• Encourage the child to count aloud.• Sing a song and have the child sing along.

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Chapter 8: Priniciples of Atraumatic Care

• Point out the pictures on the ceiling.• Have the child blow bubbles.• Play music appealing to the child.

Focus of Family-Centered Care• Respect for the child and family• Recognition of the effects of cultural, racial, ethnic, and socioeconomic diversity on the

family’s health care experience• Identification of and expansion of the family’s strengths• Support of the family’s choices related to the child’s health care• Maintenance of flexibility• Provision of honest, unbiased information in an affirming and useful approach• Assistance with the emotional and other support the child and family require• Collaboration with families• Empowerment of families

Positive Outcomes of Family-Centered Care for Children• Anxiety is decreased.• Children are calmer and pain management is enhanced. • Recovery times are shortened.• Families’ confidence and problem-solving skills are improved.• Communication between the health care team and the family is also improved.• A decrease in health care costs is seen.• Health care resources are used more effectively.

Family-Centered Approach to Health Care• Providing a Sense of Control for the Hospitalized Child• Provide effective communication and teaching.

– Find a balance between neutral and affective communication.– Use verbal communication and nonverbal communication.– Use developmental techniques for communicating with children.

• Assist family to obtain necessary information and resources.

Working With an Interpreter• Help the interpreter prepare and understand what needs to be done ahead of time.

– The interpreter is the communication bridge, not the content expert; the interpreter’s timing may not match that of others involved.

• Speak slowly and clearly; avoid jargon.• Pause every few sentences so the interpreter can translate your information. • Talk directly to the family, not the interpreter.• Give the family and the interpreter a break.• Express the information in two or three different ways if needed.• Use an interpreter to help ensure the family can read and understand translated written

materials.• Avoid side conversations during sessions.• Remember that just because someone speaks another language, it doesn’t mean he or she

will be a good interpreter.• Do not use children as interpreters

.Goals of Child and Family Education

• Improve the child and family’s health literacy• Encourage communication with physicians or nurse practitioners• Improve health outcomes and promote healthy lifestyles• Encourage involvement of child and family in care and decision making about care• Improve compliance with care and treatment plan• Promote a sense of autonomy and control

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Chapter 8: Priniciples of Atraumatic Care

Tips on Working With an Interpreter

Specific Learning Principles Related to Parents

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Chapter 8: Priniciples of Atraumatic Care

• Adults are self-directed.• Adults are problem focused and task oriented.• Adults want an immediate need satisfied.• Adults value past experiences and beliefs.

– Knowles (1990)Questions Appropriate to Ask When Performing a Cultural Assessment

• Who is the person caring for the child at home?• Who is the authority figure in the family?• What is the social support structure?• Are there any special dietary needs and concerns?• Are any traditional health practices used?• Are any special clothes or other items used to help maintain health?• What religious beliefs, ceremonies, and spiritual practices are important?

Components of Learning Needs Assessment

Red Flags Indicating Poor Literacy Skills• Difficulty filling out forms• Frequently missed appointments• Noncompliance and lack of follow-up with treatment regimens• History of medication errors• Responses such as “I forgot my glasses” or “I’ll read this when I get home”• Inability to answer questions about treatment or medicines• Avoiding asking questions for fear of looking stupid

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Cone of Learning

Techniques to Improve Learning• Slow down and repeat information often.• Speak in conversational style using plain language.• “Chunk” information and teach in small bites.• Prioritize information and teach “survival skills” first.• Use visuals.• Teach using an interactive, “hands on” approach.

Evaluating Learning• The child or family demonstrates a skill.• The child or family repeats back or teaches back the information in own words.• The child or family answers open-ended questions.• The child or family responds to a pretend scenario in their home.

Documentation of Child and Family Teaching• The learning needs assessment• Information on the child’s medical condition and plan of care• Goals of child education; date goal is met• Teaching method used and how received by child and family• Medications, including drug–drug and drug–food interactions• Modified diets and nutritional needs• Safe use of medical equipment• Follow-up care and community resources discussed

Identifying family strengths, reinforcing positive behaviors, and providing anticipatory guidance and resources can support the family. Identifying strengths will help the family target resources to

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Chapter 8: Priniciples of Atraumatic Care

draw from for daily functioning as well as when crises develop. From there, support, teaching, and resolving of family conflicts can occur.

The only way to determine the effectiveness of teaching is to test or evaluate if learning has occurred. Structure the time and method of evaluation when first establishing a teaching plan

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