Nursing Paediatric Patients - Effective Procedural Communication
Published: 25 October 2020
Published: 25 October 2020
Compared to adults, children have fewer coping mechanisms. When experiencing pain or illness, their distress levels often escalate, causing a flow-on effect to not only parents and caregivers, but healthcare providers alike (Stock, Hill, and Babl, 2012). This is perhaps no more evident than when attempting painful or uncomfortable procedures, such as taking blood. In some circumstances, even obtaining vital signs may have negative emotional or behavioural consequences (Duff et al. 2011).
The chance of a nurse being involved in the care of a child that hasn’t resulted in tears at some stage is slim. However, by applying the use of age-appropriate language, as well as various distraction techniques, nurses and healthcare providers can successfully assist their paediatric patients through such procedures, resulting in the best patient outcomes.
Explain the procedure. This reduces anxiety and any misconceptions by allowing the child to understand the purpose of the procedure, rather than perceive it as a form of punishment. Your explanation should be honest, developmentally appropriate, succinct and free of unnecessary details that can heighten anxiety (Stock, Hill and Babl 2012). As children get older, involving them in the process and explaining intentions increases the child’s confidence, allows them to ask questions and makes them feel that their independence is being maintained throughout their care (Curtis & Ramsden 2012).
Avoid negative words. Words like ‘hurt’ and ‘sting’ when used during procedure preparation do not have any effect on reducing painful sensations, and may induce greater distress before the procedure even takes place. It is recommended that these are instead replaced with affirmative language such as ‘this medicine will make you more comfortable’ or ‘the needle will help your body get better’ (Stock, Hill and Babl 2012).
Give choices and empower. Children may feel like they have a loss of control in unfamiliar environments. This can further heighten anxiety, so by offering choices such as ‘which arm would you like the blood pressure cuff on?’ can empower the child in a situation where many choices are already removed (Stock, Hill and Babl 2012). Similarly, allowing children to play and become familiar with certain pieces of equipment – such as an oxygen mask – returns some feelings of control and reduces apprehension (Stock, Hill, and Babl 2012).
Evidence strongly supports the use of distraction to reduce pain and distress during medical procedures in children. Duff et al. (2011) identified two main principles:
The Royal Children’s Hospital Melbourne (2016) recommends a variety of distraction approaches depending on the age and development stage of the child, such as: breastfeeding for infants, playing with textured toys for toddlers, blowing bubbles for pre-school aged children, using an iPad to play games or music for school-aged children, and conversation about school or hobbies in adolescents. These are all proven to be effective.
|Breastfeeding||Dummy, blanket, favourite toy||Blanket, favourite toy||Non-procedural talk about favourite topics||Non-procedural talk about favourite topics|
|Watching bubbles||Textured toys (e.g. squishy balls), imaginary play, popping bubbles||Textured toys (e.g. squishy balls), imaginary play, popping bubbles||Humour||Humour|
|Relaxed breathing of caregiver||'Blowing the hurt away', blowing bubbles||'Blowing the hurt away', blowing bubbles||Breathing and relaxation||Breathing and relaxation|
|Singing and music, music therapist||Singing and music, music therapist||Singing and music, music therapist||iPod, music therapist||iPod, music therapist|
|Sucrose and non-nutritive sucking||Computer game/DVD/iPad||Computer game/DVD/iPad||Computer game/DVD/iPad||Computer game/DVD/iPad|
|Rattle/shaker||Sound/pop-up books||‘I Spy’/sound books||‘I Spy’/’Where’s Wally’||Prompt cards and conversation starters|
It is important to plan two to three options so that a new distractor can be introduced should the child become distressed, as well as to ensure the child does not remove focus from the distractor and attempt to look at the procedure (RCHM 2016). The positioning of the child and the procedure are important; a blanket or book may assist in shielding anxiety-provoking views in certain circumstances.
Ultimately, the building of trust between nurse and child and avoiding a negative hospital or healthcare experience is one of the main goals when nursing paediatric patients. Through effective communication techniques and applying some of the strategies discussed, this is not only achievable, but will enable optimum assessment, management and interventions. Of course, there are many other strategies other than language and distraction that can be utilised, and with experience and exposure, each nurse can find their own individual way of communicating with children.
Natalie is a Critical Care Registered Nurse who started off her nursing career in a rural setting before migrating back to Melbourne where she now works in a busy Emergency Department. Natalie comes from a science background, holding a Bachelor of Science (BSc) with majors in anatomy and physiology, before deciding to change career paths into nursing. She undertook a Master of Nursing Practice (MNP) and has never looked back, going on to complete her Graduate Certificate in Emergency Nursing and developing a keen interest for trauma assessment and management. See Educator Profile