Child Life Exam.
Goal of psychological preparation -
Increase children and family members sense of predictability and control over potentially
overwhelming life experiences
-Allowing them to proceed in these situations with a resulting sense of mastery and with the lowest
possible level of distress
Emotional readiness fostered by -
Helping understand circumstances and experiences
Helping them cope
Helping them organize their emotional experience to make meaning of events
Advance preparation -
Begins as soon as one knows an event is to happen
Emotional support and facilitation of coping -
Preparation during the actual event
Post procedural play -
Preparation continued after event has concluded
Helps for child to process event
Post procedural questions -
What made it easier?
What could have made it easier?
What made it harder?
What would you like us to do differently?
Psychological upset -
Caused by unexpectedness and unfamiliarity events encountered in hospital
How to minimize discrepancy -
Inform with sensory information,explanations, and demonstrations
-see, feel, hear, smell, or taste
Systematic desensitization -
Fear eliciting stimuli identified and gradually introduced over a period of time
Emotional contagion hypothesis -
Anxious parent presence during intrusive medical procedures indirectly affects patient
Modeling (behaviorally based technique) -
Bandura (1967)
-Model encounters stressful circumstances similar to patient
-model expresses affect appropriate to situation
,Stress - coping framework -
Lazarus (1984)
-not all people respond to the same set of potentially stressful circumstances in the same manner
-relationship between potential stressor and individuals perceptions of stressor
Primary appraisal -
- initial decision regarding whether an event is harmful
- Am I in trouble?
- May be influenced by changing the nature of the circumstances to make them less threatening and by
providing child with accurate info about potentially stressful circumstances
Secondary appraisal -
- Determining whether the stressor is something you can handle or not
- "What can I do?"
- Help child identify practice and implement strategies that are compatible with the demands of the
situation and that the child will perceive as effective
- Use of cognitive strategies to alter behavioral reactions and patterns helps the child identify and
practice techniques for coping
Cognitive versus behavioral coping -
Cognitive: use of comforting messages or actively deny that an event is to occur
Behavioral: exercising prior to examination to release tension, hold still during procedure, or practice
useful behaviors
Automized Responses -
Lazarus stated reactions and responses in response to a potential threat is not considered considered
coping
-any response that reflects is spontaneous internal or behavior reaction to stress rather than a deliberate
attempt to cope is referred to as stress response
Cognitive behavioral approaches to instruction in coping skills -
- Relaxation techniques (deep in regular breathing or blowing the feeling away)
- Alternate focus (paying attention to visually interesting material or imagined pleasant event or setting)
- Converting self talk (reassuring oneself that all is proceeding well and that the event will be over
soon)
Stress point preparation -
Children and families identify stress points and prepare for each one using combo of interventions
including presentation of info through play-based activities in rehearsal of coping responses to be used
Exposure to Traumatic and repeated painful procedures -
Lead to changes in brain structure in Neurochemistry
Effects of PTSD -
Detrimental changes in brain structure in size as well as problematic behavioral emotional cognitive
and psychological symptoms
Components/process leading to PTSD -
, - Heightened sensitivity
- Sudden primary appraisal of extreme threat
Limbic system -
- Survival mode in brain
- Secretion of neurochemicals that construct vivid memories and responses
Stress coping and psychological preparation model -
- Provide info to affect the primary appraisal
- Provide language to help child and family remain responding from cortical centers of brain
- Affect secondary appraisal by helping child and family plan and rehearse what they can do to manage
control and cope
More effective than basic verbal info in prep -
- Sensory info
- Detailed info about ones condition
- Combo of info and instruction in coping skills
How past experiences affect children's responses to care -
Prior experience makes Child more sensitive, higher levels of stress/anxiety
Pre-admission programs -
Increase patient understanding and reduce level of distress
Recommended preparation for Children's ages -
Younger children closer to event, older children initiated earlier
- 4-12yrs (6-9 days prior to hospitalization
- 6+ yrs (5-7 days prior)
Effect of presenting too much info immediately prior to event -
Not enough time for processing potentially threatening info
Useful tactic when too long a time between contact with family and the planned procedure, when child
is receiving home care, and when repeated procedures are expected -
Giving parents an active role during procedures (empower parents)
- Helps to counter helplessness, distress, and anxiety when observing ones child in discomfort
Preparation and involving team members -
- Primary caregivers are best resource for understanding Childs past experience and what has been
useful or disruptive in past as well as current needs and expectations; Child life shit support parents
whenever possible as leaders and delivery of support to their children
- Collaborative work: learn from others; request formal or informal and services about procedures that
children will experience
Questions related to other members of the healthcare team -
- Are parents empowered to be central to child coping?
- Are all team members empowered to be appropriately involved in nurturing and supporting child?
- Can one person serve as designated coach to minimize discussion and commands?
, - Are we communicating and documenting what we know of child's preferred coping strategies and
enabling others to facilitate them? What form of communication will be most effective?
- Have we were Hearst options that will be available to child and family?
Gathering information for preparation -
Accurate information about sensory info, sequence of events, and timing induration and procedures
- Help families and children become familiar with the unknown (decreasing distress and positively
influence seeing primary appraisal)
- Info helps in predicting potential stress points
- Gather information on what family already understands and expects
Assessing demands of situation for preparation -
Continuum of care -
Progression through and between various phases of care
Psychosocial stressors for child and family; can help predict responses
Managed care -
Population-based medicine = prevention
Ethic: do what works and only what works
Decision making: physicians uses regulations/guidelines to decide course of action with strong
justification
Academic Medical Model -
Everything that can possibly be done is done for individual patient and continues to be done even
when situation looks futile
Decision making: autonomous decisions that result in variations in quality of care
Children's Hospitalization & Other Healthcare Encounters -
Erickson: Theory of Personality Development (1963) -
Trust vs Mistrust (0-1)
Autonomy vs shame/doubt (1-3)
Initiative vs guilt (3-6)
Industry vs inferiority (6-12)
Identify vs role confusion (12-18)
Intimacy/solidarity vs isolation (20s)
Generatively vs self-absorption (20s-50s)
Integrity vs despair (50+)
Trust vs Mistrust -
Infant (0-1)
Autonomy vs Shame/Doubt -
Goal of psychological preparation -
Increase children and family members sense of predictability and control over potentially
overwhelming life experiences
-Allowing them to proceed in these situations with a resulting sense of mastery and with the lowest
possible level of distress
Emotional readiness fostered by -
Helping understand circumstances and experiences
Helping them cope
Helping them organize their emotional experience to make meaning of events
Advance preparation -
Begins as soon as one knows an event is to happen
Emotional support and facilitation of coping -
Preparation during the actual event
Post procedural play -
Preparation continued after event has concluded
Helps for child to process event
Post procedural questions -
What made it easier?
What could have made it easier?
What made it harder?
What would you like us to do differently?
Psychological upset -
Caused by unexpectedness and unfamiliarity events encountered in hospital
How to minimize discrepancy -
Inform with sensory information,explanations, and demonstrations
-see, feel, hear, smell, or taste
Systematic desensitization -
Fear eliciting stimuli identified and gradually introduced over a period of time
Emotional contagion hypothesis -
Anxious parent presence during intrusive medical procedures indirectly affects patient
Modeling (behaviorally based technique) -
Bandura (1967)
-Model encounters stressful circumstances similar to patient
-model expresses affect appropriate to situation
,Stress - coping framework -
Lazarus (1984)
-not all people respond to the same set of potentially stressful circumstances in the same manner
-relationship between potential stressor and individuals perceptions of stressor
Primary appraisal -
- initial decision regarding whether an event is harmful
- Am I in trouble?
- May be influenced by changing the nature of the circumstances to make them less threatening and by
providing child with accurate info about potentially stressful circumstances
Secondary appraisal -
- Determining whether the stressor is something you can handle or not
- "What can I do?"
- Help child identify practice and implement strategies that are compatible with the demands of the
situation and that the child will perceive as effective
- Use of cognitive strategies to alter behavioral reactions and patterns helps the child identify and
practice techniques for coping
Cognitive versus behavioral coping -
Cognitive: use of comforting messages or actively deny that an event is to occur
Behavioral: exercising prior to examination to release tension, hold still during procedure, or practice
useful behaviors
Automized Responses -
Lazarus stated reactions and responses in response to a potential threat is not considered considered
coping
-any response that reflects is spontaneous internal or behavior reaction to stress rather than a deliberate
attempt to cope is referred to as stress response
Cognitive behavioral approaches to instruction in coping skills -
- Relaxation techniques (deep in regular breathing or blowing the feeling away)
- Alternate focus (paying attention to visually interesting material or imagined pleasant event or setting)
- Converting self talk (reassuring oneself that all is proceeding well and that the event will be over
soon)
Stress point preparation -
Children and families identify stress points and prepare for each one using combo of interventions
including presentation of info through play-based activities in rehearsal of coping responses to be used
Exposure to Traumatic and repeated painful procedures -
Lead to changes in brain structure in Neurochemistry
Effects of PTSD -
Detrimental changes in brain structure in size as well as problematic behavioral emotional cognitive
and psychological symptoms
Components/process leading to PTSD -
, - Heightened sensitivity
- Sudden primary appraisal of extreme threat
Limbic system -
- Survival mode in brain
- Secretion of neurochemicals that construct vivid memories and responses
Stress coping and psychological preparation model -
- Provide info to affect the primary appraisal
- Provide language to help child and family remain responding from cortical centers of brain
- Affect secondary appraisal by helping child and family plan and rehearse what they can do to manage
control and cope
More effective than basic verbal info in prep -
- Sensory info
- Detailed info about ones condition
- Combo of info and instruction in coping skills
How past experiences affect children's responses to care -
Prior experience makes Child more sensitive, higher levels of stress/anxiety
Pre-admission programs -
Increase patient understanding and reduce level of distress
Recommended preparation for Children's ages -
Younger children closer to event, older children initiated earlier
- 4-12yrs (6-9 days prior to hospitalization
- 6+ yrs (5-7 days prior)
Effect of presenting too much info immediately prior to event -
Not enough time for processing potentially threatening info
Useful tactic when too long a time between contact with family and the planned procedure, when child
is receiving home care, and when repeated procedures are expected -
Giving parents an active role during procedures (empower parents)
- Helps to counter helplessness, distress, and anxiety when observing ones child in discomfort
Preparation and involving team members -
- Primary caregivers are best resource for understanding Childs past experience and what has been
useful or disruptive in past as well as current needs and expectations; Child life shit support parents
whenever possible as leaders and delivery of support to their children
- Collaborative work: learn from others; request formal or informal and services about procedures that
children will experience
Questions related to other members of the healthcare team -
- Are parents empowered to be central to child coping?
- Are all team members empowered to be appropriately involved in nurturing and supporting child?
- Can one person serve as designated coach to minimize discussion and commands?
, - Are we communicating and documenting what we know of child's preferred coping strategies and
enabling others to facilitate them? What form of communication will be most effective?
- Have we were Hearst options that will be available to child and family?
Gathering information for preparation -
Accurate information about sensory info, sequence of events, and timing induration and procedures
- Help families and children become familiar with the unknown (decreasing distress and positively
influence seeing primary appraisal)
- Info helps in predicting potential stress points
- Gather information on what family already understands and expects
Assessing demands of situation for preparation -
Continuum of care -
Progression through and between various phases of care
Psychosocial stressors for child and family; can help predict responses
Managed care -
Population-based medicine = prevention
Ethic: do what works and only what works
Decision making: physicians uses regulations/guidelines to decide course of action with strong
justification
Academic Medical Model -
Everything that can possibly be done is done for individual patient and continues to be done even
when situation looks futile
Decision making: autonomous decisions that result in variations in quality of care
Children's Hospitalization & Other Healthcare Encounters -
Erickson: Theory of Personality Development (1963) -
Trust vs Mistrust (0-1)
Autonomy vs shame/doubt (1-3)
Initiative vs guilt (3-6)
Industry vs inferiority (6-12)
Identify vs role confusion (12-18)
Intimacy/solidarity vs isolation (20s)
Generatively vs self-absorption (20s-50s)
Integrity vs despair (50+)
Trust vs Mistrust -
Infant (0-1)
Autonomy vs Shame/Doubt -
