- Email: [email protected]
Implications of psychosocial development on the care of children
Implications of Psychosocial Development on the Care of Children
This article is written to help home care providers adapt their assessment and care skills to fit the psychosocial needs of their young clients and efficiently accomplish the goals of the visit. Home care providers caring for children must use their judgment and complex decision-making skills because often they are the only clinicians in the home. To accurately assess children of various ages, home care providers need to understand the general guidelines for establishing a rapport with them and the variations in child psychosocial development.
I
n caring for young children, the following general guidelines may facilitate making the child more comfortable and cooperative, which will help you manage the client’s care. Build trust. Most children view a stranger’s approach with some degree of apprehension. One technique that often helps clinicians is to focus on the parent first, seemingly ignoring the child. The child will see you establishing rapport with his or her parent and have a chance to check you out before dealing with your advances. Observe as much as you can from a distance. Home care providers can assess general appearance, count respirations, and make other observations several feet away from the child. If the child is unaware that you are watching him or her, so much the better. Respirations are most accurate when the child is sleeping or quietly awake. Consider positioning. The home care provider should do as much as possible with the child in his or her preferred position. Children often object to being laid on their backs for procedures. Many feel much more comfortable in a parent’s arms. You usually can ascertain all the vital signs while the child is in a parent’s arms or lap. You also can let the child sit up and play with a toy during the assessment. Do least invasive procedures first. Start with observation, move to comparably less-threatening assessment tasks, and finish with the most intrusive parts and those that will not be affected by crying. For example, many young children perceive a stethoscope on their
220
HOME
CARE PROVIDER
chest as an invasion, but they may be less worried if you approach them slowly. After observing respirations, take the apical pulse, and listen to the lungs while you’re at it. Take blood pressure after pulse, respirations, and observations because the child’s arm must be restrained and the cuff feels tight. Temperature usually is taken last because it is least affected by crying. Children younger than 3 usually cannot hold an oral thermometer under their tongue or refrain from biting it. Tympanic thermometers are great but sometimes inaccurate in infants. In that case, rectal readings are most accurate, but the axillary site can be used if a ballpark temperature will suffice and you can hold the thermometer in place long enough to obtain a valid reading. Be sure to chart the method used. The parent is an important source of information on the child’s condition. You should always ask the parent’s perception of how the child looks and any behavior changes because these subtle signs of illness may not be obvious to someone who does not know the child well. ASCERTAINING A CHILD’S DEVELOPMENTAL LEVEL Your approach to the assessment and care of a child should be adapted to that child’s developmental level. For example, the home care provider in the following case studies needs to assess children for evidence of infection, skin breakdown, and lower extremity neurovascular status. The family’s understanding of cast care, safety, and the adaptations that have been made to manage the activities of daily living also need to be assessed.
DECEMBER
1999,
VOL. 4 NO. 6
Psychosocial
be
Development Psychosocial
Birth to 1 year
Rapid
motor,
Working
secure
trust
if familiar
with
Nursing
anxiety
Developing
language
Very busy
experimenting
gross
development
in caregivers
trusted
becomes
motor
Make
and the world
caregiver
an issue
skills,
present
(usually
working
in older
infants
sure infant
on autonomy
with their world
not clear
Still most
with mother
(eg, even in sight
stethoscope
seen
as
more
Magical thinking: thoughts can make things may believe he caused his own problem) Strong imaginations: missing knowledge
Take things literally (eg, “take “take all your blood”) Developing
awareness
your blood
of sexual
Still more comfortable holding hand or other
6 to 13 years
interested happen
will invent own explanations with own ideas
May
demonstrate
on mother
first
Give
simple,
directions
and explanations
Increasing
very
May feel bad about
may
and importance regressing,
Want to be treated ly or trusted adult, Privacy
and seeming
as adults especially
yourself getting
Assess nations
equipment
so you are at child’s
too close
child’s
handle
to child’s
eye level
face
and give simple
expla-
and give choices
when
Offer child the chance to help where possible, as taking her own temperature with electronic mometer, listening with stethoscope
such ther-
Let child
understanding
(also true
handle
Make short, possible
equipment
simple
requests
be OK just
“profes-
Teach
of peers
loss of control,
as is being
unwilling
accepted
as you go
Provide
etc. to
by peers
Provide privacy parent present
on top of it still very
from
and use proper
draping
and give them or not
a choice
Be matter of fact and nonjudgmental are sensitive to your responses Emphasize
but still need support at younger ages
privacy
Try to support them or give them information in a way which does not imply weakness on their part
Working on ideal versus practical; self-esteem based on how close they think they are to ideal and how they think others perceive them Body image a major issue, and not seeming different
let child
differences
if parent present, token contact
May want to seem on top of it and therefore admit fears or lack of understanding 13 to 17 years
(ie, child
important socialization
short
means
Take pride in developing competency at life skills; sional learners” enjoy mastery of real stuff Privacy
in
and fill in
pressure”
or toys for distraction
and solicit her help for level of understanding
When possible, for preschoolers)
or holding
about world and therefore doing and equipment
objects
lap
Establish rapport with mother simple explanations at child’s
Avoid
Very curious what you’re
at least can see mother
Do as much as you can with baby on mother’s or in as familiar a position as possible
Position
3 to 6 years
Implications
and
activity
Body boundaries intrusive) secure
Implications Nursing
Use bright
Separation toddlers.
Enjoy
of Children
Development
and social
on establishing
Feel more mother)
1 to 3 years
cognitive,
Levels
normal
if they because
want
a
they
findings
fami-
important
Continuedon page
DECEMBER
1999, VOL. 4 NO. 6
HOME
CARE PROVIDER
225
221
This article is written to help home care providers adapt their assessment and care skills to fit the psychosocial needs of their young clients and efficiently accomplish the goals of the visit. Home care providers caring for children must use their judgment and complex decision-making skills because often they are the only clinicians in the home. To accurately assess children of various ages, home care providers need to understand the general guidelines for establishing a rapport with them and the variations in child psychosocial development.
I
n caring for young children, the following general guidelines may facilitate making the child more comfortable and cooperative, which will help you manage the client’s care. Build trust. Most children view a stranger’s approach with some degree of apprehension. One technique that often helps clinicians is to focus on the parent first, seemingly ignoring the child. The child will see you establishing rapport with his or her parent and have a chance to check you out before dealing with your advances. Observe as much as you can from a distance. Home care providers can assess general appearance, count respirations, and make other observations several feet away from the child. If the child is unaware that you are watching him or her, so much the better. Respirations are most accurate when the child is sleeping or quietly awake. Consider positioning. The home care provider should do as much as possible with the child in his or her preferred position. Children often object to being laid on their backs for procedures. Many feel much more comfortable in a parent’s arms. You usually can ascertain all the vital signs while the child is in a parent’s arms or lap. You also can let the child sit up and play with a toy during the assessment. Do least invasive procedures first. Start with observation, move to comparably less-threatening assessment tasks, and finish with the most intrusive parts and those that will not be affected by crying. For example, many young children perceive a stethoscope on their
220
HOME
CARE PROVIDER
chest as an invasion, but they may be less worried if you approach them slowly. After observing respirations, take the apical pulse, and listen to the lungs while you’re at it. Take blood pressure after pulse, respirations, and observations because the child’s arm must be restrained and the cuff feels tight. Temperature usually is taken last because it is least affected by crying. Children younger than 3 usually cannot hold an oral thermometer under their tongue or refrain from biting it. Tympanic thermometers are great but sometimes inaccurate in infants. In that case, rectal readings are most accurate, but the axillary site can be used if a ballpark temperature will suffice and you can hold the thermometer in place long enough to obtain a valid reading. Be sure to chart the method used. The parent is an important source of information on the child’s condition. You should always ask the parent’s perception of how the child looks and any behavior changes because these subtle signs of illness may not be obvious to someone who does not know the child well. ASCERTAINING A CHILD’S DEVELOPMENTAL LEVEL Your approach to the assessment and care of a child should be adapted to that child’s developmental level. For example, the home care provider in the following case studies needs to assess children for evidence of infection, skin breakdown, and lower extremity neurovascular status. The family’s understanding of cast care, safety, and the adaptations that have been made to manage the activities of daily living also need to be assessed.
DECEMBER
1999,
VOL. 4 NO. 6
Psychosocial
be
Development Psychosocial
Birth to 1 year
Rapid
motor,
Working
secure
trust
if familiar
with
Nursing
anxiety
Developing
language
Very busy
experimenting
gross
development
in caregivers
trusted
becomes
motor
Make
and the world
caregiver
an issue
skills,
present
(usually
working
in older
infants
sure infant
on autonomy
with their world
not clear
Still most
with mother
(eg, even in sight
stethoscope
seen
as
more
Magical thinking: thoughts can make things may believe he caused his own problem) Strong imaginations: missing knowledge
Take things literally (eg, “take “take all your blood”) Developing
awareness
your blood
of sexual
Still more comfortable holding hand or other
6 to 13 years
interested happen
will invent own explanations with own ideas
May
demonstrate
on mother
first
Give
simple,
directions
and explanations
Increasing
very
May feel bad about
may
and importance regressing,
Want to be treated ly or trusted adult, Privacy
and seeming
as adults especially
yourself getting
Assess nations
equipment
so you are at child’s
too close
child’s
handle
to child’s
eye level
face
and give simple
expla-
and give choices
when
Offer child the chance to help where possible, as taking her own temperature with electronic mometer, listening with stethoscope
such ther-
Let child
understanding
(also true
handle
Make short, possible
equipment
simple
requests
be OK just
“profes-
Teach
of peers
loss of control,
as is being
unwilling
accepted
as you go
Provide
etc. to
by peers
Provide privacy parent present
on top of it still very
from
and use proper
draping
and give them or not
a choice
Be matter of fact and nonjudgmental are sensitive to your responses Emphasize
but still need support at younger ages
privacy
Try to support them or give them information in a way which does not imply weakness on their part
Working on ideal versus practical; self-esteem based on how close they think they are to ideal and how they think others perceive them Body image a major issue, and not seeming different
let child
differences
if parent present, token contact
May want to seem on top of it and therefore admit fears or lack of understanding 13 to 17 years
(ie, child
important socialization
short
means
Take pride in developing competency at life skills; sional learners” enjoy mastery of real stuff Privacy
in
and fill in
pressure”
or toys for distraction
and solicit her help for level of understanding
When possible, for preschoolers)
or holding
about world and therefore doing and equipment
objects
lap
Establish rapport with mother simple explanations at child’s
Avoid
Very curious what you’re
at least can see mother
Do as much as you can with baby on mother’s or in as familiar a position as possible
Position
3 to 6 years
Implications
and
activity
Body boundaries intrusive) secure
Implications Nursing
Use bright
Separation toddlers.
Enjoy
of Children
Development
and social
on establishing
Feel more mother)
1 to 3 years
cognitive,
Levels
normal
if they because
want
a
they
findings
fami-
important
Continuedon page
DECEMBER
1999, VOL. 4 NO. 6
HOME
CARE PROVIDER
225
221