Age-Specific Education, Post-Test, and Answer Sheet

Instructions for successful course completion:

I.  Read the Self-Learning Packet in its entirety.

II.  Successfully complete the Post-Test with a score of 80%.

You will be notified should your course requirements be incomplete or if you did not successfully complete the course.

If unsatisfactory completion occurs, you will be asked to review the material contained within this packet and you may retake the test.

Objectives

After completing this Self-Learning Packet, the Participant will be able to:

1.  Compare and contrast the developmental phases by depicting a wide range of normal elements in physical and motor growth for each phase

2.  Discuss specifics, which are crucial to normal emotional and social development for each developmental phase

3.  Describe communications with regard to age-appropriateness

4.  Discuss nursing implications and safety issues in caring for the hospitalized patient, including the infant, child, adolescent, adult, and geriatric adult

5.  List specific interventions related to infant, child, adolescent, adult, and geriatric adult when caring for or teaching a patient

6.  Explain how to involve the family and/or significant other in the plan of care

Growth & Development

Though growth and development are different from one another, they are part of a continuous process, which begins at the time of conception and continues until death.

Growth: A measurable event referring to physical size.

Development: Denotes skills and social development and may be difficult to measure.

Types of Developmental Stages

There is great variability in human development, but certain similarities exist in most persons. Each stage, from childhood to the end of life, is associated with specific developmental tasks. The successful completion of those tasks prepares the person to move on in life, ready to meet the challenges of the next stage. Each individual is unique and passes through developmental stages at his/her own rate.

Physical development is cephalocaudal (head to toe) and proximal to distal, with regard to body parts.

Cognitive development is a type of developmental skill, which can be measured. It refers to the ability to learn something through experience; it is the ability to learn and retain knowledge or respond to new situations to solve a problem.

Factors which Influence Growth Development

These include, but are not limited to, genetics, environmental, socioeconomic level, cultural beliefs and practices, health and wellness, and nutrition.

Genetic Influence – Determines the basic make-up of the individual from time of conception. For example, will grow to genetically permitted height regardless of the quality and quantity of exercise and nutrition.

Environmental Factors – May have tremendous influence on growth and development due to chemicals, water content, pollution, climate, and surroundings permitting certain activities.

Cultural Beliefs Practices – May affect growth and development due to types of foods eaten, styles of living, health treatment beliefs, etc.

Health & Wellness – Naturally affect both growth and development, especially if a child is ill at an early age or chronically ill.

This chart organizes the ages and stages of children according to comparative theories of child development.

Table 1-1. Ages & Stages of Children

Theories of Child Development / Birth – 18 Months / 19 Months – 2 Years / 3 Years – 5 Years / 6 Years – 11 Years / 12 Years – 18 Years
Erikson / Trust vs. mistrust / Autonomy vs. shame and doubt / Initiative vs. guilt / Industry vs. inferiority / Identity vs. role confusion
Freud / Oral - sensory / Anal / Phallic / Latency / Genital
Piaget / Sensory-motor egocentrism / Preoperational, beginnings of perceptual constancy / Preoperational, prelogical reasoning / Concrete operations / Formal operations
Task mastery / Differentiate self and non-self / Toilet training / Use of language / Logic / Abstract thinking
Pain perception / Physical but possibly not cognitive pain perceived, in younger patients / Primarily egocentric:
“Here and now”
May see pain as punishment / Pain as punishment Overextension of causality
Fear and fantasy / Beginning of understanding of true causality
Fear of destruction and death / Concept of emotional and physical pain Understanding of root causes of pain
Suggested interventions / 1. Involve caretaker in care of child. / 1. Prepare caretaker for procedures. / 1. Explain procedure immediately before performing it. / 1. Explain procedures beforehand. / 1. Give full explanations.
2. Keep child warm. / 2. Tell caretaker that he or she may assist in normal care. / 2. Allow child to see and touch samples of equipment. / 2. Enlist cooperation. / 2. Encourage child’s participation.
3. Keep room quiet / 3. Give child a familiar toy or blanket as a transitional object. / 3. Be honest: “This will sting.” / 3. Ask about simple preferences. / 3. Allow time for questions.
4. Provide comfort measures (e.g., pacifier). / 4. Use child’s name / 4. Use simple distractions and talk to child. / 4. Give alternatives (e.g., child may yell but not move.) / 4. Provide privacy. Child may want to exclude parents.
5. Keep child on caretaker’s lap during physical examination. / 5. Restrain child as little as possible. / 5. Allow child to see under bandages. / 5. Identify sensations and personnel. / 5. Avoid teasing and embarrassing child.
6. Return child to caretaker as soon as possible after procedures; allow caretaker to comfort child / 6. Avoid covering child’s face. / 6. Use praise, decorated adhesive bandages and small rewards. / 6. Use distraction and counting games. / 6. Allow as much control as possible.
7. Describe sensations and talk with child during the procedures. / 7. Include child in discharge instructions. / 7. Provide discharge instructions to patient.
8. Praise, smile, and have a cheerful attitude. / 8. Use rewards stickers, badges, and praise. / 8. Reassure child that his or her behavior was appropriate.

Learning Processes

It is essential that the healthcare worker understands how an individual learns best. For instance, though a child looks like a “little adult,” they are not. Therefore, information must be presented in the manner which promotes learning, taking into consideration numerous aspects such as attention span or deficit, readiness, and age-specific needs.

Learning: The basic developmental process of change in the individual and the results from experience or practice. We learn skills and obtain knowledge.

Readiness: Refers to a point in time when the individual has matured sufficiently to learn a particular behavior.

Age Appropriate Education of the Child

Understanding the needs of the parent and child - When a child becomes hospitalized, the fears experienced by parent and child often include the following:

·  Fear of the unknown: what will happen next and what procedures may be performed

·  Fear of pain or loss

·  Fear of isolation or separation

·  Fear of strangers caring for the child

·  Fear of the unfamiliar environment with strange machines and equipment

The following basic principles can facilitate the treatment and care of children:

Remain calm and confident

·  Speak with a calm, soft voice in order to lessen anxiety of parent and child

·  Maintain control of the situation by taking charge and being gently assertive

Establish rapport with the parent or caretaker and the child

·  Speak directly to the parent and child

·  Encourage the child to explain how he/she feels

·  Assign the same caregiver(s) when possible in order to promote continuity and effective communication

·  Listen to the needs and concerns of the parents

Be direct and honest

·  Tell the parent and/or child exactly what it is that you need them to do

·  Do not mislead. If it will be painful, tell them so

·  Discuss possible indications of unresolved problems such as bedwetting

Keep the child and caretaker informed

·  Tell the child exactly what to expect. “I am going to wipe your arm with a wet, cool piece of cotton. It will probably feel cold to you”

·  Provide information to parents regarding the child’s condition and progress

Provide the child a way to relieve or deal with distress

·  “You can wash the icky tasting medicine down with water”

·  Use “play” opportunities in order to help the child work through problems

Do not separate the parent and child any more than is necessary

·  Nurturing and familiarity of parents helps to lessen the anxiety of the child

·  Participation in care or treatment also helps to reassure parents and child

Be kind and provide feedback and reassurance

·  Children appreciate reassurance, rewards, and praise

·  Attitudes are expressed verbally and nonverbally toward the child

Always look for signs of regression during hospitalization

·  Thumb-sucking and choosing to play with toys for younger age groups

·  Some children regress when they feel a loss of self-control

·  If the child has regressed, teach the child at the present level instead of the chronological age

Address expressed concerns over the impact of the hospitalization on other family members, such as siblings

·  Involve the siblings when possible through a brief visit with the hospitalized child or through the use of photos, audio or video tapes, drawings, phone calls, etc.

·  Discuss with parents the types of behaviors that may be anticipated by siblings, such as behavior regression, in order to gain needed attention

Preparing the family for the child’s return home

·  Involve parents in planning care and setting goals throughout the hospital stay

·  Provide information to parents on the use of equipment and how to care for the child when he/she returns home

·  Plan ways in which the parent can participate in care and/or return demonstrations

General guidelines for teaching children about a procedure:

Assess the education level of the child and the parent prior to the teaching session

·  Ask the child why he/she is in the hospital

·  If assessing through medical “play,” often the child gives the doll the same condition or problem that he/she is experiencing

·  If the child is unaware as to why he/she or the “doll” is in the hospital, then provide the information

·  Ask the parent questions regarding the hospitalization in order to assess their level of understanding

Cover the steps of what to expect in a way he/she will understand

·  Explain what the child will hear, feel, smell, see, or taste

·  If the child is too young to have a sense of time, relate the procedure time to time before or after breakfast, lunch, dinner, bedtime, etc.

Go through the steps in a “play” situation when teaching a very young child

·  Play nurse with a doll and change the dressing

·  Provide the opportunity for the child to handle a mask that he/she will need to breathe deeply through during the procedure

Choose your terms wisely since children may get confused by what they hear

·  “Dye” may be understood as “die.”

·  “ICU” may be thought of as, “I see you.”

·  “Dressing Change,” child may think, “Why do I have to undress?”

Visit the department in which the child will be treated if the child is old enough

·  A hospital room or radiology room – to look, touch, and to ask questions

Assist the child to develop constructive coping mechanisms

·  Be positive in both attitude and with language

·  Begin the thought process in medical “play” by asking the child what would help the “doll” (to cope) during the procedure

·  Explain that it is okay to cry as long as he/she holds still during the procedure

Answer questions honestly, “Will it hurt?”

·  Relate it to a childhood experience, such as “just like a tiny pinch on your arm.”

Cover the steps of what to expect using a concept he/she will understand

·  If the operation is scheduled after breakfast, tell the child he/she will be out of surgery by lunch time

Short, frequent sessions provide the best learning

·  Continue sessions only as long as the child can tolerate, is interested, asks questions

·  Set up additional sessions, if the child’s attention span is not long enough, to cover all the material

·  Document the amount and response to completed teaching

Consider teaching the parents and child separately

·  Parents usually will require more extensive information in order to provide appropriate care

·  By providing the teaching at the level of the child, they will better understand

Infancy: Birth – 1 Year

Susie, an alert, active one year old, has been on a fascinating, rapidly changing adventure from birth to 12 months of age. She has moved forward from the initial stage of total dependence for all care needs at birth, to one of continual progression in motor skills, recognition and response, and social adaptation to the world around her.

Some of the major changes include a growth of nine inches in height and a tripled weight. The fontanel is closing, she has 8 teeth, and her bladder and bowel pattern is becoming more regular. Motor adaptation has evolved from raising head, turning and rolling over, to crawling and now walking with some assistance. Reactions have become more intentional. Cognitive growth has progressed from the recognition of bright objects to the ability to obey simple commands, speaking 2 words, and learning by imitation.

Psychosocially: The most significant persons are her parents. A sense of trust and security has developed as needs are met in a consistent and predictable manner. While she smiles, repeats actions that bring responses from others, and plays pat-a-cake, she is also beginning to experience a fear of strangers and separation anxiety.

Nursing Interventions: It is important to keep parents in the line of vision of the infant, encourage parents to assist in care, limit the number of strangers providing care, cuddle and hug the infant, and provide familiar objects. Safety factors include the availability of a bulb syringe for suctioning; crib side rails should be up at all times, and keep all equipment out of the reach of the infant. Toys should be safety approved and have no removable parts.

Toddler: 1 – 3 Years

Susie has now become an independent, progressively more active three year old. While her appetite has decreased somewhat, she continues to grow 2-2 ½ inches and 4-6 pounds yearly. By now she has achieved both bladder and bowel control. Susie loves to experiment, responds better to visual than spoken cues, and is very busily running, climbing and jumping. Cognitive changes include the fact that she tends to see things only from her point of view (egocentric), constructs 3-4 word sentences, ties words to actions, and has a short attention span.