Keeping the Attention and Cooperation of Pediatric Patients
Pediatric nursing, as with any specialty area, can be extremely challenging. It's difficult when patients (particularly children) don't understand what is happening and why, and completing certain nursing tasks can require specific techniques to ensure care is delivered safely.
Pediatric patients express anxiety in many different ways. Some regress and demonstrate behaviors that are found in younger children, some become angry, and some are withdrawn. It's important for nurses to understand that children lack the emotional maturity to be able to cope effectively and may need assistance adapting to the healthcare environment.
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The first step to engage pediatric patients and encourage cooperation is to create a safe, quiet environment. Dimming the lights, having the minimum number of staff in the room, and having age-appropriate toys available can help. Nurses should approach the child quietly and introduce themselves. Talking about their favorite TV shows, cartoon character, or toy helps establish a friendly relationship with children.
Being open and honest with what is going on and what will happen is also critical to increase cooperation. It's important for nurses to use age-appropriate language and descriptions, so the child understands what will happen. For example, a nurse may tell a child that the blood pressure cuff is going to give her arm a hug. The child will know what to expect, thereby reducing anxiety.
Additionally, nurses should not withhold the truth about a procedure. A typical example is when children ask if the shot is going to hurt. Nurses should never tell them it won't hurt if it will. If a nurse tells a child the shot won't hurt and then he or she feels the pain of the needlestick and pressure from the injection, the child will not trust the nurse. Each subsequent encounter will be anxiety-provoking for them. Again, nurses should use age-appropriate language to describe the procedure. In the example above, when the child asks if the shot will hurt, a good answer could be "You'll probably feel a pinch in the beginning, but it will be over in a second." That way, the child knows what to expect, and the nurse establishes trust with the child.
Allowing pediatric patients to have choices is one of the most effective ways to gain cooperation. Children are very afraid of the unknown, so their anxiety level is already elevated. When nurses tell them to do something, such as to hold out an arm so blood pressure can be taken, or to undress and put on a gown, that makes the child feel out of control and therefore, even more anxious.
Nurses can give choices to pediatric patients more often then one would think, and even the smallest choice can make a significant difference. The nurse can ask which arm they want to use for the blood pressure, which color tape do they want to use for the IV start, or which ear to check first. Giving children choices will help them feel like they are in charge of certain aspects of their health care and can lead to improved engagement and cooperation. Even something as simple as asking "May I take a look at your bandage?" can help.
It's essential to avoid any surprises when caring for pediatric patients. Describing what will happen gives the child some idea of what to expect. For example, in the outpatient setting, the nurse can tell the child that the doctor will come in and talk to the parents for a while, then ask a few questions, then listen to their chest and breathing. The child now has an idea of what to expect at the visit.
In the inpatient setting, the nurse can describe what will happen for the shift or for the day. For example, the nurse can tell the child that breakfast will come around eight, then it's time for the X-ray, then the doctor will come by to check them. Setting expectations will help reduce the child's fear of the unknown. Of course, in healthcare things can change. Nurses should be especially diligent in updating the child and family of any changes to the plan.
For smaller children, it helps keep their attention and engagement (as well as cooperation) when they can help with a task. Examples include having the child hold bandage supplies during a dressing change, applying the tape, allowing them to borrow the stethoscope to hear what the nurses hear, etc. Even creating a "job" for the child is important. For example, telling a child "I have a job for you. You can help me by holding very still for this dressing change. Can you do this job for me?" places responsibility on the child and makes them feel like their participation is essential, therefore helping them feel in control.
Caring for children is challenging, yet also very rewarding. When nurses gain the cooperation and attention of pediatric patients, the anxiety levels of both the child and parents are decreased, leading to better patient care outcomes. It also helps reduce the trauma response children may experience when hospitalized.