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How may a nurse caring for a pediatric patient best be perceived as nonthreatening?

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SPECIAL FEATURES: PEDIATRIC EMERGENCY NURSING FORUM

Kids speak: Effective communication with the school-aged/adolescent patient

O’NEILL, KATHLEEN A. RN, MSN, Section Editor

Editor(s): O’Neill, Kathleen A. RN, MSN

From the Emergency Department, Shriner’s Hospital for Children and The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania.

Nursing Forum Editorial Board

[email protected]

Lisa Bernardo, PhD, RN

Pittsburgh, Pennsylvania

[email protected]

Darlene Bradley, RN, MSN

Atwood, California

[email protected]

Pam Burke, PhD, RN, PNP

Chestnut Hill, Massachusetts

[email protected]

Mary Fallon-Smith, RN, MSN

Scituate, Massachusetts

[email protected]

Renee’ Holleran, PhD, RN

Milford, Ohio

[email protected]

Donna Nayduch, APN, RN

Greeley, Colorado

[email protected]

Gerry Silk, RN, MEd

Blackburn, Victoria

[email protected]

Valerie Smyth, RGN, RSCN, RCNT

Beamont, South Australia

[email protected]

Marla Vanore, RN, MHA

Philadelphia, Pennsylvania

[email protected]

Address for reprints: Kathleen A. O’Neill, RN, MSN, Emergency Department, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104; e-mail: [email protected]

I thank Dr. Donna Patterson and Dr. Steve Ludwig for their generous support and mentorship in advancing the art of Pediatric Emergency Care.

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Abstract

© 2002 Lippincott Williams & Wilkins, Inc.

How may a nurse caring for a pediatric patient best be perceived as nonthreatening?

The diagnosis Disturbed Thought Processes describes an individual with altered perception and cognition that interferes with daily living. Causes are biochemical or psychological disturbances like depression and personality disorders.

The focus of nursing is to reduce disturbed thinking and promote reality orientation. Often, confusion in older adults is erroneously attributed to aging. Confusion in the older adult can be caused by a single factor or multiple factors such as depression, dementia, medication side effects, or metabolic disorders. Depression causes impaired thinking in older adults more frequently than dementia.

Disturbed Thought Processes is characterized by the following signs and symptoms:

The following are the common goals and expected outcomes for Disturbed Thought Processes:

The following are the therapeutic nursing interventions for Disturbed Thought Processes:

InterventionsRationales
Assist with treatment for underlying problems, such as anorexia, brain injury/increased intracranial pressure, sleep disorders, biochemical imbalances. Cognition/thinking often improves with treatment/correction of medical/psychiatric problems.
Reorient to time/place/persin, as needed. Inability to maintain orientation is a sign of deterioration.
Have patient write name periodically; keep this record for comparison and report differences. These are important measures to prevent further deterioration and maximize level of function.
Provide safety measures (e.g., side rails, padding, as necessary; close supervision, seizure precautions), as indicated. It is always necessary to consider the safety of the patient.
Schedule structured activity and rest periods. This provides stimulation while reducing fatigue.
Maintain a pleasant and quiet environment and approach patient in a slow and calm manner. Patient may respond with anxious or aggressive behaviors if startled or overstimulated.
Present reality concisely and briefly and do not challenge illogical thinking. Avoid vague or evasive remarks. Delusional patients are extremely sensitive about others and can recognize insincerity. Evasive comments or hesitation reinforces mistrust or delusions.
Be consistent in setting expectations, enforcing rules, and so forth. Clear, consistent limits provide a secure structure for the patient.
Reduce provocative stimuli, negative criticism, arguments, and confrontations. This is to avoid triggering fight/flight responses.
Refrain from forcing activities and communications. Patient may feel threatened and may withdraw or rebel.
Do not flood patient with data regarding his or her past life. Individuals who are exposed to painful information from which the amnesia is providing protection may decompensate even further into a psychotic state.
Identify specific conflicts that remain unresolved, and assist patient to identify possible solutions. Unless these underlying conflicts are resolved, any improvement in coping behaviors must be viewed as only temporary.
Provide nutritionally well-balanced diet, incorporating patient’s preferences as able. Encourage patient to eat. Provide pleasant environment and allow sufficient time to eat. These enhance intake and general well-being.
Recognize and support the patient’s accomplishments (projects completed, responsibilities fulfilled, or interactions initiated). Recognizing the patient’s accomplishments can lessen anxiety and the need for delusions as a source of self-esteem.
Use touch cautiously, particularly if thoughts reveal ideas of persecution. Patients who are suspicious may perceive touch as threatening and may respond with aggression.
Use the techniques of consensual validation and seeking clarification when communication reflects alteration in thinking. (Examples: “Is it that you mean . . . ?” or “I don’t understand what you mean by that. Would you please explain?”) These techniques reveal to the patient how he or she is being perceived by others, while the responsibility for not understanding is accepted by the nurse.
Engage the patient in one-to-one activities at first, then activities in small groups, and gradually activities in larger groups. A distrustful patient can best deal with one person initially. Gradual introduction of others when the patient can tolerate is less threatening.
Encourage patient to verbalize true feelings. Avoid becoming defensive when angry feelings are directed at him or her. Verbalization of feelings in a non-threatening environment may help patient come to terms with long-unresolved issues.
Teach patient to intervene, using thought-stopping techniques, when irrational or negative thoughts prevail. Thought stopping involves using the command “stop!” or a loud noise (such as hand clapping) to interrupt unwanted thoughts. This noise or command distracts the individual from the undesirable thinking that often precedes undesirable emotions or behaviors.
Encourage patient to participate in resocialization activities/groups when available. This is to maximize level of function.
Assist in identifying ongoing treatment needs/rehabilitation program for the individual. This measure is important to maintain gains and continue progress if able.
Identify problems related to aging that are remediable and assist patient to seek appropriate assistance/access resources. These encourage problem-solving to improve condition rather that accept the status quo.
Assist patient and SO develop plan of care when problems are progressive/long term. Advance planning addressing home care, transportation, assistance with care activities, support and respite for caregivers, enhance management of patient in home setting.
Refer to community resources (e.g., day-care programs, support groups, drug/alcohol rehabilitation, mental health treatment programs). These measures are necessary to promote wellness.

Recommended nursing diagnosis and nursing care plan books and resources.

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What are 7 different therapeutic communication techniques?

Therapeutic Communication Techniques.
Using Silence. At times, it's useful to not speak at all. ... .
Accepting. ... .
Giving Recognition. ... .
Offering Self. ... .
Giving Broad Openings. ... .
Active Listening. ... .
Seeking Clarification. ... .
Placing the Event in Time or Sequence..

What is therapeutic communication examples?

What are some Therapeutic Communication Techniques?.
Active Listening. ... .
Sharing Observations. ... .
Sharing Empathy. ... .
Sharing Humor. ... .
Sharing Feelings. ... .
Using Silence. ... .
Using Touch. ... .
Providing Information..

Why is Paraphrasing important in nursing?

Paraphrasing can be a good way to check whether your own interpretation of what a patient has said is accurate. By playing back the message in your own words, you show the patient what you have understood.

What are the possible techniques in therapeutic communication?

Therapeutic communication techniques such as active listening, silence, focusing, using open ended questions, clarification, exploring, paraphrasing, reflecting, restating, providing leads, summarizing, acknowledgment, and the offering of self, will be described below.

nurse caring pediatric patient perceived nonthreatening

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