Communication with Children and Families

Question 1

____________ is very important

Answer 1

Introduction

Question 2

what important to do when interacting and communicating with a child and their family?

Answer 2

• Be friendly and smile
• Acknowledge child early on
• Get down to their level
• Utilise play
• Consider the communication techniques needed - What are the parents looking for? What will engage the child?
• Practice asking child agenda/age appropriate questions
• Reflect on your own agenda

Question 3

Examining infants (what not to do…)

• What went wrong?
• How was play utilised?
• What communication techniques were ineffective?
• Why was this approach taken?
• What would you do differently?

Answer 3

• Examined on bed- away from parent
• No interaction with child
• No use of toys
• Use of medical jargon
• Description potentially perceived as pathology (“liver”)
• Unrealistic expectation (“Stop her wriggling”).
• Reflects focus on own agenda

Consider your facial expressions

Question 4

Examining infants (a potential approach…)

• What went well?
• How was play utilised?
• What communication techniques were effective?
• How was the parent involved?
• How were challenges dealt with?
• Why was this approach taken?

Answer 4

• Well positioned and comfortable
• Use of toys/distraction
• Maintains dialogue throughout
• Responds to child’s actions (smiles/eye contact)
• Describes normality (jargon was present for student education)
• Utilises parental skill of distracting child
• Acknowledges + accepts challenges (“wriggly/nappy”)
• Reflects consideration of child and parent’s agenda

Question 5

Examining Toddlers (what not to do…)

• What went wrong?
• How was play utilised?
• What communication techniques were ineffective?
• Why was this approach taken?
• What would you do differently?

Answer 5

• Persists despite obvious distress
• Parent separated
• Patronising (“Oh Please”)
• Unrealistic (“Tell her to stop crying”)
• Ineffective (compromising inspection and auscultation)
• Clearly not appropriate
• However under stress these things do happen

Question 6

Examining Toddlers (a potential approach…)

• What went well?
• How was play utilised?
• What communication techniques were effective?
• How was the parent involved?
• How were challenges dealt with?
• Why was this approach taken?

Answer 6

• Well positioned on parent’s knee (accepts suboptimal to avoid distress)
• Utilises play (Illustration and distraction- visual and linguistic)
• Maintains dialogue throughout (always observing)
• Gradual exposure (listens through clothing)
• Eye contact (listens to back, positioned at front)
• Changes order (auscultation, then palpation, then percussion)
• Stops when child upset, settles and resumes
• Opportunistic assessment for trachea and clubbing at the end
• Reflects effective communication techniques

Question 7

Explaining things to Parents:

Junior Ineffective

• How will the parent feel and why?
• How have their ideas, concerns and expectations been addressed?
• Have they received effective closure?
• Why has the doctor taken this approach?
• Does the doctor relay correct medical information?
• What might you do or say differently?

Answer 7

Discussion (Parent’s Perspective)

• Low priority implied as doctor focused on his agenda (other tasks to do)
• Illness trivialised (“just a cold,” “see this a lot” flippant + dismissive)
• At fault/guilty over missed preventative therapy
• Worried about recurrence risk
• Hospital agenda placed above own needs
• Questions and (increasing) concerns dismissed
• Now has unnecessary ideas and expectations regarding investigations
• Unsure about next steps after ineffective closure

Discussion (Doctor’s Perspective)

• Doctor is busy and has other tasks to do
• Night shift compromises cognitive processes
• Building up paediatric experience and recognising common illness
• Wants to prevent illness admissions
• Aware of the recurrence risk
• Aware that some febrile seizure reflect CNS infection
• Recognises the needs of other unwell patients
• Factually correct in (almost) all of what he says
• The doctor is actually a very competent paediatrician

Question 8

• How will the parent feel and why?
• How have their ideas, concerns and expectations been addressed?
• Have they received effective closure?
• What techniques help the doctor take this approach?
• How does the doctor relay medical information?
• How does the doctor demonstrate insight?
• What phrases/questions might you use in the future?

Answer 8

Discussion (Parent’s Perspective):

• Doctor has acknowledged challenges/stress of a hospital admission
• Allowed to speak and finish points made
• Concerns (including what was seen) acknowledged
• Aware of recurrence and sibling risks
• Big worries (meningitis/ epilepsy) addressed without needing to ask
• Hears key information (no harm) several times
• Knows next steps for her and child (needs anticipated)
• Given opportunity for further questions (now and later)

Discussion (Doctor’s Perspective):

• Shows insight into the parental perspective.
• Seeks to understand/clarify the parental understanding
• Clearly describes the condition acknowledging understandable concern
• Addresses recurrence/sibling risk but emphasises key negatives
• Proactively anticipates concern (meningitis/ epilepsy/harm)
• Focuses on markers of health and reflects on experience of other children
• Explains the (lack of a) role for investigations.
• Clearly describes next steps (anticipates parental needs)
• Repeats key information and ensures mother is satisfied with discussion
• Provides opportunities for questions (now and later)

Question 9

Knowledge is important but…

• Parents want to be understood
• And not made to feel at fault
• And have things explained clearly
• Children don’t what to be there (or sick)
• Think what interests the child/adolescent
• And sometimes chat about non-clinical stuff