Chapter 8: Priniciples of Atraumatic Care 1

Principles of Atraumatic Care

Atraumatic care- Therapeutic care that minimizes or eliminates the psychological and physical distress experienced by
children and their families in the health care system


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Techniques for Providing Atraumatic Care
Therapeutic communication
Goal directed
Focused and purposeful
Therapeutic play
Provides emotional outlet or coping devices
Child education
Helps child understand the reason for the hospitalization/procedures
Preventing/Minimizing Physical Stressors
Utilize a child life specialist.
Specially trained individual who provides programs to prepare children for hospitalization and painful
procedures
Minimize physical distress during procedures.
Use positions that are comfortable to the child.
Therapeutic hugging: a holding position that promotes close physical contact between the child
and parent caregiver may be useful when the child must remain still
Use distraction methods.
Distraction Methods- box 8.2
Have the child point toes inward and wiggle them.
Ask the child to squeeze your hand.
Encourage the child to count aloud.
Sing a song and have the child sing along.
Point out the pictures on the ceiling.
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Have the child blow bubbles.
Play music appealing to the child.

Focus of Family-Centered Care
Respect for the child and family
Recognition of the effects of cultural, racial, ethnic, and socioeconomic diversity on the familys health care
experience
Identification of and expansion of the familys strengths
Support of the familys choices related to the childs health care
Maintenance of flexibility
Provision of honest, unbiased information in an affirming and useful approach
Assistance with the emotional and other support the child and family require
Collaboration with families
Empowerment of families
Positive Outcomes of Family-Centered Care for Children
Anxiety is decreased.
Children are calmer and pain management is enhanced.
Recovery times are shortened.
Families confidence and problem-solving skills are improved.
Communication between the health care team and the family is also improved.
A decrease in health care costs is seen.
Health care resources are used more effectively.
Family-Centered Approach to Health Care
Providing a Sense of Control for the Hospitalized Child
Provide effective communication and teaching.
Find a balance between neutral and affective communication.
Use verbal communication and nonverbal communication.
Use developmental techniques for communicating with children.
Assist family to obtain necessary information and resources.

Working With an Interpreter
Help the interpreter prepare and understand what needs to be done ahead of time.
The interpreter is the communication bridge, not the content expert; the interpreters timing may not match
that of others involved.
Speak slowly and clearly; avoid jargon.
Pause every few sentences so the interpreter can translate your information.
Talk directly to the family, not the interpreter.
Give the family and the interpreter a break.
Express the information in two or three different ways if needed.
Use an interpreter to help ensure the family can read and understand translated written materials.
Avoid side conversations during sessions.
Remember that just because someone speaks another language, it doesnt mean he or she will be a good interpreter.
Do not use children as interpreters
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Goals of Child and Family Education
Improve the child and familys health literacy
Encourage communication with physicians or nurse practitioners
Improve health outcomes and promote healthy lifestyles
Encourage involvement of child and family in care and decision making about care
Improve compliance with care and treatment plan
Promote a sense of autonomy and control





Chapter 8: Priniciples of Atraumatic Care 3

Tips on Working With an Interpreter



Specific Learning Principles Related to Parents
Adults are self-directed.
Adults are problem focused and task oriented.
Adults want an immediate need satisfied.
Adults value past experiences and beliefs.
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Knowles (1990)
Questions Appropriate to Ask When Performing a Cultural Assessment
Who is the person caring for the child at home?
Who is the authority figure in the family?
What is the social support structure?
Are there any special dietary needs and concerns?
Are any traditional health practices used?
Are any special clothes or other items used to help maintain health?
What religious beliefs, ceremonies, and spiritual practices are important?

Components of Learning Needs Assessment



Red Flags Indicating Poor Literacy Skills
Difficulty filling out forms
Frequently missed appointments
Noncompliance and lack of follow-up with treatment regimens
History of medication errors
Responses such as I forgot my glasses or Ill read this when I get home
Inability to answer questions about treatment or medicines
Avoiding asking questions for fear of looking stupid







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Cone of Learning



Techniques to Improve Learning
Slow down and repeat information often.
Speak in conversational style using plain language.
Chunk information and teach in small bites.
Prioritize information and teach survival skills first.
Use visuals.
Teach using an interactive, hands on approach.
Evaluating Learning
The child or family demonstrates a skill.
The child or family repeats back or teaches back the information in own words.
The child or family answers open-ended questions.
The child or family responds to a pretend scenario in their home.
Documentation of Child and Family Teaching
The learning needs assessment
Information on the childs medical condition and plan of care
Goals of child education; date goal is met
Teaching method used and how received by child and family
Medications, including drugdrug and drugfood interactions
Modified diets and nutritional needs
Safe use of medical equipment
Follow-up care and community resources discussed


Identifying family strengths, reinforcing positive behaviors, and providing anticipatory guidance
and resources can support the family. Identifying strengths will help the family target resources to
draw from for daily functioning as well as when crises develop. From there, support, teaching, and
resolving of family conflicts can occur.

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The only way to determine the effectiveness of teaching is to test or evaluate if learning has occurred. Structure the time and
method of evaluation when first establishing a teaching plan