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Dr. Ni Putu Siadi Purniti, Sp.

A(K)
Children : Growth and development
Limitation of interaction with
environment
Limitation of communication

Clinicians : difficulty in
communicating information
at the appropriate
developmental level
Dual Patient
Clinician
Patient s
Multi Patient

Clinicians

Parents
Grand mother/father
Babysiter, etc Children
TALKING WITH
PARENTS
Listening
Facilitating the dialogue
Using common courtesy
Talking with the child
Dealing with acute illnesses
Redirecting the interview
Counseling and reassurance
Closure
Active listening
Letting the parent know that

you are listening


Check your body language
Eye contact
Responding to nonverbal

expression of parent affect


The parents story should be
facilitated by empathetic
responses.

Avoid : interruptions, subject


changes, judgmental comments,
and not make prematurely
diagnostic.
a. Elicit the reasons for the parents for the
visit (main complain)
b. Elicit the parents expectations for the
visit

c. Guide but do not dominate the discourse

Fundamental four dan


Sacred seven
Greeting
Introduction your self
Set agenda jointly
Early in the visit an appropriate
approach must be
made to the child

To porpuse :
Building of good relations
Indirect to help make diagnostic
During a acute illness, the interview
must be focused
High fever, seizure
Ask : How did you handle that?
After the episode is over and the
parents less likely to anxieties
more complete and forceful
information can be given

Explaned of the therapy: benefits,


advers even, cost and etc
Keep control of the interview
When the discussion gets off tract
the clinician needs to redirect
the discourse

There are some other information I need


right now so we can decide about the
treatment for this illness
The parents : need explain about
illness of the child, diagnose, cause
and how to manage

Advice giving and counseling can be


giving continuing process :
the first mention, during the
physical examination and at the end
of the visit
Cost ?

Availability ?
Summarize the relevant points
Education
Invite questions
Jointly setting the agenda visits
Talking with
children
Goals
The primary goal of open
communication is the
establishment of therapeutic
alliance with children and parent.
1.Inhospitalized children : Reduce
surgical morbidity and improve
physiologic and behavioral
outcomes
2.Health educations programs
3.Improved coping with disease,
fewer days of school missed, and
better functional health status
Clinician should be concern
of growth and development

Exp: malnutrition, look


anemia, weakness , child
not eye contact,
hyperactive etc

Support diagnose
Children go to Hospital
stress
defence mechanism

Coping

Def : as emotional, cognitive,


or behavioral efforts to
alleviate stress
Coping :
1. Direct
efforts to modify the sources of
problems
Exp: running away or hiding

2. Internal strategies
Exp: The childs belief that he is not
very sick
1. Under age 5 years
Use direct behavioral coping
(running away)

2. Age 5-9 years


Use more sophisticated direct strategies
e.g . the doctor that the medicine
tastes bad
e.g. An adolescent with
diabetes that her illness
has advantages
because it helps her to
stay thin
ESTABLISHING THERAPEUTIC
COMMUNICATION

One useful strategy for developing a


therapeutic alliance with children and their
parents is to use the TEACHER method
of communication
Table 2. TEACHER : A method for enhancing
communication with pediatric patients and their parents
T Trust Build trust and rapport with the child by asking
non threatening questions not related illness
E Elicit Elicit information from both parent and child regarding
parental fears and concerns and the childs understanding
of the reason for the visit
A Agenda Set an agenda early in the visit to help ensure that the
parents concerns are addressed
C Control Help the child feel control over the visit (e.g. knowing what
will and will not happen), to help decrease fear and
increase cooperation
H Health plan Establish a health plan with child and parent to meet the
childs needs and limitations
E Explain Explain the health plan to the child in a way she or he can
understand
R Rehearse Have the child rehearse the health plan as a way of
assessing understanding; reinforce the childs jobs
related to health care; explore any potential problems in
the plan with the child and parent
THE PIAGETIAN STAGES OF
COGNITIVE DEVELOPMENT
1. Sensorimotor stages
Learning occurs
through sensory
experience
They want to hold
and examine
instrument
A soft tone of voice
and gentle handling
Careful examination and frequent
comments about the childs condition
will be reassuring to the parent
2. 2-6 Years old (preoperational stages)

Children confuse cause and effect


They focus on the perceptual salience,
not the logical content
Perceive illness and medical
procedures as punishments for being
bed
Information for children should be
concrete and reassuring
TRUST :
Establishing trust with preschoolers
involves using direct verbal praise and
allowing the child to have some control
over the visit
e.g. by listening with the stethoscope to
clinicians heart
3. 7-10 years old
(concrete operational stage)

Children appear able to tolerate medical


visit better
They are very much focused on the
concrete aspects of situation
TRUST :
It is useful at this stages to
begin to give them more
control over their health and
to anticipate their concerns
Make sure that both parent
and child are involved
TRUST :
Make gathering in setting the

agenda and establishing a health


plan
Explained to child : examination
will be done
Children begin to be
able to reflect on their
own thought processes
and to understand how
the body works

Growing independence
and ability to make
decisions
Trust :

The clinician should solicit the


adolescents opinion , needs, and
limitations before recommending a course
of action

Make sure that the adolescent


understands the health plan and feels
comfortable trying it out

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