Developmental and cognitive ability

        • Developmental and cognitive ability
      • Establish trust and provide support
      • Parental presence and support
        • Support parents who do not want to be present in their decision and encourage them to remain close by so that they can be available to support the child immediately after the procedure. 
        • Parents should also know that someone will be with their child to provide support. 
          • This person should inform the parents after the procedure about how the child did.
      • Provide an explanation
        • Age-appropriate explanations
      • Physical preparation
        • Preparing children for procedures
          • Determine details of exact procedure to be performed.
          • Review parents’ and child’s present understanding.
          • Base teaching on developmental age and existing knowledge.
          • Incorporate parents in the teaching if they desire, especially if they plan to participate in care.
          • Inform parents of their supportive role during procedure, such as standing near child’s head or in child’s line of vision and talking softly to child, as well as typical responses of children undergoing the procedure.
          • Allow for ample discussion to prevent information overload and ensure adequate feedback.
          • Use concrete, not abstract, terms and visual aids to describe procedure. For example, use a simple line drawing of a boy or girl, and mark the body part that will be involved in the procedure. Use nonthreatening but realistic models.
          • Emphasize that no other body part will be involved.
          • If the body part is associated with a specific function, stress the change or noninvolvement of that ability (e.g., after tonsillectomy, child can still speak).
          • Use words and sentence length appropriate to child’s level of understanding (a rule of thumb for the number of words in a child’s sentence is equal to his or her age in years plus 1).
          • Avoid words and phrases with dual meanings unless child understands such words.
          • Clarify all unfamiliar words (e.g., “Anesthesia is a special sleep”).
          • Emphasize sensory aspects of procedure—what child will feel, see, hear, smell, and touch and what child can do during procedure (e.g., lie still, count out loud, squeeze a hand, hug a doll).
          • Allow child to practice procedures that will require cooperation (e.g., turning, deep breathing, using incentive spirometry).
          • Introduce anxiety-inducing information last (e.g., starting an intravenous [IV] line).
          • Be honest with child about unpleasant aspects of a procedure but avoid creating undue concern. When discussing that a procedure may be uncomfortable, state that it feels differently to different people.
          • Emphasize end of procedure and any pleasurable events afterward (e.g., going home, seeing parents).
          • Stress positive benefits of procedure (e.g., “After your tonsils are fixed, you won’t have as many sore throats”).
          • Provide a positive ending, praising efforts at cooperation and coping.


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