Preschooler: Developing Initiative and Preoperational Thought

          • Preschooler: Developing Initiative and Preoperational Thought
            • Egocentric
              • Explain procedure in simple terms and in relation to how it affects child (as with toddler, stress sensory aspects).
              • Demonstrate use of equipment.
              • Allow child to play with miniature or actual equipment.
              • Encourage “playing out” experience on a doll both before and after procedure to clarify misconceptions.
              • Use neutral words to describe the procedure.
            • Increased Language Skills
              • Use verbal explanation but avoid overestimating child’s comprehension of words.
              • Encourage child to verbalize ideas and feelings.
            • Limited Concept of Time and Frustration Tolerance
              • Implement same approaches as for toddler but may plan longer teaching session (10 to 15 minutes); may divide information into more than one session.
            • Illness and Hospitalization Viewed as Punishment
              • Clarify why each procedure is performed; child will find it difficult to understand how medicine can make him or her feel better and can taste bad at the same time.
              • Ask child thoughts regarding why a procedure is performed.
              • State directly that procedures are never a form of punishment.
            • Animism
              • Keep equipment out of sight except when shown to or used on child.
            • Fears of Bodily Harm, Intrusion, and Castration
              • Point out on drawing, doll, or child where procedure is performed.
              • Emphasize that no other body part will be involved.
              • Use nonintrusive procedures whenever possible (e.g., axillary temperatures, oral medication).
              • Apply an adhesive bandage over puncture site.
              • Encourage parental presence.
              • Realize that procedures involving genitalia provoke anxiety.
              • Allow child to wear underpants with gown.
              • Explain unfamiliar situations, especially noises or lights.
            • Striving for Initiative
              • Involve child in care whenever possible (e.g., hold equipment, remove dressing).
              • Give choices whenever possible but avoid excessive delays.
              • Praise child for helping and attempting to cooperate; never shame child for lack of cooperation.


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