Explanation of how the nurse would offer instruction (to children) during the assessment
Comparison the physical assessment of a child to that of an adult
(focus should be on what you learned on completing childrens health assessments)
Similarities: Past medical history, current medications, chief complaint, signs and symptoms (OLDCARTS), assessment of systems (neuro, HEENT, respiratory, cardiac, GI, GU, integumentary, musculoskeletal, pain, etc).
Differences: Pain scales are very different, as adults generally use a 0-10 pain scale but children will benefit from a FACES scale or looking at behavioral or physical indicators of pain: grimacing, inconsolability, elevated heart rate, guarding (Andersen et al., 2019).
For an accurate health history, parents will need to be included in the process; without surprise, generally this history will be much shorter than an adult history, unless the child was sickly. Parents may also need to be involved for supplemental information; in our simulation, the child could tell me the cough medicine was a certain color but it was his caregiver that told me what the actual medication was.
Explanation of how the nurse would offer instruction (to children) during the assessment
Children might not respond to the nurse instructing them during the assessment so a doll to puppet to show them what to expect might be helpful (Klossner & Hatfield, 2010). For example, listening to a doll with a stethoscope allows the child to see the stethoscope in use, where it will be touching on their body, and what the nurse will ask them to do while they listen; it might be helpful to let the child touch the stethoscope and listen to the nurse’s chest. With children, some instruction might have to come from the parents or parts of the assessment completed in the arms of the parents so the child feels secure.
Adaption of communication for children of different ages
Infants are easy, nurses will communicate mostly with the parent aside from some baby talk and smiling at the infant. With young children, communication should always be done at eye level, whether that is with the child on the exam table or the nurse sitting at the same level as the child, communication should be slow, clear, calm, and in terms that a child would understand (Klossner & Hatfield, 2010). As children get older, the nurse needs to explain exactly what they will be doing in the assessment, when they are doing it, what to expect and, allowing for questions and answers.
Strategies to encourage children during the assessment
As previously mentioned, a strategy to encourage children during an assessment would include a doll or via puppet might be helpful when communicating with a young child. Always allow children to ask questions and not rush them, they might ask “why” or “what” and require frequent answers and support (Klossner & Hatfield, 2010). Nielson and Reeves make recommendations for nursing care to include, “role-play, simulation, and drama” (2019). Role play would allow the child to wear the stethoscope and listen to the nurse’s or parent’s lungs; simulation would allow the child to see the assessment on the doll (or parent) first; and drama would be puppetry, having a puppet do the assessment or the teaching to the child.