How do you want me to talk to you? Supporting practitioner - - PowerPoint PPT Presentation

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‘How do you want me to talk to you?’ Supporting practitioner communication with children with exceptional healthcare needs Workshop developed by the National managed Clinical Network for Children with Exceptional Healthcare Needs (NMCN CEN) Author: Claire Edwards for NMCN CEN www.cen.scot.nhs.uk

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Welcome and introductions

The National Managed Clinical Network for Children with Exceptional Healthcare Needs (NMCN CEN) aims to:

• Improve care for a group of children and young people defined by

their complexity of healthcare, not by their diagnostic label.

• Respond to issues identified by service users and service providers
• Produce tangible resources such as the film and workshop that

can be used to improve practice This workshop is designed especially for professionals who do not work with children with complex needs on a regular basis and practitioners early in their careers. Feedback shows that the workshop is also considered to be a useful opportunity to reflect

• n ‘own practice’ by staff working with children with complex

needs.

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Introductions

Facilitator introduction Participants – Who are you and what is your role? What are you looking for from this workshop?

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Housekeeping and Ground Rules

Housekeeping Fire alarms Comfort Breaks Mobile phones Ground rules Confidentiality Respect each other’s right to express themselves Listen to each other Take responsibility for yourself Use of ‘I’ statements Anything else?

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Aims of the workshop

To:

• Increase awareness of your own feelings in relation to working

with children and young people who are non-verbal

• Provide an opportunity to reflect on those feelings and their

implications for your practice

• Provide an opportunity to increase your confidence to engage with

children and young people with exceptional healthcare needs and their families

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What does the title of this workshop say to you? ‘How do you want me to talk to you?’

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What are your experiences of working with children with complex needs? Any work examples of interaction with non-verbal children?

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Reflective statements

Pairs exercise: Discuss the following statements in terms of whether you agree or disagree with them -

• I would always use the parent as an interpreter
• With the right augmentation equipment I would be able to get

the child to communicate with me

• Non-verbal children usually have learning disability as part of

their overall condition

• Everyone with a learning disability can understand some things

about their care

• It is important to acknowledge the child when talking about their

care and treatment

• I feel awkward when I meet a child with complex needs
• It is more important to get the information quickly than to include

the young person in your discussion

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Watching the film

In small groups – Watch the film and then discuss with regard to each of the following questions:

• 1. What do you feel watching the children and young people in the
• pening sequence?
• 2. What sort of feelings are expressed by the practitioners?
• 3. What do you think about Dr Russell’s comments about the use of

touch?

• 4. Identify what the two mothers say and do with their children,

Peter and Jessie?

• 5. What does the practitioner, Shona say and do with Rylie?
• 6. How did you feel as you watched these interactions with the

children?

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Observations 1

You may have identified the following –

• 1. A range of feelings within yourself when watching the children

including anxiety, discomfort, compassion, sadness, happiness.

• 2. The practitioners expressed feelings that included awkwardness,

fear of being patronising, avoidance, confusion, a tension between getting the information and including the child, the need to learn from the children and to adapt your communication accordingly

• 3. Some possible thoughts:

– using touch is something you would not find easy

• you are comfortable with touch and use it regularly
• you would always ask first
• using touch to communicate is not something you had thought

about before

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Observations 2

• 4. Mothers –
• mirroring of sounds
• ffering clear choices
• verbally responding to eye movements and smiles
• n-body signing
• 5. Shona –
• describing what she is doing
• asking questions
• mirroring sounds
• 6. Feelings –
• I can learn from watching them..
• The relationship is important...
• I’d feel self conscious...
• It’s all about being respectful...

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Identifying the principles

• f good practice

In small groups – In the light of what you have seen and heard in the film what are the principles towards which we should have regard when meeting non-verbal children and young people?

• Identify the elements of good practice
• Are these elements different depending on where you meet the

child or not?

• Draw from your experience
• Write these on to the flip chart
• Agree who will speak for the group

One group to share their discussion and others to add in anything missing or that you feels needs greater emphasis

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Principles of good practice in communication 1

When meeting a child/young person –

• Do not assume that the child/young person will be ‘used’ to being

in hospital or in a clinic

• Acknowledge that being in hospital or in a clinic may be distressing
• Introducing yourself directly to the child/young person by name

and by profession and explaining what your professional title means

• Addressing the child/young person’s parent or carer directly
• Asking the parent or carer if there is anything specific you need to

know about the child/young person’s communication

• If both parents are present ensure that you address each of them

and check that there is a shared understanding of the concerns and/or what information you share Some of these principles will mirror those required for any person in a hospital environment

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Principles of good practice in communication 2

• Asking what might be the best way to communicate in terms of

your position e.g. ‘Would it be best if I crouch down by your child’s wheelchair?’

• Having full regard to what you are told and referring to it when

speaking to the child/young person e.g. ‘I understand that if you don’t like something you will look away’

• Describing what you are going to do and why and pitching this at

an (developmental) age appropriate level and tone: ‘I am going to look at your gastrostomy site as there seems to be an infection’ (14 year old) ‘I am going to look at your tummy as it seems to be sore’ (6 year

• ld)

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Reflective practice

This workshop has been developed to encourage you to reflect on your own practice in relation to communicating with children, young people and their families. Through reflection you can consider your own practice and how you might want to change or improve it. Reflective notes are used by health professionals as part of CPD. There are two types of reflection –

• Think while acting: Reflection ‘in’ action
• Consider what has been done: Reflection ‘on’ action

Which are you?

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How to use the cycle

Gibb’s cycle provides a structured way to think about a situation you found challenging so that you can consider how you might do it differently –

• As a staff group to gain other perspectives and insights
• Individually to gain insight into your practice

It can also be used to reflect on a positive experience and piece of work that went well so that you can identify why it was effective and use the learning in other situations.

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Principles into practice

• A. Practice exercise – in groups of three carry out the following:

Each person to take a role –

• Parent
• Child/young person
• Practitioner

Using the scenario and the principles you have identified - each person in turn has the opportunity to be the practitioner trying to get a piece of information about the child/young person. As the practitioner draw on your own role – what would you want to ask this child? 5mins each

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Principles into practice

• B. Scenario discussion – in groups of three look at the scenarios and

discuss the following: – How would you respond as a practitioner? – How do the family (parent, child/young person) feel in this situation? – How could you improve your own practice?

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Summary

• Feelings of awkwardness and anxiety in communicating with non-

verbal children and young people are understandable

• We must move from these feelings to be effective in our practice
• Our feelings affect our behaviour and this will have implications

for our practice in relation to children, young people and their families

• You can use reflective practice to improve your skills
• Poor communication has a negative impact on children, young

people and their families

• Awareness of our feelings can help us to change our behaviour
• There is a set of principles that can guide our practice
• These principles are rooted in the very human values of courtesy

and respect

www.cen.scot.nhs.uk