EBP RATIONALE

a.       Ask: Tell me about how your interactions with your son since our last visit?

b.      What has been going well?

c.       What has been frustrating?

2. Observe interactions

a.       Tone of voice & rate of speech

b.      Eye contact

c.       Facial Expression & Gestures

·         Observe interactions with child

·         Rationale: Active listening gives full attention and allows the sender the opportunity to complete comments without interruption.  It allows us to pay attention to verbal and nonverbal communication and look for similarities.  Active listening expresses caring, and provides a comfortable environment for the client to share their concerns (Wilkinson, Treas, Barnett, & Smith, 2016)

2. Observation allows the nurse to use her senses to gather and interpret patient and environmental data. It is important to note the tone of voice, rate of speech, distance, eye movement, facial expressions, and gestures.  This way we can look for similarities between the spoken message to the child and the RN and the nonverbal messages (Wilkinson, Treas, Barnett, & Smith, 2016).  Inconsistencies in these messages can confuse the child during teaching.

At the end of this session, both parents will list/verbalize 3 strategies that will improve communication (either expressing or receiving) with 2-year-old son

Rationale: Family does not know what techniques are affective in improving communication/reducing barriers

    a. Causes of disorder

2. Behaviors that interfere with communication & teaching

   a.. Body Language

   b.. Lack of consistency

3. Actions to support communication

   a. Visual images/use of    

        Technology

   b. Working with child daily

   c. Early use of enhancement     

        programs

Discuss which strategies parents feel most comfortable using

Discuss available community resources (ECFE, preschool, HeadStart and how to access these resources

Rationale: State impact and barriers of knowledge as factors for improved interactions during teaching in this family

1a. Parents play a critical role in the treatment of language disorders, knowing what type of disorder and the cause can help the parents to understand the best way to work with the child and to access the help/care they need to develop and learn appropriately (UR Medicine, 2018).

2. Research shows that the more teachers use verbal and non-verbal communication (body language), the more successful their education and the students’ academic progress were (Bambaeeroo & Shokrpour, 2017).

3. Research has shown that children who start therapy early and engage in frequent reinforcement of teaching have the best outcome (UR Medicine, 2018).  Visuals can make the presentation of complex information easier to comprehend, more attractive, and can also reinforce written or spoken health messages.  Visual communication can benefit all audiences but can be especially helpful to individuals with lower literacy and numeracy skills (CDC, 2018).

At the end of this session, both parents will demonstrate 1 technique to improve communication with 2-year-old son

Rationale: Parents do not know how to interact with son to reduce barriers/enhance communication to reduce poor transitions and “melt-downs” due to lack of understanding

2. Visual cues and early warning (child preparation) prior to change in activity/environment

   a. Definition

   b. Values

3. Interaction enhancements

   a. Demonstration of how to

       use visual cues and pre-

       activity warnings

   b. Return demonstration

Rationale: explain why giving warnings prior to change in activity/environment and utilizing visual cues is important for interactions with this child

1. Communication skills critical to cognitive development and learning.  No improvement in communication barriers can lead to learning barriers and difficulty with school.  The ability to participate in active and interactive communication with peers and adults in the educational setting is essential for a student to succeed in school.  Spoken language also provides the development for reading and writing (ASLHA, 2018).

2a. Definition: using a picture or other visual item to communicate with a child who has difficulty understanding or using language. Visual supports can be photographs, drawings, objects, written words, or lists

2b. Value: Research has shown that visual supports work well to communicate.  Visuals can help parents communicate what they expect. This decreases frustration and may help decrease problem behaviors that result from difficulty communicating. Visuals can promote appropriate, positive ways to communicate (Loring & Hamilton, 2018).

3a.  A visual schedule is helpful for breaking down a task that has multiple steps. It is also helpful in decreasing anxiety surrounding transitions by communicating when certain activities will occur throughout the day or part of the day.

When it is time for an activity on the schedule to occur, cue your child with a quick, verbal instruction. For example, say “Check the schedule.” This helps your child pay attention as the next activity begins. At first, you may need to physically guide your child to check the schedule.  You can gradually decrease physical prompts as your child begins to use the schedule more independently. When a task is completed, cue your child to check the schedule again, using the procedure described above, and transition to the next activity (ASLHA, 2018)

3b. Demonstration and return demonstration is most effective when using items, body language, and gestures such as with the visual cues.  When the task/skill is performed correctly, return demonstration can increase self-confidence (Wilkinson, Treas, Barnett, & Smith, 2016).

At the end of this session, parents will report feeling comfortable (scale of 1-10) implementing 2 strategies to improve their communication and interaction with the child

Rationale: Family is in the preparation stage of change and is ready for learning

   a. Identify effective

      approaches for

      implementation

       (compromise approach)

   b. Establish time-line for

       change

Rationale: The compromising between parents and children can be a good learning experience for the child. If you don’t negotiate, your children may not learn how to deal with conflicts constructively. If you don’t teach them how to work with you, they may never learn how to work with others.  (Parents, 2018). 

1a. Compromising may be a good strategy when there are time limitations, such as working with a child with limited attention span and ability to understand.

1b. Establishing a time-line for change can help keep the parents on course with the instruction they are providing the child.  This helps to hold the parents accountable for sticking with the teaching/lessons.  Establishing a time-line for when teaching is best performed during the day is also important.  It needs to be the right time, place, and setting for the child and the parent to be able to teach and learn.  Also, if they perform the instruction with the child during certain times every day, this helps establish routine with the child and prepares the child for the lesson during those times of the day because they are aware it is going to happen.

2. Determine need for additional teaching, instruction, or referral