Child Life Certification Exam: A Comprehensive Guide for Child Life Specialists, Exams of Nursing

Download Child Life Certification Exam: A Comprehensive Guide for Child Life Specialists and more Exams Nursing in PDF only on Docsity!

Child Life Certification Exam.

A CLS who encourages patients and families to be experts of their own family practice is building the foundation for culturally competent and spiritually supportive care

As members of the healthcare team, how do child life specialists accurately and consistently share assessment information and care plans with other healthcare team members? documentation

Components of assessment information from the family, information from the child, and information from the healthcare team

Kubler-Ross's stages of grief denial, anger, bargaining, depression, and acceptance

culture shock results when a series of disorienting encounters occur in which an individual's basic values, beliefs, and patterns of behavior are challenged by a different set of values, beliefs, and behaviors

Cross cultural competency can be demonstrated by managing culture shock

Various Models of Assessment

1. Stress Potential Assessment Process
2. Psychosocial Risk Assessment in Pediatrics (PRAP)
3. Child Life Assessment Intervention Plan (CLAIP)
4. Hawaii Early Learning Profile (HELP)

Stress Potential Assessment Process

• encourages the CLS to formulate a care plan based on the consideration of 3 categories of information: healthcare, family, and child variables
• CLS then assigns a stress potential rating (1 to 5)
• draws upon knowledge of child development and family systems functioning with added healthcare stressors to assign a rating
• developed by Gaynard (1998)

Psychosocial Risk Assessment in Pediatrics (PRAP)

• formal screening tool to assess a patient's risk for coping during a particular intervention or healthcare encounter
• assigns a risk level based on empirical evidence using eight variables that closely correlate with the potential for negative outcomes during healthcare encounters

Child Life Assessment Intervention Plan (CLAIP)

• provides specific criteria for assessing patients and prioritizing their needs, and delineates forms of child life intervention that address the identified needs of the individual.

• begins w/ consideration of critical psychosocial variables (9) that have been found to predict psychological upset in children experiencing healthcare

Hawaii Early Learning Profile (HELP)

• formal assessment that has been validated in infant, toddler, and preschool versions, and includes assessment of multiple domains: cognitive, language, gross motor, fine motor, social-emotional, self- help, regulatory, and sensory.
• relies heavily on parent report

Documentation of a child life intervention in a patient healthcare record should be considered an extension of the intervention that is necessary to regard it as complete

Types of coping techniques/strategies sensory, cognitive, behavioral

sensory coping strategies rely on sound, touch, or movement to enhance the child's coping capacities

types of sensory coping strategies

• positioning (comfort hold, swaddling)
• movement (rocking or patting)
• soothing touch massage
• thermal regulation (warm blankets or cold packs)
• music

cognitive coping strategies approaches that include those that help reframe or refocus thoughts from negative to positive

Types of cognitive coping strategies

• conscious choice of alternate focus (distraction)
• thought stopping self-instruction (self-talk)
• therapeutic storytelling
• intellectualization (information seeking)
• reframing
• spirituality or prayer
• humor
• imagery
• hypnotherapy (magic glove)

behavioral coping strategies introduce behaviors that are compatible with the successful completion of the threatening event

Types of behavioral coping strategies

• relaxation techniques (deep breathing)
• muscle relaxation
• desensitization (medical play)
• modeling

emotion-focused coping

directed toward regulation of one's emotional responses to potentially stressful circumstance

problem-focused coping efforts directed toward managing or changing the potentially stressful situation

temperament characteristics/qualities adaptability, irritability, activity level, emotionality, and fearfulness

characteristics of play

1. intrinsically motivated (self-directed)
2. involves attention to means rather than to ends
3. may be nonliteral or symbolic
4. may be free from external rules
5. requires active engagement

Parten's theory of play play described in terms of the level of social interaction involved

Parten's Stages of Play solitary play, onlooker play, parallel play, associative play, cooperative play

Piaget's theory of play based on how children utilize play materials

Piaget's stages of play functional play (practice play), constructive play, dramatic/sociodramatic play, games-with-rules

symbolic play

• begins at 18 months - 2 years
• when playing, actively do things that represent personal images of their own experiences
• according to Piaget, is the ability to transform direct sensory data into abstract mental images

When does symbolic play emerge?

• 18 to 24 months
• While playing, children actively do things that represent personal images of their own experiences

pretend play children demonstrate their own views of themselves and others, including the roles they and the people around them assume

therapeutic play objectives

1. to establish rapport
2. to promote observation and collect useful data
3. to interpret behaviors and understand how children are making sense of their healthcare (stressful) situation

clinical advancement programs

• provide opportunities for career development within child life programs and recognize child life specialists who demonstrate a high level of clinical skills

• contributes to increased job satisfaction and better staff retention

information provided to volunteers

• responsibilities as a volunteer
• age-specific competency information and tips for approaching children and parents
• therapeutic relationships and professional boundaries
• infection control policies
• safety measures
• importance of play

Assessment variables (CLAIP)

1. response to healthcare variables
2. developmental vulnerability
3. age
4. mobility
5. culture and language
6. social and family status
7. support system
8. temperament/coping style
9. past negative experiences

Thompson and Standford (1981) described children's responses to healthcare as

1. active (ex: hitting or fighting)
2. passive (ex: withdrawn, sleeping, loss of appetite)
3. regressive (ex: return of behaviors from a previous developmental stage- loss of toilet training, changes in sleep patterns, being restless or anxious)

What age are children most vulnerable to the negative effects of hospitalization? 9 months to 4 years

How can child life specialists help with pain management issues? By advocating for the use of consistent and approved pain scales

Types of professional-patient relationships

1. Clinical relationship
2. therapeutic relationship
3. connected relationship
4. over-involved relationship

Characteristics of clinical relationship

• short/transitory
• interaction is perfunctory/rote
• patient's needs are minor and treatment-oriented
• Pt is viewed as only in pt role
• professional commitment

Characteristics of therapeutic relationship

• short/average
• interaction is professional

• Pt's needs are met and are minor/moderate
• Pt is viewed first in pt role and second as a person
• professional commitment and patient's concerns are secondary *ideal type of relationship

Characteristics of connected relationship

• lengthy
• Pt interaction is intensive/close
• pt's needs are extensive/crisis and "goes the extra mile"
• Pt viewed first as a person and second as a pt
• patient's concerns are primary and treatment concerns secondary

Characteristics of over-involved relationship

• long-term
• interaction is intensive/intimate
• pt has enormous needs
• pt viewed only as a person
• committed to patient only as a person and treatment goals are discarded

What theory best illustrates how a dx affects not only the pt, but also the entire family? Family systems theory

Grief the internal thoughts and feelings that are experienced when someone dies

Mourning grief gone public and involves taking the internal experience of grief and expressing outside oneself

Palliative care vs. hospice Palliative care extends the concept of care beyond the connotation of hospice to include a longer time frame and broadens the scope to apply to other illnesses that are life limiting

To best support a family through the death of their child the child life specialist should provide opportunities for memory making and legacy work

Anticipatory grief grief expressed in advance when the loss is perceived as inevitable

Sudden grief sudden and unexpected death as the result of an accident or injury

resilient the ability to return rapidly to a stable psychologic or physiologic state very quickly after disruption

emphathetic approach

• Johnson and Mattson (1992)
• ability to identify feelings, restate and clarify responses of family members, listen quietly, and validate a family's loss

Aspects of cross-cultural competence

1. The awareness of one's culture and limitations
2. An openness to and respect for cultural differences
3. A willingness to learn from intercultural interactions
4. An ability to use cultural resources during interventions

A culturally sensitive person

• recognizes the differences and similarities that exist between cultures
• strives to acquire knowledge about other cultural groups
• understands that cultural diversity has an impact on families' participation in intervention programs

Cross-cultural competence does NOT mean adopting the values, beliefs, or behaviors of another culture, shedding one's cultural identity, or knowing everything about another culture

Cross-culturally competent individuals are

• aware of how they are affected by, and how they affect, others of different cultures
• posses a repertoire of skills to aid in effective cross-cultural interactions

Behaviors that alert the CCLS that they may not be maintaining professional boundaries

• exaggerated feelings of shame, guilt, or inadequacy
• seeing oneself as a victim
• an exaggerated sense of responsibility for things outside of one's control
• setting unrealistic expectations of oneself or others
• avoiding conflict or confrontation
• giving help when it is not needed or requested
• putting the needs of others above personal needs

Bowlby's attachment theory

• due to physical cognitive, and social limitations of infancy, the adult influences the organization of the attachment relationship as it develops over time
• attachment reflects the relationship between the quality of care provided by the caregiver as it affects the child's confidence in the availability of the caregiver

secure attachment relationship promotes exploration of the social and physical environment as the child experiences the caregiver's ability to be sensitive to and responds to his/her needs in a contingent manner

insecure attachment relationship reflect the child's experience of a pattern of inconsistent or dismissive responses to his/her bouts for attention during times of discomfort, distress, or pain

Bowlby's stages of separation

1. Protest
2. Despair
3. Detachment

Protest

• active and aggressive response to the absence of caregiver and is characterized by screaming, kicking, or crying while constantly watching for signs of parent's return
• child refuses attention of anyone else and seems inconsolable
• may last several hours to as long as a week

Despair

• the child stops crying and appears depressed
• increasing sense of hopelessness
• may cry intermittently but more often appears withdrawn and quiet
• return of parent causes child to cry vigorously

Detachment

• appears after a long period of parental absence and is characterized by the child's reinvestment in his or her surroundings and normal activity
• copes with the pain of parental's absence by forming superficial attachments to others, becoming increasingly self-centered, and becoming more interested in material objects
• Parent's return is met with apathy and child's inability to reattach

Palliative care is most effective when a patient has a life-limiting or ultimately terminal condition

Components of the concept of death

1. irreversibility
2. nonfunctionality
3. universality
4. causality
5. afterlife

Irreversibility the understanding that once something is dead it will not come alive again

Nonfunctionality refers to a child's understanding that all external and internal functions have stopped (ex: breathing, thinking, moving)

Universality understanding that all living things eventually die

Causality ability to understand both internal and external events may bring about a death

Afterlife belief in some sort of life after death (appears in adolescence)

Elements necessary for the capacity to consent

1. Understanding the tx related information
2. Appreciation of the significance of the information for the patient's situation
3. Reasoning, which involves comparing alternatives and projecting what the impact could be on the patient's life

4. Expressing a choice

Consent involves making judgements for oneself and one's unique personal beliefs, values, and goals

autonomy independence; ability to make decisions for oneself

Beneficence doing good

Nonmaleficence duty to do no harm

Justice fairness; how society allocates benefits and burdens

Fowler's Stages of Spiritual Development

1. Undifferentiated (infants)
2. Intuitive-projective (toddlers & preschoolers)
3. Mythical-literal (school-age)
4. Synthetic-conventional (pre-adolescent)
5. Individuative-reflective (adolescent)

Undifferentiated Infants

• No concept of right or wrong; no apparent religious beliefs or convictions to guide behavior
• Beginnings of faith established with the development of basic trust through developing a relationship with their primary caregiver

Intuitive-Projective Toddlers & Preschoolers

• imitates religious gestures and behaviors of others with very limited comprehension of meaning or significance of activity
• Follows parental beliefs as part of daily life, but without an understanding of their basic concepts

Mythical-literal School-age

• spiritual development closely related to experiences and social interactions
• usually has a strong interest in religion and is able to articulate his or her faith
• conscience is developing

Synthetic-conventional pre-adolescent

• becomes increasingly aware of spiritual disappointments
• begins to reason and questions some established parental religious standards
• may drop or modify some religious practices

Individuative-reflective

adolescent

• becomes more skeptical and begins to compare religious standards of family with standards of others
• a time of asking questions and searching for answers

Healthcare design philosophies

• Plantree
• Easy Street
• Anthroposophy
• Evidence-based design
• Generative design
• Salutogenic design

Plantree

• patient-centered
• vision is the promotion of the development and implementation of innovative models of health care that focus on healing nurturing body, mind, and spirit
• fully accessible and home-like

Easy Street & Rehab 123 Easy Street

• a rehabilitative environment designed to stimulate real-life experiences
• the environment is used by adults who are attempting to reintegrate themselves into the mainstream by practicing on environments that are more closely proximate what they will encounter in the real world

Rehab 1-2-

• alternative for children designed around a gameboard concept that uses the environment to support rehabilitation

anthroposophy

• supports a philosophy focusing on opening up to the various spiritual realms connected with human life through our conscious understanding
• intent of facility is to provide a "sense of living order"
• the philosophy reflected in the building assumes an evolution on part of the healing patient from containment to exploration

evidence-based design

• the process of basing decisions about the built environment on credible research to achieve the best possible outcomes
• objective: utilization of data from various creditable sources to inform design decisions, with the eventual objective of enhancing the patient care experience, the work environment for staff, and organizational performance

Generative design

• addresses both physical space and social environment; experiencing interaction with other humans in the background of a physical environment substantially informs the patients' health outcomes
• generative environments are described as the third kind of space, in addition to physical space and social environment

Salutogenic design

• based on eliminating features that generate negative stress and enriching the environment by adding factors that result in improvements in personal control, access to nature and daylight, inclusion of spaces for private and public relaxation, and spaces with aesthetically pleasing qualities
• "psychosocially supportive design"

Kenneth Rubin's types of play

• Functional play
• Dramatic play
• games with rules

Rubin's Functional play simple, repetitive muscle movements with or without objects

Rubin's Dramatic play substitution of an imaginary situation to satisfy child's personal needs and wishes

Rubin's Games with rules acceptance of prearranged rules and adjustments to these rules

most common grief reactions during the period of anticipatory mourning despair, hopelessness, worthlessness

0-3 years understanding of death

• doesn't comprehend death
• aware of constant buzz of activity in the house
• aware of caregivers looking sad and teary-eyed
• aware that someone in the home is missing

3-5 years understanding of death

• sees death as temporary and reversible

normalization process by which difficult experiences or situations are made more familiar and acceptable

newborn-3 years understanding of death and associated behaviors

• doesn't comprehend death
• aware of a constant buzz of activity in the house
• aware of mom and dad looking sad
• aware that someone in the home is missing

BEHAVIORS:

• altered eating and sleeping patterns
• irritable and clings

3-5 years old understanding of death and associated behaviors

• death is temporary and reversible
• continually asks if person will return
• may feel ambivalent

• through magical thinking, may assume responsibility for the death

BEHAVIORS:

• concerned about own well-being
• feels confused and guilty
• may use imaginative play, re-enacting scene of CPR, etc.
• withdraws, is irritable, and may regress

6 to 9 years old understanding of death and associated behaviors

• begins to understand concept of death
• feels it happen to others
• may be superstitious about death
• may be uncomfortable in expressing feelings
• worries that other important people will die

BEHAVIORS:

• may seem outwardly uncaring, but it inwardly upset
• may use denial to cope
• may attempt to "parent" the parent
• may act out in school or at home
• may play death games

9 to 12 year olds understanding of death

• accepts death as final
• has personal fear of death
• may be morbidly interested in skeletons, gruesome details of violent deaths
• concerned with practical matters about child's lifestyle

BEHAVIOR:

• May appear tough or funny
• may express and demonstrate anger or sadness
• may act like adult but regress to earlier stage of emotional response

Steps of the cyclical child life process

1. Assessment
2. Plan
3. Interventions
4. Evaluation

stress point care the process of identifying and planning for the situations with the greatest potential to overwhelm a child's or parent's coping resources

evidence-based practice involves integrating research evidence with professional expertise and patient preferences when making clinical decisions

temperament

an individual's consistent and stable pattern of behavior or reaction, one that persists across time, activity, and context

Coping process used to alter, manage, or tolerate a stressful situation

avoidant coping when children restrict their thoughts about an upcoming event, deny their worries, and detach from stressful situations

Vigilant coping seeking out detailed information and alertness to a stressful stimulus

What is most strongly correlated with children's adverse responses during hospitalization? parental anxiety

the key issues for child life assessment child's temperament & coping style, parental level of anxiety, and the number of invasive procedures

dramatic play spontaneous and guided role play that focuses on health care themes and often includes medical or nursing equipment

Non-nutritive sucking of a pacifier and sucrose solution can be used as an analgesic for painful procedures to newborns and infants up to the age of 6 months

unilateral relationships arise when one person is unwilling to adequately invest in the relationship ex: a burned-out provider who keeps interactions superficial and brief

HIPAA Health Insurance Portability and Accountability Act

• addressed the rights of the individual related to privacy of health information
• CLSs cannot release any information or documentation about a pt's condition or treatment without the consent of the parent or legal guardian

PHI protected health information

• consists of any identifying or personal information about the pt like health hx, condition, or tx in any form, and any documentation, including electronic, verbal, or written

beneficience to do good

Nonmaleficence to do no harm

autonomy right to self-determination

respect for persons demands that every living being be acknowledged as unique and singularly valuable, intrinsically possessed of substitutive worth and potential.

veracity duty to be truthful to others

justice implying fairness and freedom from bias and prejudice

fidelity being faithful and devoted to any obligation (promise keeping)

fiduciary someone who holds something in trust for another

confidentiality ethical obligation to respect, secure, and maintain the privacy of others

competence capacity to faithfully and skillfully carry out professional responsibilities and assignments

informed consent the sharing of information sufficient for an individual to become adequately informed to consent to a proposed tx or intervention

All medical personnel are mandatory reporters and must report

• child abuse or neglect that places the child in risk of harm (physical or emotional), death, or exploitation
• sexual abuse including rape, molestation, prostitution, incest, or coercion to engage in any type of sexually explicit behavior

self-reflective skills awareness of biases, projection, and transference

bias prejudice for or against someone in a manner that is unfair or unreasonable

projection displacing personal undesirable feelings onto another person

transference displacing feelings or behaviors associated with a person in the past onto a person in the present

burnout associated with ongoing and predictable work demands

compassion fatigue can occur when the CLS overly identifies with the pain and suffering of others and begins to exhibit signs of stress as a result

stress management

• strategies that help the individual relieve stress and anxiety
• ex: meditating, deep-breathing, exercising, relaxation techniques, etc.

secondary traumatic stress

• occurs when the CLS is exposed to repeated traumatic events and problems to the point that these begin to affect his or her own personal and professional life
• ways to prevent it include: journaling, self-care groups, and balancing case loads

narrative-style charting free form

SOAP charting subjective, objective, assessment, plan

APIE charting assessment, planning, implementation/intervention, evaluation

When communicating with the media, the CLS should provide info about the child life role and advantages to healthcare organizations and to parents and children and explain academic requirements

When communicating with the donors, the CLS should stress advantages to the community and the parents and children and the need for support for hiring

When communicating with the community, the CLS should discuss role of child life professional in helping healthcare providers, parents, and children, giving examples to which people can relate

When communicating with higher education, the CLS should discuss the growing need for educational programs for child life professionals to combat shortages and employment stats supporting that need and discuss specific program needs (internships)

When communicating with healthcare professionals, the CLS should stress the advantages that the child life professional provides to staff members in caring for pts and interacting with parents

When communicating with students, the CLS should discuss educational requirements, professional rewards, range of salaries, and job opportunities

For infants ages 6 months to 1 year, the greatest threat is separation from parents (separation anxiety)

hospitalization issues for infants (0 to 1)

separation, lack of stimulation, pain

responses to hospitalization for infants (0 to 1) failure to bond, distrust, anxiety, delayed skills development

Responses to hospitalization for toddlers (1 to 3 years) regression, uncooperativeness, protest, despair, negativism, temper tantrums, resistance

hospitalization issues for toddlers (1 to 3 years) separation, fear of bodily injury and pain, frightening fantasies, immobility or restriction, forced regression

hospitalization issues for preschoolers (3 to 6 years) separation, fear of loss of control, fear of bodily mutilation or penetration by sx, injections, castration

response to hospitalization for preschoolers (3 to 6 years) regression, anger towards primary caregiver, acting out, protest, despair and detachment, physical and verbal aggression, dependency, withdrawal

hospitalization issues for school-age (6-12) separation, fear of loss of control, fear of loss of mastery, fear of bodily mutilation, fear of bodily injury and pain (especially intrusive procedures in genital area), fear of illness itself, disability, and death

responses to hospitalization for school-age (6 to 12) regression, inability to complete some tasks, uncooperativeness, withdrawal, depression, displaced anger and hostility, frustration

hospitalization issues for adolescents dependence on adults, separation from family and peers, fear of bodily injury and pain, fear of loss of identity, body image and sexuality, concerns about peer group status after hospitalization

responses to hospitalization for adolescents uncooperativeness, withdrawal, anxiety, depression

Thomas and Chess Temperament Theory

• describes 9 personality parameters to describe how children (beginning at about 4 weeks) respond to events
• personality traits will explain the child who is difficult, the child who is slow to warm, and the child who is easy/adaptable

Berk (1997) refers to children's stress as either

• normative (arising from usual life events and typical developmental processes)
• nonnormative (abuse, trauma, severe illness, etc.)

3 stages of transactional stress model Lazarus and Folkman (1984)

1. stressor identification

2. appraisal of resolution options
3. stressor mitigation (behavioral or cognitive changes and efforts)

caring

• the essential catalyst for nearly every higher-order human interaction that is ultimately effective at its end-point
• attends to both feelings and the mind, not just information alone

family systems theory

• every individual viewed as an interrelated part of many other social systems
• all individuals are interdependent upon and influenced by all other individuals
• standards, norms, expectations, values, and beliefs clarify those interactions that are acceptable and those that aren't

Family stress theory (double ABCX model) McCubbin and Patterson (1983)

• A (stressor event) reacts with B (the family resources available to meet the stressor) and factor C (the family's appraisal or definition and interpretation of the event) to produce X (the response to the crisis)
• in this model more emphasis is placed on the family's appraisal of the event (C) and the interactive and additive nature of events

cultural competence academic and other skills providing an enhanced awareness of cultural concerns

cultural imposition tendency to impose personal cultural perspectives and expectations on others, regardless of their background

culture composed of values, beliefs, traditions, etc. unique to a specific group of people

ethnicity a common race and/or nationality and language shared among a specified group

race a population sharing distinctive physical characteristics that are genetically inherited

spirituality the beliefs and guiding principles that sustain an individual from day to day

FICA Faith Importance Community Address

BELIEF Belief systems Ethics

Lifestyle Involvement in a formal religious community Education Future events

immanent justice

• common form of spiritual distress found among children that arises from children imagining that their illness has been visited upon them as retribution for some past misdeed
• most commonly seen in children under 7 years old

child-directed play one-to-one play between an adult and a child in which the child directs and leads and the adult describes, imitates, repeats, and encourages the child

therapeutic play

• play intended to help the child cope with healthcare and to achieve goals in healthcare
• ex: child encouraged to draw pictures to explore feelings

medical play involves activities designed to familiarize children with unexpected and potentially fear-inducing experiences and/or facilitate communication, target emotional issues, and help them develop needed coping skills through play with medical items

Optimal outcome of advocacy is to have patients and family members in a collaborative relationship with health care providers

In order to be an effective advocate the CLS will need knowledge of organizational functioning as framework to apply their child development expertise, communication skills, and problem-solving abilities and teamwork

normalizing play play used for the child's enjoyment and that mirrors the type of play the child may engage in within the home environment

developmental play play intended to encourage intellectual and physical development; may include exploring the world and manipulating items, running, jumping, and playing word games

Health care play

• activities involving actual health care experiences
• Includes: expressive play, familiarization play, drama/medical play, and guided play

classical play theory children's play renews energies, revitalizes, and is a means of rehearsing for adulthood

competence motivation play theory acting upon their environment through play enables children to develop competency, to enhance feelings of efficacy and control, and thereby enables them to derive personal satisfaction regardless of other rewards

arousal-seeking play theory children are innately driven toward information seeking, environmental stimulation, and arousal and play is the mechanism by which levels of stimulation can be meditated and moderated to optimum level

Assessment Gathering of information about the child, family, and various components of healthcare situation in order to determine what type of relationship and intervention is indicated

Plan Formulated based on assessment of child and family's needs Must be based on outcome goals

Intervention Made up of the direct provision of services by the CLS Begins with building rapport and a supportive relationship Main component is the execution of plans based upon a thorough assessment of the child's psychosocial needs

Evaluation Measurement criteria or employee assessment used to determine whether the goal of the intervention was achieved and to revise plans for a specific patient and for future services