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Child Life Certification Exam questions with 100%
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- 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 ac- ceptance
- 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 breath- ing)
- muscle relaxation
- desensitization (medical play)
- modeling
- emotion-focused coping: directed toward regulation of one's emotional re- sponses 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, dra- matic/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 develop- ment 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 health- care 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 hospital- ization?: 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 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 profession- al 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 phys- ical 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 charac- terized 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 devel- oping 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
- 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- 3
- 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 environ- ment 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 pro- fessional 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 dur- ing 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 respon- sibilities 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 unreason- able
- 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, evalua- tion
- 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