00:00
So what kind of nursing diagnosis do you think that we would come up with for a child who
who has ADHD? I can even hear you say "Safety, safety, safety." Yes, risk for injury
related to accident-prone behavior and impulsivity. These are the kids that are going to
go full force and are going to end up injuring themselves because they don't know how
to stop. We may have a child who has very low self-esteem and that would be related
to the negative feedback that they are getting in all these different environments or
perhaps the dysfunctional family system. If you know a family who has a child who has
ADHD, the caregivers, the parents, the grandparents, this is a difficult situation to deal
with unless you have some support and you know how to deal with clinical manifestations.
01:03
If you are thinking that your child is doing this to get under your skin rather than that
it is a clinical manifestation of a disease process, we need to be able to help that parent
understand how to help the child cope. Also, one of our nursing diagnosis might be
noncompliance with task expectations. And what is that related to? Well the child has a
short attention span, also low frustration tolerance. And finally, this impaired social
interaction. This child does not learn the normal social cues that other children have
learned. They do not know how to wait their turn because of their impulsivity. They
cannot wait until they are called on if they have an answer, which is a reflection of
immature behaviors. Their level of frustration is very very low, they become easily
frustrated. So what do we want to do as nurses? What kind of interventions do you think
that we can do to be able to help the child and the family with ADHD? Well, we want to
have that therapeutic relationship. We want to develop that trusting therapeutic
relationship with the patient, also with the family. We want to be able to give this child
an opportunity to thrive. So let's reduce the environmental distractions that might get
in the way with staying focused. We have to have good boundaries. This is what is
allowed, this is what is not allowed. This is where you are allowed to go, this is where
you are not allowed to go. The child will actually respect the boundaries once they are
able to adhere to them. It is very difficult initially when you're setting boundaries, but
just be consistent and kind. And then give the immediate positive feedback for acceptable
behavior, "Oh I notice you were just about to go and pick up that ball and I noticed you
stopped and I'm so proud of you 'cause I know that was hard to do, but I appreciate
that because now is not the time to play with the ball. Let's move over here. I think I'll
put a sunshine on your planner for today because that was really good." So that is your
positive feedback and your rewording. You want to be able to set realistic goals. If
your goals are unrealistic, you're setting the child up for failure and a child with ADHD
by the time they are 7 years old understands what failure is. If they have not been
diagnosed early, if they have not been having some interventions to help them to learn
how to control some of their behaviors, they understand failure. And it is for nurses,
for us to look at a child who comes in and who's defeated and still energetic and doing
the wrong thing and getting yelled at any way, we want to help that child at least while
they're with us to understand that we have realistic goals for them. We want to plan
activities that give them the opportunity to achieve the goal and we want to be able
to be kind. We want to have a positive and respectful regard for the child and show
acceptance. When we give instructions, they have to be concrete, no abstractions.
04:54
"I need you to put the toothbrush in the holder and I need you to do it now." And if you
can work one on one with the child whenever it is possible, if it is important that they
do what you need them to do in the way you're asking them to do it, make a game, say
"I'm going to say something I need you to say it after I say it." I used to have a game
that I played with these kids that I work with and with their parents. I would say "I'd
like you to turn on the light." And the child had to say to me "Oh, Dr. Marshall do you
want me to turn on the light?" And I'd say "I would love for you to turn on the light."
And then they would say "Okay, I'm going to turn on the light." What we found out was
that when they ask me "Do you want me to turn on the light?" that was the first time
they actually heard what I wanted them to do. Knowing that they had to repeat what
I said made them pay attention. And so, that way of engaging them, they started doing
it with their parents. So if their parents said "I need you to turn off the TV" instead of
getting "uh-huh, uh-huh, uh-huh" the child had to say "You want me to turn off the TV?"
and then it would register "Oh, you want me to turn off the TV." And vice versa the child
had the right to say to the parent "I want you to take me to school now" and instead of
getting "Don't you see I'm busy" mom had to stop and say "Oh, you want me to take you
to school now?" and she then allowed him to know he was being heard. So, when you
do that I "listen, repeat, listen, do, listen, repeat, listen, do." "I want you to." "Oh,
you want me to?" "Yes, I want you to." "Okay, I'll do it." Also, you want to provide this
environment as free as distractions as is possible when they have a task to do that is
going to require some mental effort. How do we treat ADHD?