Gain a child's trust to obtain accurate history
Gain a child's trust to obtain accurate history
To obtain an accurate history from a child, you need to gain their trust, just as you do with adult patients that are in crisis, says Freda Lyon, RN, BSN, MHA, service line administrator at Bixler Emergency Center in Tallahassee, FL.
"It is not unusual for the emergency nurse to hear only a partial truth, omission of the truth and even answers that are not truthful," she says.
Nonverbal clues include failure to make eye contact or a "flat" affect when talking. "Patients may also change the subject or let others answer for them," Lyon says.
Lyon recommends interviewing the child in a quiet, private area where he or she feels comfortable speaking with you. Misty N. Eiler, RN, BSN, clinical nurse leader at the Emergency Center at All Children's Hospital in St. Petersburg, FL, says, "Adolescents can be stoic and unwilling to speak with strangers about what they have done or what they are feeling."
Sometimes it is necessary to separate the parent or caregiver from the child and speak with them individually, says Lyon. "When asking a pediatric patient about sexual history and drug and alcohol use in front of an adult caregiver, you are likely to get less than a truthful answer," she says. "The pediatric patient may also be uncomfortable describing some symptoms with a family member in the room."
Remember that you might not always get an accurate history from the child's parents, warns Eiler. "The parent may be trying to cover something up and may not tell the whole truth. The parents are usually requested to leave the room so we can speak with the patient one on one. Then we speak with the parents," she says.
Does the story a child or parent tells you match the injuries or illness? If not, this could be a clue that someone is not being truthful and abuse could be the reason, says Pamela Bucaro, MS, RN, clinical nurse specialist for the Emergency and Trauma Center at Dayton (OH) Children's Hospital. "Make sure that the child or adolescent's history or chief complaint is consistent with the nursing assessment and physical exam," she says.
At Dayton Children's, ED nurses make social service referrals for patients whose story does not match the injury or illness. The social worker then performs a detailed assessment of the patient and the family in the ED. He or she determines if law enforcement needs to be involved.
At Children's Healthcare of Atlanta, if abuse is suspected, a social worker interviews the caregiver in one room, with the ED nurse talking to the child at the same time in a different room, says Michelle Clark, RN, assistant manager of nursing for the ED. "I let the child know I will do anything I can to help them, but I need them to be honest in return," says Clark.
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