Sales Training Feb 2014 - Nursing

U N I T 1 Foundations of Pediatric Nursing

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choices when possible. Discipline involves teaching and is ongoing, not something that is done just when the child misbehaves. The American Academy of Pediatrics (2004) sug- gests three strategies for effective discipline (see also Teaching Guidelines 2.1): • Maintaining a positive, supportive, nurturing care- giver–child relationship • Using positive reinforcement to increase desirable behaviors • Removing positive reinforcements or using punish- ment to reduce or eliminate undesirable behaviors

Teaching Guidelines 2.1 TEACHING TO PROMOTE EFFECTIVE DISCIPLINE

• Set clear, consistent, and developmentally appropri- ate expected behaviors; offer choices whenever pos- sible. • Maintain consistency in responding to behaviors;

FIGURE 2.5 Although he might not like it, quiet solitude helps the child develop inner control.

provide encouragement and affection. • Role-model appropriate behaviors.

• Provide an age-appropriate explanation of the con- sequence that will occur if the child demonstrates unacceptable behavior. • Always administer the consequence soon after the unacceptable behavior. • Keep the consequence appropriate to the age of the child and the situation. • Stay calm but firm without showing anger when administering the consequence. • Always praise the child for displaying appropriate behavior. • Set the environment to assist the child in accomplish- ing the appropriate behavior; remove temptations that may lead to inappropriate behavior. • Reinforce that the child’s behavior was bad, not that the child was bad. POSITIVE REINFORCEMENT Attention from parents is a very powerful form of positive reinforcement and can help increase desirable behaviors. The key is to focus on the child’s appropriate behaviors rather than emphasizing the inappropriate ones. Immedi- ate, consistent, and frequent feedback is crucial. This feed- back can be in the form of smiles, praise, special attention, or rewards such as extra privileges or a special token or activity. Providing the feedback immediately is important so that the child learns to associate the feedback with the appropriate behavior, thereby reinforcing the behavior. EXTINCTION Another form of discipline is extinction, which focuses on reducing or eliminating the positive reinforcement for

inappropriate behavior. Examples are ignoring the temper tantrums of a toddler, withholding or removing privileges, and requiring a “time-out.” Withholding or removing privi- leges such as TV, music, or computer or phone use is most effective for older children and adolescents. The adoles- cent may be grounded for a short time or not allowed to drive the car. To be effective, the privilege being withheld or removed must be something that the child values. Time-out is an extinction discipline method that is most effective with toddlers, preschoolers, and early school-aged children. It involves removing the child from the problem area and placing him or her in a neutral, nonthreatening, safe area where no interaction occurs between the child and parents or others for a specifically determined period (Fig. 2.5). Take Note! The amount of time that a child spends in time-out is typically 1 minute per year of age; for example, a 3-year-old would spend 3 minutes in time-out (American Academy of Pediatrics, 2011). PUNISHMENT Discipline is often confused with punishment , but punishment involves a negative or unpleasant experi- ence or consequence for doing or not doing something. Although punishment is sometimes a necessary element of discipline, to be an effective tool it must be coupled with rewards for good behavior (American Academy of Pediatrics, 2004).

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