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Communicating With Children

Communicating With Children

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Communicating with Children: Age-Related Techniques
Communicating with the child is essential for promoting effective coping and facilitating nursing care. Specialsensitivity to the child's developmental needs and cognitive ability is necessary. Children are highly sensitive to bothverbal and nonverbal means of communication and internalize their personal interpretations of communicatedmessages. They are normally not as likely to share their interpretations unless prompted by an adult, thus placing thebulk of the responsibility for effective communication on the nurse.Nursing DiagnosesImpaired verbal communication related to developmental level, language, physiologic or cultural barriers; Fear oranxiety related to unmet informational needs about or changes in health status, or threat to self-concept.
Steps RationaleAssessment
1. Identify nature of the child's diagnosis and prognosis. This information provides a basis for predicting feelingsthe child may be experiencing and the type of information that needs to be communicated.2. Determine the child's age and developmental level(see Table 1, Age-Related Communication Needs).Age and developmental level influence factors such asword selection, complexity, and approach. Youngerchildren are more concrete in their communication,whereas adolescents can think abstractly.3. Determine presence of developmental or perceptualdisorders (e.g., developmental delay, deafness).Developmental or perceptual disorders may influence oralter the communication process.4. Assess family's basic value system and other culturallyprescribed determinants of communication (seeGuidelines box, Culturally Sensitive Interactions, text p.109).The more the family's value orientation is understood,the greater the probability communication will beappropriate and responsive to the family's and child'sneeds. Culture can affect communication patterns andword meanings. For example, in Native American andsome Asian cultures, direct eye-to-eye contact isconsidered disrespectful.5. Determine need for an interpreter (see Guidelines box,Using an Interpreter, text p. 111).When the nurse and child/family speak differentlanguages, an interpreter facilitates communication.6. Consider readiness for communication, e.g., the abilityto focus thoughts.In a crisis situation or when in a state of fear or denial,the child may not be able to listen.7. Determine past medical events and experiences withprofessionals.Children’s past experiences with medical professionalsmay have an effect (either positively or negatively) oncommunication.8. Determine purpose of communication (e.g., to elicitinformation, to provide information, to offerpsychosocial support, to prepare the child for an event,or to build rapport).Communication with the child is an ongoing process.Determining the purpose of each communicativeencounter guides selection of techniques and choice of communication setting.9. Assess personal feelings and attitudes about thechild/family.Feelings and attitudes are easily communicated to thechild and family nonverbally. The appropriate person tointeract with the child is someone who is capable of communicating positive feelings and attitudes. If this isCopyright © 2006 by Elsevier, Inc.
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not possible for the caregiver, reassignment should bestrongly considered.
Planning and Goal Setting
 1. Choose where communication will occur. Much communication occurs during the routine courseof the day. However, if the purpose of thecommunication demands privacy, a quiet room may bemore appropriate.
Special Considerations:
 If play materials are to beused, the playroom may be the most appropriate setting.
2. Select an appropriate time, considering factors such astiming, readiness, and the child's schedule.A consideration of such factors offers the greatestpossibility for successful communication.3. Develop a nursing goal of care:To engage in an accurate and communicativeexchange.To establish open communication.To establish a therapeutic relationship.
Implementation
 1. Communicate a caring attitude toward the child. Providing communication with a caring attitudeestablishes a safe emotional environment in which trustcan develop.Nonverbally, a statement is made that this child islovable and that all children are worthy of being lovedregardless of appearance, behavior, or life situation. If there is a conflict between verbal and nonverbalcommunication, the nonverbal communication willcommonly be believed above the verbal.a. When speaking to the child, use his or her name. Using a child’s name demonstrates value for andappreciation of individual uniqueness.b. Speak directly to the child at eye level.
Special Considerations:
Avoid extended eye contact,which can be uncomfortable to some children. Also achild may be distrustful of a new face with a too broad smile, or of an overly friendly manner.
c. Touch the child (e.g., pat the child on the arm or hand,touch his or her shoulder, or hold the infant).
Special Considerations:
Touch must be used  judiciously, considering readiness and cultural factors.
d. Handle the child and speak in a gentle and lovingmanner.e. Attend to responses of the child, especially whenperforming procedures. Allow enough time for the childto complete a statement or ask a question.f. Convey the recognition of the uniqueness andindividuality of the child, e.g., refer to a specialendearing characteristic of the child.2. Be an empathetic listener. Empathetic listening facilitates establishment of atrusting relationship.a. Active listening (e.g., "It sounds like you areconcerned that you won't be able to use your hand afterAn active listener demonstrates interest and concernabout what the listener perceives is important to theCopyright © 2006 by Elsevier, Inc.
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the surgery"). person.b. Reflective listening (e.g., "Are you saying you think your blood might all come out if you have an IV?").A reflective listener rephrases what was said forclarification.3. Provide opportunity for ventilation of feelings andacknowledge feelings expressed. If the child is unable toexpress feelings verbally, use play to encourage self-expression (see Skill, Therapeutic Play, Unit VIII).When the child ventilates feelings, he or she is able tocope more effectively. Young children especially havedifficulty expressing feelings and need an adult to helpname their feelings. A child learns it is acceptable tofeel/express emotions when an adult acknowledges thefeelings.4. Use silence when appropriate. A quiet presence can communicate caring and concern.A common misconception is that something needs to besaid to be therapeutic.5. Communicate as honestly and as accurately aspossible.a.
 
Give accurate information. Tell the child if theinformation is a guess.b.
 
Offer to get answers; locate information whennecessary.c.
 
Use terms the child understands; explainmedical terms when used.d.
 
Use visual aids, e.g., charts, drawings, ormodels to promote accuracy.Honest, accurate communication facilitates trust andestablishes safe parameters in which concerns andquestions can be aired.6. Observe for blocks to communication (see Box 6-2,Blocks to Communication, text p. 110).Blocks have an adverse effect on the communicationprocess.7. Allow time for questions, both at the time and later.Provide paper and pen or pencil.Absorbing information is a process. Additionalquestions may surface after the passage of time and theopportunity for reflection. With paper and pen or pencil,questions can be written down in order to remember toask them at a later time.8. Convey sincerity.a.
 
When choosing phrases of comfort or support.Phrases such as "I understand" are of no value unless theperson saying it has truly been in that situation.Furthermore, most situations are viewed as unique, andsuch a statement may provoke well-deserved anger.
Special Considerations:
Use of 
 
the third person could be more effective, e.g., "Other children in your situationhave told me
 
they felt very helpless. Is that how you're feeling right now?
"b.
 
When sharing private information about self. Traditionally, personal disclosure was discouraged. Amore open approach is advocated today. However,relating private information should have a purpose.Validation of feelings through personal experience canprove very supportive to the child.9. Use humor when appropriate. Sharing humor invites those present to come a littlecloser. Humor provides a common ground to softencultural and economic barriers.10. Use a variety of communication methods (see Box 6-4, Creative Communication Techniques for Children,text pp. 115-116).Using a variety of communication techniques may elicita more effective response.
Evaluation Outcomes Observational Guidelines
1. Communication is effective. Techniques of therapeutic communication areemployed. The child communicates and interacts in acomfortable manner. Needed information is exchanged.Copyright © 2006 by Elsevier, Inc.
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