Transcript Communicating with Children

Communicating
with Children
Objectives
• To describe the development of language
as a means of communication
• To discuss normal communication patterns
of children of various ages
• To discuss strategies that the nurse can
use to enhance communication with
children
Family-Centered
Communication
• Process involving the nurse, parent(s)
• In today’s expanded society: may also
involve caregiver, significant other, gay
parents, and/or many others.
• Age and cognitive development dictate how
much communication happens with the
family present and if separate
discussions might be more
appropriate.
Communication In Children
• From infancy to adolescence,
communication is a dynamic, on-going,
ever-changing, and constantly developing
process.
• Somatic language is focused on
communicating through non-verbal
vocalization and is the primary language
of infants’ communication: crying,
grimmacing, jerking movements,
reddening of skin, etc.
Communication Con’t….
• Action Language begins later in infancy, as
child learns to communicate wants by
reaching, pointing, crawling toward or away
from, turning head, closing/opening lips.
• The infant’s ability to communicate is
guided by what these actions mean to
him/herself and how these actions are
interpreted by the caregiver
Communication Con’t…
• Verbal Language begins with 1st
spoken word (6-7mos.) but does not
really become effective until
toddlerhood.
• Progresses from repetitive noises
and sounds, to word usage, to phrase
usage, and finally to sentences.
Cognitive Development
• Age 1-6mos: infant responds to tactile
stimulation and by sound and tone of
adult’s voice.
• Nursing stategies for this age group:
use of touch, speaking in high-pitched,
gentle voice, maintaining eye contact,
games such as “peekaboo”.
Older Infants
• Older infants (6-12mos.) builds on
what has been learned previously.
• Egocentric (sees self as center of
the universe) and is beginning to build
a vocabulary.
• Stranger anxiety begins at this stage
and withdrawing or rejecting
unfamiliar people is appropriate.
Older Infant Cognitive Stage
• Also at the 6-12mos. stage, the
infant has no sense of object
permanence. (when an object is out
of sight, it does not exist)
• Nursing strategies at this stage
include all that were used with the
younger infant; in addition, the nurse
should look for clues that the infant
wants to play or interact, as through
eye contact or reaching out
with his or her arms.
Toddler/Preschool
Cognitive Development
• The toddler/preschool years span
from 1-6yrs. of age
• These children remain egocentric and
focus on communication for and about
themselves, how they feel, and what
they can do.
• They communicate with their hands
when words are not there
Toddler/Preschool…
• At this stage, the child can easily
misinterpret phrases and interprets
words “literally.”
• “Coughing your head off” means that
your head will fall off of your body.
“A little stick in the arm” means that a
tree stick will be put in the child’s arm.
“Bleeding Out” means blood will come
out of the body without stopping. This
is known as concrete thinking.
Toddlers/Preschoolers…
• Nursing strategies for this stage:
using patience in listening, as it
sometimes takes the child extra time
to express his/her thoughts in words.
• Do not interrupt the child.
• Do not discuss frightening or serious
subjects with the parents in the
presence of the child.
• Choose your words carefully….
Nursing Strategies
Toddlers/Preschoolers
• Set limits for the child in order to
provide a sense of security.
• Offer structured choices and redirect
behavior when warranted: for example offer
a choice between 2 different foods for
lunch rather than asking an open-ended
question like “what would you like for
lunch?”
•
Use play as a form of communication
School Age Children
• School-age period is age 6-12yrs old
• These children want explanations and
reasons for everything (such as what
procedures are being done to them
step by step and WHY?)
• Use simple explanations while still in
concrete stage and may use more
details as child progresses to more
abstract thinking
School Age Children
• These children want to use logic and
often misinterpret adult conversations.
• Nursing Strategies: use simple straight
forward questions & answers
• Often reluctant to express own needs,
so speaking in 3rd person is helpful
(Some children like to hold my hand
when their IV is started.)
• Obtain the child’s perceptions before
explaining anything to avoid confusion.
Adolescent Period
• This period ranges from 12-18yrs old.
• These children range between childlike and adult thinking and behavior.
• The adolescent has a genuine
interest in their care and want to
participate in the decision-making
process.
Adolescent Period
• The adolescent has attitudes and
feelings that need to be communicated
such as peer groups, identity, sex,
substance abuse, and his/her parents.
• The nurse must recognize where and
when to discuss these issues with the
adolescent and how much
communication can take place with and
without the parents.
Adolescent Period
• Communication with the adolescent begins
with development of trust.
• It is essential for the nurse to build a
rapport and to LISTEN verses talk.
• It is also imperative to be non-judgmental
and straightforward.
• Let the adolescent control the
communication within the limitations of
confidentiality without minimizing thoughts
and feelings.
Communication Strategies
• Verbal, non-verbal, combination of verbal &
non-verbal.
• Verbal include word games and storytelling
• Non-verbal include drawing and story
writing
• Combination center on various forms of
play therapy (young children will often act
out their experiences with dolls or plush
animals and reveal their feelings and
concerns.)
Communication Strategies…
• Communication with children takes
time and patience, thought and skill,
creativity and practice.
• Table 6-1 on page 70 has a list of
“do’s and don’ts” for establishing
rapport with children.
Word Games
• “Happy Faces” The nurse asks the
child to describe how his or her face
looks today…yesterday…and how it
will look tomorrow.
• “Word Association” The nurse asks
the child to “describe in one word
how you feel.”
• The nurse can focus on the words,
faces. Are they more
positive or negative in tone?
Storytelling
• Can be guided or directed as in “tell a
story about a girl/boy like you” or
“tell a story about this picture.”
• Storytelling allows the reality and
imagination to become integrated.
Drawing
• This allows the externalization of internal
mental images and emotions.
• It is safe and familiar to all children.
• The idea is not to focus on how well the
child can draw, but in the ability of the
child to get in touch with feelings and
healing through the drawing so that it is
therapeutic.
• Can be structured in that the child can be
asked to draw something specific about an
emotion or experience.
• Notice what colors are used—will reflect
childs emotions.
Story Writing
• Similar to storytelling but used with
an older child or adolescent
• Can be actual event-driven stories,
journal writing, or letters
• Can even be writing on the Internet:
chat rooms, blogs, or posting a story
on a web page
• Allows personal reflection and
privacy
Play
• Play is children’s work.
• It is what they know, what they
understand, and how they communicate
• Both verbal and non-verbal
• May be structured or free
Play
• Infants: simple hand games
• Older infants: “peekaboo”
• Toddlers and Preschoolers: play
with safe medical equipment
• School-Aged: “Dolls” “Stuffedanimals” and more technical toys
• Older children: computer games,
online support groups, sending
email to the nurse
Imaginary Friends
• Appropriate for older preschoolers and
school-age children
• Utilizes their desire to communicate in
the 3rd person and they can communicate
about themselves without acknowledging
the connection. For example: children
talk to the “friend” and they allow their
friend to talk for them, expressing how
they feel while maintaining their own
inner self.
Conclusion
• Communication with children is not
defined by a script, by generalities, or
by steadfast rules.
• A child’s ability to communicate
changes and evolves over time.
• Nurses must be aware that
communication with a child involves
appreciating their uniqueness, having
an understanding of the physical and
psychosocial development, & patience…
To communicate
with children
effectively, the
nurse must see
the world through
their eyes!