36 Unit 2 | Psycho-Social-Cultural Assessment of the Child and the Family
● Irreversible ● Learned through culture and society ● Denotation: the dictionary meaning of a word ● Connotation: meanings and feelings associated with a word based on past experiences
● Nonverbal: ● Body language: An open stance is welcoming; crossed arms indicate coldness or displeasure. ● Gestures: ● Confirming behaviors such as nodding of your head or restating what you hear ● Nonconfirming behaviors such as tapping your foot, standing in the doorway, being in one’s personal space, or looking at your watch ● Paralanguage: Pitch, volume, and pausing Children are very aware of anxiety and fear in their caregiv- ers, which can be conveyed through both nonverbal and verbal behaviors. Speak slowly and be mindful of long pauses and the tone or manner in which you speak to the child. Nurses should practice effective listening; this key to successful communication requires active involvement in the communication process. Empathy enhances the communication process. Empathy is an understanding of a person’s feelings—not sympathy, which is not therapeutic. Responding positively to an individual helps develop communication skills, language, self-esteem, and trust. Typically, children communicate in a manner consistent with their developmental level (see Chapter 7 for growth and devel- opment information).
Patterns of Family Communication
While working with families, the pediatric nurse will observe a range of communication patterns (Fig. 3–1). These most com- monly include: ● Clear and direct, the most productive form of communica- tion, is a clear message directed to the appropriate family member. For example, “I’m irritated that you didn’t put the dishes in the dishwasher away as I asked you.” ● Clear and indirect is a clear message directed to the wrong family member. The mother tells the father: “I can’t stand it when people don’t put the dishes away when asked.” ● Masked and direct means an unclear message is delivered to the appropriate family member: “It’s really annoying when children don’t work hard in this family.” ● Masked and indirect communication is the least productive, characterized by an unclear message not directed to a specific family member: “Kids are all lazy” (Oster, 2017). Components of the Communication Process The importance of establishing good communication cannot be overstated because it affects all aspects of a child’s care. ● Verbal: ● Spoken words: Choose clear, concise language; avoid dis- tancing language such as assigning gender; and do not use avoidance language, such as euphemisms (e.g., “passed on” instead of “died”). ● Written words: Written communication, such as storybooks that highlight certain information, or journaling for adoles- cents; do not write directions above the reading level of the child or family, and do not use complex wording or medical jargon.
Barriers to Health Care Within Families
Although children learn health habits from their families, this does not occur in a vacuum; lifestyle is also influenced by com- munity and environment. The National Coalition on Health- care (2016) provides a framework for community health edu- cation through schools. It includes eight initiatives focused on health education, health promotion and literacy, health risks, and health behaviors influenced by family, peers, media, or the culture (U.S. Department of Health & Human Services, 2014). In addition, decision-making and goal-related skills are included to help enhance the community, the family, and the individual (National Cancer Institute, 2021). Another resource, National Health Education Standards (NHES), provides a framework for teachers, administrators, and policy makers to design or select curricula, allocate resources, and assess progress in education (Centers for Disease Control and Prevention, 2016). Access to health care varies among U.S. families. In 2015, 29 million Americans did not have health insurance despite the Afford- able Care Act (Kaiser Family Foundation, 2016). The term under- insured, which describes individuals or families who have insurance coverage considered inadequate, applied to 38 million Americans in 2019 (U.S. Census, 2020). The insurance status of uninsured or underinsured families affects their health-care practices. They may: ● Forgo treatment until a condition worsens ● Use emergency rooms for primary care in the absence of a relationship with or access to a primary care physician ● Miss follow-up appointments because of transportation, em- ployment, inadequate knowledge, and other barriers ● Lack resources to obtain needed medication to treat acute or chronic conditions
Clear and Direct
Hidden and Direct
Clear and Indirect
Hidden and Indirect
Communication in Families
FIGURE 31 Concept map of patterns of family communication.
Powered by FlippingBook