38 Unit 2 | Psycho-Social-Cultural Assessment of the Child and the Family
Barriers to Effective Communication
deviations in hearing that may prevent the child from reaching developmental milestones, such as turning the head toward a sound, being soothed by the voice of a caregiver, mimicking sounds heard, and learning to talk. These primary skills of communication must be obtained before the development of the communication process. Infections passed from the mother and the antibiotics used to treat such infections may cause ototoxicity and alter hearing. In addition, chronic ear infections or infections transmitted in utero can cause limitations in hearing.
The pediatric nurse can facilitate effective communication by identifying potential barriers to client/family communication and removing them when possible. Barriers to effective commu- nication may include: ● Physical abnormalities such as cleft lip or cleft palate. ● Physiological alterations such as hearing or visual impairment (Fig. 3–2). ● Cognitive barriers may affect perceptions, expression, or con- crete or abstract thinking. For example, this may include the ability to understand and use jargon, sarcasm, or irony. ● Avoidance or distancing language, such as acting out, denial, projection, rationalization, or trivializing (Koehly, 2017). ● Environmental noise. ● Cultural differences, particularly when the message sender does not focus on the beliefs, values, goals, and outcomes of the child and family (see Chapter 4 for further cultural factors). ● Language barriers, hearing or speech difficulties. ● Psychological alterations: children with disabilities have communication rights that must be met by the health-care practitioner. ● Sender and receiver biases. ● Closed-ended, yes-or-no questions: use only when the nurse needs focused information. ● Ignoring family and psychosocial issues (Koehly, 2017). Additional barriers are described in Box 3-1.
FIGURE 32 Child using American Sign Language for the word love.
BOX 31 | Barriers to Communication Barriers to communication with children and families include: 1. Closed-ended questions with yes-or-no answers 2. Prejudiced or preconceived messages based on race, age, ethnicity, culture, gender, lifestyle, wealth, appearance, or status 3. Preconceived messages based on the practitioner’s beliefs of what constitutes correct family structure, function, or roles 4. Unaddressed fears of the child or the caregiver 5. Child, family, or caregiver not being treated with respect 6. Insufficient information 7. Not answering minor questions, such as those related to diet 8. Failure to include parents in the care plan 9. Parents not being treated as partners in their child’s care 10. Failure of nurses to understand parent–child relationships 11. Failure to meet the developmental needs of the child 12. Failure to consider cultural aspects or speaking in nuanced language that is specifically culturally based
CLINICAL JUDGMENT Protection for Individuals With Hearing Disabilities
“Title III of the Americans with Disabilities Act (ADA) prohibits discrimination against individuals with disabilities by places of public accommodation” (42 U.S.C. §§ 12181–12189). Private health-care providers are considered places of public accommodation. As noted by the National Association of the Deaf (2017), “The U.S. Department of Justice issued regulations under Title III of the ADA at 28 C.F.R. Part 36. Health care providers have a duty to provide appropriate auxiliary aids and services when necessary to ensure that communication with people who are deaf or hard of hearing is as effective as communication with others. 28 C.F.R. § 36.303(c).”
CLINICAL JUDGMENT Hearing Screenings
Hearing screenings are performed before discharge on all infants born in the hospital. This evaluation detects
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