Chapter 3 | Family Dynamics and Communicating With Children and Families 51
● Have toys available during procedures. Allow the child to perform the procedures on a doll or stuffed animal so he or she can better understand what will occur. Supporting pre- tend and fantasy play with the child provides opportunities to express fears and anxieties. ● Use the parents and caregivers to assist with providing care and communication. ● Support preschoolers who self-talk (internal speaking that helps to identify information about emotions, attitudes, and beliefs). This practice encourages the alignment of thought patterns (Traub, 2016). ● When appropriate, offer the child choices so that control can be maintained (e.g., do you want water or juice after you swal- low your medicine?) ● Prepare the child for the procedure just before the procedure, not days in advance.
● Allow the child to voice concerns. ● Encourage children to ask questions and answer honestly and simply, in concrete verbiage. ● Allow the child to have time to play, explore questions, and have fun. ● Older children may wish to journal their experiences. ● Other children may serve as a support group. ● Facilitate playtime, which allows the child to communicate thoughts or feelings in a nonthreatening environment.
Communicating With Adolescents
Adolescence, from ages 13 to 18 years, is a time of developing independence and maturity. The adolescent typically focuses on social networks and friends and may seek counsel and feedback from sources other than parents and caregivers. Sexual devel- opment, including menstruation and emission, has occurred. Behavior may fluctuate between adult and childlike. Adoles- cents are independent with activities of daily living but require adult supervision and input (Fig. 3–19). Trust is extremely important in relationships and influences the extent of com- munication. Adolescents tend to develop their own language and culture, which may be different from those of parents and caregivers. Medical decisions may be influenced by the adoles- cent’s peer group. Nursing Interventions for Communicating With Adolescents ● Use open-ended questions. ● Encourage the child to express his or her feelings and concerns. ● Provide privacy, as many adolescents will not be honest if interviewed in the presence of parents or caregivers. ● Explain the limits of confidentiality.
Communicating With School- Age Children
The period of physical and psychosocial development from ages 6 to 12 years includes many milestones, such as entering school, communicating independently, and beginning to conceptualize the environment. Direct communication with children of this age is equally important as communicating with their parents. School-age children are energetic and want answers to their questions. They develop connections between new information and existing knowledge. Other communication characteristics of the school-age child include: ● Curiosity: ● Used to asking questions in school when they cannot understand ● Want to know why or how things happen ● Knowledge gained by hands-on experience: ● Enjoy having a job or task to complete ● Eager to please and want to complete a task independently ● Work well with positive feedback ● May bargain to postpone an intervention ● Concreteness: ● Unable to think abstractly ● Learns well when given physical examples ● May overreact if feeling threatened ● Able to verbalize thoughts, feelings, or concerns Nursing Interventions for Communicating With School-Age Children ● Tell the child that he or she is part of the medical team to get well and recover. ● Assign daily jobs, such as an exercise or a task, so that the child can assist with care. ● Explain the why and how in simple, nondescript, and non- fearful terms. ● Remember that abstract thinking has not yet been accom- plished at this age. ● Allow the child to participate in procedures safely, such as tak- ing off an adhesive bandage or depressing a blood pressure cuff.
FIGURE 319 Adolescents are becoming more independent, but still require adult supervision and input.
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