Diana Morris and Janet Orr. Chapter 4. COMMUNICATING WITH ADOLESCENTS. Introduction. This presentation explores the communication with adolescents in a healthcare setting. You should work through the notes here in conjunction with the skills covered in the printed book.
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COMMUNICATING WITH ADOLESCENTS
Increasing diversity of experience influences social and moral development.
This is characterised by a child’s attitude and behaviour towards others.
If language and literacy are not well established during the early years of a child’s life, the ongoing development of other useful skills throughout adolescence can be problematic.
An adolescent’s level of maturity is closely related to levels of communication. Self-esteem problems may be related to school and family life.
The onset of puberty can also impact on quality interaction with teenagers.
Adolescent stress, either physical or emotional, can be exacerbated by traumatic experiences. These can impact on a young person’s level of maturity, beliefs, attitudes, health, behaviour and communication.
Verbal – speech, tone
Non-verbal – a large percentage of feeling is communicated non-verbally via physical appearance, eye movements, utilization of space, touch, facial expression, and gestures
Relational communication - all behaviour has some message value and can be interpreted as caring or non-caring
Digital communication – using symbols (words are symbols)
Analogical communication – involves representing something with a likeness and includes non-verbal communication
For many adolescents, it is very important to ‘fit in’,
and to be liked and respected by their peer group.
Examples of attempts to do so could include being good at sport, adopting the “goth culture”, wearing the “right” trainers and clothes or listening to particular types of music.
In today’s digital society, use of a mobile phone, texting and e-mail are second nature and very important to many adolescents.
Behaviour is very relevant to the communication needs of the adolescent, especially in the health setting where adolescents are frequently affected by eating disorders or episodes of self-harm.
Aggressive behaviour offends or isolates its object. It is a demonstration, perhaps both physically and verbally, of anger or dominance. It may be an automatic or a one-off reaction to a particularly sensitive or threatening situation, or it might simply be “the final straw”. Aggression can sometimes be a result of fear, lack of self-esteem, or the inability to control a situation in another way.
Submissive or accommodating behaviour allows the reduction of anxiety, guilt or fear by allowing views or thoughts to be misconstrued, ignored or taken advantage of.
It is often instilled in children by parents, schools and hierarchical organisations. Adages such as “don’t rock the boat”, “let sleeping dogs lie” and “let it go over your head” exemplify the way in which submissive behaviour has been historically promoted.
This is confusing to the adolescent with no respect to their individuality.
National standards in health and social care encourage user participation.
The RCN adolescent forum is currently producing guidance for health care professionals working with teenagers. This will highlight the importance of individual communication needs.
SOCIO-ECONOMIC FAMILY DYNAMICS
The early years of childhood greatly influence the
attitudes of the adolescent.
Social status can be conveyed by language.
In the UK, a person’s range of vocabulary can be indicative of the level of education attained.
Dialect, accent, ‘trendy words’, or specialist vocabulary almost constitute a ‘language culture’ in certain occupations and professions.
In the medical profession it is important to use language and communication methods appropriate to the patient and carers.
‘Yeah but, no but, yeah . . .’ may seem to constitute a significant part of contemporary adolescent conversation, but this is not true in all areas of Britain.
The ‘in’ words for adolescents change with time and vary regionally and nationally. These can be identified through examination of television and radio programs, internet chat rooms and magazines.
The top 20 words used by adolescents : ‘me, I, the, and, it, a, to, yeah, that, what, no, in, know, he, of, it’s oh, is, like, on’ (as researched by Lancaster University).
Consideration of body language and other aspects of non-verbal communication are also important.
Many aspects of communication come down to not ‘what’ is said but ‘how’ it is said.
Clear messages can be conveyed without words, simply by using body language or altering the meaning of a message by changing emphasis or tone of voice.
The adolescent may find this difficult.
They may not immediately tell you how they feel, so getting to know the young person is integral to good communication.
In an unfamiliar environment such as a clinic, hospital ward,
accident and emergency unit or minor injuries unit, an ordinarily articulate, confident young person may feel isolated and apprehensive or disorientated and confused.
It should be remembered that an anxious person does not retain as much new information as they would normally.
It is important for nurses to make time to talk with their patients.
Often, student nurses are encouraged to talk to both the families and the patients.
This is a valuable time to build a rapport with your patient and find out if anything may be troubling him or her. This can be difficult if the patient does not wish to talk, but an act or word of kindness may be all that is needed to break down barriers.
To effectively connect and communicate with young patients you must listen carefully, ask questions to verify the adolescent’s story and listen for what is left unsaid by both parents and the adolescent.
Pay attention to the emotion behind the words.
Maintain frequent eye contact and be prepared to share information about yourself.
Explain possible treatment options and ask for the young person’s preferences.
You will need intuition and to be able to interact sensitively.
Be confident when confronted with parents’ distress.
Whenever possible, be empathic.
Parents of sick children of all ages are often frightened by their lack of control in a clinical setting.
Young people and their parents frequently feel disorientated and confused by it.
So . . .
Welcoming the adolescent patient and their family, explaining the care plan, immediate and long-term treatment and possible options are key parts of a nurse’s job.
Grandparents, siblings and other family members may also need support and information.
Don’t appear bored/impatient/threatening
Don’t be negative
Don’t jump to conclusions
Don’t pass judgement
Don’t argue or disagree
Don’t use multiple questions
Don’t be distracting
Do communicate clearly and ensure consistency between verbal and non-verbal communication
Self-awareness can be a significant tool to improve nurse-client interaction.
Looking at the Johari Window model may help some nurses to improve their communication skills.