Solution Manual for Child Health Nursing 3rd Edition by

Bindler Cowen Shaw ISBN 0134624726 9780134624723

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CHAPTER 6

CHILD AND FAMILY COMMUNICATION

Resource Library

Student Resource Site

Audio Glossary

NCLEX Review

Critical Thinking: Communication Techniques, Creating an IPR

Case Study: A School-Age Child Who Is Non-English Speaking

Care Plan: Infant with a Hearing Impairment

Media Links: Communication Skills

Media Link Applications

Videos and Animations: Caring and Empathy; Alternate Methods of Communication;

Nonverbal Communication

Copyright 2014 by Pearson Education Inc.

Pediatric Dosage Calculations

Image Library

Figure 6–1 The nurse is sending a message to the older child, the receiver. Notice the nonverbal

communication expressed by the young girl.

Figure 6–2 Facial expressions are a powerful means of communication.

Figure 6–4 Most hospitals have designated interpreters that you should use.

Figure 6–5 Taking time to listen to the family members and child is important to the

establishment of trust and developing a rapport with the child and family.

Figure 6–6 Putting a mask on her doll gives this child some mastery over her coming surgical

experience.

Figure 6–7 Most teens are happy to keep a journal of important events and feelings.

Table 6–4 Language Alternatives When Communicating with Children

LEARNING OUTCOME 1

Describe the major components of the communication process as they apply to nursing care of

children and their families.

CONCEPTS FOR LECTURE

1. Communication is defined as an ongoing, cyclical exchange of information, thoughts, and

feelings. It provides the means by which individuals, from birth through adulthood, learn

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 about the physical and social world.

2. Trust and rapport form the basis for communication with children and families.

3. The major components of communication are the sender, message, channel, receiver, and

response.

4. Barriers to effective communication include language and use of medical jargon, gender,

environment, health status, emotions, space, and culture.

5. Communication is supported by empathy and caring on the nurse’s part.

6. The sender initiates the process and should consider age, developmental level, language,

dialect, and understanding of the receiver, and the purpose of the communication.

7. The message involves words, body language, and manner of transmission, while the channel

is the medium through which the message is transmitted: auditory, visual, and/or kinesthetic.

8. The receiver must determine the meaning of the message through decoding.

9. The receiver responds to the message by providing feedback to the sender and continues the

cycle until it is terminated by sender, receiver, or both.

POWERPOINT LECTURE SLIDES

Communication

 Ongoing and cyclical

 Exchange of thoughts, feelings, information

 Importance of trust and rapport

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  Components—sender, message, channel, receiver, response

Components of Communication Cycle

 Sender—generates the message

 Message—verbal, nonverbal, or abstract

 Channel—auditory, visual, kinesthetic

 Receiver—decodes the message

 Response—feedback to sender

LEARNING OUTCOME 2

Identify forms of communication and their related concepts.

CONCEPTS FOR LECTURE

1. Communication can be verbal, nonverbal through gesture or body language, or abstract

through play or other representations.

2. Verbal communication should take into consideration culture and level of language and

cognitive development.

3. Aspects of nonverbal communication include paralanguage, gestures, touch, personal space,

facial expression, body language, eye contact, and physical appearance.

4. Paralanguage involves tone, pitch, pace, volume, and inflection, and is important in the

receiver’s interpretation of a message.

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5. Interpretations of nonverbal communication are influenced by culture, context of a situation,

development level, and other factors.

6. Abstract communication can include the sending of messages through activities such as play

or through appearance, such as selection of clothing by an adolescent.

7. Incongruence between verbal and nonverbal forms of information can result in

misinterpretation of the intended message.

POWERPOINT LECTURE SLIDES

Communication Forms

 Verbal

 Nonverbal

 Abstract

Verbal Communication

 Verbal and written words, vocalizations

 Speaking to another

 Writing a letter

 Crying, laughing

 Influenced by development and cognitive level

 Influenced by culture

 How does the nurse use verbal communication in nursing care?

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 Nonverbal Communication

 Forms of Nonverbal Communication

 Paralanguage

 Gestures

 Touch

 Personal space

 Facial expression

 Body language

 Eye contact

 Physical appearance

 Facial expression

 (Figure 6–1, Figure 6–2)

 Ambiguity

 Influence of development and cognitive level

 Influence of context—what is the situation?

 Influence of culture

 Congruence between verbal and nonverbal message

 How should nonverbal communication be applied to nursing care?

SUGGESTIONS FOR CLASSROOM ACTIVITIES

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Assign students to observe children of various ages in a naturalistic setting, such as on a

playground or in a mall (to observe adolescents). Have them document examples of nonverbal

and abstract communication. Discuss the various interpretations of these during class.

SUGGESTIONS FOR CLINICAL ACTIVITIES

 Assign students to complete a process recording of a 10-minute interaction with a child

during the clinical experience, using a template such as the following:

Child’s Student’s Nonverbal Context/Situational Comments

Statements Statements Communication Factors/Environment

 Have students analyze the verbal, nonverbal, and abstract communication in the interaction

and the congruence among these. Discuss methods to more effectively communicate with the

child.

LEARNING OUTCOME 3

Analyze factors influencing the communication process.

CONCEPTS FOR LECTURE

1. Situational, family, environmental, physical, cultural, and psychosocial factors affect the

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 process of communication.

2. Language barriers, including the use of medical terminology, can result in significant

interference with child and family understanding.

3. Children’s experiences with healthcare providers of different genders, coupled with cultural

perceptions, can influence the effectiveness of communication among children, families, and

healthcare providers.

4. An appropriate environment for the exchange of information is essential; privacy, enough

seating, and physical comfort promote effective communication.

5. Consideration of personal space and provision of adequate time for discussion promote

effective communication.

6. The child’s current health status, and the child’s or family’s response to this, should be taken

into account in the communication process.

7. Trust, rapport, empathy, and caring enhance communication among nurses, families, and

children.

POWERPOINT LECTURE SLIDES

Influence of Physical and Psychosocial Factors on Communication Process

 Physical factors—language, gender, environment

 Psychosocial factors—culture, health status, emotions, space, and time

Influence of Language Issues

 Language and linguistic differences and expectations

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  Medical terminology and medical jargon

 Nursing strategies to minimize language barriers

Influence of Gender

 Prior experiences

 Expectations of women and men

 Cultural influences

 Nursing strategies to minimize gender barriers

Influence of Environment

 Environmental factors

 Comfort

 Privacy

 Nursing strategies to minimize environmental barriers

Influence of Health Status

 Physical condition

 Emotional responses

 Need for information

 Nursing strategies to minimize barriers

Application to Nursing Care

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  Individualized approach

 Caring

° The nurse’s emotional investment in the child and family

° Evokes a feeling of security and comfort

 Caring environment needed for communication

 Empathy

° Ability to perceive another person’s experience

° Empathetic behaviors and expressions enhance communication

SUGGESTIONS FOR CLASSROOM ACTIVITIES

Have students role-play a nurse and a parent discussing the child with a chronic illness who was

just admitted to the pediatric unit due to a serious exacerbation of the condition (select chronic

illness based on students’ prior learning). Have the class discuss communication barriers,

identify communication strategies that were effective and those that were not, and discuss their

observations of empathy and caring in the scenarios.

SUGGESTIONS FOR CLINICAL ACTIVITIES

Assign students to care for children from different cultural backgrounds. Provide an opportunity

during postconference to discuss experiences communicating with children and families,

including barriers and facilitators of communication, the influence of health status, differences in

interpretations of nonverbal and verbal communication, personal space, language, and gender

expectations.

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 LEARNING OUTCOME 4

Apply concepts of communication to the developmental levels of childhood.

CONCEPTS FOR LECTURE

1. Developmental, cognitive, and psychosocial factors influence children’s abilities to

understand and comprehend messages sent in the communication process.

2. Newborns communicate primarily through nonverbal modes and crying, and they are

responsive to the human voice, presence, and touch.

3. Infant communication evolves to the use of vocalization, touch, and crying.

4. Toddlers and preschoolers develop the ability to communicate verbally, but they are

egocentric and limited in their expression and comprehension of communication.

5. School-age children develop the abilities to see viewpoints of others, think more logically,

and express and understand explanations more fully.

6. Adolescents are developing the ability to use and understand abstractions, but do not have full

adult comprehension. Privacy, rapport, and trust are important considerations for effective

communication with adolescents.

POWERPOINT LECTURE SLIDES

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 Considerations for Communication with Children

 Developmental level

 Skills

 Language development

 Cognitive development

 Emotional/personality development

Newborns

 Primary mode of communication is nonverbal

 Express self through crying

 Respond to human voice and presence

 Touch has a positive effect

 Nursing strategies include: encourage parent to touch infant

Infants

 Communication is still primarily nonverbal

 Begin verbal communication with vocalizations

 Communicate through crying, facial expression

 Attentive to human voice and presence although no comprehension of words

 Respond to touch through patting, rocking, stroking

 Nursing strategies include: speak in high-pitched voice with soft tone; cuddle, pat, rub

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 to calm

Toddlers and Preschoolers

 Evolving verbal skills

 Use of language to express thoughts

° Greater receptive than expressive language

° Concrete and literal thinking, may misinterpret phrases

° Vocabulary depends on development and family’s use

° May ask many questions (preschooler)

 Short attention span

 Limited memory

 Cognitive development

° Egocentric

° Magical thinking

° Animism

 Nonverbal communication

° Express self through dramatic play and drawing

 Nursing strategies

 (Table 6–4)

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 School-Age Children

 Cognitive development—now able to use logic

° Begin to understand others’ viewpoints

° Begin to understand cause–effect

° Understanding of body functions

 Able to make some decisions

 Important to involve them in discussions about illness and planning care

 Verbal communication

° Vocabulary is large

° Receptive and expressive language balanced

° Misinterpretations of phrases still common

 Nonverbal communication

° Can interpret nonverbal messages

° Expression of thoughts and feelings

Adolescents

 Abstract thinking without full adult comprehension

 Interpretation of medical terminology is limited

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  Drive for independence

 Trust and understanding build rapport

 Need for privacy

 Nursing strategies include: straightforward approach, talk in private area

SUGGESTIONS FOR CLASSROOM ACTIVITIES

Divide the class into groups and assign each group a case study involving a hospitalized child in

a different age group (newborn/infant/toddler/preschooler/school age/adolescent). Have each

group develop a set of nursing strategies for age- and development-appropriate communication

and present it to the class. Have the class develop a chart that incorporates the strategies

discussed.

SUGGESTIONS FOR CLINICAL ACTIVITIES

 Assign students to care for infants and children of various ages. Provide time during

postconference to discuss challenges communicating with children related to age and

development.

 Assign students to observe children in a pediatric unit playroom. Discuss various strategies

used by staff to engage children of various ages and to encourage communication.

LEARNING OUTCOME 5

Give examples of barriers and challenges to communication with the child and family.

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CONCEPTS FOR LECTURE

1. Developmental and physical disabilities pose special communication challenges that can be

overcome with creative strategies such as the use of communication boards.

2. Intubated children or those recovering from procedures involving the face or head may have

difficulty with verbal communication.

3. Visually challenged children and children with auditory impairments require understanding

of the particular problems and special communication techniques.

4. The use of an interpreter for children and families who do not understand English may be

necessary, but family members and other ad hoc interpreters may not transmit information

with complete accuracy. Other useful strategies include communication boards and use of

common terms in the child’s native language.

POWERPOINT LECTURE SLIDES

Communicating with Children with Special Needs

 If unable to communicate, may feel helplessness, fear, anxiety

 Family may become anxious

 Strategies

° Nonverbal—use gestures, picture boards, writing tablets

° Communication augmentation—system of head nods, eye blinks

Communicating with Children Who Have Altered Vision

 Approach to child—identify self as you enter room, announce departure

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  Orient child to objects in room

 Speak before touching

 Explain any unfamiliar sounds

 Continually observe facial expressions

Communicating with Children Who Have Altered Hearing

 Approach to child—face child when speaking, enter room slowly

 Assess degree of impairment—may need interpreter

Communicating with Non-English-Speaking Children

 Cultural implications—need to develop plan of care in respect of culture

 Use of interpreters

° Family—could result in errors and inconsistency

° Use professional translators trained for patient encounters

 Other strategies include: communication with pictures, speaking in normal tone

SUGGESTIONS FOR CLASSROOM ACTIVITIES

Invite a school nurse to class to discuss experiences communicating with children who have

physical, developmental, or sensory challenges.

SUGGESTIONS FOR CLINICAL ACTIVITIES

 Assign students to care for children of various ages who have physical, developmental, or

sensory challenges. Have students develop a nursing care plan that addresses relevant nursing

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 diagnoses and nursing interventions designed to support communication.

 Assign students to care for non-English-speaking children and families. Discuss strategies

that were effective for enhancing communication.

LEARNING OUTCOME 6

Integrate the nursing process to promote effective communication and establish a therapeutic

nurse–child–family relationship.

CONCEPTS FOR LECTURE

1. Assessment of child and family establishes a foundation for effective communication and

identification of appropriate nursing diagnoses.

2. Intervention is targeted to promote the therapeutic nurse–child–family relationship and

communication process.

3. Essential components of the therapeutic relationship are trust, confidentiality, respect, and

developmentally appropriate strategies for interaction.

4. Play, art, writing, storytelling, bibliotherapy, and humor are useful interventions to promote

communication with children.

POWERPOINT LECTURE SLIDES

Communication Assessment for Child and Family

 Development

 Language

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  Physical skills

 Culture

 Barriers

Planning and Implementation

 Promote therapeutic nurse–child–family relationship (Figure 6–5)

 Promote effective therapeutic communication

 Components

° Provide appropriate environment

° Establish trust

° Maintain confidentiality

° Convey respect

 Use therapeutic communication skills

 Alternate techniques (Figure 6–6)

° Play

° Art

° Journaling (Figure 6–7)

° Storytelling

° Bibliotherapy

° Appropriate use of humor

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 Evaluation of Outcomes

 Use of effective techniques

 Establishment of therapeutic relationship

 Recognize and respond to child’s and family’s themes

SUGGESTIONS FOR CLASSROOM ACTIVITIES

Invite a child life professional to class to discuss the use of developmentally appropriate

strategies to assist acutely ill children and their families in expressing their feelings and ensuring

effective communication.

SUGGESTIONS FOR CLINICAL ACTIVITIES

Assign students to participate in a 10-minute therapeutic medical play session with a preschooler

or young school-age child. Ask students to submit a process recording of the session using a

template such as the following, and to analyze the verbal and nonverbal communication process.

Child’s Student’s Nonverbal Context/Situational Comments

Statements Statements Communication Factors/Environment

LEARNING OUTCOME 7

Communicate with patients and families with special needs, including those with low literacy

levels, alterations in sensory perception, and language barriers.

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CONCEPTS FOR LECTURE

1. Children with limited vision or hearing perception experience challenges when removed

from familiar environments and especially during hospitalization.

2. Strategies to enhance communication with children who have alterations in visual perception

include identifying yourself when entering the room, speaking in a calm voice, explaining

procedures and unfamiliar sounds, and observing the child’s facial expressions.

3. Strategies for communicating with children who have alterations in hearing include entering

the room slowly, facing the child when speaking, and clarifying the roles of the nurse and the

interpreter.

4. Strategies to enhance communication with children and families when using an interpreter

include ensuring the interpreter is skilled at both languages; speaking directly to the child and

family; arranging seating, comfort, and a quiet environment; ensuring all information is

interpreted; watching for nonverbal communication that shows discomfort.

5. With all families, maintain confidentiality and convey respect.

POWERPOINT LECTURE SLIDES

Communicating with Nonverbal Children

 Signs, gestures

 Picture cards

 Writing tablets, keyboards

 If intubated, explain when child will be able to speak, tube will be removed

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 Communicating with Children with Neurological Impairment

 Observe facial expressions, eye gaze, body language

 Use direct eye contact, speak in a calm voice

 Establish system of head nods or eye blinks

Communicating with Children with Altered Visual Perception

 Identify yourself upon entering; encourage others to do the same

 Orient ambulating child to objects in room

 Speak in a calm, slow voice

 Explain procedures before touching the child

 Continually observe facial expressions

 Announce when you are leaving the room

Communicating with Children with Altered Hearing Perception

 Enter the room slowly

 Face child while speaking

 Assess need for interpreter

o Establish nurse and interpreter roles

o Inform child interpreter bound by confidentiality

Communicating with Non-English Speaking Children and Families

 Speak in a normal tone of voice

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  Use a communication board with pictures and names of basic needs or requests

printed in both languages

 Learn commonly used words in the child’s language when possible

 Allow all family members the opportunity to express their feelings

 Encourage parents and other family members to participate in the child’s care

 Develop a plan that reflects respect for the child’s culture

 (Figure 6–4)

SUGGESTIONS FOR CLASSROOM ACTIVITIES

Divide students into pairs and have them role-play an admission interview between a nurse and a

patient with a hearing or vision impairment (using blindfolds and earplugs). Discuss both the

communication challenges experienced by the nurse and the patient and the strategies that were

helpful in meeting the challenges.

SUGGESTIONS FOR CLINICAL ACTIVITIES

Assign students to observe care for a child with a visual or hearing impairment or of a child from

a family who does not speak English. Ask students to students to submit a process recording of

what they observed using a template such as the following, and to analyze the verbal and

nonverbal communication process.

Nurse’s Child or Nonverbal Context/Situational Comments

Statements or Family Communication Factors/Environment

Actions Response

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 LEARNING OUTCOME 8

Collaborate with other members of the healthcare team to provide optimal communication to

patients and families.

CONCEPTS FOR LECTURE

1. Interdisciplinary communication and collaboration is essential to providing high-quality care.

2. Examples of collaboration include interdisciplinary rounds to discuss patients with complex

care needs and care coordination to integrate services among a variety of healthcare

providers.

3. Nurses collaborate with developmental specialists to ensure quality communication with

children with special needs and with interpreters to communicate with children and families

who do not speak English.

4. Speech and hearing specialists and pharmacists are examples of other providers with whom

nurses collaborate to provide optimal communication to children and families.

POWERPOINT LECTURE SLIDES

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 Collaborating with Other Team Members

 Interdisciplinary rounds

 Care coordination to integrate services

 Patient education

 Using interpreters

 Collaborating with pharmacists

 Speech and hearing professionals

SUGGESTIONS FOR CLASSROOM ACTIVITIES

Invite a developmental specialist or professional interpreter to class to discuss the use of

appropriate strategies to assist acutely ill children and their families in expressing their feelings

and ensuring effective communication.

SUGGESTIONS FOR CLINICAL ACTIVITIES

Assign students to observe a speech or hearing specialist work with a child who has an acute

illness or sensory impairment. In postconference, discuss what communication strategies were

used and to what extent they were effective or ineffective.

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