Communicating with Children

Communication with Children

Communication, often known as the exchange of ideas or thoughts, is the process by which two or more individuals communicate information. Interaction between the parties involved in communication allows for the verbal or nonverbal transmission of messages. Every aspect of human conduct carries a message, making it a type of communication.

Data collecting primarily comes via communication. The child, parents, other family members, and interactions between the child and parents are used to gather information on the child. Communication between the nurse-parents and the child in a pediatric health care context is focused on health promotion activities (such as growth charts, vaccines, nutrition, and accident prevention), developmental milestones, deviations on health conditions, and anticipatory guidance.

Importance of Good Communication and Trust in Child Health Nursing Communication is a critical skill for nursing.

The good communication between nurses, parents and children have many benefits.

• Nurses who take the time to listen and understand the unique challenges and concerns of each of their patients are better prepared to address issues as they arise, resulting in better patient outcomes.
• Families who have established an open and secure dialogue with a nurse are more likely to disclose the true extent of their feelings and symptoms much quicker. They also feel more satisfaction with the care they receive, if the nurse provides them with undivided attention.
• Effective communication protects patients from potential harm arising from misunderstandings. On the other hand, poor communication, or lack of communication, can lead to patients misunderstanding directions and failing to follow treatment protocols. It can also lead to workflow breakdowns on the team, resulting in medical errors (e.g poor communication during patient transfers may contribute to 80% of serious medical errors).
• At the sametime good communication in nursing not only benefits the patients, but the nurses as well. Nurses who communicate well with their coworkers and patients tend to have increased self-confidence, professional standing, job satisfaction and reduce stress.

Nurse Child Parent Relationship

Nurses who treat the parents and children with consideration, respect, and security. The acts and words of nurses are typically more effective at building trust. Every parent and kid should be approached by nurses with the goal of understanding their worries and experiences. Nurses must respond not simply to the spoken message's substance but also to the feelings and experiences expressed. When and where nurses speak with patients must be carefully considered. Every nurse-patient encounter needs to be given the time it needs. For instance, some patients might be reticent, anxious, disturbed, or otherwise incapable, which could increase the amount of time needed to have a complete discussion of the pertinent problem at hand. A hurried chat may come off as unfriendly to patients.

While interacting with the parents and children, the nurse must consider the following points:

• Listening is the most important aspect of communication. When listening, think about what the person is saying and not about how you are going to respond.
• Silence is also a form of communication; it might indicate that the person is thinking, or  unclear about what is being said, or having difficulty responding, or is angry.
• Time management is an important aspect of communication. Nurses should communicate in acalm and unhurried manner.
• Use open-ended questions followed by guided statements. It is always important to clarify statements and feelings expressed by caregivers and children.
• Good strategies while communicating with children include maintaining eye contact, playful engagement, and talking about the interests of the child and caregiver.
• Avoid communication blocks, such as giving unnecessary advice, providing false assurances, being defensive and judgmental or stereotyping, interrupting, and not allowing the person to finish a response.
• Make use of interpreters when necessary for effective communication (when the language barrier or hearing impairment is present).
• Avoid medical jargon during communication with parents and child
• Always respect the cultural differences.

Methods of Communication with Children

Both verbal and nonverbal communication approaches can be used to deliver and receive messages. While nonverbal communication makes use of various forms, such touch and gestures, verbal communication uses the spoken or written word. Although both verbal and nonverbal communication take place at the same time, nonverbal communication predominates.

Verbal Communication:

Verbal communication is an exchange of information using words, including both the spoken and written word. Nurses use verbal communication extensively when providing patient care. Verbal  communication depends on language. Verbal communication is largely conscious because people choose the words they use. The language and words used by the individuals, vary according to their culture, socioeconomic background, age, and education level.

Nonverbal Communication

The transmission of information without the use of words is termed as nonverbal communication, it is also called "body language". Nonverbal communication often tells others more about what a person is feeling than what is actually being said. Observing and interpreting the patient's nonverbal behavior is an essential skill for nurses to develop. It often helps nurses to understand subtle and hidden meanings in what is being said verbally. The various forms of nonverbal communication follow:

• Facial expressions: The face is the most expressive part of the body. Facial expressions convey emotional states (feelings) of an individual. Facial expressions can convey the message of anger, joy, suspicion, sadness, fear, and contempt. For example, a frown or an eyebrow raised expresses the feeling of doubt. Facial expressions provide the nurse with continual non-verbal feedback from the patients.

As the children are often very sensitive to the facial expressions of the nurse, it is imperative for nurses to make every effort not to facially express feelings of shock, alarm, or any other negative emotion in front of the pediatric patients. A nurse frowning facial expression while "dressing a wound" may be interpreted by the child as the nurse being worried and concerned about the look of the wound.

• . Body language (body movements and gestures): The way individuals move, walk, sit or stand communicates information about their mood, attitude, state of mental and physical health, and self-esteem. An upright posture, smiling face, quick and purposeful movements communicates a sense of wellbeing and self-confidence, whereas a flaccid posture, slow and hesitant movements and awkward gait may indicate depression, physical illness or impairment or fatigue.

Although most of the time the body language can communicate about the patient's feeling sometimes it can be a mistake to interpret a single movement, gesture or facial expression in isolation. Therefore all non-verbal clues need to be observed together when considerin what is really happening. When a person's actions or gestures do not match with the spoke words, it is important to nurse to clarify what is happening.

• Posture: The way a person holds the body carries nonverbal messages. People in go health and with a positive attitude usually hold their bodies in good alignment. Depressed tired people are more likely to have slouched posture. Posture also often provides nonver clues concerning pain and physical discomfort, for instance, a rigid, stiff appearance migh a good indicator of tension and pain.
• Eye contact: Communication often begins with eye contact. Eye contact is another esse element of facial communication. In many cultures, eye contact suggests respect and a  of willingness to listen and to maintain communication open. Some individuals who experienc of eye-contact often indicates anxiety or defenselessness, or avoidance of communication. fear might be unable to speak and only their eyes will send the message blank stare can indicate daydreaming or inattentiveness. Absence
• Touch: Touch is one of the most powerful and personal forms of expression. It is the mos effective forms of non-verbal communications of comfort, love, affection, security, anger, frustration, aggression, excitement, and many others. Touch is a personal behavior: means different things to different people. Factors such as age and sex also play a l meanings associated with touch. and key role in conveys Soothing touch can be used to transmit the message of positive feelings of understanding compassion or reassurance. The way that the nurse touches the child feelings towards the child and their illness. To be effective, touch must be used at the nurses appropriate time and place, otherwise it can be seen as an "invasion of privacy" unless it is desired. Therefore nurses always need to be sensitive to assess "how comfortable the child and parents" are with being touched.
• Tone of voice: The tone and pitch of voice, and inflection have a powerful effect. Tone and pitch of voice can display anger, apathy, enthusiasm, excitement and other emotion, through which the person can determine the way in which the words are spoken than from the a words used. Loud and forcefully spoken words can frighten the child and communicate aggression; a patronizing tone can communicate arrogance, while expressionless speech can communicate lack of interest. e actual
• Personal appearance: Personal appearance of the nurse and health care person has a strong influence on the initial perceptions and impressions of the child. Physical characteristics, degree of cleanliness, manner of dress, style of hair and makeup are some of the things that provide the information from which impressions are formed. The Child forms a general impression from the initial appearance of a nurse, and well-groomed, soft-spoken nurses are likely to create a favorable impression among the child.

Technique of Effective Communication with Children and Parents

Communicating with Infants

• Infants are unable to use words, infants primarily use and understand nonverbal communication. Infant evaluates only the approach how they are being handled or cared and responds only to sensory cues. Infants cannot differentiate the nurse who handles them abruptly and hurriedly are rushed or insecure, they feel only that the nurse is frightening and unloving; and start to mistrust them.
• While communicating with infants and caregiver it is important to establish a relationship with the caregiver at first. Have passion and spend adequate time in the beginning of an interaction to calm down and to get connected with the infant. To comfort the infants' hold, cuddle, and pacify them, or allow caregivers to do so.
• While initiating the conversation, allow the caregiver to hold the infant, and begin observing the infant, caregiver, and their interactions. When necessary, ask the caregiver for permission to hold the infant or to place him or her on an examination table or bed.
• Sensory play activities, such as massaging the infant, stretching the arms and legs, showing a colorful or moving object, and singing a song, can ease the infants and convey a sense of safety and comfort. Avoid loud, harsh sounds and sudden movements, because these are frightening to infants.

Communicating with Young Children

• Allow the caregiver to hold the young child as you initiate conversation, and begin observing . the child, caregiver, and their interactions.
• As young children are egocentric, they see things only in relation to themselves and from their point of view. Therefore, focus communication on them. It is mandatory to explain to the child "how they will feel" or "what they can do". Always use short sentences, positive explanations, familiar and non-t with them. threatening terms, and concrete explanations while talking with them.
• A sudden appearance of strangers, abrupt and noisy approaches signal danger and frightens the young children. Therefore adequate time needs to be provided to the children to evaluate the situation while they are still in the arms of the caregiver.
• Give adequate time for the child to initiate the relationship, do not rush the situation. A casual conversation (talking about their doll, toy, dress colour, shoes) is an effective approacha as it might put them at ease.
• Children might show temper-tantrum, rejecting or aggressive behavior, ignore these behaviors unless they are harmful to the child or someone else.
• If feasible allow young children to handle or explore equipment that will come in contact with them. For example, have them touch the bell of a stethoscope, listen to their teddy bear's heart, or play a simple game with these objects. Such activities may communicate better than words, since young children cannot yet understand abstract ideas.
• When speaking with young children, do not stand over and talk down to them. Instead, get down on eye level with them. .
• Use a simple word and speak in a slow, clear, positive voice. Keep sentences short. Express statements and questions positively. Listen to the child's fears and worries and be honest in your answers.
• Whenever possible, give choices to the child so that they will feel a sense of having some control over the situation and often will be more cooperative. Choices must be offered only if they exist and it should be simple and limited.
• Young children cannot separate fantasy from reality; therefore analogies (words having similar meaning) should not be used. For example, while giving injection if the nurse s says traumatic "This will be a little bee sting" young children visualize a bee sting, which might be
• As they have limited verbal skills, attention should be given to nonverbal clues such as pushing an object away, covering the eyes, crying, kicking, pointing, clinging, exploring an object with the fingers, which indicates their frustration and anger.

Communicating with School-Age Children

• Allow time for the child to initiate the relationship, do not rush the situation, and acknowledge the presence of parents if present.
• Include the child in the plan of care. Provide simple explanations that help them understand how equipment works.
• As school-age children are very curious and interested to know things they often ask "what" "why" and "How" questions if their curiosity is not satisfied. Using age appropriate language simple, concrete responses should be provided.
• They have concerns about body integrity. Anything that poses a threat of injury to their bodies creates anxiety to them. Their anxieties can be reduced by allowing them to verbalize their concerns and by providing reassurances.
• Play or artwork can give insight into how well a child understands procedure or experience. Subsequent play can provide clues to the child's progress or changing feelings.

Communicating with Adolescents

• Communicating with adolescents might be challenging as they waiver between thinking like an adult and thinking like a child.
• Adolescents respond positively to individuals who show a genuine interest in them.
• While communicating with adolescents, interviews should focus on them rather than the problem.
• Effective rapport can be established by informal conversation about friends, school, hobbies, and family. Once rapport has been established, return to more open-ended questions.
• Adolescents might not reveal much of the information with caregivers present. If adolescents and caregivers are to be interviewed, first interview the adolescent alone (to establish relationship), then the adolescent and caregivers together, and then the caregivers separately
• Ensure the adolescent and caregiver about confidentiality of the information. As well as adolescents should be discussed regarding, what will not be shared with caregivers, and what must be shared with caregivers.
• Encourage adolescents to discuss sensitive issues with caregivers. Listen to adolescents in an open-minded, nonjudgmental way and avoid asking private or embarrassing questions.
• While dealing with sensitive issues, encourages the adolescent to respond without feeling embarrassed. Anxiety can be reduced by confining conversations to non-threatening topics until the adolescent feels at ease. Observe for clues that he or she is ready to talk.
• Make contracts with adolescents so that communication can remain open and honest and the plan of care may be more closely followed.

Communicating with Parents

• Much of the information about the child comes from the family. Always view the parents/ caregivers as experts in the care of their child and respect them.
• Identify the child's caregivers (not always mom or dad) and clarify roles.
• When talking with caregivers, observe how they interact with the child and how the child interacts with them. Watch how caregivers set limits or fail to set limits.
• Include caregivers in providing information, problem solving, and planning of care.
• Keep caregivers well informed of what is going on.
• Explain procedures and invite caregivers to help, but do not force them to participate if they are not comfortable doing so.
• Make the caregiver feel welcome and important.
• Pay attention to the verbal and nonverbal clues a parent uses to convey concerns, worries, and anxieties about the child.
• Create a trusting atmosphere that allows parents to be open about all of their concerns. Ask facilitating questions: "Do you have any other concerns that you would like to tell me about?" "Was there anything else that you wanted to tell or ask?"
• When communicating with the parent, provide positive reinforcement and ask open-ended questions. Be supportive, not judgmental. This approach is non-threatening and encourages description.
• Acknowledge the hard work of parenting and praise successes.
• Sometimes caregivers might not perceive a problem the nurse sees; other times parents might perceive a problem that the nurse does not see. Explore what's behind the parents' perception and work toward a mutual agreement.
• Provide caregivers with opportunities to discuss and explore their anxieties, concerns, or problems. Demonstrate genuine care and concern to help ease these feelings.
• Provide anticipatory guidance related to normal growth and development, nurturing childcare practices, and safety and injury prevention.
• Avoid communication blocks, such as giving unnecessary advice, providing false assurances, being defensive and judgmental or stereotyping, interrupting, and not allowing the person to finish a response.