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Diana Morris and Janet Orr


Chapter 4 COMMUNICATING WITH ADOLESCENTS Diana Morris and Janet Orr Introduction This presentation explores the communication with adolescents in a healthcare setting. – PowerPoint PPT presentation

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Title: Diana Morris and Janet Orr

Chapter 4
  • Diana Morris and Janet Orr

  • 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.
  • Part 1 - Adolescence and development
  • Part 2 Communicating with an adolescent
  • Part 3 Barriers to communication
  • Part 4 Transactional Interaction

PART 1 Adolescence and Development
What is Adolescence?
  • The World Health Organisation (1995) definition
    states that adolescence is commonly associated
    with physiological changes occurring with the
    progression from the appearance of secondary
    sexual characteristics (puberty) to sexual and
    reproductive maturity.
  • The National Service Framework for Children and
    Young People states that adolescence is defined
    as ages 13-19 (DOH 2004). Within health and
    social care the NSF standard should be the model
  • Adolescence can be defined as the process of
    growing from childhood to adulthood and
    establishing ones identity.
  • Differing definitions of the adolescent age range
    can be confusing.

  • Development
  • From birth, a child instinctively attempts to
    communicate, focusing on its mothers face and
    crying for food or when its uncomfortable. A
    baby continues to expand its methods of
    communication. Once at school a childs language
    development is increasingly influenced by wider
    social and cultural experiences as well as
  • Increasing diversity of experience influences
    social and moral development.
  • This is characterised by a childs attitude and
    behaviour towards others.
  • If language and literacy are not well established
    during the early years of a childs life, the
    ongoing development of other useful skills
    throughout adolescence can be problematic.

Adolescent Development and Communication
An adolescents 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 persons level of maturity,
beliefs, attitudes, health, behaviour and
  • PART 2 Communicating with an adolescent

Types of 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
The Communication Process
Communicating with an adolescent
Communication is a two-way process. How you
listen is as important as the words used, body
language and manner of speaking It is important
to remember when communicating with an ill child
or adolescent that he/she is the patient BUT The
parent/carer is a key person in any
transaction. On the next slide you will see
examples of some of the issues that relate to
communication with adolescents
(No Transcript)
Peer Pressure 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 todays digital
society, use of a mobile phone, texting and
e-mail are second nature and very important to
many adolescents.
Communication Behaviour
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.
1. Submissive/Accommodating Behaviour
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 dont 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.
2. Avoidance Behaviour
  • Avoidance behaviour is used to avoid
  • Adolescents can be highly adept at avoiding
    uncomfortable situations, either through a
    refusal to recognise a problem or by deliberately
    side-stepping confrontational situations.
  • This is particularly evident in the adolescent
    within the health care setting.
  • For example
  • Taking drugs
  • Substance misuse
  • Unprotected sex
  • Refusing to get a diagnostic test
  • Not answering phone calls
  • Avoiding socialising in certain

  • 3. Assertive Behaviour
  • What does the term assertive behaviour mean to
  • A method of getting what you want at the expense
    of others?
  • Being masterful and in control?
  • Being aggressive, domineering or bossy?
  • Adopting a mutual acceptance of others points of
  • Getting your own way?
  • Assertive behaviour means stating your own
    feelings whilst acknowledging other points of
  • It involves clear and steady communication,
    standing up for your rights and beliefs and
    looking for possible ways to resolve problems.

Verbal Communication 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 persons 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.
LANGUAGE TRENDS 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, its oh, is, like,
on (as researched by Lancaster University).
Non-Verbal Communication
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.
  • PART 3 Barriers to Communication

Barriers to 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.
Key Skills To effectively connect and
communicate with young patients you must listen
carefully, ask questions to verify the
adolescents 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
persons 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 nurses job.
Grandparents, siblings and other family members
may also need support and information.
  • Guidelines for Effective Communication
  • Use appropriate manner
  • Convey warmth
  • Show respect
  • Convey understanding, interest and empathy
  • Take time
  • Use open questions
  • Build on others ideas
  • Use statements
  • Clarify and summarise
  • Ensure congruence between verbal and non-verbal
  • Active listening
  • Be aware of ways to improve listening skills

Pitfalls Dont appear bored/impatient/threateni
ng Dont be negative Dont jump to
conclusions Dont pass judgement Dont argue or
disagree Dont interrupt Dont use multiple
questions Dont be distracting Do communicate
clearly and ensure consistency between verbal and
non-verbal communication
  • Barriers to Effective Communication
  • In what ways would you adapt your communication
    when an individual is
  • Aurally impaired?
  • Visually impaired?
  • Mentally impaired?
  • Confused?
  • Aggressive?
  • Distressed?
  • Unable to speak your language?

  • PART 4 Transactional Interaction

  • Interaction
  • Transactional analysis has at its core the ego
  • People are perpetually demonstrating an aspect of
    their personality in one of three ego states
  • Parent ego state concerns behaviour copied from
  • Adult ego state concerns behaviour appropriate
    to the present situation or interaction.
  • Child ego state concerns behaviour replayed from
  • Transactional analysis looks at the communication
    between two people and identifies the different
    ego states in play.

  • Transactions are either
  • Complementary appropriate conversation flows
    back and forth in a consistent manner.
  • OR
  • Crossed the ego state which is addressed is
    not the one which responds. This can move the
    other person into the child ego state or make
    them feel hurt.

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.
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