Diana Morris and Janet Orr

1. Diana Morris and Janet Orr Chapter 4 COMMUNICATING WITH ADOLESCENTS

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

3. PART 1: Adolescence and Development

4. 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 used. • Adolescence can be defined as the process of growing from childhood to adulthood and establishing one’s identity. • Differing definitions of the adolescent age range can be confusing.

5. From birth, a child instinctively attempts to communicate, focusing on its mother’s face and crying for food or when it’s uncomfortable. A baby continues to expand its methods of communication. Once at school a child’s language development is increasingly influenced by wider social and cultural experiences as well as literacy. 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. Development

6. Adolescent Development and Communication 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.

7. PART 2: Communicating with an adolescent

8. 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

9. The Communication Process

10. 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

12. 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 today’s digital society, use of a mobile phone, texting and e-mail are second nature and very important to many adolescents.

13. 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.

14. 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 “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.

15. 2. Avoidance Behaviour • Avoidance behaviour is used to avoid confrontation. • 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 places

16. 3. Assertive Behaviour • What does the term ‘assertive behaviour’ mean to you? • 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 view? • Getting your own way? • Assertive behaviour means stating your own feelings whilst acknowledging other points of view. • It involves clear and steady communication, standing up for your rights and beliefs and looking for possible ways to resolve problems.

17. 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 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.

18. 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, it’s oh, is, like, on’ (as researched by Lancaster University).

19. 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.

20. PART 3: Barriers to Communication

21. 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.

22. Key Skills 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.

23. 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.

24. 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 communication • Active listening • Be aware of ways to improve listening skills

25. Pitfalls 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 interrupt Don’t use multiple questions Don’t be distracting Do communicate clearly and ensure consistency between verbal and non-verbal communication

26. 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?

27. PART 4: Transactional Interaction

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

29. 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.