When you’re nursing for two: effective patient communication with adolescents and their parents

Adolescence is a very tricky time for everyone; it’s tough for the child to come to terms with their transition to adulthood and their relations with parents may be strained. It is imperative that in a healthcare setting, with its additional stress and uncertainly, nurses can quickly gain trust and deal with what can be challenging and complex three-way communication process between a parent and teenage patient.

Nurses should try involve older children and adolescents in the whole decision making process as much as possible, even though the parent is ultimately responsible for giving consent. This requires educating the family and patient appropriately and ensuring communication is on a level that they can understand, setting expectations about future tests and treatments.

This is especially important in the context of adolescents, who will likely have the intellectual capacity of their parents and be perfectly capable of making their own healthcare decisions. The general rule of thumb to follow is that if a child is asked their opinion about the direction of treatment or participation in research, then their views and desires should be seriously considered.

The older the child is, the greater the need to involve them in the decision-making process and obtain assent, or agreement from the child to participate. Depending on the age of the patent, their involvement in this stage would typically be as follows:

• 10 – 12 years: Partially involve the child in the decision-making process to obtain mutual agreement;
• 13 – 17 years: Obtain agreement for treatment even though they are not the primary decision maker.

In trying to obtain assent, it is essential that a nurse firstly develops an understanding of the child’s level of development as well as their age. How well do they understand what’s happening, the process to come and any implications? Are they being influenced unduly? How willing are they to be treated? Could their attitudes change over the course of a treatment programme?

What are the key stages to follow in getting assent?

Each stage needs to be modified in line with the child’s individual developmental level:

• Help the child understand their health condition and inform them of the treatment planned
• Determine what the child understands about their condition
• Ensure they are not being unduly influenced to make any decisions/ follow a course of action
• Ascertain how willing they are to participate in the treatment or pursue a course of action.

Appreciating differences in communication preferences

Adolescents will have very different communication preferences to their parents, so obtaining assent and ensuring they understand their situation may require a different style of approach. For instance, teens tend to use fewer words than adults and may rely more on non-verbal cues, of which silence and pauses in communication are very important.

If a teenager appears shy, focus on the parents initially as they may need extra time to warm up. Some will process information more slowly than their parents and having conversation gaps will allow the young person to assimilate what’s being discussed.

Another aspect to consider is the importance of comfort giving and the establishment of trust. Whereas the parents will be happy with the facts and detailed information to answer their questions, adolescents will need to establish an immediate rapport with their nurse and achieve a level of trust in order to go forward. The best communicators in paediatric nursing are able to quickly find this balance.

Top tips for effective verbal communication with adolescents

1. Avoid medical jargon and acronyms when explaining but appreciate many parents and adolescents will have conducted some initial research online and be reasonably well informed from the outset
2. Stick to open-ended questions to result in more detailed answers (i.e. avoid yes/no answers)
3. If the conversation digresses, actively get it back on track. Manage the conversation to maintain focus on the key topic to be discussed
4. Reflect on what has been discussed to verify the parent and child’s immediate feelings
5. Demonstrate empathy by reiterating their previous answers
6. Acknowledge their emotions
7. Demonstrate active listening by using the same words as the child and family in your replies
8. Don’t interrupt. Always let the patient and family finish their points.

Ensuring that you communicate effectively with children and guardians according to their age and needs is an easily overlooked aspect of patient care. Doing so with these considerations in mind will help ease the process of managing patient care and build trust with younger patients.

For further reading, the General Medical Council has further information on the subject:

http://www.gmc-uk.org/guidance/ethical_guidance/children_guidance_14_21_communication.asp