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Course: Pediatric Nursing�Topic: Verbal and non-verbal communication

The Nurses International Community

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Communication

Cambridge Dictionary,n.d.

Communication is the form of exchanging and expressing information, feelings, ideas, views between person-person that can result in understanding.

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Importance of Effective Communication with The Clients and Their Families

Relieves distress, soothes anxiety and provides reassurance
Establishes rapport with the child and family members
Assesses the child’s speech and language development
Obtains cooperation
Obtains information needed to make an accurate diagnosis
Obtains consent (adult patient or caregiver) and assent (pediatric patient) for care
Improves patient and family adherence to treatment
Educates patients and families about healthcare conditions
Shows respect and regard for the individual

Palazzi et al., 2015

Contact info: info@nursesinternational.org

Communication entails not only verbal and non-verbal output but also the ability to comprehend and interpret input. Those who focus on the care of children and their families are well served to appreciate developmental milestones of communication, to recognize other factors that impact communication and to tailor their own communication styles to maximize interactions. Understanding the goals and purposes of communication enhances one’s success in communicating with patients and their families.

These goals vary with the age of the child, but for the healthcare provider, the goals would likely include some combination of the following:

Relieve distress, soothe anxiety and provide reassurance
Establish rapport with the child and family members
Assess the child’s speech and language development
Model appropriate communication strategies and language stimulation for parents and family members
Obtain cooperation with the conduct of a physical examination and with treatment Obtain information needed to make an accurate diagnosis
Obtain consent (adult patient or caregiver) and assent (pediatric patient) for care
Improve patient and family adherence to treatment
Educate patients and families about healthcare conditions
Develop and model the care provider-patient relationship that the child will recreate as an adult
Show respect and regard for the individual

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Types of Communication

Ernstmeyer & Christman, 2021

Verbal communication:

An exchange of information using words understood by the receiver in a clear, concise a way that conveys professional caring and respect.

Use of medical jargon or slang interferes with effective communication.

Contact info: info@nursesinternational.org

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Communication With Young Children

Communication requires special attention
Direct communication enhances engagement in medical care and decision making
Consider the health literacy of caregivers and children
Use combination of verbal and non-verbal communication
Be constantly aware and adapt use and choice of communication strategies based on the client’s response

Lapum et al., 2020

Contact info: info@nursesinternational.org

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Verbal Communication in Younger Children

Verbal communication:

Infants enjoy hearing the human voice
Use relaxed and pleasant tone
May use ‘baby talk’; vocal intonation and hyper articulation of sounds
Adopt communication to child’s age; use short, simple sentences
Give compliments and encouragement: (Great job!)

Palazzi et al., 2015

Lapum et al., 2020

Contact info: info@nursesinternational.org

Most infants enjoy hearing the human voice, and this is how they learn and make sense of language.

A nurse/ care provider should talk to them in a relaxed and pleasant tone of voice even though they cannot verbally respond. It’s also okay to use baby talk with infants as it can help with language development: baby talk is a type of speaking where they use enhanced vocal intonation and hyperarticulation of sounds such as vowels and consonants.

With children, a nurse/ care provider should adapt the communication to their developmental stage. Tailor the language to a level that children will understand, avoiding long complex sentences and instead using short sentences with simple words. Although they may use baby talk with infants, they should use a different approach with toddlers, who often want to be included in the conversation. As children get older, they enjoy receiving compliments and encouragement to connect with them (e.g., “look how much you have grown” or “great job!”).

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Critical Thinking Question

A father is discussing his child’s cancer diagnosis with the nurse.

Father - “We never thought stomach pain could mean something like this. I’m just in shock”.

Nurse - “I can only imagine what you’re feeling right now. It must be the worst pain to worry that your child will suffer.”

Father - “That’s exactly it. Not knowing what’s going to happen is killing me.”

Nurse - “It sounds like you’re worried about the unknowns in this situation.“

Father - “Yes. The doctor said we don’t even know at this point if the cancer has spread.”

Nurse - “The next step in this process will be to take some more images to find out if the cancer has spread and to meet with a doctor that specializes in the treatment of cancer.”

What techniques is the nurse using here to facilitate communication?

Contact info: info@nursesinternational.org

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Points to Consider With Care Partner

Lapum et al., 2020

Consider the care partner as secondary source of data

Some of the client interview may be conducted with the care partner when the child is unable to speak or fully articulate

For example, if they say that their infant is in pain, ask how they know this

Contact info: info@nursesinternational.org

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Points to Consider With Care Partner

Lapum et al., 2020

Allow the infant or toddler to sit on their parent’s lap and/or play with a toy.
Be patient and demonstrate unconditional positive regard.
With sensitive topics; interview the parent without the child.

Contact info: info@nursesinternational.org

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Verbal Strategies for A Repertoire of Rapid Responses: Examples (continued)

A Grief-stricken Parent:

Effective response: “I appreciate how upsetting this is for you. Are you able to talk about the situation and what you’re feeling, or do you need some time to gather your thoughts?”

A Parent Who Talks for the Child:

Effective response: “Let me ask Joseph to tell me how he feels to fill in the information a bit. Is that okay? (addressing both mother and patient)

Palazzi et al., 2015

Contact info: info@nursesinternational.org

The examples below are meant to illustrate how these general principles can be applied to specific situations and to suggest some appropriate responses. Each clinician will need to find the words that fit his or her style. Mentally rehearsing these responses will not only smooth the rough edges but also will help ensure that they are quickly recalled when needed.

A Grief-stricken Parent:

After being told that her child’s cancer was not responding to chemotherapy and had spread, a mother cries and appears shocked and devastated.

Effective response: “I appreciate how upsetting this is for you. Are you able to talk about the situation and what you’re feeling, or do you need some time to gather your thoughts?”

Suboptimal response: “You’re upset, understandably. Do you need a minute to relax?” (How can she relax?)

A Parent Who Talks for the Child:

A parent monopolizes the conversation and answers questions directed at the 12-year-old child.

Effective response: “Let me ask Joseph to tell me how he feels to fill in the information a bit. Is that okay? (addressing both mother and patient)

Suboptimal response: “Why don’t you let Joseph tell me?” or “Why don’t you let Joseph speak for himself.” (This is really an order disguised as a question.)

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Verbal Strategies for A Repertoire of Rapid Responses: Examples (cont.)

An Angry Parent Using Profanity

Effective response: “I can see that you’re very upset and angry, and I understand that, but I have to ask you not to use that kind of language here. It’s not helpful, and it makes it hard for us to communicate.”

A Parent Objects to the Treatment Plan

Effective response: “We all want to do what’s best for Joey, so would it be all right if we looked at the options.”

Palazzi et al., 2015

Contact info: info@nursesinternational.org

An Angry Parent Using Profanity

A six-year-old child has been NPO awaiting a surgical procedure scheduled for 1pm. When told that the procedure has been delayed for two hours, the parent becomes angry and begins using profanity.

Effective response: “I can see that you’re very upset and angry, and I understand that, but I have to ask you not to use that kind of language here. It’s not helpful, and it makes it hard for us to communicate.”

Suboptimal response: “I know that you’re upset but that kind of language is unacceptable.” (The word “unacceptable” is usually seen as judgmental and often triggers a defensive response. It is best to avoid the word and instead explain why something is unacceptable. Remember, profanity may be the norm in the parent’s culture.)

A Parent Objects to the Treatment Plan:

Effective response: “We all want to do what’s best for Joey, so would it be all right if we looked at the options.”

Suboptimal response: “I know you want to do what’s best for Joe, but…” (Beware the “but…” It tends to denigrate the preceding statement.)

Who’s Fault Is This?

A child received the wrong medication and the parents are irate. They ask, “Who’s fault is this?”

Effective response: “I’m really sorry that this happened. We’re looking into it and trying to determine how it happened. I will get back to you as soon as we have all the information.”

Suboptimal response: “It’s not anyone’s fault. These things happen.” (Denial.)

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Verbal Strategies for A Repertoire of Rapid Responses: Examples (cont.)

Who’s Fault Is This?�

Effective response: “I’m really sorry that this happened. We’re looking into it and trying to determine how it happened. I will get back to you as soon as we have all the information.”

Palazzi et al., 2015

Contact info: info@nursesinternational.org

An Angry Parent Using Profanity

A six-year-old child has been NPO awaiting a surgical procedure scheduled for 1pm. When told that the procedure has been delayed for two hours, the parent becomes angry and begins using profanity.

Effective response: “I can see that you’re very upset and angry, and I understand that, but I have to ask you not to use that kind of language here. It’s not helpful, and it makes it hard for us to communicate.”

Suboptimal response: “I know that you’re upset but that kind of language is unacceptable.” (The word “unacceptable” is usually seen as judgmental and often triggers a defensive response. It is best to avoid the word and instead explain why something is unacceptable. Remember, profanity may be the norm in the parent’s culture.)

A Parent Objects to the Treatment Plan:

Effective response: “We all want to do what’s best for Joey, so would it be all right if we looked at the options.”

Suboptimal response: “I know you want to do what’s best for Joe, but…” (Beware the “but…” It tends to denigrate the preceding statement.)

Who’s Fault Is This?

A child received the wrong medication and the parents are irate. They ask, “Who’s fault is this?”

Effective response: “I’m really sorry that this happened. We’re looking into it and trying to determine how it happened. I will get back to you as soon as we have all the information.”

Suboptimal response: “It’s not anyone’s fault. These things happen.” (Denial.)

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Verbal Strategies for A Repertoire of Rapid Responses: Examples (cont.)

Parents Do Not Want Anyone to Tell the Patient the Diagnosis:

Effective responses:

Immediate response:

“Let’s talk about this. Tell me why you feel she shouldn’t know that she has cancer.”

Follow up responses:

“I understand how difficult this is for the entire family. I wonder how we can be sure what Molly wants to know or not know.” “Almost always these children do know, and by not telling them, we deprive them of the opportunity to share their feelings and fears.”

Palazzi et al., 2015

Contact info: info@nursesinternational.org

Parents Do Not Want Anyone to Tell the Patient the Diagnosis:

The parents of a 15-year-old girl do not want anyone to tell her that she has cancer. “We don’t want you to tell her. Don’t say anything about cancer.”

Effective responses:

Immediate response: “Let’s talk about this. Tell me why you feel she shouldn’t know that she has cancer.”

Follow up responses: “I understand how difficult this is for the entire family. I wonder how we can be sure what Molly wants to know or not know.”

“I wonder if you’ve thought about some of the practical issues involved in not telling her, for example, how to explain the radiation or the chemotherapy? And she will be going to a clinic with other children who know they have cancer.”

“Almost always these children do know, and by not telling them, we deprive them of the opportunity to share their feelings and fears.”

Suboptimal response: “We have to tell her. She has a right to know.” (Ultimately, this approach may be necessary, but as an initial response it is confrontational and doesn’t explore or acknowledge the parents’ reasons for not telling.

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Suggested Responses for Effective Communication:

“The situation is serious but not hopeless.”
“There is still a lot that can be done to keep him comfortable, and we will be with you all the way.”
“What else do we need to talk about?” or “Is there something else you would like to discuss?”
“I wish I had better news.”
“I wish we had a cure, but there are things we can do to help keep you as comfortable as possible.”
“I am so sorry for your loss.”
“Let me take a moment to think about what you have told me.”
“May I interrupt you for a moment to clarify…”

Palazzi et al., 2015

Contact info: info@nursesinternational.org

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Non-Verbal Aspects of Communication

Kinesis: Refers to communication through body movements

Proxemics: Refers to issues of distance between the nurse and the patient as well as the presence of physical barriers

Paralinguistics: Refers to characteristics of the voice, tone, volume and emphasis

Atonomics: Body reactions generally beyond voluntary control

Palazzi et al., 2015

Contact info: info@nursesinternational.org

Nonverbal Aspects of Communication:

Also known as body language, can be as important as what is said verbally. Nonverbal communication can be divided into four categories: kinesis, proxemics, paralinguistics, and autonomics.

Kinesis:

Kinesis refers to communication through body movements such as facial expressions, gestures and posture. The clinician needs to look for and interpret kinetic signs in the patient. Some of these signs are obvious (clenched hands, furrowed brow, folded arms, foot tapping, looking away) others are more subtle (e.g., frequent swallowing as a sign of nervousness). Clinicians also can use their own kinetic actions as tools for effective communication.

Proxemics:

Proxemics refer to issues of distance and the presence of physical barriers. For example, the presence of a desk between nurse/ care provider and the patient heightens the feeling of separation and diminishes the feeling of working together as a team. In pediatrics, we need to be concerned about vertical as well as horizontal distance. Towering over a small child can be intimidating. Getting down to the child’s level, for example, by kneeling at the bedside, is a useful pediatric skill.

Paralinguistics:

Paralinguistics are characteristics of the voice, such as tone, volume and emphasis. Examples include the whisper of confidentiality and the rising volume of anger. It is generally useful to match the patient’s tone and volume (Ishikawa et al., 2006), but do not answer shouting by shouting. This category also includes utterances that are not really words, for example, hmm or uh huh.

Autonomics:

Autonomics are body reactions generally beyond voluntary control. Examples include the flushing of embarrassment and the pallor of shock or fear. Tears are probably the most common autonomic reaction.

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Kinesis:

Let the body language speak
Sit down, face the patient and parent and look at them
Lean slightly forward
Maintain eye contact and calm facial expression
A gentle smile to put the patient at ease; but not when delivering bad news
Keep chest area unobstructed and arms unfolded
Avoid leaning back
Touch the patient/parent by shaking hands (if culturally appropriate)

Palazzi et al., 2015

Contact info: info@nursesinternational.org

Kinesis:

Kinesis refers to communication through body movements such as facial expressions, gestures and posture. The clinician needs to look for and interpret kinetic signs in the patient. Some of these signs are obvious (clenched hands, furrowed brow, folded arms, foot tapping, looking away) others are more subtle (e.g., frequent swallowing as a sign of nervousness). Clinicians also can use their own kinetic actions as tools for effective communication.

Let their body language portray that they are unhurried and attentive.
If possible, sit down, face the patient and parent and look at them. Lean slightly forward.
Maintain frequent but not intrusive eye contact, an open, relaxed body posture and an appropriate, calm, facial expression.
A gentle smile will usually help put the patient at ease but may be perceived as inappropriate when delivering bad news.
Keep the chest area unobstructed and arms unfolded to avoid a barrier between them and the patient.
Avoid looking over the rim of the glasses, which may be perceived as authoritative or dubious of what they are being told.
Avoid leaning back, which may be perceived as withdrawing or being aloof.
Touching the patient or parent is considered a kinetic behavior.
If culturally appropriate, shake hands.
In a serious conversation, if touching is appropriate, the hand and the forearm are usually perceived as the least threatening areas.
Many patients appreciate a gentle touch, but others dislike any touch and will flinch or withdraw.
The basic rule is, don’t touch if they have any reason to anticipate that the individual would respond negatively.

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Case Study

A nurse is caring for an infant in respiratory distress that has progressed to respiratory failure.

The physician notifies the family that the infant will need to be intubated and the nurse goes into the room to prepare for the procedure.

The parents appear frightened and are crying. The mother asks, “Is our baby dying?”

What are some verbal strategies the nurse can use to respond appropriately and communicate effectively with the parents in this situation?

Contact info: info@nursesinternational.org

The nurse can use the following general rapid response principles in this situation:

Diagnose: Recognize the circumstances and the emotions. In this situation, the nurse might say something like, “I appreciate what a frightening situation this is for you.”

Validate: show that one recognizes the circumstances and the emotions. The nurse might say something like, “This is a difficult situation. Anyone in this situation would feel scared.”

Explain: clarify the current situation and explain or inform what will or should happen next. The nurse might say something like, “Your baby is very sick, but the situation is not hopeless and we are doing everything we can to help him get better. What’s going to happen next is that I’m going to bring in some equipment and medicines that the doctor is going to use to place the special breathing tube that she told you about.”

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Non-Verbal Communication in Younger Children

Palazzi et al., 2015

Lapum et al., 2020

Non-verbal communication

Relaxed body posture
Smile
Appropriate eye contact
Congruent hand gestures

Contact info: info@nursesinternational.org

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Non-Verbal Communication in Older Children

Relaxed body posture
Positive facial expression: Gentle smile, attentive
Appropriate eye contact
Congruent hand gestures
Speak at the child’s level
Open communication posture
Appropriate gestures: Nodding head, thumbs up
Vocal responses to validate: Use umm, humm, ah
Maintain therapeutic distance: Respect personal space (1-2 feet)
Provide undivided attention

Palazzi et al., 2015

Lapum et al., 2020

Contact info: info@nursesinternational.org

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Case Study

A perioperative nurse is assigned to care for a 15-year-old adolescent scheduled for an abdominal surgery. When the nurse enters the room, the adolescent is visible agitated and states, “I don’t want to do this. I’m afraid of needles and I’m going to look so ugly with a big scar across my stomach!”

What are some non-verbal communication techniques the nurse could use in this situation to help the adolescent feel heard and understood?

Contact info: info@nursesinternational.org

There are many non-verbal techniques the nurse could use in this situation to help the child feel understood, which can help to alleviate the child’s anxiety. Some things the nurse could do include:

Speaking at the child’s level by pulling up a chair and sitting down if the child is lying in bed
Making eye contact with the child so they know the nurse is listening
Using appropriate gestures, such as nodding their head, to let the child know they are listening
Using an open communication posture, such as arms relaxed at the side or in the lap and leaning forward slightly to indicate interest
Maintaining a facial expression that expresses interest in and sympathy for what the child is saying
Provide undivided attention by using all the techniques above (versus doing something else like charting while the child is talking)

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Strategies with Challenging Communications:

Language Discordance:

Speak directly to the client
Use simple language; no jargon, no medical language
Be aware of non-verbal language and consider appropriate gestures
Use pictures- paper and pen if needed
Consider incorporating the care partner as translator and interpreter
Consider interpreter if needed; consider using a translating app such as Google Translate

Palazzi et al., 2015

Contact info: info@nursesinternational.org

Additional Considerations

As a nurse, they will encounter other populations and situations that will require them to thoughtfully consider how to best communicate in a way that is respectful, effective, and therapeutic. They might not even know when they are caring for certain populations, because it may not be obvious, so it is always best to ground the communication in best practices (e.g., College of Nurses of Ontario practice standard concerning therapeutic nurse-client relationship). For example, it is not necessarily readily apparent when a language discordance exists, or when a person is experiencing intense emotions, or when a person has a disability.

Language discordance

There will be times when they and the client and/or family do not speak the same language. In this case, they need to carefully assess and evaluate their understanding.

Here are some strategies to address language discordance:

Speak directly to the client using simple language (no jargon, no medical language).
Be aware of non-verbal language and consider how gestures may help the client understand what nurse/ care provider is trying to communicate.
Use pictures and/or have a paper and pen for them to write down notes and questions.
Consider how best to incorporate the care partner into conversations if they speak the same language as you, but the client does not. Care partners can be an integral part of the care processes and may be constantly translating what is going on for their loved one. Thus, in everyday communication, a nurse/ care provider may consider engaging the care partner in interpreting for them and the client. For example, it may be appropriate to ask them to interpret when introducing yourself and asking the client about benign and less sensitive topics (e.g., “Are you hungry?” “Can you sit up?”).
However, sometimes the use of an interpreter is needed. Many healthcare institutions have access to interpretation services, but these can be expensive. A nurse/ care provider may also have professional colleagues who are trained in the ethics of interpretation and can help.
Consider using a translating app such as Google Translate that can help translate one language into another. Although a nurse/ care provider may not speak the other language, they can show the written translation to the client so that they can read it. Additionally, the client can also type concerns, responses to the questions, and their own questions into the translating app.

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Strategies with Challenging Communications (con.):

Palazzi et al., 2015

Heightened Emotions

Health and illness prompts various emotional responses
Cultivate a therapeutic environment
Use open-ended questions
Consider using permission statements to assess emotions
Acknowledge the client’s emotions and provide space
Avoid changing topics
Allow the client time to voice their emotions
Using silence and active listening
Do not argue with a client who is angry or upset

Contact info: info@nursesinternational.org

Heightened Emotions

Clients commonly experience sadness, anger, fear, anxiety, embarrassment, and other emotional responses in the context of health and illness. It is important that a nurse/ care provider cultivate a therapeutic environment where clients feel comfortable to open up about their emotions. Open-ended questions like “Tell me about how a nurse/ care provider are feeling” can facilitate discussions about a client’s emotional response. Additionally, a nurse/ care provider might consider using permission statements to help normalize how the client is feeling and provide an opening for them to speak about emotions. For example, “Clients often experience sadness or anger when they are diagnosed, how are you feeling?”

It is important that a nurse/care provider acknowledge the client’s emotions and provide space for them to experience the emotions. Avoid changing topics. Give the client time to voice their emotions or even cry. Using silence and active listening are effective communication strategies during these circumstances.

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Strategies with Challenging Communications

(continued)

Violence and trauma

Use a trauma-informed approach with all clients
Offer help and ensure safety
Introduce self and purpose of being there
each step of what a nurse/care provider is doing
Ask permission to touch
Give the client options on what topic to discuss first

Palazzi et al., 2015

Contact info: info@nursesinternational.org

Violence and trauma

Many clients will have experienced violence and trauma in their lives such as abuse, bullying, grief or loss of a loved one, or natural disasters or war. A nurse/ care provider will often not even be aware that they have experienced violence or trauma, so it’s best to use a trauma-informed approach with all clients. Approach all clients with the assumption that they may have experienced violence and trauma at some point in their lives. Reflect on how best to help them feel safe and provide them as much choice and control in the clinical encounter as possible.

Some communication strategies that are consistent with a trauma-informed approach include:

Introducing who a nurse/ care provider are and why they are there.
Explaining each step of what they are doing.
Asking permission to touch.
Giving the client options on what topic to discuss first.

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Strategies with Challenging Communications (continued):

Palazzi et al., 2015

Hearing and visual impairment

Minimize background noise and distractions
Speak in clear, slightly louder voice
Use steady tone with a deeper pitch
Avoid shouting
Face the client directly
Make sure the child has access to an assistive device (if any)
Use of enhancing hearing devices

Contact info: info@nursesinternational.org

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Strategies with Challenging Communications

(continued)

Intellectual Impairment

Consider how each client can best participate in communication (e.g., listening, talking, understanding and processing information)
Use active listening
Focus on client needs
Speak clearly and ask simple questions
Speak in positive tone with steady pace
Avoid speaking too soft
Involve care partner when necessary

Palazzi et al., 2015

Contact info: info@nursesinternational.org

Intellectual impairment

Some of the clients will have intellectual or cognitive impairments that may result in disabilities affecting their ability to learn and reason (e.g., Down syndrome, fetal alcohol syndrome). A nurse/ care provider should consider how each client can best participate in communication (e.g., listening, talking, understanding and processing information). A nurse/ care provider should engage in active listening and determine what is important to the client. Speak clearly and ask simple questions. Speak in a positive tone with a steady pace and avoid speaking slower as this can come across as patronizing. They may encourage them to bring someone with them that they trust, such as a care partner; should still focus the attention on the client but also create an inclusive space for the care partner to be involved.

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Strategies with Challenging Communications (continued)

Substance Impairment

Present with non-judgemental attitude
Convey unconditional positive regard
Respect client’s agency and self-determination
Speak clearly
Use short and simple sentences
Focus on client need and priority issues
Collaborate discussion and health promotion once the effects of the substance have dissipated

(Palazzi et al., 2015)

Contact info: info@nursesinternational.org

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Strategies with Challenging Communications (con.):

Threatening behavior

Ensure safety of self and others
Acknowledge and value the feelings of the client
Present in non-judgemental attitude
Avoid downplaying or judging how client feels
Listen and understand the client’s situation
Explore the reason of the escalation
Offer genuine interest, concern and empathy
Remain calm, use soft tone
Maintain personal space and remain confident
Don't take situation personally
Do not argue with or challenge client

Lapum et al., 2020

Contact info: info@nursesinternational.org

Escalation

Communication is a particularly important strategy to use when the purpose is to de-escalate a situation. Escalation can occur in any healthcare situation when clients are encountering intense emotions and experiences entangled with stress, fear, anger, uncertainty, pain, and lack of control. This can lead to the client spiraling out of control, agitation, aggression, and even violence. Contextual factors may include clients who have received bad news such as a diagnosis, clients who are under the influence, and/or clients who are having a mental health crisis. Attend to own safety and be aware of the potential risk factors. It is important to notify a colleague(s) when interviewing a client who is at risk of, or has a history of, escalating.

De-escalation includes ways to reduce and/or prevent escalation. De-escalating communication strategies include:

Acknowledge and value how the client feels and be non-judgmental.
Avoid downplaying or judging how the client feels.
Engage in active listening to understand the situation and explore the reason for the escalation.
Offer genuine interest, concern, and empathy.
Remain calm and do not allow voice or non-verbal communications to demonstrate rising emotions.
Recognize the client’s self-determination and collaborate with them on how to address the issue.
Maintain the safety, but do not act afraid.
Maintain professionalism and do not take the situation personally.

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Case Study

A family has been waiting for more than an hour for the doctor to see their sick child. When the nurse tells the family that the doctor is in the middle of a procedure and will see their child as soon as he is finished.

The father jumps to his feet and angrily tells the nurse, “If the doctor doesn’t come see my child in the next few minutes you’re all going to be sorry! You don’t even know what’s wrong with him. He could be really sick and nobody around here even cares!”

What strategies should the nurse use in this situation?

Contact info: info@nursesinternational.org

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Red Flags

Poverty
Malnourishment
Signs or symptoms of abuse
Poor living conditions described in home and/or neighborhood
Low health literacy of parents/caregivers
Unemployment of parent(s)/caregivers
Other childhood adverse experiences: Violence in home or neighborhood, divorce, incarceration of parent, bullying in school or homes

Contact info: info@nursesinternational.org

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

Contact info: info@nursesinternational.org

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

Contact info: info@nursesinternational.org

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Cultural Considerations: Examples

Palazzi et al., 2015

Lapum et al., 2020

In some cultures, children are expected to speak only when adults address them.
Children from Latin America and Asia may avoid eye contact with adults in authority as a sign of respect.
There are a large number of children who are raised by lesbian or gay parent(s).

Contact info: info@nursesinternational.org

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Reference:

Andrews, M.M., Boyle, J.S. & Collings, J. W. (2020). Transcultural Concepts in Nursing Care (8th Ed.). Wolters Kluwer, Philadelphia, PA.

Cambridge Dictionary. (n.d). English: Communication definition. Retrieved on August 19, 2021 from https://dictionary.cambridge.org/dictionary/english/communication

Ernstmeyer, K., & Christman, E. (Eds.). (2021a). Open RN: Fundamentals of Nursing. By Wisconsin Technical College System licensed under CC BY 4.0. https://wtcs.pressbooks.pub/nursingfundamentals/chapter/2-3-communicating-with-patients/

Lapum, J. L., St-Amant, O., Hughes, M., Garmaise, J. (2020). Communication for the Nursing Professional (1st Canadian edition) is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. https://pressbooks.library.ryerson.ca/communicationnursing/

Palazzi, D. L., Lorin, M. I., Turner, T. L., Ward, M. A., Cabrera, A. G. (2015). Communicating with Pediatric Patients and their Families: The Texas Children’s Hospital Guide for Physicians, Nurses and other Healthcare Professionals. Texas Children’s Hospital https://cdn.bcm.edu/sites/default/files/2015/13/pcg-v21.pdf

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