DEVELOPMENTALLY APPROPRIATE COMMUNICATION
Overview
Developmentally appropriate communication applies skills of communication that are aligned with the developmental stage of the patient as defined by the theoretical frameworks of Piaget, Erikson, and Freud (Ball, Bindler, & Cowen, 2013, 2014). Effective, developmentally appropriate communication can affect the emotional well-being, medical compliance, and preparation of patients to care for themselves into adulthood (Bell & Condren, 2016; Brand, Fasciano, & Mack, 2016). Developmentally appropriate communication in nursing keeps the patient at the center of triadic communication between nurse, parent, and child, which is a unique factor in the pediatric population (Brand et al., 2016).
Background
Communication is a process where the sender encodes a message that is sent to the receiver who decodes the message and responds, providing feedback to the original sender for decoding (D’Amico & Barbarito, 2015). Communication can have positive and negative effects on behavior. In pediatric nursing, the way in which the message is encoded and sent can make a significant difference in the behavior and emotion that results during decoding. The patient’s developmental age and previous experience contribute to his or her ability to decode information (Bell & Condren, 2016). Nurses who identify the patient’s developmental age and exhibit appropriate approaches to interactions and communication gain a greater trust from the parent/caregiver and have a greater effect on the future nurse-to-patient encounters (Salmani, Abbaszadeh, & Rassouli, 2014). These encounters provide an opportunity to build and sustain a relationship that provides mutual respect between the patient, parent, and nurse, each in their significant role promoting well-being and providing care (Salmani et al., 2014).
Communication can be verbal, nonverbal, or abstract. Verbal communication includes pace, intonation, simplicity, clarity, timing, and adaptability that accompany the spoken words (Ball et al., 2013; Pearson Education, 2015). Nonverbal communication, posture, gait, facial expression, and gestures can be interpreted during the process of communication to be supportive or contradictory to verbal communication (Ball et al., 2013; Pearson Education, 2015). Verbal and nonverbal messages should be consistent and congruent for the nurse to gain trust and credibility. Children who play with dolls or cars as they see others do or teenagers who dress to make a statement are exhibiting abstract communication (Ball et al., 2013).
Therapeutic communication is the process of interacting and sharing information in a professional–patient relationship. For the purpose of this discussion, the focus is on the relationship between nurse and child or nurse and family. This 55relationship is founded on mutual respect and trust between the patient/parent and nurse (Pearson Education, 2015). Therapeutic communication includes verbal and nonverbal communication that is meaningful and adjusted to the situation. Techniques include the use of broad, open-ended statements, active listening, physical presence, and clarification (Pearson Education, 2015).
Clinical Aspects
ASSESSMENT
Developmentally appropriate communication is specific to the patient’s developmental and cognitive age, which may differ from one’s chronological age. Humans communicate from birth, initially with cries, followed by pointing and grunting, and proceeding eventually to putting words together to create meaningful sentences. Communication aids in alleviating fears, building trusting relationships, and developing confidence to sustain treatment plans. Erik Erikson’s theory of psychosocial development and Jean Piaget’s theory of cognitive development are most often used as frameworks for nursing care of the pediatric patient. Erikson (1979) categorizes the stages of psychosocial development as birth to 1 year of age: trust versus mistrust; ages 1 to 3 years: autonomy versus shame and doubt; ages 3 to 6 years: initiative versus guilt; ages 6 to 12 years: industry versus inferiority; and ages 12 to 18 years: identity versus role confusion. Piaget (1976) provides four stages of cognitive development age: birth to 2 years: sensory motor; ages 2 to 7 years: preoperational; ages 7 to 11 years: concrete operational; and 12 years of age and older: formal operational.
To organize the following presentation of developmentally appropriate approach and communication, Erikson and Piaget’s stages are combined. Examples are presented for the newborn, infant, toddler and preschooler, school-age, and adolescent. Newborns communicate with cries to get their basic needs such as feeding, clean clothes, and comfort met (Ball et al., 2013). Human voice and touch, kangaroo care, gain a greater importance for this stage, especially for those born prematurely (Ball et al., 2013). Infants continue to need comforting touch and predominately communicate nonverbally, making it important for the nurses caring for this patient to use voice inflection and facial expression to engage (Ball et al., 2013). Toddlers and preschoolers need time to process their thoughts without interruptions and are gaining their independence, requiring time commitments from the nurse (Ball et al., 2013). Nurses who provide simple responses, simple directions, and choices that result in the decision of the child to be acceptable while carving out time for responses allow for the greatest exchange with this age group. School-age children are exploring the world around them, initiating activities, and engaging in groups (Ball et al., 2013). Patients at this stage like to take part in decisions that affect them. Nurses should clarify the extent of patient involvement in decision making before initiating conversations (Brand et al., 2016). Communicating at the same physical level of the patient and including the patient in the conversation allows the patient the ability to answer the question, allowing the 56parent/caregiver to answer after the patient for any required clarification (Ball et al., 2013). Adolescents are seeking their position into adulthood (Ball et al., 2013). Nurses should build a rapport with this age group by active listening and presenting a nonjudgmental attitude.
NURSING INTERVENTIONS, MANAGEMENT, AND IMPLICATIONS
Adjustments to the approach and techniques for communication may vary based on the physiological, psychological, and emotional state of the patient. For example, patients diagnosed with autism spectrum disorder, attention deficit disorder, mental retardation, or developmental delay, adjusting the approach may require combining skills from more than one stage to produce meaningful communication, trust, and respect. As another example, children with chronic conditions may regress to an earlier stage or mature to a higher cognitive or developmental stage that requires tailoring to individual needs.
OUTCOMES
Outcomes of developmentally appropriate communication are increasingly reported.
Relationship-based care provides an example of an approach to improving patient safety, satisfaction, and motivation, which are grounded in trusting relationships with a foundation in developmentally appropriate, highly individualized communication (Bell & Condren, 2016). Research has established that patients are more likely to take appropriate doses of medication, at the correct intervals, for the prescribed amount of time when their education is presented in ways that are appropriate for their stage of cognition and development (Bell & Condren, 2016).
Summary
Nurses play an integral role in the relationship, satisfaction, and adherence to medical treatment, and are more effective when they apply developmentally appropriate communication and approaches with the patients. As children mature and seek input into their medical care, shared decision-making frameworks should be considered as a means to maintain the therapeutic relationship, promote satisfaction, and achieve adherence to treatment plans.
Ball, J. W., Bindler, R. C., & Cowen, K. J. (2013). Child health nursing: Partnering with children and families (3rd ed.). Upper Saddle River, NJ: Pearson.
Ball, J. W., Bindler, R. C., & Cowen, K. J. (2014). Principles of pediatric nursing: Caring for children (6th ed.). Upper Saddle River, NJ: Pearson.
Bell, J., & Condren, M. (2016). Communication strategies for empowering and protecting children. The Journal of Pediatric Pharmacology and Therapeutics, 21(2), 176–184. doi:10.5863/1551-6776-21.2.176
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
