20. People in particular stages of the lifespan
People who represent three of the different stages of the lifespan – children, adolescents and people who are older – present with particular attitudes and associated needs. When assisting people in these stages of life it is important to remember the abilities and events that are typical of these stages.
SMALL GROUP ACTIVITY: STAGES OF THE LIFESPAN
Children
Adolescents
People who are older
• Define these stages of the lifespan.
• List some of the specific behaviours that might occur during these stages of life.
• List the individuals most susceptible to experiencing difficulty when seeking assistance from a health service during these stages of life.
• List possible negative emotions someone in these stages of life might experience when seeing a health professional and explain why.
• List principles for effective communication to remember when communicating with a person in these stages of life. Give reasons for the need to remember these principles.
• Suggest strategies for communicating with a person who is in these stages of life and experiencing issues related to that stage. Decide why you might see such a person in your particular health profession.
• Check your answers against the information below, noting any additional thoughts or ideas.
A child
When assisting children it is essential to remember the parent is the expert about the child. They are familiar with the skills and abilities of the child and if they indicate the child can do something you do not witness, they will probably be correct. It is important to avoid talking about children when they are present. Whether the child can understand the words or not, they are able to understand non-verbal cues and thus will respond with an appropriate emotion or behaviour.
Definition of a child
For the purpose of this chapter, a child is a person aged 0–16 years.
Behaviours related to being a child
The behaviour of a child will depend on their age, their personality, their culture, the experiences of their upbringing, the stability at home, their sense of security, the reason for the referral and the presence of a significant adult.
A child might be
• Quiet and non-engaging
• Shy and hiding
• Crying and clinging
• Happy but initially untrusting
• Looking to their parent for assurance
• Angry and aggressive
• Curious and wanting to explore.
Children most susceptible to experiencing difficulties when attending a health service
Children susceptible to experiencing difficulties when attending a health service include those who
• Have a history of experiencing trauma
• Are very young and are not accustomed to separating from a parent
• Are from a different cultural background
• Are unfamiliar with healthcare settings
• Are experiencing physical or emotional pain
• Are very ill
• Have a previous negative experience with a health professional
• Are a victim of an accident, attack or natural disaster
• Have communication difficulties
• Have a visual or auditory impairment.
Possible emotions a child might experience
• Fear and anxiety
• Physical or emotional ‘pain’ from any source, causing frustration and despondency
• Boredom
• Isolation and displacement
• Awareness that they are different to other children
• Lack of familiarity with the environment, people and procedures, causing uncertainty and discomfort
• Difficulties at home, school or in the neighbourhood.
Principles for effective communication with a child
When communicating with a child it is important to
• Make introductions
• Demonstrate empathy
• Carefully observe the responses of the child
• Validate their perceptions (it may be necessary to validate the perceptions of the parent if the child is unable to validate)
• Make appropriate use of non-verbal behaviour – if there is no common language, non-verbal or visual communication is essential to develop rapport and a therapeutic relationship
• Monitor the language level – use simple explanations and indicate upcoming events
• Touch only if appropriate
• Establish boundaries and expectations for behaviour
• Relate consistently with consistent expectations
• Practise holistic communication
• Disengage
• Ensure family-centred practice.
Strategies for communicating with a child
• Talk directly to the child.
• Avoid talking about the child with the child present.
• Explore toys and activities that are meaningful to the child and use them to engage, comfort and relax the child.
• Provide a safe environment.
• Understand the culture of the child.
• Understand the familial, developmental, social, physical, cognitive, cultural and spiritual background of the child.
• Tell the child what will happen and when it will happen. Give adequate warning about when the session will finish to facilitate smooth transition from the completion of the session to leaving the room.
• Respond to the non-verbal behaviours of the child with verbal questions or reflective comments about the observations.
• Avoid touching the child wherever possible or ask permission to touch the child from the child and the parent.
• Avoid distractions and use silence if appropriate to encourage concentration and focus.
ROLE PLAYS
Role-play the following scenarios. Before acting the roles you may wish to decide what type of assistance Person 1 requires. If it is not possible to role-play these scenarios, consider and explore the possible responses and communication strategies that will achieve effective communication and family/person-centred practice.
Scenario one: The male and the trained volunteer
Person 1: You are Mohammad, a 12-year-old Sudanese boy whose family has taken refuge from the Sudan. You have learnt some English, but still do not understand many of the behaviours of those around you and you cannot read or write English yet. Your older brother was killed just before your family left the Sudan. Your father does not have a job yet and your mother works until late at night for little pay washing dishes in a Chinese takeaway shop. You do not feel accepted at school, even by the other Sudanese who have been there longer than you and often tease you in Arabic. Your little sister seems happy and has friends with whom she plays. You have been feeling angry and you have begun to verbally abuse teachers and the other boys from the Sudan at school. You do not enjoy relating to anyone other than your family.
Person 2: You are a trained volunteer for the local multicultural centre and you run a group for ‘at-risk’ boys with refugee status. This afternoon is the first time you will meet Mohammad. You know he is sometimes violent, but that is all you know. Many of the at-risk Sudanese boys are violent.
Scenario two: The female and the health professional
Person 1: Your name is Elise and your 2-year-old daughter, Jenny, has just been diagnosed with an intellectual disability. She is your only child and has been a joy to your immediate family. You are confused and unsure. You are afraid of the future and while you wait to see the health professional you become sad and teary. You watch Jenny play on the floor at your feet. What does this mean for her future? She is so beautiful and you had such wonderful plans for her future.
Person 2: You are the health professional who must assess Jenny’s abilities. When you enter the waiting area you call Jenny’s name and notice a woman flinch and look up. She smiles at you and lifts Jenny from the floor. How will you relate to Jenny and Elise in this initial session? What are your communication priorities?
• Elise does not want Jenny to leave her lap and nor does Jenny want to leave it. How will you encourage them both?
GROUP DISCUSSION
As a large group discuss the observations, emotions and outcomes of the role plays. Suggest possible alternative strategies that may increase the effectiveness of the communication in a similar situation.
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