The Nursing Associate's Handbook of Clinical Skills. Группа авторов

levelLearn the child’s interests based on your observations of their activitiesTalk at the child’s level and with vocabulary they will understandInvolve the child in decision‐making appropriatelyMaintain a calm, unhurried, caring and gentle approachUse concrete examples and/or link information to activities of daily livingAllow opinions to be expressedBe an active, attentive listener Make a child self‐conscious by drawing attention to themUse abstractions with a child who is a concrete thinker (e.g., for a child who does not understand time, tell them ‘after lunch’, not ‘later’ or ‘at 2 o’clock’)Jump to conclusionsGet ‘in the middle’ between a child and a parent, especially in front of the child

When communicating with children and young people, the nursing associate must recognise the variable needs of children in relation to their age, development and ability. They must draw on their knowledge of the stages of child development and utilise communication skills, such as active listening, paraphrasing, summarising, reflecting and questioning, that are fundamental to the development of rapport and empathic therapeutic relationships (Nelson 2012). They should find out what children, young people and their parents want and need to know, what issues are important to them and what opinions or fears they have about their health or treatment.

      Babies, when in infancy, communicate via sounds such as gurgles and cries. They also use facial expressions such as smiles, grimaces and eye contact to communicate their needs (Grainger 2018). As children develop, they begin to use single words to express their needs. When communicating at this stage, it is important to make use of pictures and objects to convey meaning as well as simple language (Edwards & Coye 2019). When communicating with adolescence, it can be difficult to develop rapport due to the challenges physiologically, psychologically and socially for this age group. Templeman (2019) explains how to foster a rapport with adolescents by introducing yourself, offering a hand to shake and making small talk. This can also be done by showing an interest in the individual, what do they enjoy doing, how is school and so forth. This will encourage the therapeutic relationship, as the individual is given time to talk about themselves to someone who is interested in them. The nursing associate needs to listen carefully and respond appropriately without being directive to show the adolescents that they are being taken seriously, which will develop their confidence (Templeman 2019).

It is imperative that children and young people are involved in discussions about their care and that the nursing associate explains things using language or other forms of communication they can understand. Some tips for communicating with children adapted from Boggs (2016) are listed in Table 2.3.

      When communicating with adults, nursing associates need to be aware of the vocabulary they use, but also the words that are not spoken by the patient. The words left unspoken can be an indicator of feelings of low self‐worth or fear of judgement. For example, a patient who is withdrawn and does not talk about their future may be contemplating suicide, or patients when talking about spirituality may not give any details about their beliefs due to fear of being judged (Richardson 2017).

      The vocabulary used when talking to patients should change dependent on the person being spoken to, as those words needs to be understood. Parnell (2015) refers to this as ‘plain language’ – it should be to the point, clear and accurate. Nursing associates have a professional responsibility to communicate with colleagues, patients, patients’ family and other professionals. When delivering information or explaining a procedure, it is difficult to gauge how much the person who is receiving the information has understood. Quite often, the information that is being communicated is complex and the population receiving this information is more diverse than ever. An effective technique is to keep it simple and ask the person to repeat back what they have understood. By doing this, the nursing associate can adapt the language used to clarify any points of misunderstanding (Parnell 2015).

Currently in the United Kingdom, approximately 1.5 million people have a learning disability (Mental Health Foundation 2019), and for this group of people, it is more likely that communication may be difficult. People with learning disabilities access mainstream healthcare, and as they are significantly more likely than the general population to be diagnosed with a wide range of conditions, the nursing associate will undoubtedly care for people with a learning disability throughout their nursing career. It is important that the nursing associate take the time to get to know their patients and see them, not the disability, and listen to them and their family/carers. Where people have communication needs or a disability, it is essential that nursing associates make reasonable adjustments, providing and sharing information in a way that promotes good health and health outcomes and does not prevent people from having equal access to the highest quality of care.

      To be a good communicator with people with a learning disability, the nursing associate will need to:

       Always use accessible language and speak clearly

       Keep their head up and be on the same level as the person

       Avoid jargon or long words that might be hard to understand

       Be creative and prepared to use different communication tools such as visual cues to support understanding

       Take time and follow the lead of the person

       Go at their pace

       Check out understanding

       Ask for help if they need to

      For people with profound and multiple learning disabilities (PMLD), it can be difficult to communicate intentionally, making this group of people particularly vulnerable. Nursing associates need to adapt the way they communicate with people with PMLD to find a way of listening and communicating in a way that is individualised and appropriate (Mansell 2010). This will involve being creative; it may be through the use of hand gestures and movements, or through picture and music. The purpose of communication, although via a more creative mode, is the same; it should remain a two‐sided process where both parties are able to express themselves and communicate their needs. Mansell (2010) talks about other specialities in assisting people with PMLD such as speech and language therapists, family and carers, as each of these can provide insight into effective ways of communicating, be this a particular gesture, sign, object, sound or behaviour. A communication passport can be a useful tool, not only for people with PMLD but for a variety of people who have difficulty communicating. Communication passports should contain everything about the way that individual communicates. These should be updated regularly and readily available for anyone in contact with or involved in that person’s care (Mansell 2010).

      Supporting Evidence

      Augmentative and Alternative Communication (AAC) Scotland has online learning modules, posters, communication cards and guides to support people in communicating. https://www.aacscotland.org.uk/home/

      MENCAP has a variety of resources including case studies to help support healthcare professionals in communicating with people with complex needs. http://www.mencap.org.uk

      Blue Flag Total Communication

       Total communication is an approach that supports people with complex communication needs. It was developed to empower people to help them express themselves and form connections (Sense 2019). Total communication was born from the concept that when communicating, we are not just a talking head, we use non‐verbal communication through our bodies (Thomsen 2010). Total communication refers to all available means of communication, be this limited verbal speech, sounds, spontaneous non‐verbal means and low technological devices (Rautakoski 2010). This approach is reliant on a partner to facilitate and clarify the meaning in a conversation. A study by Rautakoski (2010) in the training of people with severe to moderate aphasia and their communication