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Communicating with Adolescents: our words matter
About the Author
Lynn Mohr, PhD APRN PCNS-BC CPN, is an Associate Professor/Associate Department Chair, Women, Children, Family Nursing at Rush University College of Nursing. Dr. Mohr has over 40 years of pediatric experience and her research focuses on the needs of adolescents with gastrointestinal ostomies where she has developed a theoretical framework for how adolescents work thru this experience. Dr. Mohr is a Fellow in the Illinois Institute of Medicine, Oversees Fellow in the Royal Academy of Medicine, London and a Fellow of the CNS Institute. She also is a past national president for the Society of Pediatric Nursing..
Lynn has received compensation from Coloplast to provide this information.
When providing healthcare guidance, working with adolescents can present many unique challenges. Many of these challenges can be mitigated with both (a) a better understanding of how adolescents think and (b) how our own communication patterns can impact our message.
Understanding adolescent thought and development is the first step to improving patient/provider communication. Usually spanning ages 12-18, adolescence represents a dynamic period in human growth and development. In addition to biological and sexual maturation, teens face questions of personal identity, sexuality, and autonomy (Christie & Viner, 2005). In addition, adolescents also experience a psychological and social shift as they move from the concrete reasoning and individualistic roots of childhood to the abstract reasoning and corporate behaviors which mark adulthood. These sudden changes are often accompanied by feelings of anxiety, awkwardness, and self-criticism which are often compounded by complex peer-relationships and the widening influence of social media (Croll, 2005).
Consequently, adolescents often vacillate between childlike and adult behaviors. In grappling with their changing lives, they become focused on their present realities rather than their long-term goals (Ginsburg, 2018). They seek solace in cultivating experiences and relationships as these provide security and a sense of self. Furthermore, the rapid growth often leads to feelings of invincibility and subsequent poor assessments of “risky” situations and long-term consequences.
While adolescent angst is nothing new, healthcare providers cannot underestimate the role it plays in effective patient communication. To practice developmentally informed adolescent communication Ginsburg (2018) together with my own research offer the following for providers working with adolescents:
- Remain Calm.
Don’t speak until you have regulated your own emotions. Resist the urge to “strengthen” your message by speaking in loud or condescending tones. Rather than focusing on your own feelings, give the adolescent your full attention. Remember to choose your words wisely as they are powerful.
- Resist Lecturing.
Patient engagement in risky, inappropriate, or dangerous behaviors often prompts a “lecture” which begins by covering consequences and ends with a “what were you thinking?” Such lectures, however, rely on the skills which teens lack most, such as abstract thinking, long-range planning, and risk-estimation (Ginsberg, 2018). While teenagers may pick up on our concern, they do not connect with our message. Not only are such lectures ineffective in the short term, but long-term they can be disempowering.
- Ask, Don’t Tell.
Use question language such as “Tell me about? How did that work? I worry that might lead to ….. what do you think?”. Remember to never be shocked or surprised by what an adolescent tells you. Don’t ridicule an adolescent’s question or comments. Instead respond with “I could see why that seems to be something good, and I am concerned about…. What do you think? or I can tell that you are worried about…..” Using the word “but” in a sentence can negate anything positive the adolescent may have tried to explain, so replace “but” with “and”. When something “goes wrong”, ask questions like “What are your plans so this doesn’t happen again?”, “What did you learn from this?”, and “What would you tell another adolescent?” (Mohr, 2012).
- Acknowledge Existing Wisdom and Reinforce Safe Thought Patterns.
Adolescents don’t crave feedback because of their insecurity, rather because it helps them learn (Ginsberg, 2018). Acknowledge when they have done something well and notice effort. Talk through an issue and ask their opinion on how something might work for them. Take time to discover their story and communicate that you value them. Often adolescents have worked through their own illnesses in creative ways. Positive feedback promotes trust and care.
- Make Directions Meaningful & Avoid Distractions.
Practice “the pause” after each direction step, allowing space for questions and anxieties to surface. Remember to exercise patience as incorporating new information takes time. Make sure you have accurate information and if you do not, then apologize and move forward. Avoid multitasking behaviors as much as possible.
- Work with Their Strengths.
Using computer-based programs or video-based learning works well. Build on the need for autonomy by teaching patients how to manage activities such as dating, dancing, work, dress etc. Incorporate their desire for connection and experiences by sharing stories from your own learning, connecting them to other adolescents who have been or are in similar situations, and recommending educational websites or other activities (such as adolescent ostomy camp).
- Promote a Positive Body Image.
Acknowledge how their appearance might be affected by their illness or treatment. Sharing information about the effects of treatments and medications encourages discussion. Using questions such as “Other adolescents have asked about or shared about …is this something you have wondered about?” These questions encourage the adolescent to express their own concerns and fears. Asking about upcoming activities and if the adolescent has thought about how they will handle can encourage conversations about care rather than anxiety (Mohr, 2012).
In summary, understanding how adolescents think and modifying our communication styles to help promote patient ownership of solutions can make the difference between our teenage patients either absorbing or discounting the information we provide. By meeting teenagers where they are, our interactions have the potential to not only be effective, but also enjoyable as well. ●
To download the “Teen Life with an Ostomy” booklet to which Lynn contributed as an author, click here.
References
Christie D , Viner R . ABC of adolescence: adolescent development Br Med J. 2005 ; 330 ( 7486 ): 301-304
Croll J . Body image and adolescents . In: Stang JS , Story M , eds. Guidelines for Adolescent Nutrition Services . Minneapolis, MN : University of Minnesota ; 2005 : 155-166. http://www.epi.umn.edu/let
Ginsberg, K. The Teen Brain; 2018. Center for Communication for Parents and Teens. https://parentandteen.com/category/communication-strategies/
Mohr, L.D. Adolescent Growth and Development Issues in Adolescents with an Ostomy: A primer for WOC nurses. J Wound Ostomy Continence Nurs. 2012;39(5):515-521.