1. Chapter 3 Communication Across the Lifespan

2. Growth and Development Theories • Factors that affect growth and development: • Biological: Inherited traits such as eye an hair color • Social: Friends, religion, and culture • Psychological: Self-esteem, stress, and learning Learning Objective 3-1

3. Growth and Development Theories • Benefits of understanding growth and development • Gives insight into patient experience • Aids communication Learning Objective 3-1

4. Cognitive Development Learning Theory • Cognitive development: refers to ability to think and reason logically and learn new ideas Learning Objective 3-2

5. Cognitive Development Learning Theory • Jean Piaget’s theory of cognitive development • Learning based on interaction with your environment • Four stages of interaction with environment • Sensorimotor activities: Zero to two years of age, interact using senses and motor skills Learning Objective 3-2

6. Cognitive Development Learning Theory • Jean Piaget’s theory of cognitive development • Four stage of interaction with environment • Preoperational thought: Two to six years of age, interact using symbols, basic language, and imagination • Concrete operational thought: Seven to eleven years of age, interact using logic, reasoning, and other people’s perspectives Learning Objective 3-2

7. Cognitive Development Learning Theory • Jean Piaget’s theory of cognitive development (cont.) • Four stage of interaction with environment • Formal operational thought: Twelve years of age to adulthood, interact using logical and abstract thought processes Learning Objective 3-2

8. Cognitive Development Learning Theory • Importance to health care professionals • Understanding how patients of any age interact with their environment helps you communicate with them Learning Objective 3-2

9. Freud’s Psychoanalytic Development Theory • Personality composed of three parts: Id, ego, superego • Id: Basic animal nature at a person’s core • Dominates from birth to two years of age • Seeks pleasure • Avoids pain • Is impatient Learning Objective 3-3

10. Freud’s Psychoanalytic Development Theory • Ego: Tries to reconcile the id’s desires with reality • Develops at age two to four • Delays pleasure-seeking until pleasure can be realistically achieved • Tolerates some pain if it will eventually result in pleasure • Is patient Learning Objective 3-3

11. Freud’s Psychoanalytic Development Theory • Superego: represents ideal rather than real behaviors • Develops by age five • Does what is “right” over what is pleasurable • Motivated by fear of punishment or internal values • Is very patient Learning Objective 3-3

12. Freud’s Psychoanalytic Development Theory • Psychosexual stages of development • Oral stage • Birth to 18 months • Region of focus is the mouth • Primary need is security Learning Objective 3-3

13. Freud’s Psychoanalytic Development Theory • Psychosexual stages of development • Anal stage • 18 months to four years • Child develops control of anal sphincter • Toilet training Learning Objective 3-3

14. Freud’s Psychoanalytic Development Theory • Psychosexual stages of development • Phallic stage • Age three to seven years old • Region of focus is genital area • Importance of gender difference increases Learning Objective 3-3

15. Freud’s Psychoanalytic Development Theory • Psychosexual stages of development • Latency stage • Age seven years old to puberty • Sexual impulses repressed in service of learning • Children identify with parent of the same sex Learning Objective 3-3

16. Freud’s Psychoanalytic Development Theory • Psychosexual stages of development • Genital stage • Puberty through adulthood • Sex drive reappears in the adolescent • Sexual pressures and conflicts manifest Learning Objective 3-3

17. Freud’s Psychoanalytic Development Theory • Importance to health care • In the healthy person, id, ego, and superego achieve enough harmony to fulfill basic needs and desires • When forces conflict and harmony fails, maladjustment can result Learning Objective 3-3

18. The Pleasure Principle • The pleasure principle • Characterizes the behavior of the id • An unconscious, essentially selfish drive to seek immediate pleasure and avoid pain Learning Objective 3-4

19. The Reality Principle • The reality principle • Characterizes the behavior of the ego • Defers pleasure or endures pain for the sake of later gratification Learning Objective 3-4

20. The Epigenetic Principle • Epigenetic principle • Erikson believed development follows a preset plan that requires mastering eight psychosocial crises Learning Objective 3-5

21. Erikson’s Eight Stages • Autonomy versus shame/doubt • 18 months to four years of age • Toddlers overcome doubt and develop autonomy by exploring and manipulating their environment • When treating toddlers, provide activities to ease their fear and preserve their sense of autonomy Learning Objective 3-5

22. Erikson’s Eight Stages • Initiative versus guilt • Three to six years of age • Initiative is a positive response to challenges • Encouraging child to seek new experiences promotes initiative • Restricting child’s learning produces guilt Learning Objective 3-5

23. Erikson’s Eight Stages • Industry versus inferiority • Six years of age to puberty • Children begin to seek recognition for accomplishments • Praise encourages an attitude of industry; rejection produces sense of inferiority Learning Objective 3-5

24. Erikson’s Eight Stages • Identity versus role confusion • Puberty to 18 years of age • Ego identity is knowing how you fit into society • Absent ego identity a person develops role confusion Learning Objective 3-5

25. Erikson’s Eight Stages • Intimacy versus isolation • Young adulthood • Capacity for intimacy is the ability to be close to others and participate in society • Absent intimacy a person slips into isolation and loneliness Learning Objective 3-5

26. Erikson’s Eight Stages • Generativity versus stagnation • Middle adulthood (the “midlife crisis”) • Generativity is concern for other generations • Absent generativity the individual becomes self-obsessed Learning Objective 3-5

27. Erikson’s Eight Stages • Ego integrity versus despair • Late adulthood • Ego integrity is the ability to reflect on and come to terms to the life you have lived • Absent ego integrity the individual dwells on regrets and slips into despair Learning Objective 3-5

28. Erikson’s Eight Stages • When dealing with a patient in late adulthood be alert to signs of despair, remind them of counseling resources, and notify physician if patient seems suicidal Learning Objective 3-5

29. The Principle of Mutuality • Mutuality refers to interaction between generations • Erikson believed children influence parents’ development as much as parents influence children • “Healthy children will not fear life if their elders have integrity enough not to fear death”  —Erik Erikson • Educating patients about Erikson’s stages helps to increase patient self-awareness and knowledge Learning Objective 3-6

30. Operant Conditioning • Principles of operant conditioning • As a person “operates” in his or her environment his or her behavior produces consequences that affect future behaviors Learning Objective 3-7

31. Operant Conditioning • Principles of operant conditioning • Reinforcement is a type of consequence • Continuous reinforcement: Every time a behavior happens, it is reinforced • Intermittent reinforcement: Behavior is reinforced only at certain intervals Learning Objective 3-7

32. Why Operant Conditioning Matters • Positive reinforcement of an action makes its repetition more likely • Example: A patient who properly takes ulcer medication before meals will experience positive effects and be more likely to continue treatment Learning Objective 3-8

33. Different Age Groups Communicate Differently • Recognize the psychological differences between patients of various ages • Helps you choose the best way of communicating with a patient Learning Objective 3-9

34. Growth and Development • As individuals grow and develop, their self-concept, self-image, and self-confidence change • Understanding growth stages will help you communicate effectively with patients and their families Learning Objective 3-10

35. Holistic Healthcare Communication • Treat the whole patient, not just the condition • Requires appropriate communication strategies for patient’s of all ages Learning Objective 3-11

36. General Principles of Patient Communication • Speak directly, giving patient full attention • Speak clearly • Verify that patient understands what you say • Be alert to verbal and nonverbal messages • Write down instructions • Communicate with age-appropriate terms Learning Objective 3-11

37. General Guidelines for Communicating with Children • Talk at eye level • Speak gently to ease fears • Move slowly • Always tell a child when you need to touch them Learning Objective 3-12

38. General Guidelines for Communicating with Children • Repeat and rephrase questions if child does not understand • Use toys to help break communication barrier • Allow children to cry and express emotion Learning Objective 3-12

39. General Guidelines for Communicating with Children • Form a relationship: Offering children a book or toy will let them know you are there to help not hurt • Environment: Give children a quiet, private examination room and provide activities to keep them busy Learning Objective 3-12

40. General Guidelines for Communicating with Children • Listen • Be patient: Do not interrupt and allow child time to answer questions completely • Watch for nonverbal clues, such as clutching a sore part of the body • If child must be still, ask caregiver if she would prefer to hold the child Learning Objective 3-12

41. General Guidelines for Communicating with Children • Choice • Giving children choices makes them feel more in control of the situation • During injections, have children take a deep breath and blow out; variation: offer a noisemaker to blow into Learning Objective 3-12

42. Talking with Adolescents • Be aware that adolescents may not understand: • The changes affecting their bodies • Sexual relations and reproduction • How to keep themselves healthy • Visual aids and diagrams can help educate adolescents Learning Objective 3-13

43. Talking with Adolescents • Some adolescents may be reluctant to share private matters in front of parents • Kindly ask parent or caregiver to leave room if necessary • Explain to adolescent under what circumstances information will be shared with a parent or caregiver Learning Objective 3-13

44. Talking with Adolescents • Choice: Provide adolescents opportunity to make choices about their health treatment • Help adolescents maintain their dignity by showing them respect • Avoid sending messages that might seem judgmental or belittling Learning Objective 3-13

45. Talking with Adolescents • “I” messages: To keep blame and judgmental statements out of the conversation, keep the focus on you not them • Honesty: Adolescents are particularly sensitive to honesty in communication Learning Objective 3-13

46. Communicating with Adults • Remember when communicating with adults that they face the constant stress of managing many responsibilities simultaneously Learning Objective 3-14

47. Communicating with Adults • Individual information • Gauge how much information the patient wants • Adults know what works for them and what doesn’t • Always verify that a patient understands you Learning Objective 3-14

48. Communicating with Adults • Delivery • Choose words you know the patient will understand—without treating the patient like a child • Always greet patients and explain any procedure before performing it Learning Objective 3-14

49. Communicating with Adults • Explanations • Use simple words • Write down important information • Verify understanding by asking questions Learning Objective 3-14

50. Communicating with Adults • Planning and collaboration • Sit down with patients and make sure they understand and can follow treatment plans Learning Objective 3-14