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Chapter 3
Communication Across the Lifespan
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
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Growth and Development Theories
• Benefits of understanding growth and development
– Gives insight into patient experience
– Aids communication
Learning Objective 3-1
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Cognitive Development Learning Theory
• Cognitive development: refers to ability to think and
reason logically and learn new ideas
Learning Objective 3-2
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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The Epigenetic Principle
• Epigenetic principle
– Erikson believed development follows a preset plan
that requires mastering eight psychosocial crises
Learning Objective 3-5
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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
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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
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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
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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
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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
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Erikson’s Eight Stages
• Generativity versus stagnation
– Middle adulthood (the “midlife crisis”)
– Generativity is concern for other generations
– Absent generativity the individual becomes selfobsessed
Learning Objective 3-5
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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
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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
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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
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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
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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
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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
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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
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Growth and Development
• As individuals grow and develop, their self-concept, selfimage, and self-confidence change
• Understanding growth stages will help you communicate
effectively with patients and their families
Learning Objective 3-10
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Communicating with Adults
• Remember when communicating with adults that they
face the constant stress of managing many
responsibilities simultaneously
Learning Objective 3-14
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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
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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
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Communicating with Adults
• Explanations
– Use simple words
– Write down important information
– Verify understanding by asking questions
Learning Objective 3-14
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Communicating with Adults
• Planning and collaboration
– Sit down with patients and make sure they
understand and can follow treatment plans
Learning Objective 3-14
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Communicating with Adults
• Relationships
– Connect positively with adult patients by
• Assessing their needs
• Understanding your treatment objective
• Providing a comfortable environment and putting
them at ease
• Respecting their privacy
Learning Objective 3-14
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Communicating with Older Adults
• Remember that older patients may suffer from memory
loss
– Write down instructions in simple words and easy-toread print
– Have patients repeat what you write down
Learning Objective 3-15
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Communicating with Older Adults
• Remember that older patients may suffer from memory
loss (cont.)
– If applicable, ask patients to demonstrate how they
will perform a procedure
– Make appointment calendars for patients to take
home
Learning Objective 3-15
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Communicating with Older Adults
• Mistaken assumptions
– It is untrue that older people are:
• Weak and sick
• Unable to learn
• Boring
• Lonely
Learning Objective 3-15
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Communicating with Older Adults
• Mistaken assumptions (cont.)
– It is untrue that older people are
• Without interest in life
• Slow at everything
• Unable to make rational decisions
Learning Objective 3-15
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Communicating with Older Adults
• Characteristics of older patients
– May have chronic conditions that must be considered
when treating new ailments
– May fear declining health and the consequent loss of
their independence
– May be fearful of death and should be encouraged to
stay active and social
Learning Objective 3-15
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Goals for Communication with Older
Adults
• Restore the patient’s sense of control
– Provide a regular schedule of appointments that is
easy to remember
• Pace of communication
– Look for verbal and nonverbal clues that a patient
follows what you say
Learning Objective 3-15
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Goals for Communication with Older
Adults
• Respect and dignity
– Use the patient’s preferred name
– Ask permission before performing all procedures
– Take time to explain all procedures
– Encourage questions and pass on to physician
– Show courtesy by saying “please” and “thank you”
Learning Objective 3-15
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Goals for Communication with Older
Adults
• Reassurance
– Take time to soothe a patient who communicates fear
or confusion with verbal or nonverbal cues
Learning Objective 3-15
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Goals for Communication with Older
Adults
• Cue detection
– Learn to detect nonverbal signals of patient confusion
• Patient might look away when confused
• Patient might blankly say, “That’s fine” or “All
right”
• Patient might change subject or want to leave
Learning Objective 3-15
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Goals for Communication with Older
Adults
• Empathy
– The ability to identify with the way another person
feels
• Show sincerity and caring with simple statements
such as, “This must be a hard time for you. How
are you doing?”
Learning Objective 3-15
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