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Caring for Pregnant Adolescents: Perils and Pearls Of Communication
Pregnant Adolescents
Perils and Pearls of Communication Ta m m y C . K in g -J o n e s,
RNC
Pregnant adolescents depend on nu rses for support, education and hea lth care and have an overall perception tha t nurses are trustworthy and caring. It’s critical that nurses recognize their sig nificant influence on these patients and the importance of establishing effectiv e and therapeutic communication.
essionals as they seek of pr re ca th al he r he ot rses and This article will assist nu cents. It includes a es ol ad nt na eg pr ith w municate to understand and com pregnant adolescent, e th d an e rs nu e th n ee hip betw discussion of the relations ggestions to facilitate su d an n tio ica un m m rs to co ways to overcome barrie ion. therapeutic communicat
One of the most challenging elements of nursing care is the establishment of effective and therapeutic communication with patients (Bush & Boccadora, 2001). When the patient is a pregnant adolescent, the magnitude of these communication complexities can be discouraging and overwhelming for the nurse. Despite these challenges, nurses’ unwavering commitment to the health and well-being of the pregnant adolescent persists.
The Adolescent’s Perspective For many pregnant adolescents, contact with the health care system most often occurs through a nurse (Cassata & Dallas, 2005). Adolescents perceive the nurse to be someone in whom they can confide and trust to provide them with accurate information (Levenburg, 1998). This perception places the nurse in an advantageous position to offer support, education and health care to this marginalized population. However, if nurses aren’t able to effectively communicate with pregnant adolescents, this advantage could quickly disappear.
The Nurse’s Perspective While the vast majority of nurses are committed to the mission of caring for pregnant adolescents, some may be unaware that their personal feelings and assumptions can affect how they approach this population. Nurses must be cautious and avoid personal biases that might taint treatment with a disrespectful or judgmental overtone (SmithBattle, 2003). Cassata and Dallas (2005) conducted focus groups with nurses who reported feelings of hopelessness when communicating with pregnant adolescents. One participant shared, “I’m not sure we can ever understand pregnant teens. That’s not who we are and they don’t know who we are” (Cassata & Dallas, p. 75). The divide that exists between nurses and pregnant adolescents should not be the focus. Rather, nurses who truly desire to provide care that is empowering and supportive must focus on examining their own attitudes and practices in order to dispel traditional stigmas and build bridges to these young women.
Barriers to Communication Struggle for Role Attainment and Autonomy Pregnant adolescents find themselves in developmental and role conflicts as they attempt to complete the tasks of adolescence and motherhood (Birkeland, Thompson, & Phares, 2005; Letourneau, Stewart, & Barnfather, 2004). These stressors confound communication due to adolescent demand for autonomy, individuation and control. Many young women feel a real sense of control for the first time during pregnancy and motherhood. Hanna (2001) found that when adolescent mothers perceived
health care providers as “bossy,” they avoided these confrontations by not using the services. The pregnant adolescent will often lash out or rebel against parents, nurses and other authority figures that threaten autonomy and independence (Levenburg, 1998), thereby creating a stalemate in communication.
Varying Levels of Cognition The cognitive development of pregnant adolescents determines how reasoning, learning and logical deduction take place. Tailoring communication to meet the individual adolescent’s cognitive development is challenging. The younger adolescent (13 to 15 years of age) employs concrete reasoning and gives little thought to the consequences of actions (Levenburg, 1998). Those 15 to 19 years of age have an increased capacity for abstract thinking and formal logic and are more apt to correlate actions with consequences (Taylor-Seehafer & Rew, 2000). “What did you expect the outcome to be?” is an example of a question related to decisions and consequences. While this is an appropriately phrased question for older adolescents, a more suitable question for younger teens would be, “What did you think would happen?” This poses the same question in a concrete form for the younger adolescent (Dashiff, 2001).
Perceived Invulnerability The diminished capacity of pregnant adolescents to foresee future consequences of actions leads to a perception of invulnerability. This perception fosters an optimistic view of risks and the misconception that harm will not befall them (Levenburg, 1998). For example, the pregnant adolescent experiencing preterm labor who is noncompliant with her health care provider’s plan may simply not believe that she or her fetus is at risk. This discounting of risks by pregnant adolescents confounds
entral tion is a c a ic n u m regnant • Com g for the p in r a c f o t aspec t. adolescen ment e develop iv it n g o c deter• The dolescents ning a t n a n g of pre g , lear e. w reasonin mines ho eduction take plac d l a ic g and lo onal bild put pers when u o h s s e • Nurs ons aside assumpti scents. ases and nant adole g re p r fo caring
Tammy C. King-Jones, RNC, is director of the Magnet Program for the University of Arkansas for Medical Sciences (UAMS) Medical Center, and a doctoral candidate in the UAMS College of Nursing, Little Rock, AR. Address correspondence to: [email protected]. DOI: 10.1111/j.1751-486X.2008.00297.x
116
© 2008, AWHONN
http://nwh.awhonn.org
therapeutic communication and challenges the nurse’s educational efforts (Breheny & Stephens, 2004).
Communication Perils Assumptions and Biases Unfortunately, nurses can sometimes unintentionally contribute to the stigmatization of pregnant adolescents by approaching them from a risk- and problem-focused viewpoint. SmithBattle (2000) identifies stereotypical assumptions nurses may work from, such as: (a) the pregnant adolescent is maternally incompetent, as evidenced by the “children raising children” label, (b) poverty and imperiled development are predictable consequences of adolescent pregnancy, and (c) pregnant adolescents are “economic pariahs and long-term welfare dependents” (p. 36). If nurses allow these assumptions to pervade the care they provide, hopes for therapeutic communication are shattered.
For ma ny pregn Talking More and Listening Less contact w ant adolescen most ofte ith the healt ts, Nurses are accustomed to being a source of n occurs h care sy education and information for their patients. t h r o ugh a nu stem Often, the delivery of information supersedes rse. information gathering for the nurse pressed to complete designated tasks in a limited amount of time. The pregnant adolescent may perceive this tendency as inattentiveness and may believe that she’s not afforded the time to express her needs. This perception can undermine therapeutic communication by leaving the pregnant adolescent feeling ignored and rejected (SmithBattle, 2003).
Condescending or Authoritarian Attitudes Pregnant adolescents have special health care and educational needs. Unfortunately, some nurses and other health care providers may provide this specialized care in a way that the young women perceive as patronizing. Pregnant adolescents don’t want to be treated differently than their older counterparts and will avoid situations and services where they feel conspicuous or infantilized (Hanna, 2001). Further, if the nurse displays an authoritarian persona and attempts to exert control over the pregnant adolescent’s health care, the patient will perceive this as threatening to her independence and will terminate communication. The nurse might not intend to project an authoritative demeanor but may unwittingly do so by utilizing a hierarchical approach to care, donning austere professional attire (white coat) and by declaring “orders” for the pregnant adolescent’s health care (Michels, 2000; Morrison-Beedy et al., 2001).
Working From One Social Script SmithBattle (2003) contends that when nurses believe that the conforming of the pregnant adolescent to behavioral norms will provide solutions to her problems, they are denying her
April
May 2008
“social inheritance” and legacies, which are highly personal and meaningful to her (p. 371). Some nurses believe that modification of the pregnant adolescent’s lifestyle to one deemed “better” by society is their responsibility (Cassata & Dallas, 2005). Imposing this social script denies the consideration of cultural and ethnic diversities and essentially disregards the meanings, traditions and practices (SmithBattle, 2003) of the pregnant adolescent, further subverting communication efforts. For example, Cassata and Dallas discuss a nurse’s frustration with Hispanic adolescents who decide to bottle-feed despite repeated educational efforts on the benefits of breastfeeding. What the nurse may not realize is that Hispanic females tend to value the opinions and advice of peers and family members over that of health care providers (Darby, 2007; Gibson, Diaz, Mainous, & Geesey, 2005). If the Hispanic adolescent’s mother or partner believes bottle-feeding is more appropriate for the baby, this may supersede the nurse’s educational efforts.
Communication Pearls Removal of Biases and Assumptions Public perception of adolescent mothers as “kids raising kids,” welfare drainers and poverty stricken is not likely to change soon (SmithBattle, 2000). It is, however, the responsibility of the nurse to remain diligent in laying personal biases and assumptions aside when caring for pregnant adolescents. Bracketing personal biases is imperative to providing nursing care that focuses on
Nursing for Women’s Health
117
“opportunities to assess for, reinforce and build upon existing strengths” of the pregnant adolescent (Cassata & Dallas, 2005, p. 73). Nurses should be aware that in spite of the myriad of challenges facing pregnant adolescents, most are resilient and have a strong desire for a better future for themselves and their children. Further, nurses can develop successful teaching and communication strategies when they bear in mind that pregnancy or parenthood can provide the impetus for positive behavior change (Logsdon, Gagne, Hughes, Patterson & Rakestraw, 2005). SmithBattle (2003) shares the remarks of a public health nurse that provides an exemplar of the stigma associated with pregnant adolescents and an approach that is empowering: “I see them as diamonds in the rough. I see more potential in them maybe than they see for themselves.” “I give her all the education I can, and we sit down and we have talks about life.” “And I’ve told her, just because you have a child does not mean that your goals and your dreams have to be put by the wayside” (p. 374).
Active Listening The rigorous schedules and time constraints that are associated with clinical practice often preclude therapeutic communication. The nurse must practice in a way that ensures the pregnant adolescent has the opportunity to share her thoughts, questions and concerns even when time is limited. However, when time isn’t an issue, the perceived inattentiveness of some nurses may simply stem from their unfamiliarity iarity with eeffective listening skills. Nurses can enhance communication with nce co comm mmun mm u ication w pregnant adolescents by incorporating skills rpor orrat atiing the active listening liste teni te n ng ski described by Bush and nd Boccadora Boccad dora (2001) ((see sseee Bo Box 1) Box 1)..
Michels (2000) shares the perspectives of pregnant adolescents on how their health care providers listen. One adolescent said, “Like…listen to your problems and not trying to tell you but just listen to what you have to say and not trying to draw you out or saying you need this, you need to do that” (p. 561). Active listening, rather than passive hearing, will allow the nurse to gain greater insight into the patient’s concerns, experiences, strengths and hopes for the future.
Building a Partnership It’s not uncommon for health care providers to regard pregnant adolescents as voiceless and passive recipients of information, rather than experts on their own lives (SmithBattle, 2003). This hierarchical approach to communication doesn’t facilitate the pregnant adolescent’s expression of her needs and feelings. Removing this hierarchy requires the establishment of a partnership between the nurse and the adolescent. Building a partnership begins with the nurse’s commitment to avoid the use of jargon and unfamiliar vernacular, authoritarian attire and demeanor and patronizing tones when caring for the pregnant adolescent. This commitment by the nurse sets the stage for reciprocity. In the Michels (2000) study, one pregnant adolescent’s comment elucidates the diminishing of this hierarchy through the health care provider’s attempt to place patient and nurse on an even plane: “Yeah, ‘cause she sits down right there…on the bed…and she starts talking to me, and I feel like she’s, you know, giving me all of her attention” (p. 562). This attitude also validates the adolescent’s input as critical to the communication process (Morrison-Beedy et al., 2001) and increases her sense of self-efficacy in decision-making (Michels, 2000). A reciprocal relationship significantly facilitates therapeutic communication and fosters the achievement of health goals (Stevens, 2006).
Tailoring Care T Prre Pregnant adolescents are a diverse group. Their needs, concerns and aspirations are as varied as their cultural, socioeconomic backgrounds. This heterogeneity demands and educational e nursing practice that is respectful of differences, sensitive to intricacies of social contexts and family worlds and focused on
Activ listening, rather than Active passive hearing, will allow the nur nurse to gain greater insight into the patient’s concerns, experiences, strengths exper and hopes for the future. 118
Nursing for Women’s Health
Volume 12
Issue 2
Box 1
Active Listening Strategies
shortcomings and efforts to improve will set them on the path to effective communication with their pregnant adolescent patients, potentially resulting in improved health outcomes for this often underserved population. NWH
• Maintain eye contact as much as possible (when culturally appropriate).
References
• Resist the impulse to interrupt or interject opinions or viewpoints.
Birkeland, R., Thompson, J., & Phares, V. (2005). Adolescent motherhood and postpartum depression. Journal of Clinical Child and Adolescent Psychology, 34, 292–300.
• Encourage continued discourse by verbally and nonverbally expressing understanding.
Breheny, M., & Stephens, C. (2004). Barriers to effective contraception and strategies for overcoming them among adolescent mothers. Public Health Nursing, 21, 220–227.
• Pay particular attention to nonverbal communication, which can elucidate the patient’s feelings and the “meanings behind the words.”
Bush, K., & Boccadora, D. (2001). Do you really listen to patients? RN Magazine, 64(3), 35–37.
Source: Bush and Boccadora (2001), p. 64.
“the way it is” rather than “the way it should be” (SmithBattle, 2003, p. 371). Further tailoring of care occurs when the nurse takes the time to assess the patient’s personality characteristics and cultural background. Morrison-Beedy et al. (2001) discuss how the nurse can use this assessment in determining the best approach to establish rapport with the pregnant adolescent. For example, it’s appropriate to take an active approach for the initial contact with the adolescent who maintains eye contact, displays open body language and is talkative. Conversely, those who are introverted (quiet, closed off and isolated) require a softer approach in which eye contact is not forced and maintenance of a greater physical distance is necessary. It’s also appropriate to consider cultural boundaries when approaching pregnant adolescents. Personal space, the use of gestures, volume of voice, touch and eye contact all have different cultural meanings and implications (Ling, 1997). Sensitivity to these characteristics and cultural differences will promote the formation of trust and pave the way for therapeutic communication to occur.
Conclusions Sensitive and comprehensive nursing care is vital for pregnant adolescents who generally perceive nurses to be trustworthy and caring (Levenburg, 1998). It’s critical that nurses recognize their significant influence and the importance of establishing effective and therapeutic communication. Nurses must take it upon themselves to increase their awareness of the developmental struggles that affect the pregnant adolescent’s perceptions and how these affect communication between the nurse and the patient. Additionally, nurses must perform a self-analysis to determine characteristics that negate communication efforts, including (a) personal biases and assumptions, (b) ineffective listening skills, (c) authoritarian attitudes and (d) insensitivity to differences. Nurses’ acknowledgment of communication
April
May 2008
Cassata, L., & Dallas, C. (2005). Nurses’ attitudes and childbearing adolescents: Bridging the cultural chasm. The ABNF Journal, 16(4), 71–76. Darby, S. B. (2007). Pre- and perinatal care of Hispanic families: Implications for nurses. Nursing for Women’s Health, 11, 160–169. Dashiff, C. (2001). Data collection with adolescents. Journal of Advanced Nursing, 33, 343–349. Gibson, M., Diaz, V., Mainous, A., & Geesey, M. (2005). Prevalence of breastfeeding and acculturation in Hispanics: Results from NHANES 1999-2000 Study. Birth, 32, 93–98. Hanna, B. (2001). Negotiating motherhood: The struggles of teenage mothers. Journal of Advanced Nursing, 34, 456–464. Letourneau, N., Stewart, M., & Barnfather, A. (2004). Adolescent mothers: Support needs, resources, and support-education interventions. Journal of Adolescent Health, 35, 509–525. Levenburg, P. (1998). GAPS: An opportunity for nurse practitioners to promote the health of adolescents through clinical preventive services. Journal of Pediatric Health Care, 12, 2–9. Ling, C. (1997). Crossing cultural boundaries. Nursing, 27(3), 32d–32f. Logsdon, C., Gagne, P., Hughes, T., Patterson, J., & Rakestraw, V. (2005). Social support during adolescent pregnancy: Piecing together a quilt. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 34, 606–614. Michels, T. (2000). “Patients like us”: Pregnant and parenting teens view the health care system. Public Health Reports, 115, 557–575. Morrison-Beedy, D., Aronwitz, T., Dyne, J., Mkandawire, L., Murphy, C., & Martin, J. (2001). The nurse clinician as research participant recruiter: Experience from a longitudinal intervention study. Journal of the New York State Nurses Association, 32(2), 9–13. SmithBattle, L. (2000). The vulnerabilities of teenage mothers: Challenging prevailing assumptions. Advances in Nursing Science, 23, 29–40. SmithBattle, L. (2003). Displacing the “rule book” in caring for teen mothers. Public Health Nursing, 20(5), 369–376. Stevens, C. (2006). Being healthy: Voices of adolescent women who are parenting. Journal for Specialists in Pediatric Nursing, 11, 28–40. Taylor-Seehafer, M., & Rew, L. (2000). Risky sexual behavior among adolescent women. Journal for Specialists in Pediatric Nursing, 5(1), 15–24.
Nursing for Women’s Health
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Perils and Pearls of Communication Ta m m y C . K in g -J o n e s,
RNC
Pregnant adolescents depend on nu rses for support, education and hea lth care and have an overall perception tha t nurses are trustworthy and caring. It’s critical that nurses recognize their sig nificant influence on these patients and the importance of establishing effectiv e and therapeutic communication.
essionals as they seek of pr re ca th al he r he ot rses and This article will assist nu cents. It includes a es ol ad nt na eg pr ith w municate to understand and com pregnant adolescent, e th d an e rs nu e th n ee hip betw discussion of the relations ggestions to facilitate su d an n tio ica un m m rs to co ways to overcome barrie ion. therapeutic communicat
One of the most challenging elements of nursing care is the establishment of effective and therapeutic communication with patients (Bush & Boccadora, 2001). When the patient is a pregnant adolescent, the magnitude of these communication complexities can be discouraging and overwhelming for the nurse. Despite these challenges, nurses’ unwavering commitment to the health and well-being of the pregnant adolescent persists.
The Adolescent’s Perspective For many pregnant adolescents, contact with the health care system most often occurs through a nurse (Cassata & Dallas, 2005). Adolescents perceive the nurse to be someone in whom they can confide and trust to provide them with accurate information (Levenburg, 1998). This perception places the nurse in an advantageous position to offer support, education and health care to this marginalized population. However, if nurses aren’t able to effectively communicate with pregnant adolescents, this advantage could quickly disappear.
The Nurse’s Perspective While the vast majority of nurses are committed to the mission of caring for pregnant adolescents, some may be unaware that their personal feelings and assumptions can affect how they approach this population. Nurses must be cautious and avoid personal biases that might taint treatment with a disrespectful or judgmental overtone (SmithBattle, 2003). Cassata and Dallas (2005) conducted focus groups with nurses who reported feelings of hopelessness when communicating with pregnant adolescents. One participant shared, “I’m not sure we can ever understand pregnant teens. That’s not who we are and they don’t know who we are” (Cassata & Dallas, p. 75). The divide that exists between nurses and pregnant adolescents should not be the focus. Rather, nurses who truly desire to provide care that is empowering and supportive must focus on examining their own attitudes and practices in order to dispel traditional stigmas and build bridges to these young women.
Barriers to Communication Struggle for Role Attainment and Autonomy Pregnant adolescents find themselves in developmental and role conflicts as they attempt to complete the tasks of adolescence and motherhood (Birkeland, Thompson, & Phares, 2005; Letourneau, Stewart, & Barnfather, 2004). These stressors confound communication due to adolescent demand for autonomy, individuation and control. Many young women feel a real sense of control for the first time during pregnancy and motherhood. Hanna (2001) found that when adolescent mothers perceived
health care providers as “bossy,” they avoided these confrontations by not using the services. The pregnant adolescent will often lash out or rebel against parents, nurses and other authority figures that threaten autonomy and independence (Levenburg, 1998), thereby creating a stalemate in communication.
Varying Levels of Cognition The cognitive development of pregnant adolescents determines how reasoning, learning and logical deduction take place. Tailoring communication to meet the individual adolescent’s cognitive development is challenging. The younger adolescent (13 to 15 years of age) employs concrete reasoning and gives little thought to the consequences of actions (Levenburg, 1998). Those 15 to 19 years of age have an increased capacity for abstract thinking and formal logic and are more apt to correlate actions with consequences (Taylor-Seehafer & Rew, 2000). “What did you expect the outcome to be?” is an example of a question related to decisions and consequences. While this is an appropriately phrased question for older adolescents, a more suitable question for younger teens would be, “What did you think would happen?” This poses the same question in a concrete form for the younger adolescent (Dashiff, 2001).
Perceived Invulnerability The diminished capacity of pregnant adolescents to foresee future consequences of actions leads to a perception of invulnerability. This perception fosters an optimistic view of risks and the misconception that harm will not befall them (Levenburg, 1998). For example, the pregnant adolescent experiencing preterm labor who is noncompliant with her health care provider’s plan may simply not believe that she or her fetus is at risk. This discounting of risks by pregnant adolescents confounds
entral tion is a c a ic n u m regnant • Com g for the p in r a c f o t aspec t. adolescen ment e develop iv it n g o c deter• The dolescents ning a t n a n g of pre g , lear e. w reasonin mines ho eduction take plac d l a ic g and lo onal bild put pers when u o h s s e • Nurs ons aside assumpti scents. ases and nant adole g re p r fo caring
Tammy C. King-Jones, RNC, is director of the Magnet Program for the University of Arkansas for Medical Sciences (UAMS) Medical Center, and a doctoral candidate in the UAMS College of Nursing, Little Rock, AR. Address correspondence to: [email protected]. DOI: 10.1111/j.1751-486X.2008.00297.x
116
© 2008, AWHONN
http://nwh.awhonn.org
therapeutic communication and challenges the nurse’s educational efforts (Breheny & Stephens, 2004).
Communication Perils Assumptions and Biases Unfortunately, nurses can sometimes unintentionally contribute to the stigmatization of pregnant adolescents by approaching them from a risk- and problem-focused viewpoint. SmithBattle (2000) identifies stereotypical assumptions nurses may work from, such as: (a) the pregnant adolescent is maternally incompetent, as evidenced by the “children raising children” label, (b) poverty and imperiled development are predictable consequences of adolescent pregnancy, and (c) pregnant adolescents are “economic pariahs and long-term welfare dependents” (p. 36). If nurses allow these assumptions to pervade the care they provide, hopes for therapeutic communication are shattered.
For ma ny pregn Talking More and Listening Less contact w ant adolescen most ofte ith the healt ts, Nurses are accustomed to being a source of n occurs h care sy education and information for their patients. t h r o ugh a nu stem Often, the delivery of information supersedes rse. information gathering for the nurse pressed to complete designated tasks in a limited amount of time. The pregnant adolescent may perceive this tendency as inattentiveness and may believe that she’s not afforded the time to express her needs. This perception can undermine therapeutic communication by leaving the pregnant adolescent feeling ignored and rejected (SmithBattle, 2003).
Condescending or Authoritarian Attitudes Pregnant adolescents have special health care and educational needs. Unfortunately, some nurses and other health care providers may provide this specialized care in a way that the young women perceive as patronizing. Pregnant adolescents don’t want to be treated differently than their older counterparts and will avoid situations and services where they feel conspicuous or infantilized (Hanna, 2001). Further, if the nurse displays an authoritarian persona and attempts to exert control over the pregnant adolescent’s health care, the patient will perceive this as threatening to her independence and will terminate communication. The nurse might not intend to project an authoritative demeanor but may unwittingly do so by utilizing a hierarchical approach to care, donning austere professional attire (white coat) and by declaring “orders” for the pregnant adolescent’s health care (Michels, 2000; Morrison-Beedy et al., 2001).
Working From One Social Script SmithBattle (2003) contends that when nurses believe that the conforming of the pregnant adolescent to behavioral norms will provide solutions to her problems, they are denying her
April
May 2008
“social inheritance” and legacies, which are highly personal and meaningful to her (p. 371). Some nurses believe that modification of the pregnant adolescent’s lifestyle to one deemed “better” by society is their responsibility (Cassata & Dallas, 2005). Imposing this social script denies the consideration of cultural and ethnic diversities and essentially disregards the meanings, traditions and practices (SmithBattle, 2003) of the pregnant adolescent, further subverting communication efforts. For example, Cassata and Dallas discuss a nurse’s frustration with Hispanic adolescents who decide to bottle-feed despite repeated educational efforts on the benefits of breastfeeding. What the nurse may not realize is that Hispanic females tend to value the opinions and advice of peers and family members over that of health care providers (Darby, 2007; Gibson, Diaz, Mainous, & Geesey, 2005). If the Hispanic adolescent’s mother or partner believes bottle-feeding is more appropriate for the baby, this may supersede the nurse’s educational efforts.
Communication Pearls Removal of Biases and Assumptions Public perception of adolescent mothers as “kids raising kids,” welfare drainers and poverty stricken is not likely to change soon (SmithBattle, 2000). It is, however, the responsibility of the nurse to remain diligent in laying personal biases and assumptions aside when caring for pregnant adolescents. Bracketing personal biases is imperative to providing nursing care that focuses on
Nursing for Women’s Health
117
“opportunities to assess for, reinforce and build upon existing strengths” of the pregnant adolescent (Cassata & Dallas, 2005, p. 73). Nurses should be aware that in spite of the myriad of challenges facing pregnant adolescents, most are resilient and have a strong desire for a better future for themselves and their children. Further, nurses can develop successful teaching and communication strategies when they bear in mind that pregnancy or parenthood can provide the impetus for positive behavior change (Logsdon, Gagne, Hughes, Patterson & Rakestraw, 2005). SmithBattle (2003) shares the remarks of a public health nurse that provides an exemplar of the stigma associated with pregnant adolescents and an approach that is empowering: “I see them as diamonds in the rough. I see more potential in them maybe than they see for themselves.” “I give her all the education I can, and we sit down and we have talks about life.” “And I’ve told her, just because you have a child does not mean that your goals and your dreams have to be put by the wayside” (p. 374).
Active Listening The rigorous schedules and time constraints that are associated with clinical practice often preclude therapeutic communication. The nurse must practice in a way that ensures the pregnant adolescent has the opportunity to share her thoughts, questions and concerns even when time is limited. However, when time isn’t an issue, the perceived inattentiveness of some nurses may simply stem from their unfamiliarity iarity with eeffective listening skills. Nurses can enhance communication with nce co comm mmun mm u ication w pregnant adolescents by incorporating skills rpor orrat atiing the active listening liste teni te n ng ski described by Bush and nd Boccadora Boccad dora (2001) ((see sseee Bo Box 1) Box 1)..
Michels (2000) shares the perspectives of pregnant adolescents on how their health care providers listen. One adolescent said, “Like…listen to your problems and not trying to tell you but just listen to what you have to say and not trying to draw you out or saying you need this, you need to do that” (p. 561). Active listening, rather than passive hearing, will allow the nurse to gain greater insight into the patient’s concerns, experiences, strengths and hopes for the future.
Building a Partnership It’s not uncommon for health care providers to regard pregnant adolescents as voiceless and passive recipients of information, rather than experts on their own lives (SmithBattle, 2003). This hierarchical approach to communication doesn’t facilitate the pregnant adolescent’s expression of her needs and feelings. Removing this hierarchy requires the establishment of a partnership between the nurse and the adolescent. Building a partnership begins with the nurse’s commitment to avoid the use of jargon and unfamiliar vernacular, authoritarian attire and demeanor and patronizing tones when caring for the pregnant adolescent. This commitment by the nurse sets the stage for reciprocity. In the Michels (2000) study, one pregnant adolescent’s comment elucidates the diminishing of this hierarchy through the health care provider’s attempt to place patient and nurse on an even plane: “Yeah, ‘cause she sits down right there…on the bed…and she starts talking to me, and I feel like she’s, you know, giving me all of her attention” (p. 562). This attitude also validates the adolescent’s input as critical to the communication process (Morrison-Beedy et al., 2001) and increases her sense of self-efficacy in decision-making (Michels, 2000). A reciprocal relationship significantly facilitates therapeutic communication and fosters the achievement of health goals (Stevens, 2006).
Tailoring Care T Prre Pregnant adolescents are a diverse group. Their needs, concerns and aspirations are as varied as their cultural, socioeconomic backgrounds. This heterogeneity demands and educational e nursing practice that is respectful of differences, sensitive to intricacies of social contexts and family worlds and focused on
Activ listening, rather than Active passive hearing, will allow the nur nurse to gain greater insight into the patient’s concerns, experiences, strengths exper and hopes for the future. 118
Nursing for Women’s Health
Volume 12
Issue 2
Box 1
Active Listening Strategies
shortcomings and efforts to improve will set them on the path to effective communication with their pregnant adolescent patients, potentially resulting in improved health outcomes for this often underserved population. NWH
• Maintain eye contact as much as possible (when culturally appropriate).
References
• Resist the impulse to interrupt or interject opinions or viewpoints.
Birkeland, R., Thompson, J., & Phares, V. (2005). Adolescent motherhood and postpartum depression. Journal of Clinical Child and Adolescent Psychology, 34, 292–300.
• Encourage continued discourse by verbally and nonverbally expressing understanding.
Breheny, M., & Stephens, C. (2004). Barriers to effective contraception and strategies for overcoming them among adolescent mothers. Public Health Nursing, 21, 220–227.
• Pay particular attention to nonverbal communication, which can elucidate the patient’s feelings and the “meanings behind the words.”
Bush, K., & Boccadora, D. (2001). Do you really listen to patients? RN Magazine, 64(3), 35–37.
Source: Bush and Boccadora (2001), p. 64.
“the way it is” rather than “the way it should be” (SmithBattle, 2003, p. 371). Further tailoring of care occurs when the nurse takes the time to assess the patient’s personality characteristics and cultural background. Morrison-Beedy et al. (2001) discuss how the nurse can use this assessment in determining the best approach to establish rapport with the pregnant adolescent. For example, it’s appropriate to take an active approach for the initial contact with the adolescent who maintains eye contact, displays open body language and is talkative. Conversely, those who are introverted (quiet, closed off and isolated) require a softer approach in which eye contact is not forced and maintenance of a greater physical distance is necessary. It’s also appropriate to consider cultural boundaries when approaching pregnant adolescents. Personal space, the use of gestures, volume of voice, touch and eye contact all have different cultural meanings and implications (Ling, 1997). Sensitivity to these characteristics and cultural differences will promote the formation of trust and pave the way for therapeutic communication to occur.
Conclusions Sensitive and comprehensive nursing care is vital for pregnant adolescents who generally perceive nurses to be trustworthy and caring (Levenburg, 1998). It’s critical that nurses recognize their significant influence and the importance of establishing effective and therapeutic communication. Nurses must take it upon themselves to increase their awareness of the developmental struggles that affect the pregnant adolescent’s perceptions and how these affect communication between the nurse and the patient. Additionally, nurses must perform a self-analysis to determine characteristics that negate communication efforts, including (a) personal biases and assumptions, (b) ineffective listening skills, (c) authoritarian attitudes and (d) insensitivity to differences. Nurses’ acknowledgment of communication
April
May 2008
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