COMMUNICATION
SECTION I BASIC NURSING
COMMUNICATION
The process by which information is exchanged between the sender and receiver.
Includes six aspects: sender, message, method, receiver, feedback, and influences.
THE SENDER
The person who has a thought, idea, or emotion to convey to another person.
Messages stem from a person’s need to relate to others, to create meanings, and to understand various situations.
THE MESSAGE
The thought, idea, or emotion one person sends to another person.
A stimulus produced by the sender and responded to by the receiver.
THE METHOD
The person sending the message must decide how to send the message.
May be verbal or nonverbal.
THE RECEIVER
The physiological component involves auditory, visual, and kinesthetic processes.
Psychological processes may enhance or hinder receiving of messages.
The cognitive element is the “thinking” part of receiving.
FEEDBACK
The response from receiver that enables sender to verify that the message received was the message sent.
Messages are sent and received until receiver understands the message sent by sender.
INFLUENCES
Culture, age, emotions, language, attitudes, and education influence both the sender and receiver.
All of these elements together are called a person’s frame of reference.
The frame of reference may help or hinder communication.
VERBAL COMMUNICATION
The use of words, either spoken or written, to send a message.
Methods of verbal communication include speaking, listening, writing, and reading.
SPEAKING/LISTENING
For communication to take place, both speaking and listening must occur.
Speaking rate: 125–150 words per minute.
Hearing rate: 450–800 words per minute. Listening is one of the most difficult skills
to learn and execute well.
WRITING/READING
Receiver reads the words. Reader must understand the words and
then attach meaning to them. There is generally no opportunity for
immediate feedback. Clarity in writing is essential to good
communication.
NONVERBAL COMMUNICATION
Also referred to as “body language.” A method of sending a message without
using speech or writing. Is primarily unconscious and is believed
to be more honest than verbal communication.
NONVERBAL COMMUNICATION (continued)
Gestures Facial expressions Posture and gait Tone of voice
Touch Eye contact Body position Physical
appearance
Includes:
GESTURES
“Talking with the hands.” May help clarify a verbal message. May emphasize an idea. May hold other’s attention. May relieve stress. May indicate nervousness, tension,
impatience.
FACIAL EXPRESSIONS
Nurses must be very aware of their facial expressions.
Clients will be reassured and comforted by a nurse’s facial expression indicating caring, concern, and empathy.
POSTURE AND GAIT
Good posture and a purposeful gait usually convey self-confidence, competence, and a positive self-image.
Stooped shoulders and a shuffling gait generally convey low self-esteem, depression, lack of confidence, or apathy.
TONE OF VOICE
Has been estimated to convey 23% of the context of a message.
The same words said in different tones of voice can have very different meanings.
Tones include pleasant, sincere, sorrowful, sarcastic, joyful, or angry.
TOUCH
Can convey caring, understanding, encouragement, warmth, reassurance, or affection.
Can also convey anger, displeasure. Many nursing tasks involve touch. Most clients accept touch when done
appropriately and professionally.
EYE CONTACT
Generally interpreted as indicating interest and attention.
Lack of eye contact is thought to indicate avoidance, disinterest, or discomfort.
BODY POSITION
Often a good indicator of a person’s attitude.
Open body positions, with the arms held freely at the sides, are usually taken to mean a receptive attitude.
PHYSICAL APPEARANCE
A clean, neat, appropriately dressed individual conveys a positive self-image, knowledge, and competence.
Does influence communication.
INFLUENCES ON COMMUNICATION
Age Education Emotions Culture Language Attention Surroundings
CONGRUENCY OF MESSAGES
It is important that verbal and nonverbal communications are in agreement.
The nurse should ask for clarification when incongruity exists.
LISTENING/OBSERVING
Two of the most important skills a nurse can have.
These skills are used to gather the subjective and objective data for the nursing assessment.
ACTIVE LISTENING
Reflects the process of hearing spoken words and noting nonverbal behavior.
Takes energy and concentration. At eye level with the client. Lean slightly forward and make eye
contact.
PSYCHOSOCIAL ASPECTS OF COMMUNICATION
Gestures Style Meaning of time Meaning of space Cultural values Political correctness
GESTURES
Movements of the body to reflect a thought, feeling, or attitude.
The nurse must be sensitive to cultural variances and exercise good judgment when caring for clients of different backgrounds and heritages.
STYLE
Three types of style: Passive–very compliant, asks for nothing,
and gets little attention. Aggressive–shows little concern for
anyone else’s feelings Assertive–respects the rights, needs, and
feelings of others.
MEANING OF SPACE
Humans have four comfort zones: Intimate–touch to 18 inches; family, friends,
and nursing procedures Personal–18 inches to 4 feet; friends, co-
workers, interviewing, data gathering Social–4 to 12 feet; casual acquaintances Public–12 feet or more; strangers
MEANING OF TIME
In the U.S., emphasis is placed on schedules and being on time.
Some cultures have other ways of perceiving and dividing time.
CULTURAL VALUES
It is important that the nurse be familiar with the cultural values of the people in the nurse’s region of employment.
POLITICAL CORRECTNESS
Using language that shows sensitivity to those who are different from oneself.
Intended to avoid the use of language that offends and to help eliminate prejudice.
THERAPEUTIC COMMUNICATION
Also called effective communication. Purposeful and goal-directed. Creates a beneficial outcome for the
client. The focus of the conversation is the
client and the client’s needs or problems.
GOALS OF THERAPEUTIC COMMUNICATION
Develop trust. Obtain or provide information. Show caring. Explore feelings.
ENHANCING COMMUNICATION
Caring Warmth Active listening Genuineness Empathy Acceptance and respect Self-disclosure
COMMUNICATION TECHNIQUES
Clarifying/validating Open questions Indirect statements Reflecting
Paraphrasing Summarizing Focusing Silence
COMMUNICATION BARRIERS
Closed questions False reassurance Judgmental
responses Offering opinions Giving advice
Stereotyping Belittling Defending Requesting an
explanation Changing the subject
NURSE/CLIENT COMMUNICATION
Progresses through three phases:1. Introduction–fairly short, introductions and
mutual goals.
2. Working–the major portion, used to accomplish the goals set in introduction.
3. Termination–the end of the interaction, may include summarizing.
FACTORS AFFECTING THE NURSE’S COMMUNICATION
Past experiences State of health Home situation Workload Staff relations Attitude and emotions
FACTORS AFFECTING THE CLIENT’S COMMUNICATION
Hearing and speech ability
Level of consciousness
Language proficiency Social factors
Stage of illness Religion Family situation Visual ability
COMMUNICATING WITH THE HEALTH CARE TEAM
Providing care is a team effort. Effective communication is necessary. May take several forms:
Oral Written Individual Group Electronic
ORAL COMMUNICATION
All members must communicate orally. Nurse–student Nurse–nursing assistant Nurse–nurse Nurse–physician Nurse–other health professionals Group communication, telephone
WRITTEN COMMUNICATION
Most relates to the client’s chart. All aspects of care recorded on chart. Requisitions to other departments for
diagnostic tests and therapies and the results are written.
Interdepartmental memos are necessary to keep the unit functioning effectively.
ELECTRONIC COMMUNICATION
Computers are widely used in many areas of health care.
Slowly entering direct care areas. It is important for all health care
workers to have some knowledge about computers.
COMMUNICATING WITH YOURSELF
Positive self-talk–thinking, saying, and hearing positive statements about oneself reinforces positive self-esteem.
Negative self-talk–self-destructive. Self-image is lowered by your own criticism, and you begin to see yourself as a failure.