COMMUNICATION SECTION I BASIC NURSING. COMMUNICATION The process by which information is exchanged between the sender and receiver. Includes six aspects:

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.