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COMMUNICATION

AND NURSING PROCESS COMMUNICATION

• Communication - its meaning depends

on the setting and the context of its use.

• Necessary component in human

relationships, and, therefore, means or is
used for thought/information exchange
NH between or among two or more people as
well as intra-personally (self-talk).

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B. PROCESS OF COMMUNICATION.
A. MODES OF COMMUNICATION.
• Verbal communication = both spoken (type • Effective communication involves either a
words and tone of voice, speed),written (words personal (face to face) communication or
and the meaning they convey), timing and some means of an encounter that requires the
clarity of the message. following four necessary components: a
sender, a message, a receiver and a response.
• Non-verbal communication = body language,
facial expressions, appearance, posture, • Sender = may one, two or a group of people with
gait (manner of walk) gestures, nods, etc. a message to send/convey and a system of
sign(s) or symbol(s) (code, i.e. - language, etc.)
•Electronic communication = computer to use in transmission/sending (encoding) it.
messages, i.e. e-mail, etc.

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• Message (from sender) and (from receiver)

1. Sender--the originator or source of the
• contents or meaning, language (words
idea.
arrangement and use) and the tone which the
message is meant to convey.
2. Message--the idea.
• Receiver
• the recipient/listener of the message decodes 3. Channel--the means of transmitting
(i.e. - relates to or understands message) and (either verbally or nonverbally) the idea.
returns communication.

4. Receiver--someone to receive and

• Response interpret the message.
• the message or feedback (non-verbal cues, i.e.
winks nods, etc.) that the receiver sends back
to the sender. 5. Feedback--the response to the message.

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METHODS OF NONVERBAL
COMMUNICATION Eye behaviors
 (avoiding eye contact, staring, wide
eyes).
 Rapport.
 The harmonious feeling experienced by
 Use (and avoidance) of touch or physical
two people who hold one another in
contact.
mutual respect, acceptance, and
understanding.
Posture(slouching, leaning toward/away
from someone)
 Empathy.
 Empathy is that degree of
understanding, which allows one person  Walk.
to experience how, another feels in a
particular situation.

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Body Language. SILENCE

Remember that actions speak louder than
words. A person will generally pay more
 Silence can be an extremely effective
attention to what you do than what you
say. communication tool.

 Silence can be used to communicate the

Facial expressions
deepest kind of love and devotion, when
 (smile, frown, blank look, grimace).
words are not needed.

Gestures/mannerisms

 (fidgeting, toe tapping, clenched fists).

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SILENCE
LISTENING
 Silence can be a cold and rejecting sort of As a patient speaks, think about what he
punishment, the "silent treatment" must be feeling.
received for coming home late or
forgetting birthday.  Sometimes, as a listener, you must cut
through layers of words to get to the real
 Silence can be used in an interview or message. You must read between the
conversation to encourage the other lines. Pick up the underlying meaning of
person to "open up." Conversely, it can be the message (intent); don't rely entirely
used to intentionally create anxiety and upon the obvious or superficial meaning
discomfort in the other person. (content).

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C. FACTORS THAT INFLUENCE

COMMUNICATION.  Gender - males and females develop
differently and so have some
 Level of development - helps in
difference communicate, even in
modifying both the message and adulthood.
the response.
 Values = the standards (personal,
communal and societal) that influence
behavior
 therefore, personal value traits and
experiences do influence the perception
of communication and behaviors of
others as well as the response to them.

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 Perception = is a personal view of - Caring - indication of deep emotional

any situation, which in effect, influences warmth.
the perception and response to events.
- Warmth - an indication of emotional
closeness.
 Attitude = of caring, concern,
interest, etc., are portrayed or - Respect - an attitude that conveys
betrayed by either good or bad individual worth and respect for his/her
mood. wishes, regardless what the wishes are.

- Acceptance - places emphasis on

neither approval nor disapproval.

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• Personal space (proxemics - study of - Social distance = 4-12 ft and

the distance between people in characterized by a clear view of the
interaction). whole individual with clear and
louder tone of voice.
• Example of distances in
communication: - Public = 12-15 ft, requires careful
- Intimate = 1&1/2 ft - is characterized enunciation, a louder tone of voice
by body contact, etc. and a clearer vocality.

- Personal = 1&1/2 - 4ft - characterized

by more space, less overwhelming,
with a moderate tone of voice.

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• Territoriality = is also about space a • The environment = a comfortable

domain that one considers as personal i.e. surrounding with controlled
a client’s room or space around the temperature, and noise-free, etc.
bed with a demarcating curtain.
• Congruence = this refers to
• Roles = student/teacher, father- compatibility of verbal and non-verbal
mother/son-daughter, roles etc. messages - that they both match and
not seen as giving two or more different
• Relationships = this is a similar role as messages.
the teacher/student relationship above.

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D. USE OF COMMUNICATION • Attentive Listening.

•This is an active listening
COMMUNICATION IS USED TO: GET A without giving the impression of
RESPONSE, INFLUENCE OR OBTAIN
either selective listening or not
INFORMATION.
listening, that the message is not
all that important to you or that
you are in a hurry and would
rather be somewhere else.
• Therapeutic Communication.
Therapeutic communication helps • Physical Attending. This
in promoting understanding and portrays a physical presence
constructive relationship - with full attention span and
understanding of both the content and interested
feelings

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E. BARRIERS TO COMMUNICATION.
• Failure to listen - not listening by looking
away or doing other things as a sign of disinterest.
Barriers to communications occur
principally as a result of non-therapeutic • Wrong environment or poor environmental
communication. Good examples to this control - noisy surrounding or environment.
failure include:
• Wrong or improper decoding of the • Wrong timing - while or when client is eating
message. or doing something or in pain.
• Poor choice of words.
• Inconsideration by the nurse or health
• Wrong tone - raised voice, etc.
professional- client eating or sleeping, with
nurse not willing or ready to wait.

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II. THERAPEUTIC
RELATIONSHIP PHASES OF THERAPEUTIC RELATIONSHIP.

The therapeutic relationship or helping • Pre-interaction phase

relationship is typified by the relationship •- similar to planning the interview stage
between a health professional and a client, but
when information about client is
especially between nurses and their patients. Of
obtained and planning of visit with
great importance are:
some level of anxiety.

•Trust - the development of trust facilitates

acceptance of the nurse by patient.

•Belief - allows client to believe that the nurse

cares about him/her and his/her needs.

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PHASES OF THERAPEUTIC RELATIONSHIP. • Working phase -

• when both nurse and client view each other
as individuals with separate but important
roles and start to explore feeling and act
• Introductory (or pro-helping) phase - towards accomplishing a set goal with empathy
• during this time that the tone for and:
relationship is set, and client may display - Respect.
some level of resistance. This initial - Genuine concern and rapport.
resistance can be alleviated by a
genuine caring attitude by the nurse. - Giving of correct information.
- Friendly confrontation as nurse
points out areas of discrepancies.

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B. DEVELOPING THERAPEUTIC
• Termination phase RELATIONSHIP.
•a summary, by reviewing the process and
accomplishment of the interview session. THIS IS COMMONLY ACHIEVED BY:

• Attentive listening - not only

paying attention, engaged with body
language.

• Identifying with the feelings of

client, i.e. “You seem angry about
the unfairness of…”

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B. DEVELOPING THERAPEUTIC • Genuineness and credibility

RELATIONSHIP. •about being truly concerned.
• Empathy - by putting yourself
their shoes and showing that you • Maintain an understanding of
understand. Cultural differences
• as this fosters client- nurse
• Honesty - by admitting that you do interaction.
not know some of the answers to
some of the questions that you are • Ingenuity
being asked.
• by employing some other
means/avenues in handling the
situation.

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• Confidentiality GROUP COMMUNICATION.

•maintain patient’s rights of privacy as
confidential on all information.  Group Dynamics.

• Remaining within the boundaries of  Communication with any given group is

professional role known as group dynamics as determined
• seek help if you need it, and clarify the by a variety of factors as each member
functions of your role. affects the dynamics, depending on goal,
feelings and the level of participation
of each member, motivation and
maturity of the group.

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Types of Health Care Groups. - Teaching group

- main purpose is to impart
- Task group information: i.e. continuing
- most common of work-related education, client health care
groups that nurses belong, with groups, etc.
chairperson
- : i.e. health planning committees, - Self-help group
nurse team meetings, nursing care - usually small and composed of
conference, etc. volunteers with similar health
problems and similar beliefs in self-
help, etc.

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 Self-awareness COMMUNICATION & NURSING

 purpose is to develop interpersonal PROCESS.
strength for improving functioning.
The principal and overriding concerns are:
 Therapy group professional conduct, clarity, attentive
 for self-satisfaction and stress relief. listening and a caring attitude in:

 Work-related • Assessment.
 form to provide support and encourage • Be aware of barriers to communication;
cultural influence, level of development and
members in dealing with work related anxiety; make sure to have a clear
stress. communication; and to seek clarification on
statements that are ambiguous.

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• Diagnosis. • Implementation.
• Follow the same line of approach as above. • Make every effort to facilitate clear
communication; and effectively control
• Plan of care. the environment in a therapeutic setting
of the interview.
• Provide clear and effective
communication in the use of language; by
using every available means to have no • Evaluation.
anxiety or decreased levels of it; and • Share information about the progress
consult with appropriate resources. being made by patient with him/her.

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COMMUNICATION AMONG HEALTH

PROFESSIONALS. COMMUNICATION BETWEEN NURSES
AND PHYSICIANS.

There are no available guidelines for

Communication is an important aspect
within and between the various health verbal communication between
professions and their practitioners, but doctors and nurses.
especially between the nurse and the
physician as well as between the nurse and Nurses’ prefer to focusing their
patient. communication more on the “narrative
and descriptive” aspect

Physicians focus mainly on the “need or

problem” of patients by “ruling out
alternatives”.

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ASSERTIVE COMMUNICATION. NONASSERTIVE COMMUNICATION.

An assertive communication’s hallmark There are two types/kinds of non-assertive
is that it seeks to promote patient communication:
safety in reducing miscommunication • Submissive
by seeking clarification for medical orders
from doctors as well as with colleagues
• Aggressive
through the “I” and “you’ statements.

Example: “I’m worried /concerned

about this medication order” ; or,
“…you did this/that in that way”, etc.

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NONASSERTIVE COMMUNICATION. NONASSERTIVE COMMUNICATION.

• Submissive type (believed to be due to
insecurity or low self-esteem) • Aggressive type (assertive aggression)
• people who allow their rights to be • assert and defend legitimate rights,
violated by seeking to meet the but using such aggressive behavior
demands made by others with no or little (as sarcasm, jokes rude behavior or
regard to their own needs and feelings. downright insults, etc.) in disregard
for the feelings, rights and or opinion
of others around them.

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TECHNIQUES FOR COMMUNICATING TECHNIQUES FOR COMMUNICATING

WITH PATIENTS WITH PATIENTS
Establishing the Setting.
Provide a comfortable environment (lighting, Face the speaker and maintain eye
temperature, furnishings). contact.

Establish a relaxed, unhurried setting. Provide for privacy.

 Sit down when speaking to the patient. Avoid interruptions and other distracting
Although you probably have dozens of things, influences.
you need to be doing at that moment, try to
relax. Don't stand at the doorway or sit on
the edge of your seat, as if you are preparing
to jump and run as soon as you can get away.

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VERBAL COMMUNICATION SKILLS. VERBAL COMMUNICATION SKILLS

Clarify patient responses to questions, not
Let the patient do the talking.
just for your own use, but also to let the
patient know that you are listening (be
Keep questions brief and simple. sure you really are) and that you
understand.
 Use language that is understandable to
the patient. Avoid acronyms and Avoid leading questions.
medical/nursing jargon if the patient is  You want the patient to tell you what he is
nonmedical. feeling, not what he thinks you want to hear.
So avoid putting words in his mouth. For
example, it might be better to ask, "How are
Ask one question at a time. Give the
you feeling?" rather than "I suppose you're
patient time to answer. feeling rested after your nap.”

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NURSING INTERVENTION WITH

VERBAL COMMUNICATION SKILLS PATIENTS WITH SPECIAL
COMMUNICATION NEEDS
Avoid the use of cliché statements like,
"Don't worry; it'll be all right." or "Your Blind Patients.
doctor knows best." Always speak to the patient when you
enter the room so he will know who is
there.
Avoidquestions, which require only a
simple "yes" or "no" response. You want to  Speak directly to the patient; do not turn

encourage the patient to talk to you. your back.

 Speak to the patient in a normal tone of
voice; he is blind, not deaf.
 Speak to the patient before touching
him/her.

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Deaf Patients.
Look directly at the patient when speaking REFERENCES.
with him/her.
 Kozier, B. et al, Fundamentals of Nursing,
Concepts, Process and Practice. 9th Ed., Upper
Do not cover your mouth when speaking Saddle River, N.J.: Pearson Education, Inc.,
because the patient may read lips. 2012.

 If the patient does not lip-read, charts with

pictures may be used, or simply writing your
questions or comments on a piece of paper
may be helpful.

Charts with hand signs are available at the

local society for deafness.
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