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Department of Nursing
Nur 2700 Fall 2010
Professional Nursing Seminar


COMMUNICATION is a dynamic ongoing process between two or more people - both

participants must be actively involved. In the nurse-client relationship, the nurse
uses effective communication in order to develop a trust and rapport with the client
and to accomplish nursing process (assessment, diagnoses, planning,
implementation, and evaluation.)

The following criteria have been identified by this faculty as necessary for effective
communication. EFFECTIVE communication implies appropriate use of the criteria.

1. Listen (L) - to receive input via all your senses and to actively let the client know
you have heard his message. In other words, listening requires concentration and
is indicated by your subsequent responses to the client's verbal message. In
other words, listening requires concentration and is indicated by your subsequent
responses to the client's verbal message. The nurse indicates listening by:

a. Giving FEEDBACK to the client's VERBAL message.

b. CLARIFYING the verbal message.
c. RESPONDING to a direct question or request appropriately.

Listening implies recognition of expressed feelings or underlying feeling tone of the

verbal message as well as words.

2. Observe and respond to the non-verbal behavior (ONV) - This criteria may be
used alone as follows:

a. Respond verbally by NAMING the non-verbal behavior observed (e.g., "you are
holding your side, you are perspiring and your muscles look tense.")
b. Respond verbally by summarizing/interpreting the non-verbal observed (e.g.:
"you look like you are having pain.")
c. Sometime you might both name the non-verbal and give you interpretation
(e.g.: "I noticed you are frowning, looking down and your shoulders are
slumped. You look kind of sad.)

Responding to non-verbal does not show listening to VERBAL message. However,

sometimes it MAY be used WITH GIVING FEEDBACK to a verbal message. The
FEEDBACK shows listening.

Example: Client - (looking down, frowning, shoulders slump) "It seems like I'll
never be able to go home.
R.N. - "You LOOK sad [ONV] and it SOUNDS like you are pretty discouraged

Responding to the non-verbal may also sometimes be used with CLARIFYING a non-
verbal message. In the following example, there is no verbal message; therefore,
listening is not shown in the response.
Example: Client - (skin is pale and is swallowing hard)
R.N. - "You're pale and swallowing hard [ONV]. Do you feel like you might
vomit? [C]"
3. Give feedback(F) - giving a verbal response to a client's verbal message or to the
feeling tone of the verbal message. In other words, you feedback to the client's
vocal message to show that you are actively listening and understanding the
message. Feedback may be in the form of (a) reflecting back the message, (b)
restating the message in different words or (c) responding to the feeling tone of
the message. However, reflection should be used minimally. Responding to the
feeling tone of the message is the preferred response.

Example: Client - "I've never had an operation before. You know this is the first
time I've been in the hospital; all this is new to me."
R.N. - (a) "All this is new to you"
(b) "You don't really know what to expect"
(c) "It's kind of scary to be in a new situation."

4. Clarify(C) - asking for more information or validation if the message received was
understood correctly. If in response to a verbal message, it shows listening.
Clarification may be used in the form of requesting about the message.

Example: Client - "I'm so nervous waiting for the results of those tests."
R.N. - "What are some of the things you are nervous about?"

Clarification may also be in the form of implying that the verbal or non-verbal
message of the client was not clear enough for the nurse to be sure (s)he

Example: Client - "I finally went like you all have been wanting me to."
R.N. - "Do you mean you had a bowel movement?"

Clarifying is usually, though not always, in the form of a question. The following is an
example of clarification without a question.

Example: Client - "I did those things the doctor asked me to do."
R.N. - "I'm not sure I understand what you mean by 'those things'. --or-- "Tell
me more about 'those things'."

5. Speak in a clear, concise and understandable manner(SCC) - This includes a clear,

unambiguous meaning: a short non rambling speed and volume. This criteria
should be used in conjunction with the other criteria or when responding to a
client's questions or when teaching. This criteria may be used (in other words,
the message may be clear, concise, and understandable), although the nurse's
response may not be effective (i.e., what should have been said).

Special Notes: 1. On an exam you will be asked identify the criteria used effectively
by circling the criteria or identify the criteria that should have been used or said by
the RN (SHS = should have said) by Xing the criteria. [L, ONV, F, C, SCC] You are
“forced” to select the best choice on a written exam (i.e., if F is better than C at this
point in the conversation with the patient, you should select F over C). In addition, if
the communication was ineffective, you will be asked to provide an effective RN
response associated with the criteria that you Xed. 2. Thoughts and feelings of both
patients and yourself as an RN will also be identified. Thoughts = cognitive ideas [I
think the patient is upset about waiting for her test.] and Feelings = emotions [I feel
sad, glad, anxious, etc.] Identifying thoughts and feelings can assist you in
determining what criteria might be most effective as the conversation unfolds. For
example, if you have asked several clarification questions, you should have the
information you need to move on to use of other criteria. 3. You must keep in mind
that when we use effective communication, we are also using the nursing process
(problem-solving framework in nursing) and trying to solve patient problems and
reach patient goals or outcomes.

JC: 5/10