Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4
Communication
- interchange of information between two
or more people
- exchange of ideas and thoughts
- uses method such as talking or listening
or writing and reading
- any means of exchanging information or
feelings between two or more people\
- basic component of human relationships
including nursing
Communication process
Elements of communication process:
Face to face communication involves
1. sender
2. message
3. receiver
4. response or feedback
A. Sender
- a person or group who wishes to convey
message to another
- source encoder
- the person or group sending the
message must have an idea or reason
for communicating (source) or put the
idea or feeling into a form that can be
transmitted (encode the message and
feelings)
✓ Encoding - involves the
selection of signs
and symbols (codes) to transmit the
message.
B. Message
- what is actually said or written, the body
of language that accompanies the words
and how the message is transmitted
- the medium (method to receive) used to
convey the message is the channel; can
target any of the receiver’s senses;
important channel to be appropriate for
the message, and it should help make
the intent of the message clearer.
- talking face to face may be more
effective
- recording messages or communicating
by radio or television may be more
appropriate for larger audience
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- written communication is appropriate for
long explanation that needs to be
preserved
- the nonverbal channel of touch of touch
is often highly effective appropriate
forms of touch can communicate caring
C. Receiver
- the one who decodes the message
(decoder) who must perceive what the
sender intended (interpretation)
- the listener who must listen observe and
attend
- to decode means to relate the message
received and to sort out the meaning of
the message
- if the meaning of the decoded message
matches, he intent of the sender, the
communication is effective
- ineffective communication occurs when
the message sent is misinterpreted by
the receiver
D. Response
- the message that the receiver returns to
the sender
- also called feedback
- can either be verbal or nonverbal or both
Modes of communication
1.Verbal Communication
- Utilizes spoken or written words
- Nurses need to consider the following
when choosing words to say or write:
Place and Intonation - the manner of
speech will modify the feeling and impact
of the message; intonation can express
enthusiasm, sadness, anger and
amusement; pace may indicate interest,
anxiety, boredom or fear
Simplicity - includes the use of commonly
understood words, brevity, and
completeness; complex technical terms
become natural to nurses but laypersons
often misunderstood these terms
Clarity and Brevity - the message is
direct and simple will be more
effective; clarity is saying precisely what is
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4
meant and brevity is using few words,
meaning message that is simple and clear.
Timing and relevance - nurses needs to
be aware of both relevance and timing
when communicating with clients. No
matter how clearly or simply words are
stated or written, the timing needs to be
appropriate to ensure that words are
heard. The message needs to relate to the
persons interest and concerns
Adaptability - spoken messages need to
be altered in accordance with behavioral
cues from the client; this adjustment is
referred to as adaptability.
✓ if the patient is sad do not smile, be
sensitive
Credibility - worthiness of belief,
trustworthiness and reliability. May be the
most important criteria of effective
communication. Nurse must be consistent
dependable and honest. Nurse needs to
be knowledgeable about what is being
discussed and have accurate information,
nurses should convey confidence and
certainty in what they are saying while
being able to acknowledge their
limitations.
Humor - the use of humor can be positive
and powerful tool in the nurse client
relationship, but it must be used with care.
Can be used to help client adjust to
difficult and painful situations. The physical
act of laughter can be both an emotional
and physical release reducing tension by
providing a different perspective and
promoting sense of well-being.
✓ if the patient is in pain it may not be
effective
2.Nonverbal Communication
- sometimes called the body language
- it includes gestures, body movement, use
of touch, and physical appearance,
including adornment
- observing and interpreting he client’s
nonverbal behaviors is an essential skill for
nurses to develop
- To observe nonverbal behavior efficiently
requires a systematic assessment
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Physical Appearance- how a person
dresses is often indicator of how
person feels. Someone who is tired or ill
may not have the energy or desire to
maintain their normal grooming. The nurse
must Validate and observe nonverbal data
by asking the client
Posture and Gait - the way people talk
and carry themselves are often
reliable indicators of self-concept, current
mood and health. The nurse must clarify
the meaning of the observed behavior to
have a correct interpretation
Facial Expression - no part of the body is
as expressive as the face. Feelings of
surprise, fear, anger, disgust, happiness
and sadness can be conveyed by facial
expression.
- Gestures - hand and body gestures may
emphasize and clarify the spoken word, or
they may occur without word to indicate a
particular feeling or to give a sign
3. Electronic Communication - Emails
Factors affecting Communication
Process
1. Development
- language, psychosocial and intellectual
development moves through the stages
across the life span.
- knowledge of a client’s developmental
stage will allow the nurse modify the
message
2. Gender
- females and males communicate
differently
- girls tend to use language to seek
confirmation, minimize differences
3. Values and Perception
- standards that influences behavior and
perception are the personal view of an
event
- because each person has a unique
personality, traits, values and life
experiences, each will perceive and
interpret message and experiences
differently
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4
- it is important for the nurse to be aware
of a client’s values and to validate or
correct perceptions to avoid creation
barriers in the nurse client relationship
4. Personal Space- the distance people
prefer in interaction with others
Proxemics - the study of distance
between people in their interaction
Communication alters in accordance with
four distances, each with close and far
phase
A. Intimate distance communication -
0 to 1 1/2 feet
- characterized by body contact,
heightened sensations of body heat and
smell, and vocalizations that are low.
Vision is intense, is restricted to a small
body part, and may be distorted. Nurses
frequently use intimate distance.
Examples include cuddling a baby,
touching a client who is blind, positioning
clients, observing an incision, and
restraining a toddler for an injection.
B. Personal distance - 1 1/2 to 4 feet
- less overwhelming than intimate
distance. Voice tones are moderate, and
body heat and smell are noticed less.
Physical contact such as a handshake or
touching a shoulder is possible. More of
the person is perceived at a personal
distance, so that nonverbal behaviors
such as body stance or full facial
expressions are seen with less distortion.
Much communication between nurses
and clients occurs at this distance.
Examples occur when nurses are sitting
with a client, giving medications, or
establishing an intravenous infusion.
C. Social Distance - 4 - 12 feet
- is characterized by a clear visual
perception of the whole person. Body
heat and odor are imperceptible, eye
contact is increased, and vocalizations
are loud enough to be overheard by
others. Communication is therefore more
formal and is limited to seeing and
hearing. The person may feel protected
and out of reach for touch or personal
sharing of thoughts or feelings. Social
distance allows more activity and
movement back and forth. It is expedient
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for communicating with several people at
the same time or within a short time.
Examples occur when nurses make
rounds or wave a greeting to someone.
Social distance is important in
accomplishing the business of the day.
However, it is frequently misused.
D. Public distance - 12 feet and
beyond
- requires loud, clear vocalizations with
care full enunciation. Although the faces
and forms of people are seen at public
distance, individuality is lost. Instead, the
perception is of the group of people or
the community.
5. Territoriality - concept of the space things
that an individual considers as belonging
to the self.
Example: Clients in the hospital often
consider their territory bounded by the
curtains around the bed unit or by the walls
of the private room.
6. Roles and relationships - the roles and
relationships between the sender and the
receiver affect the communication process.
Roles such as nursing student and
instructor, client and physician, or parent
and child affect the content and responses
in the communication process.
7. Environment - people usually
communicate in a comfortable
environment
- temperature extremes, excessive noise,
and a poorly ventilated environment can all
interfere with communication.
8. Congruence - in congruent
communication, the verbal and nonverbal
aspects of the message match
- clients more readily trust the nurse when
they perceive the nurse communication as
congruent
- congruence between verbal and nonverbal
expressions easily seen by the nurse and
the client.
9. Interpersonal Attitudes
- attitudes are communicated convincingly
and rapidly to others.
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4
- attitudes such as caring, warmth, respect
and acceptance facilitate communication;
lack of interest, condescension, coldness
inhibit communication.
Levels of Communication
Intrapersonal Communication
- communication that happens among the
individual
- must be positive
Interpersonal Communication
- occurs between two or more people with a
goal to exchange message
- the ability to communicate effectively in this
level may influence your sharing, problem
solving, goal attainment and other critical
nursing roles.
Group Communication
- includes small group and organizational
group communication
- to determine effectiveness, one studies
group dynamics
1. Small Group Communication
a) Interaction with two or more
individuals
b) Members must communicate to
achieve goal
c) The more people in the group, the
more complex it becomes
Example: Staff Meeting, Conferences,
Teaching Sessions or support groups
2. Organizational Communication
a) Occurs when individuals and
groups within an organization
communicate to achieve
established goals
Example: Nurses practice council
meeting, nurses working with
interdisciplinary groups.
3. Group Dynamics
a) Can be described most simply as
how individual group members
relate to one another during the
process of working
b) Categories:
➢ Task oriented Role – focusing
on the work to be done.
Example: information giver,
clarifier, coordinator
➢ Group-building or Maintenance
Role – focuses on the well-
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being of the group. Example:
active listener, harmonizer
supporter
➢ Self-serving Role - which
advance the needs of
individual members at the
groups expense. Example:
attention seeker, dominator,
blocker
Barriers to Communication
- nurses need to recognize barriers or non-
therapeutic responses to effective
communication
Major barriers to communication are:
• Failure to listen.
• Improperly decoding the client’s
intended message.
• Placing the nurse’s needs above the
client’s needs.
1. Closed Questions
- questions that can be answered by yes
or no, communication is usually ended
and there is no other avenue for the
communication or conversation to follow.
Instead use why or how questions so
that the client will be able to expound
what he or she is saying.
Example: Is the pain gone? Did you
sleep well?
2. Clichés
- are overused trite phrases that are
almost meaningless. Impersonal and
often used when an individual is at loss
for anything better to say. Used without
thinking of the impact on the other
person and often seem disrespectful of
the client's individual circumstances
Example: Hang in there, tomorrow is
another day. It could be worse.
3. Rejecting
- refusing to discuss certain topics with the
client.
- these responses often make clients feel
that the nurse is rejecting not only the
communication but the client themselves
Example:
➢ "I don't want to discuss that. Let's talk
about .... "
➢ “I can't talk now. I'm on my way for
coffee break”
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4
➢ “let's discuss other areas of Interest to
you rather than the two problems you
keep mentioning."
4. Being Defensive
- attempting to protect a person or
health care services from negative
comments
- this prevent the client from expressing
true concerns; is if the nurse is saying
“You have no right to complain."
- the response protects the nurse from
admitting weaknesses in the health
care services and personnel
weaknesses
Example:
➢ Client: "Those night nurses
must just sit around and talk all
night. They didn't answer my
light for over an hour
Nurse: "I'll have you know we
literally run around on nights.
you’re not the only client, you
know”
5. Giving Advices
- Involves offering personal rather than
professional opinion
- the client's responsibility for making
decision is diminished; no autonomy
from patient
- some clients may end up feeling
unable to make their own choices and
may become more dependent on the
nurse
Example:
➢ Client: ''Should I move from my
home to a nursing home?"
Nurse: ''If I were you, I'd go to
a nursing home, where you'll
get your meals cooked for you
6. Changing the Subject
- An abrupt change of subject by the
nurse generally indicates to the client
that the nurse is uncomfortable or
anxious about the topic under
discussion.
- It is often used to avoid listening to a
client’s fear, distress, or problems and
is interpreted by the client as a lack of
interest
Example:
➢ Client: "I'm separated from my
wife. Do you think I should
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have sexual relation with
another women?"
Nurse: "I see that you're 36
and that you like gardening.
This sunshine is good for my
roses for I have a rose
garden."
7. Agreeing or Disagreeing
- Imply that the client is either right or
wrong and that the nurse is in a
position to judge this
- the responses deter clients from
thinking through their position and
may cause a client to become
defensive
Example:
➢ Client: ''I don't think Dr. Broad
Is a very good doctor. He
doesn't seem interested in his
patient."
Nurse: ''Dr. Broad Is head of·
the department of Surgery and
is an excellent surgeon. ''
8. Stereotyping
- offering generalized or oversimplified /
beliefs about groups of people that are
based on experiences too limited to be
valid
- these responses categorize clients
and negate their uniqueness as
individuals
Example:
➢ "Two-year-olds are brats.
➢ "Women are complainers."
➢ "Men don't cry."
9. Judgmental Responses
- giving opinions, approving or
disapproving responses, moralizing, or
implying own values
- these responses imply that the client
must t think as the nurse thinks,
fostering client
Example:
➢ "That's good (bad)."
➢ ''You shouldn't do that'
➢ ''That's not good enough.''
10. False Reassurance
- often used in an effort to cheer up the
client regardless of the facts, giving
false hope about the outcome of the
situation
- can be traumatic to a desperately ill
client who may be desperate to
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4
believe assurances even if they are
not founded in reality
Example:
➢ "Don't worry, I'm sure
everything will be fine.''
Therapeutic Communication
- To carry out the role effectively,
the nurse -must become aware of
the way in which she is interacting
with patients
- Note: Every communication from
the nurse to the patient can be
evaluated as having therapeutic or
non-therapeutic value
- Promotes understanding and
helps establish a constructive
relationship between the nurse
and the client
- Client and Goal -directed
- Attentive listening
- Focusing on the client's needs and
not the nurses needs
Therapeutic Communication
Techniques
- Therapeutic communication
techniques are responses that
facilitate interaction and enhance
communication between client and
nurse
- Nontherapeutic communication
techniques are responses that cut
off communication and make it
more difficult for the interaction to
continue
- Techniques are tools -not ends in
themselves
- They are only as therapeutic as
the person who uses them
Purpose:
➢ To offer the nurse a greater
variety of therapeutic
responses;
➢ To limit the use of non-
therapeutic responses
➢ To help her gain awareness of
what is happening as she/he
interacts with the patient
Goals of Therapeutic Communication
- Establishing rapport
- Identifying issues of concern
6
- Being empathetic, genuine, caring
and unconditionally accepting of
the person
- Understanding the client's
perception.
- Exploring the client's thoughts and
feelings Developing problem-
solving skills
- Promoting the client's evaluation
solutions
1. Using Silence
- utilizing absence of verbal
communication. This encourages the
client to verbalize
- this gives time to organize thoughts
and reflect on the topic
- client’s nonverbal behavior may
indicate mood, feelings,
thoughtfulness or any variety of
behaviors
2. Accepting
- giving indication of reception
- may indicate that you are following
what the client is saying and does not
indicate agreement
Example:
➢ nodding, “I follow what you have
said”
3. Giving Recognition
- acknowledging, indicating awareness
- greeting by client’s name may show
that you recognize them as a person,
as an individual
Example:
➢ “Good Morning Mrs. S”
4. Offering Self
- making oneself available
- Sometimes clients are unable to
verbalize or make themselves
understood or the client may not be
ready to talk.
Example:
➢ "I'll sit with you awhile."
➢ I'll stay here with you."
➢ "I'm interested in what you're
thinking."
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4
5. Giving Broad Openings
- allowing the client to take the initiative
In Introducing the topic
- broad openings make explicit the idea
that the client has the lead In the
Interaction.
- Gives a patient the opportunity to
begin to express him/herself
Example:
➢ “Is there something you'd like
to talk about?”
➢ What are you ta/king about'?"
➢ "Where would you like to
begin?"
6. Offering General Leads
- giving encouragement to continue.
- indicate the nurse is listening and
following what the client is saying
without taking away the initiative for the
interaction.
- It encourages the client to continue If
he or she is hesitant or uncomfortable
about the topic.
- indicates that the nurse understood
what the patient has said, and the
nurse wishes to proceed with e
conversation
Example:
➢ "And then?"
➢ "Tell me about it."
7. Placing the event in time or
sequence
- clarifying the rel8tlonshlp of events in
time
- helps both the nurse, and the client to
see them in perspective
- The client may gain insight into cause-
and effect behavior and consequences,
or likewise help the client 'to see that
perhaps some things are not related to
each other.
- The nurse may gain information about
recurrent patterns or themes in the
client's behavior or relationships
Example:
➢ "What seemed to lead up to
...?”
➢ "Was this before or after. ?"
➢ ''When did this happen?"
7
8. Making Observations
- verbalizing what ls ·perceived
- making an observation gives the client
the opportunity to agree or disagree
with the nurse's observation.
- client may be showing signs of anxiety
of which he or she is unaware or the
client may have begun to hallucinate
or the nurse may be uncertain what
the client is thinking or feeling.
Example:
➢ "You appear tense ... "
➢ “Are you uncomfortable when
you?"
9. Encouraging Comparison
- Asking that similarities and differences
be noted
- Comparing Ideas or experiences or
relationship brings out many recurrent
themes
Example:
➢ ''Was this something like ... ''
➢ ''Have you had similar
experiences?''
10. Restating
- repeating the main idea expressed
- this restatement lets the client know
that the idea was communicated
effectively.
Example:
➢ Client: ''I can't sleep. I stay
awake all night.''
Nurse: ''You have difficulty
sleeping."
Client: ''I'm really so upset.'
Nurse: "You're really mad and
Upset?”
11. Reflecting
- directing questions, feelings, or Ideas
back to the client
- Reflection encourages the client to
recognize and accept his or her own
feelings
Example:
➢ Client: "Do you think I should
tell the doctor?"
Nurse: "Do you think you
should?"
➢ Client: "My brother spends all
my money and then has the
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4
nerve to ask for more"
Nurse: This causes you to feel
angry."
12. Focusing
- concentrating on a single point.
- The client can be encouraged to
concentrate his or her energies on a
single point and max avoid being
overwhelmed by a multitude of factors or
problems
Example:
➢ This point seems worth looking
at more closely”
➢ “Of all the concerns you've
mentioned, which is most
troublesome?''
13. Exploring
- delving further into a subject or idea
- When clients tend to deal with topics in
a superficial manner, exploring can help
them examine the issue more fully.
- Any problem or concern can be better
understood if explored in depth.
Example:
➢ ''Tell me more about that."
➢ ''Would you like to describe it
more fully?”
➢ ''What kind of work?''
14. Giving Information
- making available the facts the client
needs.
- Informing the client of facts increases
his or her knowledge about a topic or
lets the client know what to expect.
Example:
➢ "My name is .. "
➢ ''Visiting hours are”
➢ "My purpose in being here is.. "
➢ "I'm taking you to ..”
15. Seeking information
- seeking to make clear that which Is not
meaningful or that which Is vague.
- Clarification should be sought
throughout interactions with clients.
- helps the client articulate thoughts,
feelings and ideas more clearly
- can help the nurse avoid making
assumptions that understanding has
occurred when It has not
Example:
➢ “I’m not sure that I follow.''
➢ ''What would you. say Is the
main point of what you Just
8
said?''
➢ “Have I heard you correctly?''
16. Presenting Reality
- offering or consideration that which Is
real
- not by way of arguing with the client or
belittling the client's own experience but
rather by calmly expressing the nurse's
own perceptions or the facts of the
situation.
Example:
➢ ''I see no one else in the room."
➢ ''That sound was a car
backfiring."
➢ ''Your mother Is. not here; I'm a
nurse.''
17. Voicing Doubt
- expressing uncertainty about the
reality of the client’s perceptions.
- permits the client to become aware
that others do not necessarily perceive
events in the same way or draw the
same conclusions as the client does
- client will be encouraged to re-
consider or re-evaluate what has
occurred
Example:
➢ "Isn't that unusual?"
''Really?"
18. Seeking Consensual Validation
- searching for mutual understanding for
accord the meaning of the word
- it Is Important to avoid slang or
popular words or phrases that are
more easily misunderstood.
- Example:
➢ "Tell me whether my
understanding of it agrees with
yours”
“Are you using this word to
convey the idea that ..?"
19. Verbalizing the Implied
- voicing what the client has hinted at or
suggested
- Putting into words what has been
implied or said indirectly tends to
make the discussion less obscure
- The nurse should take care to express
only what is fairly obvious; otherwise
the nurse may be jumping to
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4 9

conclusions or interpreting the client’s Identify problems in living with other,

communication
Example:
➢ Client: "I can't talk to you or
anyone. It is a waste of time.”
Nurse: "Is it your feeling that no
one understands?
➢ Client: "My wife pushes me
around just like my mother and
sister did."
Nurse: "Is it your impression
that women are domineering?”
20. Encouraging Expression
- asking the client to appraise the
quality of his or her experience
- The client is asked to consider people
and events in the light of his or her
own values.
- The client is encouraged to make his
or her own appraisal rather than
accepting the opinions of others.
Example:
➢ "What are your feelings in
regard to ... ?" “Does this
contribute to your discomfort?''
21. Attempting to Translate into
Feelings
- Seeking to verbalize feelings that are
only expressed indirectly.
- Often what the client says, when
taken literally seems meaningless or
far removed from reality
- To understand, the nurse must
concentrate on what the client might
be feeling in order to express him or
herself in this manner.
Example:
➢ Client: "I'm dead."
Nurse: "Are you suggesting that
you feel lifeless?”
➢ Client: "I'm way out in the
ocean."
➢ Nurse: "You seem to feel lonely
or deserted."
grow emotionally, and improve the
ability to form satisfactory
relationships.
- The nurse offers to do things with the
client, rather than doing things for the
client
Example:
➢ "Perhaps you and I can discuss
and discover what produces
your anxiety:
➢ “Let’s go to your room and I’ll
help You find what you’re
looking for."
23. Summarizing
- organizing and summing up that which
has gone before
- seeks to bring out the important points
of the discussion and to increase the
awareness and understanding or both
participants
- It allows both the nurse and client to
depart with the same Ideas In mind and
provides the sense of closure at the
completion of each discussion
Example:
“Have I got this straight?"
"You've said that ... "
"During the past hour you and I have
discussed ... "
LIFESPAN CONSIDERATIONS
AND SAMPLE PROCESSES

22. Suggesting Collaboration

- offering to share, to strive, to work

together with the client for his ·or her
benefit.
- The nurse seeks to offer the client a
relationship in which the client can