Communication Skills

By: STEVE M. ESTEBAN RN, LPT, MSN, MAN

Effective Communication

Communication is the interchanged of information between two or more people; in

other words, the exchange of ideas and thought. Communicating may have a more
personal connotation than the interchange of ides and thoughts. It can be a transmission of
feelings or a more personal and social interaction between people. Frequently, one
member of a couple comments that the other is not communicating.

The intent of communication is to elicit a response. Thus communication is a

process. It has two main purposes: To influence others and to obtain information.
Communication can be described as helpful or unhelpful. The former encourages a
sharing of information, thoughts, and feelings between two or more people. The latter
hinders or blocks the transfer of information and feelings.

Nurses who communicate effectively are better able to collect assessment data,
initiate intervention, evaluate outcomes of intervention, initiate change that promote health,
and prevent legal problem associated with nursing practice. The communicating process is
built on a trusting relationship with a client or support persons. Effective information is
essential for the establishment of a nurse client relationship. Communication can occur on
an intrapersonal level within a single individual as well as on interpersonal and group
levels. Intrapersonal communication is the communication that you have with yourself;
another name is self-talk. Both the sender and the receiver of a message usually engage
in self- talk. It involves thinking about the message before it is sent, and it occurs
constantly. Consequently, Intrapersonal communication can interfere with a person’s ability
to hear a message as the sender intended.

Components of Communication

Face-to-face communication involves a sender, a message, a receiver, and a

response, or feedback. In its simplest form, communication is a two-way process involving
the sending and the receiving of a message. Because the intent of a communication is to
elicit a response, the process is ongoing; the receiver of a message then becomes the
sender of a response, and the original sender then becomes the receiver .
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Sender

The sender, a person or group who wishes to convey a message to another, can be
considered the source-encoder. This term suggest that the person or group sending
the message must have an idea or reason for communicating (source) and must put
the idea or feeling into a form that can be transmitted. Encoding involves the selection
of specific signs or symbol (codes) to transmit the message, such as which language
and words to use, how to arrange the words, and what tone of voice and gestures to
use.

Message

The second component of communication process is the message itself what is

actually said or written, the body language that accompanies the words, and how the
message is transmitted. The medium use to convey the message is the channel, and it
can target any of the receiver’s senses. It is important for the channel to be appropriate
for the message and it should help make the intent of the message clearer.

Talking face to face with a person may be more effective in some instances than
telephoning or writing a message. Recording message on tape or communicating by
radio or television may be more appropriate for larger audience. Written communication
is often appropriate for long explanation or a communication that needs to be
preserved. The nonverbal channel of touch is often highly effective.

Receiver

The receiver, the third component of the communication process, is the listener, who
must listen, observe, and attend. This person is the decoder, who must perceive what
he sender intended (interpretation). Perception uses all the senses to receive verbal
and nonverbal messages. To decode means to relate the message perceived to the
receivers storehouse to knowledge and experience and to sort out the meaning of the
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message. Whether the message is decoded accurately by the receiver according to the
receiver’s intent, depends largely on their similarities in knowledge and experience and
socio cultural back ground. If the meaning of the decoded message matches the intent
of the sender, then the communication has been effective. Ineffective communications
occur if the message sent is misinterpreted by the receiver.

Response

The fourth component of the communication process, the response, is the message
that the receiver returns to the sender. It is also called feedback. Feedback can be
either verbal, nonverbal, or both. Nonverbal examples are a nod of the head or a yawn.
Either way, feedback allows the sender to correct or reword a message.

Modes of Communication

Communication is generally carried out in two different modes: verbal and nonverbal.
Verbal communication uses the spoken or written word; nonverbal communication
uses other forms, such as gestures of facial expressions, and touch. Another form of
communication has evolved with technology – electronic communication. The most
common form of electronic communication is e-mail where an individual can send a
message, by computer, to another person or group of people.

Verbal Communication

Verbal communication is largely conscious because people choose the words they use.
The words used vary among individuals according to culture, socioeconomic background,
age and education. As a result, countless possibilities exist for the way ideas are
exchange. An abundance of words can be used to form messages. In addition, a wide
variety of feelings can be conveyed when people talk.

When choosing words to say or write, nurses need to consider pace and intonation,
simplicity, clarity and brevity. Timing and relevance, adaptability, credibility and humor.

PACE AND INTONATION. The manner of speech, as in the pace or rhythm and
intonation, will modify the feeling and impact of the message. The intonation can
express enthusiasm, sadness, anger, or amusement. The pace of speech may
indicate interest, anxiety, boredom or fear.
SIMPLICITY. Simplicity includes the use of commonly understood words, brevity,
and completeness. Nurses need to learn to select appropriate, understandable
terms based on the age, knowledge, culture, and education of the client.
CLARITY AND BREVITY. A message that is direct and simple will be more
effective. Clarity is saying precisely what is meant, and brevity is using the fewest
words necessary.
TIMING AND RELEVANCE. The timing needs to be appropriate to ensure that
words are heard. More - over, the messages need to relate to the person or to the
person’s interest and concerns.
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ADAPTABILITY. Spoken messages need to be altered in accordance with

behavioral cues from the client. This adjustment referred to as adaptability. What
nurse says and how it is said must be individualized and carefully considered.
This requires astute assessment and sensitivity on the part of the nurse.
CREDIBILITY. Credibility means worthiness of belief, trustworthiness, and
reliability. Nurses foster credibility by being consistent, dependable and honest.
The nurse needs to be knowledgeable about what is being discussed and to 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. Humor can be used to help clients
adjust to difficult and painful situations. When using humor, it is important to
consider the client’s perception of what is considered humorous. Timing is also
important to consider

Nonverbal Communication

Nonverbal communications sometimes called body language. It includes gestures, body

movements, use of touch, and physical appearance, including adornment. Non verbal
communication often tell others more about what a person is feeling than what is actually
said, because nonverbal communication either reinforces or contradicts what is said
verbally.

PERSONAL APPEARANCE. Clothing and adornments can be sources of

information about a person. How a person dresses is often an indicator of how the
person feels. Someone who is tired or ill may not have the energy or the desire to
maintain their normal grooming. When a person known for immaculate grooming
becomes lax about appearance, the nurse may suspect a loss of self-esteem or a
physical illness. The nurse must validate these observed nonverbal data by asking
the client.
POSTURE AND GAIT. The ways of people walk and carry themselves are often
reliable indicators of self-concept, current mood, and health. Erect posture and an
active, purposeful stride suggest a feeling of well-being. Slouched posture and a
slow, shuffling gait suggest depression or physical discomfort. Tense posture and a
rapid, determine gait suggest anxiety or anger. The posture of people when they are
sitting or lying can also indicate feelings or mood. Again, the nurse clarifies the
meaning of the observed behavior by describing to the client what the nurse sees
and then asking what it means or whether the nurse’s interpretation is correct.
FACIAL EXPRESSIONS. 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
expressions. Although the face may express the person’s genuine emotions, it is
also possible to control these muscles so the emotion expressed does not reflect
what the person is feeling. When the message is not clear, it is important to get
feedback to be sure of the intent of the expression.
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GESTURES. Hand and body gestures may emphasize and clarify the spoken word,
or they may occur without words to indicate a particular feeling or to give a sign. For
people with special communication problems, such as the deaf, the hands are
invaluable in communication. Many people who are deaf learn sign language. Ill
persons who are unable to reply verbally can similarly devise a communication
system using the hands. The client may be able to raise an index finger once for
“yes” and twice for “no.” Other signals can often be devised by the client and the
nurse to denote other meanings.

Electronic Communication

E-MAIL. E-mail is the most common form of electronic communication. It is important for
the nurse to know the advantage and disadvantages of e-mail and also other guidelines to
ensure client confidentiality.

Advantages. It is a fast, efficient way to communicate and it is legible. It provides a

record of the date and time of the message that was sent or received.

Disadvantage. The negative aspect of e-mail is the risk to client confidentiality. Another is
one of socioeconomics. Not everyone has a computer. While there may be available
access to a computer, not everyone has the necessary computer skills. E-mail may
enhance communication with some clients but not all clients. Other forms of
communication will be needed for clients who have limited abilities with speaking
English, reading, writing, or using computer.

When Not to Use E-mail.

When the information is urgent and the client’s health could be in jeopardy if he or
she doesn’t read it immediately.
Highly confidential information (e.g., HIV status, mental health, chemical
dependency).
Abnormal lab data. If the information is confusing and could not prompt may
questions by the client, it is better to either see or telephone the person.

Factors Influencing the Communication Process

Development

Language, psychosocial, and intellectual development move through stages across the life
span. Knowledge of a client’s developmental stage will allow the nurse to modify the
message accordingly.

Gender

Females and males communicate differently. Girls tend to use language to seek
confirmation, minimize differences, and establish intimacy. Boys use language to establish
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independency and negotiate status within a group. These differences can continue into
adulthood so that the same communication may be interpreted differently by man and
women.

Personal Space

Personal space is the distance people refer in interactions with others. Proxemics is the
study of distance between people in their interactions. Communication thus alters in
accordance with four distances, each with a close and a far phase. List of the following:

1. intimate: touching to 1½ feet

2. personal: 1½ to 4 feet
3. social: 4 to 12 feet
4. public: 12 to 15 feet

Intimate distance communication is characterized by body contact, heightened

sensations of body heat and smell, and vocalizations that are low.

Personal distance voice tones are moderate, and body heat and smell are noticed less.
Physical contact such as handshake or touching a shoulder is possible

Social distance 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 of others. Communication is therefore more formal and is limited
to seeing and hearing.

Public distance requires loud, clear vocalizations with careful 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.

Territoriality

Territoriality is the concept of the space and things that an individual considers as
belonging to the self. Territories marked off by people may be visible to others.

Roles and Relationships

Roles such as nursing student and instructor, client and primary care provider, or parent
and child affect the content and responses in the communication process. Choice of
words, sentence structure, and tone of voice vary considerably from role to role.

Environment

People usually communicate most effectively in a comfortable environment. Temperature

extremes, excessive noise, and a poorly ventilated environment can all interfere with
communication. Also, lack of privacy may interfere with a client’s communication about
matters the client considers private.
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Congruence

In congruent communication, the verbal and nonverbal aspects of the message match.
Clients more readily trust the nurse when they perceived the nurse’s communication as
congruent. This will also help to prevent miscommunication.

Interpersonal Attitudes

Attitude conveys beliefs, thoughts, and feelings about people and events. Attitudes are
communicated convincingly and rapidly to others. Attitudes such as caring, warmth,
respect and acceptance facilitate communication, whereas condescension, lack of interest,
and coldness inhibit communication.

Elder speak is a speech style similar to babytalk that gives the message of dependence
and incompetence to older adults.

Therapeutic Communication

Therapeutic communication promotes understanding and can help establish a

constructive relationship between the nurse and the client. Unlike the social relationship,
where they may not be a specific purpose or direction, the therapeutic helping relationship
is client and goal directed.

Nurses need to respond not only to the content of client’s verbal message but also
the feeling expressed. It is important to understand how the client views the situation and
feels about it before responding. The content of the client’s communication is the words of
thoughts, as distinct from the feelings. Sometimes people can convey a thought in words
while their emotions contradict the words; that is, words and feelings are incongruent.

Purpose of Therapeutic Communication

 Establishing a therapeutic provider-client relationship.

 Identify client’s concerns and problem.
 Assess client’s perception of the problem.
Recognize client’s needs.

Guide client towards a satisfying and socially acceptable solution


Attentive Listening

Attentive listening is listening actively, using all the senses, as opposed to listening
passively with just the ear. It is probably the most important technique in nursing and is
basic to all other techniques. Attentive listening is an active process that requires energy
and concentration. It involves paying attention to the total message, both verbal and
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nonverbal, and noting whether this communication is congruent. Attentive listening means
absorbing both the content and the feeling the person is conveying, without selectivity. The
listener does not select or listen solely to what the listener wants to hear; the nurse
focuses not on the nurse’s owns need but rather on the client’s need. Attentive listening
conveys an attitude of caring and interest, thereby encouraging the client to talk

Attentive listening also involves listening or key themes in the communication. The
nurse might be careful not to react quickly to the message. The speaker should not be
interrupted and the nurse (the responder) should take time to think about the message
before responding. As a listener, the nurse also should ask questions either to obtain
additional information or to clarify.

Nurses need to be aware of their own biases. A message that reflect different values or
belief should not be discredited or the reason. According to Rondeau (1992), the message
sender (i.e., the client) should decide when to close the conversation, the client may
assume that the nurse consider the message unimportant.

In summary, attentive listening is a highly develop skill but fortunately it can be learn
with practice. A nurse can convey attentiveness in listening to clients in various ways.

Therapeutic Communication Technique

TECHNIQUE DESCRIPTION EXAMPLES

Using Silence Accepting pauses or silence that Sitting quietly (or walking
may extend for several seconds with the client) and waiting
or minutes without interjecting attentively until the client
any verbal response is able to put thoughts and
feelings into words
Can you tell me how is it
Providing Using statements or questions for youPerhaps you
General leads that( a) encourage the client to would like to talk about
verbalize, (b) choose a topic of Would it help to discuss
conversation, and (c) facilitate your feelings?
continued verbalization Where would you like to
begin?
And then what?
Rate your pain on scale 0-
10 (specific statement)
Being specific Making statements that are Are you in pain? (general
and tentative specific rather than general, and statement)
tentative rather than absolute You seem unconcerned
aboutyourdiabetes
(tentative statement)
You don’t care about you

Usingopen- Asking broad question that lead
ended or invite the client to explore
question (elaborate,clarify,describe,
compare, or illustrate) thoughts or
feelings. Open ended questions
specify only the topic to be
Discussed and invite answer that
is longer than one or two words.
Using touch Providing appropriate forms of
touch to reinforce caring feelings.
Because tactile contacts vary
considerably among individuals,
families, and cultures, the nurse
must be sensitive to the
differences in attitude and
practices of client and self.
Actively listening for the client’s
Restatingor basicmessageandthen
paraphrasing repeating then repeating those
thoughts and/or feelings in similar
words. This conveys that the
nursehaslistenedand
understood the client’s basic
message and also offers clients a
clearer idea of what they have
said.
A method of making the client’s
Seeking
broad over all meaning of the
clarification
message more understandable. It
is used when par phrasing is
difficultorwhenthe
communication is rambling or
garbled. To clarify the message,
the nurse can restate the basic
message or confess confusion
and ask the client to repeat or
restate the message. Nurses can
also clarify their own message
with statements.
A method similar to clarifying that
verifies the meaning of specific
Perception
checking or
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diabetes and you never
will (absolute statement)
I’d like to hear more about
that
Tell me about …
How have you been
feelinglately?What
broughtyoutothe
hospital?
What is your opinion?
You said you were
frightened yesterday. How
do feel now?
Putting an arm on client’s
shoulder. Placing your
hands over the client’s
hand
Client: I couldn’t manage
to eat any dinner last night
not even the dessert
Nurse: you have difficulty
of eating yesterday
Client: Yes, I was very
upset after my family left.
Client: I have trouble
talking to strangers.
Nurse: You find it difficult
talking to people you do
not know?
I’m puzzled
I’m not sure I understand
that Would you please say
that again?
Would you tell me more?
I meant this rather than
that
I’m sorry that wasn’t very
clear. Let me try to explain
another way
Client: My husband never
gives me any present

seeking words rather than the overall
consensual meaning of a message.
validation
Offering self Suggestingone’spresence,
interest, or wish to understand
the client without making any
demands or attaching conditions
that the client must comply with to
receive the nurse’s attention.
Giving Providing in a simple and direct
Information manner,specificfactual
information the client may or may
not request. When information is
not known, the nurse state this
and indicates who has it or when
the nurse will obtain it
Giving recognition, in a non
Acknowledging judgmental way, of a change in
behavior, an effort the client has
made, or a contribution to a
communication.
Acknowledgement may be with or
without understanding, verbal or
non verbal.
Clarifying time Helping the client clarify an event,
and sequence situation,orhappeningin
relationship to time.
Presenting Helping the client to differentiate
reality the real from the unreal.
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Nurse: You mean he has
never given you a present
for your birthday or
Christmas?
Client: Well not never. He
does get me something
for my birthday and
Christmas but he never
thinks of giving anything
at any other time.
I’ll stay with you until your
daughter arrives.
We can sit here quietly for
a while; we don’t need to
talk unless you would like
to
I’ll help you to dress o go
home if you like.
Your surgery is scheduled
for 11 AM tomorrow.
You will feel a pulling
sensation when the tube
is removed from your
abdomen.
You trimmed your beard
andmustacheand
washed your hair.
Inoticeyoukeep
squinting your eyes. Are
youhavingdifficulty
seeing?
You walked twice as far
today with your walker.
Client: I vomited this
morning
Nurse: Was that after
breakfast?
Client: I feel that I have
been asleep for weeks.
Nurse: You had your
operation Monday, and
today is Tuesday.
That telephone ring came
from the program in
television.

Focusing Helping the client expand on and
develop a topic of importance. It
is important for the nurse to wait
until the client finishes stating the
main concerns before attempting
to focus. The focus may be an
idea or a feeling; however, the
nurse often emphasizes a feeling
to help the client recognize an
emotion disguised behind words.
Reflecting Directingideas,feelings,
questions, or content back to
clients to enable them to explore
their own ideas and feelings
about a situation.
Summarizing Stating the main points of a
and planning discussion to clarify the relevant
points discussed. This technique
is useful at the end of an
interview or to review a health
teaching session. It often acts as
an introduction to future care
planning.
Barriers to communication
TECHNIQUE DESCRIPTION
Stereotyping Offering generalized and
over simplified beliefs about
group of people that are
based on experiences too
limited to be valid. These
responsescategorize
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I see shadows from the
windows coverings.
Your magazine is here in
the drawer. It has not
been stolen.
Client: My wife says she
will look after me, but I
don’t think she can, what
with the children to take
care of, and they’re
alwaysafterabout
something-clothes,
homework, what’s for
dinner that night.
Nurse: Sounds like you
are worried about how
well she can manage.
Client: What can I do?
Nurse: What do think
would be helpful?
Client: Do you think I
should tell my husband?
Nurse: You seem unsure
abouttellingyour
husband.
During the past half hour
we have talked about…
Tomorrow afternoon we
ay explore this further.
In new days I’ll review
what you have learned
about the actions and
effects of your insulin.
Tomorrow I will look at
your feeling journal.
EXAMPLES
Two year olds are brats.
Women are complainers.
Men don’t cry.
Most people don’t have any
pain after this type of
surgery.

clients and negate their
uniqueness as individuals.
Agreeing and disagreeing Akintojudgmental
responses, agreeing and
disagreeing imply that the
client is either right or
wrong and that the nurse is
in a position to judge this.
These responses deter
clients from thinking trough
their position and may
cause a client to become
defensive.
Attempting to protect a
person or health care
Being defensive
services from negative
comments.These
responsespreventthe
client from expressing true
concerns. The nurse is
saying, You have no right to
complain.Defensive
responses protect the nurse
admitting weaknesses in
the health care services,
includingpersonal
weaknesses.
Giving a response that
makes clients prove their
statement or point of view.
Challenging These responses indicates
that the nurse is failing to
considertheclient’s
feelings, making the client
feel it necessary to defend
a position
Probing Askingforinformation
chiefly out of curiosity
rather than with the intent to
assist the client. These
responses are considered
prying and violate the
client’s privacy. Asking why
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Client: I don’t think Dr.
Broad is a very good
doctor. He doesn’t seem
interested in her patients.
Nurse: Dr. Broad is the
head of the department of
surgery and is an excellent
surgeon.
Client: Those night nurses
must just sit around and
talk all night. They didn’t
answer my light for even an
hour.
Nurses: I’ll have you know
we literally run around on
nights. You’re not the only
client, you know.
Client: I felt nauseated after
those red pills.
Nurse: Surely you don’t
think I gave you the wrong
pill?
Client: I feel as if I am dying
Nurse: How can you feel
that way when your pulse is
60?
Client: I believed my
husband doesn’t love me.
Nurse: You can’t say that;
Why, he visits you every
day?
Client: I was speeding
along the street and didn’t
see the stop sign.
Nurse: Why were you
speeding?
Client: I didn’t ask the
doctor when he was here.

is often probing and places
the client in a defensive
position.
Testing Asking the question that
makes the client admit to
something.These
responses permit the client
only limited answer and
often meet the nurse’s need
rather than the clients.
Refusing to discuss certain
Rejecting topic with the client. These
responsesoftenmake
clients feel that the nurse is
rejecting not only their
communication but also the
clients themselves.
Changing topics and Directingthe
subjects communication into areas
of self interest rather than
consideringclient’s
concerns is often a self
protective response to a
topic that causes anxiety.
These responses imply that
what the nurse considers
important will be discussed
and the clients should not
discuss certain topics.
Unwarranted reassurance Using clichés or comforting
statements of advice as a
means to reassure the
client. These responses
block the fears, feelings,
and other thoughts of the
clients.
Givingopinionsand
Passing judgment approving and disapproving
responses, moralizing, or
implying one’s own values.
These responses imply that
the client must think as the
nurse thinks, fostering client
dependence.
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Nurse: Why didn’t you?
Who do you think you are?
(forces people to admit their
status is only that of client)
Do you think I am not busy?
(forces the client to admit
that the nurse really is
busy)
I don’t want to discuss that.
Let’s talk about…
Let’s discuss other areas of
interest to you rather than
the two problems you keep
mentioning.
I can’t talk now. I’m on my
way for coffee break.
Client: I’m separated from
my wife. Do you think I
shouldhavesexual
relationswithother
woman?
Nurse: I see that you’re 36
and that you like gardening.
This sunshine is good for
my roses. I have a beautiful
rose garden.
You’ll feel better soon.
I’m sure everything will turn
out all right.
Don’t worry.
That’s good (bad).
You shouldn’t do that.
That’s not good enough.
What you did was wrong
(right).
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Giving common advice
Telling the client what to do.
These responses deny the
Clients’ right to be an equal
partner. Note that
giving expert rather
than common advice
is therapeutic.
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.

Physical Attending

Egan (1998) has outlined five specific ways o convey physical attending, which he
defines as the manner of being present to another or being with another. Listening, in his
frame of reference, is what a person does while attending.

Guidelines for the use of touch

To provide good quality, sensitive and respectful care for someone we need to use
appropriate touch. Physical contact is a powerful communication tool for people who have
limited understanding of verbal language. Touch is also essential to emotional wellbeing.

Touch may be used for all of the following reasons: for communication, social interaction or
Intensive Interaction; to support, prompt and guide; as part of therapy; for emotional
support; for comfort; during personal care; for medical and nursing care; to give physical
support; and for protection. Touch should always be appropriate for the person and the
situation as described in their care plan or Essential Lifestyle Plan (ELP).

The following guidelines should be considered:

- Have consent from the person

Only use physical touch if the person is happy to accept it (unless it is clearly recorded that
it is in their best interests to do otherwise). Record how you know you have their consent.

- Document it
Always explain why touch is being used, for example, record it in the client’s ELP, care
plan, diary notes or specific intervention records such as Intensive Interaction session
sheets.

- Have agreement about the best way to work with someone

The use of touch should be a matter of open discussion and regularly reviewed. There
should be agreement on the best way to work with each person, and this should be clearly
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explained in their care plan or ELP. Some people have the need for unusually light or
heavy touch. This may not be obvious and a referral to the Learning Disability Team may
be needed.

- Ensure physical contact is appropriate

The type and context of physical contact should reflect the person’s needs and wishes and
be appropriate to the situation and place they are in.

To keep staff and service users safe

Always follow the person’s care plan or ELP guidelines
Be prepared to explain your practice
Have others present, in the same room or nearby
Although it may not always be possible, the most basic safeguard for staff and service
users is to have others present in the room or nearby whenever possible in situations
where physical contact is likely to be used. However, if this is not possible it should not
prevent appropriate physical contact from happening.

- Be prepared to discuss and explain your practice

Discuss the use of touch in supervision and team meetings and as part of improving your
practice and be able to explain why you are using it.

- Know when to seek advice

1.if you think the person does not like to be touched
2.if you are unsure how someone likes to experience touch
3.if the person interprets physical contact in a sexual way
4.if you have any concerns about working with someone because of any aspect of their
behavior
Discuss the situation with your manager. Consider making a referral to the Learning
Disability Team for further support.

These guidelines do not attempt to address these issues around physical intervention in
managing aggression and violence, see the Safe and Therapeutic Management of
Aggression and Violence Policy.

GENERAL GUIDELINES FOR TRANSCULTURAL COMMUNICATION

1. Use an translator/interpreter if you are not thoroughly effective and fluent in the
patient’s language

2. Obtain a translator of the same sex as the patient, if possible

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3. Learn basic words and sentences in the patient’s language

4. Slow down and be patient when using long explanatory phrases

5. Address the patient directly, not indirectly through the interpreter as if the patient did
not exist

6. Return to the same question when:

Suspecting a problem with the patient
Getting a negative response
Noticing a puzzled look from the patient

7. Always be sure that the

Interpreter knows what you want
to ask precisely

8. Provide instructions in a orderly manner, and have patients repeat their understanding
of the medical or nursing procedure or therapy

9. Avoid complicated technical terminology and professional jargon

10. Use drawings and communication boards when you think they may be helpful
communication aids

11. Plan what you want to say ahead of time and do not confuse the interpreter by backing
up, rephrasing, or by using abstract phrases or metaphors.

12. Speak slowly and use a normal tone of voice.

13. Do not shout or speak louder because usually misunderstandings do not occur
because patients cannot hear you, but because they need a longer time to process the
information from the nurse’s language into their native language, and then back to
English to respond

14. Use only necessary words Too many unnecessary words can frustrate the patient