NCM 103

COMMUNICATION

Communication
-any forms of exchanging information or feelings between two or more people.
-basic component of human relationships, including nursing
Our job mainly needs a consumer (Our patients or clients). Without talking to them, or
communicating with them, our relationship cannot be formed.

Main Purpose of Communication:

- Influence Others
Teach our clients different health teachings especially with health promotion
- Obtain Information
Assess our clients, interview them regarding their health history

-Effective communication is essential for the establishment of the nurse-client relationship.

Nurses who communicate effectively are better able to:

- Collect assessment data
- Initiate interventions
- Evaluate outcomes of interventions
- Initiate change that promotes health
- Prevent legal problems associated with nursing practice

Different levels of communication:

- Intrapersonal: self-talk; can be positive or negative
- Interpersonal: between two or more people
- Group: With many people at the same time
Community Health Nursing. Assessment, Instructions, teachings, health programs

Communication Process:
- A two-way process involving the sending and the receiving of a message
- Has four components:
- Sender: A person or group who wishes to convey a message to another.
Considered as the source encoder.
- Source: idea or reason for communicating
- Encoding: involves the selection of specific signs/symbols
to transmit the message, such as which language or words
to use, how to arrange the words and what tone or
gestures to use

- Message: “what is actually said or written”

The body language that accompanies the words and how the message is
transmitted
 - Receiver: Must listen, observe and attend
Decoder
To decode means to relate the message perceived to the receiver’s
storehouse of knowledge and experience and to sort out the meaning of
the message.
- Effective communication: the meaning of the decoded message
matches the intent of the receiver
- Ineffective communication: occurs when the message is
misinterpreted by the receiver.

- Response/Feedback: The message that the receiver returns to sender

May be verbal, nonverbal or both
Allows the sender to correct or reword a message.
If received inappropriately

Modes of Communication
- Verbal: uses spoken/written words
- Nonverbal: Sometimes called “body language”
Includes gestures, body movements, use of touch and physical
appearance including adornment (actions that make more meaningful)
Often tells others about what a person is feeling that what is actually said;
either reinforces or contradicts what is said verbally
- Electronic Communication: a form of communication that has evolved with technology

Verbal communication considerations:

● Pace and intonation
- The manner of speech will modify the feeling and impact of the message
- Intonation can express sadness, anger or amusement
- The pace of speech may indicate interest, anxiety, boredom or fear.

● Simplicity
- Use of commonly understood words, brevity and completeness
- Nurses need to learn and select appropriate and understandable terms based on
the age , knowledge and culture, and education of the client

● Clarity and Brevity

- Direct & simple message will be more effective
- Clarity: saying precisely what is meant
- Brevity: using the fewest words necessary
- To ensure clarity, nurses need to speak slowly and enunciate carefully

● Timing and relevance

- Timing needs to be appropriate to ensure that words are heard
- Messages need to relate to the person or the person’s interests and concerns
 ● Adaptability
- Spoken messages need to be altered in accordance with behavioral cues from
the client
Tone is important
- What the nurse says and how it is said must be individualized and carefully
considered

● Credibility
- Means worthiness of belief, trustworthiness and reliability
- Nurses foster credibility by being consistent, dependent honest
- Nurses need to be knowledgeable about what is being discussed and to have
accurate information.

● Humor
- Can be a positive and powerful tool in the nurse-client relationship, but it must be
used with care
- Can be used to help clients adjust to difficult and painful situations
- Consider the client’s perception of what is humorous.
- Timing should also be considered
- May be considered offensive or distracting at a peak crisis period.

To observe NONVERBAL behavior, assess the following:

● Personal Appearance
- Choice of apparel may convey social and financial status, culture, religion, group
association and self-concept.
- If the symbolic meaning of an object is unfamiliar, the nurse can inquire about its
significance, which may foster rapport with the client.
- How the person dresses is often an indicator of how the person feels.

● Posture and Gait

- The ways people talk and carry themselves are often reliable indicators of self-
concept , current mood and health
Applicable to both clients and nurses
- Erect posture and an active, purposeful stride suggest a feeling of health-being
- Slouched posture and a slow, shuffling gait suggest depression or physical
discomfort.
- Tense posture and rapid determined gait suggest anxiety and anger.
- The nurse clarifies the meaning of the observed behavior by describing to the
client what the nurse sees and then asking what is means

● Facial Expression
- No part of the body is as expressive as the face.
 - 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 the person's
feeling.
- When the message is not clear, it is important to get feedback to be sure of the
intent of expression.
- Nurses need to be aware of their own expressions and what they are
communicating to others; clients are quick to notice the nurse’s facial expression
- It is possible to control all facial expressions, but the nurse must learn to control
expressions of feelings

● Eye contact
- Acknowledges recognition of the other person and willingness to maintain
communication; a person who feels weak and defenseless often averts the eyes
or avoids eye contact

● Gestures
- Hand and body gestures may emphasize and clarify the spoken word, or they
may occur without words to indicate a particular feeling or sign.
- May be devised by the client and nurse to denote other meanings.

Electronic communication:
● Email
- Most common form of electronic information
- Advantages
- Fast, efficient and legible
- Provides a record of the date and time of the message that was sent or
received.
- Improves communication and continuity of client care
- Disadvantages
- Risk to client confidentiality
- Socioeconomics; not all have computers or computer skills
- When not to use
- When the information is urgent
- HIghly confidential information
In this case, it’s better to see or telephone the person
- Other guidelines
- Follow agency’s guidelines, like what could be emailed to clients
- Secure email consent form that the client signs
- Identify “confidential” in the subject line
- Include a disclaimer that the message is only to be read by the person
whose address appears and that no one else is to read it.
- The disclaimer should also state if the message is sent to anyone by
mistake, they should contact the sender.
 - Considered to be part of the client’s medical record, a copy should be
placed in the client’s chart
- Not a substitute for effective verbal or non verbal communication

Factors affecting the communication process

● Development
- Language, psychosocial and intellectual development move through stages
across lifespan
- Knowing the client’s developmental stage will allow the nurse to modify the
message accordingly.

● Gender
- Girls tend to use language to seek confirmation, minimize difference and
establish intimacy
- Boys use language to establish independence and negotiate status within the
group.

● Values and perceptions

- Values: standards that influence behavior
- Perceptions: personal view of an event.
Each person will perceive and interpret messages and
experiences differently

● Personal Space
- The distance between people prefer interactions with others
- Proxemics: study of distance between people in their interactions
- Communication alters in accordance with four distances. Tamparo and Lindh
(2000) list the following examples:
- Intimate Distance
- Touching to 1 and ½ 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
maybe distorted.
- E.g. cuddling a baby, touching sightless clients and
positioning clients
- In their therapeutic roles, nurses often are required to
violate this personal space (to communicate warmth and
caring) therefore, it is important for the client to know when
this will occur and to be forewarned
- Personal Distance
- 1 ½ feet to 4 feet
- Much communication between the nurses and clients
occurs at this distance
 - Voice tones are moderate
- Body heat and smell are less noticed
- Social Distance
- Characterized by clear visual perception of the whole
person, body heat is imperceptible, eye contact is
increased and vocalizations are loud enough to be
overheard by others
- More formal and limited to seeing and hearing
- Allows more activity and movement back and forth
- E.g. nurses make rounds or wave as a greeting to
someone
- Public distance

● Territoriality
- Concept of the space and things that an individual considers as a belonging to
the self
- Nurses need to obtain permission from clients to remove , rearrange or borrow
objects in the hospital area

● Roles and Relationships

- The roles and relationships between sender and receiver affect the
communication process
- Choice of words, sentence structure and tone of voice vary considerably from
role to role.
- The specific relationship between the communicators is significant

● Environment
- People usually communicate most effectively in a comfortable environment
- Temperature extremes, Excessive noise and poorly ventilated environment can
interfere with communication
- Lack of privacy also interferes communication

● Congruence
- In congruent communication, the verbal and nonverbal aspects of the message
match
- If there is incongruence, the body language or the nonverbal communication is
usually the one with the true meaning

● Interpersonal Attitudes
- Attitudes convey beliefs, thoughts and feelings about people and events.
- Attitudes such as caring, warmth and respect and acceptance facilitate
communication
- Condescension, lack of interest and coldness inhibit communication
 - Caring and warmth convey a feeling of emotional closeness, in contrast to an
impersonal approach
- Caring coveys deep and genuine conversation for the person; warmth conveys
friendliness and consideration, shown by acts of smiling and attention to physical
comforts
- Respect is an attitude that emphasizes the other person’s worth and individuality
- Acceptance emphasizes neither approval or disapproval; the nurse willingly
receives the client’s honest feelings
- An accepting attitude allows the clients to express personal feelings freely and to
be themselves
- The nurse may need to restrict acceptance in situations where clients’ behaviors
are harmful to themselves of others

● Boundaries
- Limits of individuals, objects, or relationships (Boyd, 2012)
- Professional boundaries are crucial in the context of the nurse-client relationships
- Nurses should avoid sharing personal information
- Decline invitation if client seeks friendship or relationship outside of work
environment
- Gift-giving, spending more time than necessary and believing that he/she
understands client should be addressed
- Diligent about not crossing nurse-client boundaries in an online setting
- Aylott (2011) encourages the:
- P - ause and process
- C - choices
- A - ct accountably