Communication Finan1st Year

Communication
Communication
 Efficient communication is ESSENTIAL to
being successful in life.
 The biggest source of interpersonal
problems is poor communications.
 In nursing, communication is a dynamic
process used to gather assessment data,
to teach and persuade, and to express
caring and comfort.
Communication
 Communication is the process of
sharing our ideas, thoughts, and
feelings with other people and having
those ideas, thoughts, and feelings
understood by the people we are
talking with. When we communicate
we speak, listen, and observe.
Definition
 Communication is the process of
transmitting messages and
interpreting meaning.
 The sending and receiving of a
message.
Importance of communication
 Is important to understand and to
exchange ideas with patients and their
relatives, doctors and other members of
health team.
 It improves interpersonal relationship and
reduces tension.
 Poor communication results in poor patient
care.
 Good communication keeps everything in
order and helps the nurse to interpret
hospital policies and patient care.
THE COMMUNICATION PROCESS
The communication process consists of a message
being sent and received.
The message may be verbal or non-verbal.
Effective communication involves a message
being sent and received. Added to this
however, is the element of feedback to ensure
that the
message sent was received exactly as intended.
Communication Process
Basic elements of communication
process
A. Sender – The communicator or sender is
the person sends/ delivers the message.
B. Message – A communication in writing, in
speech, or by signals. Verbal and non verbal
information expressed by the sender.
C. Channel –Is the means of conveying and
receiving the message through visual,
auditory and tactile senses. The sender’s
facial expression conveys a visual message,
spoken words travel through auditory
channels, and placing a hand on another
person uses the channel of touch.
process
D. Receiver – The receiver is simply the person receiving
the message, making sense of it, or understanding and
translating it into meaning.
Communication is only successful when the reaction of the
receiver is that which the communicator intended.
Effective communication takes place with shared
meaning and understanding.
E. Environment: It is the physical and emotional climate
in which the interaction takes place. For effective
communication, the environment should be comfortable
and suited to participant’s needs.
process
 F. Feedback – Feedback is the message
returned to the original sender by the
receiver. It can be a verbal or nonverbal
reaction or response. Without feedback,
there would be no way of knowing if
meaning had been shared or if
understanding had taken place.
communication is a two-way
process.
 The information goes out to a person
on the other end. There is a sender
and a receiver. Simply put, effective
communication is getting your
message across to the receiver.
 It is the sender’s responsibility to
make sure that the receiver gets the
message and that the message
received is the one sent.
The Communication Process
Feedback
Source Encoding Channel Decoding Receiver

Message Message Message Message
Feedback
Source Encoding Channel Decoding Receiver

“I take sugar in my tea”

Feedback
Receiver Decoding Channel Encoding Source

“One lump or
two?”
Essentials of good communication
 Sender and receiver should use the
same language and express the ideas
in simple words.
 Avoid technical words and
abbreviations that are not in use.
 Clarity should be there in expression.
 Pay attention to non verbal
messages.
Essentials of good communication
 Communication should be relevant and
appropriate to person and time.
 Sender should have thorough knowledge
of the subject.
 To be a good listener means: face the
person who talks; maintain good eye
contact; maintain a relaxed posture to
show interest.
 Giving a feedback is essential.
 For effective communication, both sender
and receiver need to be good listeners.
Forms/Types of communication
 Verbal Communication involves the spoken or written
word. Verbal language is a code that conveys specific
meaning as words are combined.
Most important aspects:
 vocabulary –
 A message spoken in terms the client understands, makes
communication more effective.
 clarity and brevity
 A clear, simple phrase communicates more effectively.
 denotative and connotative meaning
 denotative meaning is shared by individuals who use a
common language ; connotative meaning is the shade or
interpretation of a word’s meaning influenced by the
thoughts, feelings or ideas people have about the word.
Forms/Types of communication
 Verbal Communication
 pacing when speaking
 appropriate speed or pace
 Intonation (tone of voice)
 Timing and Relevance
 Relevant messages are more effective.
 Humour
Forms of communication
 Non verbal communication includes
messages sent through the language of
the body, without using words. Non
verbal communication facial
expressions; vocal cues; eye contact;
gestures; posture; touch; odor; physical
appearance; dress; silence; and the use
of space, time, and objects. 80-90% of
Communication
 Often not conscious
Non verbal communication
 Factors
 Personal appearance is indicator of well
being, personality, social status, religion,
culture, occupation
 Facial expression : face is the most
expressive part of the body. Facial exp reveals
emotions.
 Posture / Gait : the way people sit, stand
and walk is a form of self expression.
 Non verbal communication
 Eye Contact: signals a readiness to contact
 Gestures: a salute, thumbs up, and a tapping foot
are types of gestures.
 Touch
 Personal Space
 It is the distance people prefer in interactions with
others.
 Intimate: touching to 11/2 feet
 Personal : 11/2 to 4 feet
 Social: 4 to 12 feet
 Public: 12 to 15 feet
Levels of communication
 INTRAPERSONAL COMMUNICATION
is a powerful form of communication
within an individual. Also called self
talk, self verbalization, and inner
thought.
 positive self talk can be used to
improve health and self esteem.
Levels of communication
 INTERPERSONAL COMMUNICATION
 Is interaction between two people or
within a small group. It refers to non
verbal and verbal behavior within a
social context and includes symbols and
cues used to give and receive meaning.
 PUBLIC COMMUNICATION
 Is the interaction of one individual with
large groups of people.
Factors influencing communication
process
 Development
 Language, psychosocial, and intellectual
development move through stages across the
life span.
 With aging also come changes in vision and
hearing acuity.
 Gender
 Girls tend to use language to seek confirmation,
minimize differences, and establish intimacy.
Boys use language to establish independence
and negotiate status within a group.
process
 Values and perceptions
 Values are the standards that influence
behaviour, and perception are the
personal views of an event.
 Because each person has unique
personality traits, values, and life
experiences, each will perceive and
interpret messages and experiences
differently.
process
 Personal space
 It is the distance people prefer in interactions
with others.
 Intimate: touching to 11/2 feet
 Personal : 11/2 to 4 feet
 Social: 4 to 12 feet
 Public: 12 to 15 feet
 Roles and relationships
 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.
process
 Environment
 Temperature extremes, excessive noise, and a
poorly ventilated environment can all interfere
with communication.
 Congruence
 The verbal and non verbal aspects of the
message match in congruent communication. If
there is incongruence, the body language or non
verbal communication is usually the one with the
true meaning.
process
 Interpersonal attitudes
 Attitudes such as caring, warmth,
respect and acceptance facilitate
communication, whereas lack of interest
and coldness inhibit communication.
Barriers of communication
 The message may be distorted by various
factors.
 EMOTION : Jealousy, suspicion, fear, anger,
anxiety.
 PHYSICAL FACTORS: fatigue, illness, speech
defect, deafness and pain.
 INTELLECTUAL FACTORS: low IQ, lack of
knowledge, misinterpretation of words.
 SOCIAL FACTORS: difference in culture,
language.
 ENVIRONMENTAL FACTORS: noise, lack of
privacy, uncomfortable accommodation
Barriers of communication
 Communication may be blocked by
 CHANGING THE SUBJECT
 LACK OF LISTENING
 INAPPROPRIATE USE OF KNOWLEDGE
 JUMPING INTO CONCLUSION
 FALSE AND INAPPROPRIATE REASSURANCE
 STATING OWN OPINION AND IDEAS.
 STEREOTYPING - GENERALIZED BELIEFS HELD
ABOUT PEOPLE
The nurse client helping
relationship
 Nurse client relationship are referred to by
some as interpersonal relationship, by
others as therapeutic relationship, and still
by others as helping relationships.
 Helping is a growth facilitating process
that strives to achieve 2 basic goals:
 Help clients to manage their problems more
efficiently and develop unused or underused
opportunities more fully.
 Help clients become better at helping
themselves in their everyday lives.
relationship
 The keys to the helping relationship are:
 the development of the trust and acceptance
between the nurse and the client
 an underlying belief that the nurse cares about
and want to help the patient
 Age, sex, appearance, diagnosis,
education, values, ethnic and cultural
background, personality, experiences and
setting can all affect the development of
the nurse- client relationship.
relationship
 Characteristics
 A helping relationship is an intellectual
and emotional bond between the nurse
and the client and is focused on the
client.
 Respects the client as an individual
 Respects client confidentiality
 Focuses on the client’s well being
 Is based on mutual trust, respect and
acceptance
relationship

PHASES
1. PREINTERACTION PHASE
 The nurse reviews pertinent
assessment data and knowledge,
considers potential areas of
concern, and develops plans of
interaction.
relationship
2. INTRODUCTORY PHASE/ ORIENTATION OR
PREHELPING PHASE
 OPENING THE RELATIONSHIP
 Both the client and nurse identify each other by
name.
 CLARIFYING THE PROBLEM
 The nurse’s major task is to help clarify the
problem
 STRUCTURING AND FORMULATING THE CONTRACT
 Nurse and client develop a degree of trust and
verbally agree about a) location, frequency, and
length of meetings b) overall purpose of the
relationship c) how confidential matter will be
handled d) tasks to be accomplished e) duration
and indications for termination of the relationship
relationship
 PHASES
3. WORKING PHASE
Nurse and client work together to solve problems and
accomplish goals, nurse
 encourage and help the client to express feelings about
his or her own health
 Provide information needed to understand and change
behavior
 Take actions to meet the goals set with the client
 Use therapeutic communication skills to facilitate
successful interactions
 Use appropriate self disclosure and confrontation
relationship
 PHASES
4. TERMINATION PHASE
During the end of the relationship,
nurse
 Remind the client that termination is near
 Evaluate goal achievement with the client
 Reminisce about the relationship with the
client
 Separate from the client by relinquishing
responsibility for his or her care
 Achieve a smooth transition for the client
to other caregivers as needed
Developing helping relationship
 There are many ways of helping clients that do not require
special training.
 Listen carefully
 Help to identify what the person is feeling
 Put yourself in other person’s shoes (i.e empathize)
 Be honest
 Be genuine and credible
 Be aware of cultural differences that may affect meaning and
understanding.
 Maintain client confidentiality
 Know your role and limitations
Forms of Communication
 Therapeutic- Communication that is

beneficial in developing a nurse-client
helping relationship
 Non-Therapeutic- Communication
that is not beneficial or helpful to
people involved
Effective communication
 Effective communication is a two-way
process - sending the right message,
that is also being correctly received
and understood by the other
person/s.
Skills required for effective
communication
 Trust & Rapport Building skill
 First Impressions are CRITICAL!!!
 Address the Patient Professionally &
Appropriately
 Establish eye contact
 Be nice, polite and respectful EVEN to those who you feel don’t
deserve it
 Use voice tone & inflection to demonstrate
concern, confidence and reassurance
 Calm and moderate volume level at a moderate pace
 Demonstrate concern and compassion
 Watch your non-verbal communication signals
10/04/20
communication
 Trust & Rapport Building skill
 Explain your actions and concerns to the patient
using words he/she understands
 Be honest
 Explain, in simple words, why you are doing
something
 Warn before causing pain
 Let the patient know what to expect
 Choose the style of communication most appropriate
for the situation
 A calm, concerned voice generally works for most
cases
 May need to switch to more authoritative tone and
expressions
communication
 Empathy
Empathy is a crucial element in facilitative communication
and it is an ability to appreciate another person's thoughts
and feelings from his point of view but never losing your
own identity!
 The central focus is "with" and "in" the client's world. It
involves accurate perception of the client's world,
communication of your understanding to the client, and
then reacting in a helpful way. it is probably one of the
most important aspects of the helping relationship.
Example: "You feel angry and let down because she never
came to your dinner party after she actually accepted the
invitation".
communication
 Active/Attentive Listening
 Active listening is a way of sharing a
patient's thoughts and feelings. In its most
simple form, you hear what the patient is
saying, repeat what you heard, and then
check with the patient to make sure the
reflection is correct.
 Most important technique in Nursing
 Involves listening actively with all the senses
 Highly developed skill that can be learned
with practice
communication
 Active Listening!!
 S – Sit facing the client
 O – Open Posture
 L – Lean forward towards client
 E – Establish eye contact
 R- Relax!!
Active Listening!!
 To become a more effective listener:
 Do not TALK while listening
 Assume an open, relaxed position
 Focus on what the other person is saying
 Listen to understand rather than to respond
 Secure a quiet environment, free of distraction
 Validate the other person’s feelings
 Do not criticize
 Accept the person as he/she is
 Be alert to nonverbal cues
 Avoid being distracted
Techniques of Communication within caring
relationships
 Professionalism
 The client’s acceptance of you as a
professional often depends on the
manner in which you present a
professional and caring image.
 Professional appearance and behavior
are important in establishing
trustworthiness and competence.
Techniques of Communication within
caring relationships
2. Courtesy
It conveys respect for others and oneself.
Courtesy techniques include saying hello
and goodbye, knocking on doors before
entering, introducing oneself and stating
one’s purpose, addressing people by name,
saying please , thank you.
Self introduction is especially important.
Avoid terms of endearment like honey, dear,
grandpa
Avoid referring to clients by diagnosis, room
number, or other attribute
3. Confidentiality
It is essential that you safeguard the client’s
right to privacy by carefully protecting
information of a confidential nature.
4.Trust
You foster trust when you communicate
warmth, and caring and demonstrate
consistency, reliability, honesty, and
competence.
4. Availability
It means being present for the other person
when needed and offering your presence
even when the need is not expressed
verbally.
5. Empathy
Empathy is the ability to understand and
accept another person’s reality, to
accurately perceive feelings, and to
communicate this understanding to other.
6.Sympathy
It is the concern, sorrow or pity you feel for the client,
when you personally identify with the client’s needs.
7. Listening and responding
Active listening means listening attentively with the
whole person – mind, body and spirit. It includes
listening for main and supportive ideas;
acknowledging and responding; giving appropriate
feedback; and paying attention to other person’s total
communication, including the content, the intent and
feelings expressed.
 Paraphrase communication (Restating what was said
in the receiver’s own words to make sure information
has been accurately received.)
 Clarifying communication ( clarifying is
used to validate whether the message was
interpreted correctly.)
 Focus communication
Focusing directs conversation to a specific topic or
issue when a discussion becomes unclear and limits
the area to which the sender can respond.
 Summarize communication
Summarising provides a concise review of
main ideas from a discussion.
 Avoid inattentive listening
 Avoid medical vocabulary ( technical
words can cause confusion and anxiety
and should be avoided or translated)
 Avoid giving personal opinions
 Avoid prying (asking irrelevant personal
questions to satisfy your curiosity is
inappropriate and invasive)
 Avoid changing the subject
8. Acceptance and respect
It means you are non judgmental. Acceptance
is a willingness to hear a message or to hear
a message or to acknowledge feelings yet
does not mean that you agree or approve.
 Asking for explanations
 Avoid approval or disapproval
 Avoid arguing
 Avoid being defensive
9. Silence
Silence is therapeutic in times of profound
sadness, deep thought, or grief when there
are no ‘right’ words.
10. Hope and encouragement
Hope is essential for healing and
communicates a “ sense of possibility” to
others.
Avoid false reassurance that can do more
harm than good.
10. Socializing
A friendly, informal, and warm
communication style helps establish
trust.
Avoid inappropriate socializing.
11. Assertiveness and autonomy
12. Humor
13. Touch
Therapeutic Communication
Techniques
 Listening - nonverbal; conveys interest in the client; active listening
 Listening vs. Hearing
 Nod as client speaks
 Appear attentive
 Conveying Acceptance - listen without judging
 Paraphrasing
 Focusing - centering information on the key elements of the message
 Stating observations
 Clarifying
 Focus
 Assertiveness
 standing up for one’s rights without violating those of others
 Summarizing - concise review of main ideas
 Appropriate self-disclosure
Techniques in nursing
 • Giving Broad Openings
– Allows the client to take the initiative in introducing the topic.
– “You seem to be thinking about something.”
– “Where would you like to begin?”
– “Is there something you’d like to discuss?”
– “Tell me about your health.”
 Offering General Leads - gives encouragement to continue.
– “Go on.”
– “And then…”
– “Tell me about it.”
 Giving Information - Making available the facts the client needs.
– “My name is…”
– “Visiting hours are…”
– “My purpose in being here is…”
 Focused questions/comments - Encourages client to
give more information about specific topic.
– “Tell me about your pain.”
– “How has your family reacted?”
– “What is your biggest fear?”
 Sharing Observations - verbalizing what is perceived.
The nurse and the client compare their observations.
• “You appear tense.”
• “I notice that you’re biting your lips.”
• “You seem upset.”
 Restating or Paraphrasing - repeating the main
idea
• CLIENT: “I can’t sleep.” I stay awake all night.”
• NURSE: “You have difficulty sleeping.”
 Reflecting - focuses patient on identified
feelings based on verbal or nonverbal cues
• CLIENT: “My brother spends all my money and
then has the nerve to ask for more.”
• NURSE: “This causes you to feel angry?”
 • Offering Self - makes the nurse
available
• “I’ll sit with you for awhile.”
• “I’ll stay here with you.”
• “I’m interested in your comfort.”
 • Exploring - many clients deal only superficially with topics, as if
testing to see whether the nurse is really interested enough to look
further.
• “Tell me more about that.”
• “Would you describe it more fully?”
 • Clarifying - Seeking to make clear that which is not meaningful or
that which is vague.
• “I’m not sure that I follow.”
• “The main point here then is…”
 • Summarizing - Reduces the interaction to 3 or 4 points identified
by nurse as significant.
Allows client to agree or add other concerns.
– “So there are three things you are upset about, your family being too busy, your diet, and
being in the hospital so long.”
 Silence
• It is not the absence of communication
• Provides quiet opportunity for both parties to reflect
• Decrease tension after emotional issue
Non-therapeutic Techniques
 Advising
 Agreeing
 Belittling feelings
 Challenging
 Defending
 Disagreeing
 Disapproving
 Probing
 NURSING INTERVENTION FOR
PATIENTS WITH SPECIAL
COMMUNICATION NEEDS
Blind Patients.
 Always speak to the patient when you enter the

room so he will know who is there.
 Speak directly to the patient; do not turn 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.
 Offer to help with arrangements for patients
who may enjoy hearing tapes or reading Braille
literature.
Deaf Patients.
 Avoid shouting
 Use simple sentences
 Look directly at the patient when speaking
with him/her.
 Do not cover your mouth when speaking
because the patient may read lips.
 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.
Patients Speaking a Foreign Language.
 Obtain a translator if possible

 Have a chart with basic phrases in
English and the foreign language.
 Consider using charts with pictures.
Clients who are mute or cannot
speak clearly
 Listen attentively, be patient and do not

interrupt.
 Do not finish client’s sentences for them.
 Ask simple questions that require ‘yes’ or ‘no’
 Allow time for understanding and responses
 Allow only one person to speak at a time
 Do not shout or speak too loudly
 Encourage the client to converse
 Let the client know if u do not understand
 Use communication aids as needed.
Children
 Give periodic attention to infants and younger

children as they play to include them.
 Avoid sudden movements or gestures
 Be Calm and gentle
 Use a quiet, friendly and confident tone of voice.
 Be honest
 Short simple concrete sentences and explanations
 Avoid staring at the child
Communication with the older adult
 Changes in hearing, Tinnitus, Decrease in visual

acuity are barriers for effective communication
 Make sure that assistive devices, glasses, and
hearing aids are being used and are in good working
order.
 Make use of communication aids, such as
communication boards, computers or pictures.
 Keep environmental distractions to a minimum
 Speak in short, simple sentences, on subject at time
 Always face the person when speaking
 Include family and friends in communication

Communication with the Health
Care Team:
 Necessary for the good of the patient!

 Be courteous
 Be professional
 Follow appropriate chain of
commands
 Answer phone with unit, your name,
position—student nurses do not take
orders over the phone nor give out
info
Communications – Did you know?
 People remember:
 10 percent of what they read
 20 percent of what they hear
 30 percent of what they see
 50 percent of what they see and hear
 80 percent of what they say
 90 percent of what they say and do
Conclusion
 When communicating with patients,
each Practical Nurse has to find the
ways that are the most effective for
the people and circumstances
concerned. If the Nurse tries to
express care and concern for the
patient and can communicate well
verbally and nonverbally, the nurse-
patient relationship will thrive.
The quality of care you can
provide is, in many ways,
dependent on the quality of
communication that exists
between you and your patient.

Communication Finan1st Year

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Communication

Source Encoding Channel Decoding Receiver

Source Encoding Channel Decoding Receiver

“I take sugar in my tea”

Receiver Decoding Channel Encoding Source

 Therapeutic- Communication that is

 Always speak to the patient when you enter the

 Obtain a translator if possible

 Listen attentively, be patient and do not

 Give periodic attention to infants and younger

 Changes in hearing, Tinnitus, Decrease in visual

 Necessary for the good of the patient!

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