Basic Concepts of Communication

Dr. Belal M. Hijji, PhD, RN

Febuary 6, 2011
 Learning Outcomes
By the end of this lecture, students will be able to:
• Define the communication process and identify its components
• Describe the component system of communication
• Identify the factors that impact on verbal communication
• Describe the importance of nonverbal communication in health
care settings
• Discuss the factors that impact on nonverbal communication
• Identify communication style factors that influence the nurse-
client relationship
• Describe the levels and types of communication
• Discuss the various techniques of therapeutic communication

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 The Communication Process and its Components
Communication: It is the process of transmission thoughts,
feelings, facts, and other information. In nursing, communication
is a vehicle for establishing therapeutic relationship with the
patient. The quality of patient client relationship is dependent on
the quality of communication between them. Its components are:
• Sender: Generates a message which stems from the person’s
need to relate to others, to create meaning, and to understand
various situations.
• Message: Is a stimulus produced by a sender. Messages may
be verbal, nonverbal, written material, and arts.
• Channel: The medium through which a channel is transmitted.
Channels are visual, auditory, and kinesthetic.
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• Receiver: Is the person who receives and interprets the
sender’s message. Receiving is influenced by complex
physiological, psychological, and cognitive processes.

• Feedback: Is the information the sender receives about the

receiver’s reaction to the message.

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 Basic concepts of Communication

Metacommunication
Definition: It is a broad term used to describe all factors that
influence how a message is perceived or interpreted (Slide 4).
For ten years (1952-1962), Bateson and colleagues conducted
research on communication, and pioneered the concept of
metacommunication.
Verbal and nonverbal components of communication are
interrelated; they need to be congruent with each to avoid
misinterpretation.

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 Metacommunication

Verba v er b al
l No n

Culture Body language

Native language Culture
Gender Gender
Vocal pitch Appearance

Factors in communication styles

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 Verbal Communication

Spoken words are symbols that people use to think about ideas, to
share experiences with others, and to validate the meaning of
perceptions about the world and one’s place in.

Spoken words are essential for classifying and ordering information

in ways that individuals understand them.

Feedback on spoken words is essential in enabling mutual

understanding of the meaning of a message.

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 Factors Impacting on Verbal Communication

• Culture: Many nurses lack an understanding of communication

principles and techniques of effective communication with patients
from other than their own culture.
– Effective communication requires, amongst others, knowledge
of the values of another person’s culture. Example: A Muslem
patient admitted in Ramadan in a UK hospital.
• Language: Nurses need to be proficient in the language of the
patient they care for. Otherwise, the communicative process will
be impaired which will negatively impact on the quality of care.

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• Gender: Gender differences in communication patterns exist
between men and women in both the content and process.
– Content:
• Men use less verbal communication that women.
• Women tend to disclose more personal information than
men
• Men are more likely to initiate an interaction, talk more,
interrupt and use hostile language, when discussing
issues.
– Process:
• In health care settings, women use more active
listening, using encouraging responses, and using more
supportive words.

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• Vocal pitch and tone:
– Paralanguage: is the oral delivery of a verbal message,
expressed through tone of voice and inflection, sighing, or
crying.
– Understanding paralanguage affects how the verbal
message is likely to be interpreted.
– A statement by a nurse in a voice that sounds rushed, high
pitched, or harsh is likely to be misinterpreted by the
patient, although the nurse’s intention is good. In contrast,
the same statement made in soft, unhurried voice would
express genuine interest.
– To achieve mutual understanding, the tone of voice should
support the content of the message.

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 Nonverbal Communication
Function: To convey cues about a content to be communicated.
Channels: Facial expression, eye movement, body movement,
posture, gestures, touch, and proxemics.

Confusion arises when the nonverbal cue is inconsistent with the

verbal message. Therefore, congruency aids understanding.

Nurses use nonverbal communication to build rapport with

patients. The patient’s nonverbal behaviour may reveal important
information that affect nurse-patient relationship.

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 Factors That Affect Nonverbal Communication

Body language: Your body language is as important as your

patient’s. During history taking, keep your body posture relaxed
to convey a calm, reassuring attitude. Work at the same level as
your patient. Standing over her/ him conveys a sense of
dominance and authority, enhancing her/ his sense of
dependence. Give reaffirming gestures such as nodding. Your
facial expression should convey care and concern. Maintain eye
contact to show the patient you are interested in what s(h)e has to
say.

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• Culture: Nonverbal gestures convey different meanings in
different cultures. Putting thumb and index finger into a circle
means “approval” in the American culture, but is an obscene
gesture in Brazil.
– Touch: As Muslems, touch is prohibited between a man
and a woman who are from outside of family. However,
touch in health care is important component of assessment.
Therefore, care needs to be taken so that the use of touch is
not misinterpreted.
• Gender: Women tend to demonstrate more effective use of
nonverbal communication and are better decoders of
nonverbal meaning.
• Women tend to use more facial expression, smiling more
often, maintaining eye contact, and touching more often.
• Men prefer a greater interpersonal distance between
themselves and others. 13
• Appearance: For example, a patient who tells you he is
having “crushing chest pain” should look like he is having
“crushing chest pain.”His nonverbal behavior should be
consistent with what he is telling you. A relaxed posture with
arms at the sides conveys openness, whereas a tense posture
with arms crossed may reflect anger, discomfort, or mistrust.
A tense, guarded posture may also indicate pain. A tripod
position (sitting position, leaning forward with elbows on table
and hands supporting head) is assumed to ease breathing.

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 Interpreting Nonverbal (Slide 15) Body Cues

• The emotional component of a message can be indirectly

interpreted by observing the client’s body language.
• Body stance may convey a message about an individual.
– Direct eye contact while talking or listening create more a
sense of confidence and credibility than turning one’s body
to one side.
– A slumped, head-down posture and slow movements may
indicate lassitude or low self-esteem; erect posture and
decisive movements suggest confidence and self-control.
– Rapid, diffuse, and agitated body movements may suggest
anxiety.

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• Downward glances or averted eyes signal submission,
weakness, or shame.
• Facial expression either reinforces or modifies the message
being conveyed. In circumstances of incongruence, nonverbal
expression assumes prominence and generally is perceived as
more trustworthy than the verbal content.
• Is your facial expression always an indicator of emotional
response to a situation?

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Style Factors That Influence Nurse-Client Relationship

• Responsiveness of participants:
– How responsive the participants are affects the depth and
breadth of communication.
– Nurses should direct efforts to increase the responsiveness
of less verbal clients, through verbal and nonverbal
approvals, active listening, demonstration of empathy, and
acknowledgment of the content and feelings of messages.
– Sometimes, acknowledging the difficulty a client has in
expressing certain feelings, praising efforts, and
encouraging use of different routes of communication helps
promote responsiveness.

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• Roles of participants:
– The relationship between the roles of the sender and of the
receiver influence how a message is likely to be received
and interpreted.
– A statement of constructive criticism issued by a friend and
by one’s immediate supervisor may be interpreted
differently.
– Communication between nurses and their supervisors is
more likely to be influenced by power and style than by
gender.
– More powerful supervisors tend to speak in a more
dominant style

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• Validation of individual worth:
– A caring style conveys a message of individual worth and
this fosters the relationship with the clients.
– Confirming responses validate the intrinsic worth of an
individual. These responses that affirm the individual’s
right to be treated with respect, and affirm his autonomy.
– Disconfirming responses disregard the validity of feelings.
Such responses take the form of changing the topic, or
presuming to know what a client means without verifying
the message with him.

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• Context of the message:
– Communication is always influenced by the environment in
which it takes place.
– Nurses should take sometime to evaluate the physical
setting, time, and space in which contact takes place, in
order to select the most appropriate context.

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• Involvement in the relationship:
– Relationships generally develop over time
– Hospital nurses have less time to develop relationships with
patients
– Community-based nurses may have greater opportunities to
develop relationships
– Nurses’ should be aware of behaviours that increase a
client’s involvement and apply them
– Nurses should be aware of behaviours that decrease
involvement and avoid them

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 Levels of Communication

• Intrapersonal level: This is the message one sends to oneself,

including a self talk, or communication with oneself.
• Interpersonal level: Is the process that occurs between two
people either in face-to-face encounter, over the phone, or
through other communication media.
• Group communication: This occurs when 3 or more people
meet in face-to-face encounters or through another
communication medium. An example is a focus group
interviews.

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 Types of Communication

• Interdisciplinary communication: The health care team

consists of the patient and all medical personnel involved in
providing care. Each member of the medical performs
important, though different, role and responsibility. Members
of the team should communicate with each other regarding
assessment, interventions, and client status.
• Therapeutic communication: Is the use of communication for
the purpose of creating a beneficial outcome for the patient.

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 Principles of Therapeutic Interaction

• Choose an appropriate interview time

• Assure privacy
• Establish guidelines for therapeutic interaction
• Provide for comfort during interaction
• Accept the client as is
• Encourage spontaneity
• Focus on the client, avoid talking for the sake of curiosity
• Encourage the expression of feelings

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 Techniques of Therapeutic Communication
• Affirmation/Facilitation. Acknowledge the patient’s responses
to reassure him that you are paying attention.
• Silence. Sometimes this may facilitate communication.
Periods of silence allow your patient to collect her or his
thoughts before responding. Silence also gives you more time
to think and plan your responses.
• Clarifying. If you are unsure or confused about what your
patient is saying, rephrase what she said and then ask the
patient to clarify.
• Restating. Indicates to the patient that you are listening and
acknowledging his feelings.
• Active Listening. Pay attention, maintain eye contact, and
really listen to what your patient tells you both verbally and
nonverbally. Active listening conveys interest and acceptance.
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• Broad or General Openings. This technique is effective when
you want to hear what is important to your patient. Use open-
ended questions such as," What would you like to talk about?”
• Reflection. Reflection allows you to acknowledge your
• patient’s feelings, encouraging further discussion.
• Humor. Humor (‫لفكاهة‬OO‫لدعابة وا‬OO‫ )ا‬can be very therapeutic when
used in the right context. It can reduce anxiety, help patients
cope more effectively, put things into perspective, and
decrease social distance.
• Informing. Giving information allows your patient to be
involved in his or her healthcare decisions.
• Redirecting. Redirecting your patient helps keep the
communication goal-directed. Keep your patient on track.

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• Focusing. Focusing allows you to hone in on a specific area,
encouraging further discussion. Examples include: “You said
your mother and sister had breast cancer?” or “Do you do BSE,
and have you ever had a mammogram?”
• Sharing Perceptions. With this technique, you give your
interpretation of what has been said in order to clarify things and
prevent misunderstanding.
• Identifying Themes. Identifying recurrent themes may help your
patient make a connection and focus on the major theme. For
example, you might say, “From what you’ve told me, it sounds
like every time you were discharged from the hospital to home
you had a problem.”
• Sequencing Events. If your patient is having trouble sequencing
events, you may need to help her or him place the events in
proper order.
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• Suggesting. Presenting alternative ideas gives your patient
options. Suggesting is also a good teaching tool. For example,
if the patient says, “I’ve tried so hard to lose weight, but I
can’t,” you might say, “Have you tried combining diet and
exercise?”
• Presenting Reality. If your patient seems to be exaggerating or
contradicting the facts, help her or him re-examine what has
already been said and be more realistic.
• Summarizing. Summarizing is useful at the conclusion of a
major section of the interview. It allows the patient to clarify
any misconceptions you may have. For example, you might
say, “Let me see if I have this correct: You came to the
hospital with chest pain, which started an hour ago, after
eating lunch.”

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