COMMUNICATION

Ms. Sumaira Asim

Contents
■ Define communication
■ Elements of communication process
■ Ways of communication
■ Modes of communication
■ Characteristics of the effective verbal communication
■ Factors influencing communication
■ Factors facilitating effective communication
■ Factors interfering effective communication
 Therapeutic relationships and its phase
 Communication with other professionals
■ Disruptive behavior
■ Assertive communication
■ Non-assertive communication
■ Documentation and its legal aspects
 Communication
■ Definition:
■ . “communication is any means of exchanging information or feelings between
two or more individuals. It is a basic component of human relation-ships, including
nursing”
Communication is a critical skill for nursing. It is the process by which humans
meet their survival needs, build relationships, and experience emotions.
■ In nursing, “com-munication is a dynamic process used to gather assessment data, to
teach and persuade, and to express caring and comfort. It is an integral part of the
helping relationship”
Elements of communication process
1. Sender (encode)
2. Message
3. Media or channel
4. Receiver (decode)
5. Response ( Feedback)
 Sender

■ The sender, an individual or group wishing to communicate a message to

another, can be considered the source encoder.
■ This term suggests that the individual 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 he selection of specific signs or symbols (codes) to trans-mit
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 the communication process is the message itself—what is said or
written, the body language that accompanies the words, and how the message is transmitted.
■ The method used to convey the message can target any of the receiver’s senses. It is important
for the method to be appropriate for the message, and it should help make the intent of the
message clearer.
■ For example, talking face to face with an individual may be more effective in some instances
than telephoning, emailing, or texting a message. Written communication is often appropriate
for long explanations or for a communication that needs to be preserve
 Receiver
■ The receiver, the third component of the communication process, is the listener,
who must listen, observe, and attend.
■ This individual is the decoder, who must perceive what the sender intended
(interpretation). Perception uses all the senses to receive verbal and nonverbal
messages.
■ To decode means to translate the message sent via the receiver’s knowledge
and experiences to sort out the meaning of the message
 Ways of communication
■ in person
■ by phone
■ voice mail
■ text
■ e-mail
■ Postal mail
■ posting on social media sites, including blogs
 Directions of communication
■ Formal or informal communication may be downward, upward, lateral, or diagonal.
■ Downward communication (manager to staff) is often directive. The staff is told what needs
to be done or given information to facilitate the job to be done.
■ Upward communication occurs from staff to management or from lower management to
middle or upper management. Upward communication often involves reporting pertinent
information to facilitate problem solving and decision making.
■ Lateral communication occurs between individuals or departments at the same hierarchical
level (e.g., nurse managers, department heads).
■ Diagonal communication involves individuals or departments at different hierarchical levels
(e.g., staff nurse to chief of the medi-cal staff). Both lateral and diagonal communication
involve information sharing, discussion, and negotiation.
 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, facial expressions,
and touch. Although both kinds of communication occur concurrently, most
communication is nonverbal. Learning about nonverbal communication is
important for nurses in developing effective communication patterns and
relationships with clients.
Verbal communication
Nurses need to consider the following when choosing words to say or write pace and intonation,
simplicity, clarity and brevity, timing and relevance, adaptability, credibility, and humor.

Characteristics
PACE AND INTONATION
The manner of speech, as in the rate or rhythm and tone, will modify the feeling and impact of a
message. The tone of words can express enthusiasm, sadness, anger, or amusement. The rate of
speech may indicate interest, anxiety, boredom, or fear. For example, speaking slowly and softly to
an excited client may help calm the client.
■ SIMPLICITY
Simplicity includes the use of commonly understood words, brevity, and completeness. The use of
complex technical terms becomes natural to nurses. However, clients often misunderstand these
terms. Words such as vasoconstriction or cholecystectomy are meaningful to the nurse and easy to
use but not advised when communicating with clients. Nurses need to select appropriate, under-
standable, and simple terms based on the client’s age, knowledge, culture, and education.
■ CLARITY AND BREVITY
A message that is direct and simple will be effective. Clarity is saying precisely what is meant, and
brevity is using the fewest words necessary. The result is a message that is simple and clear. An
aspect of this is congruence, or consistency, where the nurse’s behavior or nonverbal
communication matches the words spoken.
■ TIMING AND RELEVANCE
Nurses need 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. Furthermore, the messages need to relate to the client or to the client’s interests
and concerns.
■ ADAPTABILITY
The nurse needs to alter spoken messages in accordance with behavioural cues from the client. This
adjustment is referred to as adaptability. What the nurse says and how it is said must be
individualized and carefully considered. This requires smart assessment and sensitivity on the part
of the nurse.
■ CREDIBILITY
Credibility means worthiness of belief, trustworthiness, and reliability. Credibility may be
the most important criterion for effective communication. Nurses foster credibility by
being consistent, dependable, and honest.
■ HUMOR
The use of humour can be a positive and powerful tool in the nurse–client relationship, but
it must be used with care. Humour can be used to help clients adjust to difficult and
painful situations. The physical act of laughter can be an emotional and physical release,
reducing tension by providing a different perspective and promoting a sense of well-being.
Non-verbal communication
Nonverbal communication, sometimes called body language, includes;
1. Gestures
2. Facial expression
3. Body gait and posture
4. Use of touch
5. Physical appearance
6. In adornment.
Factors facilitating/interfering communication
Many factors influence the communication process. Some of these are;
1. Ddevelopment
2. Gender
3. Values and perceptions
4. Personal space(Proxemics is the study of distances that people allow between themselves and objects or other
people)Intimate: 0 to 1.5 ft,Personal: 1.5 to 4 ft, Social: 4 to 12 ft, Public: 12 feet and beyond.
5. Territoriality
6. Roles and relationships
7. Environment
8. Congruence
9. Interpersonal attitudes( caring and warmth)
10. Boundaries.
 Techniques facilitates communication

1. Using silence
2. Providing general lead
3. Being specific and tentative
4. Use open ended questions
5. Using touching
6. Rephrasing and paraphrasing
7. Seeking clarification
 Conti......
8. Perception checking or seeking consensual validation
9. Offering self
10. Giving information
11. Acknowledging
12. Clarifying time and clearance
13. Presenting reality
14. Focusing
15. Reflecting
16. Summarizing and planning
 Techniques interfering with communication
1. Stereotyping
2. Agreeing and dis-agreeing
3. Being defensive
4. Challenging
5. Probing
6. Testing
7. Rejecting
 Conti.......
8. Changing topic and subject
9. Unwarranted reassurance
10. Passing judgement
11. Giving common Advice
 Therapeutic Relationship
■ It’s a trusting relationship which promotes growth and healing in a patient's life and is a source of energy,
gratification, and growth in nurse as well.
■ Nurse–client relationships are referred to by some as interpersonal relationships, by others as therapeutic
relationships, and by still others as helping relationships. Helping is a growth-facilitating process that
strives to achieve three basic goals :

1. Help clients manage their problems in living more effectively and develop unused or underused
opportunities more fully.
2. Help clients become better at helping themselves in their everyday lives.
3. Help clients develop an action-oriented prevention mentality in their lives
Phases of a Helping Relationship
 Pre-Interaction Phases:
➢ Information before the first face to face
meeting.
➢ Pt.'s name, address, age, medical diagnose
etc.
 Introductory Phase
(Orientation phase)

➢ Begins when nurse/patient first meet.

➢ Both closely observe each other.
➢ Name, explain role.
➢ Purpose, how long.
➢ What is expected.
➢ Indication of termination phase.
➢ Develop trust.
 Handle Resistive behavior
■ Working Phase
➢ Acting to complete task
➢ Responding and exploring.
Exploring and understanding thoughts and
feelings
➢ Empathetic listening and responding
➢ Respect
➢ Genuineness
➢ Concreteness
➢ Confrontation
■ Termination Phase
➢ Starts from orientation phase
➢ Pt. can function effectively without nurse
➢ Plan and satisfaction action
➢ Evaluation of goal achievement
 Communication Among Health Team
➢ Health team members communicate through:
➢ Discussion
➢ Report
➢ Record keeping
➢ A record is always written. It is a formal, legal documentation of a patient’s
progress and treatment.
SBAR techniques( Situation, Background, Assess, Recommendations)
 Disruptive Behaviors

■ Incivility, bullying, and workplace violence have touched too many members of
the nursing profession for nearly a century.
■ Incivility:
consists of behaviors that are disrespectful, rude, impolite, and promote
conflict while increasing stress. Examples include, but are not limited to, rolling of
the eyes, gossiping, spreading rumors, name calling, using a condescending tone,
sarcastic comments, interrupting others when they are speaking, and using public
criticism.
■ Bullying
“repeated, health-harming mistreatment of one or more persons by one or more perpetrators”.
Central to all bullying behavior in nursing is the consistent demonstration of inappropriate
behavior. An occasional angry outburst or rude comment constitutes poor judgment but is
generally not bullying behavior.
■ The Joint Commission (2016) states that bullying is “abusive conduct that takes one or more of
the following forms: verbal abuse; threatening, intimidating or humiliating behaviors (including
nonverbal); work interference— sabotage—which prevents work from getting done”.
■ Examples of bullying actions include those that harm, undermine, and degrade. These include
behaviors such as persistent hostility, intimidation, isolation, exclusion, regular verbal attacks,
refusal to assist with duties, and taunting the nurse in front of others.
■ These actions can cause physical and psychologic effects on victims, such as headaches,
anxiety, insomnia, gastrointestinal disorders, poor concentration, depression, helplessness, and
loss of confidence and self-esteem.
■ Workplace Violence
The Occupational Safety and Health Administration (OSHA) defines workplace
violence as “any act or threat of physical violence, harassment, intimidation, or other
threatening disruptive behavior that occurs at the work site. It ranges from threats and
verbal abuse to physical assaults and even homicide”
■ There are four types of violence that nurses may come upon in the work setting, with
types 2 and 3 being the most common in healthcare:
1. Criminal intent
2. Customer or client
3. Worker-on-worker
4. Personal relationship
 Assertive Communication
■ Assertive communication promotes client safety by minimizing miscommunication
with colleagues. People who use assertive communication are honest, direct, and
appropriate while being open to ideas and respecting the rights of others.
■ An important characteristic of assertive communication includes the use of “I”
statements versus “you” statements. The “you” statement places blame and puts the
listener in a defensive position, whereas the “I” statement encourages discussion.
■ For example, a nurse who states “I am concerned about . . . ” will be gaining the
attention of the primary care provider while also giving a message about the
importance of working together for the benefit of the client.
■ It is then important for the nurse to be clear, concise, organized, and fully informed
when verbally presenting the client concern.
 Nonassertive Communication
Two types of interpersonal behaviors are considered nonassertive: passive and aggressive.

1. PASSIVE
When people use a passive or submissive communication style, they say nothing even when they have been
wronged. This is also known as self-silencing. Individuals who use passive communication tend to internalize
their frustrations, which may build into rage that explodes later.

2. AGGRESSIVE
There is a fine line between assertive and aggressive communication. Assertive communication is an open
expression of ideas and opinions while respecting the rights, opinions, and ideas of others.
Aggressive communication is self-serving in that it is directed toward what one wants without considering the
feelings of other.
This type of communication is ineffective and leads to frustration for the nurse and the primary care provider.
 Legal Documenting

■ “The method of writing and recording the client’s data and health history
including Assessment, Diagnose, Planning, Implementation, Evaluation is
called Documentation”.

■ Client’s data is a legal document so it is necessary to write it carefully because

it can be use as a legal evidence.
 Legal aspects
 Accuracy ( Date, time and scenario)
 Timely events
 Record facts
 Do not leave blank space
 Chart by your self
 Overwriting
 Plagiarism & Fabrication
 Continue…….
 Legibility
 Accepted terminology
 Correct spelling
 Always sign
 Completeness
 Conciseness