COMMUNICATING

NUR 101
chapter 26
November /2022

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 Learning Outcomes
• Describe the components of the communication process
• State why effective communication is imperative among
health professionals
• Describe factors influencing the communication process
• Recognize barriers to communication
• Describe the four phases of the helping relationship.
• Identify the characteristics of therapeutic communication

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 Communication
• In nursing, communication 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.
• Means “interchange of information or feelings
between two or more people”.
• Helps establish and maintain effective nurse – client
relationships
• Can occur on an intrapersonal ( individual single
level: yourself, self talk) level or interpersonal level
(others and groups)
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 The Goals of Communications:

To change behavior

To get and give

To get action
Information

To persuade To ensure understanding

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 The Communication Process
• Sender
• Message
• Receiver
• Response/Feedback

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Communication is the process of sending
and receiving information among people…
Feedback

receiver sender

SENDER RECEIVER

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 Communication Process
• Sender: the source –encoder: who communicate
a message with others

• Receiver: the listener who observe, listen and

attend (the decoder)

• Encoding: the selection of specific signs or

symbols to transmit the message (language,
words, voice tone, and gesture).
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 Message
• the second component of the communication
process

• What actually said or written

• Content of communication
Verbal
Nonverbal
Symbolic
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 RECEIVER
• The receiver, the third component of the communication
process

• the listener, who must listen, observe, and attend.

• This person is the decoder, who must perceive what the

sender intended (interpretation).

• 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.
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 Response/ feedback
• The fourth component of the communication process

• The message that the receiver returns to the sender.

• Can be verbal or non verbal or both

• The original sender becomes the receiver.

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 What are the most common ways
we communicate?

ag es
a l I m
Word Visu
en
Spok

Bod
y L an
Written Word gua
ge

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 Modes of Communication

• Verbal communication
• Nonverbal communication
• Electronic communication

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 Verbal Communication
• Spoken or written word
• May vary related to culture, age , educational background
• Nurse should consider the following when choosing words to say or write:
- Pacing and intonation: manner of speech , rate and rhythm of (can indicate
anxiety, interest, fear) & Intonation: (can express enthusiasm, sadness , and anger)
- Simplicity (the use of commonly understood words).nurse should use
simple terms based on the age , knowledge , culture and education of client
- Clarity and brevity: direct and simple message
Clarity: what is meant, brevity: using few. words (saying precisely what you
want
and using fewest words)
- Timing and relevance nurse should be aware of both. (being sensitive to
clients needs, and appropriate time)
- Adaptability ( nurse need to alter spoken messages in accordance with
behavioral cues from the client)
- Credibility (trustworthiness & reliability): as nurse being dependable,
honest, have accurate information
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Humor: can be positive and powerful, can reduce tension, and reduce 14
stress
 Nonverbal communication: “Body
Language”
• Communication without using words
• Personal appearance (clothing can be sources of
information about person), convey social,, financial,
culture, religion background….
• Posture and gait (the ways people walk and carry
themselves)., can tell about person self concept, current
mood, and health.
• Facial expression (can convey fear, anxiety, anger,
surprise, happiness)
• Gestures: hand and body gestures may emphasize and
clarify spoken words, when you are nervous , make some
movement on the hands, tapping a foot. Sign language
• Eye contact
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 Electronic Communication
• Using computers. Electronic medical records

• E-mail: Is the most common forms of

electronic communication.

• Can be used for scheduling and confirm

appointments, report normal lab results,
conduct client education, and follow up
with discharged client
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 Electronic Communication
• E-mails:
• Advantages: fast, efficient, provides a record of the
date and time of the message, and promises better
access.
• Disadvantages: risk to client confidentiality and
socioeconomics.
• When not to use E-mail:
• 1. When the information about the client is urgent
• 2. Highly confidential information
• 3. Abnormal lab data
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All messages do not reach the receiver due to
“distortion”
Feedback

Sender Receiver

Distortion
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Factors Influencing Communication
Process
• Development • Roles & Relationships,
student, nurse,..
• Gender
• Environment: comfort one,
• Values & Perception temp, quiet, ventilated
• Personal Space • Congruence: verbal and
nonverbal
(intimate 1.5 f,
personal 1-4f, • Boundaries: limits of
social4-12f, and individual
public space12-15) • Nurse should keep boundaries
and avoid sharing personal
• Territoriality: what information or meetings
consider belonging. • Interpersonal attitudes
Permission is needed (beliefs, thoughts, & feelings
about people & events; caring
& warmth, respect,
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19
convey closeness emotions
 Therapeutic Communication
• Promote understanding and can help establish a
constructive relationship between the nurse and
client.

• It is a helping relationship and client goal directed

• Dynamic
• Purposeful and time limited
• Person providing assistance is professionally
accountable for the outcomes
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 Therapeutic Communication
(Helping Relationship)

• Does not occur spontaneously

• Characterized by an unequal sharing of
information
• Built on the patient’s needs

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 Professional vs. Social
Relationships
Professional Social
Time limited Not time limited
Goal directed Usually not goal directed
Client centered Centered on both parties
Obligation to No obligation to problem
problem solve solve
Non-judgmental May or may not have
acceptance been judgmental
Aim is improved Aim is pleasure
health Spontaneous
Planned and
purposeful
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Criteria for Therapeutic Communication
1. Attentive listening
• Active listening with all senses
• Most important technique in nursing.
• Requires energy and concentration.
• Paying attention to total messages, both verbal
and nonverbal.
• Conveys an attitude of caring and interest.
• Not selective and focus on patient’s needs
• The nurse should not be reactive but take time to
think about the message.
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How can we improve our listening skills?
Eliminate distractions
Concentrate
Focus on the speaker
Maintain an open mind
Look for nonverbal cues
Do not react to emotive words
Ask questions
Sit so you can see & hear
Avoid prejudices
Take notes
Ask for clarification
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Criteria for Therapeutic Communication

2. Physical Attendance
• Facing the patient
• Adopting an open posture
• Leaning toward the patient
• Maintaining good eye contact
• Being relatively relaxed
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 Communication Techniques
• Barriers – nontherapeutic techniques that can hinder or
damage professional relationships.
• Major barriers to communication are:
• Failure to listen
• Improperly decoding the clients messages
• Placing the nurses` needs interest above the client's
interest

( See table 26-3 p.474)

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 Barriers to Communication
• Failure to perceive the patient as a human
being
• Stereotyping
• Being defensive
• Challenging
• Using questions that probe
• Using questions containing the words “why”
and “how”
• Testing
• Rejecting
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 Barriers to Communication

• Changing the subject

• Giving common advise
• Giving personal opinions/advise
• Offering false reassurances
• Passing judgment
• Sympathy
• Asking personal questions
• Using closed questions
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What one can do to foster communication (both
verbal and non-verbal)…

Repeat the last

Nod Your Head word or two of the
prior speaker

Maintain eye Keep an open

contact body position

Make encouraging Repeat a sentence

statements or part of one

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 Helping Relationship
• Two main goals:
1. Help clients manage their problems

2. Helping clients become better at helping

themselves in their every day lives.
• Personal and professional characteristics of the
nurse and the client influence the relationship
• Age, education, culture, religion, gender,
appearance, diagnosis , and values affect
development of client nurse relationship
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 Phases of
Nurse-Client Relationship (Helping Relationship)

• Pre-interaction Phase

• Introductory/ Orientation Phase

• Working Phase

• Termination Phase
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 Pre-interaction Phase
• Similar to planning stage before an
interview
• Data nurse collects before meeting the
client:
Review medical/nursing history
Interaction with other health care
workers
Plans for interaction
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 Introductory/ Orientation Phase
• Goal: to establish trust security within nurse client relationship.
• Initial meeting between the nurse and the client involves:
 Opening the relationship
 Observation of each other
 Clarifying the problem
 Structuring and formulating contract
By the end of this role the client should begin to:
 Develop trust,
 view the nurse as competent, honest, and respectful,
 feel comfortable with nurse
 Client should active participants in setting care plan (see table 26 – 4)
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 Working Phase
• Nurse encourages self-exploration, provides information, helps
set goals, takes action, uses therapeutic communication
• Has two major stages:
1. Exploring and understanding thoughts and feelings
The nurse requires the following skills for this phase:
Empathetic listening & responding; listen
attentively and communicate in the right way
Respect, genuineness(real honest with another),
concreteness ( also be specific), and confrontation
2. Facilitating and taking actions. Support client and help
him/her to make decisions and be more effective
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 Termination Phase
• Ending the relationship
Evaluate goals
Summarizing
Referral/ Smooth transition to another caregiver
Allow client to adjust independence
Make suggestions for future efforts if necessary
Encourage patient to express his or her emotions
about the termination

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 Summarizing…try it out!
Summarizing pulls
important ideas, facts or
data together to establish a
basis for further discussion
and/or review progress.

The person summarizing

must listen carefully in
Try out these summarizing phrases: order to organize the
“If I understand you correctly, information systematically.
your main concerns are…”

“These seem to be the key

ideas you have expressed…” It is useful for emphasizing
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Developing helping relationship
• Listen actively
• Identify what person is feeling
• Put your self on other shoes
• Be honest
• Be genuine , & credible : client know you are
truly concerned
• Be aware of cultural differences
• Maintain confidentiality, privacy
• Know your role and limitation, you are
unable to handle some problems.
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Professional relationship 37
 Group communication
• Group is two or more people who have shared needs and goals.
• Group Dynamics: communications that takes place between members of
any group.
• Types of health care groups:
• Task groups: work related group: e. g. planning services committee,
nurse team meeting
• Teaching groups: convey transmit information for group: e.g.
contentious education group.
• Therapy groups : Therapy groups work toward self-understanding,
more satisfactory ways of relating to or handling stress, and changing
patterns of behavior toward health.
• Work-related social support groups.
• Group members who know about the work of others can encourage
and challenge members to be more creative and enthusiastic about their
work and to achieve more. For ex- ample, a nurse may help another
team member consider alternative strategies for intervention.
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 Communication among health
professional
• Disruptive behaviors reported among nurses are

• Incivility: “rude or disruptive behavior that may result in

psychological or physiological distress for the people involved.
Uncivil behavior exists along a continuum ranging from distracting,
annoying, irritating behaviors to bullying and potentially violent
behavior
• Lateral violence: physical, verbal, or emotional abuse or aggression
directed at RN coworkers at the same organizational level. It usually
includes verbal or nonverbal
• Bullying is defined as “repeated, unreasonable actions of individuals
(or a group) directed towards an employee (or a group of employees),
which are intended to intimidate, degrade, humiliate, or undermine; or
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which create a risk to the health or safety of the employee(s)”
 Summary
• Comminication indcates. Two forms verbal( written and said)
noverbal 9Body language
• Effective commuication dictats attentive listening and
physical attendence
• It. is important for nurse to establish helping relationship with
client
• Helping relationship dictates feelings of empathy, trust
relationship, being honest with client, and listen actively
• Nurse should overcome barriers to communication to
promote therapeutic relationship and improve client
particpantion in caring plan and improve his health
accordingly
• Nurses should consider the : age, gender, culture, education,
health status, when communicating and educating client at
different health settings
Dr. Ahlam Al- Natour …11/2020. 40