COMMUNICATION SKILLS

OCN 0117
 MAIN OBJECTIVE

By the end of the course;

The learner will acquire knowledge on communication,

develop skills and attitudes to enable him/her promote
health and prevent illness in the individual family and
community.
 ENABLING OBJECTIVES

1. Discuss communication by defining and purpose

2. Explain the components/elements of effective

communication.

3. Describe methods of communication

4. Describe therapeutic communication.

5. State factors that enhance therapeutic

communication.

6. Describe barriers to communication

7. Describe problem solving technique

 Communication
i. A process of transferring thoughts and ideas from one
person to another.
ii. A process by which one relates to others or affects their
behavior, state of mind or emotional response through
messages.
iii. A transmission of information, knowledge, skills, ideas,
feelings and opinions in a commonly understood way.
iv. The transfer of meaningful information and the
establishment of commonality with the audience.
 Basic purposes of communication
• To inform-This is enabling someone to know
something.
• To evoke-This is arousing e.g. with the aim of
taking action.
• To entertain-This is cheering up to make
someone happy and excited.
 Communication can either be verbal or non-
verbal.
Cont’

• Verbal-using the spoken language.

• Non verbal-stands for body language that can
take any of the following cues:
– Gestures
– Facial expression
– Body movements
– Gait
– Dress code
– Paralinguistic(volume and pitch of voice)
– Absence of sound e.g. taking a pause.
– Certain sounds e.g. yawning
 Uses of communication in learning

1. To acquire/generate knowledge

2. To disseminate/utilize acquired knowledge.

3. To manage/organize knowledge.
 Types of Communication

• Communication can be formal, informal or

unconscious.
FORMAL COMMUNICATION
Any official method of communicating with people
(employees) in an organization.
– May be passed orally or in written form.
– The message flows from top to bottom.
– Mainly involves giving instructions to be followed
and clarifying the roles of staff in the organization.
– It also emphasizes the use of available resources to
achieve the desired goals.
 Formal cont’

flows in three directions, namely:

1. Downward communication
2. Upward communication
3. Horizontal communication
• Downward Communication

– The communication flow come from top management

to the lowest level.
– Communication channels used include oral messages,
telephone calls, written(circular letters memoranda,
pamphlets or posters).
 CONT’

Advantage:

Information is received Immediately and is not

distorted.

Disadvantage:

It is unidirectional(there is no return path for

communication which delays feedback.)
Downward communication in the MoH
 CONT

Upward Communication
-Communication flows from staff at lower and middle levels to the
top management.
– This provides feedback regarding organizational progress, a
consultative forum to improve the quality of service and a means
for staff to request clarification of goals and/or additional
resources.
Advantage :
-It helps to maintain the discipline of staff at lower levels and
protects the seniority of staff at the middle levels.
Disadvantage :
-The middle level staff management may refuse to forward the
grievances coming from the lower level staff.
Upward communication
 Horizontal Communication
 The communication flow occurs between heads of
departments or Supervisors who are at the same level.
 The supervisors may discuss the common problems
affecting their departments with a view of getting
solutions to recommend to the top management for
approval.
Advantages
 It encourages free communication by all staff in the
departments all the time.
 Ensures that staff do not fear each other, thus improving
interpersonal relationships.
INFORMAL COMMUNICATION(GRAPEVINE)

• Unofficial form of communication between groups of

people in the organization.
• The messages are discussed casually and are not
recognized by the management.
• The grapevine should not be ignored because it gives a
warning of impending issues of concern to the
employees.
• The top management should provide current information
to minimize grapevine rumors.
• Grapevine communication also gives a chance to the
colleagues to express their views.
 UNCONSCIOUS COMMUNICATION

• Situation where a wrong meaning has been transferred

because of the way the communication has been
conveyed unconsciously to the receiver.
• Usually the sender of the message is unaware that
their behaviour is sending the wrong signals.
• It is important for health workers to be aware of
unconscious communication.
 Importance of effective comunication
 No single medical personnel can provide effective quality
care without involving the others.
 Effective communication in a health facility is important
because it highlights the role each professional is playing
towards the care of the patients.
 It is through communication that the managers are able to
harmonizes the care of the patients.
 Forms of communication
• Communication in a health facility may occur in
four forms, namely:
• Intrapersonal Communication
 Intrapersonal communication occurs when you
communicate to yourself without verbalizing.
 It is an imaginary conversation reflecting the
individual’s thoughts and feelings.
 Intrapersonal communication helps one to think
critically about important issues before solving a
problem.
 Intrapersonal communication is important before
planning a health message to share with a group of
people/patients.
 Interpersonal communication
• Interpersonal communication is face-to-face
communication between two or more persons.
• This may occur between nurses and patients or
other medical professionals.
• Interpersonal communication is very effective
when sharing health messages with the
community/patients in order to change their
attitudes and behaviours.
Advantages
 Audience can ask questions on unclear issues for
clarification.
 They can also give their own views on the matter under
discussion.
Mass communication
• Communication that is used to reach many people at
the same time through the media of mass circulation
or coverage, for example, television, radio and
newspapers.
• Usage.

– During major events such as vaccination campaigns

– During emergencies e.g. times of war, disaster or disease

outbreaks
 Organizational communication
• Occurs between the management and the employees.
• Necessary in achieving the desired goals of the
organization.
• May occur vertically or horizontally.
• Also occurs btw organizations with common interest.
Advantages:
– It explains the behaviours or conduct expected of the
employees
– Harmonizes all activities performed by different technical
and nontechnical personnel in the institution.
– Regularizes the activities of the public and private institutions
sharing common interests in the same locality for example
public hospitals and NGO’s.
 COMMUNICATION PROCESS

• Elements:
1. Source/sender

2. Message

3. Channel

4. Receiver

5. Effects

6. Social setting
Communication process
Cont’
 ASSIGNMENT

Describe the methods of communication:

1.Verbal

2.Written

3.Technological devices
 Skills used in communication

• In an academic setting,effective communication is very

important .
• Effective communication therefore rests on possession of
certain skills, viz:
A)Intellectual skills
• Are skills of selecting information,analyzing,
interpreting,comparing,prioritizing……
B)Interpersonal skills.
• These enable individuals to co-exist well with others.
They include the following sub-skills:
Interpersonal skills cont’

Social skills
– Ability to control non-verbal behavior
– Ability to appreciate others /their ideas
– Ability to give feedback well etc
Perceptual skills-
– Ability to notice verbal and non-verbal behavior in
others in order to evaluate their attitudes and
personalities.
Listening skills-
– Paying attention to what is said
– Ability to give feedback to a speaker
– Ability to ask questions to check our
understanding
 Cont’
Presentation skills
– Ability to address various audience effectively
– Controlling verbal and non-verbal behavour while
talking.
– Involves reading and speaking skills.

C)Group skills: Ability to:

Maintain role behaviors
Participate in discussions and give ideas
Evaluate and react to other peoples’ ideas
Give room to others in the group
Accommodate views of others
Change one’s ideas and opinions
 Cont’

D)Functional skills-ability to produce

communication in graphic and written forms
e.g letters,minutes,memos,reports etc using
standard procedures.
BARRIERS TO EFFECTIVE COMMUNICATION

 Barriers are the factors that prevent effective

Communication.
 After being placed in a channel, the message may be
interfered with by some disturbance which increases
the difficulty in perception or prevents some
elements of the message from reaching the receiver.
 FROM THE SOURCE
• Failure to recognize the importance of these socio-cultural
and psychological factors of the audience.
• Physical barriers attributed to the climate, for example, very
cold or very hot weather, windy, noisy etc.
• System overload may occur where an individual sends too
much information at the same time.
• Failure to maintain privacy and confidentially especially
when dealing with patients.
• Use of complex language.
 MESSAGE

• In order for the message to be well-received and

effective, the sender must plan it well with the needs
of the audience in mind i.e. What the sender want the
receiver to know, to feel and if they want to change
the behaviour of the receiver.
• Unless the sender plans their message with these
factors in mind, the message is unlikely to have the
desired effect on the audience.
 Techniques for Creating Effective Messages
 Use of simple language.
 Must be short and to the point.
 Should involve proper communication, pauses and stressing
of key words.
 The message must be problem-centred.
 It must address a health concern or issue affecting the
individual or the community.
 The message should be culturally Relevant ·
 The message must fall within the socioeconomic abilities of
the audience.
 Do not propose solutions that are beyond the reach of your
audience.
 BREAKDOWN AT THE RECEIVER

• If the receiver of the message is inadequately prepared

physically, socially and psychologically about the venue
and time of giving a health message.
• If the receiver does not know the benefits to gain from the
message, they may have little interest to listen to the
message.
• If the receiver of the message does not understand the
language because it is expressed in complicated jargon.
• If the sender stammers and speaks inaudibly.
 CONT’

• If the message is received in a noisy environment·

• If the receiver is emotionally disturbed hence lack of

concentration.
• If the message transmitted is against the religious
beliefs of the community leading conflict of interests
and communication breakdown.
 CONT’

• If the sender of the message does not know the socio-

economic status of the community.

• If the message contains too much information, the

receiver may not be able to cope with the information.

• If the the message takes a long time to reach the receiver,

the audience will change their priorities.

 BARRIERS FROM THE SOCIAL SETTING

• Noise

• Unrelated posters

• Social status/position of audience

• Age and marital status of audience

• Cultural beliefs

• Non-action oriented message

 BARRIERS AFFECTING THE CHANNEL
• Sender speaking in a low voice that the receiver cannot hear
well. (talking to a large crowd in a low voice without an
amplifier).
• Using the mass media like the radio, television without
considering the socio-economic status of the receiver.
• Selecting a verbal communication channel without
considering the age of the receiver.
• NB: use of more than one channel minimizes
communication breakdown.
CONT’

• The sender of the message fails to use the appropriate

language and to prepare the audience on the
importance of the message
• Failure to acquire knowledge will not influence the
audience to change their attitudes and behaviours.
• The sender fails to involve the receiver (audience) in
the planning phase
 BARRIERS AFFECTING THE FEEDBACK

• Occurs when the sender receives negative feedback which is

an indication of communication breakdown.
• EXAMPLE:
Sender: Please send me the report via post office by tomorrow
afternoon.
Receiver: Please, I cant bring it now just give me until
tomorrow morning that I may come over.
 LISTENING

Def:
 Paying attention to and trying to get meaning out of
something we hear.
 Process by which spoken language is converted into
meaning in the mind of the listener.

Unlike hearing which is involve physical reception of

sounds as noise, listening is an intentional activity of
receiving sounds and engaging mental
interpretations.
 Importance
• A lot of information is received thro’ listening
• A fundamental skill which is the foundation of all other
communication skills
• A crucial skill for professionals e.g. medics
• Vital source of information in learning(training)

Percentage of time spend

– Listening-45%
– Speaking-30%
– Reading-16%
– Writing-9%
 Types
• Comprehensive listening-listening to information and
instructions.
– Helps in increasing understanding,experience and
acquisition of knowledge.
– Make listener concentrate on key ideas,themes,supporting
details and facts.
• Evaluative listening-Used when someone is trying to change
the attitudes, beliefs and actions of others.
– Areas of use: Arguments,negotiations,persuation and
political rallies
 Listening cont’

• Appreciative listening-Listening to gain pleasure,to

relax,enjoy,gain inner peace,induce emotional
understanding or spiritual satisfaction.

Examples:music,preaching,story telling.

• Empathic listening-Listening for the benefit of the

speaker.

Examples—Counseling and friendship talks.

 Characteristics of a good listener
• A good listener should:
• Prepare self for listening before the event.
• Position self where speaker is visible
• Be able to give the speaker verbal &non-verbal feedback
• Keep all possible interruptions away e.g. phone calls
• Ask questions and evaluate self
• Have a focus-looking for particular information
• Listen critically
• Not stereotype the speaker
• Distinguish facts and opinions
• Listen to meaning not words and expressions
• Exploit the message fully(introduction, main body and
conclusion)
 Problems encountered in listening
• Based on the speaker,listener,message and
external environment.
• Listener
Language(vocabulary-understanding)
Motivation-needs and purpose
Mental organization
Concentration-divided listening
State –sleepy, sick,tired.
Disposition-intro/extroverts
Lack of listening skills etc
Cont’

Speaker:
• Rate of speaking-slow, fast,…
• Emotional –elated or suppressed
• Lack of organization.
• Speaking above the level of the audience
• Ineffective use of non verbal cues-mannerisms
• Showing off of the speaker
• Attitude-undermining listeners
• Improper delivery of message- lack of speaking
skills.
• Status of the speaker-how listeners view him/her.
 Cont’

Message:
• Lack of coherent structure
• Long message without break
• Too many ideas in the message
• Full of concentrates without roughage
• Lack of significance
• Non-challenging messages
• Lack of new information in the message
• Very complex message.

• How to achieve effective listening!

 SPEAKING
Public speaking-This is addressing the public
Types of speakers:
• Nothing to say speakers-These are not bothered by the content
of the speech.
• Show off speakers-Speakers who put on a show but don’t have
anything worthwhile to say.
• Ineffective speakers : Those with important information but say
it badly.
• Effective speakers: Those with important things to say and say
it well.
 Ingredients needed (REQUIREMENTS)
– Confidence.

– Choosing familiar topic and preparing well.

– Knowing the audience well.

– Clear organization-logical flow of ideas.

– Rehearsal beforehand

– Establishment of eye contact with the audience.

– Preparation of enough materials.

– Positive image towards self (visualize success.)

– Acceptance of nervousness(certain degree)

– Relaxation-use appropriate techniques

 Delivery of message
By memory
– Delivering a speech by memorizing what the speaker had
prepared earlier.
Advantage-Maintenance of eye contact
Disadvantages-forgetting, nervousness and disorganization.

From notes:-having notes to help speaker in reference.

Advantages:
– Notes help speaker not to forget
– There is proper organization
Disadvantages-
– lack of eye contact.
– Reduces creativity.
 CONT’

From manuscript-this is where the speaker reads from a

prepared speech.
Advantages
– Saves time
– Can be verified before delivery
– Prevents speaker from misinterpretation/misquotiong
– Can be delivered by a different person.
– Prevents speaker from mentioning unintentional material.
Disadvantages-
makes speaker lose personal state(originality).
 CONT’

Off-the cuff speaking(Imprompt)

• This is where the speaker is given the opportunity to
address the public without prior information.

Advantages:
– It is spontaneous in nature

– Encourages creativity

Disadvantage-:
– involves speaking without prior knowledge of what is to be
said may lead to disorganization and poor delivery.
– Can be affected by nervousness.
 Tactics

i. Begin with a general statement e.g. appreciation of

the opportunity-this gives time for thinking of what

to say.

ii. Speak on a subject you know well(if choice is

available).

iii. Ensure confidence.

iv. Think of the conclusion.

 During the actual delivery
 Avoid panicking-be confident
 Do not rush in-take time
 Display an organized start
 Acknowledge the opportunity
 Adopt a stance
 Project voice well
 Articulate words/sound well
 Avoid swaying sideways, forwards or backwards
 Don’t be static-make controlled movements to:
– Emphasize points.
– Show transition of parts
– Take control of audience.
 cont

Adopt an alert &expressive face-afford

an occasional smile
Use appropriate humour
Choose proper language
Acknowledge feedback fro audience
Respond to unexpected situation
Give a clear structure from introduction
to conclusion
 READING SKILLS
• This s an interactive process of getting out of
the text as closely as possible the message of
the writer.
• It is not merely recognizing letters and words
in print but processing these to make a
meaning out of it.
• Reading should never be passive bur an active
process.
Factors involved in reading
a) Selection

b) Interpretation

c) Extraction

d) Reacting to

e) Evaluation/analysis

f) Assimilation

g) Synthesizing

h) utilization
 Characteristics of a good reader
o Active-able to predict and critically thinking of the content of the
text.
o Logical-able to see connection of ideas
o Selective-reading only what is important.
o Varies speed-according to text and purpose
o Able to exploit how the text is organized
o Able to pick out the outline used in the text
o Relates what is read with prior knowledge.
o Able to concentrate while reading
o Able to recognize the writer’s intention
o Read s silently
o Have a reading strategy-pre reading, study reading and reviewing.
 REPORT WRITING
Principles of writing a good report(standards)
 Know the reason why you are writing a report.
 Know the subject matter you are writing about.
 Omit your opinions from sections concerned with
facts.
 Keep the report accurate, relevant and concise.
 Organize your points in a logical manner. All the
related ideas should follow each other.
 The main ideas or key points in the report should be
highlighted.
 When writing a report always start with the most
pressing problem which needs immediate action.
 Cont’

 Use a language suitable to the reader.

 Use clear headings for each section of the report. A new

paragraph should be started for unrelated ideas.
 Use your judgment and experience when suggesting actions
or making recommendations to the reader/authority.
 The report should always emphasize ideas or facts which
provide solutions to the problems.
 Negative incident/accident report
• A Negative Incidence Report is a formal statement on any
unusual event occurring in a nursing unit/ward with a risk of
possible legal action.
• A legal action may be taken against the hospital by the patient
or relatives for negligence or malpractice.
Purpose:
• To inform the employer of the unusual incident which has
occurred.
• It will serve as evidence in case a law suit is launched by the
patient.
Incidents Requiring a Negative Incidence/Accident
Report
• A patient committing suicide in the ward.
• A child absconding from the ward.
• A patient falling from the bed and sustaining
injuries.
• A patient sustaining burns in the ward.
• A patient being given wrong medication.
• A nurse fighting with a mentally ill patient.
• Wrong identification of a patient leading to
wrong treatment or surgical intervention.
Principles for Writing a Negative Incident Statement

1. The hospital accident reporting form should be completed

in triplicate. (to the hospital authorities, ward and patient’s
file).
2. The statement should be concise, brief, clear, unambiguous
and non-emotional.
3. It is a factual report (facts without exaggeration.)
4. Write the events that occurred at the time of the accident.
5. Quantify the observable damage. For example, if it is a
burn, indicate the extent in centimeters.
6. The writing should be legible(avoid use of medical jargon
and abbreviations).
 Cont’

7. State only the truth of exactly what you saw with your own
eyes.
8. Write down the names of all the witnesses who saw the
accident happening including staff on duty.
9. Give an accurate date and time when the accident occurred.
10. Describe the immediate action which taken after the accident
occurred:
– The first aid offered
– The observations made
– The time the patient was reviewed
– The immediate investigations ordered and the findings
– Medications prescribed after reviewing the patient
11. The statement should include the name of the patient in full,
diagnosis, inpatient number and the bed number.
12. When you have completed writing the statement, write your
name in full, designation, and signature.
 Appraisal report
• Appraisal reports are written annually for each employee.

• It gives a summary of an employee’s performance and

abilities for that period based on their job description.
• The supervisor writing an appraisal report should be very
objective and accurate.
• The information written on the report should reflect the
actual behaviour of the employees without any bias.
• The report should be written in a balanced manner, giving
the strengths and weaknesses of the appraised.
 Contents of an Appraisal Report
i. Qualifications of the appraisee

ii. Seniority/experience

iii. Ability to perform assignments

iv. Strengths

v. Character

vi. Relationships with co-workers

vii. Areas needing improvements

viii.Recommendation for competency

 Writing an official letter
Components:
• Our Reference / Your Reference
• Date
• Receiver’s Name and Address
• FAO: Short for 'For the Attention Of'.
• Salutation:
• Body of the letter
• Subscription or Complementary Close
• Writer's Name and Signature
• Enclosures: Abbreviated as 'Enc.‘
• PS: This stands for 'Post Scriptum'.
 Principles of Letter Writing

• Courtesy-using a polite language in

consideration of the reader.
• Clarity-using simple language that is straight
forward for easy understanding.
• Conciseness-writing a very short letter that is
easily understood by reader.
 example

FAO….