o communication is a dynamic process

o used to gather assessment data

o and to express caring and comfort

o communication is any means of exchanging

information or feelings between two or more people.

o It is a basic component
of human relationships, including nursing.
 It has two main purposes:
to influence
others and to gain information

The former encourages a sharing of

information,
thoughts, or feelings between two or
more people
THE COMMUNICATION PROCESS
Nurses who communicate effectively are better able to collect assessment
data, initiate interventions, evaluate outcomes of interventions,

Effective communication is essential for the establishment of

a nurse–client relationship

The communication
process is built on a trusting relationship with a client and support
people.

 Face-to-face communication involves a sender, a message, a receiver,

and a response, or feedback .In its simplest form.

 communication is a two-way process involving the sending and the

receiving of a message
 RECEIVER
The receiver, the third component of the communication process,
is the listener, who must listen, observe, and attend.

 This person 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 relate the message perceived to

the receiver’s storehouse of knowledge and experience and to sort
out the meaning of the message.
If the meaning of the decoded message matches
the intent of the sender, then the communication has been effective.
Ineffective communication occurs when the receiver misinterprets
the sent message.
 Nurses need to know when it is and when it is not appropriate to use
e-mail for communicating with clients.

 Verbal communication is largely conscious because people choose

the words they use.

 As a result, countless possibilities exist for the way ideas are exchanged.
An abundance of words can be used to form messages. In addition, a wide
variety of feelings can be transmitted when people talk.

 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.
 PACE AND INTONATION

 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.

SIMPLICITY

 Simplicity includes the use of commonly understood

words, brevity, and completeness

Many complex technical terms become natural to nurses. However, laypersons

often misunderstand these terms. Words such as vasoconstriction or
cholecystectomy are meaningful to the nurse and easy to use but are ill advised
when communicating with clients.
CLARITY AND BREVITY

 A message that is direct and simple will be effective.

 Clarity is saying precisely what is meant

 brevity is using the fewest words necessary. The result is a message that
is simple and clear.

TIMING AND RELEVANCE

 Nurses need to be aware of both

relevance and timing when communicating with clients.

 The messages need to relate to the person or to the person’s interests and
concerns.

 This involves sensitivity to the client’s needs and concerns.

ADAPTABILITY

 The nurse needs to alter spoken messages in accordance with behavioral

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 astute

assessment and sensitivity on the part of the nurse.

For example, a nurse who usually smiles, appears cheerful, and greets the
client with
an enthusiastic “Hi, Mrs. Brown!” notices that the client is not smiling and
appears distressed.

 It is important for the nurse to then modify

his or her tone of speech and express concern by facial expression
while moving toward the client.
CREDIBILITY

 Credibility means worthiness of belief, trustworthiness, and reliability.

 Credibility may be the most important criterion of effective communication.

 Nurses foster credibility by being consistent, dependable, and honest.

 The nurse needs to be knowledgeable about what is being discussed and

to
have accurate information

 Nurses should convey confidence and

certainty in what they are saying, while being able to acknowledge
their limitations
HUMOR

 The use of humor can be a positive and powerful tool in

the nurse–client relationship, but it must be used with care.

 Humor 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.

 When using humor, it is important to consider the client’s perception

of what is considered humorous.

 Timing is also important to consider.

NONVERBAL COMMUNICATION

 Nonverbal communication, sometimes called body language.

- gestures
- body movements
- use of touch
-physical appearance, including adornment

Nonverbal communication often tells others more about what a person

is feeling than what is actually being said, because nonverbal behavior
is controlled less consciously than verbal behavior.
Nonverbal communication either reinforces or contradicts what is said
verbally
 PERSONAL APPEARANCE Clothing and adornments can be
sources of Information about a person.

 POSTURE AND GAIT The ways people walk and carry

themselves are often reliable indicators of self-concept, current
mood, and health.
1. Erect posture and an active, purposeful stride
suggest a feeling of well-being.
2. Slouched posture and a slow, shuffling
gait suggest depression or physical discomfort.

 FACIAL EXPRESSION
No part of the body is as expressive as the face
1. .Feelings of surprise, fear, anger, disgust,
happiness, and sadness can be conveyed by facial expressions.

2. Nurses need to be aware of their own expressions and what they

are communicating to others.
 GESTURES

 Hand and body gestures may emphasize and clarify the spoken word.
 they may occur without words to indicate a particular feeling or to give a
sign.

Ex. A wave good-bye and the motioning of a visitor toward a chair are
gestures that have relatively universal meanings.
Some gestures, however, are culture specific. The Anglo American gesture
meaning “shoo” or “go away” means “come here” or “come back” in some
Asian cultures.

ELECTRONIC COMMUNICATION
 Computers are playing an increasing role in nursing practice. Many
health care agencies are moving toward electronic medical records
where nurses document their assessments and nursing care.
 E-mail is the most common form of electronic communication
 ADVANTAGES (E-mail)

1. It is a fast, efficient way to communicate and it is legible.

2. It provides a record of the date and time of the message that was
sent or received.

3. Some health facilities provide information to their clients on how

they can reach, via e-mail, specified staff members.
4. This improves communication and continuity of client care.
5. E-mail promises better access, and evidence
has shown that clients and health care providers are willing to
use Internet-based technologies.
 DISADVANTAGES (E-mail)

1. One disadvantage or negative aspect of e-mail is concern by both clients

and primary care providers regarding privacy,
confidentiality, and potential misuse of information.

2. Protection of client privacy remains an issue when transferring information

electronically.

3. Another disadvantage is one of socioeconomics. Not everyone

has a computer, and even if people have access to computers at a public
library, not everyone has the necessary computer skills.
4. E-mail may enhance communication with some clients but not all clients.
5. Other forms of communication will be needed for clients who have
limited abilities with speaking English, reading, writing, or using a
computer
Factors Influencing the
Communication
Process
 Many factors influence the communication process.
Some of these are the ff:

 development,
 gender
 values
 and perceptions
 personal space
 territoriality
 roles and relationships
 environment
 congruence
 interpersonal
 attitudes
 boundaries
DEVELOPMENT
 Language, psychosocial, and intellectual development move through stages across
the life span.

 Knowledge of a client’s developmental stage will allow the nurse to modify the
message accordingly.

 The use of dolls and games coupled with simple language may help explain a
procedure to an 8-year-old.

 With adolescents who have developed more abstract thinking skills, a more detailed
explanation can be given.

 whereas a well-educated, middle-aged business executive may

wish to have a detailed technical information provided.

 Older clients are apt to have had a wider range of experiences with the health care
system, which may influence their response or understanding.

1. With aging also come changes in vision and hearing acuity that can affect nurse–
client interactions.
Gender
o From an early age, females and males communicate differently.

o 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.

 These differences can continue into adulthood so that a man and a woman
may interpret the same communication
differently.
 VALUES AND PERCEPTIONS

 Values are the standards that influence behavior,

 perceptions are the personal view of an event. Because each person has
unique personality traits, values, and life experiences, each will perceive
and interpret messages and experiences differently.

PERSONAL SPACE

 Personal space is the distance people prefer in interactions with

others.

 Proxemics is the study of distance between people in their

interactions.

 Middle-class North Americans use definite distances in various

interpersonal relationships, along with specific voice tones and body
language.

 Communication thus alters in accordance with

Four distances, each with a close and a far phase.
1. Intimate: 0 to 11⁄2 feet
2. Personal: 11⁄2 to 4 feet
3. Social: 4 to 12 feet
4. Public: 12 feet and beyond

Intimate distance communication

 is characterized by body contact, heightened sensations of body heat and
smell, and vocalizations that are low.

 Vision is intense,

 is restricted to a small body part, and may be distorted.

 Nurses frequently use intimate distance.

Examples include cuddling a baby, touching a client who is blind,

positioning clients, observing an incision, and restraining a toddler for an
injection
Personal distance

 Is less overwhelming than intimate distance.

 Voice tones are moderate, and body heat and smell are noticed
less.
 Physical contact such as a handshake or touching a shoulder is
possible.
 More of the person is perceived at a personal distance, so that
nonverbal behaviors such as body stance or full facial expressions
are seen with less distortion.
 Much communication between nurses and clients occurs at this
distance.

Examples occur when nurses are sitting with a client, giving medications, or
establishing an intravenous infusion.
Social distance
 is characterized by a clear visual perception of the whole person.

 Body heat and odor are imperceptible, eye contact

is increased, and vocalizations are loud enough to be overheard by
others.

 Communication is therefore more formal and is limited to

seeing and hearing.

 The person may feel protected and out of reach for touch or
personal sharing of thoughts or feelings.

Examples occur when nurses make rounds or wave a greeting to

someone. For example, the nurse who stands in the doorway and
asks a client “How are you today?” will receive a more
noncommittal reply than the nurse who moves to a personal
distance to make the same inquiry.
Public distance
 requires loud, clear vocalizations with careful
enunciation.

 Although the faces and forms of people are seen at public distance,
individuality is lost.

 Instead, the perception is of the group of people or the community

TERRITORIALITY
 Territoriality is a concept of the space and things that an individual
considers as belonging to the self.

 Territories marked off by people may be visible to others.

For example, clients in a hospital often consider

their territory as bounded by the curtains around the bed unit
or by the walls of a private room.

 Health care workers must recognize this human tendency to claim territory.

 Clients often feel the need to defend their territory when it is invaded by
others;

for example, when a visitor or nurse removes a chair to use at another bed,
the visitor has inadvertently violated the territoriality of the client whose
chair was removed.
ROLES AND RELATIONSHIPS
 The roles and the relationships between sender and receiver affect
the communication process.

 The roles and the relationships between sender and receiver affect
the communication process.
 Roles such as nursing student and instructor, client and primary care
provider, or parent and child affect the content and responses in the
communication process.

 Choice of words, sentence structure, and tone of voice vary considerably

from role to role.

 In addition, the specific relationship between the communicators is

significant.
ENVIRONMENT
 People usually communicate most effectively in a comfortable
environment.

 Temperature extremes, excessive noise, and a poorly ventilated

environment can all interfere with communication.

 Also, lack of privacy may interfere with a client’s communication about

matters the client considers private.

For example, a client who is worried about the ability of his wife to care
for him after discharge from the hospital may not wish to discuss this
concern with a nurse within hearing of other clients in the room.

 Environmental distraction can impair and distort communication.

CONGRUENCE
 In congruent communication, the verbal and nonverbal aspects
of the message match.

 Clients more readily trust the nurse when they perceive the nurse’s
communication as congruent.

 This will also help to prevent miscommunication.

 Both nurse and client can easily determine if there is congruence between
verbal expression and nonverbal expression.

For example, when teaching a client how to care for a colostomy, the nurse
might say, “You won’t have any problem with this.” However, if the nurse
looks worried or disgusted while saying this, the client is less likely to trust
the nurse’s words

 Nurses are taught to assess clients, but clients are often just as adept at
reading a nurse’s expression or body language.
INTERPERSONAL ATTITUDES
 Attitudes convey beliefs, thoughts, and feelings about people and
events.
 Attitudes are communicated convincingly and rapidly to
others.
 Attitudes such as
1. caring,
2. warmth,
3. respect, and
4. acceptance
Facilitate communication, whereas condescension, lack of interest,
and
coldness inhibit communication.
 Caring and warmth convey a feeling of emotional closeness, in
contrast to an impersonal approach. Caring is more enduring and
intense than warmth.

 Respect is an attitude that emphasizes the other person’s worth

and individuality. It conveys that the person’s hopes and feelings
are special and unique even though similar to others in many ways.

Health care providers may unknowingly use speech that they

believe shows caring but the client perceives as demeaning or patronizing.

Elderspeak is a speech style similar to baby talk that gives

the message of dependence and incompetence and is seen as patronizing
by older adults. It does not communicate respect.

 Acceptance emphasizes neither approval nor disapproval. An accepting

attitude allows clients to express personal feelings freely and to be
themselves.
 BOUNDARIES
Boundaries are defined by Boyd as “limits of individuals,
objects, or relationships” . If the client seeks friendship with the nurse or a
relationship outside the work environment, the nurse affirms his or her
professional role and declines the invitation.
 Therapeutic communication promotes understanding and can
help establish a constructive relationship between the nurse and
the client.

 Unlike a social relationship, where there may not be a specific

purpose or direction, the therapeutic helping relationship is client
and goal directed.
ATTENTIVE LISTENING
 Attentive listening is listening actively and with mindfulness,
using all the senses.

 paying attention to what the client says.

 Attentive listening is an active process that requires

energy and concentration.

 Attentive listening means absorbing both the content and the

feeling the person is conveying, while putting aside your own
judgments and ideas to hear and focus on the client’s needs.
Kneisl and Trigoboff (2013) point out the following blocks to
listening that may prevent the nurse from hearing what the client is
saying and hinder therapeutic communication:

• Rehearsing—being too busy thinking about what you want to say

Being concerned with yourself—the focus should be on the client

• Assuming—thinking that you know what the client “really means”

without validation

• Judging—framing what you hear or see in terms of your judgment

about the client as being immature, depressed, etc.

• Identifying—focusing on your own similar experiences, feelings,

or beliefs

• Getting off track—changing the subject if you become uncomfortable,

bored, or tired

• Filtering—tuning out or only hearing certain things

VISIBLY TUNING IN
 At times, your nonverbal behavior may be as important, or more
important, than your words.

 Egan (2014) describes key nonverbal skills that can be used to

visibly tune in to clients, which is an expression of empathy that
tells “clients that you are with them, and it puts you in a position to
listen carefully to their concerns”
 Nurses need to recognize barriers or
nontherapeutic responses to effective
communication.
 Failing to listen,
 improperly decoding the client’s intended
message,
 and placing the nurse’s needs above the
client’s needs are major barriers to
communication.
 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.
 The helping relationship process can be described in terms of four
sequential phases, each characterized by identifiable tasks and
skills.
 The relationship must progress through the stages in succession
because each builds on the one before.
 Nurses can identify the progress of a relationship by
understanding these phases:
1. Preinteraction phase
2. introductory phase
3. working (maintaining) phase
4. Termination phase.
Nurse Communication
 For nurses to evaluate the effectiveness of their
own communication with clients, process
recordings are frequently used.

 A process recording is a verbatim (word-for-

word) account of a conversation.

 It can be taped or written and includes all verbal

and nonverbal interactions of both the client and
nurse
 Communication is an integral part of the nursing process.

 Nurses use communication skills in each phase of the nursing

process.

 Communication is also important when caring for clients who have

communication problems.

 Communication skills are even more important when the client has
sensory, language, or cognitive deficits.

 Impairments to Communication Various barriers may alter a client’s

ability to send, receive, or comprehend messages.

 These include language deficits, sensory deficits,

cognitive impairments, structural deficits, and paralysis.
 Language Deficits
Determine the client’s primary language for communicating and
whether a fluent interpreter is required.

 Sensory Deficits
The ability to hear, see, feel, and smell are important adjuncts to
communication.

 Cognitive Impairments Any disorder that impairs cognitive functioning (e.g.,

cerebrovascular
disease, Alzheimer’s disease, and brain tumors or injuries) may
affect a client’s ability to use and understand language

 Structural Deficits
Structural deficits of the oral and nasal cavities and respiratory system can alter a
person’s ability to speak clearly and spontaneously.

 Paralysis
If verbal impairment is combined with paralysis of the upper extremities that
impairs the client’s ability to write, the nurse should determine whether the
client can point, nod, shrug, blink, or squeeze a
hand.


 In assessing communication style, the nurse considers both verbal
and nonverbal communication.

 In addition to physical barriers, some psychological illnesses (e.g.,

depression or psychosis) influence the ability to communicate.

 The client may demonstrate constant verbalization of the same

words or phrases, a loose association of ideas, or flight of ideas.
Verbal Communication
 When assessing verbal communication, the nurse focuses on three
areas:
1. the content of the message
2. the themes
3. and verbalized emotions.

Nonverbal Communication
 Consider nonverbal communication in relation to the client’s culture.
 Pay particular attention to :
1. facial expression
2. gestures
3. body movements
4. affect
5. tone of voice
6. posture
7. and eye contact.