Communication

Definition

• It is the process of exchanging information or feelings between two or more people. It is a basic component of human relationship, including nursing.

The Communication process

Referent

• Or stimulus motivates a person to communicate with another. It may be an object, emotion, idea or act.

Sender

• Also called the encoder, is the person who initiates the interpersonal communication or message

Message

• The information that is sent or expressed by the sender.

Channels

• It means, conveying messages such as through visual, auditory and tactile senses.

Receiver

• Also called the decoder, is the person to whom the message is sent

Feedback

• Helps to reveal whether the meaning of the message is received

Modes of Communication

Verbal communication– uses the spoken or written word

1. Pace and Intonation

• The manner of speech, as in the pace or rhythm and intonation, will modify the feeling and impact of the message. For example, speaking slowly and softly to an excited client may help calm the client.

2. Simplicity

• Includes the use of commonly understood words, brevity, and completeness.
• Nurses need to learn to select appropriate, understandable terms based on the age, knowledge, culture and education of the client. For example, instead of saying to a client, “the nurses will be catheterizing you tomorrow for a urinalysis”, I would be more appropriate to say, “Tomorrow we need to get a sample of your urine, so we will collect it by putting a small tube into your bladder”.

3. Clarity and Brevity

• A message that is direct and simple will be more effective. Clarity is saying precisely what is meant, and brevity is using the fewest words necessary.
• The goal is to communicate clearly so that all aspects of a situation or circumstances are understood. To ensure clarity in communication, nurses also need to speak slowly and enunciate carefully.

4. Timing and Relevance

• No matter how clearly or simply words are stated or written, the timing needs to be appropriate to ensure that words are heard.
• This involves sensitivity to the client’s needs and concerns. E.g., a client who is enmeshed in fear of cancer may not hear the nurse’s explanations about the expected procedures before and after gallbladder surgery.

5. Adaptability

• What the nurse says and how it is said must be individualized and carefully considered. E.g., a nurse who usually smiles, appears cheerful, and greets his clients with an enthusiastic “Hi, Mrs. Jones!” notices that the client is not smiling and appears distressed. It is important for the nurse to then modify his tone of speech and express concern in his facial expression while moving toward the client.

6. Credibility

• Means worthiness of belief, trustworthiness, and reliability. Nurses foster credibility by being consistent, dependable, and honest.
• Nurses should convey confidence and certainly in what they are saying, while being to acknowledge their limitations (e.g., “I don’t know the answer to that, but I will find someone who does”.

7. Humor

• The use of humor can be a positive and powerful tool in nurse- client relationship, but it must be used with care. When using humor, it is important to consider the client’s perception of what is considered humorous.

Non-verbal Communication– uses other forms, such as gestures or facial expressions, and touch.

1. Personal Appearance

• When the symbolic meaning of an object is unfamiliar the nurse can inquire about its significance, which may foster rapport with the client.
• How a person dresses is often an indicator of how person feels. E.g. For acutely ill clients n hospital or home care settings, a change in grooming habits may signal that the client is feeling better. A man may request a shave, or a woman may request a shampoo and some makeup.

2. Posture and Gait

• The ways people walk and carry themselves are often reliable indicators of self-concept, current mood, and health. Erect posture and an active, purposeful stride suggest a feeling of well being. Slouched posture and slow, shuffling gait suggest depression or physical discomfort.
• The nurse clarifies the meaning of the observed behavior, e.g. “You look like it really hurts you to move. I’m wondering how your pain is and if you might need something to make you more comfortable?”

3. Facial Expression

• No part of the body is as expressive as the face
• Although he face may express the person’s genuine emotions, it is also possible to control these muscles so the emotion expresses does not reflect what the person is feeling. When the message is not clear, it is important to get feedback to be sure of the intent of expression.
• Nurses need to be aware of their own expressions and what they are communicating to others. It is impossible to control all facial expression, but the nurse must learn to control expressions of feelings such as fear or disgust in some circumstances.
• Eye contact is another essential element of facial communication

4. Gesture

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

Electronic Communication– many health care agencies are moving toward electronic medical records where nurses document their assessments and nursing care.

E-mail

• Most common form of electronic communication.
• Advantage: It is fast, efficient way to communicate and it is legible. It provides a record of the date and time of the message that was sent or received.
• Disadvantage: risk of confidentiality
• When Not to Use Email:

a. When information is urgent
b. Highly confidential information (e.g. HIV status, mental health, chemical dependency)
c. Abnormal lab data

• Agencies usually develop standards and guidelines in use of e-mail

Factors Influencing the Communication Process

1. Development

• Language, psychosocial, and intellectual development move through stages across the lifespan.

2. Gender

• 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.

3. Values and Perception

• Values are the standards that influence behavior, and perceptions are the personal view of event.

4. Personal Space

• Personal space is the distance people prefer in interactions with others.
• Proxemics is the study of distance between people in their interactions
• Communication 4 distances:

a. Intimate: Touching to 1 ½
b. Personal: 1 ½ to 4 feet
c. Social: 4 to 12 feet
d. Public: 12 to 15 feet

5. Territoriality

• Is a concept of the space and things that an individual considers as belonging to the self

6. Roles and Relationships

• Choice of words, sentence structure, and tone of voice vary considerably from role to role. (E.g. nursing student to instructor, client and primary care provider, or parent and child).

7. Environment

• People usually communicate most effectively in a comfortable environment.

8. Congruence

• The verbal and nonverbal aspects of message match. E.g., 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.

9. Interpersonal Attitudes

• Attitudes convey beliefs, thoughts, and feelings about people and events.
• Caring and warmth convey a feeling of emotional closeness
• Respect is an attitude that emphasizes the other person’s worth and individuality. A nurse coveys respect by listening open mindedly even if the nurse disagrees.Acceptance emphasizes neither approval nor disapproval .The nurse willingly receives the client’s honest feelings.

 

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Reference:
Erbs & Kozier, Fundamentals of Nursing, 7th edition

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