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COMMUNICATION
AND NURSING PROCESS
NH
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A. MODES OF COMMUNICATION.
• Verbal communication = both spoken (type
words and tone of voice, speed),written (words
and the meaning they convey), timing and
clarity of the message.
• Non-verbal communication = body language,
facial expressions, appearance, posture,
gait (manner of walk) gestures, nods, etc.
•Electronic communication = computer
messages, i.e. e-mail, etc.
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• Message (from sender) and (from receiver)
• contents or meaning, language (words
arrangement and use) and the tone which the
message is meant to convey.
• Receiver
• the recipient/listener of the message decodes
(i.e. - relates to or understands message) and
returns communication.
• Response
• the message or feedback (non-verbal cues, i.e.
winks nods, etc.) that the receiver sends back
to the sender.
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COMMUNICATION
• Communication - its meaning depends
on the setting and the context of its use.
• Necessary component in human
relationships, and, therefore, means or is
used for thought/information exchange
between or among two or more people as
well as intra-personally (self-talk).
B. PROCESS OF COMMUNICATION.
• Effective communication involves either a
personal (face to face) communication or
some means of an encounter that requires the
following four necessary components: a
sender, a message, a receiver and a response.
• Sender = may one, two or a group of people with
a message to send/convey and a system of
sign(s) or symbol(s) (code, i.e. - language, etc.)
to use in transmission/sending (encoding) it.
1. Sender--the originator or source of the
idea.
2. Message--the idea.
3. Channel--the means of transmitting
(either verbally or nonverbally) the idea.
4. Receiver--someone to receive and
interpret the message.
5. Feedback--the response to the message.
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METHODS OF NONVERBAL
COMMUNICATION Eye behaviors
 (avoiding eye contact, staring, wide
eyes).
 Rapport.
 The harmonious feeling experienced by
 Use (and avoidance) of touch or physical
two people who hold one another in
contact.
mutual respect, acceptance, and
understanding.
Posture(slouching, leaning toward/away
from someone)
 Empathy.
 Empathy is that degree of
understanding, which allows one person  Walk.
to experience how, another feels in a
particular situation.

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Body Language. SILENCE

Remember that actions speak louder than
words. A person will generally pay more
 Silence can be an extremely effective
attention to what you do than what you
say. communication tool.

 Silence can be used to communicate the

Facial expressions
deepest kind of love and devotion, when
 (smile, frown, blank look, grimace).
words are not needed.

Gestures/mannerisms

 (fidgeting, toe tapping, clenched fists).

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SILENCE
 Silence can be a cold and rejecting sort of
punishment, the "silent treatment"
received for coming home late or
forgetting birthday.
 Silence can be used in an interview or
conversation to encourage the other
person to "open up." Conversely, it can be
used to intentionally create anxiety and
discomfort in the other person.
LISTENING
As a patient speaks, think about what he
must be feeling.
 Sometimes, as a listener, you must cut
through layers of words to get to the real
message. You must read between the
lines. Pick up the underlying meaning of
the message (intent); don't rely entirely
upon the obvious or superficial meaning
(content).

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C. FACTORS THAT INFLUENCE
COMMUNICATION.
 Level of development - helps in
modifying both the message and
the response.
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 Perception = is a personal view of
any situation, which in effect, influences
the perception and response to events.
 Attitude = of caring, concern,
interest, etc., are portrayed or
betrayed by either good or bad
mood.
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• Personal space (proxemics - study of
the distance between people in
interaction).
• Example of distances in
communication:
- Intimate = 1&1/2 ft - is characterized
by body contact, etc.
- Personal = 1&1/2 - 4ft - characterized
by more space, less overwhelming,
with a moderate tone of voice.
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 Gender - males and females develop
differently and so have some
difference communicate, even in
adulthood.
 Values = the standards (personal,
communal and societal) that influence
behavior
 therefore, personal value traits and
experiences do influence the perception
of communication and behaviors of
others as well as the response to them.
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- Caring - indication of deep emotional
warmth.
- Warmth - an indication of emotional
closeness.
- Respect - an attitude that conveys
individual worth and respect for his/her
wishes, regardless what the wishes are.
- Acceptance - places emphasis on
neither approval nor disapproval.
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- Social distance = 4-12 ft and
characterized by a clear view of the
whole individual with clear and
louder tone of voice.
- Public = 12-15 ft, requires careful
enunciation, a louder tone of voice
and a clearer vocality.
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• Territoriality = is also about space a
domain that one considers as personal i.e.
a client’s room or space around the
bed with a demarcating curtain.
• Roles = student/teacher, father-
mother/son-daughter, roles etc.
• Relationships = this is a similar role as
the teacher/student relationship above.
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D. USE OF COMMUNICATION
COMMUNICATION IS USED TO: GET A
RESPONSE, INFLUENCE OR OBTAIN
INFORMATION.
• Therapeutic Communication.
Therapeutic communication helps
in promoting understanding and
constructive relationship -
understanding of both the content and
feelings
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E. BARRIERS TO COMMUNICATION.
Barriers to communications occur
principally as a result of non-therapeutic
communication. Good examples to this
failure include:
• Wrong or improper decoding of the
message.
• Poor choice of words.
• Wrong tone - raised voice, etc.
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• The environment = a comfortable
surrounding with controlled
temperature, and noise-free, etc.
• Congruence = this refers to
compatibility of verbal and non-verbal
messages - that they both match and
not seen as giving two or more different
messages.
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• Attentive Listening.
•This is an active listening
without giving the impression of
either selective listening or not
listening, that the message is not
all that important to you or that
you are in a hurry and would
rather be somewhere else.
• Physical Attending. This
portrays a physical presence
with full attention span and
interested
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• Failure to listen - not listening by looking
away or doing other things as a sign of disinterest.
• Wrong environment or poor environmental
control - noisy surrounding or environment.
• Wrong timing - while or when client is eating
or doing something or in pain.
• Inconsideration by the nurse or health
professional- client eating or sleeping, with
nurse not willing or ready to wait.
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II. THERAPEUTIC
RELATIONSHIP PHASES OF THERAPEUTIC RELATIONSHIP.

The therapeutic relationship or helping • Pre-interaction phase

relationship is typified by the relationship •- similar to planning the interview stage
between a health professional and a client, but
when information about client is
especially between nurses and their patients. Of
obtained and planning of visit with
great importance are:
some level of anxiety.

•Trust - the development of trust facilitates

acceptance of the nurse by patient.

•Belief - allows client to believe that the nurse

cares about him/her and his/her needs.

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PHASES OF THERAPEUTIC RELATIONSHIP. • Working phase -

• Introductory (or pro-helping) phase -
• during this time that the tone for
relationship is set, and client may display
some level of resistance. This initial
resistance can be alleviated by a
genuine caring attitude by the nurse.
• when both nurse and client view each other
as individuals with separate but important
roles and start to explore feeling and act
towards accomplishing a set goal with empathy
and:
- Respect.
- Genuine concern and rapport.
- Giving of correct information.
- Friendly confrontation as nurse
points out areas of discrepancies.

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B. DEVELOPING THERAPEUTIC
• Termination phase RELATIONSHIP.
•a summary, by reviewing the process and
accomplishment of the interview session. THIS IS COMMONLY ACHIEVED BY:

• Attentive listening - not only

paying attention, engaged with body
language.

• Identifying with the feelings of

client, i.e. “You seem angry about
the unfairness of…”

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B. DEVELOPING THERAPEUTIC
RELATIONSHIP.
• Empathy - by putting yourself
their shoes and showing that you
understand.
• Honesty - by admitting that you do
not know some of the answers to
some of the questions that you are
being asked.
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• Confidentiality
•maintain patient’s rights of privacy as
confidential on all information.
• Remaining within the boundaries of
professional role
• seek help if you need it, and clarify the
functions of your role.
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Types of Health Care Groups.
- Task group
- most common of work-related
groups that nurses belong, with
chairperson
- : i.e. health planning committees,
nurse team meetings, nursing care
conference, etc.
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• Genuineness and credibility
•about being truly concerned.
• Maintain an understanding of
Cultural differences
• as this fosters client- nurse
interaction.
• Ingenuity
• by employing some other
means/avenues in handling the
situation.
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GROUP COMMUNICATION.
 Group Dynamics.
 Communication with any given group is
known as group dynamics as determined
by a variety of factors as each member
affects the dynamics, depending on goal,
feelings and the level of participation
of each member, motivation and
maturity of the group.
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- Teaching group
- main purpose is to impart
information: i.e. continuing
education, client health care
groups, etc.
- Self-help group
- usually small and composed of
volunteers with similar health
problems and similar beliefs in self-
help, etc.
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 Self-awareness
 purpose is to develop interpersonal
strength for improving functioning.
 Therapy group
 for self-satisfaction and stress relief.
 Work-related
 form to provide support and encourage
members in dealing with work related
stress.
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• Diagnosis.
• Follow the same line of approach as above.
• Plan of care.
• Provide clear and effective
communication in the use of language; by
using every available means to have no
anxiety or decreased levels of it; and
consult with appropriate resources.
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COMMUNICATION AMONG HEALTH
PROFESSIONALS.
Communication is an important aspect
within and between the various health
professions and their practitioners, but
especially between the nurse and the
physician as well as between the nurse and
patient.
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COMMUNICATION & NURSING
PROCESS.
The principal and overriding concerns are:
professional conduct, clarity, attentive
listening and a caring attitude in:
• Assessment.
• Be aware of barriers to communication;
cultural influence, level of development and
anxiety; make sure to have a clear
communication; and to seek clarification on
statements that are ambiguous.
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• Implementation.
• Make every effort to facilitate clear
communication; and effectively control
the environment in a therapeutic setting
of the interview.
• Evaluation.
• Share information about the progress
being made by patient with him/her.
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COMMUNICATION BETWEEN NURSES
AND PHYSICIANS.
There are no available guidelines for
verbal communication between
doctors and nurses.
Nurses’ prefer to focusing their
communication more on the “narrative
and descriptive” aspect
Physicians focus mainly on the “need or
problem” of patients by “ruling out
alternatives”.
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ASSERTIVE COMMUNICATION. NONASSERTIVE COMMUNICATION.

An assertive communication’s hallmark There are two types/kinds of non-assertive
is that it seeks to promote patient communication:
safety in reducing miscommunication • Submissive
by seeking clarification for medical orders
from doctors as well as with colleagues
• Aggressive
through the “I” and “you’ statements.

Example: “I’m worried /concerned

about this medication order” ; or,
“…you did this/that in that way”, etc.

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NONASSERTIVE COMMUNICATION. NONASSERTIVE COMMUNICATION.

• Submissive type (believed to be due to
insecurity or low self-esteem)
• people who allow their rights to be
violated by seeking to meet the
demands made by others with no or little
regard to their own needs and feelings.
• Aggressive type (assertive aggression)
• assert and defend legitimate rights,
but using such aggressive behavior
(as sarcasm, jokes rude behavior or
downright insults, etc.) in disregard
for the feelings, rights and or opinion
of others around them.

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TECHNIQUES FOR COMMUNICATING TECHNIQUES FOR COMMUNICATING

WITH PATIENTS WITH PATIENTS
Establishing the Setting.
Provide a comfortable environment (lighting, Face the speaker and maintain eye
temperature, furnishings). contact.

Establish a relaxed, unhurried setting. Provide for privacy.

 Sit down when speaking to the patient. Avoid interruptions and other distracting
Although you probably have dozens of things, influences.
you need to be doing at that moment, try to
relax. Don't stand at the doorway or sit on
the edge of your seat, as if you are preparing
to jump and run as soon as you can get away.

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VERBAL COMMUNICATION SKILLS.
Let the patient do the talking.
Keep questions brief and simple.
 Use language that is understandable to
the patient. Avoid acronyms and
medical/nursing jargon if the patient is
nonmedical.
Ask one question at a time. Give the
patient time to answer.
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VERBAL COMMUNICATION SKILLS
Avoid the use of cliché statements like,
"Don't worry; it'll be all right." or "Your
doctor knows best."
Avoidquestions, which require only a
simple "yes" or "no" response. You want to
encourage the patient to talk to you.
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Deaf Patients.
Look directly at the patient when speaking
with him/her.
Do not cover your mouth when speaking
because the patient may read lips.
 If the patient does not lip-read, charts with
pictures may be used, or simply writing your
questions or comments on a piece of paper
may be helpful.
Charts with hand signs are available at the
local society for deafness.
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VERBAL COMMUNICATION SKILLS
Clarify patient responses to questions, not
just for your own use, but also to let the
patient know that you are listening (be
sure you really are) and that you
understand.
Avoid leading questions.
 You want the patient to tell you what he is
feeling, not what he thinks you want to hear.
So avoid putting words in his mouth. For
example, it might be better to ask, "How are
you feeling?" rather than "I suppose you're
feeling rested after your nap.”
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NURSING INTERVENTION WITH
PATIENTS WITH SPECIAL
COMMUNICATION NEEDS
Blind Patients.
Always speak to the patient when you
enter the room so he will know who is
there.
 Speak directly to the patient; do not turn
your back.
 Speak to the patient in a normal tone of
voice; he is blind, not deaf.
 Speak to the patient before touching
him/her.
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REFERENCES.
 Kozier, B. et al, Fundamentals of Nursing,
Concepts, Process and Practice. 9th Ed., Upper
Saddle River, N.J.: Pearson Education, Inc.,
2012.
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