COMMUNICATION

COMMUNICATION
 is a critical skill for nursing.
 It is the process by which humans meet their
survival needs, build relationships, and
experience emotions.
 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
THE COMMUNICATION PROCESS
 Face-to-face communication involves a sender, a message, a
receiver,and a response, or feedback.
 is a two-way process involving the sending and the
receiving of a message.
 Because the intent of communication is to elicit a response,
the process is ongoing; the receiver of the message then
becomes the sender of a response, and the original sender
then becomes the receiver.
SENDER
 The sender, a person or group who wishes to
communicate a message to another, can be
considered the source-encoder.
 This term suggests that the person or group
sending the message must have an idea or
reason for communicating (source) and must put
the idea or feeling into a form that can be
transmitted.
ENCODING
 involvesthe selection of specific signs
or symbols (codes) to transmit the
message, such as which language and
words to use, how to arrange the
words, and what tone of voice and
gestures to use.
MESSAGE
 The second component of the communication
process is the message itself—what is actually said
or written, the body language that accompanies
the words, and how the message is transmitted.
 The method used to convey the message can
target any of the receiver’s senses.
 It is important for the method to be appropriate
for the message, and it should help make the
intent of the message clearer.
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.
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.
 Whether the message is decoded accurately by the receiver,
according to the sender’s intent, depends largely on their
similarities in knowledge and experience and sociocultural
background.
 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
RESPONSE

 The fourth component of the

communication process, the response,
is the message that the receiver
returns to the sender.
 It is also called feedback.
 Feedback can be either verbal,
nonverbal, or both
MODES OF COMMUNICATION
1. VERBAL COMMUNICATION- uses the spoken or
written word;
2. NONVERBAL COMMUNICATION -uses other forms,
such as gestures or facial expressions, and touch.
3. ELECTRONIC COMMUNICATION - A common form
of electronic communication is e-mail, in which an
individual can send a message, by computer, to
another person or group of people.
 Although both kinds of communication occur
concurrently, the majority of communication is
nonverbal.
 Learning about nonverbal communication is
important for nurses in developing effective
communication patterns and relationships with
clients
 Nurses need to know when it is and when it is not
appropriate to use e-mail for communicating with
clients.
 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
 humor
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.
 For example, speaking slowly and softly to an
excited client may help calm the client
SIMPLICITY
 includes the use of commonly understood words, brevity, and
completeness.
 Many complex technical terms become natural to nurses.
 laypersons often misunderstand these terms.
 Nurses need to learn to select appropriate, understandable, and
simple terms based on the age,knowledge, culture, and education
of the client.
 For example, instead of saying to a client, “I will be catheterizing
you for a urine analysis,” it may be more appropriate and
understandable to say, “I need to get a sample of your urine, so I
will collect it by putting a small tube into your bladder.”
CLARITY AND BREVITY
 CLARITY is saying precisely what is meant, and BREVITY is using the fewest words
necessary.
 The result is a message that is simple and clear.
 An aspect of this is congruence, or consistency, where the nurse’s behavior or nonverbal
communication matches the words spoken.
 When the nurse tells the client, “I am interested in hearing what you have to say,” the
nonverbal behavior would include the nurse facing the client, making eye contact, and
leaning forward.
 The goal is to communicate clearly so that all aspects of a situation or
circumstance are understood.
 To ensure clarity in communication, nurses also need to enunciate (pronounce) carefully.
TIMING AND RELEVANCE
 Nurses need to be aware of both relevance and timing
when communicating with clients.
 No matter how clearly or simply words are stated or
written, the timing needs to be appropriate to ensure
that words are heard.
 Moreover, the messages need to relate to the person
or to the person’s interests 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
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 (e.g.,
“I don’t know the answer to that, but I will find someone who
does”).
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.
 Though humor and laughter can help reduce stress and anxiety,
the feelings of the client need to be considered.
THERAPEUTIC COMMUNICATION

 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.
Technique Description Examples
1. Using silence Accepting pauses or silences that Sitting quietly (or walking with the client)
may extend and waiting
for several seconds or minutes attentively until the client is able to put
without interjecting any verbal thoughts and
response. feelings into words

2. Providing general Using statements or questions that “Can you tell me how it is for you?”
leads (a) encourage the client to verbalize, “Perhaps you would like to talk about. . . .”
(b) choose a topic “Would it help to discuss your feelings?”
of conversation, and (c) facilitate “Where would you like to begin?”
continued “And then what?”
verbalization.

3. Being specific Making statements that are specific “Rate your pain on a scale of zero to ten.”
and tentative rather than (specific
general, and tentative rather than statement)
absolute “Are you in pain?” (general statement)
“You seem unconcerned about your diabetes.”
(tentative
statement)”
Technique Description Examples

Asking broad questions that lead or invite the “I’d like to hear more about
4. Using open- client to explore (elaborate, clarify, describe, that.”
ended compare, or illustrate) thoughts or feelings. “Tell me more. . . .”
questions Open-ended questions specify only the topic to “How have you been feeling
be discussed and invite answers that are longer lately?”
than one or two words. “What brought you to the
hospital?”
“What is your opinion?”
“You said you were frightened
yesterday. How do you
feel now?
Providing appropriate forms of touch to Putting an arm over the client’s
5. Using touch reinforce caring feelings. Because tactile shoulder. Placing your
contacts hand over the client’s hand.
vary considerably among individuals, families,
and cultures, the nurse must be sensitive to the
differences in attitudes and practices of clients
and self.
Technique Description Examples

6. Restating or Actively listening for the client’s basic Client: “I couldn’t manage to eat
paraphrasing message and then repeating those thoughts any dinner last night—
and/or not even the dessert.”
feelings in similar words. This conveys that the Nurse: “You had difficulty eating
nurse has listened and understood the client’s yesterday.”
basic message and also offers clients a clearer Client: “Yes, I was very upset after
idea of what they have said. my family left.”

7. Seeking clarification A method of making the client’s broad overall
meaning of the message more understandable.
It is used when paraphrasing is difficult or
when
the communication is rambling or garbled. To
clarify the message, the nurse can restate the
basic message or confess confusion and ask
the client to repeat or restate the message.
Nurses can also clarify their own message with
statements.
“I’m puzzled.”
“I’m not sure I understand that.”
“Would you please say that again?”
“Would you tell me more?”
“I meant this rather than that.”
“I’m sorry that wasn’t very clear.
Let me try to explain
another way.”
Technique Description Examples

8. Perception checking A method similar to clarifying that verifies the Client: “My husband never gives me
or seeking consensual meaning of specific words rather than the any presents.”
validation overall Nurse: “You mean he has never
meaning of a message. given you a present for
your birthday or Christmas?”
Client: “Well—not never. He does
get me something for
my birthday and Christmas, but he
never thinks of giving
me anything at any other time.”

Suggesting one’s presence, interest, or wish
9. Offering self to understand the client without making any
demands or attaching conditions that the
client must comply with to receive the nurse’s
attention.
“I’ll stay with you until your
daughter arrives.”
“We can sit here quietly for a
while; we don’t need to talk
unless you would like to.”
“I’ll help you to dress to go home,
if you like.”
Technique Description Examples

10. Giving information Providing, in a simple and direct manner, specific
factual information the client may or may
not request. When information is not known,
the nurse states this and indicates who has it or
when the nurse will obtain it.
Your surgery is scheduled for 11 am
tomorrow.”
“You will feel a pulling sensation
when the tube is removed from your
abdomen.”
“I do not know the answer to that,
but I will find out from
Mrs. King, the nurse in charge.”

11. Acknowledging Giving recognition, in a nonjudgmental way, “You trimmed your beard and
of a change in behavior, an effort the client mustache and washed
has made, or a contribution to a communication. your hair.”
Acknowledgment may be with or without “I notice you keep squinting your
understanding, verbal or nonverbal. eyes. Are you having
difficulty seeing?”
“You walked twice as far today with
your walker.”
Technique Description Examples

12. Clarifying time or Helping the client clarify an event, situation, Client: “I vomited this morning.”
sequence or happening in relationship to time. Nurse: “Was that after breakfast?”
Client: “I feel that I have been
asleep for weeks.”
Nurse: “You had your operation
Monday, and today is
Tuesday.”

13. Presenting reality Helping the client to differentiate the real “That telephone ring came from
from the program on
the unreal. television.”
“Your magazine is here in the
drawer. It has not been
stolen.”
Technique Description Examples

14. Focusing Helping the client expand on and develop a Client: “My wife says she will look
topic of importance. It is important for the nurse after me, but I don’t
to wait until the client finishes stating the main think she can, what with the
concerns before attempting to focus. The focus children to take care of,
may be an idea or a feeling; however, the nurse and they’re always after her
often emphasizes a feeling to help the client about something—clothes,
recognize an emotion disguised behind words. homework, what’s for dinner that
night.”
Nurse: “Sounds like you are
worried about how well she
can manage.”

15. Reflecting Directing ideas, feelings, questions, or content Client: “What can I do?”
back to clients to enable them to explore their Nurse: “What do you think would
own ideas and feelings about a situation. be helpful?”
Client: “Do you think I should tell
my husband?”
Nurse: “You seem unsure about
telling your husband.”
Technique Description Examples

16. Summarizing Stating the main “During the past half hour we
and planning points of a discussion have talked about. . . .”
to clarify “Tomorrow afternoon we may
the relevant points explore this further.”
discussed. This “In a few days I’ll review what
technique you have learned about the
is useful at the end actions and effects of your
of an interview or to insulin.”
review “Tomorrow, I will look at your
a health teaching feeling journal.”
session. It often acts
as an
introduction to future
care planning.
Technique Description Examples

BARRIERS
1. Stereotyping
TO COMMUNICATION
Offering generalized and “Two-year-olds are
oversimplified beliefs brats.”
about “Women are
groups of people that are complainers.”
based on experiences too “Men don’t cry.”
limited to be valid. These “Most people don’t have
responses categorize any pain after this type of
clients surgery.”
and negate their
uniqueness as individuals.
Technique Description Examples

2. Agreeing and Similar to judgmental responses, agreeing and
disagreeing disagreeing imply that the client is either right or
wrong and that the nurse is in a position to judge
this.
These responses deter clients from thinking through
their position and may cause a client to become
defensive
Client: “I don’t think Dr. Broad is a
very good doctor.
He doesn’t seem interested in his
clients.”
Nurse: “Dr. Broad is head of the
department of surgery
and is an excellent surgeon.”

3. Being defensive Attempting to protect a person or health care Client: “Those night nurses must
services just sit around and talk
from negative comments. These responses prevent all night. They didn’t answer my
the client from expressing true concerns. The nurse light for over an hour.”
is saying, “You have no right to complain.” Nurse: “I’ll have you know we
Defensive literally run around on
responses protect the nurse from admitting nights. You’re not the only client,
weaknesses in the health care services, including you know.”
personal
weaknesses.
Technique Description Examples

4. Challenging Giving a response that makes clients prove their Client: “I felt nauseated after that
statement or point of view. These responses indicate red pill.”
that the nurse is failing to consider the client’s Nurse: “Surely you don’t think I
feelings, making the client feel it necessary to defend gave you the wrong pill?”
a Client: “I feel as if I am dying.”
position. Nurse: “How can you feel that way
when your pulse
is 60?”
Client: “I believe my husband
doesn’t love me.”
Nurse: “You can’t say that; why, he
visits you every day.”
5. Probing Asking for information chiefly out of curiosity rather Client: “I was speeding along the
than with the intent to assist the client. These street and didn’t see
responses are considered prying and violate the the stop sign.”
client’s Nurse: “Why were you speeding?”
privacy. Asking “why” is often probing and places the Client: “I didn’t ask the doctor
client in a defensive position. when he was here.”
Nurse: “Why didn’t you?”
Technique Description Examples

6. Testing Asking questions that make the client admit to “Who do you think you are?” (forces
something. These responses permit the client people to admit
only limited their status is only that of client)
answers and often meet the nurse’s need rather “Do you think I am not busy?”
than (forces the client to admit
the client’s that the nurse really is busy)

7. Rejecting Refusing to discuss certain topics with the client. “I don’t want to discuss that. Let’s
These responses often make clients feel that the talk about. . . .”
nurse is rejecting not only their communication “Let’s discuss other areas of
but interest to you rather than
also the clients themselves. the two problems you keep
mentioning.”
Technique Description Examples

8. Changing topics Directing the communication into areas of “I can’t talk now. I’m on my way
and subjects self-interest for coffee break.”
rather than considering the client’s Client: “I’m separated from my
concerns is often wife. Do you think I
a self-protective response to a topic that should have sexual relations with
causes another woman?”
anxiety. These responses imply that what Nurse: “I see that you’re 36 and
the nurse that you like gardening.
considers important will be discussed and This sunshine is good for my roses.
that clients I have a beautiful
should not discuss certain topics. rose garden.”
9. Unwarranted Using clichés or comforting statements of “You’ll feel better soon.”
reassurance advice as a “I’m sure everything will turn out
means to reassure the client. These all right.”
responses block “Don’t worry.”
the fears, feelings, and other thoughts of
the client
Technique Description
10. Passing judgment Giving opinions and approving or
disapproving responses,
moralizing, or implying one’s
own values.
These responses imply that the
client must think as
the nurse thinks, fostering client
dependence.
11. Giving common Telling the client what to do.
advice These responses deny
the client’s right to be an equal
partner. Note that
giving expert rather than
common advice is
therapeutic.
Examples
“That’s good (bad).”
“You shouldn’t do that.”
“That’s not good enough.”
“What you did was wrong
(right).”
Client: “Should I move from my
home to a nursing
home?”
Nurse: “If I were you, I’d go to a
nursing home, where
you’ll get your meals cooked for
you
PHASES OF THE HELPING RELATIONSHIP

1. preinteraction phase
2. introductory phase
3. working (maintaining) phase
4. termination phase
PREINTERACTION PHASE

 The preinteraction phase is similar to the planning stage before

an interview.
 In most situations, the nurse has information about the client
before the first face-to-face meeting.
 Such information may include the client’s name, address, age,
medical history, and/or social history.
 Planning for the initial visit may generate some anxious feelings
in the nurse.
 If the nurse recognizes these feelings and identifies specific
information to be discussed, positive outcomes can evolve.
INTRODUCTORY PHASE
 Also referred to as the orientation phase or the prehelping
phase, is important because it sets the tone for the rest of
the relationship.
 During this initial encounter, the client and the nurse closely
observe each other and form judgments about the other’s
behavior.
 The goal of the nurse in this phase is to develop trust and
security within the nurse–client relationship .
 Other important tasks of the introductory phase include
getting to know each other and developing a degree of trust
By the end of the introductory phase, clients should begin to:
 Develop trust in the nurse.
 View the nurse as a competent professional capable of helping.
 View the nurse as honest, open, and concerned about their welfare.
 Believe the nurse will try to understand and respect their cultural
values and beliefs.
 Believe the nurse will respect client confidentiality.
 Feel comfortable talking with the nurse about feelings and other
sensitive issues.
 Understand the purpose of the relationship and the roles.
 Feel that they are active participants in developing a mutually
agreeable plan of care.
WORKING PHASE
 Thenurse and the client begin to view each
other as unique individuals.
 Theybegin to appreciate this uniqueness
and care about each other.
 Caringis sharing deep and genuine concern
about the welfare of another person.
 Once
caring develops, the potential for
empathy increases.
The working phase has two major stages:
1. Exploring and understanding thoughts
2. Feelings, and facilitating and taking action.

 The nurse helps the client to explore

thoughts, feelings, and actions and
helps the client plan a program of action
to meet preestablished goals.
TERMINATION PHASE
 The termination phase of the relationship is often
expected to be difficult and filled with ambivalence.
 If the previous phases have evolved effectively, the
client generally has a positive outlook and feels able to
handle problems independently.
 If caring attitudes have developed, it is natural to
expect some feelings of loss, and each person needs to
develop a way of saying good-bye.
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.
 One method of writing a process recording is to make two
columns on a page.
 The first column lists what the nurse and the client said
along with the associated nonverbal behavior.
 The second column contains an analysis about the nurse’s
responses
 Once a process recording has been completed, it should be
analyzed in terms of the content and meaning of the interaction
based on communication theory.
 Each of the nurse’s statements is interpreted in terms of the
communication skill used, with the rationale for and effectiveness
of its use.
 Any barriers to effective communication can be identified with a
possible alternative response noted.
 The outcome for nurses should be increased awareness and insight
regarding their communication strengths, as well as identification
of areas for future skills development.
PROCESS RECORDING

Nurse/Client Dialogue Analysis

 Process recordings are frequently made by
nurses to evaluate the effectiveness of their
own communication.
 With them, nurses can analyze both the
process and content of the communication