GOOD AFTERNOON!!!

COMMUNICATION
LEARNING OUTCOMES
After completing the discussion, you will be able to:
1. Describe the components of the communication process.
2. Discuss the various aspects that nurses need to consider when using the
different forms of communication.
3. Describe factors influencing the communication process.
4. Compare and contrast therapeutic communication techniques that
facilitates communication and focus on client concerns
5. Recognize barriers to communication
6. Describe the four phases of the helping relationship
7. Discuss characteristics of an effectively functioning group
8. Discuss how nurses use communication skills in each phase of the nursing
process
9. State why effective communication is imperative among health
COMMUNICATION

 Any means of exchanging information or feelings

between two or more people.
 Itis an integral part of human relationship
including nursing
 Innursing it is a dynamic process used to gather
pertinent data, to teach and persuade, to
express caring and comfort
 Intent : Obtain a response
 2 main purposes :
1. To influence others
2. To gain information
 NURSES WHO COMMUNICATE EFFECTIVELY ARE
BETTER ABLE TO PROVIDE HEALTH CARE AND
SERVICES EFFECTIVELY. (NCP)
 Built on a trusting relationship
 Effective communication is essential for the
establishment of Nurse –client relationship
 Can be intrapersonal or interpersonal
THE COMMUNICATION PROCESS
-Its a 2 way process involving the sending
and receiving of a message
 SENDER
 A person or group who wishes to communicate a message to
another (SOURCE-ENCODER)
 SOURCE – The person or group sending the message must
have an idea or reason of communicating and put that idea
into a form that can be transmitted
 ENCODING – involves the selection of specific signs or
symbols(codes) to transmit the message

Which language and words to

use, how to arrange the words,
what tone of voice, gestures to
use
MESSAGE
 What is actually said or
written, the body language
used with words, and how
the message transmitted.
 The method used to
convey the message must
be appropriate for the
message→ to make the
intent of message clearer
RECEIVER
 Listener who must listen, observe and attend
 DECODER – must perceive what the sender intended
 Perception- uses all senses to receive verbal and non
verbal messages (interpret)
 DECODE- to relate the message perceived to the receiver’s
storehouse of knowledge and experience and to sort out the
meaning of the message
 meaning =the intent of the sender =>effective
RESPONSE
 FEEDBACK
 The message that the
receiver returns to the
sender
 Verbal, nonverbal or
both
 Allows sender to
correct or reword a
message
MODES OF COMMUNICATION

1. VERBAL COMMUNICATION
- spoken or written words, largely conscious
- vary according to culture, socioeconomic
background, age and education
 NURSING CONSIDERATIONS WHEN USING
VERBAL COMMUNICATION:
1. PACE AND INTONATION – manner of speech, rate or rhythm and
tone→ modifies the feeling and impact of message
*tone- enthusiasm, sadness, anger
*pace- interest, anxiety, boredom
2. SIMPLICITY- use of commonly understood words, brevity, and
completeness
3. CLARITY AND BREVITY - Precise and use of necessary few
words/ simple and clear
4. TIMING AND RELEVANCE- the message need to relate to the
person’s interest and concerns
-one question at a time
 NURSING CONSIDERATIONS WHEN USING
VERBAL COMMUNICATION:
5. ADAPTABILITY – the nurse need to adjust or alter spoken
messages in accordance to client’s behavioural cues.
6. CREDIBILITY – Worthiness of belief, trustworthiness, and
reliability,
- most important criterion of effective communication
- foster by being consistent, dependable and honest
7. HUMOR – can be a positive and powerful tool in N-C relationship
but use with care.
-timing is impt.
- feelings of client needs to consider
MODES OF COMMUNICATION
2. NONVERBAL COMMUNICATION
- BODY LANGUAGE
- gestures, body movement,, use of touch, and
physical appearance including adornment
-Less conscious than verbal
-either reinforce or contradicts what is said
verbally
-interpret properly for effective communication
- needs validation
NONVERBAL COMMUNICATION
1. PERSONAL APPEARANCE – clothing and adornment can be
source of information about patient
-how a person feels(dresses)
-Conveys financial and social status, culture, religion,
group assoc. and self concept
2. POSTURE AND GAIT- reliable indicator of self- concept,
current mood and health
- erect posture and active, purposeful stride →feeling of
wellbeing
-slouching, slow shuffling gait → pain
 NONVERBAL COMMUNICATION
3. FACIAL EXPRESSIONS –no part of the body is as expressive as the face
(beware)
- eye contact –another essential element of facial communication

4. GESTURES – Hand and body gestures may emphasize and clarify spoken words or
give a sign
-use of sign language
ELECTRONIC COMMUNICATION

 Used of computer as way of communication

 EMAIL – most common electronic communication

Purposes:
a. To schedule and confirm appointments
b. Report normal lab results
c. Conduct client education
d. Follow- up with discharge clients
ADVANTAGES DISADVANTAGES
- Fast, efficient, legible - Threat to privacy,
-easy access of confidentiality and
information potential misuse of
-improves information
communication and - socioeconomics
continuity of care
 FACTORS INFLUENCING THE COMMUNICATION
PROCESS
1. Development – depends of developmental lifespan
2. Gender
3. Values and perceptions-values- standards that influence
behaviour;
-perception - personal view of the event
4. Personal Space – the distance people prefer in interactions with
others.
*PROXEMICS- The study of distance bet. People in their
interactions
4 DISTANCE IN PERSONAL SPACE
1. INTIMATE : 0 to 1 ½ feet
– body contact, heightened sensations of body heat and smell, low vocalization
- vision is intense, restricted to small body part , distorted
- nurses frequently use intimate distance

Examples: cuddling a baby, restraining a toddler for injection, positioning patient

4 DISTANCE IN PERSONAL SPACE
2. PERSONAL DISTANCE : 1 ½ TO 4 FEET
– Voice tones are moderate, body heat and smell are
less notice
-much communication bet. Nurses and client occurs
at this distance
-can facilitates sharing of thoughts and feelings or
create tension
Example : handshake, touching of shoulder, sitting with
the client, giving medication, est. iv infusion, vs
monitoring
4 DISTANCE IN PERSONAL SPACE
3. SOCIAL DISTANCE : 4 TO 12 FEET
– A clear visual perception of the whole person
- body hear and odor are imperceptible, eye
contact increased, loud vocalization enough to be
overheard
- allows more activity and movement back and
forth

Examples: nurses rounds, wave a greeting to someone

4 DISTANCE IN PERSONAL SPACE
4. PUBLIC SPACE : 12 FEET AND BEYOND
– Requires loud, clear vocalizations with careful
enunciation.
- all faces and forms of people are seen not
individuality is lost ( perception: group of
people/community
FACTORS INFLUENCING THE
COMMUNICATION PROCESS

5. TERRITORIALITY – A concept of the space and things

that an individual considers as belonging to the self
6. ROLES AND RESPONSIBILITIES – Choice of words,
sentence structure, and tone of voice varies considerably from
role to role
7. ENVIRONMENT
8. CONGRUENCE – non verbal and verbal match
 FACTORS INFLUENCING THE
COMMUNICATION PROCESS

9. INTERPERSONAL ATTITUDE
CARING – conveys deep and genuine concern for
the person
- giving feelings, thoughts, skills and knowledge
 WARMTH- friendliness and consideration
-smiling , attention to physical comforts
 ACCEPTANCE – neither approval nor disapproval
-willingness to receive client’s honest feelings
 FACTORS INFLUENCING THE
COMMUNICATION PROCESS

RESPECT –emphasizes others worth and individuality

- Listening with open mind
- Avoid ELDERSPEAK – BABY TALK – Inappropriate endearment, plural
pronoun, tag questions
10. BOUNDARIES
 Limits of individuals, objects or relationships
 Professional boundaries
 Social media network --PCA TEST
 Pause and process ( recognize potential for boundary crossing )
 Choices ( evaluate the situation and option)
 Act accountably ( professional conduct)
THERAPEUTIC COMMUNICATION

 Promotes understanding and help establish

a constructive relationship bet nurse and
client
 Client and goal directed
 Nurses not only respond to the content of
clients verbal message but also to the
feelings expressed
ATTENTIVE LISTENING
 is listening actively and with mindfulness, using all the sense, and
paying attention to what the client says, does and feels as opposed to
passively listening with just the ear
 It is probably the most important technique in nursing and basic to all
other techniques
 Absorbing both the content and the feeling the person is conveying,
while putting aside your own judgements and ideas to really hear and
focus on client’s needs/
 It conveys an attitude of caring and interest, thereby encouraging the
client to trust you, open up and talk.
 The nurse should not interrupt the speaker and should take time to
think about the message before responding
 The sender should decide when to close the conversation
ATTENTIVE LISTENING
Blocks to listening (Kneisl and Trigoboff (2013)
1. Rehearsing- being too busy thinking about what you want to say
2. Being concerned with yourself- the focus should be on the client
3. Assuming- thinking that you know what the client “really means” without
validation
4. Judging- framing what you hear or see in terms of your judgement about the
client as being immature, depressed, etc
5. Identifying- focusing on your own similar experiences, feelings or beliefs
6. Getting off track- changing the subject if you become uncomfortable, bored and
tired
7. Filtering – tuning out or only hearing certain things.

 ATTENTIVE LISTENING- A highly developed skills and it can be learned in

practice.
VISIBLY TUNING IN
 Using of non verbal skills as an expression of
empathy to patient
GUIDELINES: S-O-L-E-R
• S: face the person squarely. Adopt a posture that
indicates involvement
• O: Adopt an open posture. The nondefensive
position is one in which neither arms nor legs are
crossed
• L: Lean toward the person
Therapeutic Communication Techniques
 Using Silence
 Acknowledging
 Providing General leads
 Being Specific and  Giving information
tentative  Clarifying time or
 Using open ended sequence
questions
 Using touch  Focusing
 Restating or paraphrasing  Reflecting
 Seeking clarification  Summarizing and
 Perception checking planning
 Offering self
Barriers to Communication

 Stereotyping  Changing topics and

 Agreeing or subject
disagreeing  Unwarranted
 Being defensive reassurance
 Challenging  Passing judgement
 Probing  Giving common
advice
 Testing
 Rejecting
THE HELPING RELATIONSHIP
 Also known as INTERPERSONAL RELATIONSHIP and THERAPEUTIC RELATIONSHIPS
 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
 KEYS TO THE HELPING RELATIONSHIP
A. the development of trust and acceptance
between the nurse and the client
B. an underlying belief that the nurse cares
about and wants to help the client
Characteristics of a Helping Relationship
 Isan intellectual and emotional bond between the
nurse and the client and is focused on the client
 Respects the client as an individual, including:
• Maximizing the client’s abilities to participate in decision
making and treatments
• Considering ethnic and cultural aspects
• Considering family relationship and values
➢ Respects client confidentiality
➢ Focuses on the client’s well-being
➢ Is based on mutual trust, respect, and acceptance
PHASES OF THE HELPING RELATIONSHIP

1. PREINTERACTION PHASE
- Planning stage before the interview
- The nurse has the information
about the client before the first
face-to-face meeting
-
PHASES OF THE HELPING RELATIONSHIP

2. INTRODUCTORY PHASE
- ORIENTATION PHASE / PREHELPING PHASE
- sets the tone for the rest of the relationship
- the N-P closely observe each other and form
judgment about others behaviour
- getting to know each other
Goal of Nurse: develop trust and security within the
N-P rel’nship
 The nurse engage in some social interaction to put client at ease
 The client may display resistive behavoirs
 RESISTIVE BEHAVIOR- those that inhibit involvement, cooperation
or change
e.g. difficulty in acknowledging the need for help
fear of exposing and facing feelings
Can be overcome by conveying a caring attitude, genuine
interest in the client and competence. →fosters trust
Trust – reliance on someone without doubt or question
Involves risks- client become vulnerable
Enables the clientto express thoughts and feelings
openly
At the end of Introductory phase, the client
should begin to:
 Develop trust in the nurse
 View the nurse as a competent professional capable of helping
 Views 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
3. WORKING PHASE
 Begin to appreciate uniqueness and care about
each other
 potential for empathy increases
 2 major stages:
1. Exploring and understanding thoughts and feelings
2. Facilitating and taking action
EXPLORING AND UNDERSTANDING
THOUGHTS AND FEELINGS

The must have these skills:

✓ Empathetic listening and responding.
✓Respect
✓Genuineness
✓Concreteness
✓Confrontation
 Theintensity of interaction increases and feelings
such as anger, shame, or self consciousness may
FACILITATING AND TAKING ACTION

 The client must make decisions and

take action to become more effective
 Client: Responsibility of action
 Nurse: collaborates in decisions,
provide support and may offer option
or information
4. TERMINATION PHASE
 Often expected to be difficult and filled with ambivalence
 The client has a positive outlook and feels able to handle
problems independently
 Caring attitude developed: expect feeling of loss and each
person needs to develop a way of saying good-bye
 METHODS USED TO TERMINATE RELATIONSHIP : SUMMARIZING OR
REVIEWING
 Need to start in advance- allows the client to adjust to
independence
 Some needs referrals or follow ups through phone call or email
DEVELOPING HELPING RELATIONSHIP

1. Listen actively 6. Use your ingenuity

2. Helpto identify what the 7. Be aware of cultural
person is feeling differences
3. Empathize with the client 8. Maintain client
4. Be honest confidentiality
5. Be genuine and credible 9. Know your role and
limitations
TYPES OF HEALTH CARE GROUPS

1. Task Groups
2. Teaching groups
3. Self-Help groups
4. Self-awareness and growth groups
5. Therapy groups
6. Work-related social support groups
COMMUNICATION AND THE NURSING PROCESS

ASSESSMENT
 Impairments to communication
 Language deficits
 Sensory deficits
 Cognitive impairment
 Structural deficit
 Paralysis
 Style of Communication
Verbal communication / non verbal communication
DIAGNOSIS
 Impaired verbal communication
 Anxiety r/t Impaired verbal communication
 Powerlessness r/t Impaired verbal communication
 Situational low self-esteem r/t Impaired verbal
communication
 Social Isolation r/t Impaired verbal
communication
 Impaired social interaction r/t Impaired verbal
communication
PLANNING
 Impaired verbal communication

 Overall
outcome: to reduce or resolve the factors impairing the
communication
 Specific nursing interventions will be planned
 Examples of outcome criteria to evaluate the effectiveness of nursing
interventions:
THE CLIENT :
•Communicates that needs are being met
•Begins to establish a method of communication
•Perceivesthe message accurately as evidenced by appropriate
verbal/nonverbal responses
•Communicates effectively
IMPLEMENTATION

1. Manipulating the environment

-quiet with limited distractions
-sufficient light
-calm and relaxed environment
2. Provide support
3. Employ measures to enhance communication
4. Educate the client and support people
EVALUATION

 Client Communication
To establish whether client outcomes have been met, the
nurse must listen actively, observe non verbal cues, and
use therapeutic communication skills to determine that
communication was effective.
Nurse Communication
Process recording is frequently used to evaluate the
effectiveness of nurse patient communication
It is a verbatim account of a conversation. It
can be taped or written including no nonverbal