COMMUNICATION

(VERBAL AND NON VERBAL)

Verbal Communication
-occurring through words, spoken or written.
 
Non-Verbal Communication
 - Does not involve spoken or written word, includes cues from all 5 sense.

It is estimated that about:

 
7% is transmitted by words.
38% is transmitted by paralinguistic cues such as voice.
55% is transmitted by body cues.

 
 Vocal Cues include all nonverbal qualities of speech; such as, pitch, tone of
voice, loudness or intensity, rate & rhythm of talking. Also unrelated nonverbal
sounds, like laughing, groaning, nervous coughing, sounds of hesitation („um‟,
„uh‟).
 Action Cues are body movements (kinetics), like, automatic reflexes, posture,
facial expression, mannerisms.
 Object Cues are the speaker's use of objects, like dress, furnishings, possessions.
 Space provides a clue to the nature of relationship of 2 people (Proxemics). It is
based on sociocultural norms.
TYPES OF SPACING
 Intimate Space: up to 18 inches.
 Personal Space: 2 to 4 feet. (Used for close relationships & when touching
distance is desired).
 Social- consultative Space: 4 to 12 feet. Less personal. Louder speech.
 Public Space: 12 feet up. Used in public occasions.
Intimate Space
Intimate Space
 Vocal Cues include all nonverbal qualities of speech; such as, pitch, tone of
voice, loudness or intensity, rate & rhythm of talking. Also unrelated nonverbal
sounds, like laughing, groaning, nervous coughing, sounds of hesitation („um‟,
„uh‟).
 Action Cues are body movements (kinetics), like, automatic reflexes, posture,
facial expression, mannerisms.
 Object Cues are the speaker's use of objects, like dress, furnishings, possessions.
 Space provides a clue to the nature of relationship of 2 people (Proxemics). It is
based on sociocultural norms.
TYPES OF SPACING
 Intimate Space: up to 18 inches.
 Personal Space: 2 to 4 feet. (Used for close relationships & when touching
distance is desired).
 Social- consultative Space: 4 to 12 feet. Less personal. Louder speech.
 Public Space: 12 feet up. Used in public occasions.
Personal Space
 Vocal Cues include all nonverbal qualities of speech; such as, pitch, tone of
voice, loudness or intensity, rate & rhythm of talking. Also unrelated nonverbal
sounds, like laughing, groaning, nervous coughing, sounds of hesitation („um‟,
„uh‟).
 Action Cues are body movements (kinetics), like, automatic reflexes, posture,
facial expression, mannerisms.
 Object Cues are the speaker's use of objects, like dress, furnishings, possessions.
 Space provides a clue to the nature of relationship of 2 people (Proxemics). It is
based on sociocultural norms.
TYPES OF SPACING
 Intimate Space: up to 18 inches.
 Personal Space: 2 to 4 feet. (Used for close relationships & when touching
distance is desired).
 Social- consultative Space: 4 to 12 feet. Less personal. Louder speech.
 Public Space: 12 feet up. Used in public occasions.
Social- consultative
Space
 Vocal Cues include all nonverbal qualities of speech; such as, pitch, tone of
voice, loudness or intensity, rate & rhythm of talking. Also unrelated nonverbal
sounds, like laughing, groaning, nervous coughing, sounds of hesitation („um‟,
„uh‟).
 Action Cues are body movements (kinetics), like, automatic reflexes, posture,
facial expression, mannerisms.
 Object Cues are the speaker's use of objects, like dress, furnishings, possessions.
 Space provides a clue to the nature of relationship of 2 people (Proxemics). It is
based on sociocultural norms.
TYPES OF SPACING
 Intimate Space: up to 18 inches.
 Personal Space: 2 to 4 feet. (Used for close relationships & when touching
distance is desired).
 Social- consultative Space: 4 to 12 feet. Less personal. Louder speech.
 Public Space: 12 feet up. Used in public occasions.
Public Space
 Therapeutic Touch
 The midwive’s laying hands on body of ill
person for helping or healing.
 Most fundamental means of communication.
 Types of Therapeutic Communication:
1. Open-ended leads & questions: Begin with a broad subject. Avoid questions answerable by “yes” or “no”.
 Ex.
“What is it you wanted to talk me about?” “What brought you to hospital?”
“Tell me something about your family.”
2. Clarifying: Offers client an opportunity to make clear what he is saying.
 Ex.
“I‟m not following, could you go over that again.” “I‟m not sure I understand. Are you saying…?”
3. Silence: allows client to organize his thoughts. Can convey acceptance. 
4. Focusing: helps client to look at the specific and main issues.
 Ex. “What led up to …”
5. Active Listening: Indicates awareness of what is going on in the interaction.
 Ex. “Yes.” “uhm-hmm.” “Go on.” Nodding
7. Verbalizing Observations: Commenting on what midwife has perceived
Ex. “You sound frustrated.”
8. Reflecting Feelings: verbalizing either stated or implied feelings of patient.
Ex. “You're feeling anxious. You feel that no one cares about you?”
9. Giving Recognition: indicates awareness of (+) change in behaviour. Includes greeting.
Recognizes individual as a person.
Ex. “You look clean after taking your bath.” “Good morning. Ms. X.”
10. Giving Information: provides factual data which patient needs.
Ex. “My name is….”
11. Encourage
Encourages hope (never with false assurance).
11. Non- Therapeutic Communication
 False Reassurance
 Giving advice
 Rejecting, belittling
 Probing
 Overloading
 Underloading

12. Never:
 Give response that belittles, negates or devalues.
 Advice or show approval or disapproval.
 Ask for explanation or “why”.
 Avoid
 Be defensive
End of Part 1…
 ASEPSIS
Learning Outcome 1: Explain the concepts of medical and surgical asepsis.

Asepsis is the freedom from disease-causing microorganisms. To decrease the possibility of transferring
microorganisms from one place to another, aseptic technique is used.
 1. Medical asepsis includes all practices intended to confine a specific microorganism to a specific area,
limiting the number, growth, and transmission of microorganisms. In medical asepsis, objects are referred
to as clean, which means the absence of almost all microorganisms, or dirty (soiled or contaminated),
which means likely to have microorganisms, some of which may be capable of causing infection.
 2. Surgical asepsis, or sterile technique, refers to those practices that keep an area or object free of all
microorganisms. It includes practices that destroy all microorganisms and spores (microscopic dormant
structures formed by some pathogens that are very hardy and often survive common cleaning techniques).
Surgical asepsis is used for all procedures involving sterile areas of the body.
 LEARNING OUTCOME 2: Identify signs of localized and systemic infections and
inflammation.

 1. Signs of localized infections include: localized swelling, localized redness, pain or tenderness
with palpation or movement, palpable heat in the infected area, and loss of function of the body
part affected, depending on the site and extent of involvement. In addition, open wounds may
exude drainage of various colors.
 2. Signs of systemic infection include fever; increased pulse and respiratory rate if the fever is
high; malaise and loss of energy; anorexia; and, in some situations, nausea and vomiting, and
enlargement and tenderness of lymph nodes that drain the area of infection.
 3. Laboratory data that indicate the presence of an infection include the following: elevated
leukocyte (white blood cell or WBC) count; increases in specific types of WBCs revealed in the
differential count; elevated erythrocyte sedimentation rate; and urine, blood, sputum, or other
drainage culture.
LEARNING OUTCOME 3 : Identify risks for nosocomial and health care–associated
infections.

 1. Nosocomial infections are associated with the delivery of health care services in a
health care facility. A number of factors contribute to nosocomial infections. Diagnostic or
therapeutic procedures may cause iatrogenic infections. Another factor contributing to the
development of nosocomial infections is the compromised host, that is, a client whose
normal defenses have been lowered by surgery or illness. Hands of personnel are a
common vehicle for the spread of microorganisms; therefore, insufficient hand cleansing
is an important factor contributing to the spread of nosocomial infections.
LEARNING OUTCOME 4 : Identify factors influencing a microorganism’s ability to produce an
infectious process.
 The extent to which any microorganism is capable of producing an infectious process depends on the
number of microorganisms present (virulence).
 Potency of the microorganisms (pathogenicity).
 The ability of the microorganisms to enter the body (susceptibility) of the host, and the ability of the
microorganisms to live in the host’s body.

LEARNING OUTCOME 5 : Identify anatomic and physiological barriers that defend the body
against microorganisms.
 Intact skin and mucous membranes are the body’s first line of defense against microorganisms. The
dryness of the skin, the resident bacteria of the skin, and the normal secretions of the skin also inhibit
bacterial growth. The moist mucous membranes and cilia of the nasal passages and the alveolar
macrophages are also barriers against microorganisms. Each body orifice also has protective
mechanisms. The oral cavity sheds mucosal epithelium to rid the mouth of colonizers; saliva flow and
buffering action help prevent infection. Saliva also contains microbial inhibitors. The eyes are protected
by tears. The high acidity of the stomach inhibits microbial growth, the resident flora of the large
intestine help prevent the establishment of disease-producing organisms, and peristalsis also tends to
move microbes out of the body. The low pH of the vagina inhibits the growth of many disease producing
microorganisms. It is believed that the urine flow through the urethra has a flushing and bacteriostatic
action.
LEARNING OUTCOME 6: Differentiate active from passive immunity.
 1. In active immunity, the host produces antibodies in response to natural antigens or artificial antigens. The
duration of active immunity tends to be long.
 natural active immunity, antibodies are formed in the presence of active infection in the body and the
duration of this type of immunity is lifelong.
 artificial active immunity, antigens are administered to stimulate antibody formation. This type of active
immunity lasts for many years, but artificial immunity must be reinforced by booster.
 2. In passive (or acquired) immunity, the host receives natural or artificial antibodies produced from another
source. The duration of passive immunity tends to be short.
 natural passive immunity, the antibodies are transferred naturally from an immune mother to her baby
through the placenta or in colostrum. This type of immunity lasts 6 months to 1 year.
 Artificial passive immunity occurs when immune serum (antibody) from an animal or another human is
injected. This immunity lasts 2 to 3 weeks.
LEARNING OUTCOME 7: Identify interventions to reduce risks
for infections.
 Many nosocomial infections can be prevented by using proper hand
hygiene techniques, environmental controls, sterile technique when
warranted, and identification and management of clients at risk for
infections. Midwives use critical thinking and agency policy in
implementing infection control procedures.
LEARNING OUTCOME 8: Identify measures that break each link in the chain of
infection.
 1. The chain of infection includes the etiologic agent, reservoir, portal of exit from the
reservoir, method of transmission, portal of entry to the susceptible host, and a susceptible
host link.
 2. Interventions that affect the etiologic agent (microorganism) include correct cleaning,
disinfecting, or sterilizing articles before use and educating clients and support individuals
about appropriate methods to clean, disinfect, and sterilize articles.
 3. Interventions to reduce the reservoir (source) include changing dressings and bandages
when soiled or wet, assisting clients to carry out appropriate skin and oral hygiene,
disposing of damp and soiled linens appropriately, disposing of feces and urine in
appropriate receptacles, ensuring that all fluid containers are covered or capped, and
emptying suction and drainage bottles at the end of each shift or before they become full
or according to agency policy.
 4. The portal of exit from the reservoir can be controlled by avoiding talking, coughing, or
sneezing over open wounds or sterile fields, and covering the mouth and nose when
coughing or sneezing.
LEARNING OUTCOME 9: Compare and contrast category-specific, disease-
specific, standard, and transmission-based isolation precaution systems.
 Isolation refers to measures designed to prevent the spread of infections or
potentially infectious microorganisms to health personnel, clients, and visitors.
Several sets of guidelines have been used in hospitals and other health care
settings.
 Category-specific isolation precautions includes: strict isolation, contact
isolation, respiratory isolation, tuberculosis isolation, enteric precautions,
drainage/secretions precautions, and blood/body fluid precautions.
 Disease-specific isolation precautions provide precautions for specific
diseases. They may delineate use of private rooms with special ventilation,
having the client share a room with other clients infected with the same
organism, and gowning to prevent gross soilage of clothes for specific infectious
diseases.
 
 Universal precautions (UP) are techniques to be used with all clients to decrease the
risk of transmitting unidentified pathogens. These obstruct the spread of blood borne
pathogens, namely hepatitis B and C viruses and HIV. The Centers for Disease
Control and Prevention (CDC) did not recommend that universal precautions replace
disease-specific or category-specific precautions, but that they be used in conjunction
with them.
 Standard precautions are used in the care of all hospitalized individuals regardless
of their diagnosis or possible infection status. They apply to blood; all body fluids,
secretions, and excretions except sweat (whether or not blood is present or visible);
nonintact skin; and mucous membranes.
 Transmission-based precautions are used in addition to standard precautions for
clients with known or suspected infections that are spread in one of three ways: by
airborne transmission, by droplet transmission, or by contact. The three types of
transmission-based precautions may be used alone or in combination but always in
addition to standard precautions.
LEARNING OUTCOME 10:
 Performing hand hygiene.
 Applying and removing a gown, face mask, eyewear, and clean gloves.
 Establishing and maintaining a sterile field.
 Applying and removing sterile gloves by the open method.
 Applying and removing sterile gloves by the closed method.
 The midwife should follow the principles of surgical asepsis when setting up a sterile field:
all objects used in a sterile field must be sterile; sterile objects become unsterile when touched
by unsterile objects; sterile items that are out of vision or below the waist or table level are
considered unsterile; sterile objects can become unsterile by prolonged exposure to airborne
microorganisms; fluids flow in the direction of gravity; moisture that passes through a sterile
object draws microorganisms from unsterile surfaces above or below to the sterile surface by
capillary action; the edges of a sterile field are considered unsterile; the skin cannot be
sterilized and is unsterile; and consciousness, alertness, and honesty are essential qualities in
maintaining surgical asepsis.
 Many pieces of equipment are supplied for single use only and are disposed of after use.
Some items are reusable. Agencies have specific policies and procedures for handling soiled
equipment in order to prevent inadvertent exposure of health care workers to articles
contaminated with body substances and to prevent contamination of the environment.
 Positioning, Exercise, Body
Mechanics, Basic Procedures
 POSITIONING
Position- Description When to Use Contraindications

PRONE – client faces down Alternate position for Post-abdominal surgery, and
immobilized patient among those with respiratory or
spinal problems.

SUPINE – client lies flat on Clients on bed rest, post spinal Clients with dyspnea or those at
back surgery and post-anesthesia risk for aspiration

SIDE LYING – client lies on the A choice position for clients with Clients with post hip
side with weight on the hip and pressure sore on bony replacement and other
shoulder, with pillows support prominences of back and sacrum orthopedic surgery
legs, arm, head and back
PRONE
SUPINE
 Position- Description
SIM’S – client lies on the side with
weight distributed toward the
anterior ileum, humerus and
clavicle with pillows support on
flexed arms and legs
FOWLER’S – sitting position
raises clients head 80-90 degree
with pillows support for head,
arms, legs
SEMI FOWLER’S – semi sitting
position with head elevation of 30-
45 degrees
When to Use Contraindications
A choice position for clients with Clients with supine or orthopedic
pressure sore on bony prominences conditions
of back and sacrum.
Clients with difficulty of breathing, Post spine or brain surgery
for eating, improvement of cardiac
output and watching TV
Clients with difficulty of breathing, Post spine or brain surgery
for eating, improvement of cardiac
output and watching TV
 Position- Description When to Use Contraindications

DORSAL RECUMBENT – For vaginal examination, Post spine or brain surgery

client lie supine with legs Leopold’s Maneuver
flexed and rotated outward

KNEE CHEST – lies prone Rectal procedures and Arthritis and other joint
with buttocks elevated and examination deformity
knees drawn to the chest

LITHOTOMY- lies supine For vaginal and rectal Post spine or brain surgery
with hips flexed and calves examinations and procedure
and heels parallel to the floor
using stirrups
 Position- Description When to Use Contraindications
TRENDELENBURG – For postural drainage and Increase intracranial
lies supine with head 30- promotion of venous pressure. Hypotension
40 degree lower than the return may result from this
feet position.
 BASIC PROCEDURES

HANDWASHING
- Single most effective and least expensive method to prevent nosocomial infection.
- Part of every beginning and end of procedures
1. Use warm (not hot that removes protective oils) running water.
2. Apply soap and rub palms, wrists, and back of hand firmly with circular motion, interlace fingers
and thumbs and rub with lather and friction (mechanically loosens dirt).
3. Rinse hands and wrist with hands held lower than forearm (medical asepsis, surgical asepsis is
reversed).
4. Dry with paper towel (or blower) wiping from fingertips toward the forearm, turn off faucet with
clean paper towel.
 ENEMA
Purpose
• To cleanse the bowel in preparation for diagnostic test or surgery (cleansing enema)
Types:
1. Carminative enema -to relieve gas
2. Retention/ Emolient enema - soften the stool or relieve constipation of fecal
impaction
3. Medicated enema - administer medication like neomycin and kayexelate
4. Cleansing enema - stimulates peristalsis by irritating the colon and rectum to
facilitate bowel movement.
 COMMONLY USED ENEMA SOLUTION
Solution Constituents Action Time to take effect

Hypertonic (ex. 90-20 ml of solution Draws water into 5-10 minutes

Fleet) colon

Hypotonic ( ex. Tap 500- 1000 ml of tap Distends colon, 15-20 minutes
water) water stimulates peristalsis
and softens feces

Isotonic (safest) ex. 500-1000 ml of Distends colon, 15-20 minutes

Normal Saline normal saline stimulates peristalsis
and softens feces
Hypertonic (Fleet)
Hypotonic ( Tap water)

Isotonic (safest)
Normal Saline
 Solution Constituents Action Time to take
effect
Soapsuds (ex. 3-5 ml soap to Irritates mucosa, 10-15 minutes
Castile soap) 1,000 ml water distends colon

Oil (mineral, 90-20 ml Lubricates the ½ to 3 hours

olive, cotton seed) feces and colonic
mucosa

ENEMA CATHETER
Adult-Fr 22 to 32
Children-Fr 14-18
Infant-Fr 12 (or bulb syringe)
Soapsuds (Castile soap)
OIL
PROCEDURE:
1. Provide privacy, and position in left lateral sim's with right knee flexed.
2. Fill enema container with appropriate amount of solution of lukewarm
(tepid) temperature
(105-110F)
3. Open clamp on tubing to allow solution to low (and remove air that cause
discomfort), then clamp.
4. Lubricate and ask patient to take slow deep breath as rectal tube is
inserted gently (3-4 inches in adult, no more than 4 inches)
5. Open clamp to allow solutions to flow slowly from container at maximum
18 inches height.
6. If client complains of fullness or pain, lower the container or use the
clamp to stop the flow for 30 seconds, and then restart the flow at lower
rate.