THE COMMUNICATION COMMUNICATION PROCESS Commu Communi nica cati tion on is the the exch exchang ange e of thou thought ghts, s, feel feelin ing, g, and other other information ►Is the interchange of information between two or more people; in other words the exchange of ideas or thoughts. ►Thoughts are conveyed to others not only by spoken or written words but also by gestures or body actions. ►It can be transmission of feelings or a more personal and social interaction between people. ►It is a basic component of human relationships. ►the intent of any communication is to elicit a response. It includes all the techniques by which an individual affects another. *Two main purpose: purpose: a. to influence others b. to obtain information The communication Process Face Face-t -to-f o-fac ace e comm commun unic icat atio ion n invo involv lves es a send sender er a mess messag age e a rec receiver and a respons onse or feedb edback ack. In its simplest form, communication is a two away process involving the sending and the receiving of a message. Sender The sender a person or groups who wish to convey a message to another can be considered the source-encoder. This term suggest that the person or group sending a message must have an idea or reason communicating (source) and must put the idea or feeling into a form that can be transmitted. Encoding involves the selection or specific signs or symbol (codes) to transmit the message such as which language and words to use how to arrange the words to use how to arrange the words and what tone of voice and gestures to use. Message The The secon econd d compo ompone nent nt of the the comm commun unic icat atio ion n proce rocess ss is the the message itself-what is actually said or written the body language that accompanies the words and how the message is transmitted. The
medium used to convey the message is the channel and it can target any of the receiver’s senses. It is important for the to be appropriate for the message and it should help make the intent of the message more clear. Receiver The receivers the third component of the communication process is the listener who must listen observe and attend. This person is the decod decoder er who who must must perc percei eive ve what what the the inte intende nded d (int (interp erpret retat atio ion). n). Perce Percept ptio ion n uses uses all all of the the sens senses es recei receive ve verba verball and and nonv nonverb erbal al messages. Response The fourth component of the communication communication process the response is the message that the receiver returns to the sender is also called feedb feedbac ack. k. Feedba Feedback ck can can be eith either er verb verbal al or non non verb verbal al or both. both. Nonverbal examples are a nod of the head or a yawn. Either way feedback allows the sender to correct or record message. Modes of Communication Verbal Communication Verbal Communication is largely conscious because people choose the the words ords they hey use. use. The The word words s used used vary vary amon among g indi indivi vidu dual als s according to culture socioeconomic background, age, and education. As a resu result lt coun countl tles ess s poss possib ibil ilit itie ies s exis existt for for the the way way idea ideas s are are exchange. An abundance of word can be used to form messages. In addition, a wide variety of feelings can be conveyed when people talk. When choosing words to say or write, nurses need to consider. A.
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PAGE AND INTONATION. INTONATION. The manner of speech as in the pace pace rhyth rhythm m and and intona intonati tion on will will modif modify y the the feel feeling ing and the the impact of a message. The intonation can express enthusiasm, sadn sadnes ess, s, ange angerr, or amus amusem emen ent. t. The The pace pace of spee speech ch may may indi indica cate te inte intere rest st,, anxi anxiet ety y, bore boredo dom, m, or fear fear.. For For exam exampl ple e speaking slowly and softly to an excitement may help calm the client. SIMLPICITY. Simplicity includes the use of commonly under stead words brevity and completeness. Many complex technical
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term erms become ome natural to nurses rses.. Howe owever laype ayperrsons misunderstand these terms. CLARITY AND BREAVITY BREAVITY.. A message that is direct and single will be more effective. Clarity is saying precisely what is meant and brevity is using the fewest words necessary. The result is a message age that is simple ple and and clear. An aspect of this is cong congrue ruenc nce e or cons consis iste tency ncy where where the the nurs nurse’ e’s s behav behavio iorr or nonverbal communication matches the words spoken. TIMING AND RELEVANCE. Nurses need to be aware of both rele relevan vance ce and and timin timing g when when commu communi nica cati ting ng with with clie client nts. s. 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. This involves sensitivity to the client’s needs and concerns. ADAPTABILITY. Spok Spoken en mess messag ages es need need to be alt altered ered in accordance with behavioral cues fro the client. This adjustment is referred to as adaptability. What the nurse says and how it is said said must must be indi indivi vidu dual aliz ized ed and and care carefu full cons consid ider ered ed.. This This requires astute assessment and sensitivity to the client’s needs and concerns. CREDIBILITY. Credi redibi bili lity ty mean means s worth orthin ines ess s of beli belief ef trus trustw twort orthin hines ess s and and reli reliab abil ility ity.. Credi Credibi bili lity ty may be the the most most importa important nt criter criterion ion of effec effectiv tive e commun communica icatio tion. n. Nurses Nurses foster foster credibility by being consistent, dependable, and honest. The nurs nurse e need needs s to be know knowle ledg dgea eabl ble e abou aboutt what hat is bein being g discus discussed sed and to have have accurat accurate e informa informatio tion. n. Nurses Nurses should should convey confidence and certainty in what they are saying while being able to acknowledge their limitation (e.g.,” I don’t know the answer to that but I will find someone who does”) HUMOR. The use of humor can be positive and powerful tool in the nurse client relationship but is must be used with care. Humor can be used to help clients clients adjust to difficult difficult and painful situation. The physical act of laughter can be both emotional and physical release reducing tension by providing a different perspective and promoting a sense of well being.
Nonverbal Communication Nonverbal communication is sometimes called body language. It include includes s gesture gestures s body movements movements use of touch touch and physica physicall
appearance including adornment. Nonverbal communication often tells other more about what a person is felling than what is actually said because nonverbal behavior is controlled less consciously than verbal behavior. Nonverbal communication either reinforces or contradicts what is said verbally. verbally. PERSONAL APPEARANCE. Clothi Clothing ng and adornme adornments nts can be sources of information about a person. Although Although choice choice of apparel is high highly ly pers person onal al it may may conv convey ey soci social al and and fina financ ncia iall stat status us,, culture, culture, religion, group association association,, and self concept. concept. Charms and amul amulet ets s may maybe worn worn for for deco decora rati tive ve or for for heal health th prot protec ecti tion on purpose. When the symbolic meaning of an object is unfamiliar the nurse nurse can can be inqui inquire re about about its its signi signifi fica canc nce e whic which h may fost foster er rapport with the client. POST POSTUR URE E AND GAIT GAIT.. The ways ays people walk and carry themse themselve lves s are often often reliab reliable le indicat indicators ors of self self concep conceptt current current mood and health. Erect posture and an active purposeful stride sugg sugges estt a feel feelin ing g of well ell bein being. g. Slou Slouch ched ed post postur ure e and and slow slow shuff shufflin ling g gait gait suggest suggest depress depression ion or physic physical al discom discomfor fort. t. Tense ense posture and a rapid determined gait suggest anxiety or anger. FACIAL EXPRESSION. No part of the body is as expressive as his face suggests happiness and sadness can be conveyed by facial expres ression. on. Nurs urses need eed to be awar aware e of thei heir own own expression and what they are communicating to others. Clients are quick to notice the nurse’s facial expression particularly when the clie client nts s feel feel unsure unsure or uncom uncomfo fort rtabl able. e. Eye Eye cont contac actt is anot another her esse essent ntia iall eleme element nt of faci facial al commu communi nica cati tion on.. In many many cult cultur ures es,, manual eye contact acknowledges acknowledges recognition of the other person and the willingness to maintain communication. GESTURES. Hand Hand body body gestu gestures res may empha emphasi size ze and and clar clarify ify spok spoken en word ord or they they may may occu occurr with withou outt word words s to indi indica cate te a part partic icul ular ar fell fellin ing g or to give give a sign sign.. A wave wave good good-b -bye ye and and the the moti motion onin ing g of a visi visito torr towa toward rd a chai chairr are are gest gestur ures es that that have have relatively universal meaning.
Communication in different level of deployment. Infants *Infants communicate through their senses. Teach parents about the importance of touch. *They respond best to high-pitched high-pitched soft or gentle tone of voice and eye contact. Toddlers and Preschoolers *Allow time for them to complete verbalizing their thoughts without interruption. *Provide a simple response to question because they have short attention spans. *Drawing a picture can provide another way for the child communicates. School-Age Children *Talk to the children at his or her eye level to help decrease in *Include the children in the conservation when communicating with the parents. Adolescent *Take time to build rapport with the adolescent * Use active listening skills. *Project z nonjudgmental attitude and non reactive behavior even when the adolescent says disturbing remarks. Factors influencing the Communication Process A. Development Langua Language ge psyc psychos hosoc ocial ial and inte intell llec ectu tual al deve develo lopm pment ent moves through the stages across the life span. Knowledge of a client’s development stage will allow the nurse to modify the message accordingly. The use of dolls and games with simple language may help explain a procedure procedure to an 8-years-old. With adolescent who have developed more abstract thinking skill a more more deta detail iled ed expl explan anat atio ion n can can be give given n where herere reas as a well well educated educated middle-a middle-age ge busines business s execut executive ive may wish wish to have have detailed detailed technical technical information information provided. provided. Older clients clients are apt to have a wider range of experiences with the health care system
which may influence their response and understanding. With aging also come changes in vision and hearing acuity that can affect nurse-client interactions. B. Gender From From an early early age age fema female les s and males males commu communi nica cate ted d differently. Girls tend to use language to seek conformation, minimize differences and establish intimacy. intimacy. Boys use language to establish independence and negotiate status within a group. These differences can continue into adulthood so that the same comm commun unic icat atio ion n may may be inte interp rpre rete ted d dif differe ferent nt a man man and and a woman C. Values Values and Perceptions Pe rceptions Value alues s are are stand tandar ards ds that that inf influen luenc ce beha behavi vior or and and perceptions are the personal view of an event. Because each person has unique personality traits, values, and life expression each each will will percei perceive ve and interpr interpret et messag messages es and experie experiences nces differently. For example if the nurse draws the curtain around a crying woman and leaves her alone the woman may interpret this as “The nurse thinks that will upset others and that I should cry” or” The nurse respects my need to be alone”. It is important for the nurse to be aware of client’s values and to respect or to corr correc ectt perce percept ptio ion n to avoi avoid d crea creati ting ng bartr bartrie ies s in nurs nurse e clie client nt relationship. D. Personal Space Personal space is the distance people prefer in interact with others. Proxemics is the study of distance between person in their their interac interactio tion. n. Middle Middle class class North North America Americans ns use defini definite te dist distanc ances es in vari various ous inte interpe rpers rson onal al relat relatio ions nshi hips ps alon along g with with specific specific voice tones and body language. Communication Communication alters in accordance with four distances each with a close to a far phas phase. e. Tampa amparo ro and and Lind Lindh h (200 (2000, 0,p. p.91 91)) list list the the foll follow owin ing g examples: Intimate:Touching to 1 1/2 feet 1. Intimate:Touching 2. Personal: 11/2 to 4 ft 3. Social: 4 to 12 ft 4. Public: 12-15 ft
Inti Intima mate tes s dista distanc nce e comm communi unica cati tions ons char charac acte teri rize zed d by body body cont contac actt heigh heighte tened ned sens sensat atio ions ns of body body heat heat and and smel smelll and and voca vocali liza zati tion on that that are are low low. Visio ision n is inte intens nse e rest restri rict cted ed to a specific body part and may be distorted. Personal Personal distance distance is less overwhelming overwhelming than intimate intimate distance. distance. Voice tones are moderate and body heat and smell are notice less less.. Phys Physic ical al cont contac actt such such as hand handsh shak ake e or touc touchi hing ng a shoulder is possible. Social distance is characterized a clear visual perception of the whole person. Body heat and other odor are imperceptible eye contact is increased and vocalizations are loud enough to be hear by others. Communication is therefore more formal and is limited to seeing and hearing. Public distance requires loud clear vocalization with carefree reification although the faces and forms of people are at public distance individuality is lost instead the person is of the group of people or the community. E. Territoriality Territoriality is a concept of the space and things that an indi indivi vidua duall cons consid iders ers are are belo belongi nging ng to the the self self.. Territ erritori orial ality ity marked off by people may be visible to others. For example clients in a hospital often considered their territory as bounced by the curtains around the bed unit or by the walls of the private room. om. This his huma uman tend endency ncy to claim aim territ ritory must ust be recognized by all health care workers. Clients often feel the need to defend their territory when it is invaded by others for ex. When a visitors or nurse removes a chair to use at the other bed the visitor has inadvertently violated the territoriality of the clie client nt whos whose e chai chairr was was remo remove ved. d. Nurs Nurses es need need to obta obtain in permission from clients to remove rearrange or borrow object in their hospital area. F. Roles and Relationship The The role roles s and and the the rela relati tion onsh ship ip betw betwee een n send sender er and and receiver affect communication process. Roles such as nursing student and instructor client and physician or parent and child
affect the content and responses in the communication process. Choi Choice ce of words words sent sentenc ence e stru struct ctur ure e and and tone tone of voic voice e vary vary considerably from the role to the role In addition the specific relat relatio ions nship hip betwe between en the the commu communic nicat ators ors is sign signif ific icant ant.. The The nurse who meets with a client for the first time communicates diff differe erent ntly ly from from the the nurs nurse, e, who who has has previ previou ously sly deve develop loped ed a relationship with that client, G Environment Peop People le usua usuallly commu ommuni nica cate te mos most effe effec ctiv tively ely in a comfor comfortab table le enviro environmen nment. t. Temperat emperature ure extreme extremes s excess excessive ive noise and a poorly ventilated environment can all interfere with communicatio communication n Also lack of privacy may interfere with a clients clients communication about matter that clients considers private. For Ex. A client who is worried about the ability of his wife to care for for him him afte afterr disc discha harge rge from from hospit hospital al may not not wish wish disc discus uss s concern with a nurse hearing of others clients in the room. Environmental distraction can impair and distort communication. H. Congruence In Congruence communication the verbal and non verbal aspects of the message match. Clients more readily trust the nurs nurse e when hen they they perc percei eive ve the the nurs nurse’ e’s s comm commun unic icat atio ion n as congrue congruent. nt. This This will will also also help to prevent prevent miscom miscommuni municat cation. ion. Congr ongrue uenc nce e betw etween een verb verbal al expr expres essi sion on and and non non verb verbal al expression is easily seen by the nurse and the client. Nurses are taught to asses clients but clients often just adept at reading a nurses expression or body language If there are incongruence the body language or nonverbal communication is usually the one with the true meaning For ex, 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 looked worried or disgusted while saying this the clients are less likely to trust the nurse’s words. Therapeutic Communication Therapeutic Therapeutic communication communication promotes understanding understanding and can can help help esta establ blis ish h a cons constr truc ucti tive ve relat relatio ions nshi hip p betw between een the the nurse and the client. Unlike the social relationship where there
way not be a specific purpose of direction the therapeutic helping relationship is client and goal directed. Nurses needed to respond not only the content of client’s verbal message but also the felling expressed. It is important to understand how the clients view the situation and feels about it before responding. Attentive Listening Attentive Listening is listening actively using all these senses as opposed to listening passively with just the ear It is probably the most most impo import rtan antt tech techni niqu que e in nurs nursin ing g and and is base based d all all othe other r techniques attentive listening is an active process that requires energy and concentration. It involves paying attention to the total message both verbal and nonverbal. Barriers to communication THE HELPING RELATIONSHIP Nurse client relationshi nship p are referred to by some ome as interpersonal relationship by other as therapeutic relationships and by still others as helping relationship Helping is a growth facilitating process that strives to achieve two basic goals (Egan 1998) 1. Helps elps clie client nt mana manage ge their heir prob proble lems ms more more eff effecti ective vely ly and and develop unused or underused opportunities more fully. 2. Help Helps s clie client nt beco become me bett better er at help helpin ing g them themse selv lves es in thei their r everyday lives. A helping relationship may be develop over weeks of working with a client, client, or within minutes. minutes. The keys o the helping relationship relationship is {the development of trust and acceptance between he nurse and {b} an underlying belief that the nurse cares about and wants to help the client. The The helpi helping ng relat relation ionsh ship ip is infl influen uence ced d by the the pers persona onall and profess professiona ionall charact characteris eristic tics s of the nurse nurse and the client. client. Age, sex, sex, appea appearan rance ce,, diagn diagnos osis is,, educ educat atio ion, n, valu values es,, ethni ethnic, c, and and cult cultura urall background, personality, expectations, and setting can all affect the development of the nurse- client relationship.
Phases of the Helping Relationship The helping relationship process can be described in terms of four sequential phases, each characterized by identifiable tasks and skills. The relatio relationsh nship ip must must progres progress s through through the stages stages in succes successio sion n becaus because e each each buil builds ds on the the one one befo before. re. Nurs Nurses es can can iden identi tify fy the the progress of a relationship by understanding these phases.
Preinteraction Phase The preinteraction phase is similar to the planning stage before an interview. In most situations, the nurse has information about the client client before before the first first face-to face-to-fa -face ce meetin meeting. g. Such Such informa informatio tion n may include the client’s name, address, age, medical history and or social history. Planning for the initial visit may generate some anxious and feeling specific information to be read positive outcomes can evolve. Introductory Phase Introductory phase, also referred to as the orientation phase, is important because it sets the tone for the rest of the relationship. During this initial encounter, encounter, the client and the nurse closely closely observe each other and form judgments about the others’ behavior. The tree stag stages es of this this intr introd oduc ucto tory ry phas phase e are are open openin ing g the the rela relati tion onsh ship ip,, clarifying the problem, and structuring and formulating the contact. Other important tasks of the introductory phase include getting to know each other and developing a degree of trust. After introductions, the nurse may initially engage in some social interaction to put the client at ease. For example nurse and client may talk about what a nice day it is and what they would like to do if at home. Characteristics of a Helping Relationship A helping relationship * Is an intellectu intellectual al and emotional emotional bond between between he nurse and the client and is focused on the client. *Respect 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
*Respect on the client’s well- being *Is based on mutual trust, respect, and acceptance. By the end pf the introductory phase, clients should begin to *Develop trust in the nurse. *View the nurse as a competent professional capable of helping. iew the the nurs nurse e as hone honest st,, open open,, and and conc concer erne ned d abou aboutt thei their r ►View welfare. ►Believe the nurse will try to understand and respect their cultural values and beliefs. confidentialit y. ►Believe the nurse will respect client confidentiality ►Fell comfortable talking with the nurse about feeling and others sensitive issues. ►Understand the purposes of the relationship and the roles. Feel that that they they are acti active ve part partic icip ipant ants s in deve develop lopin ing g a mutual mutually ly ►Feel agreeable plan of care. Working Phase During the working phase of a helping relationship, the nurse and the client begin to each other as unique individuals. They begin to appreciate this uniqueness and care about each other. Caring is shari sharing ng deep deep and genuin genuine e conc concern ern about about the the welf welfar are e of anot anothe her r person. Once caring develops the potential for empathy increases. The working phase has two major stages: exploring and under underst stand anding ing thou thought ght and feel feelin ings gs,, and and faci facili lita tati ting ng and and talk talkin ing g action. The nurse helps the client to explore thought, feelings, and acti action ons s and and help helps s the the clie client nt plan plan a prog progra ram m of acti action on to meet meet preestablished goals. EXPLORING AND UNDERSTANDING THOUGHT AND FEELINGS . The nurse requires the following skills for this phase of the helping relationship. Empathetic listening and responding nurses must listen attent attentive ively ly and commun communica icate te (respon (respond) d) in ways ways that that indicat indicate e they have listened to what was said and understand how the client feels the nurses respond to content and feeling or both as appropriate. The nurse’s nonverbal behaviors are also important. Nonverbal behaviors indicating empathy include moderate gesturing and little activity or body movement. Accord According ing to Egan (1998) empathy “can be seen as an intellectual process that involves understanding correctly another ●
person’s emotions state and point of view” and also as an emotional response experienced by the helper. Empathetic listening focuses on a kind of “being with” clients to develop an understanding of them and their world. This understanding, however, must also be communicated effectively to the client-emphasis response. The end result of empathy is comforting and caring for the client and a helping, healing relationship. Respect. The nurse must show respect for the client’s will willin ingne gness ss to be avai availab lable le,, desi desire re to work work with with the the clie client nt,, and a manner that conveys the idea of taking the clients point of view seriously. ●
Genuineness. Personal statements can be helpful in solidifying the rapport between the nurse and the client. The nurse migh mightt offe offerr such such comm commen ents ts as “I reca recall ll when when I was was in (sim (simil ilar ar situation), and I felt angry about being put down.” Egan outlines five behav behavior iors s that that are comp compone onent nts s of genuin genuinen enes ess. s. Nurs Nurses es need need to exercise caution when making references about themselves. These statements must be used with discretion. The extreme of matching case of the client’s client’s problems with with a better story of the nurse’s own is of little value to the client. ●
● Concre Concreten teness ess.. The The nurse nurse must must assis assistt the the clien clientt to be concrete and specific rather than to speak in generalities. When the client says, “I’m stupid and clumsy.” The nurse narrows the topic to the specific by pointing out, “You tripped on the rugs.” ● Confrontation Confrontation.. The nurse points points out discrepancies discrepancies between between thoug oughts hts, feel eelings, and and act actions ons that inhibit bit the clients self elf unde unders rsttandi anding ng or expl explor orat atio ion n of spec specif ific ic area areas s. This his is done done empathetically, empathetically, not judgmentally. judgmentally. During the first stage of the working phase, the intensity of interaction increases, and feelings such as anger, shame, and selfconsciousnes consciousness s may be expressed. If the nurse is skilled in this stage and if client is willing to pursue self-exploration the outcome is a beginning understanding on the part of the client about behavior and feelings.
Termination Phase The termination phase of the relationship is often expected to be difficult difficult and filled with ambivalence. However, However, if the previous phases have evolved effectively, the client generally has a positive outlook and feels able to handle problems problems independently. independently. On the other hand, because caring attitudes have developed, it is natural to expect some feeling loss, and each person needs to develop a way of saying good-bye. Many methods methods can be used used to terminat terminate e relatio relationsh nships ips.. Summarizing or reviewing the process can be produced a sense of accompl accomplish ishment ment.. This This may include include sharing sharing reminis reminiscen cences ces of how things were are the beginning of the relationship and comparing them to how they are now. It is also helpful for both the nurses and the client to express their feelings about termination openly ad honestly. Thus Thus term termin inat atio ion n disc discus ussi sion ons s need need to star startt to adva advanc nce e of the the independence. In some situations referrals are necessary or it may be appropriate to offer an occasional standby meeting to give support as needed. Follow-up Phone calls or e-mails are other interventions that ease the client’s transition to independence.
