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Nutrition Counseling
and Education Skills
for Dietetics
Professionals
6th Edition
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 2
Communication
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Objectives
• List the components of the communication
model
• Discuss ways to make verbal communication
collaborative and effective
• Relate ways to improve listening skills
• Identify common communication barriers
and how to overcome them
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communication
• A required skill for practice
– In nutrition/health care
– In human resource management
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communication Defined
• A process in which “meaning is co-created
simultaneously among people” and is a
learned skill.
 To develop a relationship with
clients/staff
 To relieve anxiety
 To enhance recall; provide feedback
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
FIGURE 2-1 Communication model.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sender
• Speaks first
• Decides message
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Receiver—A Listener
• Interprets message
• Decides how to respond
• Exhibits nonverbal behavior
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Message
• Receiver interprets verbal message
• Receiver interprets nonverbal message
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Feedback—To Sender
• Receiver’s reactions to message
– Example: agreement, surprise, boredom
– Allows sender to adjust message
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Barriers
• Interference and distortions
• Physical environment; noise
• Physiologic state
• Cultural, ethnic background
• Psychological state
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Verbal and Nonverbal
Communication
• Both occur simultaneously during
communication
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Verbal Communication
• Actual words used
• Way words are arranged
• Providing a supportive climate is crucial to
trust, caring and acceptance
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Five Guidelines to Create a
Supportive Climate
1. Discuss problems descriptively, not
evaluatively
2. Describe situations with a problem
orientation, not manipulatively
3. Offer alternatives provisionally, not
dogmatically
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Five Guidelines to Create a
Supportive Climate(con’t)
4. Treat clients as equals
5. Be empathic, not neutral or self-centered
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Climate: Descriptive rather
than Evaluative
• Avoid judging behaviors, attitudes, & work
• Describe facts/problems objectively
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Climate: Problem-Oriented
rather than Manipulative
• Plan opening remarks descriptively
• Allow for problem solving
• Avoid preplanned solutions
• Promote others initiating solutions
• Repeat what you have understood
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Climate: Provisional rather
than Dogmatic
• Provide several alternatives
• Allow for added information
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Climate: Egalitarian rather
than Superior
• Treat clients as equals
• Avoid being superior
• Show respect
• Emphasize collaboration
• People uphold their own solutions
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Climate: Empathic rather than
“Neutral”
• Put yourself in the other person’s shoes
• Demonstrate that you want to understand
• Allow person to express feelings/concerns
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Paraphrasing the Client or
Employee
• Paraphrase comments/problems/feelings
• Paraphrase critical information
• Shows you are trying to understand
• Ask person to paraphrase plans/actions
• Can lead to added disclosure
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Self-Assessment
• Paraphrase the following:
– Client: “I’ve been overweight most of my
life. I’ve tried many different diets. I lose
a few pounds and then gain it all back”
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nonverbal Communication
and Image Management
• Usually more influential than verbal
• Monitor own nonverbal messages
• Monitor other person’s nonverbals
• Varies with culture
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cultural Context
• Patient-centered approach
– Assessing cross-cultural issues
– Exploring the meaning of the illness
– Inquiring about the social context of
living
– Engaging in collaborative
negotiations
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Professionals Must Be Alert to
Nonverbal Signals
•
•
•
•
•
•
Tone of voice
Clothing, hair style, accessories
Eye contact
Posture, gestures, touch
Physical environment/office
Cultural/ethnic differences
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Positive Affect Must be
Consistent
•
•
•
•
•
•
Communication should be supportive
Treat others with respect
Create environment of trust & openness
Observe nonverbal cues
Respond in an affirming way
Verbal and nonverbal messages must be congruent
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Listening Skills
• Essential for interpersonal communication
• Need developing
• Concentrate on verbal & nonverbal messages
• Require practice
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Common Issues Related to
Poor Listening
• People have limited/underdeveloped attention
span
• People don’t listen to uninteresting messages and
listen to what they “like” or benefit from
• People base judgments on nonverbal behavior
• People believe messages from media
• Being biased, prejudice and ignoring the concerns
of others
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Improving Listening Skills
• Remind self to listen carefully & concentrate
• Have an open mind
• Determine what is said & important
• Relate information to what is known
• Notice verbal/nonverbal messages
• Listeners can provide feedback
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Negotiation
• Refers to the exchange of alternatives for
dietary change between the professional &
client
• A process of exchanging goods/services &
agreeing on the exchange rate
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Five Stages of the
Negotiation Process
1. Preparation & planning
2. Definition of ground rules
3. Clarification & justification of positions
4. Actual bargaining & problem solving
5. Closure & implementation
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Improving Negotiation Skills
• Begin with a positive overture
• Address problems, not personalities
• Pay attention to initial discussions/offers
• Emphasize win–win solutions
• Create an open & trusting climate
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communicating with
Legislators
• Get to know elected representatives
• Develop relationships
• Work with professional associations
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins