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Foundations of nursing: first year /lecture 2
‫ م فادية حسين علي‬.‫م‬
Communication
1. Process of Communication:
Communication is the process by which information is exchanged between
the sender and receiver. The six aspects of communication are sender, message, channel,
receiver, feedback, and influences.
►Sender
The person who has a thought, idea, or emotion to convey to another person is
called the sender. Messages stem from a person's need to relate to others, to create
meanings, and to understand various situations.
►Message
The thought, idea, or emotion one person sends to another person is called the
message. It is a stimulus produced by the sender and responded to by the receiver. A
person's perception (the meaning that the individual assigns to any sensory input) can
alter the message.
►Channel
The person sending the message must decide how to send the message. The
method by which a message may be transmitted is verbal or nonverbal.
►Receiver
The physiological component involves auditory, visual, and kinesthetic processes.
The person's psychological processes may enhance or hinder the receiving of messages.
For example, anxiety may cause an individual to experience alterations in
hearing (act or power of perceiving sounds), vision, or feeling.
The cognitive element is the "thinking" part of receiving. It involves interpreti ng
stimuli and converting them into meaning, as in listening (interpreting sounds heard and
attaching meaning to them).
►Feedback
Feedback is a response from the receiver that enables the sender to verify that the
message received was the message sent. When these are not the same, more messages
are sent and received until the receiver understands the message sent by the sen der.
►Influences
Culture, age, emotions, language, and attention influence both the sender and
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Foundations of nursing: first year /lecture 2
‫ م فادية حسين علي‬.‫م‬
receiver as well as the situation within which they find themselves. All of these elements
together are called a person's frame of reference. These influences so metimes help
communication, and sometimes they hinder communication.
2. Methods of Communication:
There are two methods of communicating: verbally and nonverbally. Which is
better? The answer is neither, or, more accurately, it depends on what the sender is
trying to communicate.
1. Verbal Communication
Verbal communication is the use of words, either spoken or written, to
send a message. Methods of verbal communication include speaking, listening, writing,
and reading.
a. Speaking/Listening
Speaking is usually thought of as verbal communication, but the receiver of a
spoken message must listen. For communication to take place, both speaking and
listening must occur. Have you ever spoken to someone in the same room with you and
received a no meaningful, senseless response from that person or no response at all? The
other person probably was only hearing words but not listening to the message.
b. Intonation
Tone of voice has been estimated to convey 23% of the context of a message.
When the same words are said in different tones of voice, they can have very different
meanings. Tone of voice might be pleasant, sincere, sorrowful, sarcastic, joyful, or
angry.
c. Writing/Reading
The receiver of the written message reads the words. The reader must understand
the words and then attach meaning to them. With a written message, there is generally
no opportunity for immediate feedback.
A good example is charting. The physician may read the caregivers' notes after
they have gone home, allowing no opportunity for immediate feedback. In such an
instance, if the notes read that a client was "uncooperative," the physician would
have little idea exactly what the caregiver meant. An entry of "refused to eat lunch,
refused to get out of bed and sit in chair," however, is far more exact, illustrating the
clarity in writing that is essential to good communication.
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Foundations of nursing: first year /lecture 2
‫ م فادية حسين علي‬.‫م‬
2. Nonverbal Communication
Nonverbal communication, or body language, is a method of
sending a message without using speech or writing. Communication without words is
done in many ways, including gestures, facial expressions, posture and gait, tone of
voice, touch, eye contact, body position, and physical appearance.
Clients are particularly sensitive to nonverbal messages and seem to believe them.
Nurses must therefore make every effort to be aware of the nonverbal messages they
may be sending to clients. Consider, for example, the nursing skills that are not pleasant
yet must be done. How would the client feel if the nurse had a facial expression of
disgust or revulsion when emptying a bedpan?
a. Gestures
Gestures are often referred to as "talking with hands:' Gestures may be used to help
clarify a verbal message, to emphasize an idea, to hold another's attention, or to relieve
stress. Finger tapping, fidgeting, or ring twisting generally indicates tension,
nervousness, or impatience. Shaking a fist indicates anger, whereas pointing may be
used to clarify directions.
b. Facial Expressions
Although some people have very expressive faces, others do not. A big smile is
easily interpreted as indicating happiness. Eyebrows can be very expressive, showing
surprise, worry, thoughtfulness, or displeasure. The manner in which the forehead is
wrinkled also sends a message.
Nurses must be very aware of their own facial expressions, especially when caring
for a client under "unpleasant" conditions, such as when a client is vomiting or suffering
from bowel incontinence. An expression of displeasure manifested as a "curled -up" nose
or disgust is easily identified by the client. The client, often already embarrassed at
requiring such care, will be reassured and comforted by a nurse's facial expres sion
indicating caring, concern, and empathy.
c. Posture and Gait
Good posture, with the head held up, and a purposeful gait are usu ally interpreted
as meaning self-confidence, competence, and a positive self-image. Stooped shoulders, a
downward-held head, and a shuffling gait generally convey low self-esteem, depression,
lack of confidence, or apathy.
d. Touch
Touch is a simple yet powerful form of nonverbal communication that even a
newborn infant can understand. Touch can communicate caring, understanding,
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Foundations of nursing: first year /lecture 2
‫ م فادية حسين علي‬.‫م‬
encouragement, warmth, reassurance, or affection. Of course, touch can also
communicate anger, displeasure, or a lack of caring and understanding.
Many nursing tasks involve touching the client (i.e., bathing, dressing changes,
ambulating). Touch, along with other nonverbal communication such as facial
expression, posture, eye contact, and tone of voice, will convey the nurse's c aring and
acceptance. Most clients accept touch as an integral part of nursing care when it is done
appropriately and professionally.
e. Eye Contact
Eyes, it is said, mirror the soul. Have you ever seen joy, sadness, pain, or laughter
in someone's eyes? It is very difficult to control these messages of the eyes.
Eye contact is generally interpreted as indicating interest and attention, whereas
lack of eye contact is thought to indicate avoidance, disinterest, or discomfort.
f. Body Position
Body position is often a good indicator of a person's attitude.
For example, crossed arms generally indicate withdrawal, although the person
could just be cold. The nurse needs to be cautious not to misinterpret the client's body
language. Open body positions, with the arms held freely at the sides, are usually
taken to mean a receptive attitude.
g. Physical Appearance
A person's physical appearance says a great deal about that person. A clean, neat,
appropriately dressed individual conveys a positive self-image, knowledge, and
competence. A dirty, sloppy, or inappropriately dressed person conveys the message of
"I don't care how I look," with the potential implication of "maybe I am not too
knowledgeable or competent" or "I am sloppy in what I do."
It is very important for every nurse to be clean, neat, and professionally dressed.
Clients and families understand the nonverbal message that appearance conveys.
Appearance does influence communication.
3. Influences on Communication:
Communication involves more than just sending and receiving verbal and nonverbal
messages. How a person sends or receives a message is influenced by such factors as age,
education, emotions, culture, and language. These factors must be taken into account for
accurate communication to take place.
1. Age
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Factors related to age affect communication. For instance, communicating with a child
is different from communicating with an adult and depends on the child's age.
Nonverbal communication, particularly touch, and facial expression can be understood
by infants. Before learning to understand words, a child can interpret tone of voice and
gestures.
Preschool children respond well to communication involving toys or play situations.
They should be allowed some choices, but no more than two alternatives should be offered. As
the child's vocabulary increases, more verbal communication can take place.
Elderly persons may have some degree of hearing loss or a slowed response
time. The nurse should face the elderly client when speaking and allow time for a
response. The client should be addressed as "Mr. ' or "Ms." unless he or she asks to be called
by his or her first name. These measures reflect respect to the individual from the caregiver.
2. Developmental Level
Individuals with mental retardation or developmental delays will communicate at their
level of development, not at what is usually expected for their chronological age.
3. Education
Vocabulary generally increases as does the ability to discuss and understand concepts
and abstract ideas.
4. Emotions
Someone who is very anxious or upset, for example, may not hear what is said or may
interpret the message differently than the sender intended. This same person typically speaks in
an abrupt manner, loudly, and in harsh tones. The depressed person, on the other hand,
typically says very little, speaking only one or two words or in very short sentences.
5. Culture
Each culture has its own standards of communication, especially with regard to nonverbal
behavior. In the United States, for example, eye contact is considered a sign of openness and
honesty. Those of Spanish heritage, however, believe eye contact to be disrespectful.
Similarly, in many parts of Europe, a kiss on the cheek between two men is accepted. People
from other parts of the world, however, may look suspiciously on this behavior.
6. Language
Speaking the same language assists people in understanding each other, although
regional accents or dialects of a language can inhibit communication and understanding.
When verbal communication comes to a standstill, nonverbal communication is often
employed to assist. Any nurse who works in an area where there is a predominant second
language should learn a few words or phrases in that language to help put clients at ease and
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to facilitate their understanding.
7. Attention
The amount of attention each individual focuses on a given communication
greatly affects the outcome. In selective listening, the receiver hears only what he wants
or expects to hear. Pain or discomfort, physical or mental, may result in preoccupation,
limiting the attention given to the communication.
8. Surroundings
Most people do not want to talk about the intimate details of their health care concerns
in public. Thus, privacy should be provided. If the client occupies a room alone, the nurse
should close the door; if the client shares a room, the nurse should take the client to a
conference room or to another private place, if possible, to discuss personal information.
4. Listening/ Observing:
Listening and observing are two of the most valuable skills a nurse can have. These two
skills are used to gather the subjective and objective data for the nursing assessment. Because
the nursing diagnoses and nursing interventions are based on the assessment, it is imperative
that the assessment be accurate.
The term active listening
has been used to describe the behavior of
listening and observing; it reflects the process of hearing spoken words and noting nonverbal
behavior.
It is listening for the meaning behind the words. This takes energy and concentration.
To show undivided attention to the client, the nurse should be at eye level with the client, lean
slightly forward toward the client, and make eye contact. In this position the nurse will be
able to listen and observe more accurately. Responses from the nurse such as "go on," "yes,"
"tell me more," "mmhm; or "what else?" communicate that the nurse is really listening and
encourage the client to continue.
5. Psychosocial Aspects of Communication:
The psychosocial aspects of communication are important for nurses to understand
and then apply when caring for individual clients. Consideration of these aspects makes communication more effective.
The psychosocial aspects of communication include gestures, style, meaning of
space, meaning of time, cultural values, and political correctness.
These aspects are based on individuality and culture and influence the nurse–client
relationship.
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Foundations of nursing: first year /lecture 2
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1. Gestures
Gestures are movements of the body to reflect a thought, feeling, or attitude. Some
gestures are known globally, such as applause to indicate approval. Some gestures, however,
have entirely different meanings in various countries.
The nurse must be sensitive to cultural variances and exercise good judgment when
caring for clients of different backgrounds and heritages.
2. Style
Each person has a style of communication reflecting the personality and self-concept of
that person. According to Jack (2000), there are three common types of style: passive, aggressive, and assertive. Remember that a person's style of communication is learned and has been
reinforced over the years. Because communication style is learned, it can be changed.
a. Passive
The person using the passive style of communication is not able to share feelings or
needs with others, has difficulty asking for help, does not stand up for himself, and is hurt and
angry when others take advantage of him. This person has a weak, soft voice; uses apologetic
words; makes little eye contact; and is often fidgety.
b. Aggressive
The person using the aggressive style of communication puts his own needs and
feelings first. Communication is done in a haughty or angry manner. The voice is often
demanding. This person works to control or manipulate others, shows so concern for
anyone else's feelings, and has an attitude of superiority.
c. Assertive
The assertive person stands up for himself without violating the basic rights of others.
True feelings are expressed in an honest, direct manner, and others are not allowed to take
advantage of him. The voice is firm and confident, and appropriate eye contact is made. Such
a person also respects the rights, needs, and feelings of others; takes responsibility for the
consequences of his actions; and behaves in a manner that enhances self-respect.
3. Meaning of space
The study of space between people and its effect on interpersonal behavior.
How much space do you prefer between yourself and another person? This distance
usually varies with the person and the situation. The distance at which one person is comfortable with another person is influenced by age, gender of those interacting, and cultural
values.
Hall (1959) categorizes these comfort zones as intimate, personal, social, and public
space, defined as follows:
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Foundations of nursing: first year /lecture 2

‫ م فادية حسين علي‬.‫م‬
Intimate: (touch - 18 inches) ; usually limited to family and close friends; necessary
when performing most nursing procedures

Personal: (18 inches - 4 feet) used with friends and coworkers; effective for many
nurse–client interactions involving interviewing or data gathering

Social: (4 to 12 feet) preferred distance with casual acquaintances

Public: (12 feet or more) generally used with strangers in public places
Much of nursing care involves touching the client, yet on admission the nurse and
client generally do not know each other. The nurse must move from the client's public
space to the client's intimate space in a very short span of time to provide care. When
care is given competently and professionally, it helps the client feel more comfortable as
the nurse occupies the client's intimate space.
4. Meaning of time
Time is money. The clock is watched, so individuals know where they are to be
every hour of the day and night. When scheduled appointments are kept, the person is
considered to be dependable.
5. Cultural Values
It is important that the nurse be familiar with the cultural values of the people
in the nurse's region of employment, especially when those values differ from the
values of the dominant culture.
6. Political Correctness
Politically correct communication uses language that shows sensitivity to those
who are different from oneself it is intended to avoid the use of language that offends and to
help eliminate prejudice. Terms that suggest inferior status for members of minority
groups and terms that exclude older people, women, and those with handicaps are replaced
by politically correct language. Prejudice and false ideas, which often lead to violence, are
perpetuated by racist and bigoted language.
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