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Communication Skills for Midwifery Practice
Part A
By Richard Byrt Former Lecturer/Practitioner, Nursing De Montfort University,
Leicester and Arnold Lodge Medium Secure Unit, Nottinghamshire Healthcare NHS
Trust.
Adapted for midwifery by Jacqui Williams, Senior Lecturer in Midwifery
1.1. Introductory Notes
Welcome to the lectures and exercises on communication skills.

A list of recommended reading/references is at the end of this handout.

The examples of clients based on the lecturer’s practical nursing experience are fictitious
and not intended to describe clients in local services or elsewhere.

The terms woman and midwives have replaced the original terms of clients, patients,
residents and other users of health services.
1.2. Aim of Lectures/Topics for Consideration
The aim of the lectures is to enhance our reflection on, and understanding of
communication and therapeutic professional - client relationships in midwifery.
Topics include:

The meaning of communication. Verbal and non verbal communication in midwifery

Why effective communication is essential for good midwifery care.

Active listening to women.

Empathy: the importance of women’s perspectives.

The concept of presence in relation to non verbal communication and empathy.

The influence of cultural and other factors on communication.

Nursing and Midwifery Council (NMC) requirements for effective communication,
respect and dignity.

Women with specific communication needs.

Communication in health promotion.
1.3. Methods to Enable Reflection and Understanding of Communication
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During the lectures on communication, a variety of methods will be used to enable reflection
on communication and to gain information about specific communication skills in nursing.
Some of these methods may be new to you, but it is suggested that you give them a
try, as they may enhance your reflection on communication in midwifery. We will
consider:

The use of women’s accounts of their care in prose .

Exercises involving two or three midwifery students.

Research studies and other literature on communication in midwifery , especially on
clients’ experiences of communication with midwives.
2.1. What is Communication?
O’Carroll and Park (2007) define interpersonal communication (communication between
people) as:
“The process by which information, meanings and feelings are shared by people
through the exchange of verbal and non – verbal messages”.
(O’ Carroll and Park, 2007, p106).
(The word “meanings” in O’Carroll and Park (2007), probably refers to things that people
understand or experience).
2.2. Verbal and Non – Verbal Communication

Verbal communication refers to using speech and writing to share thoughts,
feelings and ideas with other people.

Non – verbal communication includes all other ways that people share their
thoughts. feelings and ideas: e.g.:






Facial expressions.
Touch.
Gestures such as nods of the head.
Silence.
The way people sit or stand.
The space they maintain between them.
(Arnold and Boggs 2007, Sully and Dallas 2010)
Aspects of verbal and non – verbal communication are considered in more detail later in this
handout.
3. Why Effective Communication is an Important Part of Professional Care
Effective communication is a vital part of midwifery and other professional care for the
following reasons:

Effective communication enables holistic care: caring for the whole person and her/his
many needs, instead of concentrating on only one aspect of care, for example, physical
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health needs (American Holistic Nurses’ Association 2011, Hunter et al 2008, McKenna
and Slevin 2008).

Good communication skills help the health professional to appreciate and understand
the woman’s feelings and perspectives: e.g., her perception of health needs. This
understanding constitutes part of empathy (Arnold and Boggs 2007, Butler et al 2008).

Empathy includes an appreciation of the woman’s perspectives related to aspects of
diversity: e.g., her culture, spirituality, ethnic group, age, gender, sexual orientation and
gender identity (Andrews and Boyle 2008). (Spirituality refers to the individual’s
important religious and other beliefs; and their sense of hope, purpose and what gives
their life meaning (McSherry 2006). Gender identity refers to the person’s sense of
herself/himself as a woman/girl or as a man/boy (Poorman 2009).

Some women have specific communication needs. It is not possible to provide
assessment, care and treatment unless the midwife adapts her/his communication to the
client’s needs related to their specific communication skills and problems (Arnold and
Boggs 2007).
Research findings from different health care settings suggest that:
o
Clients are more satisfied, and less anxious if there is effective communication and a
therapeutic professional – client relationship (Byrt et al 2008, Hunter et al 2008).

An example from nursing suggests that there is evidence that some nurses avoid
communicating with certain clients: e.g., people who are dying (Taylor 2006); or who
are seen as “difficult”: e.g., because they don’t “fit in” with ward regimes or staff
expectations (Duxbury 2000, Stockwell 2004).
o
Many complaints from clients and their carers at home are about poor communication
from health professionals (Jangland et al 2009, The Patients’ Association 2009: This is a
voluntary organization concerned with the health and welfare of patients and clients).

Clients who do not speak or understand English sometimes have less access to
health services and relevant information (Peckover and Chidlaw 2007, Tribe and
Raval 2003).
o
Good communication skills, particularly relieving anxiety and giving clear information,
result in positive outcomes in physical and psychological health following surgery
(operations) and other procedures (Morrison and Bennett 2009, Taylor 2006). Many
studies have found statistically significant positive outcomes (that is, these outcomes are
unlikely to have occurred by chance: Gerrish and Lacey 2006).
o
Effective communication, including clear information, can improve the health of people
with long – lasting illnesses: e.g., diabetes and asthma (Morrison and Bennett 2009)
and with illnesses which may recur (occur again), such as schizophrenia (Gamble and
Brennan 2006).
o
Communicating in ways which are meaningful and understandable to clients may,
amongst other factors, enable individuals to make informed choices related to their
own health or that of their children (including unborn children). This has been found
in research on breastfeeding (Wood 2009), cessation of smoking and changes in diet
(Morrison and Bennett 2009).
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4.Effective Communication in 1888 and Today
“As long ago as 1888, Eva Luckes, [Matron of the Royal London Hospital], referred to the
importance of good…communication with clients:
“It is especially when your patients are weak and helpless and irritable, that you need
to be gentle and considerate towards them; they are so completely in your power,
and they may so easily be made to suffer more than they need do, by your having a
sharp way of speaking, a rough touch, or a grumbling manner of attending to them”.
(Luckes, 1888, p14, quoted in Ford et al 2010, p85)
More recently, Boggs (2007) writes:
“Since effective communication has been shown to produce better health outcomes,
greater client satisfaction, and increased client understanding, nurses ( include
midwives here) should be interested in improving their communication styles”.
(Boggs 2007, p186)
The next part of this handout will consider the importance of effective communication in more
detail.
5. Communication in Holistic Care
The term “holistic care” refers to recognizing that clients have a wide variety of physical,
psychological, spiritual, cultural, psychosexual, safety and other needs; assessing
these needs; and providing care which meets them (American Holistic Nurses’
Association 2011). According to many theories and models of nursing and midwifery,
effective communication enables holistic care of clients and the meeting of a wide range
of needs (Cutcliffe et al 2009, Lavender and Jacob 2008, McKenna and Slevin 2008).
Holistic care can be contrasted, for example, with care which is concerned with a narrow
range of clients’ needs: e.g., only carrying out a practical procedure such as dressing a
wound, without considering the client’s feelings or need for information. Examples of this are
given in Exercise , p8 of this handout.
Most theories and models of nursing and midwifery emphasise the importance of the
client’s experiences and perspectives (Arnold and Boggs 2007, McKenna and Slevin
2008), as do many innovations in nursing practice. The latter include developments in:

Child-centred/family – centred nursing (Smith et al 2002).

Patient-centred care in adult nursing (Koubel and Bungay 2009).

Humanistic or client-centred approaches in mental health nursing and learning disability
nursing (Sanderson 2007), based on the theories of Carl Rogers (Barker 2009, Freeth
2007).
6. Sensitivity to Women’s Needs and Perspectives
Good communication skills, including active listening and the development of empathy,
enhance professionals’ ability to be sensitive to, and meet, clients’ specific needs; and
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understand their perspectives, including those related to culture, spirituality, ethnic
group, age, gender, sexual orientation and gender identity (defined earlier in this
handout).
Examples include the following:

Monica Khan needs a quiet time to pray each day whilst she is on the antenatal ward as
an inpatient due to Placenta Praevia. The midwives demonstrate empathy by
appreciating Ms Khan’s need not to be disturbed during these times. Where this is
not possible, e.g., because of an urgent procedure, a midwife explains this to Monica
Monica’s need to pray are also documented in her handheld notes and included in a
care plan on her spiritual needs, which are assessed soon after Monica is admitted.

Ameera Kaur is 22 weeks gestation and is admitted following a vaginal bleed. Mrs Kaur,
who lives in the Punjab region of India, is visiting family in Leicester. She speaks and
understands several languages, but not English. A professional interpreter is
arranged as soon as possible. In the meantime, besides attending to Mrs Kaur’s
physical care needs, the midwives enable Mrs Kaur to feel welcome and relieve her
anxiety through verbal communication (interpreted by her sister) and non – verbal
communication. The latter includes appropriate eye contact, and the use of touch,
which Mrs Kaur finds comforting. For example, she derives considerable comfort from
holding the hand of a student midwife. The midwives’ comforting tone of voice is also
important.

When Ms Hyacinth Churchill is admitted with premature labour she tells the midwife
looking after her that she wants her lesbian partner to be given information. The midwife
and the rest of the ward team ensure that Ms Churchill’s partner is given relevant
information, in line with Ms Churchill’s request. They also avoid assuming, in their
assessments, that all women and men are heterosexual: that is, attracted to someone
of the opposite sex (Fish 2006, Royal College and Unison 2004).

Janet Jones, aged 31, is asked (as all clients should be) his preferred name and title.
She prefers to be called “Jane”, as only her mother calls her Janet. The Community
Midwife who will be visiting her at home ensures that her preferred name is used. The
person’s preferred name needs to be ascertained and recorded at the booking
appointment , and all staff need to address the woman in the way she prefers.
7.1. Verbal Communication
Verbal communication includes the following:

What is said (speech content).

Clarity of speech: whether what is said is clear or not. A midwife could, for example,
explain a procedure in a way that was clear to the woman. In doing so, the professional
would need to adapt her/his explanation to take account of the individual’s communication
strengths, needs and problems. In relation to clear communication, the professional
would need to take account of the following:

Whether the client understands and speaks English or other languages.

The client’s level of cognitive development (related, e.g., to thought,
understanding, memory, perception, vocabulary, intelligence: Gross 2010).
Cognitive development varies considerably amongst children of the same
age; and nurses adapt their communication in relation to this (Arnold 2007b).
In addition, cognitive development in a child or adult can be influenced by
brain damage or changes to brain functioning. The structure and/or
functioning of the brain affects understanding and responding to
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communication in many individuals with learning disabilities (Ferris – Taylor
2007); and some people with mental health problems or brain injury: for
example, from strokes or road traffic accidents (Gamble and Brennan 2006,
Richardson 2007).

The individual’s understanding of her/his health problem, and how
she perceives this. This might be related to the person’s culture
(shared values, beliefs and ideas by members of a specific social
group: Thompson 2003) and experience. (Women with diabetes or
epilepsy for example are experts in knowing about, and managing,
long – term or recurrent health problems of themselves or their
children or other family members. It is seen as good practice for
professionals to respect the expertise of clients and their carers at
home; and to work collaboratively with them (Byrt and Dooher 2003).

The client’s level of anxiety may affect the individual’s ability to
concentrate on, or retain information given by the midwife. Some
mental health problems and learning disabilities may also affect
this (Barker 2009).
7.2. Other Aspects of Verbal Communication
These include:

The tone of voice: the way in which something is said. For example, a midwife could
have a tone of voice that was abrupt or harsh. Alternatively, her voice could indicate
concern and interest.

The voice’s pitch: how high or low it is.

The use or absence of jargon (e.g., terms the woman doesn’t understand: Boggs 2007,
O’Carroll and Parks, 2007).
7.3. Communication Difficulties
“The interpretation of the meaning of words may vary according to the individual’s background
and experience. It is dangerous to assume that words have the same meaning for all
persons who hear them… (Boggs 2007 p. 187)
For example,
A midwife speaking to a woman who does not have English as her first language.
Talking to a woman about antenatal screening.
7.4. Cultural Variations in Spoken Communication
Of crucial importance is midwives’ appreciation of variations in cultural expression (Boggs
2007). What may appear to be rude or aggressive in the midwife’s culture might be
friendly behaviour in another. In a study of black mental health clients’ views, one
individual said:
“The perception that goes along with being black is that they’re violent and they
are aggressive, and the misconception that necessarily, because we might
gesticulate quite a lot or we might talk loudly, we might laugh loudly, yeah, the
perception that’s linked with that is of a violent and aggressive nature”.
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(Chandler – Oatts and Nelstrop 2008, p36, quoted in Ford et al 2010, p118)
Boggs (2007, p188) comments:
“The tone of voice used to express anger and other emotions varies according
to culture and family. For example, it is sometimes difficult for [a]…nurse to tell
when someone from another culture is angry because their vocalization of strong
emotion may be more controlled.
“By contrast, loud, rapid vocalization may seem angrier than intended, when in reality,
they just convey culturally learned emotional intensity.
“Through repeated interaction with clients, the nurse [and midwife] learns to
understand the message the client is trying to communicate”.
(Boggs 2007, p188)
8.1. Non – Verbal Communication and Therapeutic Relationship Skills
Non – verbal communication and related skills include the following:

Active listening to the client’s verbal and non verbal communication.

“Non verbal body cues” or “body language” (Boggs 2007a, p190), including:

“Facial expression” (Boggs 2007a, p190).

Eye contact.

Gestures: e.g., to convey understanding: for example, appropriate nods of the head.

Ways of sitting or standing (including posture).

Amount of space: e.g., between the professional and the client.

The therapeutic use of touch: e.g., to comfort a child or adult client.

Empathy: attempting to understand the feelings and experiences of the client; conveying
this understanding; and taking related practical action.

Presence: “being with” the client: e.g., conveying compassion non-verbally to an
individual whose relative has just died.

Non – judgmentalism: accepting the client and what she/he says, without making moral
judgments and whilst conveying respect for her/him.

Respect includes valuing the person and her/his individuality, uniqueness and
diversity related to culture, spirituality, ethnic group, age, gender, sexual
orientation and gender identity .

Ensuring an individual’s privacy and dignity is crucial to respecting the individual:
(Barker 2009, Baughan and Smith 2009, Gates 2007, Hunter et al 2008)
8.2. Ensuring Dignity
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“To treat someone with dignity is to treat them as being of worth, in a way that is
respectful of them as valued individuals…
“Dignity may be promoted or diminished by…the attitudes and behaviour of the nursing team
and others; and by the way in which care activities are carried out”.
(Royal College of Nursing 2008)
8.3. Respect for Clients and the Nursing and Midwifery Council
The Nursing and Midwifery (NMC) (2008) Code: Standards of Conduct, Performance
and Ethics for Nurses and Midwives states that nurses and midwives must “make the care
of people your first concern, treating them as individuals and respecting their dignity…
“You must not discriminate in any way against those in your care”.
8.4. Exercise 1. Communication as Part of Care
Choose one of the examples below, and discuss with one or more colleagues sitting near
you:

In what ways could the midwife communicate more effectively with the woman?

In what ways would this be likely to benefit the woman?

In preparing Ms Ann Amber for an elective lower caesarean section , a midwife
concentrates on her physical needs, but fails to recognize that Ms Amber is very
anxious about her operation, and worried about whether her husband has been told that
she is being prepared. Ms Amber is worried about bothering the midwife, but her facial
expression reveals considerable anxiety.

A midwife ignores Magda’s concerns whether she is producing enough breast milk
for her baby, assuming that these concerns are “a new mother being over
anxious”. Magda has given up breast feeding when she visits later in the week.

Mr Gus Green, a young man of 18, is rude and hostile towards the midwife , who decides
that she will not bother communicating with him if he is going to behave in this
way. However, Mr Green’s behaviour is partly caused by his fears for his partner who is
bleeding per vaginum. It’s easier for him to be rude and hostile than to cry or say he’s
anxious, partly because he’s worried about losing face, and wants to appear tough when
his best mate (his partner’s brother) comes in to visit.
9. Active Listening and Empathy: Two Key Skills in Midwifery and for other Health
Care Professionals
In the examples we’ve just considered, the use of two key skills would have helped the
clients:

Active listening: careful attention to the clients’ non – verbal and verbal communication.

Empathy: attempting to understand the client’s feelings and experiences, communicating
this understanding to her/him; and taking practical action to help the client.
(Arnold and Boggs 2007, Baughan and Smith 2009)
10.1. Active Listening
Arnold and Boggs (2007, p531) define active listening as:
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“A dynamic, interpersonal process whereby a person” (such as a midwife):

“Hears a message”. (The message may be verbal and non verbal, as when Mr Gus
Green describe says he doesn’t have any concerns or queries because he’s worried that
the midwife will ask him questions about having sexual intercourse with his partner earlier
in the day. However, the midwife might pick up Mr Green’s non verbal messages and put
him at ease before asking more direct questions to gain the information.

“Decodes its meaning”: that is, the midwife interprets the non verbal message (“Mr
Green is in pain because he’s grimacing and clutching his abdomen)”; or the possible
meaning behind a verbal message: (“Mr Green is being rude to me because he’s acting
tough so as not to lose face, when he’s really anxious about whether or not he has
caused the bleeding).

“Conveys an understanding about the meaning [of the verbal or non verbal
message] to the sender”. The midwife could convey understanding by saying: “Many
woman experience bleeding per vaginum but we need to find out the cause and ensure
she and the baby are okay.’ Or: “If you’d like to, you’re very welcome to tell me if
anything’s bothering you”. The midwife could also show an interest in anything that Mr
Green said about his relationship with his partner.
(Quotes, above, are from Arnold and Boggs 2007, p531).
10.2 Features of Active Listening
In active listening, the professional expresses interest and concern in what the client is
saying through:

Close attention to what is being said, without interruption.

Close attention to the client’s non – verbal communication, such as angry or sad
facial expressions (as in the above example with Magda).

The use of prompts, such as “would you like to tell me more?” can also indicate
interest and a readiness to listen.

The professional’s tone of voice -

And appropriate eye contact is also important.
(Arnold and Boggs, 2007, Sully and Dallas 2010)
The compiler of this handout once facilitated percussion bands for men and women with
learning disabilities. The music provided a means of communication, as an alternative to
speech, for some of these individuals. It was necessary to actively listen: to observe
clients’ non - verbal communication to assess whether or not they enjoyed the music,
and benefitted from using it to communicate and express feelings.
For example, one individual conveyed distress by rushing out of the music room, and was
provided with quiet space and an alternative activity. Another individual showed his
enjoyment of the music by smiling broadly, especially when his hands were moved in rhythm
to the music. This provided him with an additional means of communication and enjoyment
(Gates 2007). (This example also has applicability to the use of music with other
people: e.g., younger or older people with dementia).
10.3. Active Listening and Babies: Understanding the Meaning of Babies’
Communications
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Horgan et al (2002) studied non – verbal communication in recently born babies:
“…Further study…identified LIDS [the Liverpool Infant Distress Scale] as providing a
continuum along which all neonatal behaviour could be measured, ranging from no
distress/relaxed, at one end, to extreme distress/pain at the other. For example, the
category for facial expression is defined from:
0 –“Eyelids closed and relaxed - no lines, lips slightly apart. No movement of nostrils or face”:
indicating normal, comfortable behaviour; to 5 – “Practically all the time without relief, a
constantly furrowed brow. Very flared nostrils, unnaturally open mouth with tightly held lips.
Eyes tightly shut. A grey pallor to face” : indicating very distressed behaviour…”
(Horgan et al, 2002, p98).
10.4. Exercise 2. Active Listening
Please divide into pairs. Student A talks to Student B about her/his hobbies and
interests for 2 minutes. During this time, Student B is to look as uninterested and
bored as possible: e.g., yawn, look at your watch, read this handout, whilst appearing
completely uninterested.
After 2 minutes, swap roles so that Student B talks about her/his hobbies and interests
and Student A is as uninterested and bored as possible.
.
After this exercise, please discuss the following question:

What did it feel like to be completely ignored?

How easy was it to ignore your fellow Student?

Has the exercise helped you at all to reflect on what it is like for clients to be
ignored or not listened to?
ACKNOWLEDGEMENT
This exercise was devised by Ian Rudd, Senior Lecturer in Nursing, School of Nursing
and Midwifery, De Montfort University. Thanks to Ian Rudd for agreeing to the use of
this exercise, and its inclusion in this handout.
11. Congruence Between Verbal and Non–Verbal Communication
An important part of active listening involves congruence. One aspect of congruence
concerns the match between the individual’s verbal and non verbal communication. A
midwife would be congruent if her/his facial expression and the way she was sitting mirrored
her verbal communication.
An example of incongruence would be for the professional to state that she/he was
interested, but then look out of the window or glance at a watch to see if it was time to go
off duty (Arnold and Boggs 2007).
Congruence is also relevant to nurses noticing whether or not there is a match between
clients’ non verbal and verbal communications. For example, a woman might say that he
is not in pain because she doesn’t want to trouble the midwives. “They’re always rushed off
their feet, poor things, I don’t like to trouble them”.
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12.1. Empathy
Empathy comprises:

An attempt to accurately understand and appreciate the feelings, views,
perspectives and experiences of the client.

Clearly conveying this understanding to the client so that she/he feels understood
and accepted (Freeth 2007, Stuart, 2009).

“In addition, Kunyk and Olson (2001) argued that empathy must also include taking
practical action in relation to the client’s expressed concerns” (Ford et al 2010, p87),
including “nursing (read midwifery) interventions that meet the physical needs of
the client and alleviate emotional suffering…” (Kunyk and Olsen, p322).
12.2. Checking that the Client’s Experiences and Feelings Have Been Correctly
Understood
Another aspect of empathy is for the midwife to check that she/he has correctly
understood the woman’s non – verbal and/or verbal communication. For example, a
woman might seem anxious just before a procedure such as taking blood. It would be easy to
assume that the venepuncture is the cause of the anxiety, when this might not be the case.
An empathetic midwife would check this: “Are you worried about having your blood taken?”
Clarifying this would enable the client to say “yes”, or give information that they are worried
about what will happen if the results are abnormal. In using empathy, the professional:
“…offers the [client] an opportunity to validate the accuracy of the
[professional’s] perceptions and to experience being understood. The
[client’s]…awareness of the [professional’s] communication allows him/her to say,
“Yes, that is how I see things” and, “Yes, that is what I would like to happen”.
(Reynolds 2005, p95)
12.3. An Example of Empathy
“In relation to a [woman] called (“Kay”) who is expressing a complaint in a verbally aggressive
manner, a [midwife’s] empathy would include an attempt to appreciate “Kay’s” perspective
through active listening…(Arnold 2003, p235).
“Part of the [midwife’s] empathetic response would be to seek clarification if she/he was
not sure what Kay meant, or ask for more precise details: e.g., related to the nature of the
complaint.
“The “taking practical action” aspect of empathy could be offering an apology, giving
information about the [woman’s] complaints procedure and responding by remedying
a situation about which the client is concerned.”
(Ford et al 2010, p87, citing Evans and Byrt, 2002).
12.4. Empathy and Self – Awareness
“In some situations and with some women, it may be appropriate to see empathy as a
developing process, which improves as the [midwife] gets to know the [woman] better”
(Ford et al 2010, p87). Empathy involves self – awareness, including the midwife’s
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appreciation of gaps in her/his understanding of the woman, and an acceptance that this may
take time to develop. Self – awareness has been defined as “the means by which a person
gains knowledge and understanding” (Arnold and Boggs 2007, p536).
Recommended Reading and References
Key Texts on Communication
Arnold, E. and Boggs, K. U. (2007). (5th Ed.). Interpersonal Relationships. Personal
Communication Skills for Nurses. St. Louis, Missouri. Saunders Elsevier.
Barker, P. (ed.). (2009). (2nd Ed.). Psychiatric and Mental Health Nursing: The Craft of
Caring. Arnold: London.
Baughan, J. and Smith, A. (2009). Caring in Nursing Practice. Harlow. Pearson
Education, Ltd.
Burnard, P. (2005). (4th Ed.). Counselling Skills for Health Professionals. Cheltenham.
Nelson Thornes, Ltd.
Ferris – Taylor, R. (2007). Communication. In: Gates, B. (Ed.). (2007). (5th Ed.).
Learning Disabilities. Towards Inclusion. Edinburgh. Churchill Livingstone Elsevier.
Riley, J.B. (2008). (6th Ed.). Communication in Nursing. St. Louis, Missouri. Elsevier
Mosby.
Sully, P. and Dallas, J. (2010). (2nd Ed.). Essential Communication Skills for Nursing
and Midwifery. London. Mosby.
Nursing and Midwifery Council (NMC) Publications
Nursing and Midwifery Council. (2002). (Revised Ed.) Practitioner – Client Relationships
and the Prevention of Abuse. London. Nursing and Midwifery Council.
Nursing and Midwifery Council. (2008). The Code. Standards of Conduct,
Performance and Ethics for Nurses and Midwives. London. Nursing and Midwifery
Council.
Nursing and Midwifery Council. (Undated). Guidance for the Care of Older People.
London. Nursing and Midwifery Council.
Communication in Specific Areas of Nursing
Andrews, M.M. and Boyle, J.S. (Eds.). (2008). Transcultural Concepts in Nursing Care
(Chapter 1). Philadelphia. Lippincott, Williams and Wilkins.
Arnold, E. (2007a). Developing Therapeutic Communication Skills in the Nurse-Client
Relationship. Chapter 10 in: Arnold, E. and Boggs, K. U. (2007). (Eds.). (5th Ed.).
Interpersonal Relationships. Personal Communication Skills for Nurses. St. Louis,
Missouri. Saunders Elsevier.
Arnold, E. (2007b). Communicating with Children. In: Arnold, E., Boggs, K.U. (Eds.).
(2007). (4th Ed.). Interpersonal Relationships. St. Louis, Missouri. Saunders Elsevier.
Arnold, E. (2007c). Intercultural Communication. Chapter 11 in: Arnold, E., Boggs,
K.U. (Eds.). (4th Ed.). Interpersonal Relationships. St. Louis, Missouri. Saunders
Elsevier.
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Arnold, E. and Ryan, J.W. (2007). Communicating with Older Adults. In: Arnold, E.
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