Communication

Prepared by: Zarah Samuel

BSc.N, RN
Specialized In: ICU, CCU

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Objective
At the end of this session learner will be able to;
 What is communication?
 Definition of communication
 Communication process
 Modes of communication
 Factors influencing the communication process
 Therapeutic communication
 Barriers to communication
 Define Helping Relationship
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 Characteristic of Helping Relationship
 Phases of Helping Relationship
 What is Group Communication
 What is Disruptive Behavior
 Communication Styles

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What is Communication?
 Communication is the critical skill of nursing.
 In nursing, communication is a dynamic process used to gather
assessment data, teach and persuade, and to express caring and
comfort.
 It is an integral part of the helping relationship.

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Define Communication
It can be defined as;
“Communication is any means of exchanging information or
feelings and ideas between two or more people or group of
individuals.”

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The Communication Process

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Modes of Communication
Communication is generally carried out in two different modes;
1. Verbal Communication
2. Non-Communication
Another form of communication has evolved with technology.
 Electronic Communication

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1. Verbal Communication
 Verbal communication uses the spoken or written words.
 Nurses need to consider the following when choosing words to
say or write.
1. Pace and Intonation
2. Simplicity
3. Clarity and Brevity
4. Timing and Relevance
5. Adaptability
6. Credibility
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7. Humor
2. Non-Verbal Communication
Non verbal communication sometimes called body language,
includes gestures, body movements, use of touch and physical
appearance including adornment.
It includes;
1. Personal Appearance
2. Posture and Gait
3. Facial Expression
4. Gestures

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Electronic Communication
 E-mail is the most common form of electronic communication.
 It is important for the nurse to know the advantages and
disadvantages of e-mail and also other guidelines to ensure client
confidentiality.

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Advantage Dis-Advantages
• E-mail has many positive • One negative aspect of e-mail is
advantages. concern by both client and primary
• It is fast, efficient way to care provider regarding privacy,
communication. confidentiality and potential misuse
of information.
• It is legible.
• Another disadvantage is
• It provide record of the data and socioeconomics.
time of the message that was sent
• Not everyone has a computer.
or received.
• This improve communication and
• Even if people have access to
computer at public library, not
continuity of client care.
everyone has necessary computer
skills.
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Factors Influencing the Communication Process
Many factors influence the communication process includes;
 Development
Language, psychosocial, and intellectual development move through
stages across the life span. Knowledge of a client’s developmental
stage will allow the nurse to modify the message accordingly.
 Gender
From an early age, females and males communicate differently.
Girls tend to use language to seek confirmation, minimize
differences, and establish intimacy. Boys use language to establish
independence and negotiate status within a groups.
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 Values and Perception
Values are the standards that influence behavior, and perceptions are
the personal view of an event. Because each person has unique
personality traits, values, and life experiences, each will perceive
and interpret messages and experiences differently.
 Personal Space
Personal space is the distance people prefer in interactions with
others.
Proxemics is the study of distance between people in their
interactions. Middle-class North Americans use definite distances in
various interpersonal relationships, along with specific voice tones
and body language.

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Beebe, Beebe, and Redmond (2014, p. 202) list the following
examples:
1. Intimate: 0 to 11 ⁄2 feet
2. Personal: 11 ⁄2 to 4 feet
3. Social: 4 to 12 feet
4. Public: 12 feet and beyond.
 Territoriality
Territoriality is a concept of the space and things that an individual
considers as belonging to the self. Territories marked off by people
may be visible to others.

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 Roles and Relationship
The roles and the relationships between sender and receiver affect
the communication process. Roles such as nursing student and
instructor, client and primary care provider, or parent and child
affect the content and responses in the communication process.
 Environment
people usually communicate most effectively in a comfortable
environment. Temperature extremes, excessive noise, and a poorly
ventilated environment can all interfere with communication. Also,
lack of privacy may interfere with a client’s communication about
matters the client considers private.

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 Congruence
In congruent communication, the verbal and nonverbal aspects of
the message match. Clients more readily trust the nurse when they
perceive the nurse’s communication as congruent. This will also
help to prevent miscommunication.
 Interpersonal Attitudes
Attitudes convey beliefs, thoughts, and feelings about people and
events. Attitudes are communicated convincingly and rapidly to
others. Attitudes such as caring, warmth, respect, and acceptance
facilitate communication, whereas condescension, lack of interest,
and coldness inhibit communication.

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 Boundaries
Boundaries are defined by Boyd (2012) as “limits of individuals,
objects, or relationships.”
For nurses, professional boundaries are crucial in the context of the
nurse–client relationship.
Aylott encourages nurses to reflect before publishing anything to a
web-based social network site and to review the submission using
the following PCA test:
1. Pause and process (recognize potential for boundary crossing)
2. Choices (evaluate the situation and options)
3. Act accountably (professional conduct)

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Therapeutic Communication
Therapeutic communication promotes understanding and can help
establish a constructive relationship between the nurse and the
client.

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Kneisl and Trigoboff (2013) point out the following blocks to listening that may
prevent the nurse from hearing what the client is saying and hinder therapeutic
communication:
1. Rehearsing—being too busy thinking about what you want to say.
2. Being concerned with yourself—the focus should be on the client
3. Assuming—thinking that you know what the client “really means” without
validation.
4. Judging—framing what you hear or see in terms of your judgment about the
client as being immature, depressed, etc.
5. Identifying—focusing on your own similar experiences, feelings, or beliefs
6. Getting off track—changing the subject if you become uncomfortable, bored,
or tired.
7. Filtering—tuning out or only hearing certain things.

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Helping Relationship
Helping is a growth-facilitating process that strives to achieve three
basic goals (Egan, 2014, pp. 9–12):
1. Help clients manage their problems in living more effectively
and develop unused or underused opportunities more fully.
2. Help clients become better at helping themselves in their
everyday lives.
3. Help clients develop an action-oriented prevention mentality in
their lives.

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Characteristics of a Helping Relationship

A helping relationship:
1. Is an intellectual and emotional bond between the nurse and the client and is
focused on the client.
2. Respects the client as an individual, including;
3. Maximizing the client’s abilities to participate in decision making and
treatments
4. Considering ethnic and cultural aspects
5. Considering family relationships and values.
6. Respects client confidentiality.
7. Focuses on the client’s well-being.
8. Is based on mutual trust, respect, and acceptance
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Phases of Helping Relationship
The helping relationship process can be described in terms of four
sequential phases, each characterized by identifiable tasks and skills.
1. Pre-Interaction Phase
2. Introductory Phase
3. Working Phase
4. Termination Phase

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Developing Helping Relationship
 Listen actively.
 Help to identify what the person is feeling.
 Put yourself in the other person’s shoes (i.e., empathize).
 Be honest.
 Be genuine and credible.
 Use your ingenuity.
 Aware of cultural differences that may affect meaning and
understanding.
 Maintain client confidentiality.
 Know your role and your limitations. 23
 Group Communication

A group is two or more people who have shared needs and goals,
who take each other into account in their actions, and who thus are
held together and set apart from others by virtue of their
interactions.
Group Dynamics
The communication that takes place between members of any group
is known as group dynamics.

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Types of Health Care Group

As a participant in a group, the nurse may be required to fulfill different

roles member or leader, teacher or learner, adviser or advisee, and so on.
Common types of health care groups include;
1. Task Group
2. Teaching Group
3. Self-Help Group
4. Self-Awareness Growth Group
5. Therapy Group
6. Work Related Social Support Group
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Comparison of Effective and Ineffective Group

Factors Effective Group Ineffective Group

Atmosphere Comfortable and Relaxed Lack of Privacy

Purpose Goals, tasks and outcomes Purpose are unclear,

are clarified misunderstood or imposed

Leadership & Member Leadership is democratic Authoritarian leader

Participation

Communication Open: ideas and feelings are Closed: only ideas are
encouraged encouraged feelings are
ignored

Decision Making By the group By the highest authority in

the group 26
Cohesion Facilitated through valuing Leader claims full credit
other group members for achievement
Conflict Tolerance The reason for disagreement Fear of conflict prevents
or conflicts are carefully decision making
examined and resolved them
Power Determined by the members Determine by position in the
abilities and information group. Obedience to
they possess. Power is authority is strong.
shared
Problem Solving High: constructive criticism Low: criticism may be
is frequent, frank, relatively destructive
comfortable and oriented
towards problem solving
Creativity Encouraged Discouraged

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Disruptive Behaviors

Disruptive behaviors reported among nurses are

1. Incivility
2. Lateral violence
3. Bullying

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1. Incivility
Rude or disruptive behavior that may result in psychological or
physiological distress for the people involved and, if left unaddressed,
may progress into threatening situations.
2. Lateral Violence
Lateral violence, also known as horizontal violence and horizontal
hostility, are terms that describe physical, verbal, or emotional abuse or
aggression.
3. Bullying
Bullying is defined as “repeated, unreasonable actions of individuals (or
a group) directed towards an employee (or a group of employees), which
are intended to intimidate, degrade, humiliate, or undermine; or which
create a risk to the health or safety of the employee.
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Emotional Intelligence

Emotional intelligence is the ability to form work relationships with

colleagues, display maturity in a variety of situations, and resolve
conflicts while taking into consideration the emotions of others.
 Assertive Communication
Assertive communication promotes client safety by minimizing
miscommunication with colleagues. People who use assertive
communication are honest, direct, and appropriate while being open
to ideas and respecting the rights of others.

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 Non-Assertive Communication
Two types of interpersonal behaviors are considered nonassertive.
1. Submissive
2. Aggressive
Submissive
o When people use a submissive or passive communication style they
allow their rights to be violated by others.
o They meet the demands and requests of others without regard to their
own feelings and needs because they believe their own feelings are not
important.
o Some experts believe that people who use the submissive behaviors or
communication style are insecure and try to maintain their self-esteem by
avoiding conflict (e.g., negative criticism and disagreement from others).
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Aggressive
o There is a fine line between assertive and aggressive
communication.
o Assertive communication is an open expression of ideas and
opinions while respecting the rights, opinions, and ideas of
others.
o Aggressive communication is “directed toward what one wants
without considering the feelings of others.”
o This type of communication is ineffective and leads to frustration
for the nurse and the primary care provider.

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