Communication PDF
Communication PDF
Communication in nursing is vital to quality and safe nursing care. It is the fundamental element
of the nurse-client relationship, client teaching, case management, staff development, and all the
activities performed by nurses. Communication is the foundation of the relationship between
nurse and other members of the health team. Poor working relationships and failure to
communicate can lead to serious problems for the nurse and patient.
DEFINITIONS
Acc. to Webster's Dictionary, communication is define as a process by which information
is exchanged between individuals through a common system of symbols, signs or
behaviour.
Acc. to Paul Leagens, "Communication is a process by which two or more people
exchange ideas, facts, feelings or impressions in ways that each gains a common
understanding of meaning, intent and use of a message."
Communication is the process of transmitting thoughts, feelings, facts, and other
information,includes verbal and nonverbal behaviour.
Acc. to Keith Davis, communication is the transfer of information and understanding
from one person to another person. It is a way of reaching others with facts, ideas,
thoughts and values.
Communication is the process of exchanging the information, and the process of
generating and transmitting meanings, between two or more individuals.
Communication is commonly defined as the exchange of thoughts, ideas, feelings,
information, opinions, and knowledge". It also involves mutuality of understanding.
Communication is defined as an exchange ot facts, ideas, opinions or emotion by two or
more persons.
PURPOSE OF COMMUNICATION
To obtain information
To collect assessment data
To initiate interventions
To evaluate outcome of intervention
To initiate change which helps in promoting health .
To take measures for preventing legal problems associated with nursing practice
To analyse factors affecting the health team
CHARACTERISTICS OF COMMUNICATION
Communication is a two-way process.
Communication process happens between/among two or more parties
Communication involves at least two persons-the sender and the receiver
It involves the transfer of ideas, facts, emotions, gestures, symbols and action
It involves exchange of information, thoughts and knowledge.
Communication involves mutuality of understanding between Sender and Receiver
Communication is a continuous process.
Communication is a dynamic process, that is, it grows and develops.
Communication may be intentional or unintentional.
Communication is systematic, that is, every component of the process is affected by
every other component.\
PRINCIPLES OF COMMUNICATION
1. Communication should have objective and purpose.
2. Should be appropriate to situation.
3. Systematic analysis of the message, i.e., the idea, the thought to be communicated, so that one
is clear about it.
4. Selection and determination of appropriate language and medium of communication according
to its purpose.
5.Organizational climate, including appropriate timing and physical setting to convey the desired
meaning of the communication.
6.Consultation with others for planning of communication; involves special preparation.
7.message should convey something of value to the receiver in the light of his needs and
interests.
8.The communication action following a communication is important in effective
communication as this speaks more than his/her words.
9.Sender has to understand the receiver's atitude and reaction by careful, alert and proper
listening to ensure that desired meaning of message has been comprehended by the receiver.
10. Communication programme should make use of existing facilities to the great extent possible
and should avoid challenging them unnecessarily.
LEVELS OF COMMUNICATION
Intrapersonal Communication: Intrapersonal communication occurs within an
individual.
It can be defined as communication with one's self, and that may include self-talk,acts of
imagination and visualization, and even recall and memory. It is self talk or an internal dialoque
that occurs constantly and consciously.
Nurse use self-talk to enhance positive interaction with the patients and family.the
communication is crucial because it affects the nurses behavior.
Sender: The communication process begins when a person, known as the source/encoder,
generates a message or interpersonal communication. The person who sends the message is
called as sender or the person who initiates conversation or sending message. It suggests that
source/ sender must have an idea or feelings into a form that can be transmitted. Encoding
includes choosing a sign or symbols to transmit the message.
Encoding: The sender begins with the encoding process wherein he uses certain words or non
verbal methods such as symbols, signs, body gestures, etc. to translate the information into a
message. The sender s knowledge, skills, perception, background, competencies, etc. has a great
impact on the success of the message.
Message: The second element of communication is message. The message is a stimulus
produced by a sender and responded to by a receiver. Messages may be verbal, nonverbal,
written materials, and arts intended to convey information to the receiver and require
interpretation by the persons.
Channel: The channel is the medium through which a message is conveyed or transmitted. The
message having unique elements, structure, content, treatment and codes are transmitted along
channels. There are three major communication channels: visual, auditory, and kinesthetic. The
more channels the nurse uses to send a message, the better the client will understand.
Decoding: Here, the receiver interprets the sender message and tries to understand it in the best
possible manner. An effective communication occurs only it the receiver understands the
message in exactly the same way as it was intended by the sender.
Receiver: The receiver is the person who intercepts the sender's message. The receiver is also
Called the decoder. Observer who interprets message based on his or her own communication
Skills, attitudes, knowledge and socio-cultural systems. Correct interpretation of the message
depends on the similarities in knowledge experience and socio-cultural back ground of the
sender and receiver.
Feedback: Feedback is the information the sender receives about the receiver's reaction to the
message. It is also known as response which may be verbal or non-verbal. The receiver's verbal
and non-verbal response sends feedback to the sender to reveal the receiver's understanding of
the and message.
TYPES OF COMMUNICATION
The process of passing any information from one person to the other person with the aid of some
medium is termed as communication.
Based on Relationship
Based on the relationship or style of communication, there can be two broad categories of
communication, which are formal and informal communication that have their own set of
characteristic features
Formal Communication :Formal communication includes all the instances where
communication has to occur in a set formal format. The style of communication in this form is
very formal and official and between officials on various positions in any organization or
institution.
Formal communication can also occur between two strangers when they meet for the first time.
Informal Communication - Informal communication requires two people to have a similar
wavelength and hence occurs between friends and family. Informal communication does not
have any rigid rules and guidelines. There is no formality in delivering the message among
people.
MODES OF COMMUNICATION
Mode means the way by which communication occurs. The message can be sent verbally
(talking) or non verbally (gestures).
There are two modes of communication, i.e. Verbal and Non verbal. These are described as
follows
VERBAL COMMUNICATION
It includes all the words, the speaker speaks. Talking is most common activity. It is the primary
tool of instruction while speaking. Source/sender communicates beliefs, values, perception,
meaning, interest and also understands it. The various aspects of verbal communication are
following:
i. Vocabulary : For the effective communication, sender as well as receiver should have
similarity in language, understanding. Because person belonging to different culture, ethnic
group may find difficulty to understand and interpret the message.
ii. Pacing: Using pause at right time in order to make communication effective. Sender must
speak slowly, clearly and use pauses to stress particular point.
e.g. While giving Health education on importance of "Balanced diet" Nurse should give
high weightage to the well Balanced diet and also use pauses at right time. Pace of speech in-
dicates interest, anxiety, boredom or fear.
viii)Credibility
Credibility means worthiness of belief, trust worthiness, reliability. Nurse fosters credibility by
being consistent, dependable and honest. For this nurse must be knowledge able as well as skilful
and should provide accurate information to client. By doing so she can gain trust of client.
(ix) Humor
Humor is useful in case, client finds loneliness in Hospital/having painful situation.
Humor helps in promotinga sense of wellbeing
iii)Gesture
Gestures means use of hands, body parts in explaining the things. Gestures are in- valuable way
of communication for client with deafness, tracheotomy, intubated. Client may blink his eyes or
move his eyes side by side to convey his "Yes" or "no" response. Nodding the head, raising
index finger etc. are the gestures commonly used by such clients.
iv)Eye contact:
Eye contact maintenance during interaction shows the confidence and willingness of client to
listen. Lack of eye contact may reflect anxiety, discomfort in communication.
Even eye movements reveal feelings and emotions. Wide eyes express frankness, terror
Raised upper eyelids reveal displeasure. Constant staring may be associated with hatred or
coldness. Looking down on a person establishes authority while interacting at the same level
indicates equality in relationship
Facial expression: Frown, smile, grivances, yawn, pursed lip, tongue movement.
PROFESSIONAL COMMUNICATION
Professional communication refers to the oral, written, visual, and digital forms of delivering
information in the context of a workplace. Effective communication ensures a smooth flow of
ideas, facts, decisions, and advice.
The term professional communication refers to the various forms of speaking, listening, writing,
and responding carried out both in and beyond the workplace, whether in person or
electronically.
Effective communication plays an instrumental role throughout a patient's entire healthcare
experience, and a large portion of the responsibility falls on nurses. Good communication
between nurses and patients have many benefits. It greatly contributes to the ability to provide
patients with individualized care.
Nurse and patient communication begin at first contact; at the initial moment of patient care.
This communication lasts the duration of the care cycle. For the most benefit, the patient must
feel comfortable, which requires a peaceful and private environment and confidentiality.
To achieve health care goals and achieve patient satisfaction, effective communication skills by
nurses require good interpersonal skills, understanding of patient needs, training and continuing
education of nurses in matters relating to the proper technique to enable them to respond
adequately and humanely to the expectations of patients.
Accuracy: Accuracy is one of the most vital features of professional communication. The nurse
is must provide the correct information to the client.
Clarity: Professional communication needs to be brief and to the point. They will feel more
comfortable with short letters designed to convey the message quickly.
Distinctiveness: The more specific the message is, the more the target audience is likely to
understand it and the more it meets the desired objective.
Nurse-patient relationship is defined as an interaction in which the nurse fulfills her role
by using her professional knowledge and skill in such a way that she is able to help the
patient physically, socially, and emotionally.
Infant
Infants communicate with coos, gurgles and grunts, facial expressions, cries, body
movements like cuddling or back arching, eye movements, and arm and leg movements.
Quickly respond to infant communication (e.g., Comfort a crying baby, smile at a smiling
infant, and relax if a baby turns her head to the side).
Use a sing-song, high-pitched tone of voice, exaggerated facial expressions and wide-
open eyes when interacting with young infants.
Pay attention to an infant's style of expressing emotions, preferred level of activity and
tendency to be social.
Toddlers
The child communicate verbally and nonverbally. Respond quickly and predictably to
toddlers' communicative efforts.
Give toddlers one direction at a time, and provide warnings before transitions.
Toddlers communicate with a combination of gestures and grunts, one- and two-word
sentences, positive and negative emotional expressions, and body movements.
Expand on toddlers' one- and two-word communications, and build sentences around
their words.
During play with toddlers, follow their lead and let them create the play. Describe for
toddlers what they are doing during play and let them have control.
The nurse use simple, short and familiar words while communicating with toddler.
Preschoolers
The child communicate verbally. Preschoolers begin to talk in full sentences that are
grammatically correct.
Encourage preschoolers to talk about their feelings- both positive and negative - and
discuss the possible causes for those emotions.
Ask preschoolers questions about past events; probe for details and provide new words to
enhance description of experiences.
School- Age
School-age children's speech is primarily verbal and talk in full sentences.
Encourage children to talk about their feelings and the possible reasons for their
emotions.
The child allowed to express fears and concerns.
The child is concerned about body integrity.
Adolescent
Adolescents are interested in talking in-depth about themselves and think abstractly.
Children at this age want to talk about how they are different from their parents, and they
are beginning to recognize that their parents are imperfect people.
Stay interested, and gently ask questions and seek explanations for their behavior douo
The nurse should avoid imposing values and judgment.
Talk to persons With disabilities in the same way and with a normal tone of voice no
shouting) as you would talk to anyone else.
Avoid being self-conscious about your use of wording such as "Do you see what I mean?
when talking to someone with vision impairment.
Talk to people with disabilities as adults and talk to them directly rather than to an
accompanying person.
Ask the person with a disability if assistance is needed; do not assume that help is needed
until you ask.
Use "people-first language": refer to "a person with a disability" rather than "the disabled
person" or "the disabled".
When communicating with a person with a disability, it is important to take steps to
ensure that effective communication strategies are used. This includes sitting or standing
at eye level with the patient and making appropriate eye contact.
Keep in mind that the personal space of a person with a disability includes the person's
wheelchair, scooter, crutches, walker, cane, or other mobility aid.
Do not push or move a person's wheelchair or grab a person's arm to provide assistance
without asking first.
When speaking to a person seated in a wheelchair or scooter, sit so that you and the
person are at the same eye level.
When giving directions to people with mobility limitations, consider distance, weather
conditions, and physical obstacles such as stairs, curbs, and steep hills.
Shake hands when introduced to a person with a disability. People who have limited hand
use or who wear an artificial limb do shake hands.
Identify yourself when you approach a person who has low vision or blindness. Introduce
anyone with you to the person with vision loss.
If the person uses glasses, ensure that they are readily available to the person and that he
or she uses them.
Touch the person's arm lightly when you speak so that he or she knows to whom you are
speaking before you begin.
Face the person and speak directly to him or her. Use a normal tone of voice.
When offering directions, be as specific, 1.e., "Left about 10 feet" or "Right 2 yards." Use
clock cues, if the person is accustomed to using this approach: "The door is at 10’o
clock."
Explain when you are leaving the environment.
When you offer to assist someone with vision loss, allow the person to take your arm.
When a5S1stance the person to a chair, place the person's hand on the back or arm of the
seat.
Never pet or otherwise distract a canine companion or service animal unless the owner
has given you permission to do so.
Ask the person who is hard of hearing, deaf, or deaf-blind how he or she prefers to
Communicate and eliminate or minimize background noise and distractions.
It the person uses an assistive hearing device (hearing aid), ensure that it is readily
available to the person and in working order and that he or she uses it.
If you are speaking through a sign language interpreter, pause occasionally to allow the
interpreter time to translate completely and accurately.
Talk directly to the person who is assisted by a sign interpreter, not to the interpreter,
even if the person is looking at the interpreter and does not make eye contact with you.
Before you start to speak, get the attention of the person you are addressing. Visual
(wave) or tactile signals (light touch) can be used to get the person's attention.
Speak without exaggerating your words. Do not raise your voice, unless you are
specifically requested to do so. Speak in a normal tone without shouting.
If the person lip reads, face the person and keep your hands and other objects away from
your mouth. Maintain eye contact. Do not turn away or walk around while talking.
Consider that written English may not be the primary language for some people with
disabilities and make appropriate accommodations in communicating with them.
Anticipate that only 30% of lip reading (speech reading) will be understood because of its
level of difficulty; be prepared to repeat information or questions.
If you do not understand something that is said, ask the person to repeat it or to write it
down. Do not pretend to understand if you do not.
Communicating with Patients with Speech Disabilities or Speech Difficulties
Talk to people with speech disabilities as you would talk to anyorne else; use your
regular tone of voice without shouting.
Be patient because it may take the person extra time to communicate. Do not speak for
the person or complete the person's sentences.
Give the person your undivided atterntion and eliminate background noise and
distractions.
If the person uses a communication device, such as a manual or electronic
communication board, ask the person the best way to use it.
Do not pretend to understand if you do not. 'Tell the person you do not understand what
he or she has said and ask the person to repeat the message, spell it, tell it in a different
way, or write it down. Use hand gestures and notes.
Repeat what you understand and note the person's reactions, which can indicate if you
have understood correctly.
Develop a specific communication strategy that is consistent with the person's abilities:
nod of head or blink to indicate agreement or disagreement with what you have asked or
said.
To obtain information quickly, ask short questions that require brief answers or a head
nod.Avoid insulting the person's intelligence with oversimplification.
Approach the person as you would anyone else; speak directly to the person, using clear,
simple communication.
Treat persons who are adults as adults. Do not patronize, condescend, or threaten when
communicating with the person.
Do not make decisions for the person or assume that you know the person's preferences.
Offer to shake hands when introduced. Use the same good manners in interacting with a
person who has a psychiatric/mental health disability that you would with anyone else.
Make eye contact, and be aware of your own body language. Like others, people with
psychiatric/mental health disabilities will sense your discomfort.
Listen attentively, and wait for the person to finish speaking. If needed, clarify what the
person has said.
Do not pretend to understand if you do not. Ask the person to repeat what was said. Be
patient, flexible, and supportive.
Recognize that a person with psychiatric/mental health disabilities often has the same
wants, needs, dreams, and desires as anyone else.
Interacting with seriously ill patients takes special care and attention. The Commission
recommends following these principles:
1. Spend at least a moment giving the patient your complete, undivided attention.
2. Start with the patient's agenda.
3. Track both the emotion and the cognitive data you get from the patient.
4. Stay with the patient and move the conversation forward one step at a time.
5. Articulate empathy explicitly.
6. Talk about what you can do before you talk about what you can't do.
7. Start with big-picture goals before talking about specific medical interventions.
Start with the Right Body Language: A seated position directly opposite the patient
improves communication by reducing distractions.
Exercise Patience: Care providers must exercise patience when treating seniors. Older
patients may also take longer to react during conversation.
Show Proper Respect: While many have heard the phrase "respect your elders," the
sentiment proves indispensable during treatment
Practice Active Listening: When treating seniors, it's important to actively listen to their
dialogue and remember that both parties may have difficulty expressing ideas to each
other.
Build Rapport: To build patient rapport, health organizations must make sure that all
personnel create positive interactions. Strong rapport also leaves clients With a positive
overall impression of the organization.
Show Sincerity: During visits, care providers should ask appropriate questions about
clients' living conditions and social circles.
Recognize Sensory Challenges: Distractions, such as accompanying caregivers,
cognitive impairments, or hearing loss, can make communication difficult,
Ensure Comfort: Physical comfort is important for both patients and their family
members. Alleviating physical discomfort reduces distractions during treatment.
Use Plain Language: As patients grow older, their physiology changes considerably.
Using plain language makes it easier for senior clients to understand new concepts.
Show Empathy: Sincere empathy builds rapport. Patients should feel as though care
providers understand and identify with their concerns.