B.

COMMUNICATION
a. Definition: any means of exchanging information or feelings or a more personal and social interaction between
people which is basic component of human relationships and built on a trusting relationship
b. Purpose: influence others and obtain information
c. Elements: a two way process of involving the sending and receiving of a massage
I- Sender: source encoder
A person/ group that wishes to convey a message that has an idea or message for communicating and must
put the idea or feeling into a form that can be transmitted
Encoding: selection of specific signs and symptoms to transmit the message
Impairments to communication (sender/ receiver)
i. Language deficit
ii. Sensory deficit
iii. Cognitive impairment
iv. Structural deficits
v. Paralysis
II- Message: what is actually said or written, the body language that accompanies the word and how the
message is transmitted
Channels: medium to convey the message that can target any of the receivers senses. It should be
appropriate for the message and should help make the intent of the message clearer.
III- Receiver: decoder
Listeners, who must listen, observe and attend. The person must perceive what the sender intends
Decode: relate the message perceived to the receivers storehouse of knowledge and experience to sort
out the meaning of the message
How the message is decoded depends largely on their similarities in knowledge, experience and sociocultural background
IV- Response: Feedback
The message the receiver returns the sender which can be verbal, non verbal or both which allows the
sender to correct or reword the message
d. Modes
1. Verbal: spoken or written words
Factors to consider in using verbal communication
A) Pace (rhythm) and intonation: the manner of speech that modifies the feeling or impact of the message
B) Simplicity: use of commonly understood words, brevity and completeness. The selection of appropriate
understandable terms based on the age, knowledge, culture and education of the client
C) Clarity and Brevity

D)
E)
F)
G)

Brevity- using the fewest words necessary

Congruence/ consistency- the behavior matches the spoken words
Timing and relevance: timing needs to be appropriate to ensure that the words are heard and it must
relate to the persons interest and concerns
Adaptability: adjustment to the spoken messages in accordance with the behavioral cues from the
client
Credibility: worthiness of belief, trustworthiness, and reliability
to foster credibility, we must be consistent, dependable and honest. Being able to convey confidence
as well as able to acknowledge their limitations
Humor: the quality of being amusing
A positive and powerful tool that must be used with caution
The physical act of laughter can be emotional and physical release, reducing tension by providing a
different perspective and promoting a sense of well being
When using humor, the nurse considers what the clients perception of what is humorous and the
timing.

2. Nonverbal (body language): other forms of communication like gestures, facial expressions, body movements
and use of touch, physical appearance including adornment
Types:
a. Appearance: the choice of apparel can convey social and financial status, culture, religion, group,
association and self concept. How a person dresses is often an indicator of what the patient feels
b. Posture and Gait: the way people walk and carry themselves are often reliable indicators of self concepts,
current mood and health
c. Facial expression: the act of conveying information with the face
d. Gestures: hand and body gestures may emphasize and clarify the spoken word, or may occur without words
to indicate a particular feeling or to give a sign.
3. Electronic : sending message via computer to a person or group of people
E-mail: most common form of electronic communication
Advantages:
a. Fast
b. Efficient
c. Legible
d. Provides a record of date and time of message
Disadvantages
a. Risk of confidentiality
b. Socioeconomics

a.
b.
c.

When not to use E-mails

Information is urgent and the clients health is in jeopardy
Highly confidential information
Abnormal laboratory data

e.Factors Influencing the Communication Process

1. Development: language, psychological, intellectual development
2. Gender
3. Values and perception
Values: standards that influence a behavior
Perception: personal view of event
4.Personal space
Personal space: distance people refer in interaction with others
Proxemics: study of the distance between people and their interactions
Types:
a. Intimate: touching to 1 feet
Characterized by body contact, heightened sensation of the body heat and smell, and vocalization
are low
b. Personal space: 1 to 4 feet
Less overwhelming than intimate distance, voice tones are moderate, and body heat and smell are
less noticed
c. Social: 4 to 12 feet
It is characterized by clear visual perception of the whole person. Body heat and odor are
imperceptible, eye contact is increased and vocalizations are loud enough to be overheard by the
others
d. Public: 12 to 15 feet
Requires loud, clear vocalization and careful enunciation
5.Territoriality: concept of space and things that an individual considers as belonging to self
6.Roles and Relationships: choice of words, sentence structure and tone and voice vary considerably from role to
role
7. Environment: a comfortable environment fosters an effective communication
8. Congruence: verbal and non verbal communication match
9. Interpersonal attitudes: conveys beliefs, thoughts and feelings about people
Types:
a.Caring and warmth: convey a feeling of emotional closeness
Caring: more enduring and intense, conveying deep and genuine concern for people
Warmth: conveys friendliness and consideration
b. Respect: an attitude that emphasizes the other persons worth and individuality
c.Acceptance: emphasizes either approval or disapproval
f.Kinds
i. Effective / therapeutic communication
1. Purpose: promotes understanding and help establish a constructive relationship between the nurse and
the client. It facilitates communication and focuses on the clients concerns
2. Components:
a. Attentive listening (listening actively)
An active process that requires energy and concentration, paying attention to both verbal and
non verbal, and noting whether these communications are congruent
Absorbing both the content and the feeling of the person is conveying without selectivity
conveying an attitude of caring and encouraging the client to talk
b. Physical attending: the manner of being present to another or being with another
Posture of Involvement:
i. Face the person
ii.
Open posture
iii. Lean towards the person
iv.
Eye contact
v.
Relatively relaxed
3. Major Barriers of Effective communication
a. failure to listen
b. improperly decoding the clients intended message
c. placing the nurses needs above the clients need
4. Therapeutic communication techniques
a. Using silence: accepting pauses or silences that may extend for several seconds or minutes without interjecting any
response
b. Providing general leads: using statements or questions that encourages the client to verbalize, choose a topic and
facilitate a continued verbalization
c. Being specific and attentive: making statements that are specific rather than general, tentative than absolute
d. Using open ended questions: asking broad questions that lead or invite clients to explore thoughts and feelings. It
specifies only the topic to be discussed and invite answers that are longer than one or two words
e. Using touch: providing appropriate forms of touch to reinforce caring feelings
f. Restating or paraphrasing: actively listening to the clients basic messages and then repeating those thoughts and/ or
feelings in similar words.
g. Seeking clarification: method of making the clients overall meaning of the message more understandable. Used
when paraphrasing is difficult or when communication is rambling or garbled. To clarify the message, the nurse can
restate the basic message of confess confusion and ask the client to repeat or restate the message.

h. Perceptual checking or seeking consensual validation: method similar to clarifying that verifies the meaning of the
specific words rather that the overall meaning of the message
i. Offering self: suggesting ones presence, interest or wish to understand the client without making any demands or
attaching conditions that the client must comply with to receive the nurses attention
j. Giving information: providing, in a simple and direct manner, specific factual information the client may or may not
request
k. Acknowledging: giving recognition, in a non judgemental way, of a change in behavior, an effort the client has made,
or a contribution to the communication. It may be with or without understanding, verbal or non verbal
l. clarifying time and sequence: helping the client understand an event, situation, or happening in relationship to time
m. Presenting reality: helping the client to differentiate what is real from the unreal
n. Focusing: helping the client expand on and develop a topic of importance
o. Reflecting: directing ideas, feelings, questions or content back to clients to enable them to explore their own ideas
and feelings about the situation
p. Summarizing and planning: stating the main points of a discussion to clarify the relevant points to be discussed.
Useful to end the interview or to review the health teaching session.
ii. Ineffective/ Barriers of Communication
a. Stereotyping: offering generalization and oversimplified beleifs about group of people that are based on
experiences too limited to be valid
b. Agreeing and disagreeing: similar to judgemental responses, it implies the the client is neither right nor wrong
and the nurse is in the position to judge this
c. Being defensive: attempting to protect a person or a health care service from negative comments that prevents
the client from expressing true concerns
d. Challenging: giving a response that makes the client prove their statement or to a point of view that indicates
failure to consider the clients feelings, making the client feel its necessary to defend a position.
e. Probing: asking for information chiefly out of curiosity rather than with intent to assist the client. This responses
are considered prying and violate the clients privacy. Use of why is often probing and places the client in a
defensive position
f. Testing: asking questions that make thee client admit something, and permits limited answers
g. Rejecting: refusing to discus certain topics with the client that makes the client feel that the nurse is not only
rejecting their communication but also the client themselves
h. Changing the topics and subjects: directing communication into areas of self interest rather than considering the
clients concerns is often a self protective response to a topic that causes anxiety
i. Unwarranted assurance: using cliches or comforting statements of advice as means to reassure the client. These
responses vlock the fears, feelings and other thoughts of the client
j. Passing judgement: giving opinions and approving and disapproving responses, moralizing or implying ones own
value. These responses imply that the client must think as the nurse thinks, fostering dependence
k. Giving comon advice: telling the client what to do. These responses deny the clients right to be an equal partner
g.Developmental considerations
1. Infants
Use non verbal communication
Sensory stimuli
2.Toddlers and preschooler
Allow time to complete verbalizing their thoughts without interuption
Provide simple response to questions due to short attention spans
Drawing a picture, painting and other art forms can be other means to communicate with child
3.School-age
Talk with the child at eye level to help decrease intimidation
Include child in the conversation when communicating with parents
4.Adolescents
Take time to build rapport
Use active listening skills
Be non-judgemental and non-reactive
5.Elder
Make sure assistive devices, glassesand hearing aids are being used and in good working order
Make referals to speech therapy
Make use of communication aids such as communication boards, computers or pictures when possible
Keep environmental distractions to a minimum
Speak in short, simple sentences and one subject at a time reinforce or repeat what is said when necessary
Always face the person when speaking
Include family and friends in communication
Use reminiscing to maintain memory connections and to enhance self identity asn self esteem
Avoid elderspeak
i.Diminutives: inappropriate intimate terms of endearment, imply parent-child relationship
ii. Inappropriate plurals: substituting a collective pronoun
iii. Tag questions: prompts the answer to the question and implies the older adult cant act aloine
iv. Shortened sentences, slow speech rate and simple vocabulary(sounds like baby talk)
h.Communication with people (guidelines)
i. Physical challenge
ii. Cognitive challenge
iii. aggressive