The Communication Process

THE COMMUNICATION PROCESS Communication is the exchange of thoughts, feeling, and other information ►Is the interchange of information between two or more people; in other words the exchange of ideas or thoughts. ►Thoughts are conveyed to others not only by spoken or written words but also by gestures or body actions. ►It can be transmission of feelings or a more personal and social interaction between people. ►It is a basic component of human relationships. ►the intent of any communication is to elicit a response. It includes all the techniques by which an individual affects another. *Two main purpose: a. to influence others b. to obtain information The communication Process Face-to-face communication involves a sender a message a receiver and a response or feedback. In its simplest form, communication is a two away process involving the sending and the receiving of a message. Sender The sender a person or groups who wish to convey a message to another can be considered the source-encoder. This term suggest that the person or group sending a message must have an idea or reason communicating (source) and must put the idea or feeling into a form that can be transmitted. Encoding involves the selection or specific signs or symbol (codes) to transmit the message such as which language and words to use how to arrange the words to use how to arrange the words and what tone of voice and gestures to use. Message The second component of the communication process is the message itself-what is actually said or written the body language that accompanies the words and how the message is transmitted. The

medium used to convey the message is the channel and it can target any of the receiver’s senses. It is important for the to be appropriate for the message and it should help make the intent of the message more clear. Receiver The receivers the third component of the communication process is the listener who must listen observe and attend. This person is the decoder who must perceive what the intended (interpretation). Perception uses all of the senses receive verbal and nonverbal messages. Response The fourth component of the communication process the response is the message that the receiver returns to the sender is also called feedback. Feedback can be either verbal or non verbal or both. Nonverbal examples are a nod of the head or a yawn. Either way feedback allows the sender to correct or record message. Modes of Communication Verbal Communication Verbal Communication is largely conscious because people choose the words they use. The words used vary among individuals according to culture socioeconomic background, age, and education. As a result countless possibilities exist for the way ideas are exchange. An abundance of word can be used to form messages. In addition, a wide variety of feelings can be conveyed when people talk. When choosing words to say or write, nurses need to consider. A. PAGE AND INTONATION. The manner of speech as in the

pace rhythm and intonation will modify the feeling and the impact of a message. The intonation can express enthusiasm, sadness, anger, or amusement. The pace of speech may indicate interest, anxiety, boredom, or fear. For example speaking slowly and softly to an excitement may help calm the client. B. SIMLPICITY. Simplicity includes the use of commonly under stead words brevity and completeness. Many complex technical

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terms become natural to nurses. However laypersons misunderstand these terms. CLARITY AND BREAVITY. A message that is direct and single will be more effective. Clarity is saying precisely what is meant and brevity is using the fewest words necessary. The result is a message that is simple and clear. An aspect of this is congruence or consistency where the nurse’s behavior or nonverbal communication matches the words spoken. TIMING AND RELEVANCE. Nurses need to be aware of both relevance and timing when communicating with clients. No matter how clearly or simply words are stated or written the timing needs to be appropriate to ensure that words are heard Moreover the messages need to relate to the person or to the person’s interests and concerns. This involves sensitivity to the client’s needs and concerns. ADAPTABILITY. Spoken messages need to be altered in accordance with behavioral cues fro the client. This adjustment is referred to as adaptability. What the nurse says and how it is said must be individualized and careful considered. This requires astute assessment and sensitivity to the client’s needs and concerns. CREDIBILITY. Credibility means worthiness of belief trustworthiness and reliability. Credibility may be the most important criterion of effective communication. Nurses foster credibility by being consistent, dependable, and honest. The nurse needs to be knowledgeable about what is being discussed and to have accurate information. Nurses should convey confidence and certainty in what they are saying while being able to acknowledge their limitation (e.g.,” I don’t know the answer to that but I will find someone who does”) HUMOR. The use of humor can be positive and powerful tool in the nurse client relationship but is must be used with care. Humor can be used to help clients adjust to difficult and painful situation. The physical act of laughter can be both emotional and physical release reducing tension by providing a different perspective and promoting a sense of well being.

Nonverbal Communication Nonverbal communication is sometimes called body language. It includes gestures body movements use of touch and physical

appearance including adornment. Nonverbal communication often tells other more about what a person is felling than what is actually said because nonverbal behavior is controlled less consciously than verbal behavior. Nonverbal communication either reinforces or contradicts what is said verbally. PERSONAL APPEARANCE. Clothing and adornments can be sources of information about a person. Although choice of apparel is highly personal it may convey social and financial status, culture, religion, group association, and self concept. Charms and amulets maybe worn for decorative or for health protection purpose. When the symbolic meaning of an object is unfamiliar the nurse can be inquire about its significance which may foster rapport with the client. POSTURE AND GAIT. The ways people walk and carry themselves are often reliable indicators of self concept current mood and health. Erect posture and an active purposeful stride suggest a feeling of well being. Slouched posture and slow shuffling gait suggest depression or physical discomfort. Tense posture and a rapid determined gait suggest anxiety or anger. FACIAL EXPRESSION. No part of the body is as expressive as his face suggests happiness and sadness can be conveyed by facial expression. Nurses need to be aware of their own expression and what they are communicating to others. Clients are quick to notice the nurse’s facial expression particularly when the clients feel unsure or uncomfortable. Eye contact is another essential element of facial communication. In many cultures, manual eye contact acknowledges recognition of the other person and the willingness to maintain communication. GESTURES. Hand body gestures may emphasize and clarify spoken word or they may occur without words to indicate a particular felling or to give a sign. A wave good-bye and the motioning of a visitor toward a chair are gestures that have relatively universal meaning.

Communication in different level of deployment. Infants *Infants communicate through their senses. Teach parents about the importance of touch. *They respond best to high-pitched soft or gentle tone of voice and eye contact. Toddlers and Preschoolers *Allow time for them to complete verbalizing their thoughts without interruption. *Provide a simple response to question because they have short attention spans. *Drawing a picture can provide another way for the child communicates. School-Age Children *Talk to the children at his or her eye level to help decrease in *Include the children in the conservation when communicating with the parents. Adolescent *Take time to build rapport with the adolescent * Use active listening skills. *Project z nonjudgmental attitude and non reactive behavior even when the adolescent says disturbing remarks. Factors influencing the Communication Process A. Development Language psychosocial and intellectual development moves through the stages across the life span. Knowledge of a client’s development stage will allow the nurse to modify the message accordingly. The use of dolls and games with simple language may help explain a procedure to an 8-years-old. With adolescent who have developed more abstract thinking skill a more detailed explanation can be given wherereas a well educated middle-age business executive may wish to have detailed technical information provided. Older clients are apt to have a wider range of experiences with the health care system

which may influence their response and understanding. With aging also come changes in vision and hearing acuity that can affect nurse-client interactions. B. Gender From an early age females and males communicated differently. Girls tend to use language to seek conformation, minimize differences and establish intimacy. Boys use language to establish independence and negotiate status within a group. These differences can continue into adulthood so that the same communication may be interpreted different a man and a woman C. Values and Perceptions Values are standards that influence behavior and perceptions are the personal view of an event. Because each person has unique personality traits, values, and life expression each will perceive and interpret messages and experiences differently. For example if the nurse draws the curtain around a crying woman and leaves her alone the woman may interpret this as “The nurse thinks that will upset others and that I should cry” or” The nurse respects my need to be alone”. It is important for the nurse to be aware of client’s values and to respect or to correct perception to avoid creating bartries in nurse client relationship. D. Personal Space Personal space is the distance people prefer in interact with others. Proxemics is the study of distance between person in their interaction. Middle class North Americans use definite distances in various interpersonal relationships along with specific voice tones and body language. Communication alters in accordance with four distances each with a close to a far phase. Tamparo and Lindh (2000,p.91) list the following examples: 1. Intimate:Touching to 1 1/2 feet 2. Personal: 11/2 to 4 ft 3. Social: 4 to 12 ft 4. Public: 12-15 ft

Intimates distance communications characterized by body contact heightened sensations of body heat and smell and vocalization that are low. Vision is intense restricted to a specific body part and may be distorted. Personal distance is less overwhelming than intimate distance. Voice tones are moderate and body heat and smell are notice less. Physical contact such as handshake or touching a shoulder is possible. Social distance is characterized a clear visual perception of the whole person. Body heat and other odor are imperceptible eye contact is increased and vocalizations are loud enough to be hear by others. Communication is therefore more formal and is limited to seeing and hearing. Public distance requires loud clear vocalization with carefree reification although the faces and forms of people are at public distance individuality is lost instead the person is of the group of people or the community. E. Territoriality Territoriality is a concept of the space and things that an individual considers are belonging to the self. Territoriality marked off by people may be visible to others. For example clients in a hospital often considered their territory as bounced by the curtains around the bed unit or by the walls of the private room. This human tendency to claim territory must be recognized by all health care workers. Clients often feel the need to defend their territory when it is invaded by others for ex. When a visitors or nurse removes a chair to use at the other bed the visitor has inadvertently violated the territoriality of the client whose chair was removed. Nurses need to obtain permission from clients to remove rearrange or borrow object in their hospital area. F. Roles and Relationship The roles and the relationship between sender and receiver affect communication process. Roles such as nursing student and instructor client and physician or parent and child

affect the content and responses in the communication process. Choice of words sentence structure and tone of voice vary considerably from the role to the role In addition the specific relationship between the communicators is significant. The nurse who meets with a client for the first time communicates differently from the nurse, who has previously developed a relationship with that client, G 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 clients communication about matter that clients considers private. For Ex. A client who is worried about the ability of his wife to care for him after discharge from hospital may not wish discuss concern with a nurse hearing of others clients in the room. Environmental distraction can impair and distort communication. H. Congruence In Congruence communication the verbal and non verbal 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. Congruence between verbal expression and non verbal expression is easily seen by the nurse and the client. Nurses are taught to asses clients but clients often just adept at reading a nurses expression or body language If there are incongruence the body language or nonverbal communication is usually the one with the true meaning For ex, when teaching a client how to care for a colostomy the nurse might say “You won’t have any problem with this.” However if the nurse looked worried or disgusted while saying this the clients are less likely to trust the nurse’s words. Therapeutic Communication Therapeutic communication promotes understanding and can help establish a constructive relationship between the nurse and the client. Unlike the social relationship where there

way not be a specific purpose of direction the therapeutic helping relationship is client and goal directed. Nurses needed to respond not only the content of client’s verbal message but also the felling expressed. It is important to understand how the clients view the situation and feels about it before responding. Attentive Listening Attentive Listening is listening actively using all these senses as opposed to listening passively with just the ear It is probably the most important technique in nursing and is based all other techniques attentive listening is an active process that requires energy and concentration. It involves paying attention to the total message both verbal and nonverbal. Barriers to communication THE HELPING RELATIONSHIP Nurse client relationship are referred to by some as interpersonal relationship by other as therapeutic relationships and by still others as helping relationship Helping is a growth facilitating process that strives to achieve two basic goals (Egan 1998) 1. Helps client manage their problems more effectively and develop unused or underused opportunities more fully. 2. Helps client become better at helping themselves in their everyday lives. A helping relationship may be develop over weeks of working with a client, or within minutes. The keys o the helping relationship is {the development of trust and acceptance between he nurse and {b} an underlying belief that the nurse cares about and wants to help the client. The helping relationship is influenced by the personal and professional characteristics of the nurse and the client. Age, sex, appearance, diagnosis, education, values, ethnic, and cultural background, personality, expectations, and setting can all affect the development of the nurse- client relationship.

Phases of the Helping Relationship The helping relationship process can be described in terms of four sequential phases, each characterized by identifiable tasks and skills. The relationship must progress through the stages in succession because each builds on the one before. Nurses can identify the progress of a relationship by understanding these phases. Preinteraction Phase The preinteraction phase is similar to the planning stage before an interview. In most situations, the nurse has information about the client before the first face-to-face meeting. Such information may include the client’s name, address, age, medical history and or social history. Planning for the initial visit may generate some anxious and feeling specific information to be read positive outcomes can evolve. Introductory Phase Introductory phase, also referred to as the orientation phase, is important because it sets the tone for the rest of the relationship. During this initial encounter, the client and the nurse closely observe each other and form judgments about the others’ behavior. The tree stages of this introductory phase are opening the relationship, clarifying the problem, and structuring and formulating the contact. Other important tasks of the introductory phase include getting to know each other and developing a degree of trust. After introductions, the nurse may initially engage in some social interaction to put the client at ease. For example nurse and client may talk about what a nice day it is and what they would like to do if at home. Characteristics of a Helping Relationship A helping relationship * Is an intellectual and emotional bond between he nurse and the client and is focused on the client. *Respect the client as an individual, including *Maximizing the client’s abilities to participate in decision making and treatments * Considering ethnic and cultural aspects * Considering family relationship and values *Respects client confidentiality

*Respect on the client’s well- being *Is based on mutual trust, respect, and acceptance. By the end pf the introductory phase, clients should begin to *Develop trust in the nurse. *View the nurse as a competent professional capable of helping. ►View the nurse as honest, open, and concerned about their welfare. ►Believe the nurse will try to understand and respect their cultural values and beliefs. ►Believe the nurse will respect client confidentiality. ►Fell comfortable talking with the nurse about feeling and others sensitive issues. ►Understand the purposes of the relationship and the roles. ►Feel that they are active participants in developing a mutually agreeable plan of care. Working Phase During the working phase of a helping relationship, the nurse and the client begin to each other as unique individuals. They begin to appreciate this uniqueness and care about each other. Caring is sharing deep and genuine concern about the welfare of another person. Once caring develops the potential for empathy increases. The working phase has two major stages: exploring and understanding thought and feelings, and facilitating and talking action. The nurse helps the client to explore thought, feelings, and actions and helps the client plan a program of action to meet preestablished goals. EXPLORING AND UNDERSTANDING THOUGHT AND FEELINGS. The nurse requires the following skills for this phase of the helping relationship. ● Empathetic listening and responding nurses must listen attentively and communicate (respond) in ways that indicate they have listened to what was said and understand how the client feels the nurses respond to content and feeling or both as appropriate. The nurse’s nonverbal behaviors are also important. Nonverbal behaviors indicating empathy include moderate gesturing and little activity or body movement. According to Egan (1998) empathy “can be seen as an intellectual process that involves understanding correctly another

person’s emotions state and point of view” and also as an emotional response experienced by the helper. Empathetic listening focuses on a kind of “being with” clients to develop an understanding of them and their world. This understanding, however, must also be communicated effectively to the client-emphasis response. The end result of empathy is comforting and caring for the client and a helping, healing relationship. ● Respect. The nurse must show respect for the client’s willingness to be available, desire to work with the client, and a manner that conveys the idea of taking the clients point of view seriously. ● Genuineness. Personal statements can be helpful in solidifying the rapport between the nurse and the client. The nurse might offer such comments as “I recall when I was in (similar situation), and I felt angry about being put down.” Egan outlines five behaviors that are components of genuineness. Nurses need to exercise caution when making references about themselves. These statements must be used with discretion. The extreme of matching case of the client’s problems with a better story of the nurse’s own is of little value to the client. ● Concreteness. The nurse must assist the client to be concrete and specific rather than to speak in generalities. When the client says, “I’m stupid and clumsy.” The nurse narrows the topic to the specific by pointing out, “You tripped on the rugs.” ● Confrontation. The nurse points out discrepancies between thoughts, feelings, and actions that inhibit the clients self understanding or exploration of specific areas. This is done empathetically, not judgmentally. During the first stage of the working phase, the intensity of interaction increases, and feelings such as anger, shame, and selfconsciousness may be expressed. If the nurse is skilled in this stage and if client is willing to pursue self-exploration the outcome is a beginning understanding on the part of the client about behavior and feelings.

Termination Phase The termination phase of the relationship is often expected to be difficult and filled with ambivalence. However, if the previous phases have evolved effectively, the client generally has a positive outlook and feels able to handle problems independently. On the other hand, because caring attitudes have developed, it is natural to expect some feeling loss, and each person needs to develop a way of saying good-bye. Many methods can be used to terminate relationships. Summarizing or reviewing the process can be produced a sense of accomplishment. This may include sharing reminiscences of how things were are the beginning of the relationship and comparing them to how they are now. It is also helpful for both the nurses and the client to express their feelings about termination openly ad honestly. Thus termination discussions need to start to advance of the independence. In some situations referrals are necessary or it may be appropriate to offer an occasional standby meeting to give support as needed. Follow-up Phone calls or e-mails are other interventions that ease the client’s transition to independence.