The Importance of Nonverbal Communication during the Preanesthesia Period
Maria Trevizan1992, Clinical Nursing Research
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Nonverbal Communication During the Preanesthesia Period. Clinical Nursing Research,
v.01, n.2, p.207-213, 1992.
The Importance of Nonverbal Communication During the
Preanesthesia Period
Namie Okino Sawada∗, Isabel Amelia Costa Mendes*, Cristina Maria Galvão*, Maria Auxiliadora
Trevizan*
BRIEF
This article discusses the phenomenon of nonverbal communication as evidenced between
preoperative patients and the nurses attending them. Ten. such patients and the nursing group
assigned to them were directly observed for frequency of nonverbal Interaction during the period
immediately preceding surgery. Patients' nonverbal expressions of tension, fear, anxiety, and so on
were noted, videotaped, and then analyzed according to three categories of interaction: positive,
neutral, and negative. of 2,173 registered nonverbal interactions, 65.1% (1,416) were rated as
negative, a finding that should alert nurses to the need to identify patients' manifestations of anxiety so
as to provide assurance and a sense of courage preceding surgery. Positive means of communicating
nonverbally are discussed.
∗
All authors are affiliated with the College of Nursing at the University of São Paulo in Brazil where Namie Okino Sawada and
Cristina Maria Galvão are Assistant Professors. Maria Auxiliadora Trevizan is an Associate Professor, and Isabel Amelia Costa
Mendes is an Associate Professor and Vice Dean.
Preoperative anxiety is a phenomenon and an emotional reality found in most patients. Several
studies (Hathaway, 1986; Lindeman, 1972; Lindeman & Stetzer. 1973; Schmitt & Wooldridge, 1973;
Ziemer, 1983) have indicated that anxiety can influence the patient's response to surgery and also
have a negative effect on postoperative recovery. Operating room nurses therefore need to consider
patient anxiety when they plan nursing care in the immediate preoperative period.
Communication, one of the most important instruments used by the professional nurse, should be
used to minimize preoperative anxiety in surgical patients. As cited by Lewis (1973), communication is
a continuous process that involves perceptions of ourselves and perceptions of others as well as
verbal and nonverbal messages. It includes the process by which one person can influence another
through the transmission of content and feelings. Content is often transmitted by verbal messages and
feelings by nonverbal messages.
Myers and Myers (1972) emphasized that nonverbal communication is a means of expressing feelings
and emotion. Through nonverbal communication, we can express love, desire, Interest, admiration,
anxiety, acceptance, and other feelings that we do not express verbally. The presence of great anxiety
and tension might not. therefore, be expressed verbally.
For the purpose of investigating communication, Bales (1950) suggested a group of 12 categories that
can be used to analyze the Interaction process. Interactions can be classified into four sections
(positive reactions, attempted answers, questions, and negative reactions) encompassing three areas
(emotional expressive, instrumental adaptive, and task). In addition, the identification of the sender
and receiver are required. Another way of analyzing communications data is by grouping the sections
into three areas categorized as positive, neutral, and negative (Bales. 1950, 1970; Jacobs, 1978). The
positive and negative areas are related to the expression of emotional reactions and tension that
indicate the needs of maintaining group integrity, whereas the neutral area is related to the execution
of tasks.
Nonverbal communication in the preoperative period is important for surgical patients. The objective of
this study was to detect the frequency of nonverbal interaction between nursing staff and patients in
the immediate preoperative situation.
METHOD
The subjects for the study were a sample of 10 patients who were in the hospital for surgical treatment
and a nursing group that was assigned to them in the preanesthesia room of a Brazilian government
teaching hospital. Direct observation of interactions between the patients and the nursing staff in the
preanesthesia room was videotaped.
Bales's (1950) categories were used for analyzing and classifying Interactions. The nonverbal
Interactions categorized according to positive, neutral, and negative areas are shown in Table 1. The
videotapes were analyzed by observers trained in the classification of interactions using Bales's
criteria.
RESULTS
Of 2,173 registered nonverbal interactions, 468 (21.5%) were in the positive area, 289 (13.2%) were in
the neutral area, and 1,416 (65.1%) were in the negative area (see Table 2). By grouping Bales's
categories in positive area (Categories 1, 2, and 3), neutral area [Categories 4, 5. 6, 7, 8, and 9), and
negative area (Categories 10, 11, and 12). the predominance of the negative area over the others was
verified.
DISCUSSION
The result of this study is contrary to Mendes and colleagues' previous studies (Mendes. 1986;
Mendes, Trevizan, Nogueira. & Okino, 1988; Mendes, Trevizan, Nogueira, Takakura, & Cardoso,
1988; Mendes, Trevizan, Takakura, & Nogueira, 1988) where the neutral area predominated. The
situation showed more interactions linked to the execution of tasks, despite some leaning toward
verbal communication, demonstrating a mechanized and depersonalized professional relationship.
The predominance of the negative area was due to the high frequency of nonverbal interaction
registered in Category 11 by the 10 patients who were observed. Category 11 is defined as
manifestations of impatience, tension, agitation, nervousness, demonstration of anxiety, indications
that the person is alarmed,
Table 2
Distribution of Interactions According to Patients and Areas of
Bales's Categories
Bales's
categories
of
areas
Neutral
•
Negative
Patient
POsitive
Total
1
13
(6.0)
34
(15.8)
168
(78.1)
215
(100)
2
6
(3.6)
24
(14.5)
135
(81.8)
165
(100)
3
20
(6.6)
54
(23.5)
155
(67.6)
229
(100)
4
71
(25.0)
24
(8.4)
188
(66.4)
283
(100)
5
22
(9.7)
22
(9.7)
181
(80.4)
225
(100)
6
36
(22.5)
29
(18.1)
95
(59.3)
160
(100)
7
211
(49.4)
27
(6.3)
189
(44.2)
427
(100)
8
16
(14,0)
14
(12.2)
84
(73.6)
114
(100)
9
30
(19.1)
21
(13.3)
106
(67.5)
157
(100)
10
43
(21.7)
40
(20.2)
115
(58.0)
198
(100)
Total
468 (21.5)
289 (13.2)
1,416 (65.1)
2,173 (100)
Note. The data and the numbers within parentheses correspond to observed frequency and
percentage, respectively.
disturbed, or worried about something that he or she has done or intends to do.
All of the 10 patients studied demonstrated tension through disturbance, moving their heads up,
constant movements of their limbs, or motionless positions associated with a look of sadness and fear.
The nursing personnel, however, did not perceive this nonverbal communication, as there was a low
frequency of interaction exchange between the studied patients and the nursing staff in the positive
area. According to Bales's equilibrium theory (Bales, 1950, 1970; Jacobs, 1978), a reaction in the
negative area must be followed by another reaction in the positive area, which in this case would be
the nurse's reaction. Of the 2,173 recorded nonverbal interactions, only 468 (21.5%) were classified in
the positive area; on the other hand, 1,416 (65.1%) were classified in the negative area.
IMPLICATIONS FOR NURSING
Because these results are related to a small sample, further studies are needed before results can be
generalized. Some issues, nevertheless, need to be considered. This investigation showed that
surgical nurses, who assist patients during the preanesthesia period, need to maximize their ability to
identify nonverbal communicative activities. They need to be prepared to respond to patients'
manifestations of fear, tension, and anxiety.
Nonverbal communication is the behavior that speaks silently; through it, actions are transmitted as
clearly as words and are understood as displayed (Blondis & Jackson, 1982). Nonverbal behavior
transmits information about the patient to the nurse and the nurse's intentions of providing care to the
patient. Nurses, therefore, have to develop abilities to recognize nonverbal communication, realizing
that if verbal communication is received by hearing, nonverbal communication is directed to the other
senses, namely, sight, touch, smell, and taste.
Previous studies (Heidt. 1981; Pearce. 1988; Weiss, 1979) have shown the effectiveness of using
touch in the care of patients. Touch as a means of nonverbal communication can be most effective in
the preoperative phase by relieving tension and providing assurance and courage that will lead to
recuperation in the postoperative period. Nonverbal communication on the part of the surgical nurse is
of extreme importance and a vital component of nursing.
REFERENCES
Bales. R.F.(1950). Interaction process analysis: A method for the study of small groups. Cambridge.
MA: Addison-Wesley.
Bales, R. F. (1970). Personality and interpersonal behavior. New York: Holt, Rinehart & Winston.
Blondis, N. M.. & Jackson, B. E. (1982). Non-verbal communication with patients: Back to the human
touch (2nd ed.). New York: Wiley.
Hathaway, D. (1986). Effect of preoperative instruction on postoperative out-comes: A meta-analysls.
Nursing Research, 35, 269-275.
Heidt, P. (1981). Effect of therapeutic touch on anxiety level of hospitalized patients. Nursing
Research. 30. 32-37.
Jacobs, M. K. (1978). Equilibrium theory applied to small nurse group. In Aspon Systems (Ed.),
Advances in nursing science. New York: Aspon Systems Corp.
Lewis, G. K. (1973). Nurse-patient communication (2nd ed.). Dubuque. IA:
William C. Brown.
Lindeman. C. A. (1972). Nursing intervention with the presurgical patient. Nursing Research, 21, 196209.
Undeman. C. A., & Stetzer. S. L. (1973). Effect on preoperative visits by operating room nurses.
Nursing Research, 22, 4-15.
Mendes. I.A.C. (1986). Interacão verbal em situacões de enfermagen hospitalar:
Enfoque humanístico. Unpublished doctoral dissertation, University of São Paulo, Brazil.
Mendes, I.A.C.. Trevizan, M. A., Nogueira. M. S., & Okino. N. (1988). Matriz de interação: Auxiliar de
enfermagem e paciente. Reuista Gaucha de Enfermagem. 9. 43-46.
Mendes. I.A.C.. Trevizan. M. A., Nogueira, M. S.. Takakura, M. S., & Cardoso, M. C. (1988). Perfil de
interação: Atendente de enfermagem e paciente. In Simpósio Brasileiro de Comunicação. em
Enfermagem. Anais. São Paulo: Ribeirão Preto. Universidade de São Paulo.
Mendes. I.A.C.. Trevizan. M. A.. Takakura, M. S.. & Nogueira, M. S. (1988). 0 padrão de comunicação
do enfermeiro com o paciente. Revista Paulista de Enfermagem, 8. 13-16.
Myers. G. E.. & Myers, M. T. (1972). The dynamics of intrapersonal communication. New York:
McGraw-Hill.
Pearce, J. (1988). The power of touch. Nursing Times, 84. 26-29.
Schmitt.F. E.. & Wooldridge, P.J. (1973). Psychological preparation of surgical patients. Nursing
Research, 22, 108-116.
Weiss. J. (1979). The language of touch. Nursing Research. 28. 76-80.
Ziemer. M. M. (1983). Effects of information on postsurgical coping. Nursing Research. 32. 282-286.
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