Modes of communication
Communication is carried out in different modes.
There are 3 different modes of communication
1.Verbal communication
2 .Non verbal communication
3 .Electronic communication
1.Verbal communication :The traditional way of communication has been
by word of mouth .Language is the chief vehicle of communication .The
words used vary among individuals according to
culture ,socioeconomic ,background ,age and education .
Nurses need to consider the following when choosing words :
a.Pace and intonation :verbal communication is successful when expressed
at an appropriate speed or pace.`The manner of speech ,as in the rate or
rhythm ,will modify the meaning and impact of a message
b .simplicity: simplicity includes the use of commonly understand words
and completeness.many complex terms became natural to nurses .however
laypersons often misunderstood these terms .words such as vasoconstriction
or cholestectomy
c.credibility :credibility means worthiness of belief ,trustworthiness
reliability .credibility may be the most effective criterion of effective
communication .Nurses foster credibility by being consistent ,dependable
and honest.
d.humour:The use of humour can be a positive and powerful tool in nurse
client relationship ,but it must be used with care .Humour can be used to
help clients adjust to difficult and painful situations .The physical act of
laughter can be an emotional and physical release ,reducing tension by
promoting a sense of well being .but it should be used in good sense
according to circumstances and events.
2.Non-verbal communication :Non-verbal communication ,sometimes called
body language, includes ,gestures ,body movements ,use of touch and
physical appearance .To compensate for the inadequacy of verbal
message information people unconsciously use facial
expressions ,gestures,touch to amplify the meaning of spoken
communication .it is one of the powerful way people convey message to
others.
Observing and interpreting the client’s non verbal behaviour is an essential
skill for nurses to develop .To observe non-verbal behaviour efficiently
requires a systematic assessment of the person’s overall ,physical
appearance ,posture ,gait facial expressions and gestures
How a person dresses is often an indicator of how the person feels .people
who are tired or ill may not have the energy or desire to maintain their
normal grooming ,the nurse may suspect a loss of self seteem or physical
illness .For acutely ill clients in hospital or home care setting ,a change in
grooming habits may signal that the client is feeling better.example,a
man may request a shave or a woman may request a shampoo.
a .Posture and gait: The way people walk and carry themselves are often
reliable indicators of self-concept ,current mood ,and health .erect posture
and an active suggest a feeling of well being .sloughed posture and
shuffling gait suggest physical discomfort or depression .Again the nurse
clarifies the meaning of the observed behaviour by asking the client to
check whether the nurse interpretation is correct .
Example you look like it really hurts for you to move .I am wondering
how your pain is and if you might need something to make you more
comfortable ?.
B .Facial expressions :No part of the body is as expressive as the
face .Feeling of surprise ,fear ,anger,disgust, happiness and sadness can be
conveyed by facial expressions .Although the face may express the person
genuine emotions .Many facial expressions convey a universal meaning the
smile express happiness and sadness can be conveyed by facial expressions .
Nurses need to be aware of their own expressions and what they are
communicating to others .clients are quick to notice the nurse ‘s facial
expression particulary when the client feels uncomfortable .
Eye contact is another essential element of facial communication .In many
cultures ,mutual eye contact acknowledge recognition of the other person
and a willingness to maintain communication .often a person initiates a
contact with another person with a glance ,capturing the person’s
attention prior to communicating .A person who feels weak or defenceless
often averts the eye or avoid eye contact ,the communication received
may be” too embarrassing” or” too dominating”.
C .Gestures: Hand and body gestures may emphasize and clarify the
spoken words ,or they may occur without words to indicate a particular
feeling or to give a sign .It identifies three functions such as illustrating
an idea ,expressing an emotional state and signalling by use of sign.
3.Electronic communication: computers are playing an increasing role in
nursing practice .many health care agencies are moving towards electronic
medical records where nurses documents their assessments and nursing
care .Electronic mail(email)can be used in health facilities for many
purposes to schedule and confirm appointments,report normal lab
result,conduct client education ,and follow up for discharged clients.
Email:email is the most common form of electronic communication ,It is
important for the nurses to kno w the advantages and disadvantages of
email and also other guidelines to ensure client confidentially .
Advantages
Email has many positive advantages .it is fast effective way to
communicate .It provides a record of the date and time of the message
that was sent or received .this improves communication and continuity
of client care .
Disadvantages:
Not everyone has computer and not everyone has necessary computer
skills .Other forms of communication will be needed for clients who have
limited abilities with speaking English ,reading ,writing or using a
computer
Therapeutic communication
Therapeutic communication promotes understanding and can help
establish a constructive relationship between the nurse and the client
Nurses need to respond not only to the content of the client’s vebal
message but also to the feeling expressed it is important to understand
how the client views the situation and feels about it before responding .
Techniques of therapeutic communication
1.using silence :Accepting pauses or silences that may extend for several
secons or minutes without interjection any verbal response
example-sitting quietly and waiting until the client is able to put thoughts
and feeling into words .
2,Providing general leads: Using statements or questions that (a)encourage
the client to verbalize (b) choosing a topic of conversation (c) facilitate
continued verbalization .
example –can you tell me “how it is for u”
3.using open ended questions :Open ended questions specify only the topic
to be discussed and invite answers that are longer than one or two
words .example- tell me more.....,what is your opinion
4.Restating or paraphrasing :Active listening for the client ‘s basic message
and then repeating those thoughts and/or feeling in similar words .This
conveys that the nuse listened and understood the client ‘s basic
message .example-client-I couldn’t manage to eat any dinner last night not
even the dessert
nurse-‘you had difficulty eating last night “
client-“yes,i was upset after my family left “
5.offering self : Suggesting one’s presence ,interest or wish to understand
the client without making any demands or attaching conditions that the
client must comply with to receive the nurse ‘s attention .
example –“i will stay with you until your daughter arrives “
6.Giving information :Providing in a simple And direct manner ,specific
factual information the client may or may not request .when information is
not known , the nurse states this and indicates who has it or when the
nurse will obtain it .
example- “your surgery will scheduled for 11am tomorrow”
“you will feel a pulsing sensation when the tube is removed from your
abdomen “ .
7.Clarifying time or sequence :Helping the client clarify an
event ,situation or happening in relationship to time.
Example-client ”I vomited this morning”
nurse ‘was that after breakfast”
client ”I feel that i have been sleeping from several weeks “
nurse “you had your operation Monday ’and today is Tuesday’
8.presenting reality:Helping to client to differentiate from unreal to real
example – Your magazine is here in your drawer .it has not been stolen .
9.Refelecting:Directing ideas ,feeling ,questions ,or content back to clients to
enable them to explore their own ideas and feelings about a situation
example- client “what can i do “
nurse “what do you think would be helpful “
Client “Do u think i should tell my husband “
nurse “You seem unsure about telling your husband “
Barriers of communication
1.physical/environmental barriers: Noise,invisibility ,environmental and
physical discomfort ,distraction ill health
2.Personal barriers: Language,mental status,personality complexes,bias and
prejudice,impatience inhibition attitude etc.
3.physiological barriers :Difficulties in hearing ,expressions disease condition
etc.
4.psychological barriers:Disinterest ,inattention feeling of anxiety and level
of intelligence
5.cultural barriers:Language variation ,customs, believes,religion etc
(difference between urban and rural education)
6.Background barriers:Previous learning ,cultural background ,previous
environment of working.
7.Challenging:Giving a response that makes client prove their statement
or point of view .These responses indicate that the nursing is failing to
consider the client feel it necessary to defend a position .
example:client-“I feel nauseated after that red pill
nurse-“Surely you dont’t think I gave you the wrong pill ?.
8.Rejecting :Refusing to discuss certain topics with the client . These
responses often make clients feel that the nurse is rejecting not only their
communication but also the client themselves.
Example-“I don’t want to discuss that. Let’s talk about ...
9.Changing topics and subjects :Directing the communication into areas of
self –interest rather than considering the client’s concerns is often a self-
protective response to a topic that causes anxiety . These responses
imply that what the nurse considers important will be discussed and the
clients should not discuss certain topics .
10. Unwanted reassurance: Using comforting statements of advice as a
means to reassure the client .These responses block the fears ,feelings,and
other thoughts of the client .
example-“I am sure everything will turn out all right “
“don’t worry “.
11.Giving common advice: Telling the client what to do .These responses
deny the client’s right to be an equal partner .Note that giving expert
rather than common advice is therapeutic
example-client-Should I move from my home to a nursing home ?.
nurse-“If I were you I’d go to a nursing home ,where you will get your
meals cooked for u “.
