Communication and nurse patient relationship

COMMUNICATION AND
NURSE PATIENT
RELATIONSHIP
CHAPTER: IV

• Communication is a dynamic (constant change)
process that takes place around us all the time.
• In fact we spend 70% of our time receiving and
sending messages.
• Communication word derived from Latin -
commūnicāre, meaning "to share“

• It is exchange of idea, facts, feelings, thought, opinion, and
information which is vital in facilitating human interaction
through (written or spoken) words, symbols or actions.

Meaning
• Communication is simply the actof transferring information from
one person to another person
• It is imparting or exchanging of information by speaking,
writing, or using some other medium.
•

definition
• Communication is a process in which a message is transferred
from one person to other person through a suitable media and
the intended message is received and understood by the
receiver.
• “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 message”
• - Paul Leagens.

• Extrapersonal communication
• Interpersonal communication
• Intrapersonal communication
• Organizational communication
• Mass communication
1
2
3
4
5

Extrapersonal Communication:
• Communication is a process that takes place with
human entities and non-human entities as well.
• When communication is done with non-human entities
it is called to be extra personal communication.

• The perfect coordination and understanding between
human and non—human entities results to extra
personal communication.
• In this communication one participant of the
communication process uses sign language and the
other is verbal.

• For example, the bark of a pet dog when something
happens to the master, wagging of the tail when
master shows bone to the pet dog, licking of cheek at
the returning of master from the work field, chirping of
birds when a stranger is at the door, Parrot calling the
name of the master in the morning, etc

Interpersonal Communication:
• It involves two parties-a sender and a receiver who
use common language to transit message either
through oral communication or written
communication.

lntrapersonal Communication:
• Intrapersonal communication is all about talking to
ourselves.

• Prefix ‘intra’ means
‘within’ hence
intrapersonal
communication is ‘self
talk’.

Organizational Communication:
• In a team-based business organization,
communication becomes its lifeblood where people
communicate with one another.

• The flow of communication inside an organization
may filter in up, down and horizontal directions.

• Besides internal communication companies
depend on external communication also.
• Companies exchange messages with
outside the
people
organization through external
communication.

Mass Communication:
• Newspapers, magazines and periodicals, the means
of mass communication are frequently used for oral or
written communication.

• Besides, technologies such as the intemet,
e-mail, voicemail, faxes, audiotape,
teleconferencing, videoconferencing and
closed
options
circuit
for
televisions
internal
have increased
and external
communication.
• These fast means help people
parts of the world to work together.
from all

› Source idea
› Message
› Encoding
› Channel
› Receiver
› Decoding
› Feedback
ELEMENTS:
There are seven elements of communication:

› The Source idea is the process by which one
formulates an idea to communicate to another
party.
› This process can be influenced by external stimuli
such as books or radio, or it can come about
internally by thinking about a particular subject.
› The source idea is the basis for the
communication.
1. Source
idea:

› The Message is what will be communicated to
another party.
› It is based on the source idea, but the message is
crafted to meet the needs of the audience.
› For example, if the message is between two
friends, the message will take a different form than
if communicating with a superior.
2.
Message:

› Encoding is how the message is transmitted to
another party.
› The medium of transmission will determine the
form of the communication.
› For example, the message will take a different form if
the communication will be spoken or written.
3.
Encoding:

› The Channel is the medium of thecommunication.
› The channel must be able to transmit the message
from one party to another without changing the
content of the message.
› The channel can be a piece of paper, a
communications medium such as radio, or it can be an
email.
› The channel is the path of the communication from
sender to receiver.
4.
Channel:

› The Receiver is the party receiving the
communication.
› A receiver can be a television set, a computer, or a
piece of paper depending on the channel used for
the communication.
5.
Receiver:

› Decoding is the process where the message is
interpreted for its content.
› It also means the receiver thinks about the
message's content and internalizes the message.
6.
Decoding:

› Feedback is the final step in the communications
process.
› This step conveys to the transmitter that the
message is understood by the receiver.
› The receiver formats an appropriate reply to the
first communication based on the channel and
sends it to the transmitter of the original message.
7.
Feedback:

Types of communication
I. Based on the means of delivering the message
II. Based on the purpose of communication
III. Based on the levels of communication
IV. Based on the pattern of communication

Based on the means of delivering the message
a) Verbal communication:
• It occurs through the medium of spoken or written.
• A combination of several words is used & each words conveys a
specific meaning.
• Some important elements of verbal communication are language,
vocabulary, denotative & connotative meaning, pacing,
intonation, clarity, consciousness, preciseness, comprehension,
brevity, timing & relevance.

Subtypes of verbal communication
• Spoken communication
• Written communication
• Telecommunication
• Electronic communication

b) Nonverbal communication
• This communication occurs without words; where the five senses
& whole range of body movements, posture, gesture, facial
expressions & silence are used for sending & receiving the
message.
• Nonverbal communication is a more accurate way of
communication because it convey the true & intended meaning of
the message.

• Nonverbal communication may be accomplished by the following
means:
• Touch
• Eye contact
• Facial expression
• Posture
• Gait
• gesture
• Physical appearance
• Sound
• Silence

II. Based on the purpose of communication
• a) Formal communication
• Formal communication follows line of authority & is generally
used in organization to achieve organizational objectives.
• For example, the nursing superintendent of a hospital will
communicate with staff nurse through assistant nursing
superintendents, supervisors & ward-in-charge nurses.

b) Informal communication
• Informal communication does not follow line of authority.
• Examples of informal communication are gossip, chitchat & kitty
parties.
• It is very fast & usually takes place in social groups like friends,
family, peer groups, etc.

• c) Therapeutic communication:
• Therapeutic communication takes place between a health care
personnel & a patient, with the purpose of modifying the patient
behavior.
• • This is accomplished with repeated interaction using certain
essential attribute such as trust, empathy, tenderness, concern &
non-judgemental attitude.

III. Based on the levels of communication
a) Intrapersonal communication
• It take place within an individual; we may also say it is self-talk.
• It is crucial because it provides a person with an opportunity to
assess self or a situation, before acting on it, ultimately affecting
the person behavior.

b) Interpersonal communication
• It takes place whenever two or more people interact & exchange
messages or ideas.
• This is also one of the most common forms of communication in
our daily lives.
• Interpersonal communication may further categories into
assertive, non-assertive & aggressive communication.

c) Transpersonal communication
• It takes place within a person’s spiritual domain.
• The purpose of transpersonal communication is to realize
selfhood, enhance spirituality & answer questions that are
spiritual in nature.

d) Small-group communication
• An example of a small-group communication is when nurse
interact with two or more individuals face-to-face or use a medium
(like a conference call).
• Patient care conferences, staff meetings & reports are good
examples of small-group communication

e) Public communication
• Public is generally defined as a large group of people.
• Communication with such a large group of people is known as
public communication.
• Public communication requires essential skills to influence people
at large & media material to reach member of the public clearly &
loudly.

f) Organizational communication
• It takes place when individuals & groups within an organization
communicate with each other to achieve established
organizational goals.

IV. Based on the Patterns of communication
• a) One-way communication
• It take place when message are delivered to the audience from
the communicator only without constant feedback.
• A common example of one-way communication is lecture
delivered in a classroom.

b) Two-way communication
• It takes place when both the communicator & audience take part
in the process.
• The audience may raise questions & add information, ideas &
opinions on the subject.

• c) One-to-one communication
• Communication between one sender & one recipient at one time
is termed as one-to-one communication.
• A nurse providing information to a patient is an example of one-
to-one communication

• d) One-to-many communication
• Where one person communicates with may people at the same
time, it is termed as one- to-many communication.
• A nurse providing health education to a community is an example
of one-to-many communication.

e) Many-to-one communication
• Many-to-one communication takes place when several people
communicate with one person at the same time.
• A panel of expert taking an interview is an example of many-to-
one communication.

FACILITATORS OF COMMUNICATION
• Seven Cs of effective communication
• Completeness
• Clarity
• Courtesy
• Consideration
• Conciseness
• Concreteness
• Correctness

• Other attributes
• Positive attitude
• Improving communication skills
• Getting feedback of communication skills
• Goal-oriented communication
• Using creative alternative approaches
• Minimizing negative impact
• Warmth & friendliness
• Openness & respect
• Empathy
• Comfortable environment

› Listening
› Broadopenings
› Restating
› Clarification
› Reflection
› Focusing
› Sharingperceptions
› Silence
› Humour
› Informing
› Suggesting

› An active process of receivinginformation.
› The complete attention of the nurse is required
and there should be no preoccupation with
oneself.
1.
Listening:

› Listening is a sign of respect for the person who is
talking and a powerful reinforce of relationships.
› It allows the patients to talk more, without which the
relationship cannot progress.

› These encourage the patient to select topics for
discussion, and indicate that nurse is there,
listening to him and following him.
› For e.g. questions such as what shall we discuss
today? ―can you tell me more about that‖? ―And
then what happened?‖
› From the part of the nurse encourages the patient
to talk.
2. Broad
openings:

› The nurse repeats to the patient the main thought
he has expressed.
› It indicates that the nurses is listening.
› It also brings attention to somethingimportant.
3.
Restating:

4. Clarification
• › The person‘s verbalization, especially when he is
disturbed or feeling deeply, is not always clear.
• › The patients remarks may be confused, incomplete or
disordered due to their illness.
• › So, the nurses need to clarify the feelings and ideas expressed
by the patients.

› The nurses need to provide correlation between the
patient‘s feeling and action.
› For example ―I am not sure what you mean ―?
―Could you tell me once again?‖ clarifies the
unintelligible ideas of the patients.

5.
Reflection:
• This means directing back to the patient his ideas, feeling,
questions and content.
• Reflection of content is also calledvalidation.
• Reflection of feeling consists of responses to the patient‘s
feeling about the content.

6. Focusing:
• It means expanding the discussion on a topic of importance.
• It helps the patient to become more specific, move from
vagueness to clarity and focus on reality.

› These are the techniques of asking the patient to
verify the nurse understands of what he is thinking
or feeling.
› For e.g. the nurse could ask the patient, as ―you
are smiling, but I sense that you are really very
angry with me‖.
7. Sharing
perceptions:

› This involves identifying the underlying issues or
problem experienced by the patient that emerges
repeatedly during the course of the nurse-patient
interaction.
› Once we identify the basis themes, it becomes easy
to decide which of the patient‘s feeling and thoughts
to respond and pursue.
8. Theme
identification:

› This is lack of verbal communication for a
therapeutic reason.
› Then the nurse‘s silence prompts patient totalk.
› For e.g. just sitting with a patient without talking,
non verbally communicates our interest in the
patient better.
9.
Silence:

› This is the discharge of energy through the comic
enjoyment of the imperfect.
› It is a part of nurse clientrelationship.
› It is constructive coping behavior, and by learning to
express humor, a patient learns to express how he
feel.
10.
Humor:

› This is the skill of givinginformation.
› The nurse shares simple facts with thepatient.
11.
Informing:

› This is the presentation of alternative ideas
related to problem solving.
› It is the most useful communication technique when
the patient has analyzed his problem area, and is
ready to explore alternative coping mechanisms.
› At that time suggesting technique increase the
patient‘s choices.
12.
Suggesting:

The two main ways it is used in communication are:
• verbal,
• non-verbal

• Both spoken (type words and tone of voice,
speed),
• written (words and the meaning they convey),
• timing
• and clarity of the message.
Verbal
communication

› bodylanguage,
› facialexpressions,
› posture,
› gait (manner ofwalk)
› gestures,
› nods,etc.
Non-verbal
communication

• Effective communication involves either a personal
(face to face) communication or some means of an
encounter that requires the following four necessary
components:
• a sender,
• a message,
• a receiver
• and a response.

› Sender may one, two or a group of people with a
message to send/convey and a system of sign(s) or
symbol(s) (code, i.e. – language, etc.) to use in
transmission/sending (encoding) it.
Sender

• Message (from sender) and (from receiver) =
contents or meaning, language (words arrangement
and use) and the tone which the message is meant
to convey.
Message

• Receiver is the recipient/listener of the message
decodes (i.e. – relates to or understands message)
and returns communication.
Receiver

› Response is the message or feedback (non-verbal
cues, i.e. winks, nods, etc.) that the receiver sends
back to the sender.
Response

1. Attending
Skills
› Definition of AttendingSkills
› Attendi.
ng is a skill that involves the nurse observing
client verbal and nonverbal behaviours as one way of
understanding what clients are experiencing, and
displaying effective nonverbal behaviours to clients.
› Egan (1994) elaborates upon these two major aspects
of attending, which he refers to as “psychological
attending,” and “physical attending,” respectively.

› The attending cluster consist of the followingSkills:
› A Posture ofInvolvement
› Appropriate BodyMotion
› EyeContact
› Creating a Non distractingEnvironment

› Bolton, in his book People Skills (1979), describes
attending as giving all of your physical attention to
another person.
› The process of attending, whether you realize it or
not, has a considerable impact on the quality of
communication that goes on between two people.
› For example, by attending you are saying to the
other person "I am interested in what you have to
say", however, a lack of good attending
communicates that "I really don't care about what
you have to say."

› The body can be used as a tool to facilitate good
communication. This is done through positioning the
parts of the body so that they invite and hold an
interpersonal relation. A relaxed alertness
expressed by body posture seems best suited for
fostering good communication

› Bolton offers these suggestions to establish a posture
of involvement:
› Lean toward the speaker. This will communicate
energy and attentiveness.
› Face the other squarely (i.e., your right shoulder to
the speakers left). This communicates your
involvement. It is especially important for you to
position yourself so that you are at eye level with the
speaker if you are seen as a authority figure. This will
circumnavigate feelings of threat and can greatly aid
in forming an interpersonal relationship.

› Maintaining an open posture is also important for
fostering interpersonal relatedness. A closed
posture (i.e., crossed arms and or legs) often
communicates coldness and defensiveness.
› You also need to be aware of your proximity to the
speaker. We all have a concept of "personal space."
When those boundaries are crossed it puts the
other on the defensive and makes them feel
uncomfortable. However, to much distance
communicates aloofness and disconectedness.

› Body motion, it's a funny thing! Have you ever paid
attention to what your hands were doing during the
course of a conversation? Some of us simply shove
them in our pockets or let them hang aimlessly by
our sides.
› Then there are others, like me, who tend to fling
them around as if to place some kind of emphasis
on each word! There is such a thing as too little and
too much.

› Body motion is good but it can be over done if you
are not careful.
› The purpose of gesturing when you are listening is
to encourage the speaker to continue speaking.
This can most easily be done with a periodic head
nod. A good listener moves his or her body in
response to the speaker.

› Effective eye contact says that you are visually
attuned to what the speaker is saying.
› Good eye contact involves focusing on the speakers
face and occasionally shifting the focus to other parts
of the body.
› The key is that the other is aware that they have your
attention because your eyes are "on them".
› Good eye contact should seem natural to the other
person. What ever you do, don't "stare them down."
This makes you seem anxious and sometimes critical
of them.

› The environment where the communication takes
place is also an important factor in whether an
interpersonal relationship can be formed.
› It is not always possible to move the conversation
into a private room or office, but every attempt
should be made to reduce the number of
distractions that are present.

› In his book, The Skilled Helper (1998), Gerad
Egan offers what he has labelled the Micro Skills
of Attending.
› The are very close to the information presented
above from Bolton's People Skills.
› S - face the clientsquarely
› O- have an openposture
› L- lean into theconversation
› E- eyecontact
› R- berelaxed

› What IsRapport?
› Rapport forms the basis of meaningful, close and
harmonious relationships between people.
2. Report building
relationship

› According to researchers when you have a rapport
with someone, you share:
› Mutual attentiveness: you're both focused on, and
interested in, what the other person is saying or
doing.
› Positivity: you're both friendly and happy, and you
show care and concern for one another.
› Coordination: you feel "in sync" with one another,
so that you share a common understanding. Your
energy levels, tone and body language are also
similar.

› How to BuildRapport?
› Rapport must be a two-way connection between
people, so it's not something that you can create by
yourself.
› You can, however, learn how to stimulate it by
following these six steps.

› 1. Check YourAppearance
› First impressions count , and your appearance
should help you to connect with people, not create
a barrier.
› A good rule of thumb is to dress just a little "better"
than the people you're about to meet.
› However, if you arrive and see that you're
overdressed, you can quickly dress down to suit the
situation.

› 2. Remember the Basics
› Always remember the basics of good
communication :
› Be culturally appropriate.
› Smile.
› Relax.
› Remember people's names .
› Hold your head up and maintain a goodposture.
› Listen carefully and attentively .
› Don't outstay your welcome.

› 3. Find CommonGround
› Identifying common ground can help to establish
rapport, so use small talk to find something that
you both share.

› 4. Create Shared Experiences
› Rapport can't grow without human interaction, and a
great way to interact is to create new, shared
experiences.
› Shared experiences can be as simple as attending the
same conference session together, or as complex as
cooperating on a new management process.
› Working collaboratively to define problems, devise
solutions, and design strategies, for example, can help
to bring you and the other person closer.

› 5. Be Empathic
› Empathy is about understanding other people by seeing
things from their perspective, and recognizing their emotions.
› So, to understand and share another person's perspective,
you need to learn what makes him tick.
› You need to really hear what they say, so that you can
respond intelligently and with curiosity. So, it's important to be
a good listener, and to fine-tune your emotional
intelligence. You can also use Perceptual Position – a
technique for seeing things from other people's perspectives

› 6. Mirror andMatch
› Research shows that we prefer people who we
perceive to be just like ourselves.
› Mirroring and matching are techniques for building
rapport by making yourself more like the other
person.

, including
techniques to build rapport:
› Watch the other person's body language
gesture, posture and expression.
› Adopt a similar temperament. If the other person is introverted
or extroverted, shy or exuberant, you should behave in the
same way.
› Use similar language . If he uses simple, direct words, then
you should, too. If he speaks in technical language, then match
that style. You can also reiterate key or favourite words or
phrases.
› Match the other person's speech patterns, such as tone, tempo
and volume. For ex, if he speaks softly and slowly, then lower
the volume and tempo of your voice.

› Re-Establishing Rapport
› It takes time to rebuild rapport when it has been lost.
› First, address why you lost rapport in the first place.
› Be humble and explain honestly and simply what
happened. If you need to apologize , do so.
› Next, focus on ways of repairing any broken trust. Put
in extra work if you need to, and keep your word.
› Transparency and genuine concern for the other
person's needs will go a long way to rebuilding trust
and re-establishing rapport.

› Empathy is the ability to accurately put yourself "in someone
else's shoes"– to understand the other’s situation,
perceptions and feelings from their point of view – and to be
able to communicate that understanding back to the other
person.
› Empathy is a critical skill for you to have as a leader. It
contributes to an accurate understanding of your employees,
their perceptions and concerns.
› It also enhances your communication skills because you can
sense what others want to know and if they are getting it from
you or not.
3. Empathy
skill

› Guidelines to DevelopEmpathy
› 1. Experience the major differences amongpeople.
› 2. Learn to identify your own feelings – develop
some emotional intelligence.
› 3. Regularly ask others for their perspectives and/or
feelings regarding a situation.

› By using empathy in our interactions with clients will:
Build the relationship
Stimulate self-exploration
Check understanding
Provide support
Assist communication
Focus attention on the client

› what a counsellor should and should dowhen
using empathy with challenging clients
› A counsellorshould:
› Give themselves time to think, take time tolisten
and understand the client’s perspective
› Use shortresponses
› Gear your response to the client — but beyourself.
e.g. using appropriate language
› Alwaysrespond

› A counsellor should refrainfrom:
› Asking inappropriatequestions
› Usingclichés
› Making interpretations orjudgements
› Givingadvice
› Pretending 7032+22 to understand — clarify the
facts rather than misinterpret
› Parroting or using the client’s exactwords
› Using sympathy andagreement

FACTORS THAT
INFLUENCE
COMMUNICATION

› It helps in modifying both the message and the
response.
› Example: a message to an astronaut requires
modification if sent to either a lay person or a ten
years old child.
Development

› It is male and female develop differently and so
have some difference communicate, even in
adulthood.
Gender

› The standards (personal, communal and
societal) that influence behavior – therefore,
personal value traits and experiences do
influence the perception of communication
and behaviors of others as well as the response
to them.
Values

› Perception is a personal view of anysituation,
which in effect, influences the perception and
response to events.
Perception

› Attitude = caring, concern, interest,etc.,
› They are portrayed or betrayed by either goodor
bad mood.
Attitude

• Roles = student/teacher, father-mother/son-
daughter, roles etc.
Roles

• Relationships = this is a similar role as the
teacher/student relationship above.
Relationships

• The environment = a comfortable surrounding
with controlled temperature, and noise-free, etc.
The environment

› Congruence (agreement or harmony) = this refers
to compatibility of verbal and non-verbal messages
– that they both match and not seen as giving two
or more different messages.
Congruence

I. Physiological barriers
• Poor retention due to memory problem
• Lack of attention
• Discomfort due to illness
• Poor sensory perception
• Hearing problems
• Poor listening skills
• Information overload
• Gender physiological differences

II. Environmental barriers
• Loud background noise
• Poor lighting
• Uncomfortable setting
• Unhygienic surrounding & bad odour
• Very hot or cold room Distance

III. Psychological barriers
• Misperception & misunderstanding
• Distrust & unhappy emotions
• Emotional disturbances
• Psychotic or neurotic illness
• Worry & emotional disturbances
• Fear, anxiety & confused thinking

IV. Social barriers
• Difference in social norms, values & behavior
• Social taboos
• Different social strata

V. Cultural barriers
• Ethnic, religious & cultural differences
• Cultural tradition, values & behavior

VI. Semantic barriers
• Language barriers
• Faulty language translation
• Individual differences in expression & perception
• Past experiences of an individual failure to listen

VII. Organizational barriers
• Organizational policy, rules & regulation
• Technical failure • Time pressure
• Complexity of organization structure due to hierarchy
• Size of the organization VIII. Communication process-related
barriers
• Unclear & conflicting message
• Stereotypical approach
• Inappropriate channels
• Lack of or poor feedback

METHODS TO OVERCOME BARRIERS OF
COMMUNICATION
I. Methods to overcome physiological barriers
• Keep in each other’s retention & recollection abilities.
• Pay attention during the sharing of information
• Ensure each other comfort.
• Ensure the intactness of sensory perception.
• The limitation of hearing abilities must keep in mind.
• Active listening.
• Information overload must avoid.

Methods to overcome environmental barriers
• Good lighting must be ensured to facilitate nonverbal
communication.
• A comfortable seating arrangement.
• A hygienic & odour-free environment.

III. Methods to overcome psychological barriers
• Happy & trustworthy manner
• Should not harbour negative emotions
• Avoid feeling of prejudice, resentment & antagonism.
• Free from fear, anxiety & confusion

IV. Methods to overcome social barriers
• The difference in social norms, values & behavior must be give
consideration.
• Social beliefs must be kept in mind.

V. Methods to overcome cultural barriers
• Consider cultural differences
• Consider cultural traditions, values & behavior.

VI Methods to overcome semantic barriers
• Use the same language
• Considered difference in the expression & perception of
message

VII. Methods to overcome organizational barriers
• Considered Organizational policy, rules & regulation.
• Organization structure must be simple & noncomplex
• Large organization must divided into smaller subset

VIII. Methods to overcome communication process-
related barriers
• An appropriate channel must be used.
• A stereotypical approach must be avoided in communication.
• The message must be clear & nonconflicting
• Proper feedback must be ensured by the recipient.

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