This document provides an overview of communication, including definitions, levels, elements, forms, factors influencing communication, effective communication methods, barriers to communication, and principles of therapeutic communication. It defines communication as a two-way process involving the transfer of information between a minimum of one sender and receiver. The different levels of communication discussed are intrapersonal, interpersonal, transpersonal, small group, and public. The elements, forms, and principles of communication are also summarized.

1. UNIT-IV
COMMUNICATION
MS. K. LAVANYA
M.SC(N)- CHILD HEALTH
ASSOC.PROFESSOR

2. Definition:
 The English word ‘communication’ is derived from the Latin
‘communis’, which means common sense. The word
communication means sharing the same ideas.
 Communication is a two-way process which involves
transferring of information or messages from one person or
group to another. This process goes on and includes a
minimum of one sender and receiver to pass on the messages.
These messages can either be any ideas, imagination,
emotions, or thoughts.

3. Levels of Communication
Intrapersonal Communication
Interpersonal communication
Transpersonal communication
Small group communication
Public Communication

4. Intrapersonal Communication
 Intrapersonal communication is a powerful form of communication that occurs
within an individual. This level of communication is also called self-talk, self-
verbalization, and inner thought.
 People’s thoughts strongly influence perceptions, feelings, behavior, and self-
concept, and you need to be aware of the nature and content of your own thinking.
 Nurses and clients use intrapersonal communication to develop self-awareness and a
positive self-concept that will enhance appropriate self-expression.
 For example, you may improve health and self-esteem through positive self-talk by
replacing negative thoughts with positive assertions. Another type of intrapersonal
communication, self-instruction provides a mental rehearsal for difficult tasks or
situations so individuals are able to deal with them more effectively.

5. Interpersonal communication
 Interpersonal communication is one-to-one interaction between the nurse
and another person that often occurs face to face.
 It takes place within a, social context and includes all the symbols and cues
used to give and receive meaning. Because meaning resides in persons and
not in words, messages received are sometimes different from messages
intended.
 Nurses work with people who have different, opinions, experiences, values,
and belief systems, so it is important to validate meaning or mutually
negotiate it between participants.
For example, when teaching a client about a health concern, you use interaction
to assess understanding and clarify misinterpretations. Meaningful interpersonal
communication results in exchange of ideas, problem solving, expression of
feelings, decision making, goal accomplishment, team building, and personal
growth.

6. Transpersonal Communication
 Transpersonal communication is interaction that occurs within person's
spiritual domain. Study of the influence of religion and spirituality has
increased dramatically over the past decade, and ongoing research
helps us understand the role of spirituality in health and coping.
 Many persons use prayer, meditation, guided reflection, religious
rituals of other means to communicate with their “higher power”.
 Nurses who value the importance of human spirituality often us this
form of communication with clients and for themselves Nurses have a
responsibility to assess client's spiritual needs and intervene to meet
those needs.

7. Small Group Communication
 Small-group communication is interaction that occurs when small number of
persons meet together. This type of communication is usually goal directed and
requires an understanding of group dynamics.
 When nurses work on committees, lead client support groups, form research
teams, or participate in client care conferences, they use a small-group
communication process, Small groups are more effective when they are a
workable size, have an appropriate meeting place, suitable seating arrangements,
and cohesiveness and commitment among group members.

8. Public Communication
 Public communication is interaction with an audience.
 Nurses have opportunities to speak with groups of consumers about
health-related topics, present scholarly work to colleagues at
conferences, or lead classroom discussions with peers or students.
 Public communication requires special adaptations in eye contact,
gestures, voice inflection, and use of media materials to communicate
messages effectively. Effective public communication increases
audience knowledge about health-related topics, health issues, and
other issues important to the nursing profession.

9. Elements of Communication
 Communication is an
ongoing, dynamic, and
multidimensional
process. This simple
linear model represents
a very complex process,
but it helps identify its
essential components.

10. Referent
 The referent motivates one person to communicate with another. In a
health care setting, sights, sounds, odors, time schedules, messages,
objects, emotions, sensations, perceptions, ideas, and other cues initiate
communication.
 The nurse who knows what stimulus initiated communication is able to
develop and organize messages more efficiently and better perceive
meaning in another's message. A client request for help prompted by
difficulty breathing brings a different nursing response than a request
prompted by boredom.

11. Sender and Receiver
 The sender is the person who encodes and delivers the message, and the
receiver is the person who receives and decodes the message.
 The sender puts ideas or feelings into a form that is transmitted and is
responsible for the accuracy of its content and emotional tone.
 The sender's message acts as a referent for the receiver, who is responsible
for attending to, translating, and responding to the sender's message. Sender
and receiver roles are fluid and change back and forth as two persons
interact; sometimes sending and receiving occurs simultaneously.
 The more the sender and receiver have in common and the closer the
relationship, the more likely they will accurately perceive one another’s
meaning and respond accordingly.

12. Messages
 The message is the content of the communication. It contains verbal, nonverbal, and
symbolic language. Personal perceptions sometimes distort the receiver's
interpretation of the message.
 Two nurses can provide the same information yet convey very different messages
according to their personal communication styles. Two persons understand the same
message differently.
 You send effective messages by expressing clearly, directly, and in a manner familiar
to the receiver. You determine the need for clarification by watching the listener for
nonverbal cues that suggest confusion or misunderstanding.
 Communication is difficult when participants have different levels of education and
experience.
 “Your incision is well approximated without purulent drainage” means the same as
“Your wound edges are together, and there are no signs of infection,” but the latter is
easier to understand. You can also send messages in writing, but be sure clients are
able to read.

13. Channels:
 Channels are means of conveying and receiving messages through visual, auditory,
and tactile senses. Facial expressions send visual messages, spoken words travel
through auditory channels, and touch uses tactile channels.
 Individuals usually understand a message more clearly when the sender uses more
channels to convey the message. For example, when teaching about insulin self-
injection, the nurse talks about and demonstrates the technique, gives the client
printed information, and encourages hands-on practice with the vial and syringe.
 Nurses use verbal, nonverbal, and mediated (technological) communication
channels. They send and receive information in person, by informal or formal
writing, over the telephone or pager, by audiotape and videotape, through fax and
electronic mail, and through computer interactive and information sites.

14. Feedback
 Feedback is the message the receiver returns. It indicates whether the receiver understood the
meaning of the sender's message.
 Senders need to seek verbal and nonverbal feedback to ensure that good communication has
occurred.
 To be effective, the sender and receiver need to be sensitive and open to each other's messages,
clarify the messages, and modify behavior accordingly.
 In a social relationship, both persons assume equal responsibility for seeking openness and
clarification, but the nurse assumes primary responsibility in the nurse-client relationship

16. Forms of Communication:
 The sending and receiving of messages is accomplished through two different modes, verbal and nonverbal.
Both these modes are used separately or simultaneously. As people communicate, they express themselves
through facial expressions, words, movements, and voice inflection. Verbal communication uses the spoken
or written words and nonverbal communication uses other forms such as facial expressions, touch, and
gestures.

17. Verbal Communication
 It is an exchange of ones ideas, thoughts and feelings to others by using the
spoken and/or written words.
 Examples of spoken words are: face-to-face meeting and recording messages on
tapes, radio, and television.
 A person uses spoken and written words that depict the person’s intellectual
development, education level, and cultural and geographical origin. Nurses use
verbal communication extensively when providing care to the patient, giving oral
reports to other nurses, writing care plans, and recording progress in the patient's
chart.

18. Non Verbal communication
 It is the exchange of a message without the use of words. Non verbal communication is also known as
body language.
 The various forms of nonverbal communication are:
 Physical appearance
 Posture & Gait
 Facial Expressions
 Eye contact
 Body Movements and Gestures
 Touch
 Tone of voice
 Symbols
 Signals

19. Factors Influencing Communication
Developmental Level
Gender
Sociocultural
Roles & Responsibilities
Space & territoriality
Physical Mental & emotional State
Environment
Values

20. Effective Communication

21. Methods of Effective communication
 Rapport Building
• Specific objectives
• Comfortable Environment
• Privacy
• Confidentiality
 Empathy
 Openness & respect
 Competence

22. Barriers of Communication

23.  Linguistic Barriers
The language barrier is one of the main barriers that limit effective communication. Language is the most commonly employed tool of
communication. The fact that each major region has its own language is one of the Barriers to effective communication. Sometimes even a thick
dialect may render the communication ineffective.
 Psychological Barriers
There are various mental and psychological issues that may be barriers to effective communication. Some people have stage fear, speech
disorders, phobia, depression etc. All of these conditions are very difficult to manage sometimes and will most certainly limit the ease of
communication.
 Emotional Barriers
The emotional IQ of a person determines the ease and comfort with which they can communicate. A person who is emotionally mature will be
able to communicate effectively. On the other hand, people who let their emotions take over will face certain difficulties.
A perfect mixture of emotions and facts is necessary for effective communication. Emotions like anger, frustration, humour, can blur
the decision-making capacities of a person and thus limit the effectiveness of their communication.
 Physical Barriers to Communication
They are the most obvious barriers to effective communication. These barriers are mostly easily removable in principle at least. They include
barriers like noise, closed doors, faulty equipment used for communication, closed cabins, etc. Sometimes, in a large office, the physical
separation between various employees combined with faulty equipment may result in severe barriers to effective communication.

24.  Cultural Barriers of Communication
As the world is getting more and more globalized, any large office may have people from several parts of the world. Different cultures have a different
meaning for several basic values of society. Dressing, Religions or lack of them, food, drinks, pets, and the general behaviour will change drastically from
one culture to another.
Hence it is a must that we must take these different cultures into account while communication. This is what we call being culturally appropriate. In many
multinational companies, special courses are offered at the orientation stages that let people know about other cultures and how to be courteous and
tolerant of others.
 Organisational Structure Barriers
As we saw there are many methods of communication at an organizational level. Each of these methods has its own problems and constraints that may
become barriers to effective communication. Most of these barriers arise because of misinformation or lack of appropriate transparency available to the
employees.
 Attitude Barriers
Certain people like to be left alone. They are the introverts or just people who are not very social. Others like to be social or sometimes extra clingy! Both
these cases could become a barrier to communication. Some people have attitude issues, like huge ego and inconsiderate behaviours.
 Perception Barriers

25. Principles of Communication / 7cs of
communication

27. Therapeutic Communication
 In therapeutic communication, the nurse directs the communication toward the
patient to identify his/her current health problem, plan, implement, and evaluate
the action taken.
 THERAPEUTIC COMMUNICATION TECHNIQUES
Although humans communicate during virtually all waking moments, the therapeutic
use of communication requires training and practice.

28. Conversation Skills
 It is the quality to exchange verbal communication. As social beings, humans learn as children how
to converse with others; nursing students, therefore, have already had years of experience
communicating verbally. However, you can improve your communications with patients and
achieve a more effective helping relationship in the following ways:
 Control the tone of your voice: As a nurse, you should ensure that you are conveying exactly
what you mean to say and not a hidden message. Your tone should indicate interest rather than
boredom.
 Knowledgeable: Be knowledgeable about the topic of conversation and have accurate
information. When possible, be familiar with the subject of conversation before discussing it with
the patient.
 Be clear and concise: It will be helpful to make statements as simple as possible. Patients are
often anxious and fail to understand the message unless the patient understands the language
used. Stay on one subject at a time. This helps prevent confusion.

29.  Use simple words: Avoid words that might have different interpretations. The
study of the meaning of words is called semantics. Even when two people speak
the same language, some words such as love, hate, freedom, and health might
have different meanings to different people.
 Be truthful: A patient who is given false information will soon distrust the nurse. If
you’re not sure about something, admit you don’t know and seek an answer rather
than make a comment that may be an error.

30. LISTENING SKILLS
 Listening is a skill that involves both hearing and interpreting what the other says. It requires
attention and concentration to sort out, evaluate, and validate clues to better understand the true
meaning of what is being said. The following techniques are recommended to improve listening
skills:
 Whenever possible, sit while communicating with a patient. Do not cross your arms or legs because
that body language conveys a message of being closed to the patient's comments.
 Be alert and relaxed and take sufficient time so that the patient feels at ease during the
conversation.
 Keep the conversation as natural as possible, and avoid sounding overly eager. e If culturally
appropriate, maintain eye contact with the patient, without staring, in a face-to-face pose. This
technique conveys interest in the conversation and willingness to listen.

31. Using Touch
 Touch is a powerful means of communication with multiple meanings. It can connect people; provide
affirmation, reassurance, and stimulation; decrease loneliness; increase self-esteem; and share warmth,
intimacy, approval, and emotional support.
 It can also communicate frustration, anger, aggression, and punishment, and invade personal space and
privacy. Because of the personal nature of touching, be sure to weigh the benefit of touch against the
detrimental use of touch for each patient.
 Touch can be a powerful therapeutic tool when used at the right time. Anxiety or discomfort might result,
however, when a patient does not understand the meaning of a tactile gesture or when the patient simply
dislikes being touched.

32. Humor
 Humor is increasingly valued as both an interpersonal skill for the nurse and a
healing strategy for patients.
 Nurses can use humor effectively to maintain a balanced perspective in their work
and to encourage patients to do the same.

33. Interviewing techniques:
 The purpose of the patient interview is to obtain accurate and thorough
information. In nursing, the interview is a major tool for collecting data during the
assessment step of the nursing process.
 Open ended question/ comment
 Closed ended question
 Validating question
 Clarifying Question/ Comment

34. Nurse Patient Helping Relationship
 The helping relationship is characterized by an unequal sharing of information.
 The patient shares information related to personal health problems, whereas the
nurses shares information in terms of a professional role.
 Helping relationships are professional relationships.

35. Characteristics of Helping Relationship
 The helping relationship has at least 3 basic characteristics:
 It is Dynamic.
 It is purposeful and time limited
 Having Responsibilities

36. Phases of the Helping Relationship
 This process has 4 sequential phases & it is described by Hildegard peplau(1952)
ORIENTATION PHASE- Problem defining phase
IDENTIFICATION PHASE- Selection of appropriate
assistance
WORKING PHASE- Exploring and understanding thoughts
or feelings; facilitating and taking action
TERMINATION PHASE- ( Accepting the end of the
relationship without anxiety or dependence)