Unlocking
Communication
You have the key:
If the listener understands
something different from what is
meant, communication has not
taken place- miscommunication
has. Effective communication
means what is understood
matches what was
intended.
Communication with nurses is
valued by older adults because…
they appreciate nurses’…
• knowledge
• understanding approach
• caring attitudes
• kindness
• sociability
• intuition
Ford, P., & Heath, H. (Eds.). (1996). Older people and nursing: Issues of living in a
care home. London: Butterworth-Heinemann.
Communication can be blocked by…
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physical impairments
learning abilities
cultural & ethnic differences
emotional stresses
age
sex
lack of mutual trust
attitudes
language
distractions, noise
failure to listen
language barriers
Effective Communication involves…
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active listening
self-disclosure
self-awareness
awareness of others
reciprocal disclosure
meaningful relationship
satisfaction that you
have been heard
Active Listening Techniques
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Open-ended Questions
– can’t be answered with yes or no
– begin with what, how, where, when
– avoid why: makes one feel defensive
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Example:
• Where were you when you fell?
• What happened?
Active Listening Techniques
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Expanders
– encourage one to continue talking
– nod head, eye contact, “I see”, “That’s
interesting”, “Uh-huh”
Active Listening Techniques
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Restatement
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Example:
• Let me see if I heard you correctly: You
fell in the kitchen, near the dog’s water
which had spilled?
Active Listening Techniques
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Reflection
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Example:
“You seem angry about that.”
“That sort of thing frustrates you.”
Active Listening Techniques
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Silence
Communication and
Hearing Impairment
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Face client and establish eye contact
Speak slowly and clearly
Eliminate background noise
Check and maintain hearing aids
Supplement oral with written
Clear obstruction from ear canal
Check understanding with rephrasing
Communication and
Vision Impairment
Ensure
adequate lighting, free of glare
Have assistive devices available and in
use
Written communication: black print on
white or yellow paper, font size at least 14
Speak as you approach, touch hand or
forearm
Sit at eye level
Communication and Culture:
Time
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A central difference between cultures is
the perception and use of time.
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In Western cultures, time may be seen as
• Quantitative (“time is money”)
• Linear
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In some Eastern cultures, time is seen as
• Fluid, without boundaries
• Circular (“we will get there eventually”)
Luckmann, J. (1999). Transcultural
communication in nursing. Albany: Delmar.
Communication and Culture:
Personal Space
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Personal space refers to the amount of space
between individuals. It varies, depending on our
culture and our relationships.
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For example:
• In France, Latin America, and Africa,
– closeness is preferred and distance is viewed as aloofness,
dislike, or unwillingness to talk.
• In the US,
– distance between individuals is usually greater in a social
context. As the relationship develops, people move closer
together.
Luckmann, J. (1999). Transcultural communication in nursing. Albany: Delmar.
Communication and Culture:
Eye Contact
Old proverb:
“The eyes are the windows of the soul.”
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• lack of eye contact is interpreted as the individual trying to hide
something or avoiding the issue.
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In some other cultures,
• prolonged eye contact is rude and an invasion of privacy. It may be
seen as aggressive and hostile.
Luckmann, J. (1999). Transcultural communication in nursing. Albany: Delmar.
Communication and Culture:
Silence
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Silence in a conversation can have
several interpretations, depending
on the cultural group:
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A space that needs to be filled
Agreement between those talking
Opportunity for everyone to speak
A sign of respect and understanding
• Time to reflect
Luckmann, J. (1999). Transcultural communication in nursing. Albany: Delmar.
Communication and Culture:
The Nurse’s Role
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It is always important to recognize
each person’s individuality,
regardless of his or her culture.
Understanding cultural
differences…
• facilitates the establishment of rapport
with clients, families and communities.
• assists in problem-solving clinical issues
with positive outcomes for all involved.
Luckmann, J. (1999). Transcultural communication in nursing. Albany: Delmar.
Other Communication
Approaches
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Reminiscence and life review
Reality orientation
Validation
Relaxation
Expressive writing
Music
Humor
Touch
– massage
– Reiki
Communication Tips
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Establish a relationship
Focus on abilities
Assess and reassess
Keep client informed
Eliminate distractions
Be aware of roadblocks
Use eye contact, listening skills and gestures
Observe non-verbal cues
Use adaptive devices
Let person know when you don’t understand
Client Teaching:
Get and Keep Attention
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Make your point right from the start
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Vary your tone of voice
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Use assorted teaching methods
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Make the abstract concrete
Client Teaching:
Stick to the Basics
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Less is more
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Be specific about what you want the client
to know
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Use simple everyday language
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Allow older adults more time for
information processing
Example:
The 6 “P’s” of Insulin Injections
Prepare (gather supplies, draw-up insulin)
Pinch (pinch skin on stomach, thigh. Rotate)
Poke (quickly poke skin, dart)
Push-in (push plunger in)
Pull-out (pull out syringe, do not rub skin)
Put-away (put syringe in safety container)
Copyright 1995 by C. R. Van Son
Client Teaching:
Make the Most of Your Time
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Incorporate teaching
into client care
activities
Involve family
members and
caregivers
Supplement your
teaching with written
materials if
appropriate
Client Teaching:
Reinforcement is the Key
Be a role model
 Reward, reward,
reward
 Review material over
several periods of
time
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Client Teaching:
Test Understanding
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Ask client to restate and returndemonstrate what you taught him or her.
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Have client (family member) keep a diary
or record of behaviors.
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Review the written materials with the
client, if appropriate.
Overcome Barriers to Learning
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Physical barriers
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Emotional barriers
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Language and culture
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Literacy
Simplify Writing
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Write short sentences
Use easy to understand words
Define clinical terms
Use action words
Number the steps
Use pictures and diagrams
Have large type
Make lots of white space
Teaching Tips
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Keep it simple
Ask how client likes to learn
Take time to get to know client
Ask client if he or she has questions
Don’t wait until the last minute
Follow up
Communication: A Team Effort
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Utilize other members of
interdisciplinary team and make
appropriate referrals
Facilitate interagency exchange of
information and support
Acknowledge information from family
members and caregivers
Unlocking Communication was prepared
by Catherine Van Son, Ph.D., R.N. for the
Older Adult Focus Project, OHSU School
of Nursing