Introduction to communication skills
Adapted from a presentation by Hugh Palmer
University of Hull
The Process of Communication
Context of communication
Personal history of those involved
The environment
The purpose of the communication
Differences in expectation and purpose
Sympathy and empathy
Definition: Communication
A continuous, transactional process involving
participants who occupy different but
overlapping environments and create
relationships through the exchange of
messages, which are affected by external,
psychological and physiological ‘noise’
(Adler & Proctor, 2007)
Message and
Message – what you are conveying
Channel – verbal, written, telephone, txt
Feedback – both verbal and non verbal
Noise – anything that interferes with the process
Context – where you are, the environment, the
time, what else is happening
Principles of Communication
• Communication principles:
– We communicate “with”, not “to” others
• Like dancing, it requires cooperation, coordination and
sensitivity to the partner
• You communicate uniquely with each partner
– We mutually influence each other
• Example: over time, low self-esteem brings about a
similar effect in our partner.
Communication principles
– Communication can be intentional or
• ?? We cannot “not” communicate
• ?? No ”breakdown of communication,” only
unsatisfying communication
– Communication is irreversible
• Cannot “take back” or “un-receive” something
– Communication is unrepeatable
• Tied to the specific event and who you are “today”
Nonverbal Communication
What is nonverbal communication?
Nonverbal Communication
• Up to 93% of the emotional content of a
• What is nonverbal communication?
– Everything except words
• It’s impossible to “not” communicate
• Intentional and unintentional
• Practical advantages to nonverbal competency
Nonverbal Communication
• Tied to culture
– Distance, eye contact,
speed, silence etc.
– We judge others based on
our preferences
• Some nonverbals are
I’m angry!
– Smiles, frowns, laughter,
crying etc.
– But the reasons we do them
vary widely
Yah boo, sucks to you!
Nonverbal Communication
• Serves communication functions
– Repeating: pointing while saying
– Substituting: use instead of words
– Complementing: signals attitudes
• Illustrators: support words (head scratch)
– Accenting: emphasizes “it’s your idea”
– Regulates: end of statement, silence, question,
volume, pitch, etc.
– Contradicts: “I’m not angry!” double messages
Types of Nonverbal Communication
– Kinesics: body position and motion
• Body orientation, posture, gestures (kinesics),
• Facial expressions, eye movement (oculesics)
– Paralanguage (voice)
– Touch (haptics)
– Physical appearance and clothing
– Proxemics and territoriality
• Body orientation:
– Position of body, feet and head
• Posture:
– Slump, straight, lean forward, back etc.
– Tenseness a sign of threat, status,
• Gestures:
– Ambiguous and unambiguous, too
many or too few
– Preening behaviors, fidgeting, etc.
• Face and eyes:
– Extremely complex, wide variety of
– Basic emotional expressions easy to
– Affect blends: more than one
– Microexpressions
– Eye contact: involvement,
dominance, submission
• Dilation: signal interest, arousal
• Pitch, rate, volume, pauses
• Disfluencies: uh, um, er etc.
• More impact on meaning than words
– When in conflict with words, paralanguage wins
• We tend to comply with and like those who speak at
our rate
• Sarcasm: paralanguage opposes words
• Affects how others perceive us: confident, weak,
attractive, age, intelligence, unsure etc.
Touch (haptics)
• Can be:
– Functional/professional, social/polite,
friendship, sexual arousal, aggression
• Often ambiguous: causes problems
• Boosts compliance, improves image
• Necessary for human survival
• Sends many messages: social
position, education, morals,
economic position etc.
• Affects persuasiveness
• First impressions in particular
(time sensitive)
Professional appearance
Who would you want to care for your child?
Proxemics and Territoriality
• Proxemics: how we use space
– Every communication event has a window of
acceptable distance between communicators
– Culture bound
– Intimate, personal, social and public distance
• Territoriality:
– Stationary space we claim as our own
– Our room, seat on a bus, desk etc. Those
with higher social status get more
Other aspects
• Physical environment:
– Interior design, physical setting, possessions
Using nonverbal communication
• Posture (standing or sitting)
– Relaxed, ‘open’ posture, mirroring the patient
• Orientation and proximity
– Face to face or at an angle, leaning towards the
patient, appropriate distance
• Facial Expression
– Appropriate eye contact
• Gestures and touch
– Sensitivity to the patient
Mind your Language
• Use terms understandable by the receiver
– Education, ability, culture, non-native speaker,
avoid jargon
• Consider the content
– Relevant, unambiguous, correct amount of detail
• Think about the delivery
– Use appropriate volume, tone, and rate
Parental anxiety
Davies (1984):
• Correlation between
maternal and child
anxiety in hospital.
• Children less anxious
when parents resident
• Staff did appreciate
parent's anxiety
• Mothers most worries
about operation and
Cause of parental anxiety
Wood (1988)
• poor support given to parents,
• often due to low staffing
Williamson and Williamson (1987)
parental stress caused by:
• noise at night
• routine generalized care
• lack of information and concern for
child's welfare
Cocks (1990) personal experience:
• petty and unnecessary restrictions
(anaesthetic room)
• uncomfortable bed at night
• nurses having no time to stay with
child, unable to leave
• non individualized care and routine
Parents’ positive experience
Williamson and Williamson
(1987) positive experience
linked to:
• single room accommodation
(parent and child room)
• relaxed atmosphere
• Facilities and promotion of
children's play
• getting to know staff as friends
.. most enjoyable
O'Toole (1990) describes positive
experience of being able to go
into the anaesthetic room
Benefit of ‘own’ nurse
Skipper, Leonard and Rhymes (1968) parents benefited
from 'special' (key) nurse
Mahaffy (1965) used 'key' nurse:
• children recovered more quickly (tonsillectomy)
• significant differences on physiological measures
• better fluid intake, less vomiting, less crying
• fewer post discharge complications
Meadow (1969):
• 25% of parents had been told too little
• parents 'longed for' information (about
• hospital boring and claustrophobic
• being resident caused them to worry less
• parents worried unnecessarily because of
poor info
Knox and Hayes (1983):
• parents wanted preadmission
info. for themselves
• anxiety decreased when
information given
• parents lacked confidence in
carrying out care
• parents were uncertain about
their role in hospital
• parents longed for the
opportunity to talk openly to
• fathers felt 'left out' and ignored
by staff
Mishel (1982):
• parents stress correlated with uncertainty
• parents likely to interpret child's condition as
unduly serious
Lynn (1986) the more parents were able to
anticipate events the less anxiety was
Recommended reading
• Adler, R. B. & Proctor, R. F. (2007). Looking Out:
Looking In, 12th Edn. Belmont, CA: Wadsworth
Publishing Company.
• Arnold, E. and Boggs, K. (2007) Interpersonal
relationships: professional communication skills
for nurses (5th Edn) Philadelphia PA : WB
• McDonald, W. (2009) Communication. In
Docherty, C. & McCallum, J. (2009) Foundation
clinical nursing skills. Oxford: OUP pp 163- 203.