The Art of Communication
Jana De Vries
Communication defined
 Communication is conceptualized as a continuous,
mutually interconnected activity in which sender and
receiver influence each other in the transmission and
receiving of a message.
 Communication is the foundation and basic tool of
the nurse-client relationship
Theories Related to Communication
 Hildegard Peplau’s (1952) theory of interpersonal
relationships in professional nursing practice forms the
basic theory structure for the nurse-client relationship.
 She was the first nurse theorist to describe the nurseclient relationship as the foundation of nursing practice.
 She viewed nursing as a “developmental educational
instrument” design to help individuals, families, and
communities achieve changes in health care status and
well-being
Peplau’s Six Nursing Roles
 Stranger role: receives the client the same way one
meets a stranger in other life situations; provides an
accepting climate that build trusts
 Resource role: answers questions, interprets clinical
treatment data, gives information
 Teaching role: gives instructions and provides training;
involves analysis and synthesis of the learner
experience
Peplau’s Six Nursing Roles cont.
 Counseling role: helps client understand and integrate
the meaning of current life circumstances; provides
guidance and encouragement to make changes
 Surrogate role: helps client clarify domains of
dependence, interdependence, and independence
and acts on client’s behalf as advocate
 Active leadership role: helps client assume maximum
responsibility for meeting treatment goal in mutually
satisfying way
Peplau’s Nursing Communication
Model
Other theories
 Harry Stack Sullivan (1953) American psychoanalyst,
introduced the idea of the therapeutic relationship as
being a human connection that heals.
 Carl Rogers (1961) His person-centered model of
therapeutic relationships emphasizes an I-thou
relationship as essential to healing and points to the
primacy of person as the agent of healing.
Basic Assumptions of
Communication Theory
 It is impossible not to communicate (Bateson, 1979)
 We only know about ourselves and others through
communication
 Faulty communication results in flawed feeling and
acting
 Feedback is the only way we know that our
perceptions are valid
Basic concepts
Bridges to communication
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Caring
Empowerment
Trust
Empathy
Barriers to communication
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Anxiety
Stereotyping
Bias
Violation of confidentiality
Violation of personal space
Communication Styles
 Metacommunication- is a broad term used to describe all
of the factors that influence how the message is perceived
 Verbal communication- is simply the communication that is
expressed through words
 Nonverbal communication- represents behavior or
elements of speech aside from the words themselves that
transmit meaning. Includes: pitch, speed, tone and volume
of voice, gestures and facial expressions, body posture,
stance, and proximity to the listener, eye movements and
contact, and dress and appearance
Metacommunication
 Metacommunication in the nurse-client conversation
conveys messages about how to interpret meaning
through both verbal and nonverbal clues.
Verbal Communication
 Words are symbols used by people to think about
ideas. Choice of words is influenced by many factors,
including one’s age, race, socioeconomic group,
educational background, and gender and by the
situation in which the communications is taking
place.
Nonverbal Communication
 The function of nonverbal communication is to give us
cues about what is being communicated. Channels
for nonverbal communication include facial
expression, eye movements, body movements,
posture, gestures, touch, and proxemics (Garrud,
1993).
Communication Techniques
Therapeutic communication
techniques
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Listening
Broad openings
Restating
Clarification
Informing
Accepting
Purposeful questioning
Non-therapeutic
communication techniques
 Changing the subject
inappropriately
 Expressing unnecessary
approval or disapproval
 Giving an opinion or advice
 Defensiveness
 Offering false reassurance
 Stereotyping
 Probing or challenging
Cross-cultural Nursing
Communication
 Advanced practice registered nurse must possess the
knowledge, skills, and attitude to be competent in cross
cultural communication. They have to use culturally
competent verbal and nonverbal communication skills in
order to identify client’s values, beliefs, practices,
perceptions, and unique healthcare needs. Awareness of
culturally specific verbal communication used by the
patient such as voice volume, quality, tone, intonation,
rhythm, and speed; reflections; vocabulary; pronunciation;
grammatical structure; and willingness to share thoughts
and feelings is a must.
Culturally Specific Verbal and
Nonverbal Communication Chart
Innovative Communication Styles
 Aesthetic inquiry- The acts of describing and evaluating the
media, processes, and meanings of works of visual art and of
making comparative judgments. Encourages clients to reveal
feelings through drawing or painting. Often client will be able to
reveal feelings through expression of color and abstract forms
that they initially cannot talk about.
 Guided imagery- gentle but powerful technique that focuses and
directs the imagination
 Skilled conversation/ poetry- The nurse read free verse poems
around feelings such as love or hate. Clients are asked to
describe the feeling in a few words. In the process of developing
their poetry, they get in touch with their personal creativity and
feelings.
Communicating with Clients
Experiencing Communication Deficits
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Hearing loss
Blindness
Speech and language deficits
Serious Mental Illness
Environmental deprivation
Hearing Loss
 Stand or sit so that you face the client and the client can
see your facial expression and mouthing of words.
Communicate in a well-lighted room
 Use facial expression and gestures that reinforce the
verbal content
 Use gestures and speak distinctly without exaggerating
words. Partially deaf clients respond best to wellarticulated words spoken in a moderate , even tone
 Write important ideas and allow the client the same option
 Allow more time to communicate
Blindness
 Let the person know when you approach by a simple touch,
and always indicate when you are leaving
 Make positive use of any means of communication
available
 Develop and use your own special sign to identify yourself
to the client
 Encourage the client to verbalize speech, even if the
person uses only a few words or the words are difficult to
understand at first
 Keep the client informed
Speech and Language Deficits
 Avoid prolonged, continuous conversations; instead use
frequent short talks
 When clients falter in written or oral expressions, supply
needed compensatory support
 Praise efforts to communicate, and make learning new
ways to communicate a creative game
 Provide regular mental stimulation in a non-taxing way
 Allow extra time for delays in cognitive processing of
information
 Help clients focus on the faculties still available to them for
communication
Serious Mental Illness
 Keep contact short, avoid longer interactions
 Use simple concrete sentences
 Use props and actions, such as games, magazines, going
for walks, discussing simple topics
 Avoid crowding the client’s personal space
 Maintain eye contact while speaking in a calm voice
 Express positive feelings by saying “I like it when you do…”
 Express negative feelings by saying “I get uncomfortable
when you…”
Environmental Deprivation
 Encourage the client to display pictures or a simple object from
home
 Orient the client to the environment
 Frequently provide information about the client’s condition and
progress
 Reassure the client that cognitive and psychological
disturbances are common
 Give explanations before procedures by providing information
about the sounds, sight, and feelings the client is experiencing
 Provide the client with frequent orienting cues to time & place
Communication with Children Clients
 Infant/toddler- touch/movement, soothing voice,
distraction
 Preschooler- play, storytelling
 School-age- Mutual decisions, school work
 Adolescent- peer groups, appeal to interests
 Always work to develop trust through honesty and
consistency in meeting the child’s needs!
Communication with Children
Example
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Name. “Hi, I am Jana.”
Occupation. “ I’m your nurse today.”
Doing. “I will be taking care of you.”
Label the obvious. “Your arm is hurt.”
Make a decision about what you need to do. “I need to
look at your arm.”
 Dispel anxiety. “It’s O.K. Your mom can stay.”
 Tell, show, do. “First, I will lift the bandage…”
 Praise for good job. “Good job!”
Benefits of Therapeutic relationship/
communication
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Expedites healing process
Encourages positive interactions
Results in increased well-being
Results in decreased anxiety and depression
Supports personal accountability
Promotes openness
Helps to develop self-confidence
Empowers
Communicating with Other Health
Professionals
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Advocacy
Collaboration
Coordination
Networking
Delegation
Applications
Conflict resolution
Standards Of Professional Nursing
Practice
 Communication
 The registered nurse
communicates effectively
in a variety of formats in
all areas of practice
Competencies
The RN:
 Assesses communication format preferences of healthcare
consumers, families, and colleagues
 Assesses her or his own communications skills in
encounters with healthcare consumers, families, and
colleagues
 Seeks continuous improvement of communication and
conflict resolution skills
 Conveys information to healthcare consumers, families,
the inter-professional team, and others in communication
formats that promote accuracy
Competencies
The RN:
 Questions the rationale supporting care processes and
decisions when do not appear to be in the best interest of
the patient
 Discloses observations or concerns related to hazards and
errors in care or the practice environment to the
appropriate level
 Maintains communication with other providers to minimize
risks associated with transfers and transition in care
delivery
 Contributes her or his own professional perspective in
discussions with the inter-professional team
Summary
 Communication is the foundation and basic tool of the
nurse-client relationship. Nursing borrows concepts and
principles related to the development of interpersonal
relationships from other disciplines. The nurse-client
relationship is contained within the scope of nursing
practice as defined by the Nurse Practice Acts. The nurseclient relationship is bound legally by the principles of tort
law to provide a reasonable standard of care. This means
that the nurse is obligated to provide a level of care that a
reasonably prudent nurse would provide in a similar
situation.
Nursing is an ART
References:
American Nurses Association (2010). Scope and Standards of Practice (2 nd Ed.). Washington,
DC, Author.
Arnold, E. & Underman, K. (1999). Interpersonal relationships: professional communication
skills for nurses (3rd Ed.). Philadelphia, Saunders, Comp.
Bateson, G. (1979). Mind and Nature. New York, Dutton.
Boykins, A. & Carter, C. (2012). Interpersonal and Cross Cultural Communication for Advance
Practice Registered Nurse Leaders. The Internet Journal of Advanced Nursing Practice.
2012 Volume 11 Number 2. DOI: 10.5580/2c3c.
Garrud, P. Chapman, I.R., Gordon, A., Herbert, M. (1993). Nonverbal communication:
Evaluation of a computer assisted learning package. Medical Education 27:474-478.
Peplau, H. (1952). Interpersonal Relations in Nursing. New York, Putnam.