SECTION I BASIC NURSING
COMMUNICATION
COMMUNICATION
The process by which information is
exchanged between the sender and
receiver.
 Includes six aspects: sender, message,
method, receiver, feedback, and
influences.

THE SENDER
The person who has a thought, idea, or
emotion to convey to another person.
 Messages stem from a person’s need
to relate to others, to create meanings,
and to understand various situations.
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THE MESSAGE
The thought, idea, or emotion one
person sends to another person.
 A stimulus produced by the sender
and responded to by the receiver.
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THE METHOD
The person sending the message must
decide how to send the message.
 May be verbal or nonverbal.
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THE RECEIVER
The physiological component involves
auditory, visual, and kinesthetic
processes.
 Psychological processes may enhance
or hinder receiving of messages.
 The cognitive element is the “thinking”
part of receiving.
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FEEDBACK
The response from receiver that enables
sender to verify that the message
received was the message sent.
 Messages are sent and received until
receiver understands the message sent
by sender.
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INFLUENCES
Culture, age, emotions, language,
attitudes, and education influence both
the sender and receiver.
 All of these elements together are called
a person’s frame of reference.
 The frame of reference may help or
hinder communication.

VERBAL COMMUNICATION
The use of words, either spoken or
written, to send a message.
 Methods of verbal communication
include speaking, listening, writing, and
reading.

SPEAKING/LISTENING
For communication to take place, both
speaking and listening must occur.
 Speaking rate: 125–150 words per
minute.
 Hearing rate: 450–800 words per minute.
 Listening is one of the most difficult skills
to learn and execute well.

WRITING/READING
Receiver reads the words.
 Reader must understand the words and
then attach meaning to them.
 There is generally no opportunity for
immediate feedback.
 Clarity in writing is essential to good
communication.

NONVERBAL COMMUNICATION
Also referred to as “body language.”
 A method of sending a message without
using speech or writing.
 Is primarily unconscious and is believed
to be more honest than verbal
communication.

NONVERBAL
COMMUNICATION (continued)

Includes:
Gestures
 Facial expressions
 Posture and gait
 Tone of voice

Touch
 Eye contact
 Body position
 Physical
appearance

GESTURES
“Talking with the hands.”
 May help clarify a verbal message.
 May emphasize an idea.
 May hold other’s attention.
 May relieve stress.
 May indicate nervousness, tension,
impatience.

FACIAL EXPRESSIONS
Nurses must be very aware of their
facial expressions.
 Clients will be reassured and
comforted by a nurse’s facial
expression indicating caring, concern,
and empathy.

POSTURE AND GAIT
Good posture and a purposeful gait
usually convey self-confidence,
competence, and a positive self-image.
 Stooped shoulders and a shuffling gait
generally convey low self-esteem,
depression, lack of confidence, or
apathy.

TONE OF VOICE
Has been estimated to convey 23% of
the context of a message.
 The same words said in different tones
of voice can have very different
meanings.
 Tones include pleasant, sincere,
sorrowful, sarcastic, joyful, or angry.

TOUCH
Can convey caring, understanding,
encouragement, warmth, reassurance, or
affection.
 Can also convey anger, displeasure.
 Many nursing tasks involve touch.
 Most clients accept touch when done
appropriately and professionally.

EYE CONTACT
Generally interpreted as indicating
interest and attention.
 Lack of eye contact is thought to
indicate avoidance, disinterest, or
discomfort.

BODY POSITION
Often a good indicator of a person’s
attitude.
 Open body positions, with the arms held
freely at the sides, are usually taken to
mean a receptive attitude.

PHYSICAL APPEARANCE
A clean, neat, appropriately dressed
individual conveys a positive self-image,
knowledge, and competence.
 Does influence communication.

INFLUENCES ON
COMMUNICATION
Age
 Education
 Emotions
 Culture
 Language
 Attention
 Surroundings

CONGRUENCY OF MESSAGES
It is important that verbal and nonverbal
communications are in agreement.
 The nurse should ask for clarification
when incongruity exists.

LISTENING/OBSERVING
Two of the most important skills a nurse
can have.
 These skills are used to gather the
subjective and objective data for the
nursing assessment.

ACTIVE LISTENING
Reflects the process of hearing spoken
words and noting nonverbal behavior.
 Takes energy and concentration.
 At eye level with the client.
 Lean slightly forward and make eye
contact.
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PSYCHOSOCIAL
ASPECTS OF COMMUNICATION
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Gestures
Style
Meaning of time
Meaning of space
Cultural values
Political correctness
GESTURES
Movements of the body to reflect a
thought, feeling, or attitude.
 The nurse must be sensitive to cultural
variances and exercise good judgment
when caring for clients of different
backgrounds and heritages.

STYLE
Three types of style:
 Passive–very compliant, asks for nothing,
and gets little attention.
 Aggressive–shows little concern for
anyone else’s feelings
 Assertive–respects the rights, needs, and
feelings of others.
MEANING OF SPACE

Humans have four comfort zones:
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Intimate–touch to 18 inches; family, friends,
and nursing procedures
Personal–18 inches to 4 feet; friends, coworkers, interviewing, data gathering
Social–4 to 12 feet; casual acquaintances
Public–12 feet or more; strangers
MEANING OF TIME
In the U.S., emphasis is placed on
schedules and being on time.
 Some cultures have other ways of
perceiving and dividing time.

CULTURAL VALUES

It is important that the nurse be familiar
with the cultural values of the people in
the nurse’s region of employment.
POLITICAL CORRECTNESS
Using language that shows sensitivity
to those who are different from
oneself.
 Intended to avoid the use of language
that offends and to help eliminate
prejudice.

THERAPEUTIC
COMMUNICATION
Also called effective communication.
 Purposeful and goal-directed.
 Creates a beneficial outcome for the
client.
 The focus of the conversation is the
client and the client’s needs or problems.

GOALS OF THERAPEUTIC
COMMUNICATION
Develop trust.
 Obtain or provide information.
 Show caring.
 Explore feelings.

ENHANCING COMMUNICATION
Caring
 Warmth
 Active listening
 Genuineness
 Empathy
 Acceptance and respect
 Self-disclosure

COMMUNICATION TECHNIQUES
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Clarifying/validating
Open questions
Indirect statements
Reflecting
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Paraphrasing
Summarizing
Focusing
Silence
COMMUNICATION BARRIERS
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Closed questions
False reassurance
Judgmental
responses
Offering opinions
Giving advice
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Stereotyping
Belittling
Defending
Requesting an
explanation
Changing the subject
NURSE/CLIENT
COMMUNICATION

Progresses through three phases:
1.
2.
3.
Introduction–fairly short, introductions and
mutual goals.
Working–the major portion, used to
accomplish the goals set in introduction.
Termination–the end of the interaction, may
include summarizing.
FACTORS AFFECTING THE
NURSE’S COMMUNICATION
Past experiences
 State of health
 Home situation
 Workload
 Staff relations
 Attitude and emotions
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FACTORS AFFECTING THE
CLIENT’S COMMUNICATION
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Hearing and speech
ability
Level of
consciousness
Language proficiency
Social factors
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Stage of illness
Religion
Family situation
Visual ability
COMMUNICATING WITH
THE HEALTH CARE TEAM
Providing care is a team effort.
 Effective communication is necessary.
 May take several forms:

Oral
 Written
 Individual
 Group
 Electronic

ORAL COMMUNICATION
All members must communicate orally.
 Nurse–student
 Nurse–nursing assistant
 Nurse–nurse
 Nurse–physician
 Nurse–other health professionals
 Group communication, telephone
WRITTEN COMMUNICATION
Most relates to the client’s chart.
 All aspects of care recorded on chart.
 Requisitions to other departments for
diagnostic tests and therapies and the
results are written.
 Interdepartmental memos are necessary
to keep the unit functioning effectively.

ELECTRONIC COMMUNICATION
Computers are widely used in many
areas of health care.
 Slowly entering direct care areas.
 It is important for all health care
workers to have some knowledge about
computers.

COMMUNICATING
WITH YOURSELF
Positive self-talk–thinking, saying, and
hearing positive statements about oneself
reinforces positive self-esteem.
 Negative self-talk–self-destructive. Selfimage is lowered by your own criticism,
and you begin to see yourself as a failure.
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