Healthcare Core Curriculum
Competency #1: Components of Communications
Dede Carr, BS, LDA
Karen Neu, MSN, CNE, CNP
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Objective
 Describe the components of verbal and nonverbal
communications & situations in which these skills
can be effectively used
Identify & describe components of verbal and nonverbal
communication
Identify factors that influence the communication process
Identify some barriers to communication
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Hubert H. Humphrey: The right to be heard does not
automatically include the right to be taken seriously.
Ernest Hemingway: When people talk, listen
completely. Most people never listen.
Franklin Delano Roosevelt: Be sincere; be brief; be
seated.
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Anne Morrow Lindbergh: Good communication is as stimulating
as black coffee, and just as hard to sleep after.
Edward R. Murrow: People say conversation is a lost art; how often
I have wished it were.
Jonathan Swift: Argument is the worst sort of conversation.
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“An interchange of information between two or more
people; the exchange of thoughts or ideas”
(Berman et al. p. 460)
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“An exchange of information or thoughts between two or
more people”
(Ramon & Niedringhaus, p. 228)
Example: “Use of speaking, writing, listening or reading,
or, such as painting, dancing, or storytelling”
“Gestures & body actions convey thoughts to others….”
“Speaking louder than words”(Ramon & Niedringhaus, p. 228)
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“An interchange of information between two or more
people; an exchange of ideas or thoughts” using methods
of talking & listening, writing & reading-painting,
dancing, & storytelling are forms of communication”
(Berman et al., p. 460)
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“Transmission of feelings or more personal & social
interactions between people” (Berman et al., p. 460)
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“Basic component of human relationships, including
health care” (Berman et al., p. 460)
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Purpose of Communication—To elicit a response
1.
2.
To influence others
To obtain information
Effective communication takes thought; Individuals have to
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go beyond knowing the information they want to express.
Steps need be taken to best present information in a clear &
concise manner
Built on a trusting relationship with another (patient &
support person)
Necessary for establishment of healthcare worker & client
(Berman et al., p. 460)
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Decrease any background noise
◦ Turn down the TV, close the windows, etc.
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Listen carefully
Pace your speech & make sure that you are speaking
clearly & not too fast
Show interest in the topic being discussed
Make eye contact with the person that you are
speaking with
Make sure to speak loudly enough so that the
receiver can hear the message being sent
(Berman et al., p. 460)
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Communication Process: 4 steps required for effective
communication
1. Sender
2. Message
3. Receiver
4. Feedback (Response)
Medium or Channel is the means that message is
sent through
(Berman et al., p. 460)
All 4 steps are required for effective communication &
must be done in the proper order.
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(Industrial Engineering)
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Communication “the transmission of a message from a
sender to a receiver via a medium (or channel) of
transmission.
(Industrial Engineering, n.d.)
Message can be verbal (spoken or written), nonverbal (a
photograph, an illustration, or a symbol), or a
combination of the two.
 Verbal message, whether it is spoken or written, can
usually contain more specific product (or service)
information than a nonverbal message
 Nonverbal information takes place in both
interpersonal channels & in impersonal channels & often
takes the form of symbolic communication.
(Industrial Engineering, n.d.)
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Sender: Person or group who wishes to convey a message
to another
(Berman et al., p. 461)
When I lecture in class, I am the sender. When you read
this power point, I am the sender. In order for any
communication to take place, there MUST be a sender.
Characteristics of the sender:
 Speaking clearly,
 Organizing thoughts,
 Proper grammar,
 Eye contact,
 Accurate information
(Berman et al., p. 461)
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Encoding: Selection of specific signs or symbols (codes)
to transmit the message, such as
 Language & words used
 How to arrange the words
 Tone of voice
 Gestures used
 Examples of Encoding: Tone of voice, shake of the head,
or rolling of eyes can send different messages; In text
messaging using partial words
(Berman et al., p. 461)
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Most important element in communication
process.
The message can be delivered in many forms, i.e.
written form, spoken word, gestures, or even body
art (tattoos and piercings)--Encodes
The message isn't necessarily what the sender
intends it to be. Rather, the message is what the
receiver perceives the message to be.
(Berman et al., p. 461)
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Channel: Medium used to convey message & can target any of
receiver’s senses
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Must be appropriate for the message being sent &
Should make the intent of message more clear
Example:
◦ Talking face-to-face with a person may be more effective than
telephoning or writing a message
◦ Recording or television messages may be better for larger
audiences
◦ Written communication better if to be preserved for longer
periods of time
◦ Non-verbal channel of touch can be very effective at times too
(Berman et al., p. 461)
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The listener (One who listens, observes, & attends)
The “decoder” (Must perceive what sender intended
(interpretation) (Berman et al, p. 461)
Who is receiving the message? Who is your audience?
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As the instructor, my students are my audience.
As the healthcare provider, your patient & their family are the
receiver.
Often times the receiver is sitting across the table from
the sender, however now that technology has taken
us to new places, the receiver can be across an ocean.
The receiver can be one person or an entire audience
(Berman et al., p. 461)
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• Sit up straight
• Listen carefully
• Make eye contact
• Avoid distractions
• Nod and smile
(Ramon & Niedringhaus, pp. 232-233)
(www.buzzle.com, n.d.)
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Receiver returns a message to the sender
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Can be verbal, nonverbal, written (emails)
Critical to effective communication
Summarizes the message
Allows evaluation of the message & allows sender to
correct or reword the message or sender knows message
was interpreted accurately as sender intended
(Berman et al., p, 461)
(www.schools.nt.edu.au)
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1. Clarity -- Be clear about what you want to say.
2. Emphasize the positive – Focus on strengths
rather than weaknesses.
3. Be specific -- Avoid general comments & clarify
pronouns such as “it,” “that,” “they,” etc.
4. Focus on behavior or issues rather than the
person.
(McGill & Beatty, pp. 159-163)
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5. Refer to behavior that can be changed.
6. Be descriptive rather than evaluative.
7. Own the feedback -- Use ‘I’ statements.
8. Generalizations -- Notice “all,” “never,” “always,”
etc., and ask to get more specificity -- often these
words put limits on behavior.
(McGill & Beatty, pp. 159-163)
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9. Be very careful with advice
 People rarely struggle with an issue because of the
lack of some specific piece of information.
 Often the best help is helping the person to come
to a better understanding of their issue and how it
developed.
 Help the person identify actions to address the
issue more effectively.
(McGill & Beatty, pp. 159-163)
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Verbal communication is when we send our message
by speaking or writing to a receiver.
It is primarily oral communication often supported
with visual aids, but feelings can also be conveyed
Words & feelings can be conveyed
Can be face-to-face, telephone or written
Key components are sound, words, speaking,
language, pace & intonation, simplicity, clarity &
brevity, timing & relevance, adaptability, credibility,
& humor
(Berman et al., p. 461)
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When people are verbally communicating with one
another it is critical to take care with choice of words,
tone of speech, speed of speech, and volume of
speech.
Over 6,809 distinct languages are spoken world wide
according to Ethnologue Organization
(http://www.ethnologue.com thnologue.com, n.d.)
Speaking Hints are things to be aware of when
communicating verbally with someone else
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Pace/Rhythm & Intonation: modifies feeling &
impact of message
 Intonation (tone): expresses enthusiasm, sadness,
anger, or amusement
 Pace: indicates interest, anxiety, boredom, or fear (i.e.
speaking slowly & softly extends a calmness)
Simplicity: using commonly understood words, brief, &
complete; select appropriate understandable terms
based on age, knowledge, culture, education of other
(Berman et al, p. 462)
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Clarity & Brevity: direct & simple message
 Clarity: saying precisely what is meant &
 Brevity: Using the fewest words possible
 Verbal & Nonverbal communication are
congruent—means nonverbal matches what is said
 Example: “I am interested in what you have to say,”
(nonverbal): facing patient, making eye contact, &
leaning forward
 Ensure clarity by speaking slowly & enunciating
carefully
(Berman et al., p. 462)
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Timing & Relevance: Appropriate timing to ensure
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words/message are heard
Must relate to person or person’s interests or concerns
Show sensitivity to other’s needs as may have fears, such as
cancer (client does not “hear”)
When asking a question allow time for person to answer
Allow patient to respond to social talk or chat to develop
rapport & facilitate effective conversation
(Berman et al., p. 462)
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Adaptability: Spoken messages need to be altered in
accordance with behavioral cues from the client
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Example: One who usually smiles, appears cheerful, &
greets the other with an enthusiastic, “Hi, Mrs. Brown!”
notices client is not smiling & appears distressed.
One would adapt or modify tone of speech & express
concern in facial expression while moving near the client.
(Berman et al., p. 462)
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Credibility: means worthiness of belief, reliability
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trustworthiness; most important criterion for effective
communication
One fosters credibility by being consistent, dependable, &
honest
One must be knowledgeable about what is being discussed &
have accurate information
Must convey confidence & certainty in what one is saying,
while being able to acknowledge limitations (e.g. “I don’t
know the answer to that, but I will find someone who does.”)
(Berman et al., p. 462)
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Humor: The use can be a positive & powerful tool, but
must be used with care (can help patients adjust to
difficult & painful situations)
 Physical act of laughter can be emotional & physical
release, reduce tension by providing different
perspectives & promoting a sense of well-being
 Always consider client’s perception of what is considered
humorous
 Timing is important to consider
 Humor & laughter can help reduce stress & anxiety in
early & recovery stages of crisis, may be considered
offensive or distracting at peak of crisis
period
(Berman et al., p. 462)
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When speaking or trying to explain something, ask
the listeners if they are following you.
Ensure the receiver has a chance to comment or ask
questions
Try to put yourself in the other person's shoes —
consider the feelings of the receiver
Be clear about what you say.
Look at the receiver
(Berman et al.)
(www.enoughisenoughau.blogspot.com )
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Make sure your words match your tone and body language
(nonverbal behaviors)
Vary your tone and pace
Do not be vague, but on the other hand, do not complicate
what you are saying with too much detail.
Do not ignore signs of confusion (Berman et al., p. 463)
(www.communication-type.com)
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WHAT you say is not nearly as important as
HOW you say it
A dull message delivered by a charismatic person
filled with energy and enthusiasm will be
accepted as brilliant.
An excellent message delivered by someone who is
dull will lack enthusiasm of its audience.
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Go to the “Content” tab for specific directions to
complete “Lesson #1A: Verbal Communication”
Discussion Activity
Watch Dr. Martin Luther King’s speech, "I Have A Dream"
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◦ The speech was recited on August 28, 1963 during the March on
Washington. King spoke in front of the Lincoln Memorial to over
250,000 people
◦ One of the most famous of American speeches
◦ The repetition of phrases used for emphasizing points have
become well-known throughout time
◦ Things to be aware of while watching the speech are the content
of the speech, the timing and the delivery
(see next slide for video website)
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Defined as “a process of communication through
sending wordless messages” or “body language”
 Communicating through the use of gestures, body
movements, facial expressions, posture, gait, use of
touch, & physical appearance including adornments,
such as hairstyles, tattoos, body piercing, clothing,
 May have to ask for correct message being sent
(Berman et al, p. 462)
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Facial Expressions
Face
Eye Movements
Placement and Movements of Hands,
Hands
Arms, Head, and Legs
Body Posture and Orientation
Proxemics
Variation in Voice Characteristics
◦ Speaking Rate and Pause Duration Feet
◦ Pitch or Frequency
◦ Intensity and Loudness
(University of Mississippi Business Faculty)
Head
Arms
Legs
Posture
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Cluster Name
Cluster Meaning
Body Posture &
Orientation
• Moving closer
• Leaning forward
Movement of Hands, Arms, &
Legs
Eyes & Facial Expression
• Open hands
• Removing coat
• Unbutton collar
• Uncrossed arms & legs
• Slight smile
• Good eye contact
• Minimal eye contact
• Glancing sideways
• Pursed lips
• Tilted head
Openness
Openness, flexibility and
sincerity
Defensiveness
Defensiveness,
skepticism, and
apprehension
• Rigid body
• Crossed arms & legs
Evaluation
Evaluation and
consideration of message
• Leaning forward
• Hand on cheek
• Stroking chin
• Chin in palm of hand
Deception
Dishonesty and
secretiveness
• Patterns of rocking
• Fidgeting with objects
• Increased leg movement
• Increased eye movement
• Frequent gazes elsewhere
• Forced smile
Readiness
Dedication or commitment
• Sitting forward
• Hands on hips
• Legs uncrossed
• Feet flat on floor
• Increased eye contact
Boredom
Lack of interest and
impatience
• Head in palm of hands
• Slouching
• Drumming fingers
• Swinging a foot
• Brushing & picking at items
• Tapping feet
• Poor eye contact
• Glancing at watch
• Blank stare
• Dropping glasses to lower
nose
(University of Mississippi Business Faculty)
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Nonverbal communication tells more about what the
person is feeling than what he/she has actually said
(occurs less consciously than verbal)
Expresses emotions
Expresses interpersonal attitudes
Accompanies speech in managing the cues of interaction
between speakers & listeners
Self-presents one’s personality
Nonverbal communications are used in rituals, i.e.
greetings: Hand-shake, waving good-bye
Integral part of interactions – Cultural traditions
(Berman et al., p. 463)
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Physical Environment & Communication–
 How the furniture is placed in your home
 Are the lights bright or dim?
 Is your home quiet or is music on all the time?
 What colors have you painted on the walls of your
home?
 Establish the setting for communication
◦ Provide a comfortable environment (lighting,
temperature, furnishings).
◦ Establish a relaxed, unhurried setting
(Medical Education Division)
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Time–
 How do you think of time?
 Are you a punctual person?
 Are you willing to wait for someone that is late?
 What is your speed of speech?
 Do you participate in a time system in which you
do one thing at a time in short, precise units?
 Perhaps you use a time system that allows you to
do several things at once (Medical Education Division)
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Personal Appearance
 Clothing & adornments provide information
about a person
 Although choice of apparel is highly personal, it
can convey social & financial status, culture,
religion, group association, & self-concept
 Charms & amulets may be worn for decoration or
for health protection purposes
 Personal dress can indicate how a person feels by
looking at their grooming
(Berman et al., p. 463)
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Posture & Gait: Way people walk & carry themselves often
are reliable indicators of self-concept, current mood, &
health
 Erect posture & active purposeful stride suggest a feeling
of well-being;
 Slouched posture & slow, shuffling gain suggest
depression or physical discomfort;
 Tense posture & a rapid, determined gait suggest anxiety
or anger;
 Posture of sitting or lying can indicate feelings or mood
Posture in communication indicates how committed one is
to the conversation. A person who leans forward
indicates a positive interest in the conversation.
(Berman et al., p. 463)
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Facial Expression
 No part of the body is more expressive than the face
 Shows surprise, fear, anger, disgust, happiness, sadness
 Facial muscles can also control expressions so the
emotion felt is not being expressed
 Smile is universal sign of happiness
 Contempt conveyed by mouth turned down, head tilted
back, & eyes directed down the nose
 No single expression can be interpreted accurately
without considering other reinforcing physical cues
 When a message is not clear, it is important to get
feedback to check intent of expression
(Berman et al. p. 464)
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Touching– handshakes, holding hands, kissing, back
slapping, brushing an arm, high fives.
◦ The meaning of the touch will depend greatly on the context
of the situation
Remember that “actions speak louder than words.” A
person will generally pay more attention to what you do
than what you say (Medical Education Division)
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Gestures –Gestures are a “non-vocal bodily movement
intended to express meaning.”
◦ A wave “hello” or “goodbye”.
◦ A nod or shake of the head
◦ Winking or rolling of the eyes
◦ Wringing hands
◦ Tapping a foot
◦ Picking at fingernails
◦ Pacing back & forth
May emphasize & clarify spoken words, may occur without
words to indicate a particular feeling or to give a sign or use
“Sign Language”
◦ Indicate shape or size of an object
(Berman et al., p. 463)
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Access website: Non-Verbal Communication Tips
1.
Pay Attention to Nonverbal Signals
2. Look for Incongruent Behaviors
3. Concentrate on Your Tone of Voice When Speaking
4. Use Good Eye Contact
5. Ask Questions About Nonverbal Signals
6. Use Signals to Make Communication More Effective
and Meaningful
7. Look at Signals as a Group
8. Consider Context
9. Be Aware That Signals Can be Misread
10. Practice, Practice, Practice
(Cherry)
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It is critical to send clear messages when
communicating to those around us. Our
messages convey feelings, thoughts, ideas, and
emotions.
When referring to communication, it is not only
verbal communication that I am referring to but
nonverbal communication as well.
Barriers to communication prevent proper, healthy
communication to occur
(Berman et al., p. 465)
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Many healthcare agencies are moving toward
electronic medical records, where all care is
documented.
Electronic mail (e-mail) can be used for many
purposes in healthcare: schedules, confirmation of
appointments, report normal lab values, conduct
client education, & follow-up with discharged clients
(Austin, p. 76 as cited in Berman et al., p. 464)
E-mail: Most common form of electronic
communication
 Important to know advantages & disadvantages &
guidelines for assurance of client confidentiality
(Berman et al., p. 464)
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E-Mail
Advantages
 Fast, efficient way to communicate & it’s legible
 Provides a record of date & time message was sent or
received
 Some messages provide information to clients on how to
contact or reach them or how to reach specified staff
members
 This improves communication & continuity of client care
 E-mail promises better access, & ½ of internet users like to
communicate with a physician online
(Delbanco & Sands, as cited in Berman et al., p. 464)
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E-Mail
Disadvantages
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Risk to client confidentiality
Health Insurance Portability & Accountability Act (HIPAA)
requires “reasonable & appropriate safeguards” when emailing protected health information
Healthcare agency must have e-mail encryption system to
ensure security
Another disadvantage is socioeconomics as not everyone has a
computer, not everyone has computer skills, not everyone has
internet access
Other forms of communication are necessary for those with
limited abilities with English-speaking, writing, reading &
computer
(Berman et al., p. 464)
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When Not to Use E-mail in health care
 When the information is urgent & client’s health could
be in jeopardy if he/she cannot read it immediately
 Highly confidential information
 Abnormal lab data
 Any information that may be confusing & could
prompt many questions by the client, it is better to
either see or telephone the person
 Know the healthcare agencies guidelines & policies &
procedures for the use of e-mail & electronic
communication (Berman et al., p. 464-465)
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Development
 Language, psychosocial, & intellectual development
move through stages across the lifespan & thus
influence communication
 Ex. Explaining a procedure to an 8-year old requires a
different approach than that for a 40-year old person
 Older clients are more apt to have wider range of
experience which may influence response or
understanding
 Aging clients may have visual and hearing acuity
changes that affect interactions with others
(Berman et al., p. 465)
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Environmental and Physical Influences
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Closed office doors, marked out territories in which strangers
are not allowed, blinds or shades, a curtain that is pulled
separating first class passengers from those in coach.
Temperature extremes, excessive noise, poorly vented
environment
 Lack of privacy (If someone wants to share private
information)
 Environmental distractions can impair & distort
communication (Berman et al., p. 466)

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Perceptual Barriers
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We all see the world differently. We all have our own
views, unique personality traits , values, belief system,
attitudes, & life experiences.
The lens in which we view the world is made up of our
own life experiences and therefore may lead to
assumptions, stereotyping, & misunderstanding.
(Berman et al., p. 466)
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Emotional
 The emotional barrier is one of the primary barriers
to communication.
 This barrier is made up of fear, suspicion, mistrust.
Emotional mistrust is first learned in one’s early
childhood. This mistrust of others prevents one
from communicating with another person free from
barriers (Berman et al., p. 465)
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Public Zone: >12 feet
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Social Zone: 4 - 12 feet
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Personal Zone: 2-4 feet
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Intimate Zone: 0-2 feet
You
Me
(University of Mississippi Business Faculty)
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Personal Space
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Distance people prefer in interactions with others
Proxemics: Study of distance between people in their
interactions (Middle-class, North Americans use definite
distances in various interpersonal relationships, along with
specific voice tones & body language) (Berman, p.466)
Communication alters in accordance with 4 distances:
◦ Intimate,
◦ Personal
◦ Social
Intimate
◦ Public
Space
(Berman et al., p. 466)
See next slide for explanation.
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Intimate distance communication:
 Touching to 1 ½ feet
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Characterized by body contact, heightened sensations of body
heat & smell, & vocalizations that are low
Vision is intense, restricted to small body part, may be
distorted
Examples: Cuddling a baby, touching a blind person,
observing a wound,
Natural instinct to maintain a certain amount of space
immediately around self & varies with individuals & cultures
When communicator sender steps too close, receiver
automatically steps back a pace or two
Many times healthcare worker is required to enter one’s
personal space so healthcare worker should forewarn the
patient
(Berman et al., p. 466)
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Personal distance: 1 ½ feet to 4 feet
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Voice tones moderate, body heat & smell less noticed
Physical Contact: Handshake or touching a shoulder
More of person perceived so clear body stance & facial
expressions seen
Much healthcare communication occurs at this distance, so
more sharing of thoughts/feelings
Bantering & some social conversation usually take place at
this distance
(Berman et al., p. 466)
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Social distance: 4 feet to 12 feet
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Characterized by clear visual perception of whole person, eye
contact increased, vocalization loud enough to be overheard
by others
Communication-more formal/limited to seeing & hearing;
out of reach for touch or personal sharing of thoughts or
feelings; more activity & movement back & forth
Expedient communication with several people at same time &
within short time
Example: when healthcare worker makes rounds to meet
assigned patients, he or she will use communication at a social
distance
(Berman et al., p. 466)
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Public distance: 12 feet to 15 feet
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Requires loud, clear vocalizations with careful enunciation
Although faces & forms of people are seen, individuality is
lost and
Perception is of the group of people or the community
(Berman et al., p. 466)
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Territoriality: the concept of space & things that an
individual considers as belonging to the self” (Berman et al,
p. 466)
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Territories marked off by people may be visible to
others
Example: Patient in hospital consider territory
bounded by curtains around bed unit
People feel need to defend their territory when
invaded by others
Healthcare worker must obtain permission from
clients before removing, rearranging, or borrowing
objects in hospital area (Berman et al., pp. 466-467)
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Components of
Communication
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Gender
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Girls learn to speak earlier than boys
Girls tend to use language to seek confirmation, minimize
differences, & establish intimacy
Boys use language to establish independence & negotiate
status within a group
(Berman et al., p. 466)
A woman speaks between 22,000 – 25,000 words a day.
A man speak 7,000 – 10,000 words a day.
A man speaks in linear ways, step-by-step.
Women talk emotion & their logically thinking is more
random
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Gender
(www.physicaltherapyclub.forumotion.com, n.d.)
66
Roles & Relationships between sender & receiver
affect communication process
 Choice of words, sentence structure, tone of voice
vary considerable from role to role
 One meeting someone for first time communicates
differently than one who has previously developed a
relationship with the other

Trust (Berman et al., p. 467)
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Congruence
 Congruent communication: verbal & nonverbal
aspects of message match
 If incongruence, body language & nonverbal
communication usually the one with true meaning
(www.yawriters.blogspot.com, n.d.)
68
Interpersonal Attitudes


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Attitudes convey beliefs, thoughts, & feelings about people &
are communicated convincingly & rapidly to others
Attitudes such as caring, warmth, respect, & acceptance
facilitate communication whereas condescension, lack of
interest, & coldness inhibit communication (Berman et al, p, 467)
Sharing a joke or laughing with patients can assist in reducing
stress & supporting a therapeutic relationship
(Leahy & Kizilav, 1998 as cited in Berman et al., p. 467)
69
Caring & Warmth:

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Convey emotional closeness;
Caring is more enduring & intense than warmth; conveys
genuine concern for person whereas warmth conveys
friendliness & consideration, shown by acts of smiling &
attention to physical comforts
Caring involves giving feelings, thoughts, skill & knowledge;
requires psychological energy & poses risk of
gaining little in return, yet by caring, people
usually reap the benefits of greater
communication & understanding
(Berman et al., p. 467)
70
Respect:

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Attitude that emphasizes the other person’s worth &
individuality
Conveys that person’s hopes & feelings are special & unique
even though similar to others in many ways
People have need to be different from– yet at same time
similar to – others
Being too different can be isolating & threatening
One conveys respect by listening open-mindedly to what
other is saying even if one disagrees
One can learn new ways of approaching situations when
conscientiously listening to another’s perspective
(Berman et al., p. 467)
71

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Healthcare workers my unknowingly use speak that they
believe is caring but clients perceive as demeaning or
patronizing.
Frequently happens in settings for elderly or disabled
Elderspeak: Speech style similar to baby talk, that gives
message of dependence & incompetence & does not
communicate respect
Many healthcare workers unaware of their use of elderspeak
or that it can have negative meanings to the client
Characteristics of elderspeak include diminutives
(inappropriate terms of endearment-imply parent-child
relationship), inappropriate plural pronoun use, tag
questions, & slow, loud speech (Berman et al., p. 467)
72
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Diminutives (inappropriately intimate terms of
endearment implying parent-child relationships)
Examples “honey, sweetie, dearie, grandma”
Inappropriate plural pronouns (substituting a collective
pronoun e.g. we, when referring to an independent older
adult) Example: “Are we ready for our bath?”
Tag questions: (prompts the answer to the question &
implies older adult can’t act alone) Examples: “You would
rather wear the blue socks, wouldn’t you?”
Shortened sentences, slow speech rate, & simple
vocabulary (sounds like baby talk)
(Berman et al., p. 468)
73
Recognize special needs & obtain appropriate resources to
promote socialization & quality of life
Interventions to improve communication
1.
Use assistive devices, such as glasses, hearing aids,
2.
Make use devices are in good working order
3.
Other resources, such as communication boards,
computers, pictures
4.
Keep distractions to minimum
5.
Speak in short, simple sentences, one subject at a time,
reinforce or repeat or clarify message
6.
Include family & friends in conversation
7.
Reminisce when possible & enhance self-identity & selfesteem
(Berman et al., p. 477)
74
Acceptance
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Emphasizes neither approval or disapproval
Allows clients to express personal feelings freely & to be
themselves
May need to restrict acceptance in situations where
clients’ behaviors are harmful to themselves or others
(Berman et al., p. 467)
75
Language Barriers
Slang, buzz words, jargon,
If these types of words are used in verbal communication,
they may be a barrier if the receiver is not familiar with such
words
Go to the following website to review barriers & strategies to
overcome language barriers in communication
10 Strategies for Overcoming Language Barriers
(www.ask.com, n.d.)
76
Threatening, warning, ordering, lecturing and preaching
are also barriers to communication
(www.people.howstuffworks.com, n.d.)
The next slides present some examples for each of
the barriers listed above.
77
Threatening, Warning
You better clean up your room or else you won’t be
able to play with your friends
If you don’t show up to work on time, you will be fired.
Preaching
You should be ashamed of yourself for the way that
you incorrectly transferred that patient….. You ought
…
Ordering
You must….. You will…. You have to…
Lecturing
You always…. You never…. Do you realize
78
(Project Management Consultant, 2002)
79

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Decreased hearing
Decreased vision
Belittling someone, putting them down
Having a negative attitude
Being in a hurry
False reassurance. Telling a patient that
everything is going to be OK when it is not
80
Components of
Communication
81
Blind Patients
 Always speak to the patient when you enter the room
so individual will know who is there
 Speak directly to the patient; do not turn your back.
 Speak to the patient in a normal tone of voice; patient
is blind, not deaf
 Speak to the patient before touching him/her.
 Offer to help with arrangements for patients who may
enjoy hearing tapes or reading Braille literature
(Medical Education Division)
82
Deaf Patients
 Look directly at the patient when speaking with
him/her
 Do not cover your mouth when speaking because
the patient may read lips
 If the patient does not lip-read, charts with pictures
may be used, or simply writing your questions or
comments on a piece of paper may be helpful.
 Charts with hand signs are available at the local
society for deafness and/or hearing preservation
(Medical Education Division)
83
Patients Speaking a Foreign Language
 Obtain a translator or interpreter or language
dictionary if possible
◦ The Red Cross or the Patient Administration Division (PAD)
may be of assistance
◦ Most healthcare facilities have access to a translator


Have a chart with basic phrases in English & the
foreign language
Consider using charts with pictures
(Medical Education Division)
84

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

Listen carefully, validating verbal & nonverbal
expression
Anticipate patient’s needs until effective
communication is possible
Use simple communication, speak in well-modulated
voice, smile, show concern for the client
Maintain eye contact at patient’s level & read patient’s
eyes as able
Use touch as appropriate; holding a patient’s hand or
stroking the arm is simple & not an intrusive way of
showing empathy & concern
(Kathol, p. 49)
85

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
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Spend time with patient, allow time for responses, make
call light readily available
Explain all procedures & cares
Determine client’s literacy status
Use communication equipment: electronic devices, letter
boards, picture boards, & magic slates as indicated
Establish an alternative method of communication, such as
writing, phrases, picture cards, or simple drawings of basic
needs
Give praise for progress noted, Ignore mistakes & watch for
frustration & fatigue
Never raise your voice or shout at a patient (Kathol, p. 49)
86



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

If you are unsure how much the unresponsive patient can
hear or interpret, important to:
Assume that all sound & verbal stimuli have potential to be
heard by patient
Do not make negative comments or anxiety-producing
statements in the presence of the patient
Speak to the unresponsive patient as if he/she is awake
(before doing procedures or cares
Talk about patient’s previous daily activities, read
newspapers or books to patient
Health care workers should not talk about personal life &
activities in the room while caring for client
(Kathol, p. 50)
87

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Use Silence
Provide general leads
Being specific
& tentative
Open-ended questions
Use touch
Restate or Paraphrase
Clarify message
Check perception or Seeking
consensual validation

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Offering Self
Give information
Acknowledge feelings
Clarify time or sequence
Present reality
Focus on idea or feeling
Reflect
Summarize & Plan

(Berman et al., pp. 469-470)
[Therapeutic Communication
Techniques List under Lesson #1
“content” tab]
88
In addition to the document list of Therapeutic
Communication Techniques under the “content”
tab, access the website to see additional examples at
Therapeutic Communication Techniques and
Examples
(www.elliemae.com, n.d.)
89
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Stereotyping
Agreeing & Disagreeing
Being defensive
Challenging
Probing
Testing
Rejecting
Changing topics & subjects
Unwarranted reassurance
Passing judgment
Giving common advice
(www.worldhum.com, n.d.)
90
Berardo, K. (2007). 10 Strategies for overcoming language barriers. Retrieved
from
http://www.culturosity.com/pdfs/10%20Strategies%20for%20Overcoming%
20Language%20Barriers.pdf
Berman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008). Communicating. In A.
Berman, S.J. Snyder, B. Kozier, & G. Erb (Eds.). Kozier & Erb’s Fundamentals
of nursing: Concepts, process, and practice (8th ed.) (pp. 459-85). Upper
Saddle River, NJ: Prentice Hall
Cherry, K. (2011). Top 10 Nonverbal Communication Tips Improve Your
Nonverbal Communication Skills With These Tips. Retrieved from
http://psychology.about.com/od/nonverbalcommunication/tp/nonverbalti
ps.htm
Ethnologue Organization. (n.d.) Retrieved from http://www.ethnologue.com
Industrial Engineering. (n.d.) Communication & Consumer Behavior.
Retrieved from
http://industrialeducation.blogspot.com/2009/07/communicationconsumer-behavior.html
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Kathol, D. (2006). Communication. In B.L. Christensen & E. O.
Kockrow (Eds.). Foundations and adult health nursing (5th ed.) (pp.
33-52). St. Louis, MO: Elsevier, Mosby
McGill, I. & Beaty, L. (1994). Action learning: A guide for professional
management and educational development (2nd ed.). Sterling: VA:
Stylus Publishing Inc.
Medical Education Division of Brookside Associates. (2007). Patient
relations. Nursing fundamentals I. Retrieved from
http://www.brooksidepress.org/Products/Nursing_Fundamentals_1
/lesson_1_Section_2.htm
Ramon, P.R. & Niedringhaus, D. M. (2008). Client Communication.
Fundamental nursing care (2nd ed.) (pp. 226-242). Upper Saddle
River, NJ: Person Prentice Hall
University of Mississippi Business Faculty. (2004). Module 4:
Communication Skills. Retrieved from
faculty.bus.olemiss.edu/dvorhies/.../Module%2004%203E.ppt
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