Healthcare Core Curriculum Competency #1: Components of Communications Dede Carr, BS, LDA Karen Neu,...

Communications in Health Care

Healthcare Core CurriculumCompetency #1: Components of Communications

Dede Carr, BS, LDAKaren 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 usedIdentify & describe components of verbal and

nonverbal communicationIdentify factors that influence the communication

processIdentify some barriers to communication

Competency #1 - Components of 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.

Quotes

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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.

Quotes

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“An interchange of information between two or more people; the exchange of thoughts or ideas”

(Berman et al. p. 460)

“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)

Definitions of Communication

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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)

“Transmission of feelings or more personal & social interactions between people” (Berman et al., p. 460)

“Basic component of human relationships, including health care” (Berman et al., p. 460)

Definitions of Communication

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Purpose of Communication—To elicit a response

1. To influence others2. To obtain information

Effective communication takes thought; Individuals have to 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)

Effective Communication

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Decrease any background noise ◦ Turn down the TV, close the windows, etc.

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)

Effective Communication Techniques

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Communication Process: 4 steps required for effective communication

1. Sender2. Message3. Receiver4. 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.

The Components of Communication

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Basic Communication Model

(Industrial Engineering)11

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.)

Communication Process Components

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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)

The Sender

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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


Encoding

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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)

The Message

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Channel: Medium used to convey message & can target any of receiver’s senses

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


Channel or Medium

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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?

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


The Receiver

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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.)

Characteristics of a Receiver

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Receiver returns a message to the sender 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)

The Feedback (Response)

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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)

Basic Guidelines for Giving Feedback

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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.



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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.



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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)

Verbal Communication

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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

Verbal Communication

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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)

Verbal Communication Hints

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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 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



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Adaptability: Spoken messages need to be altered in accordance with behavioral cues from the client

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.



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Credibility: means worthiness of belief, reliability 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.”)



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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 crisisperiod (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 )

Speaking Hints Review

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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)

Speaking Hints

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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.

Food for Thought

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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" ◦ 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)

Lesson #1A Stop & Think Activity

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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)

Nonverbal Communication

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Nonverbal Communication Facial Expressions Eye Movements Placement and Movements of

Hands, Arms, Head, and Legs Body Posture and Orientation Proxemics Variation in Voice Characteristics

◦ Speaking Rate and Pause Duration

◦ Pitch or Frequency◦ Intensity and Loudness (University of Mississippi Business

Faculty)

FaceFace

PosturePosture

FeetFeet LegsLegs

ArmsArmsHandsHands

HeadHead

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Common Nonverbal Clusters

(University of Mississippi Business Faculty)

Cluster Name Cluster Meaning Body Posture & Orientation

Movement of Hands, Arms, & Legs

Eyes & Facial Expression

Openness Openness, flexibility and sincerity

• Moving closer• Leaning forward

• Open hands• Removing coat• Unbutton collar• Uncrossed arms & legs

• Slight smile• Good eye contact

DefensivenessDefensiveness, skepticism, and apprehension

• Rigid body • Crossed arms & legs

• Minimal eye contact• Glancing sideways• Pursed lips• Tilted head

Evaluation Evaluation and consideration of message

• Leaning forward• Hand on cheek• Stroking chin• Chin in palm of hand

• Dropping glasses to lower nose

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

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


Functions of Nonverbal Communication

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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)

Nonverbal Characteristics

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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)41


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 moodPosture in communication indicates how committed one is

to the conversation. A person who leans forward indicates a positive interest in the conversation.



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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) 43


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 & forthMay 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 Signals2. Look for Incongruent Behaviors3. Concentrate on Your Tone of Voice When

Speaking4. Use Good Eye Contact5. Ask Questions About Nonverbal Signals6. Use Signals to Make Communication More

Effective and Meaningful7. Look at Signals as a Group8. Consider Context9. Be Aware That Signals Can be Misread10. Practice, Practice, Practice (Cherry)

Non-Verbal Communication Tips

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http://www.youtube.com/watch?v=8CL2npjSXMc&feature=related

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)

Barriers & Communication

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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) 48

Electronic Communication

E-MailAdvantages 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-MailDisadvantages Risk to client confidentiality Health Insurance Portability & Accountability Act

(HIPAA) requires “reasonable & appropriate safeguards” when e-mailing 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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Communication Cycle

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


Factors Influencing Communication

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Environmental and Physical Influences 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 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.



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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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Personal Distance

Public Zone: >12 feet

Social Zone: 4 - 12 feet

Personal Zone: 2-4 feet

Intimate Zone: 0-2 feet

(University of Mississippi Business Faculty)

MeMe

YouYou

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Personal Space 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 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)

Personal Space

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Personal distance: 1 ½ feet to 4 feet 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)

Personal Space

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Social distance: 4 feet to 12 feet 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


Personal Space

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Public distance: 12 feet to 15 feet 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)

Personal Space

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Territoriality: the concept of space & things that an individual considers as belonging to the self” (Berman et al, p. 466)

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)

Territoriality

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Components of Communication

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Gender 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.)

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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.)


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Interpersonal Attitudes 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)


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Caring & Warmth: 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)

Interpersonal Attitudes

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Respect: 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



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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)


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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)


Elderspeak Examples

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Recognize special needs & obtain appropriate resources to promote socialization & quality of life

Interventions to improve communication1. 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, pictures4. Keep distractions to minimum5. Speak in short, simple sentences, one subject at a

time, reinforce or repeat or clarify message6. Include family & friends in conversation7. Reminisce when possible & enhance self-identity

& self-esteem (Berman et al., p. 477)

Communication with Elders

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Acceptance 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



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Language BarriersSlang, 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 communication10 Strategies for Overcoming Language Barriers

(www.ask.com, n.d.)

Barriers to Communication

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http://www.culturosity.com/pdfs/10%20Strategies%20for%20Overcoming%20Language%20Barriers.pdf

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.


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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

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Barriers to Communication (Berman et al., p. 471)

(Project Management Consultant, 2002) 79

Communication Barrier Examples

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

Additional Barriers

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Communication Interventions

Components of Communication

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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)


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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)


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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)


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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)

Interventions when Impaired Verbal Communication

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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)

Interventions for Clients with Impaired Verbal Communication

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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)

Communication Interventions for Unresponsive Patient

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Therapeutic Communication Techniques Use Silence Provide general leads Being specific & tentative Open-ended questions Use touch Restate or Paraphrase Clarify message Check perception or

Seeking consensual validation

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]

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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.)

Therapeutic Communication Techniques

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http://www.austincc.edu/richb/thercom.html

http://www.austincc.edu/richb/thercom.html

Stereotyping Agreeing & Disagreeing Being defensive Challenging Probing Testing Rejecting Changing topics & subjects (www.worldhum.com,

n.d.)

Unwarranted reassurance Passing judgment Giving common advice


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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/nonverbaltips.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/communication-consumer-behavior.html

References

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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

References

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Healthcare Core Curriculum Competency #1: Components of Communications Dede Carr, BS, LDA Karen Neu,...

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Transcript of Healthcare Core Curriculum Competency #1: Components of Communications Dede Carr, BS, LDA Karen Neu,...