King Saud University

College of Nursing
Medical surgical Nursing

Module 3 -123

Prepared By

Lecturer/ Magda Bayoumi

Lecturer/ Magda Bayoumi

At the end of this lecture the student will be able to:

• Define communication
• List importance of communication
• Mention element of communication
• Explain level of communication
• Discuss modes of transmission.
• Explain factor influencing communication
• List principle of communication
• Identify blocks and barrier of effective
communication
• Discuss therapeutic communication.

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:Define communication

Communication is the transmission and receiving information, feeling and or attitudes

with the overall purpose of having understood producing a response. It is a process of
passing messages, idea, facts, opinions, attitudes, information and understanding from
one person to another. Communication is an enabling process that allows information
.to be transferred and ideas to be translated into action

Communication is the basic element of human interaction that allows people to

.establish, maintain and improve contacts with others

:Importance of Communication

:Communication skills help the nurse in many ways

• Communication skills help to generate trust between the nurse and
patient.
• Communication skills provide the nurse with professional satisfaction,
i.e: provide job satisfaction.
• Communication is also a means for bringing about change' i.e. nurse
listens, speaks and acts to negotiate change that promotes client's wellbeing.
• Communication is the foundation of all relationship between the nurse
and other member of the health team. It induces human being to put forth
greater efforts in their worm performance.
• Communications serve as a lubricant fostering in smooth operation of
the management process, i.e. it helps promotion of managerial efficiency.
• Communication provides basis for leadership action.
• It provides means of coordination.

Element of Communication:
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 1- Sender- refers to a person who initiates and transmits message. The
sender is also called the encoder.
2- Massage- refers to information, opinion, effect that are directed to a
target, i.e. the information that is sent or expressed by the sender.
3- Signal- refers to sign that symbolized message contents.
4- Channel- refers to route through which a messages, such as through,
visual, auditory, and tactile senses.
5- Receiver- refers to an intended perceiver interpreter of message. The
receiver also is called the decoder.
6- Noise- refers to an information relayed from later to earlier stage.
Feedback helps to reveal whether the meaning of the messages received.

__ ___ ____ ___ Feedback __ ___ ____ __

| |
Sender __ (Noise) ---- Message___ (Noise) ---- Receiver
| |
|__ _ _ ___ ___ Feedback ___ ___ _ __ _|
Level of communication

Communication occurs at the intrapersonal, interpersonal, and public levels.

Intrapersonal communication:
• Occur with the individual. It is self-talk or an internal dialogue that
occurs constantly and consciously.
• The sender motivation is transmitting a message and the receivers'
mind-set in interpreting the messages are conditions by a continuous stream of
'self-talk'.
For example: nurse supervisor can detect intrapersonal messages that insulate a
worker from supervisor- initiated messages by asking workers' opinion about
controversial work issues.

Interpersonal communication:
• Is the interaction between two people or in a small group. Healthy
interpersonal communication allows problem solving, sharing of idea, decision
making, and personal growth.
In administration challenges the nurse's ability to express idea clearly and decisively.
Interpersonal communication in the heart of nursing practice.

Public communication:
is interaction with large groups of people, e.g. giving lecture to students and speaking
to a consumer group on health education.

Modes of transmission:
Messages are communicated in a number of ways, i.e; verbal, nonverbal.

Verbal communication:
Is exchange of information using words and include both spoken and written word.

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Words are signs or symbols used to express ideas or feeling, emotional responses, or
describe objects, observations, memories and influences. Words may also be used to
convey hidden meanings, test the others interest or degree of concern, or express
hostility of fear.

• Verbal communication depends on language.

• Is used tentatively by nurse when speaking with patients, giving oral
reports to others, writing care plans and recording nursing progress notes.
• To make a message clear, the nurse uses effective verbal
communication techniques; clear and concise phasing of words, a proper
pacing of statements, and understandable vocabulary.
- clarity and brevity (using example can make an explanation easier to
understand)
- Vocabulary; instead of using purely technical words, use local words
for better understanding.
- Denotative and connotative meaning: a denotative meaning is one
shared by individuals who use a common language that is used to define a
word ao that it means the same to everyone. The connotative meaning of a
word is the thought feelings of ideals that people have about to word.
- Pacing: verbal communication is successful when expressed at an
appropriate speed or pace.
- Timing and relevance: timing is critical to reception. For example; if
the supervisor/manager is in bad mood, the time is wrong to ask for a raise.
And relevance is also important, i.e that communication is most likely to have
an impact when messages pertain to an individual interest and needs.
- Humor: it can be a powerful tool in promoting all aspects in
management, and also for well being.

The Written communication must be based on four essential item

- Clear
- Correct
- Complete
- Concise
It should be written in such a language as it becomes easily intelligible to those fore
shown words and familiar phrase and avoid official jargons or ambiguous terms.

Nonverbal communication:
• Is the exchange of information without use of words; it is what not
said, i.e actions often speak louder than words. So non verbal communication
is transmission of messages. It is one of the powerful ways people convey
messages to others. It is usually motivated by subconscious feelings and
therefore a more reliable indication of true feeling than spoken word.
Observation of nonverbal clue is an important skill. Nonverbal cues add
meaning to the verbal message.
• The nurse need to be alert to nonverbal messages accompanying verbal
message sent to clients.
• Meta communication is a massage within a message within a message
that convey a senders attitudes toward the self and the message and the
attitudes, feeling and intentional toward the listener. It can explicit (verbal)
statement or an implicate (non verbal) demonstration of feelings.
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For example; when a nurse greets a client, maintaining eye contact and speaking in a
calm voice can relay a sense of security to the client.

Forms of nonverbal communication:

Personal appearance.
• It is one of the first things noticed during an interpersonal encounter.
This time general impression formed of another person influences the response
to that person. People form an impression about another person with 20
seconds to 4 minutes.
• The impression is based mostly on appearance, physical
characteristics, dress, grooming and the presence of jewellary and adornment
provide clues to the persons physical wellbeing, personality, social status,
occupation, religion, culture and self concept. Paying attention to one's
appearance can contribute to positive –image and professional image.
• A person's clothing and grooming (makeup, combing hair) practices
easy significant non verbal messages.
• Most of illness causes at least some alterations in general physical
appearance. Observing for changes in appearance. Observing for changes
appearance is an important nursing responsibility in detecting a particular
illness or in evaluating such as the condition of hair, color, of skin, weight,
energy level and the presence of physical deformity, also communicate
information about level of health. The nurse physical appearance influences
the clients perception of care received. Each client has a preconceived image
of a nurse. The traditional uniform can be a symbol of cleanliness and
competence.

Intonation:
• The tone of speakers' voice can have a significant effect on a message's
meaning.
• It is important for nurses to be a wear of how they are sending
message.
• Voice tone can be a cue to a client's emotional state and energy level.
For example, cry indicates joy and sadness; grasping indicates fear, pain or
surprise.
• Period of silence during communication often carry important
nonverbal messages. The silence between two people may indicate complete
understanding of each other, or it may mean they are angry with other.

Facial expression:
• The face is the most expressive part of the body and it has rich
communication potential. Communication often begins with eye contact.
Eyes are windows to personal soul.
• Eye contact suggests respect and willingness to listen and to keep
communication open. Absent of eye contact means many things.
• Eye contact is an important facial expression.
• Nurses need to learn some control over their own facial expressions.
Lack of eye contact or looking away may indicate embarrassment dislike,
withdrawal or possibly an attempt to remember of process what is being
said.

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Posture and gait:
• Body movement or motion may add significant meaning to a verbal
statement or total communication. Total body movement or posture may
indicate strong emotions.
• Posture and gait reflect attitudes, emotions, self concept and physical
wellness
• Nurses can receive useful information by observing client posture and
gait, specific illness can cause identifiable gait, e.g; neuromuscular disorder;
gait mat be alter by many physical factors such as pain, drugs or fractures.

Gestures:
• There are used to illustrate an idea that is difficult or inconvenient to
describe in words.
• Gestures using various parts of the body are capable of carrying
numerous messages .e.g: thumbs up means victory whereas thumb down
carries negative connection.
• Gestures may reveal specific meaning or with other communication,
they may send message e.g; kicking in object often express anger; writing
hands or tapping foot usually indicates anxiety or anger, a waving hand serves
to back on someone to come, or if waved in another way signified that
someone should leave. The hands and arms may indicate openness. Arms that
are rigid with hands clenched indicate anger, tension to explosiveness.

Teach:
• It is a powerful expression of communication. It is a meaningful
personal mode of communication and its meaning is different to different
people.
• Teach can convey warmth and interest. Teach expresses personal
behavior, various messages, such as affection, emotional support,
encouragement, tenderness, security and personal attention, are conveyed
through touch.
• Teach is the important part of the nurse-client relationship but it must
used with discrimination because strong social norms govern its use.
• The nurses must always be aware of appropriate use of teach in varied
situations of touch in varied situations and sittings. Nurses rely on teach when
carrying out intervention.

Factor influencing communication:

1- Development; the rate of speech and language development various

and is directly related to neurological and intellectual development. To
communicate effectively with children, the nurse must understand the
influence of development of languages and thought process.

2- Perception:
• Each person senses, interprets and understands event
differently.
• Perception is the personal view of events.
• Perceptions are formed by expectations and experiences.

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 • Difference in perceptions between people who are interacting,
can be a barrier of communication

3- Values: value are standards that influence behavior. They are what the
person considers important in life and thus influence expression of thoughts
and ideas. Values also affect interpretation of messages. Because values are a
general guide to behavior, it is important for a nurse to develop awareness in
them, knowing and clarifying values are important to clinical decision making
and interaction. A nurse does not allow personal values to interferes with
professional relationship.

4- Emotions: the degree to which people are physically comfortable and

mentally free to engage in interaction will also influence communications.
Emotions are personal subjective feelings about events. Nurses can assess
clients emotions by observing their interaction with family, physician, or other
nurses. When the nurses care for clients they must be aware of their own
emotions. It is helpful or nurses to develop sensitivity to the physical, mental,
emotional barriers to effective communication.
5- Sociocultural influences: culture is the sum total of learned ways of
doing feeling and thinking. It is a form of conditioning that shows itself
thought behavior. Language, gestures, values, and attitudes reflects cultural
origin. Nurses need to develop skills in recognizing ways in which culture,
economic condition, and overall life style influence a client's preferred mode
of communication.

6- Gender: men and women demonstrate different communication styles

and each influences the communication process, or may give different
interpretation to the same conversation. The nurses need to be aware of this
difference when working with clients of opposite sex.

7- Knowledge: it is very difficult to communicate when the person

communicating have different levels of knowledge. Nurses communicate with
clients and professional, who have different levels of knowledge. A common
language is essential when communicating across different levels. Nurses
assess client knowledge, by noting their response to questions, abilities to
discuss health problems and questions that they ask. After that, nurses use
terms and phrases that client understand to promote attention and interest.

8- Roles and Responsibilities: a persons occupation may give the nurse a

general idea of his or her abilities, talents, interests, and economic status.
People communicate in a style appropriate their roles, relationship and
responsibilities. As a nurse-client relationships develops and client gains
confidence in relating idea and feelings communication is more effective when
the participants remain aware of that roles in a relationship and challenge for
the nurse caregiver is to respect the role and responsibilities of the clients,
especially in their influence, their preferred manner of communicating without
denying the client needed care.

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 9- Space and territoriality: territoriality defines the meaning of a persons
right to an area of space and surroundings. People are generally most
comfortable in areas they claim as their own. Territory is important because it
provides people with a sense of identify, security and control.

10- Environment: communication happens best when the environment

facilitates an easy exchange of needed information. People tend to
communicate better in a comfortable environment. A worm room, free of
noise and distractions is best. Noise and lack of privacy or space may create
confusion, tension or comfort.

Principle of communication:
The principle of communication which are helpful and useful for communication
are as follows:
• Systematic analysis of the message.
• Selection and determine of appropriate language and medium of
communication in accordance with the purpose of communication.
• Timing, physical sitting, and the organization climate for
communication need to be appropriate to convey the desired meaning of
the communication conveyed by words.
• Consultation with other for planning of communication.
• The basic content and overtones of messages as well as the
receptiveness to the viewpoint of the receiver influences effectiveness of
communication.
• The messages should convey something of value to the receiver in the
light of his needs and interests, whenever possible.
• Feedback from receivers, follows-up of communication through
expression of the receivers, reactions and their performance review help
in effective communication.
• Communication while meeting the needs of immediate situations
should be consistent with long-term goals and interest of the
organization.
• The communication action following a communication is important in
effective communication as this speaks more than his words.
• The sender has to understand the receiver's attitude and reaction by
careful, alert and proper listening to ensure that the desired meaning of
the message has been comprehended by the receiver.

Blocks and barriers of effective communication:

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 • Asking why: when people disagree with or fail to understand others,
they are tempted to ask why the other believe or have acted in such away.
Regardless of clients perceptions of the nurses motivation 'why' questions can
cause resentment, insecurity and mistrust.
• Changing the subject inappropriate: it might be harmful. A nurse might
inadvertently stop client from discussing a subject of importance by changing
subject. Abruptly interpreting conversation is rude and shows a lack of
empathy. It is important to avoid changing the subject during assessment.
• Excessive questioning: it lace too much pressure on the client and
upsetting particularly when more than one question is asked at a time. it
becomes an interrogation rather than an interaction.
• Making judgment: it labels a client as good or bad and dose not accept
him as individual. A client needs to be encouraged to make independent
decision.
• Giving opinion: it takes decision making away from the client. It
inhibits spontaneity stalls problem solving and creates doubt. Often client
simply needs an opportunity to express feelings giving opinion the client from
developing solutions to problem. At the time client may require suggestion.
• Offering false assurance: it is non factual information that makes the
nurse feel good but may harm the client. Genuine and truthful reassurance is
important and helps validate a client self worth and sense of hope.
• Being defensive: defensiveness: is response to criticism, suggest that
the client has no right to an opinion. When the nurse becomes defensive the
clients concerns are often ignored.
• Stereotyping: every one unique; stereotyping inhibit uniqueness and
over simply the situation. Stereotyping and generalized beliefs held about
people. The use of Stereotyping inhibits communication and can threaten
nurse-client relationship.
• Using highly emotional words (angry, crazy, hostile and guilty) these
should be avoided because many clients will not admit to having these strong
feelings.
• Showing approval or disapproval expressing: excessive approval can
harmful to a nurse-client relationship, as stating disapproval. Offering
excessive praise implies that the behavior being praised is only acceptable one.
often the client shares a decision with the nurse, not in an effort to seek
approval but to provide a means to discuss feeling.
• Focusing on self: it is one way; some nurses maintain distances from
client.

In addition the language differences, deafness, stuffering, muteness, and

blindness, are the physical barrier to communication.

Therapeutic communication

Promotes understanding and can help establish a constructive relationship

between the nurse and the client.

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