Communication and PR Jan2011Sunita

COMMUNICATION
AND
PUBLIC RELATIONS
DNBS 121
Tutor Name: K.Sunita Das

Communication and Public Relations
Learning Objectives:
1. To impart knowledge and the
dynamic of effective
communication
2. To provide opportunities for

students to improve their
communication skills
Course Content
1) Introduction to communication.
2) Methods of communication.
3) Barriers in communication & measures to overcome them.
4) Role of communication in nursing.
5) Role of communication in projecting the corporate image & culture of

organization.
6) Handling difficult clients and complaints.
7) Our role in meeting clients expectation.
8) Listening.
9) Telephone courtesies.
10) Basic counseling skills.

ASSESSMENT – DNBS 112
Formative Summative
assessment assessment
Formative 1 = 10% 70%
Formative 2 = 20%
Chapter 1
Introduction to Communication
• Definition
• Objective
• Communication process
Learning Outcomes
The student will be able to:
1. Define communication
2. State the objectives of
communication
3. Explain the communication process

Communication - Definition
• The activity or process of expressing ideas
and feelings or of giving people
information.
(Oxford Dictionary)
• Communication is the sharing of
information between two or more
individuals or groups to reach a
common understanding.
(Lemone, 2006)
• “Communication is one of the most
persuasive, important, and
complex aspects of human life.”
(Littlejohn,
2002)
In this photo, the police officer is communicating with dispatch
through his two-way radio to reach the understanding that the
officer is unavailable or busy and cannot answer to a call.
Effective Communication
• Effective communication occurs
only if the receiver understands the
exact information or idea that the
sender intended to transmit.
Communication
Process
Communication Process
Communication Process –
1. Source
• As the source of the message, you need
to be clear about:
– Why you're communicating.
– What you want to communicate.
• You also need to be confident that the

information you're communicating is useful
and accurate.
2. Message / Thought
• The information that you want to
communicate.
• Exists in the mind of the sender.
• This can be a concept, idea, feelings.

3. Encoding
• A message is sent to a receiver in words or
other symbols.
4. Channel
• Messages are conveyed through channels,
with verbal including face-to-face meetings,
telephone and video conferencing; and
written including letters, emails, memos and
reports.
5. Decoding
• The receiver translates the words or
symbols into a concept or information that
he or she can understand.
6. Receiver
• Your message is delivered to
individual members of your
audience.
7. Feedback
• Your audience will provide you with feedback,
verbal and nonverbal reactions to your
communicated message.
8. Context
• Is the way the message is delivered, it
includes the tone of voice, the look in the
sender’s eye’s, body language, hand
gestures, state of emotions (anger, fear,
uncertainty, confidence).
5 Steps in Communication
1. Message formation.
2. Message encoding.
3. Message transmission.
4. Message reception.
5. Message decoding.
ACTIVITY TIME
• 10 volunteers (mix group)
• Choose a team leader
• Time: 15 mins
Audience Duty:
- Note what activity you see – e.g.
facial expression, body language,
emotions…..
ACTIVITY TIME
1. Answer: Last person……..?
2. Volunteers answer questions:
3. Audience feedback: What did

you observe ?
Communication + factors =
Effective communication
Factors Influencing Communication
Process
1) Development
2) Gender
3) Value and Perceptions
4) Personal Space
5) Territoriality
6) Roles and relationship
7) Environment
8) Congruence
9) Interpersonal Attitude
Factors Influencing
Communication Process (cont.)
1) Development:
– Language, psychosocial, and

intellectual development moves
through stages of the life span.
– Knowledge of the client’s
developmental stages will allow us
to modify the message accordingly.
Factors Influencing
2) Gender:
– Females and males communicate differently.

– Girls and girls.
– Man and woman.
Factors Influencing
3) Value and Perceptions:
– Values are the standards that influence

behavior.
– Perception are the personal view of an event.
– Each will perceive and interpret message
differently base on their personality, life
experience.
Factors Influencing
(cont.)
4. Personal space:
Factors Influencing
5) Territoriality:
– Definition: is a concept of the space

and things that an individual
considers as belonging to the self.
– Example: clients consider their
territory as bounded by the curtain
around the bed unit or by walls.
Territoriality
Personal space
(0-18 inches)
Personal Intimate
Personal (18 inches-4 ft)
Social (4 ft- 12 ft)
Public (12 ft or more)
WK 37
Factors Influencing
6) Roles and relationship:
– The roles and relationships between sender

and receiver affect the communication process.
– Client and physician, tutor and student, parent
and child.
Factors Influencing
7) Environment:
– More effective in a comfortable environment.

– Warm temperature, excessive noise, lack of
privacy may interfere communication process.
Factors Influencing
8) Congruence:
– The verbal and nonverbal aspects of the

message match.
– Congruence between verbal expression and
nonverbal expression is easily seen by the
nurse and the client.
Factors Influencing
9) Interpersonal Attitude:
– Attitudes convey beliefs, thought and feelings

about people and events.
– Caring and warmth convey feelings of
emotional closeness.
– Respect is an attitude that emphasizes the
other person’s worth and individuality.
Interpersonal Attitude
Any Question??????????
Types of Communication
1) Intrapersonal – self talk.
2) Interpersonal.
3) Social – purpose, telephone
courtesy.
4) Therapeutic – characteristic of a
helping relationship.
5) Organization.
6) Group Interaction.
Types of Communication (cont.)
1. Formal / Informal.
– Official and unofficial information
exchange.
2. Vertical or horizontal.
– Subordinate and peers.
Types of Communication (cont.)
3. Personal / impersonal.
– Situation of mutual influence / exchange
without mutual influence.
4. Instrumental / expressive.
– Necessary for job or non job information
transmission.
Group Activity- Date:
• Group 1 – Drama (Verbal communication e.g. in a
restaurant- cover types)/ 30 mins
• Group 2 – Debate (Non verbal communication is
better than verbal communication- cover
advantages and disadvantages/ influencing
factors) / 30 mins
• Group 3 – Presentation (Therapeutic
communication/ scenarios)/ 20 mins
• Group 4 – Quiz session/ 20 mins
• Group 5 – Drama (only non verbal communication
e.g. bank – cover all types)/ 20mins
THANK YOU
Chapter 2: Methods of
Communication
Learning Outcomes
1. Explain the methods of
communication
Methods of Communication
1) Verbal.
2) Non Verbal.
3) Therapeutic
Communication.
Definition
• Communication is the process that
people use to exchange the information.
• Messages are simultaneously sent and

received on two levels: verbally through
the used of words and nonverbally by
behaviors that accompany the words.
(Devito, 2004)
Verbal Communication
Definition:
– The process of sending and receiving

messages with words, including writing and
sign language.
Verbal Communication (cont.)
• Verbal communication is when a person
puts across a message by speaking.
• The message can be sent to an individual,
a team or a group.
• The message can be sent in person, via
an intercom, over the phone, email etc.
When I can get my It will be with you by 10
new TV delivered? am tomorrow
I'll ask an
oral question
Sender
Decide what is the
best
Choose the best
medium – face to face Receive Feedback
form of question
or telephone
- written, oral ?
• The person sending the message should

express the message clearly so that the
receiver is able to understand and act, if
required, on the message.
• The receiver of the message should be

able to understand what was said.
Verbal Communication
(cont.)
• Many times the message may not be

received as the sender intended, due to a
range of factors including lack of attention
or interest.
• Verbal communication requires the use

of words, vocabulary, numbers and
symbols and is organized in sentences
using language.
• Everyone's brain is forever having

thoughts and they are primarily with
words.
• Words spoken, listened to or written
affect your life as well as others.
• They have the power to create emotions

and move people to take action.
• Types of Communication:
– Oral.
– Writing.
– Reading.
• This involves the use of words, but not on

paper oral communication is spoken.
• Including :
1. Face-to-face communication.
2. Telephone.
3. Public speech.
4. Interview.
5. Meeting.
6. Presentation.
Written Communication
• It is used for many purposes. It
includes letters, circulars, notices,
memos, reports, forms, manuals
etc.
• Everything that is put down on

paper in writing comes under
written communication.
Types of written communication
1) Letters:
– It is the most commonly used form of written

communication.
– They are mostly used for external
communication letters have a fixed and
formal layout, which must be adhered to there
can be sales letters, complaint letters and
many others.
Types of written communication (cont.)
2) Memo:
– Informal communication between members

of the same organization and usually relates
to day-to-day work.
– It is used to convey information and
instructions.
– They are normally pre-printed formatted
papers on which memos are written.
Types of written communication (cont.)
3) Circulars:
– This is a written document giving instructions
or orders on a specific matter.
4) Report:
– Document prepared by an individual or a
committee.
– It is prepared after research. After the data
collection and analysis, the results have to be
presented.
The Advantages of Verbal
Communication
• It is precise and accurate.
• It is usually formulated with great case,

since it can be checked and verified any
time.
• The writer has to be careful about what is

being communicated.
The Advantages of Verbal
Communication (cont.)
• It is a permanent record.
– Can be used in the future for reference.
• Helps in the formulation of new policies

and reports easily as they can be based
on improvement required in the previous
ones.
The Disadvantages of Verbal
• Time consuming.
• Takes time to write letters, circulars etc,
whereas oral communication is much
faster.
• Can be expensive.
• Feedback is slow, takes a longer time to
get the feedback.
Factors Influence Verbal
Communication
1) Pace and Intonation.
– The pace or rhythm and intonation.
– Speaks slowly, softly.
– Depends on your mood.
2) Simplicity.
– Use simple and understandable terms based
on culture, back ground and education.
3) Timing and Relevance:
– Give time to your client to answer the
questions.
4) Adaptability:
– Adapt or sensitive to the client feelings.
5) Credibility:
– Being consistent, honest, dependable.
6) Humor:
– Humor can be a positive and powerful tool but
must be use with care.
Effective in Written Communication
1) Purpose of writing should be clear.
2) Clarity and proper used of words.

– Content should also be precise and clear
enough for the reader to understand.
3) Respect to the reader.

Effective in Written Communication
(cont.)
4) Know the details of your conversation.
5) Try not to be a forgetful.
6) Free from jargon.

Effective Verbal Communication
1) Be specific:
– Speak it loudly, clearly and confidently when
describe your need, wants and limits.
2) Used appropriate tone of voice respectful

words:
– Think before you speak.
Effective Verbal Communication
(cont.)
3) Keep conversation going by encourage

the person to talk, start with greetings.
4) Slow down – People will perceive you as

nervous and unsure of yourself if you talk
fast.
Effective Verbal Communication (cont.)
5) Make eye contact.
6) Use appropriate volume:

– Use a volume that is appropriate for the
setting.
– Speak more softly when you are alone
and close.
– Speak louder when you are speaking to
larger groups or across larger spaces.
Group Activity
Activity 1 (10 mins)
• Volunteer – 10 persons
• Communication is Simple?
Activity 2 (10 mins)

• Volunteer – 10 persons
• Arrange yourself according to your
date of birth
• Without TALKING !
Nonverbal Communication
• Definition:
– All the messages other than words
that people exchange in interactive
contexts.
(Hecht, DeVito, and Guerrero)

Methods of Communication
• Words are 7%
effective
• Tone of voice is
38% effective
• Non-verbal clues
are 55% effective.
Nonverbal Communication (cont.)
• Nonverbal include:
– Shaking hand. – How close you

– Posture. stand to others.
– Facial expressions. – Your breathing.
– Expression in your – The way you
eyes. move, the way
– Color choice. you stand.
Nonverbal Communication (cont.)
• It is unplanned communication.
• Body languages facial expressions and

vocal characteristics are not controllable.
Nonverbal Communication
(cont.)
• Has greater impact than verbal

communication.
• Non-verbal clues have an equally

important role to play in conveying,
thoughts, ideas and feelings.
Functions of non-verbal
communication
• Although non-verbal communication can

stand alone in many situations, it
frequently works hand-in-hand with
speech.
• Our words only carry a part of the

message; our non-verbal symbols carry
the rest.
Types of Non Verbal
Messages
1. Paralanguage 6. Haptics.
vocal cues. 7. Chronemics.
2. Kinesics. 8. Artifacts /
3. Facial expression. appearance.
4. Gestures & 9. Silence.
postures.
5. Proxemics.
PARALANGUAGE VOCAL
CUES
• We use it to:
– Identify someone.
– Judge personalities.
– Judge emotions.
KINESICS
BODY LANGUAGE
• Eyes.
• Face.
• Posture.
• Gestures.
Facial Expression
• The face is a powerful conveyor of non-

verbal messages.
• It is the primacy site for expression of

emotion.
– You can see both the type and intensity of
emotion.
Facial Expression (cont.)
• A person’s eyes are especially very

expressive.
• They can convey interest, quest

attention and influence others.
Gestures and Postures
• Many gestures have a specific meaning.
• These unconscious sign reveal whether

a person is coefficient or nervous,
friendly or hostile, assertive or passive,
happy or sad.
PROXEMICS
SPACE & DISTANCE
• Territoriality:
– A geographic location for
which we feel some
ownership.
• Personal space:
– Tells us how close to stand
to another person.
HAPTICS
TOUCH
• The most basic form of human

communication.
• This is an extremely important tool to

demonstrate the type of communication that
we want to show.
– If we hug a person spontaneously, we show
love and affection.
CHRONEMICS
TIME
• Culture is relevant to our ideas

about time.
• People demonstrate their

importance by making people
wait, at other places they show
respect by being on time.
ARTIFACTS / APPEARANCE
(HOW WE ADORN OURSELVES)
• Clothing.
• Jewelry.
• Tattoos.
• Etc.
ARTIFACTS/APPEARANCE
(HOW WE ADORN OURSELVES) (cont.)
• An individual’s appearance helps to

establish his or her social identity.
• Although an individual features and body

type impose limitations, most of us are
able to attract others.
ARTIFACTS/APPEARANCE
HOW WE ADORN OURSELVES (cont.)
• Clothing,
accessories,
style all can
modify our
appearance.
Silence
• One of the effective communication.
• Examples:
– Shyness - after a girl gets a proposal from a
boy.
– Ignorance - after a teacher asks a question
from a student.
Silence (cont.)
• Examples (cont.):
– Anxiety - after you get to know that your child
is seriously sick.
– Satisfaction - when you are in the prayer
room all by yourself etc.
• Silence is therefore very powerful.

Therapeutic
Communication
Therapeutic relationship
• Clients and nurses alike come to the

relationship with unique cognitive, affective
and psychomotor.
1. Cognitive:
– Clients and nurses both know something

about health and illness in general, and
about the individual client’s health concerns
in particular.
2. Affective:
– All clients and nurses have positive and

negative about helping relationships; each
also biases about the other.
• Attitudes of both clients and nurses
greatly affect whether:
– They work in harmony or discord.

– Their respective knowledge surfaces
or is submerged.
– They carry out the commitment of
improving the health of individual
clients.
3. Psychomotor:
– The client needs to know what skills

the nurse has, and the nurse needs to
find out about the client’s ability to
participate in his / her own treatment
plan.
– Both parties must come to an
agreement about what their respective
tasks will be in their effort to improve
the client’s health status.
Therapeutic Communication -
Definition
• Is an interpersonal interaction between the
nurse and client during which the nurse
focuses on client’s specific needs to
promote an effective exchange of
information.
Therapeutic Communication
– Goals
1. Establish a therapeutic nurse-
client relationship.
2. Identified the most important

client concern at the moment.
3. Assess the client’s perception of

the problem as it unfolds.
Therapeutic Communication
– Goals (cont.)
4. Facilitate the client’s expression
of emotions.
5. Teach the client and family

necessary self-care skills.
6. Recognize the client’s needs.

Therapeutic Communication –
Goals (cont.)
7. Guide the client toward identifying a plan

of action to a satisfying and socially
acceptable resolution.
Elements of therapeutic
communication
• Empathy. • Validation.
• Trust. • Caring.
• Honesty. • Active listening.
110
Empathy
• Is the ability to enter into another
person’s experience.
– E.g.: Fit / put yourself into other
persons shoes.
• To perceive accurately to
understand the client’s perspective
point of view.
111
Empathy (cont.)
• A nurse respond to other’s
experience while still maintaining
objectivity.
• Done through a process of

reflective or “active” listening.
• Can be communicated in both

verbally and
112
nonverbally.
Empathy (cont.)
• Focusing on feelings and being warmth,
nonjudgmental play an important role in
therapeutic communication.
113
Trust
• Client belief that nurse will behave
predictably and competently while
respecting the client’s needs.
• Nurse behavior:
– Encourage confidentiality.
– Do exactly what you say will do for
the client.
– Punctual.
114
Trust (cont.)
• Nurse behavior (cont.):
– End session on time.

– Return – when you say you will.
– Consistently open, friendly, honest.
115
Honesty
• Ability to be truthful, frank and
sincere.
• Nurse behavior:
– Provide realistic reassurance / avoid
false information.
– Develop insight into the way your
feelings and reactions affect the
client.
116
Honesty (cont.)
• Nurse behavior (cont.):
– Accept yourself.
– Accept as he / she is.
117
Validation
• Listen to client and respond
congruently in order that client and
they have same understanding of
a problem / issue.
• Nurse should declare

understanding by:
– “So you are saying…………..”
118
Validation (cont.)
• “Let me be sure / understand
about what you are saying”.
• “Tell me what you understand

about what I just said”,
• Outcome:
– To clarify communication, help client
to feel accepted, respected and
understood.
119
Caring
• Level of emotional involvement
between nurse and client.
• Nurse nonverbal actions:

– Seeking client out each day.
– Spending quality time with client.
– Paying attention to clients needs.
120
Caring (cont.)
• Nurse nonverbal actions (cont.):
– Using tactile messages – e.g.: pat on

the back to show support.
– Makes the client feel accepted.
– Provide client with knowledge that
nurses willing to help.
121
Active listening
• Hearing.
• Interpreting language.
• Noticing nonverbal and verbal
cues.
• Identifying underlying feelings.
• Required energy and
concentration.
122
Active listening (cont.)
• Nurses should:
– Take time to listen and respond.

– Maintain eye contact.
– Pay attention / respond to verbal,
nonverbal cues and signals.
– Listen in between the lines.
– Suspend judgment.
123
• Nurses should (cont.):
– Understanding feelings behind the facts.

– Noticing discrepancies between facts and
feelings.
– Noticing topics that omitted of caring and
interest, thereby encouraging client to talk.
– Allow the client to close the conversation, client
will consider that the messages is not
important.
124
• Nurse should not:
– Interrupt the client.

– Be bias.
– Discredit a message that reflects
different values and beliefs.
125
• Communication skills:
– Develop through practice.

– Respond by nodding the head,
uttering “uh huh” or “eemm”,
repeating the words that the client
has used, saying that “I see what you
mean....”
126
Effective Therapeutic
Communication
• To have effective therapeutic
communication, the nurse should
consider:
1. Privacy and respective boundaries.

2. Use of touch.
3. Active listening and observation.
Privacy & Respecting
boundaries
• Intimate zone (0 – 18
inches):
– Comfortable for parents with
young children, people
whispering.
• Personal zone (18 – 26

inches):
– Comfortable between family
and friends who are talking.
Privacy & Respecting boundaries
(cont.)
• Social zone (4 – 12 feet):
– Acceptable for communication in social, work
and business setting.
• Public zone (12 – 25 feet):

– Between speaker and audience.
boundaries (cont.)
• When the nurse need to invade the
intimate personal zone, always ask
the client’s permission.
• Example:
– “Mr. Selva, to take your blood
pressure, I will wrap this cuff around
your arm and listen with my
stethoscope. Is this acceptable to
you?”
boundaries (cont.)
• The therapeutic communication interaction
is most comfortable when the client are 3
– 6 feet apart.
Use of Touch
• Touching a client can be
comforting and supportive
when it is welcome and
permitted.
• Although touch can be

comforting & supportive, it is
an invasion of intimate and
personal space.
Use of Touch (cont.)
• Four types of touch:
1. Functional-professional touch:
• Is used in examinations or procedures.
2. Social-Polite touch:
– Is used in greeting, such
as hand shake.
3. Friendship-warmth
touch:
– Involves a hug in
greeting, an arm around
the shoulder of a good
friend.
4. Love-intimacy touch: Is this
– Involves tight hug and kisses. Intimate
Zone?
Active Listening &
Observation
• Active listening means refraining from
other internal mental activities and
concentrating on client says.
• Active observation – watching nonverbal

action as she or he communicates.
Active Listening &
Observation (cont.)
• Peplau (1952) used observation as
the 1st step in therapeutic
observation.
• Active listening & Observation help

nurses to:
– Recognize the issue that is most
important to the client at this time.
– Know what further questions to ask
the client.
Active Listening &
Observation (cont.)
• Active listening & Observation help nurses
to (cont.):
– Guide client to describe his / her perceptions

fully.
– Understand the client’s perceptions, instead
of jumping to conclusions.
– Interpret and respond to the message
objectively.
Principles of Therapeutic
Communication
1. Plan to interview at an appropriate
time.
2. Assure privacy.
3. Establish guidelines for therapeutic

communication.
4. Provide comfort during interaction.

139
Principles of Therapeutic
5. Accept client as they are.
6. Encourage spontaneity.
7. Focus on the client and cues

presented.
8. Encourage clients expression of

feelings.
9. Aware of own
140 feelings during
interaction.
Chapter 3: Barriers in
Communication
Learning Outcomes
1. Identify the barriers in
communication
2. Explain the measure to overcome
communication barriers
What is Barrier
• Definition of barrier:
– A "barrier" is anything that prevents a

person with a disability from fully
participating in all aspects of society
because of his or her disability.
Barrier in Communication
• Seven Top Barriers in Communication:
1. Physical Barriers
2. Perceptual Barriers
3. Emotional Barriers
4. Cultural Barriers
5. Language barriers
6. Gender barriers
7. Interpersonal barriers
• Distance.
• May exist in structures or designs

that will interfere a person with a
physical disability from accessing
the particular location or service.
1. Physical Barriers (cont.)
• Physical Barriers include things like:

– Doorways not wide enough.
– Poor lighting.
– Inaccessible bathrooms.
– Parking in a spot designated for persons
with disabilities.
– Lack of audible light signals.
Physical
• The world constantly bombards us with

information: sights, sounds, scents, and
so on.
• Our minds organize this stream of

sensation into a mental map that
represents our perception or reality.
Perceptual
• Every message contains both a content
meaning, which deals with the subject of the
message, and a relationship meaning, which
suggests the nature of the interaction between
sender and receiver.
• Communication can break down when the

receiver reacts negatively to either of these
meanings.
Emotional
4. Cultural Barrier
• Differences in background can be one of
the hardest communication barriers to
overcome.
• Age, education, gender, social status,
economic position, cultural background,
temperament, health, beauty, popularity,
religion, political belief.
Culture
5. Language Barrier
• When you choose the words for
your message, you signal that you
are a member of a particular
culture or subculture and that you
know the code.
Language
6. Gender Barrier
• There are distinct differences between
the speech patterns in a man and those
in a woman.
• A woman speaks between 22,000 and

25,000 words a day whereas a man
speaks between 7,000 and 10,000.
6. Gender Barrier (cont.)
• In childhood, girls speak earlier than boys

and at the age of three, have a
vocabulary twice that of boys.
• Man talks in a linear, logical and

compartmentalized way, features of left-
brain thinking.
6. Gender Barrier (cont.)
• Woman talks more freely mixing logic and

emotion, features of both sides of the
brain. It also explains why women talk for
much longer than men each day.
7. Interpersonal Barriers
• Withdrawal is an absence of
interpersonal contact. It is both refusal to
be in touch and time alone.
• Closeness is the aim of interpersonal

contact where there is a high level of
honesty and acceptance of yourself and
others.
Interpersonal
Group Activity
• Break into groups
• Choose one Barrier
• Give TEN (10) examples within the barrier
and how to overcome it
• Present to class
• Preparation time: 15 mins
• Presentation time: 5 mins per group
• Total time: within 30 mins
Barrier in Communication
• Seven Top Barriers in Communication:
4. Cultural Barriers
5. Language barriers
6. Gender barriers
7. Interpersonal barriers
Verbal Communication Barriers
• Attacking (interrogating, criticizing, blaming,
shaming).
• Showing Power (ordering, threatening,

commanding, directing).
• Other Verbal Barriers: shouting, name

calling, refusing to speak.
Nonverbal Communication Barriers
• Quick or slow movements.

• Arms crossed, legs crossed.
• Slouching, hunching over.
• Poor personal care.
• Staring at people or avoiding eye contact.
How to overcome Barriers?
• Effective Communication . . .
– It is two way.
– It involves active listening.
– It reflects the accountability of speaker and
listener.
– It utilizes feedback.
– It is free of stress.
– It is clear.
Thank You
Chapter 4:
Role of communication
in nursing
Learning Objectives
• At the end of the lesson, students should be able to:
1) Differentiate between therapeutic relationship and

therapeutic communication.
2) Identified the elements of therapeutic communication.
4) Define caring in therapeutic communication. Describe

effective therapeutic communication.
5) Explain the communication in nursing process.
6) State the principles of therapeutic interaction.

Role of communication in
Nursing
• Communication is the relationship
between nurse and client.
(Stuart & Laraia, 1998)
• Thus, therapeutic
communication is a way of being
helpful by facilitating interactions
that focus on the client’s concerns.
Nursing Process
Assessing Diagnosing Planning
Implementing
Evaluating
Communicating within the
Nursing Process
• Using communication skill to gather,
analyze and transmit information to
accomplish the work of each phase of the
nursing process.
Nursing Process -
Assessment
• Nurse should be able to communicate with
the client to gather information.
• It is important to collect data systematically

and organize the data that you have
collected.
• Barriers during assessment:
– Physical and emotional factors (injury,

breathing problem, anxiety, barrier to speech).
– Developmental factors (infant crying, hearing
problem).
– Sociocultural factors (language barriers,
background).
– Gender.
Nursing Process – Nursing
Diagnosis
• Success in accurately identifying the
client’s problem through communication
ensure the formulation of an accurate
nursing diagnosis.
Nursing Process – Planning
• Once you identify the client’s problem, you

should consider several factors to design a
plan of care.
• Motivation and encouragement improves

communication.
• Outcomes allow you to determine if your
goal has been met, once intervention are
tried.
Nursing Process –
Implementation
• Nurses need to use
communication techniques to
meet the client’s individual
needs.
• The use of therapeutic

elements is beneficial to both
nurse and clients.
Nursing Process – Evaluation
• Nurses need to evaluate the effectiveness
of the communication / interventions that
had been carried out.
• Evaluation is done to determine whether

client’s need has been met / client’s
problems is solved.
• Performing evaluation also helps to
identify the strength and weaknesses so
that the nurse will try to improve her plan
towards achieving client’s needs.
Learning outcomes:
1. Identify the techniques of communication to

minimize difficulties when communicating with
clients who have visual, hearing, speech and
cognitive impairment and unconscious
2. Apply the techniques of interview in nursing.
3. Understand different types of counseling in
nursing
WK 185
Client’s with special needs include
• Visually impaired
• Hearing impaired
• Cognitive impaired
• Mute or having speech difficulties
• Unconscious client
WK 186
Visually impaired
• Introduce yourself every time
you enter the client’s room or
area
reduce stress when client
knows who is there
• If client enters an area where
you are, alert them to your
presence
 to let client be aware of your
present
WK 187
Visually Impaired client (cont..)
• Orientate client to others in the area
• promote communication with others to reduce
sense of isolation
• Orientate client to the items and sound in the
area
• Leaves things as they are.
• reduce risk of injury or trips or spills, increase
client sense of security.
• Use a normal tone of voice.
as visually impaired client are unable to pick up
the non-verbal cues during communication
WK 188
Visually Impaired client (cont..)
• Ensure the call bell is always within reach
increase safety and sense of security
• If client needs assistance moving around, alert
client to potential dangers such as stairs,
changes and other barriers
maintain safety and prevent accidental falls
WK 189
Hearing impaired client
• Reduce or eliminate
environmental sound
minimize competing sound
• Ensure adequate lighting
• Approach from the front or the
side, not from behind
• If need to gain clients attention,
gently wave your hand in their line
of vision or lightly tapping their
shoulder
WK 190
Hearing impaired client (cont..)
• Face and look directly at client when talking.
• Allow a clear view of your face by placing
yourself near a light source
• Ensure spectacles is clean, if worn.
client’s who read lips need a clear view of the
communicator’s lips.
• Ensure hearing aid in place and working
WK 191
Hearing impaired (cont..)
• Speak towards the client’s ear that has the most
hearing capacity
• Keep your hand away from your mouth and
avoid chewing while speaking.
covering the mouth reduce the ability to lip-read
• Do not turn and work away from client while still
talking.
reduce the client’s ability to work out the
messages from facial expression or lip-read
WK 192
Hearing impaired (cont..)
• Do not shout.
• Rephrase if words are not understood.
 rephrasing statement with different words may
make lip reading easier
• Use gestures and body movement to help clarify
meanings.
• If difficulties continues, use written
communication or other communication aids
WK 193
Client who are mute and having speech
difficulties
• Listen to client attentively, practice patience and
do not interrupt.
• Ask simple question that requires a simple yes
or no answer.
• Give time for understanding and respond.
• Allow one person to speak at a time
• Do not shout or speak too loud.
a raise voice does not help and cause distress
• Use communication aid as necessary.
WK 194
Clients who are cognitively impaired.
• Minimize environmental distraction
Damage to the brain has reduce the ability to
screen out noises from outside
• Introduce yourself each time you communicate
with client if necessary.
Client might not remember from one meeting to
the next
• Make sure that you can be seen and heard
Client might not respond if simply called by
name without other sign or signal
195
WK
Clients who are cognitively impaired
(cont..)
• Get client’s attention e.g. by establishing or
maintaining eye contact.
• Keep communication simple
• Avoid long question and explanation
Client may only have minimal understanding of
words
• Be aware of how you present yourself.
When words are not understood, facial
expression, body language and appearance are
what client responds to most
WK 196
Clients who are cognitively
impaired (cont..)
• Avoid changing subject to subject

• Ask question one at a time.
• Involve family and friends in the
conversation
WK 197
Unconscious client
• Call client by name during interaction
• Communicate both verbally (in a normal tone of
voice) and by touch.
• Talk to client as if client can hear.
client may be able to hear and if they recover
they may remember what was said
• Always be careful of what you say in the
presence of the client.
hearing is believed to be the last senses to go
WK 198
Unconscious client (cont..)
Explain all procedures and sensation

involve.
not able to ask could provoke client’s
anxiety
Keep environmental sound to minimum
to allow client to focus on the
communication
WK 199
200
201
Chapter 5: Corporate Image
and Organization Culture
202
Introduction
• Nurses need to know about culture –

their own and their clients’- because it
influences both nurses’ and clients’ care
perceptions and behaviors.
203
Definition of Culture, Ethnicity,
and Ethnocentrism
Culture:
• As the learned and shared beliefs,

values, and ways of life of a particular
group that are generally transmitted
intergenerational and influence one’s
thinking and actions.
204
Ethnicity:
• Refers to the social identify and origins

of a social group due to largely to
language, religion, and national origin.
205
Ethnocentrism:
• Refers to the universal tendency of

people to think that their ways of
thinking, acting, and behaving are
the only right and natural ways.
206
Reasons Why Nurses Need To
be Informed About Culture
• Shifting demographics will influence

health care.
• The essence of human caring becomes

the most valued aspect of nursing as
technology becomes an increasingly
important part of health care.
207
• Increasing in population and diverse
groups.
– Difference in cultural beliefs, values, and
practices, rather than issues of race,
gender, class, or sexual orientation.
• Longer life expectancy in gerontology.
• Working family and nuclear family.
208
SDMC Motto
Leadership
SDMC Value
Recruitment
Accountability
Group Norms
SDMC
Staff Welfare Customer Focus
Team
Ethical Practice /
work Innovation /
Quality Activities
Creativity
Organization communication flow.
WK 211
SDMC VALUES
• Fulfill our clients needs with a spirit of genuine
care and concern for their welfare.
• Follow the highest ethical principles.
• Provide superior facilities , equipment and

operational systems.
• Maintain a constant commitment to our staffs

welfare and development.
• Maintain an environment of mutual
commitment , caring and harmony of
purpose.
• Strive of excellence , constantly improve

everything we do.
SDMC MOTTO
‘ We Care , We Serve ’
Caring Environment
Client Advocate
GROUP MOTTO
‘” EXCITE”
- Please locate it around the
college and explain during next
class……
- What about other companies,
any other motto/ vision/
mission….?
LEADERSHIP
Provides direction.
Purpose.
Support.
Encouragement.
Recognition to achieve
our vision , meet our
objectives and values.
RECRUITMENT
Credentials.
Experience.
Assessment.
GROUP NORMS
Communication.
Continuous education.
Suggestion.
Winners reward.
Sense of urgency.
Accountability.
CUSTOMER FOCUS
Informed
during
orientation.
Customer
service
courses.
Customer feedback / rewards.
Courtesy campaign.
Customer Service Department.
ETHICAL PRACTICE /
QUALITY ACTIVITIES
Maintain standards.
Standard Operating Policy.
Aware of Litigation.
ACCOUNTABILITY
Ownership
Empowerment
Sense of urgency
TEAMWORK
●Information sharing
●Win – win attitude
●Partnership with
vendors
STAFF WELFARE
Staff Health
Benefits
Staff Recreation Club
INNOVATION /
CREATIVITY
Question old ways of
doing things.
Staff suggestion.
Support ideas.
How do Others see Us?
• Teamwork environment
• Positive image
• How do Others see Us?
• What image do we want to project ?
• How do I project a positive image ?

Group Activity- Date:
Objective:
• To demonstrate efficient use of the telephone
• Demonstrate good human and public relations
Activity:
1. Break up into partners
2. Preparation ten minutes
3. Role play - Good examples and poor examples of
telephone courtesy and counter courtesy (e.g.
restaurant, bank, post office, hospital)
4. Role play for 5 mins
Thank You
Chapter 6:
Handling Difficult Clients &
Complaints
Learning Objectives
• At the end of the lesson, students
should be able to:
1. Explain the importance of customer
feedback
2. Explain the complain handling
procedure
3. State the do’s and don’ts of handling
complaints
4. Appreciate the importance of inter-
personal communication skills with
clients and the public
Customer
• Definition:
– A person who buys goods or a service.
(Cambridge advance learner’s Dictionary, 2005)

What is a Customer ?
• The most important person.
• Purpose of our work.
• Not someone to argue with.
• The lifeblood of any business.
• Deserve the most courteous and

attentive treatment we can give.
Who Are Our Customers ?
1. Internal
- all categories of staff
2. External
- People who use our services –
patient.
- our suppliers, neighbors, doctors,
families.
Customers Today
• Demanding.
• Well educated.
• High expectations.
• Value for money.
• Spoilt for choices.
• Know their rights.
• Always in a hurry.
Our Customers’ Physical,
Mental and Emotional State
• Worried. • Depressed.
• Anxious. • Traumatized.
• Confused. • Panic.
• Stressed. • In pain.
• Scared. • Angry.
• Overwhelmed. • Tired.
• Lack of sleep.
How Things Are Different For
Our Customers
• To you: • To the customer:
- routine. – New.
- familiar. – Unfamiliar.
- normal. – Strange.
- work. – Uncertainty.
Customers Needs /
Expectations
• Needs: • Expectations:
– Dependable. – Help and

– Accurate and assistance.
consistent – Respect.
service. – Comfort.
– Honesty sincere.
• Responsiveness: • Empathy:
– Assurance/ – Timely services.

Competent. – Orderly.
– Trust, Integrity. – Trouble free.
– Available Facilities. – Empathy – to feel
– Cleanliness. important.
Why Customers feel Upset ?
• Should do right thing at the right time

as per customer’s definition.
Common types of customers
• Angry customers.
• Argumentative customers.
• Demanding customers.
• The complainers (fault finders).
• The resistive customer.

• Know-it-all customer.
• Dependent customer.
• Uncommunicative customer.
• Talkative customer.
• Perfect customer.
The complainers (fault finders)
• They buy, they complain and they will

return what they bought or they want a
refund, extension or warranty.
• What ever you do for them, they will not

be happy.
• Only time they are happy when they are

complaining and make someone
miserable.
The resistive customer
• No matter what you try to do for these
patients, they will resist your every effort
to satisfy them.
• They enjoy making other miserable or

stress people out.
Know-it-all customer
• This persons knows your business better

than you do and will not hesitate to tell
you and anyone else who will listen.
• They will tell you what you are doing is

wrong even when you do things right.
Dependent customer
• Like a newborn baby who is totally

dependent on a parent.
• This type of customer wants you to do

everything and will not lift a finger to help
themselves.
Uncommunicative customer
• It is hard to know how to satisfy customer
when they do not tell you what you need
to know.
• In this case, silence is deafening (very

noticeable that nothing was said), and it
could be deadly to your efforts at
customer retention.
Talkative customer
• These customers probably just want
someone to listen to them, but they
constantly talking can become annoying.
• You should develop a way to quiet them

down without insulting them, making them
feel disrespected or shattering their self-
esteem.
Perfect customer
• Once satisfied with the services, they will

go out and recommend to others and
referring your business.
• When this customer complains = means

they are providing feedback to improve
the services.
• Ask for referrals and improvements.
• Act as advocates.
Thank You
Chapter 7:
Our role in meeting client’s
expectation
• What is our ROLE ?

• How do we achieve it?
• How do we overcome it ?
• How do we maintain it ?
Learning Outcomes
1. Explain the importance of customer
service
Thank You
Chapter 8:
LISTENING
Learning Objectives
should be able to:
1. Define active / attentive listening.

2. Explain basic steps of listening.
3. State the modes of listening.
4. State the techniques of listening.
5. List the rules of effective listening.
256
Last night I had a bad dream, Oh how nice if I am
it was so scary and I can’t having a cup of
sleep…bla…Bla…bla coffee
right now.
Are You
Listening
Introduction
• We are all guilty of listening, but not intently
enough or effectively enough to actually
hear (and fully comprehend) the message
being sent to us.
258
We Listen ……………
to obtain information
to understand
for enjoyment
to learn
Why We Are Not Listening
• Lack of time or interest that causes the
message not to be heard.
• Too busy to actually listen and

comprehend.
260
ACTIVE / ATTENTIVE
LISTENING
Definition
• Active listening means a listener

must constantly decode the
message sent.
In Nursing Context …………
Active Listening
• Nurse should listen to both content and
feelings.
• Content = messages includes thoughts, words,

opinions and ideas.
Congruency helps
nurse to understand
clients experience.
Active Listening
• Feeling = refers to clients emotions. Emotions
usually are more accurate with nonverbal
cues as facial expressions, body posture,
laughter or crying.
Active Listening
• Nurse should observe for the message being
conveyed by the client.
– E.g. conveying attitude of helplessness, rejection or
aggression towards the nurse.
Importance of Listening
Skills
• Good communication skills are essential

for any successful career.
• By improving listening skills, you can

improve your relationships with people
around you.
Importance of Listening
Skills
• Conflictive relationships become productive.
• Difficulties can be smoothed over.

Basic Steps of Listening
1. Hearing
2. Understanding
3. Judging
269
1. Hearing
• Hearing just means listening enough to

catch what the speaker is saying.
• If you can remember the detail of that

particular patient , then you have heard
what has been said.
270
2. Understanding
• The next part of listening happens when
you take what you have heard and
understand it in your own way.
271
3. Judging
• After you are sure you
understand what the speaker has
said, think about whether it
makes sense.
• Do you believe what you have

heard ?
272
Modes of Listening
1. Competitive or Combative Listening.
2. Passive or Attentive Listening.
3. Active or Reflective Listening.
273
1. Competitive / Combative Listening
• This type of listening occurs when the
receiver may be more interested in
promoting his or her point of view
instead of considering the speaker's
thoughts.
274
1. Competitive / Combative
Listening (cont.)
• When this occurs, the listener may look for
breaks in the conservation so he or she can
deliver his or her own points of view,
perhaps attacking any points they may not
agree with; hence combative listening.
275
Listening (cont.)
• In such cases, the listener may only be
pretending to pay to the speaker, while
actually formulating what they need/want
to say next.
276
Listening (cont.)
• Unfortunately, as this
happens, the listener is often
more involved in formulating
their argument or rebuttal
than in listening, which so
often results in confused
communication.
277
2. Passive / Attentive
Listening
listener is sincerely interested in both
hearing and understanding the message
that is being spoken to them.
278
2. Passive / Attentive Listening
(cont.)
• This listener is actively listening.
• However, the problem occurs when this

good listener fails to take action (does not
verify all he or she is told); and hence is
passive.
279
3. Active / Reflective
Listening
listener is genuinely interested in the
speaker’s message.
280
3. Active / Reflective Listening
(cont.)
• He or she sincerely wants to know what

the speaker thinks, how the speaker feels,
and what the speaker wants, and is active
in confirming that he or she understands
all of this before reacting.
281
3. Active / Reflective
Listening (cont.)
• This listener is very effective and will take
the time to verify the message by
repeating it to the speaker.
• Clearly, this type of listening is most

effective and highly recommended for
optimal results.
282
Techniques of listening
1. Restatement.
2. Reflection.
3. Exploring.
Restatement
• Refers to the content portion of the

communication.
• Nurse listens carefully to the clients.
• Restates the content of the communication

back to the client to verify nurse's
understanding.
Reflection
• Means identifying main feeling contained in a

communication and directing them back to the
client.
• Nurse listens to clients underlying feeling,

understand it in neutral way and open
manner.
• Purpose = verify clients feelings  client gain
a clearer understanding of feelings being
experienced.
286
E.g. Informal Therapeutic
Relationship
• Patient: I can’t sleep. It’s too hot in here and

the noise is bothering me.
• Nurse: You can’t sleep because it’s
uncomfortable in here. (Restatement)
• Patient: That’s right. All I can think about is
having that operation in the morning.
(Sounds irritable, looks anxious)
• Nurse: You seem upset about having the
surgery. (Reflection)
• Patient: I am. (Starts to cry)
What is actually bothering the
patient?
1. Nurse listened carefully.

2. Not the environment bothers
him but the surgery.
3. The surgery kept him awake.
4. The nurse opens up an
opportunity for the client to
discuss her fears.
Exploring
• Definition:
– Is a way to communicate therapeutically without
giving direct advice.
The nurse helps the patients by:
• Allow the clients express their concerns.
• Solve clients problems by exploring the

situation.
• Explore how the patient feels.
• Explore the alternatives for the problems.

Ways to EXPLORE listening skills
are
1. Focusing.
2. Encouraging elaboration.
3. Seeking clarification.
4. Giving information.
5. Looking at alternatives.
6. Silence.
7. Summarizing.
Focusing
Asking goal-directed questions that help

client to stay on the topic and talk more
about it – helps keep conversation in target
or from becoming too generalized.
Questions are open-ended and directed to

the key concerns.
Focusing (cont.)
• Example:
– You were talking about your fears about how

people will respond to your mastectomy? Can
you say more about it?
293
Encouraging Elaboration
Allows the client to describe more the

problems under discussion.
How ? – By nodding the head, saying “go

on”, “I see”, “I’m listening” helps the client to
keep talking and expressing themselves
thoroughly.
• This helps the nurse to view the emotional
state and their coping abilities and the view
of the situation.
295
Seeking Clarification
Helping the clients to put into words unclear
thoughts or ideas.
Can also clarify the events.
E.g. “What else happened?”, “What happened

then?” helps the client to put their thoughts in
orders, put events into context and pace things
in more manageable perspective.
• This will helps the client to gains new insight.
297
Giving Information
Is sharing information about the client’s health

and well being.
Information must distinguish between

suggestion and advice.
E.g. “Why don’t you…”

If the client has difficulty in making decision,
nurse can explore how the clients have dealt
with a similar situation.
299
Looking at Alternatives
Is presenting options for client's for consideration.
Increases clients perceived choice.
Clients can be asked to present some
alternatives.
Allow clients to express their fear, grief or anger
before they explore how to deal with the
situation.
Silence
A pause in communication that allows the

nurse and client to reflect on what has
taken place.
By doing this, the nurse encourages the

patient to initiate and maintain
conversation.
Summarizing
Highlighting the important points of a

conversation by condensing what was said.
Useful in ending a therapeutic conversation.
Gives a sense of closure to both nurse and
clients.
Allows the nurse and client to think about
what can be done in future.
Rules to Effective
Listening
1. Stop talking and listen.
2. Put the client at ease.
3. Show interest through eye contact and

nodding.
4. Be patient, do not interrupt.

1. Be attentive (avoid looking elsewhere).
2. Do not be critical or argumentative.
3. Withhold judgment.
4. Show empathy.
304
What type of listening
mode you are in ?
305
Listen, and Improve
Your Performance
306
Tips for Being A Good Listener
1. Give your full attention on the person
who is speaking.
– Don’t look out the window or at what else is
going on in the room
307
Tips for Being A Good Listener (cont.)
2. Make sure your mind is focused.
– It can be easy to let your mind wander if you
think you know what the person is going to
say next, but you might be wrong!
– If you feel your mind wandering, change the
position of your body and try to concentrated
on the speaker’s words.
308
Tips for Being A Good Listener (cont.)
3. Let the speaker finish before you begin

to talk.
– Speakers appreciate having the chance to
say everything they would like to say without
being interrupted.
– When you interrupt, it looks like you aren’t
listening, even if you really are.
309
Tips for Being A Good
Listener (cont.)
4. Let yourself finish listening before you
begin to speak.
– You can’t really listen if you are busy thinking
about what you want say next
310
Listener (cont.)
5. Listen for main ideas.
– The main ideas are the most important points
the speaker wants to get access.
– They may be mentioned at the start or end of
the a talk, and repeated a number of times.
– Pay special attention to statements that
begin with phrases such as “My point is …”
or “The thing to remember is …”.
311
Listener (cont.)
6. Ask questions.
– If you are not sure you understand what the
speaker has said, just ask.
312
Listener (cont.)
7. Give Feedback.
– Sit up straight and look directly at the
speaker.
– Not to show that you understand. At
appropriate points you may also smile, frown,
laugh, or be silent.
• Remember, you listen with your face as well

as your ears !
313
Listener (cont.)
8. Thinking Fast.
– Remember : time is on your side !
– Thoughts move about four times as fast as
speech.
– With practice, while you are listening you will
also be able to think about what you are
hearing, really understand it, and give
feedback to the speaker.
314
Poor Listener Effective Listener
Takes intensive notes, Take notes and organize
but the more notes important information.
taken, the less value;
has only one way to
take notes.
Is over stimulated, Doesn't judge until

tends to seek and enter comprehension is complete.
into arguments.
Shows no energy Holds eye contact and helps

output and listens for speaker along by showing an
facts. active body state and listens
for central ideas.
Poor Listener Effective Listener
Tends to "wool-gather" Thinks and mentally
with slow speakers. summarizes, weighs the
evidence, listens between
the lines to tones of voice
and evidence.
Subject is dry so tunes Finds what's in it for me.

out speaker.
Distracted easily. Fights distractions, sees

past bad communication
habits, knows how to
concentrate.
Question?????
Questions
1. Define active / attentive listening.

2. List the 3 steps in basic listening skills.
3. State the 3 modes of listening.
4. Describe 2 techniques of listening.
5. Explain the 7 ways to explore listening skills.
6. List the rules for effective listening.
Group Activity
320
Chapter 9:
Telephone Courtesies
32
1
Learning Objectives
should be able to:
1. State the steps of taking message

through phone call.
2. State the steps to be taken when a
call comes by mistake.
3. Develop skills in telephone
courtesies.
322
Learning Objectives (cont.)
4. State common types of difficult

customers.
5. State the proper ways / steps in

handling difficult customers.
323
• Why you use
telephone???
32
4
When I can get my It will be with you
new TV delivered? by 10 am tomorrow
I'll ask an
oral
question
Sender
Decide what is
Choose the best the best
form of question medium – face Receive Feedback
- written, oral ? to face
or telephone
325
Telephone Courtesy
• Telephone etiquette begins when the

phone rings, and your tone of voice will
reflect your mood when answering.
• Answer promptly and give identification.

Calls should be answered within two or
three rings whenever possible.
326
Telephone Courtesy (cont.)
• You are required to:
– Be friendly on the telephone .
– Project an image of professionalism.
– Set a positive example for the company.
– Use a cooperative tone when addressing
complaints .
327
Using Telephone
• Incoming Call.
• Outgoing call.
328
Taking Messages
1. Have a message pad with you always to
record the calls for staffs.
• Step 1:
– Ask the caller for the company, name and
telephone number and record date and time of
call.
• Step 2:
– Ask for message to be left.
Taking Messages (cont.)
• Step 3:
– Verify information. Nature of call.
• Step 4:
– Ask caller for the best time to call.
• Step 5 :
– Commitments made to the caller, such as
a returned phone call by a certain time.
330
Taking Messages (cont.)
• Repeat the information to confirm the

message and deliver or post it
promptly.
• You and your staff may want to

designate places for posting messages
to ensure prompt responses.
When a calls come to you by
mistake
• Step 1: Inform the caller of the
situation.
• Step 2: Give the caller the correct

extension.
• Step 3: Ask if the caller would like to

be transferred. Then transfer the call.
When a calls come to you by
mistake (cont.)
Step 4: If the line is busy, tell the caller
and
suggest that he/she back later or
take a message.
Step 5: Acknowledge the caller’s thanks.
333
Improving your voice
1. Hold the handset properly.
2. Have a good posture to help control.
3. Pronounce clearly.
4. Never smoke, eat, chew gum.
5. Talk at a moderate pace.

Improving your voice (cont.)
1. Avoid using unnecessary technical
terms.
2. Project enthusiasm into your voice.
3. Project a friendly attitude into your

tone.
4. Use the caller’s name.

335
TIPS FOR PHONE COURTESY
• Demonstrate phone courtesy.
• The tone and pitch of your voice can

assure the caller that you are sincere,
friendly and that you are listening.
• Create a vision for your caller that you

are responsible and dedicated to
resolving his or her issue.
(cont.)
• Smile while you answer the phone.

Your customers will notice it and
appreciate a pleasant atmosphere.
• Talk in low voice not to fast. It will

portray an image of being helpful and
in control.
(cont.)
• Identify yourself as soon as possible in

the call.
• Use the callers name as often as

possible. It builds a relationship.
Hello
(cont.)
• Listen carefully.
– Listen as if you mean it.
– The greatest compliment to another
person is listening to them.
– Take a few notes, ask clarifying questions,
and show some reaction to what is being
said.
(cont.)
• Thank the caller for calling.
• Tell the caller the name of the person

he or she is being transferred to.
• Keep calls as short as practical.

(cont.)
• Keep calm. Don't argue with unreasonable

customers. Propose alternatives.
• No matter how hectic the ward may be, it

is important to greet the caller cordially.
– Supplement a pleasant tone of voice with
orienting information and an offer of
assistance.
– A professional greeting is, "Hello, laboratory.
This is STN…….. May I help you?“
342
(cont.)
• Use the hold feature of the phone; if the

receiver is placed on a counter or desk,
the caller may overhear background
conversations.
HANDLING DIFFICULT
CUSTOMERS
Difficult Customers
1. Why customers get upset?
2. What do they want?
3. Common types of difficult customers.
What do they want?
• Reliable, dependable, accurate and

consistent service – honesty, sincere
etc.
• Responsiveness.
• Assurance/competent – trust, integrity.

What do they want? (cont.)
• Available facilities – cleanliness.
• Empathy – to feel important.
347
Common types of difficult
customers
• Angry customers.
• Argumentative customers.
• Demanding customers.
• The complainers (fault finders).
Handling difficult customers
STEPS EXAMPLES
H Hear them
E Empathize
“I am sure it was upsetting”
“I will be upset too if it happened to
me”
“It is upsetting to wait for so long, I
know”
It’s very upsetting to when you feel
your child isn’t getting good care”
Handling Difficult Customers
(cont.)
STEPS EXAMPLES
A Apologize
“I am sorry this has taken so
long”
“I am sorry that you have to
wait”
“I’m sorry for the mistake and
the time it cost you”
I’m sorry this happened and
then we upset you”.
Handling Difficult Customers
(cont.)
STEPS EXAMPLES
T Take action
“Let me look into why that happened –
to see that it does not happen again”.
“Let me check it out – see what went
wrong”
“I’ll check right now to see it you can
leave”
“Let me call and try to get you in as
soon as possible”.
Handling Complaints
Steps Action What to do
Step 1 Listen Listen carefully
Empathize
Show that you care
about how he/she
feels and what is
being said
Step 2 Get details Use open ended

questions
Take notes
Handling Complaints (cont.)
Step 3 Respond Respond by showing
that you understand the
situation.
Paraphrase complaint
Clarify details.
Step 4 Position State your position
honestly
Provide additional
information
Focus on issue, not n
the person.
Handling Complaints (cont.)

Step 5 Follow-up Agree on action-plan
Step 6 Thank Thank the individual for

bringing the complaint to
you
Be sincere
Activity
Magic Words and Phrases
Please One moment please
Thank You You’re

welcome
I am sorry Certainly sir/
madam
I beg your
May I call you
pardon
back please
Group Activity
358
Thank You
Interview technique in nursing
Interview is a communication
or conversation that is
planned to obtain accurate
and detail information
about the current illness
WK 360
Goals of an interview
• To obtain specific information necessary for
diagnosing and planning of care
• To promote nurse-client relationship by
providing an opportunity for dialogue
• Identify factors that influence the client’s health
status either in a negative or positive way
• Identify how the health status influence the
client’s abilities
• Help the nurse to identify areas for specific
investigation during the other parts of the
assessment
WK 361
Component of a nursing
interview
Biographical data
• Names
• Address
• Age
• Gender
• Race
• Religion
• Marital status
• Occupation
WK 362
Chief complaint or reason for seeking
health care:
• Reason for seeking medical or nursing
advice .
help you to focus your assessment to
gather most relevant and important
data.
• Specifically ask client what cause him
to seek help and document the answer
in the clients’ word
WK 363
History of present illness
• When this illness or problem began
• How the client’s health has change from
his usual status
• How the illness affect his daily life
WK 364
Client’s expectation of health status
and expectation for care
• Includes client’s knowledge about his illness and its
potential effect on his life.
• For e.g.
 Does the client with bad crush injury to foot think
that his foot will be normal again?
What does he thinks will be done for him? (e.g. does
he knows his foot will be amputated)?.
 And what does he wants the nurse to do to help.
WK 365
Past medical history
• Include childhood disease and immunization,
previous hospitalization and surgeries
helps to guide your assessment as well as
helping you to understand the data that has
been obtained.
For e.g. Ali tells you that he had an appendix
removed two years ago so expect to find a scar
on his abdomen
WK 366
Family and social history
Includes information regarding:
• Family and other relationships
• Economic status
• Home condition and
• Exposure to toxic materials
WK 367
Family medical history includes:
• Parents,
• Sibling,
• Maternal and
• Paternal grandparents.
As risk factors and disorders are often pass
down from generation to generation
WK 368
Social history includes information on:
• tobacco,
• alcohol
• drug use
• also exercise habits
WK 369
Medication history
• Past medication may bring about some
medical history that the client missed..
• The current medication.
• Any nutritional supplement and use of
alternative- therapies such as herbs.
as many herbs can interact with
prescription medications.
WK 370
Review of body system and associate
functional abilities:
• Data regarding body system (e.g. do
you have a productive cough?)
• Functional abilities includes (e.g. any
difficulties with bathing, dressing, eating
and elimination.
WK 371
Preparing for an interview
Preparing yourself
• Know the reason for the interview and how the
data is going to be used.
• Read the patient’s chart.
• Have some goals and think of some opening
questions for the interview.
• Choose appropriate timing.
• Collect the necessary forms and the equipments
such as blood pressure cuff, thermometer,
pencil, pen and stethoscope.
WK 372
Preparing the space
• Provide privacy.
Be aware that the presence of other family
members may prevent client to tell their story in
some cases .
You may need to postpone the interview until it
can be done in private
Remove distraction e.g. turn off Television
Position yourself at the same level as your client.
WK 373
Preparing the client
• Greet the client and others in the room
• Introduce yourself (in order to establish a
trusting and therapeutic relationship)
• Call the client by name and ask what name the
client prefers.
Don’t use term like auntie, uncle, grandma or
grandpa.
WK 374
• Inform the client:
what you will be doing and why.
the purpose of the interview and that you will be
taking notes. (to allay fears and anxiety to gain
cooperation).
all information is confidential.
• Assess whether client is ready to discuss health
issue.
• Ensure client is physically comfortable and free
from pain
• Ensure client is emotionally and physically
comfortable
WK 375
Conducting the interview
Approach interview according to client’s:
age,
developmental level
cultural background
Knowledge
• Approach sensitive topics such as substance
abuse, chemical dependency, domestic
violence, or sexual practice with sensitivity to
obtain the maximum amount of information
without upsetting the person being questioned or
disrupting the interview.
WK 376
• Respect the client
• Start with the biographical data.
• Use active listening skill.
• Pay attention to the nonverbal communication.
• Refocus the client.
• Do not give advice or voice approval or
disapproval.
WK 377
Closing the interview
• Nurse terminate the interview when the needed
information had been obtained
• In some cases client terminate it for e.g. fatigue
or unable to offer more information
• Closing is important for maintaining rapport, trust
and for facilitating future interaction
WK 378
Technique to close an interview
Prepare client for the closure
• Let client know that the interview is coming to an
end
• For e.g.
• Nurse: “well that’s all I need to for now;
these are all the questions I have
for now.
• Proceeding remarks with the word “well” usually
give a signal that the end of the interaction is
near
WK 379
Provide summary
• Summarize the most important points which
have been discussed.
• Summarize:
helps to terminate the interview
reassure client that the nurse has listened
checks the accuracy of nurse perception
clears the way for new ideas
• Summarizes are particularly helpful for client
who are anxious or who have difficulty staying
with the topic
WK 380
• Be sure you have recorded all the important
data.
• Thank the client for answering the question.
For e.g.
Nurse: Thank you for your time and help
and for sharing information about
yourself. The question you have
answered will be useful in planning
your nursing care
WK 381
• Express concern for the client’s welfare or
future:
For example:
Nurse: Take care of yourself. I hope all
goes well for you. Let us know if you
think anything else you want us to
know.
• Inform client what to expect for the rest of the
day e.g. laboratory test and so on
• Tell client when you will see him or her again.
WK 382
• Offer to answer question: For e.g.
• Nurse: Do you have any question? I would
be grateful to answer any question
you have. Or Is there anything I
can do before I leave?
• Be sure allow time for the person to answer or
the offer will be regarded as not sincere
WK 383
During the interview the nurse need:
• Observe client for sign of fatigue or discomfort.
• To observe verbal and non-verbal behaviors
• Listening attentively to the feelings as well as the
words
• Direct the flow of the interview so that adequate
information can be obtained
WK 384
Group Activity
Basic Counseling skills
386
Learning Objectives
• At the end of the lesson, students should
be able to:
1. Define counseling.
2. Explain techniques of counseling.
3. Demonstrate the skills of basic counseling:
- Attending skills
- Listening
- Questioning
- Summarizing
387
Roles and Functions of The
Nurse
• Caregiver.
• Communicator.
• Teacher.
• Client Advocate.
• Counselor.
• Change Agent.
• Leader.
• Manager.
• Research Consumer.
• Expanded Career Roles.
388
Counselor
• Helps client to recognize and
cope with stressful
psychological or social
problems.
• To develop improved
interpersonal relationship, and
to promote personal growth.
389
Counseling – Definition
• An interaction in which one person offers

another person time, attention of helping
that person to explore, discover and clarify
ways of living more resourcefully and
toward greater well being.
(British Association of Counseling, 1989)
390
(cont.)
391
(cont.)
• Counseling is two way communication

involving a person in need an uninvolved
person who is able and ready to help.
392
Counseling
When ???
How ????
Why ???
393
• Counseling is concerned with helping people
to make decisions wisely.
• It builds personal strength, confidence and

invites initiatives and growth.
394
Counseling IS a HELPING RELATIONSHIP
which:
• Involves responding to feelings and

thoughts of client, their attitudes and
behavior based on an understanding of
client’s situation and emotional and mental
world.
395
Characteristics of A
Good Counselor
1. Acceptance of client.
2. Empathic Understanding.
3. Genuineness.
4. Non possessive warmth.
5. Sensitive.
6. A good listener.
7. Good communication
skills.
396
Counseling Skills
1) Attending skills.
2) Using silence.
3) Questioning .
4) Seeking Clarification.
5) Reflection.
6) Focusing.
7) Closure.
397
Directing Question
• Direct client to the topic that was brought up
earlier to gain more information, e.g.
• Nurse: You mentioned about your mother
earlier. Did your mother develop
complications related to diabetes.
• Client: Yes.
• Nurse: What kind of complication?
• Client: Gangrene of the foot and they have to
amputate it.
• Nurse: Are you afraid it might happen to you?
WK 407
Guidelines on How to
Conduct a Counseling
1) Provide a place and atmosphere

conducive to uninterrupted discussion.
2) Encourage client to talk and express

himself freely at his own pace.
3) Allow short periods of silence.
408
Guidelines on How to
Conduct a Counseling (cont.)
1) Reflect and restate what clients says.
2) Do not register surprise at anything which

client reveals.
3) Refrain from judging.
409
Stages in Counseling
1. Exploration.
2. Finding New Perspectives.
3. Action.
410
Stages 1 - Exploration
• Counselors help clients to explore their issues
through listening and giving full attention.
411
Stages 1 – Exploration (cont.)
• The counselors genuineness, acceptance and
empathy are communicated through the use
of ACTIVE LISTENING :
a. Paraphrasing.
b. Reflecting feelings.
c. Using open questions.
d. Focusing; helping the client to be specific:
concreteness.
e. Summarizing.
412
Stage 2 – Finding New Perspective
• The counselors in stage 1, which are
fundamental to be the counseling process, are
used to help clients explore their world and
feelings.
• In stage 2, the counselor tries to help clients to

understand themselves, their situation and
feelings better and in a new perspective.
413
(cont.)
• This can be a difficult and painful experience,

so the counselor uses stage 2 skills carefully
and tentatively with phrases like:
– Perhaps you feel…
– It may be that…
– It seems as if you are feeling…
414
(cont.)
The main stage 2 skills is an extension of the

reflection, paraphrasing and summarizing
skills of stage 1.
It is called DEEPER EMPATHY.
415
(cont.)
• Stage 1 empathy reflects surface meanings

and feelings while deeper empathy of stage 2
gets at feelings and meanings, which are
buried, hidden and somehow not normally
obvious to the client.
416
Stage 3 – Action
• In stages 1 & 2, clients are helped to explore
and understand themselves, their feelings and
their world better.
• In stage 3, clients are helped to take effective

action-to achieve constructive change.
417
Stage 3 – Action (cont.)
• For some clients, stage 1 & 2 are sufficient to
enable them to mobilize their own problems
– solving resources, others will need positive
help with their decision making.
418
• Counselor will continue, though, to work in a
client-centered way using the skills of stage
1 & 2.
• The most important aspect here is that of

helping the client to turn a aim into a specific
goal-another version of concreteness.
419
• Remember that any behavior – change
technique should be used with clients – not on
them.
420
• Stage 3 skills include :
– Goal and strategy setting.
– Providing support and resources.
– Coaching and training.
– Using learning theory to pursue action plans.
– Problem solving.
– Decision-making.
– Evaluating.
421
Group Activity
Activity
• Case incident:
– A colleague of yours is concerned about one of his

staff who has been having some family problems.
Your colleague want to help his subordinate but
feels that working closely together she is being
drawn more and more into the problem. In a
conversation with you she says :-
423
Activity (cont.)
• “I really wish I knew what to do about this
young girl. She was doing so well until she got
involved with this man in the office and now
her parents are objecting to our lack of
concern about her career. I feel I should be
doing more to get her to see her priorities but
the harder I try the less she wants to listen.”
424
Activity (cont.)
• What would you say ?
 Alternative responses – please choose one :

1. I suggest you back off and let her and her
family sort out their differences first.
2. Perhaps a fresh pair of eyes might see things
differently – I’ll have a word with her if you like
but only if you’ll go along with my advice after
I’ve seen her.
425
Activity (cont.)
3. Why do you think her parents are objecting
so much ?
4. Come and tell me all about it tomorrow at

3pm and we’ll sort out a plan of action.
5. You seem to have a lot of concern about

her and her family.
426
427
428
GROUP
DYNAMICS
Learning outcomes
At the end of the session student should
be able to:
• describe stages of group formation
process
• identify types of groups
• acquire techniques of communicating
within groups and families.
WK 430
Group
• What is a
group?
• A group is two or
more individuals
interacting with
each other in
some manner to
accomplish
common task
WK 431
Group dynamic?
What is a dynamic
group?
• The forces that

influence the
behavior of the
group and the
relationship
among group
members.
WK 432
Group formation process
Forming Storming Norming
Termination Performing
WK 433
Stages of group
formation
• Forming is characterized by much uncertainty
• Storming is characterized by intragroup conflict
• Norming is characterized by close relationships
and cohesiveness
• Performing - the group is fully functional
• Termination - characterized by concern with
wrapping up activities rather than task
performance
WK 434
Forming phase
• Develop relationship with one another

and learning their expectation.
• Team building and development of
trust.
• Establishing limits on acceptable
• Deciding group and members tasks
• Group leader establish structure,
guidelines and norms.
WK 435
Storming phase
• Interpersonal conflicts, differences of
opinion and its goals will arise.
• Group may collapse
• Important to work through the conflict
to establish clear goals
• Discussion to come to an agreement
WK 436
Norming
• Conflicts are resolved, close relationships
develop, and unity and harmony emerge
• Building trust and expression of feelings and
thoughts surface
• Establishing patterns of work.
• Task delegating
• Accepted each others expectation
• Understand group operation as a whole.
WK 437
Performing phase
• Issues related to roles, expectations,

and norms are no longer of major
importance.
• Focusing on task, working intentionally

and effectively to accomplish goals.
• Learning new skills and sharing roles
WK 438
Termination
• Group disband
• Feelings of abandonment, guilt,
fear, anger, gratitude, positive
affection or frustration
sometimes emerge during this
stage
• Leader summarizes group’s
accomplishment and the ending
of the group as a whole.
WK 439
Types of groups
• Task group
• Teaching group
• Self-help group
• Self-awareness/growth group
• Therapy group
• Social support group
WK 440
Task group
• The commonest type of work related
group to which nurses belong.
• Develop to address a task or need
• Members chosen based on the ability to
complete the task.
• Usually short term and dissolves once
task is completed.
• E.g. task force to address holiday
scheduling or a panel to critic a fire drill
WK 441
Self-help group
• Made of volunteers, individuals who share the
same health, social and daily living problem.
• Members share feelings and thoughts with
others.
• Example of this groups, breast cancer survivor,
AIDS, Alcoholic, diabetes
WK 442
Teaching group
• Give information to the participants or
individual.
E.g., Continuing Education, client
healthcare groups.
• Handles many subjects which include
teaching of child birth, methods of birth
control, effective parenting, nutrition
and many more others.
WK 443
Self-awareness/growth group
• Formed for the purpose of developing or using
interpersonal strength.
• Generally to improve individual functioning in the
group.
• Focus on interpersonal concern around current
situation.
• Members are responsible to correct each other
WK 444
Therapy group
• Assist individual to change their behavior pattern
and to develop new and effective ways of
dealing with the stresses of daily living,
• Works toward self-understanding, how to relate
or handle stress in a more satisfying ways and
changing behavior patterns towards health
• Member selection by health professional
• The duration and the termination date is usually
decide by the therapies and members
WK 445
Guidelines for Communication in
group
Make clear the purpose of communication
• Clarify the purpose e.g. is it a:
meeting to make or take decision
briefing session to share knowledge
brainstorming session to look for new
ideas.
WK 446
Set the limit of communication
• Set a limit to the time and agenda

even for informal meeting
• Be realistic about what you can
accomplish within the group
• Be sensitive to other people’s
pressure of time.
WK 447
Ensure the right people are
present
• Communication works better when
every individual present :
have a legitimate reason to be there,
got something to contribute to the
discussion
having interest in the outcome
WK 448
Get the right number of people
• Five is recognized as
the optimum number
for effective debate
and decision making
for most groups.
WK 449
Facilitate introduction
• If you are group leader make clear:
people’s role
the reason for them to be there.
the expectation of their contribution
• If expectation not within reach, allow the person
to leave or suggest an alternative members
• Explain the contribution you expect to make and
your authority to make.
• Make it clear whether the authority is person or
vested
WK 450
Be active participant
• Be an active participant if you agreed to

be part of the group.
• Take full responsibility for the success
or failure of the group
• Be energetic
• Bring a positive contribution
WK 451
Be rational and open-minded
• Make a clear position on the issue but must be
willing to listen to rational argument and be
prepared to change your mind.
• Participants need to be opened to new
information and different points of view
• Give the opportunity for each member to speak
• Don’t put your own ideas ahead of the groups
objective
WK 452
Be brief, simple and organized
• Speak in short sentences clearly, slowly

and directly.
• Structure your argument logically
• Think what you are going to say first
and summarized it
• Clarify areas of support and
disagreement
WK 453
Make good use of nonverbal
communication
• Use gestures to reinforce
• Use nonverbal signal to
convey attitudes and
expression
• Make eye contact
• Use positive and non-
threatening body
language
• Observe other people’s
nonverbal signals
WK 454
Don’t’ argue, stay calm
• Stay calm
• Don’t be emotional
• Stress the points of
agreement and reduce
areas of disagreement
with new alternative
WK 456
Avoid personal attack
• Mutual respect
• Criticize the idea but not the person
• Give constructive criticism
• Resist the temptation to put blame
• Remember that you are cooperating to
find an overall solution
WK 457
Conclude the communication
• Review your expectation of the

communication
• Write up a “decision and action”
Soon after the meeting
• Make sure all the participant has
the copy ( including the absent
member
WK 458
Do’s and don’ts about
communicating in groups
• Do’s
• Be aware of other group member’s
reference point such as:
how they view an issue
the effect it cause to achieving your
own objection.
• Participate in a discussion with a
genuinely open mind and good listening
skill
WK 459
Dos and Don’ts (cont..)
Don’ts
• Avoid “group think”.
• Dominate the discussion
• Bring your own prejudice
WK 460
Communication with families
• Client and family often need

support to help them cope with the
illness.
• A person’s illness can be
disruptive times in the lives of the
family members.
• They may need to discuss their
concerns and share the frustration
of illness
WK 461
.
Guideline for communicating with
families
• Introduce yourself to the relative and inform
them that you are helping to look after their
loved ones.
• Give them opportunities for expressing any
concern and anxieties
• Include them in discussion about individual care
when appropriate.
• Demonstrate warmth, example by touch.
WK 462
Communicating with family (cont..)
• Answer their question as appropriate.
• Bear in mind the confidential issue
• Refer question as appropriate
• Never disclose information about client
medical status to the family members,
clergy or other visitors without client’s
permission
WK 463
Effective use of group dynamic in promoting
public relation
• With work group composition of multi-

professional members it is generally thought to
bring about good public relation.
• Benefit that members of the public gained from
group works are:
instillation of hope
the group can instilled the feeling of universality
WK 464
Group effective use (cont..)
members of public can get information through
teaching and suggestion by the group members.
can learn more functional pattern of interaction,
communication and behaviors that work well for
them.
development of socializing technique.
interpersonal learning.
WK 465
Group effective use (cont..)
group members provide opportunities
for individuals to explore the meaning of
their life and their place in the world.
individual will learn to express their own

feeling in a goal directed ways
WK 466
Summary
• A group is two or more individuals interacting
with each other in some manner to accomplish
common task. Group formation process include:
Forming, characterized by much uncertainty,
• Storming is characterized by intragroup conflict
• Norming is characterized by close relationships
and cohesiveness. Performing - the group is
fully functional
• Adjourning is when the group disband.
WK 467
Summary
• Types of healthcare groups include; task group,
teaching group, self-help group, self-
awareness/growth group and therapy group.
• When communicating in group make your
purpose clear, Set the limit, ensure the right
people are present, get the right number of
people, facilitate introduction, be active
participant, be rational and open-minded, be
simple. brief and organized, make good use of
nonverbal communication, don’t’ argue, avoid
personal attack.
WK 468
Group Activity
Thank you
WK 470

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COMMUNICATION

Tutor Name: K.Sunita Das

2. To provide opportunities for

3) Barriers in communication & measures to overcome them.

4) Role of communication in nursing.

5) Role of communication in projecting the corporate image & culture of

6) Handling difficult clients and complaints.

7) Our role in meeting clients expectation.

10) Basic counseling skills.

2. State the objectives of

3. Explain the communication process

• You also need to be confident that the

• Exists in the mind of the sender.

• This can be a concept, idea, feelings.

2. Volunteers answer questions:

3. Audience feedback: What did

– Language, psychosocial, and

– Females and males communicate differently.

– Values are the standards that influence

– Definition: is a concept of the space

Social (4 ft- 12 ft)

Public (12 ft or more)

– The roles and relationships between sender

– More effective in a comfortable environment.

– The verbal and nonverbal aspects of the

– Attitudes convey beliefs, thought and feelings

1. Explain the methods of

• Messages are simultaneously sent and

– The process of sending and receiving

• The person sending the message should

• The receiver of the message should be

• Many times the message may not be

• Verbal communication requires the use

• Everyone's brain is forever having

• They have the power to create emotions

• This involves the use of words, but not on

• Everything that is put down on

– It is the most commonly used form of written

– Informal communication between members

• It is usually formulated with great case,

• The writer has to be careful about what is

• Helps in the formulation of new policies

1) Purpose of writing should be clear.

2) Clarity and proper used of words.

3) Respect to the reader.

4) Know the details of your conversation.

5) Try not to be a forgetful.

6) Free from jargon.

2) Used appropriate tone of voice respectful

3) Keep conversation going by encourage

4) Slow down – People will perceive you as

6) Use appropriate volume:

Activity 2 (10 mins)

(Hecht, DeVito, and Guerrero)

– Shaking hand. – How close you

• Body languages facial expressions and

• Has greater impact than verbal

• Non-verbal clues have an equally

• Although non-verbal communication can

• Our words only carry a part of the

• The face is a powerful conveyor of non-

• It is the primacy site for expression of

• A person’s eyes are especially very