Communication skills

Course Objectives
By the end of this course the student will be able to:

- Describe the principles of interpersonal relationships and communication

techniques used for interaction with a variety of individuals and groups in
various health care setting.

- Factors affect communication

Use various approaches to therapeutic communication with individuals,

groups in various health care setting
Introduction
Communication can take many forms, such as verbal or written. It is quite simply
the transfer of information among or between people. However, it is not that
simple, as communication, especially in the nursing profession, can be a
complicated process. In nursing practice we often have a great deal of information
to give or send to others, and we need to do this effectively.
Successful communication has three major components:
1 A sender
2 A receiver
3 A message
Whenever we communicate, we should always be aware that there are factors
which could influence how our message may be interpreted.
Variables will need to be considered, such as the following
1 Who we are communicating with, be they children, adult patients,
colleagues or
patients with learning disabilities.

1
2 The setting in which the communication occurs, such as in hospital, the
maternity ward or in a service user’s own home.
3 The sender’s and/or receiver’s past experiences.
4 The sender’s and/or receiver’s personal perceptions (if known).
5 The timing of the message.
Definition of communication:
Is the art of transferring or exchanging information ideas or thoughts easily and
correctly through verbal or non-verbal language.
The communication process:
Communication process could be defined as a sending-receiving process. It
includes the sender, receiver and the massage.

What are the components of the communication process ?

 A sender – person sending the message
 A receiver - gets the message.
 A message – unit of information received.
 Feedback – involves the continuous interpretation of response of the sender
and receiver as messages are simultaneously encoded.
 Environment – are the internal and external influences affecting the
communication process. External examples: room temperature, smells and
lighting. Internal examples: feeling cold, tired or experiencing pain.
Principles of communication

Complete – the message must contain all needed for desire relation.
Clarity- there must be clarity in term of thought and expression.
Concise – the massage must be point all unnecessary words must be eliminated.
Correct – all facts, word, language and information of the massage.

2
Concrete - the massage to be communicated must be specific and vague.
Consideration – one must understand the emotions and sentiment
Of receiver.

TYPES OF COMMUNICATION
Good communication skills are central to the effective delivery of good-quality
health care.
There are four main types of communication: verbal, non-verbal, written andvisual.
1. Verbal Communication
This type of communication includes sounds, words,language and speech and can
take the form of:
• intrapersonal communication whereby we may process
our own thoughts and actions,
• interpersonal communication between two
individuals,
• small-group communication where there are more than
two people involved, and
• public communication whereby information is conveyed
to much larger groups of people.
Verbal communication is an effective way of communicating as we are able to
express our emotions using spoken language.
2. Non-Verbal Communication
This type of communication is also referred to as ‘body language’ and involves
physical communication, using body posture, signs and gestures, touch and
expressions, and even noise, such as grunts and whimpers.
Nonverbal communication often has more signifi cance than the spoken word.
3. Written Communication
3
This type of communication involves writing, and
depends on style, vocabulary, clarity and precision of language. It is often used in
the health-care setting as a means of imparting information to our patients.
For example, when a patient is given a diagnosis from a health-care professional,
they may not have listened to everything that was said, perhaps due to shock.
Following up this information in written format, for the patient to read later, is a
good way to get the information across.
4. Visual Communication
This form of communication involves the visual display of information and
includes photography, posters and all
electronic forms of visual communication.
Factors affect communication
1. THE ENVIRONMENT/PHYSICAL
DISTRACTIONS
Whether you work in a hospital.
often interrupted by emergencies, or a relative or a patient with a pressing question
and needing your support.
Work environments can also be extremely noisy, whether it is the sound of
machinery in operation, ringing telephones or general chatter.
2. LANGUAGE
While it is obvious that language barriers can impede communication, even people
who speak the same language can experience communication barriers.
The problem could be an unfamiliar accent, a speech impediment, a quiet
voice, or the use of terminology that one participant in the conversation does not
understand.
3. EMOTIONS
When people are stressed or not thinking clearly
4. PAIN

4
Pain can be a huge barrier to communication. Have you ever broken a bone,
5. MUDDLED MESSAGES
Effective communication starts with a clear message.
6. CULTURE
such as:
invading personal space: people in some countries are less comfortable with
touching than in other countries;
Some people shake hands.
7. PEOPLE WITH DISABILITIES
Communication barriers may be a problem for people with disabilities, owing to
the nature of the disability.
include:
• older people,
• children,
• people with mental health problems,
• people with learning difficulties,
• physically disabled people.
 Therapeutic communication
Establishing a therapeutic relationship is one of the most important
responsibilities of the theraptic team when working with client.
What is therapeutic communication?
A meaningful relationship between the patient and professional helper. The
patient-centered approach is influenced and directed by the professional.
Purpose of therapeutic communication
To build and maintain helping relationship with clients, families and significant
others.

5
 Therapeutic communication techniques:-
1- Offering self:
Making one self available on a unconditional basis.
§Example:
Nurse : we can eat our lunch together.
“I will walk with you”
2. Active listening
paying close attention to what the patient is saying by observing both verbal and
non-verbal cues.

3. Exploring
“Tell me more about your son”
4. Broad opining

Here the nurse is encouraging the patient to select topics for discussion. Patient
should feel that nurse is ready to listen. Open-ended questions result in more
helpful answers.
§Example:

what are you thinking about?

Can you tell me more about that?
How are you today?
What do you want to talk about today?
5-Silence
Planned absence of verbal remarks to allow patient and nurse to think over what
is being discussed and to say more.
6. Summarizing
reviewing the main points of discussions and making appropriate conclusions.

6
 7. Presenting reality
stating what is real and what is not without arguing with the patient.
“I know you hear these voices but I do not hear them”.
When the patient has a misperception, the nurse defines reality of the situation for
the patient.
§For example: patient with hallucination.
Nurse: there is no one else in the room, but you and me
8. Seeking clarification
asking patient to restate, or give examples of ideas or feelings to seek
clarification of what is unclear.
“I don’t think I understand what you are saying”.
Here, the nurse makes specific questions to help clear up a specific point the
patient talk about it.
§Example:
I am not sure what you mean.
Could you tell me about it again?
9. Reflecting
throwing back the patient’s statement in a form of question helps the patient
identify feelings.
Patient: I think I should leave now.
Nurse: Do you think you should leave now?
It signifies understanding, interest and respect for the patient.
§You are looking sad and tense. Is it related to what you have explained?
10. Restating
repeating the exact words of patients to remind them of what they said and to let
them know they are heard.
Patient: I can’t sleep. I stay awake all night.
7
 Nurse: You can’t sleep at night?
Usually a part of patient statement is repeated.
11. Asking question
using open-ended questions to achieve relevance and depth in discussion.
“How did you feel when the doctor told you that you are ready for discharge
soon?”
12. Focusing
“Let us talk more about your best friend in college”
Focusing helps the patient to talk about life experiences or problem areas and
accepts the responsibility for improving them. It allows the patient discuss central
issues and keeps the communication goal-directed.
Encouraging formulation of a plan of action
questioning for step by step actions that will be needed.
“If you decide to leave home when your husband beat you again what will you
do next?”
14- Formulate a plan of action:
When the patient has a plan in mind for dealing with stressful situation, it may be
helpful.
§For example:
Nurse:
what could you do to let your anger out harmlessly?
Giving information
providing information that will help patients make better choices
- Accepting :
- Giving recognition:
Recognize the patient by his name and do not call the patient by his bed number or
diagnosis.

8
. Encourages description of perception:
It involves asking the patient to verbalize what is being perceived. It is often used
with client experiencing hallucination.
§For example:
Nurse: are you hearing the voices again?
 Avoid :
Giving advise
Talking about your self
Telling client is wrong
Entering into hallucinations and delusions of client
False reassurance
Asking WHY?

Interpersonal Communication

What are the most common ways

we communicate?
1. Spoken Word
2. Written Word
3. Visual Images
4. Body Language

9
Interpersonal communication is a person to person, two-way, verbal
and non verbal interaction that includes the sharing of information and
feelings between individuals or in small groups that establish trusting
relationships.
IPC in health care settings takes place between service providers and
their clients and members of the community and is a key element in
maximizing access to quality care. IPC includes the process of
education, motivation and counseling and starts with understanding the
critical role of good client service.

Knowledge and skills needed for effective interpersonal

communication
• Adequate knowledge of subject area
• An understanding of one's own values and willingness to withhold
judgment about the other people’s values.
• Skills in verbal and nonverbal communication.
• Ability to show empathy and encourage others.
• Skills in asking questions and listening.
• Tolerance and patience.
• Ability to paraphrase and summarize the concerns of individuals
and the community.
• Ability to observe and interpret behavior of other people.
• Ability to use language that other people understand.
• Skills to effectively use support materials.
• Confidence
• Flexibility .

10
 Barriers to communication
• Language
• Values and beliefs
• Sex/gender and age
• Economic status
• Educational level
• Physical barriers
• Attitude
• Timing
• Understanding of message.
• Trust
Application of IPC in health care
1- History taking: Each intervention begins with a
thorough analysis of the existing situation in a given field.
2- Channeling: The objective of channeling is to
motivate community to utilize the preventive and curative
health services offered.
This is carried out through one-to-one communication
and group education sessions.
Methods and Approaches to IPC
• Identify trained personnel
• Training of service providers in different departments
11
 • Media groups
• Advocacy and community mobilization
• Organizational mobilization
• Interpersonal communication can be in the form of lecture, role
play, group discussion, drama, meetings, counseling.
• In addition, visual aids, such as posters, charts, flyers,
pamphlets, and audio visual aids such as, video, films, radio, taped
messages. These can be used to reinforce IPC.

Success for YOU

in the new global and diverse workplace requires
excellent communication skills!

- Technology in communication and nursing care.

- Practical demonstration in communication.

Questions

12
13