Biaka University Institute of Buea (BUIB)

HND Nursing Programme

Course Title: Communication Science in Nursing/Information, Education and

Communication
Course Code: NUS 216
Instructors: Nemkul/Makogah

Introduction
Communication is the foundation of every society because without some form of
communication it will be very difficult or impossible to share family experiences,
master an education, establish and maintain a government and enjoy many current
forms of entertainment. Human relationships enable us to meet not only our
physical and safety needs but also our psychosocial needs of love, belonging and self-
esteem. The ability to communicate is basic to human functioning and wellbeing.
Therefore, communication is the process of sharing information or the process of
generating and transmitting meanings.

What is Communication?
It could be referred to as the imparting or exchanging of information by speaking,
writing, or using some other medium. "Television is an effective means of
communication"

Synonyms for communication are: transmission, imparting, conveying, reporting,

presenting, passing on, handing on, relay, conveyance, divulgence, divulgation,
disclosure, just to name these few.
Also, Communication is a means of sending or receiving information, such as
telephone lines or computers. "Satellite communications"

What is Communication?
Communication is simply the act of transferring information from one
place to another.

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Although this is a simple definition, when we think about how we may
communicate the subject becomes a lot more complex. There are various
categories of communication and more than one may occur at any time.

The different categories of communication include:

 Spoken or Verbal Communication: face-to-face, telephone, radio or

television and other media.
 Non-Verbal Communication: body language, gestures, how we dress
or act - even our scent.
 Written Communication: letters, e-mails, books, magazines, the
Internet or via other media.
 Visualizations: graphs and charts, maps, logos and other
visualizations can communicate messages.

The desired outcome or goal of any communication process is understanding.

The process of interpersonal communication cannot be regarded as a

phenomena which simply 'happens', but should be seen as a process which
involves participants negotiating their role in this process, whether consciously
or unconsciously.
Senders and receivers are of course vital in communication. In face-to-face
communication the roles of the sender and receiver are not distinct as both
parties communicate with each other, even if in very subtle ways such as
through eye-contact (or lack of) and general body language.
There are many other subtle ways that we communicate (perhaps even
unintentionally) with others, for example the tone of our voice can give clues to
our mood or emotional state, whilst hand signals or gestures can add to a
spoken message.
In written communication the sender and receiver are more distinct. Until
recent times, relatively few writers and publishers were very powerful when it
came to communicating the written word. Today we can all write and publish
our ideas online, which has led to an explosion of information and
communication possibilities.

The Communication Process

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A message or communication is sent by the sender through a
communication channel to a receiver, or to multiple receivers.
The sender must encode the message (the information being conveyed) into a
form that is appropriate to the communication channel, and the receiver(s)
then decodes the message to understand its meaning and significance.
Misunderstanding can occur at any stage of the communication
process.
Effective communication involves minimising potential misunderstanding and
overcoming any barriers to communication at each stage in the
communication process.
See our page: Barriers to Effective Communication for more information.
An effective communicator understands their audience, chooses an
appropriate communication channel, hones their message to this channel and
encodes the message to reduce misunderstanding by the receiver(s).
They will also seek out feedback from the receiver(s) as to how the message
is understood and attempt to correct any misunderstanding or confusion as
soon as possible.
Receivers can use techniques such as Clarification and Reflection as
effective ways to ensure that the message sent has been understood
correctly.

Communication Channels
Communication theory states that communication involves a sender and a
receiver (or receivers) conveying information through a communication
channel.

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Communication Channels is the term given to the way in which we
communicate. There are multiple communication channels available to us
today, for example face-to-face conversations, telephone calls, text
messages, email, the Internet (including social media such as Facebook and
Twitter), radio and TV, written letters, brochures and reports to name just a
few.
Choosing an appropriate communication channel is vital for effective
communication as each communication channel has different strengths and
weaknesses.
For example, broadcasting news of an upcoming event via a written letter
might convey the message clearly to one or two individuals but will not be a
time or cost effective way to broadcast the message to a large number of
people. On the other hand, conveying complex, technical information is better
done via a printed document than via a spoken message since the receiver is
able to assimilate the information at their own pace and revisit items that they
do not fully understand.
Written communication is also useful as a way of recording what has been
said, for example taking minutes in a meeting.
See our pages: Note Taking and How to Conduct a Meeting for more.

Encoding Messages
All messages must be encoded into a form that can be conveyed by the
communication channel chosen for the message.
We all do this every day when transferring abstract thoughts into spoken
words or a written form. However, other communication channels require
different forms of encoding, e.g. text written for a report will not work well if
broadcast via a radio programme, and the short, abbreviated text used in text
messages would be inappropriate if sent via a letter.
Complex data may be best communicated using a graph or chart or other
visualisation.
Effective communicators encode their messages with their intended audience
in mind as well as the communication channel. This involves an appropriate
use of language, conveying the information simply and clearly, anticipating
and eliminating likely causes of confusion and misunderstanding, and knowing
the receivers’ experience in decoding other similar communications.
Successful encoding of messages is a vital skill in effective communication.
You may find our page The Importance of Plain English helpful.

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Decoding Messages
Once received, the receiver/s need to decode the message. Successful
decoding is also a vital communication skill.
People will decode and understand messages in different ways based upon
any Barriers to Communication which might be present, their experience
and understanding of the context of the message, their psychological state,
and the time and place of receipt as well as many other potential factors.
Understanding how the message will be decoded, and anticipating as many of
the potential sources of misunderstanding as possible, is the art of a
successful communicator.

Feedback
Receivers of messages are likely to provide feedback on how they have
understood the messages through both verbal and non-verbal reactions.
Effective communicators pay close attention to this feedback as it the only
way to assess whether the message has been understood as intended, and it
allows any confusion to be corrected.
Bear in mind that the extent and form of feedback will vary according to the
communication channel used: for example feedback during a face-to-face or
telephone conversation will be immediate and direct, whilst feedback to
messages conveyed via TV or radio will be indirect and may be delayed, or
even conveyed through other media such as the Internet.
More on feedback: see our pages on Reflection, Clarification and Giving
and Receiving Feedback
Being able to communicate effectively is the most important of all life skills
FACTORS THAT INFLUENCE COMMUNICATION

Developmental Considerations
The rate of language development varies and is directly related to neurologic
competence and cognitive development. Nurses should understand the process of
language development as well as the stages of intellectual and psychosocial
development. This would help them communicate with clients of all ages e.g. a 10-
year old child has a limited understanding of what an infection is; therefore, the
nurse must explain this in simple terms so that the child cooperates with the
treatment, whereas adolescents who are already developing abstract thinking will
need more detailed and accurate explanations.

Gender

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Men and women demonstrate different communication styles and may give different
interpretations to the same conversation. Nurses must be aware of this and when
working with clients of the opposite gender ensure that both the nurse and the client
are accurately receiving the message trying to be communicated.

Sociocultural Differences
Nurses must develop skills to recognise the ways in which culture, economic
condition, and overall lifestyle influence a client’s preferred mode of communicating
e.g. nurses working in an inner city ghetto will find it helpful to be familiar with the
city’s street language. The nurse must equally be aware that in some cultures women
may discuss personal things only with their spouses; as such the nurse may have to
discuss post-delivery care of such women with their spouses.

The nurse equally should use lay terminology when speaking with clients except
where the client is known to be a healthcare professional.

Roles and Responsibilities

A person’s occupation may give the nurse a general idea of his or her abilities,
talents, interests, and economic status. However, stereotyping a person according to
occupation can be misleading and should be avoided. For example it is dangerous
when the nurse assumes because a patient is a healthcare profession, he
understands everything about his condition and so needs little nursing assistance,
teaching and counseling. The nurse should therefore acknowledge these roles and
recognize their effect on the patients preferred manner of communicating without
denying client the needed care e.g. a successful lawyer may present a “take charge”
attitude and seem completely self-sufficient; a skilled nurse will note this but provide
an opportunity for the client to open up: “You seem well prepared for this procedure
and in control, but I know clients often have questions that never get answered or
fears that remain unvoiced. Is there anything I can help you with while I’m here?

Space and Territoriality

People are generally more comfortable in areas they claim as their own. Clients will
therefore behave differently when interviewed in their home, at a mobile screening
booth, or at a health institutional setting. Similarly nurses may behave differently
when they are “in their own territory” in a health care institution than when they
enter a client’s home as guest caregivers.

Also the actual physical distance between the nurse and patient during client
interaction is important because people have different opinions of what they
consider their private space. Anywhere between 18inches – 4feet may be considered

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optimal however the nurse should take cues from the client. If he leans forward
toward you, he is indicating that the distance is too much, or if he recoils from your
nearness, he is indicating that the distance is too close.

Physical, Mental and Emotional State

The degree to which people are physically comfortable and mentally and emotionally
free to engage in interactions will also influence communication. A full bladder, a dull
headache or chest pain, anxiety about what is happening back home or at work, and
fear can all negatively influence communication. A client who thinks that a nurse
wants to hurt him or who can think only about what it would be like to date the
nurse will be difficult to interview. The nurse must therefore be sensitive to these
barriers.

Values
Communication is influenced by the way people value themselves, one another, and
the purpose of any human interaction. The nurse who believes teaching is an
important aspect of nursing and who values empowering clients will communicate
this to clients. Similarly, the client’s motivation (or lack of) to develop new self-care
behaviours will equally influence nurse-client communication.

Environment
Communication happens best when the environment facilitates an easy exchange of
needed information. Depending on the reasons for the interaction, this may require
minimizing distractions, ensuring privacy, etc.

Factors Promoting Effective Communication

Good rapport, a feeling of mutual trust experienced by people in a satisfactory
relationship can achieved by paying attention to the following variables

Specific Objectives
Having a purpose for an interaction guides the nurse toward achieving a meaningful
encounter with the client. An example of an objective might be to discuss a client’s
feeling about a newly diagnosed condition.

Comfortable Environment
It is an environment in which both the nurse and client are at ease. Suitable
furniture, proper lighting, and a moderate temperature are important in this light.
Also when the atmosphere is relaxed and unhurried, it fosters communication.

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Privacy
Even though it may not always be possible to carry out a conversation with only the
nurse and client in the room, the nurse must do everything to provide sufficient
privacy. Sometimes just drawing the curtain/screen around the patient’s bed can
provide a sense of privacy before the necessary interaction.

Confidentiality
The confidentiality with which the information is to be treated should be established
with the client. The nurse should indicate with whom the information will be shared,
and the client should know about his right to specify the people who may have
access to the information. Failure to take this into account may be considered a
breach of the client’s right to privacy.

Client Focus
Communication in the nurse-client relationship should focus on the client and the
client’s needs, not on the nurse or an activity in which the nurse is engaged.

Use of Nursing Observation

Observation involves both seeing and interpreting and is useful for validating
information e.g. a nurse suspects that a client is afraid to hear the results of certain
blood tests, but the client insists that the tests are important. However, the nurse
observes the client pacing in the corridor while appearing to be in thought.
Observing this helps validates the nurse’s suspicions and that the client’s answers are
a cover up of his true feelings.

Optimal Pacing
A nurse must consider the pace of any conversation or encounter with a client. For
instance, it would be ineffective for the nurse to rush through a list of questions
when obtaining a nursing history: it is more effective to let the client set the pace. If
the time is limited, the nurse should make the client know this at the beginning of
the interaction.

Providing Personal Space

Perceptions of personal space varies and nurses must assess a client’s personal space
through careful observations of nonverbal communication e.g. some people would
like to sit close and even use touch while others will want some space.

BARRIERS TO EFFECTIVE COMMUNICATION

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Failure to Perceive the Client as a Human Being
Clients abhor being treated as objects rather than as persons e.g. referring to clients
as “bed 4” “that typhoid case” instead of “Mr. Oben” or “Ms. Lyonga”.

Failure to Listen
Clients may or may not feel able to speak freely to the nurse. Nurses may miss
valuable opportunities for important communication if they approach clients with
closed minds or focus on their own needs rather than on client needs.

Inappropriate Comments and Questions

Certain types of comments and questions should be avoided in most situations
because they tend to impede effective communications e.g.

 Using Cliches: a cliché is a stereotyped, trite, or pat answer, and usually

indicate that there is no cause of anxiety or concern or they offer false
assurance e.g. “Everything will be alright”, “Your doctor knows best”
 Using questions requiring only a yes or no answer: this type of questions tend
to cut off discussion, even when the person might wish to continue e.g. “Did
you have a good day?” will elicit a noncommittal answer but “Tell me about
your day” will elicit a more detail answer. However there are times when
these questions are legitimate e.g. “Do you feel pain when I touch your arm?”
 Using questions containing the words why and how: these questions are
intimidating e.g. “why were you not tired enough to sleep?” it will be better to
ask “what were you doing while you were unable to sleep”
 Using questions that probe for information: although the nurse may feel more
information is needed, if the client feels like he is being interrogated it will cut
off communication. The nurse should therefore avoid expressions like “Let’s
get to the bottom of this”
 Using leading questions: this type of question suggests a response the speaker
wishes to hear and tend to produce answers that may please the nurse but do
not encourage the client to respond without feeling intimidated e.g. “You
have been well cared for by your nurse haven’t you”
 Using comments that give advice: giving advice often implies that the nurse
knows what is best for the client and denies him or her the right to make
decisions and have feelings. However advice has a rightful place when they
are requested and giver has expert knowledge.
 Using judgmental comments: this imposes the nurse’s standards on the client.
For example a young woman is crying and the nurse says “You aren’t acting
very grown-up. How do you think your husband would see if he saw you

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 crying like this?” The nurse in this case is judging the client as being immature,
and the apparent hostility could end effective communication.
 Changing the subject: this is a quick way to stop conversation. When this
happens when the client is ready to discuss an issue, he will feel disappointed
and frustrated e.g.
o Client: “when can I expect to be told about taking my own insulin?”
o Nurse: “Let’s discuss your diet now so that you will know what to eat
when you get home. We can discuss your insulin some other time”
 Giving false assurance: through comments the nurse may sometimes try to
convince the client that things are going to turn out will even when knowing
the chances are not good. This leaves many clients with the impression that
the nurse is not interested in their problems.

Gossip and Rumour

These are common forms of communication in health care settings. Gossiping may
be used to inform, influence others, entertain, or ventilate. Generally confined to
small intimate groups, it may be harmless but may also damage the reputation of
others. Rumours serve similar functions as gossips but tend to be more widespread.
They cause damage to reputation of authority figures, coworkers, or an organization;
disharmony or divisiveness; and adversarial relations.

GROUP DYNAMICS
Communicating in Groups
Nurses communicate in groups as well as one to one with clients and other
caregivers. A group exists when two or more people are gathered together. For a
group to be functional, the members must communicate with one another in order
to achieve a goal or purpose.

Types of Groups
Groups can be categorized by size i.e. one – to – one, small and large groups. Nurses
belong to each of these types of groups both personally and professionally. E.g. most
often, the nurse and the client are involved in one – to - one group. The nurse can
also be a member of and a leader in different groups at the same time. E.g. the nurse
can lead a group of family members to discuss the needs of a patient at home during
convalescence and at the same time be a member of a multi-disciplinary committee
in the hospital. She can as well belong to a large group as Nurses’ Association.
Groups can also be classified as formal and informal. Formal groups always define
requirements for membership as well as group goals e.g. Cameroon Nurses’

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Associations (CNS). Informal groups on the other hand, have fewer rules and
regulations and sometimes none at all. E.g. a nurse discussing a drug with student
nurses on internship has formed an informal group.

Purpose of Groups
A group must have a purpose to keep its members together. The purpose of a group
may change and grow as the group develops or its membership changes. The
purpose of most groups is to effect change and this is reflected in the set goals. Some
groups dissolve once goals are met while others set new goals and move on.

Roles of Group Members

The success of a group depends on effective leadership and behavior of its members.
Each group member is expected to use his/her talents and interpersonal strengths to
help the group achieve its goals, while remaining sensitive to the needs of individual
group members. Members role are classified as follows:
Task –oriented Goals: focus here is on the work to be done e.g. information
giver, information seeker, clarifier, coordinator, delegator, energizer, and
evaluator.
Group –building or Maintenance roles: focuses on the wellbeing of people
doing the work e.g. active listener, tension reliever, supporter, trust builder
and harmonizer.
Self –serving roles: advances the needs of individual at the groups expense
e.g. attention seeker, dominator, blocker, special pleader, withdrawer,
aggression etc.

Counseling
Counseling is the interpersonal process of assisting clients to make decisions that
promote their over- all wellbeing. During counseling sessions, family members
and other significant others are included. Warmth, openness, friendliness and
empathy skills are necessary ingredients for successful or effective counseling.

Types of Counseling
There exist three types of counseling: short, long and motivational counseling.
These three types of counseling are very essential for dealing with uncooperative
or non-compliant clients/patients as well as nursing diagnoses for which
counseling is the primary intervention. However, sometimes, clients need
specified counseling regarding their care or illness. Therefore it is the place for

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 the nurse to refer such clients to the appropriate quarters e.g. psychiatrist,
psychologist, clergy, sex therapist, social worker, financial counselor, etc.
Short -Term Counseling
This counseling focuses on the immediate problem or concern of the client or family.
It can be a relatively minor concern or major crisis but whatever the situation, it
needs immediate attention. E.g. in a situational crisis where a client in the hospital
finds out that his wife has been involved in a car accident, but their only car was
demolished. The nurse can guide the client in solving the travel, financial and
emotional difficulties that arise. This holistic approach is necessary because the crisis
could adversely affect the client’s recovery.
N: B: In counseling, the nurse does not tell the client what to do to solve the
problem, but instead assists and guides the client in problem solving or decision
making. This is important because some people do not have the knowledge and
skills to approach a problem systematically.
Long –Term Counseling
This is when counseling extends over a long period. The patient may need counsel
from the nurse on daily basis, weekly or monthly intervals. A client experiencing a
developmental crisis may need long term counseling. E.g. many women going
through menopause need the assistance of the nurse when adjusting to changes
they experience. Another example is counseling a breastfeeding mother, where she
could give assistance and guidance until the baby is weaned which could be over a
period of 2 years or more.
Motivational Counseling
This involves discussing feelings and incentives with the client. This is often
frustrating to the nurse because their clients do not want to get better or learn how
to care for themselves. Perhaps, individual clients may not have the inner drive or
motivation to cooperate in their own healthcare. However, the nurse may be able to
get their clients talk about what is generating their disinterest in recovery. If the
problem is identified, the nurse and the client can use the problem – solving
technique to work towards an acceptable solution.

TEACHING STRATEGIES
These are the techniques used by a teacher to promote learning.
Role Modeling

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It is usually said that “action speaks louder than words”. When clients watch their
nurses closely, the nurse can use this opportunity to affect a client’s behavior
positively. E.g. nurses who formerly smoked can be role models for clients who are
trying to quit smoking for health reasons.
Role playing:
This strategy gives the learner a chance to experience, relive, or anticipate an event.
The nurse explains the scenario and then allows the client to play out the scene with
other clients. It can be used to work through emotional traumas or to plan for
possible traumas. E.g. a nurse could help a teenage girl prepare herself to tell her
mother about her pregnancy by letting the girl play her mother while the nurse plays
the girl.
Audio – visual Materials:
These include films, audiotapes, television programs, videotapes, posters, diagrams
etc. their use is popular and effective when combined with a discussion or lecture.
Others include: lecture, discussion, panel discussion, demonstration, discovery,
printed material, programmed instructions, computer- assisted instruction programs
etc.

HEALTH EDUCATION
Patient education is a process by which the health professional (nurse) guides
patients/clients to expand their awareness of alternatives and options for gaining
control over their health. It can also be defined as a planned change done in a
systematic way and used to facilitate voluntary adaptation of behavior conducive to
health.
There are two types of patient education:
 Education for improving compliance with therapeutic regimens
 Education for improving compliance with preventive regimens

Role of Teaching in Clinical Practice

Educating clients about their health is cost effective and provides for continuity of
care. Treating a patient with medicine may have little long term benefits if the
individual has not learned other strategies. E.g. a patient with hypertension may be
very good at taking medication, but if not educated about the importance of
reducing dietary salt, losing weight and increasing exercise, fewer long term benefits
will be achieved.
Education personalizes care and affirms that the client is unique and special because
it is designed to meet each individual’s wants, needs and goals.

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Teaching about health necessitates verbal communication between client and
provider, fosters rapport and furnishes an opportunity to tailor the education
message to the patient’s needs.
Educating clients about their health problems may improve compliance, provide long
term benefits and be cost effective. Patients who are taught about health and
disease appear more able to take charge of their health.

Techniques (Behavioral and Educational) of Health Education

Education often depends on more than one learning experience and multiple
approaches that can take place over time. You will enhance learning for your clients
if you follow the basic techniques.
 Participation
Participation by the learner is essential. Clients learn by doing or internalizing new
information. Encouraging active participation in the learning process increases the
chances that learning will take place. Active participation includes: getting patients to
paraphrase, summarizing, and describing how they plan to use the new information.
 Relevancy
Teaching must be relevant to the learner’s needs and must take into consideration
the person’s social, cultural, ethnic, racial and economic background. Culture
blindness on the nurse’s part may foster misunderstanding and create barriers to
learning. The patient may wish to comply and meet health goals but need help in
arriving at suitable strategies. E.g. the dentist and middle aged woman who could not
brush her teeth due to severe arthritis of the hand.

 Collaboration
The nurse and the patient should be partners in the education process. Establish
goals and learning out comes together because education should be an interactive
process. E.g. to make a regimen understandable, the nurse and the patient should
develop specific goals. Most regimens include multiple tasks such as taking
medications, modifying eating habits, and making lifestyle changes, you will want to
set priorities and start with behaviors that the patient can handle reasonably well.
 Reinforcement
Learning takes time and it is the nurse’s responsibility to ensure the patient gets all
the reinforcement he needs. Reinforcement should be immediate and timely
especially when a regimen is first introduced. Praising positive behavior, a smile, a
pat on the back, or a few simple words of encouragement go a long way.
 Credibility

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The nurse’s credibility and ability to establish rapport and trust affect how your
clients learn. Being professionally confident but not authoritarian or judgmental
facilitates the educational process. Your patients should feel relaxed and not anxious
and you should inspire confidence with your knowledge. You can improve credibility
by modeling good or appropriate health behavior.

 Individualization
Every plan for learning must be designed for the client, taking into consideration
differences in learning speed and efficiency. People learn in different ways and age,
multiple illnesses and anxiety can have a negative impact on learning. Learning is
more efficient and effective when the client perceives that what he/she is expected
to learn or do is relevant.

The Basics of Learning

There are three steps to follow in providing effective and efficient learning.
First, you must assess your clients by finding out who they are, what they know and
what their expectations are. You will also need to consider your clients educational
level, literacy level, wellness, type of illness and the cycle of treatment.
Also, you must now set the stage for learning by creating a positive environment and
maintaining a friendly and supportive attitude. Use language that your clients
understand and define any terms that you use.
Finally, organize the learning experience so it goes from the simple to the more
complex. Plan experience that influences attitudes, develop skills, and increase
knowledge.

RESPONDING TO SPECIAL NEEDS

Communicating with Clients Experiencing Communication Deficits

Communication Strategies with Hearing Loss

Specific strategies to maximize the quality of communication process might be as
follows:

 Stand and/or sit so that the client can see your face as you mouth your words.
The room should be well lighted.
 Use gestures and speak directly without exaggerating words.
 If he can read, write down the same ideas and give him to read.
 Help elderly clients adjust hearing aids because they lack fine motor dexterity
and may not be able to insert aides to amplify hearing.

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  Allow more time to communicate information
 Become familiar with client’s communication patterns, likes and dislikes.

Communication Strategies with Blind Clients

It is important to use words as your approach the client and to mention your name.
Remember they lack visual clues and so rely heavily on vocal tones to interpret
messages. Voice tones and pauses that reinforce the verbal content are helpful.
Always tell him/her when you are leaving the room.

When a blind client is being introduced to a new setting, the nurse should orient the
patient to the room, furniture, and people. Get the other people in the room to
introduce themselves to the client. In this way client gains an appreciation of their
voice configurations.

Remember to keep voice tone normal and natural lest the patient thinks you are
insensitive to the nature of their handicap.

Communication Strategies with the Deaf and Blind Client: The deaf and blind client
presents a special communication challenge to the nurse, but many of the strategies
described above can be used in combination to facilitate communication. You could
use Braille or print capital letters on the client’s palm. The following suggestions may
help:

 Let the person know when you approach by a simple touch, and always
indicate when you are leaving.
 Make positive use of any means of communication available
 Develop and use your own special signs to identify yourself to the client.
 Encourage client to verbalize speech, even if the person uses only a few words
or the words are difficult to understand at first.
 Keep the client informed.
 Use touch and close physical proximity which you are with the client.
 Don lead or hold the client’s arm when walking; instead, allow the person to
take your arm.
 Develop and use signals to indicate changes in pace or direction while walking.

COMMUNICATING WITH CLIENTS HAVING SPEECH AND LANGUAGE DIFFICULTY

Clients Having Speech and Language Difficulty

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Assessment of the type of aphasia aids the mine of selecting the most appropriate
intervention. Expressive language problem present by difficulty to fine words or to
associate ideas to accurate word symbols. In some cases the adult can find the right
words if given enough time

Other adults have difficulties organizing this words into meaningful sentences or
describing the sequence of events that’s with receptive communication deficits have
trouble following instructions, directions reading information and writing. They hear
words but have difficulty classifying data or relating data to previous knowledge

Special communication strategies here include:

 Avoiding prolonged continues conversation, instead use frequent short talks

 When adult fatter in writing or oral communication provide compensatory
support
 Praising efforts to communicate and making learning new ways to
communicate a game
 Providing regular mental stimulation in a non-taxing way
 Helping adults focus on the facilities still available to them for communication
 Allowing extra time for delay in cognitive processing of information
 Encouraging adults to practice what is learned in speech therapy

COMMUNICATING WITH CLIENTS IN STRESSFUL SITUATIONS AND CLIENTS IN CRISIS

Communication Strategies with Mentally/Emotionally Disturbed Clients

As a nurse, you will always come in contact with mentally or emotionally disturbed
clients and it is part of your responsibility to communicate with these clients.
Communicating with such clients is the same as communicating with normal clients
and you must use act very professionally when handling these clients.
When dealing with this type of patient, you need to determine what level of
communication the patient can understand. Always bear the following suggestions in
mind to improve communication:
 It is very important to remain calm if the patient becomes agitated or
confused
 Always avoid raising your voice or appearing impatient
 If you do not understand the patient, ask the patient to repeat what he/she
said.

Communicating with Anxious Patients

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It is a normal experience to get anxious as humans over different situations as they
arise. E.g. we sometimes get anxious once in hospital environment or health care
setting whether just visiting a hospitalized friend or family member or however the
situation may be. Patients become anxious once in the doctor’s office or in a health
care environment and this reaction is commonly known as “white- coat syndrome.”
There can be many reasons for anxiety e.g. a patient becoming anxious because
he/she is ill and does not know the cause of the illness and may even fear the worst;
fear of the outcome of diagnosis which may mean complete change of lifestyle e.g.
hypertension and diabetes. Anticipation of pain from a procedure etc. and all of
these situations makes a patient anxious thereby interfering with the communication
process. E.g. not paying attention to what you are saying or explaining to him/her.
Appearing tensed, increased blood pressure, rates of breathing and pulse, sweaty
palms, reported problems with sleep or appetite, irritability and agitation are signs of
anxiety. (See handout)

Communicating with Angry Patients

In the medical setting, anger may occur for many reasons. Anger may be a mask for
fear about an illness or outcome of a procedure. A patient may feel angry for fear of
being treated unfairly or without compassion; for being ill or injured; a reaction to
frustration, rejection, disappointment, feelings of loss of control or self-esteem, or
invasion of privacy.
As a nurse it is your responsibility to render help to them so that they can express
their anger constructively, for the sake of their health. At the same time, you must
learn not to take expressions of anger personally as you may just be an unlucky
target. Your goal is to help make these patients refocus emotional energy towards
solving the problem. The following steps will help:
 Learn to recognize anger and its causes. Anger is easy to recognize in most
people, but subtle in others. Patients who speak in a tense tone, are stubborn,
or appear to ignore your attempts at communication may be angry.
 Remain calm and continue to demonstrate genuineness and respect.
Communicate that you respect and care about the patient’s feelings.
 Focus on patient’s physical and medical needs
 Maintain adequate personal space. Place yourself on the same level as the
patient.
i) If the patient is standing, encourage him/her to sit
ii) Maintain an open posture to show that you are receptive to listening
iii) Maintain eye contact, but avoid staring at the patient, which can make
him even angrier

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  Avoid the feeling that you need to defend yourself or give reasons why the
patient should be angry, but instead listen attentively with an open mind to
what the patient is saying, as most patients’ anger will lessen if they know
someone is really listening to them and showing an interest in their emotions
and needs.
 Encourage patients to be specific in describing the cause of their anger, their
thoughts about it and their feelings. Be empathic and acknowledge the
patient’s feelings and perception. Avoid totally agreeing or disagreeing with
the patient, so just state what you can and what you cannot do for the
patient.
 Present your point of view calmly and firmly to help the patient better
understand the situation. If patients are receptive of your view point, their
perspective may change for the better.
 Avoid a breakdown in communication. Allow the patient to voice anger as
tying to outtalk the patient or over explain will only annoy or irritate him/her.
You may also suggest that the patient spend a few moments alone to gather
his thoughts or to cool off before continuing any type of communication.
 If you feel threatened by the patient’s anger or it looks as if the patient’s
anger may become violent, leave the room and seek assistance and document
any threats in the patient’s chart or file.

Communicating with Terminally Ill Clients

The ill patients are often under extreme stress and can be a challenge to care for.
Respecting the rights of these clients and treating them with dignity, communicate
with their family, and offer support and empathy is very important. (Hospice is an
area in medicine that works with terminally ill patients and their family). Terminally
ill patients are cared for by specialized staffs that are trained in issues related to
death and dying. They work with the patients from the beginning, assisting with
medication, and they end by making arrangements with the funeral. According to
Ross a world renowned authority in areas of death and dying, there are five stages of
death and dying which is used to work with terminally patients. Although the stages
are listed in an order, grieving people do not experience them in any particular order
or for any length of time and often move back and forth between the stages.

 Denial: patients are in direct or periods of disbelief. This defense is generally

temporary.

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  Anger: patients may suddenly realize what is really happening and respond
with anger. They can become difficult patients in this stage and display temper
tantrums and fits of rage.
 Bargaining: patients attempt to make deals with the physicians, clergy, and
family members. Patients at this stage may become more cooperative and
congenial.
 Depression: the patient will begin to show signs of depression such as
withdrawal, lethargy, and sobbing. The patient’s body is beginning to
deteriorate and the patient may experience more pain and realize that
relationships with family and friends will soon be gone.
 Acceptance: patients accept the fact that they are dying. They will begin
arrangements for when they expire, making funeral or burial requests. At this
stage, the family members need the most support.
N: B: Knowing the stages of death and dying is very important in communicating with
such patients and patients in general who are undergoing grieving as well.

Communicating with Cognitive Impaired Clients

 Reduce environmental distractions while conversing
 Get client’s attention before speaking
 Use simple sentences and avoid long explanations
 Ask on question at a time
 Allow time for client to respond
 Be an attentive listener
 Include family and friends in conversations, especially in subjects known to
the client

Communicating with Unresponsive Clients

 Call client by name during interactions
 Communicate both verbally and by touch
 Speak to client as if he/she could hear
 Explain all procedures and sensations
 Provide orientation to person, place and time
 Avoid talking to client to others in his/her presence
 Avoid saying things client should not hear

Communication with clients of other cultures

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Our beliefs, attitudes, values, use of language, and views of the world are unique to
us, but they are also shaped by our cultural background. In any health care setting
you will find yourself, you will most likely have contact with patients from different
or diverse cultures and ethnic groups having their own behaviors, traditions, and
values. Rather than viewing these differences as barriers to communication, strive to
understand and be tolerant of them.
Also remember that these beliefs are neither superior nor inferior to your own. They
are simply different, so never allow yourself to make value judgments or stereotype
a patient, a culture, or an ethnic group. Each patient is an individual in his /her own
right.

COMMUNICATION SKILLS

Posture
The way a person holds the body carries nonverbal messages. People in good health
with a positive attitude usually hold their bodies in good alignment. Depressed or
tired people are more likely to slouch. Posture also indicates nonverbal clues for pain
and physical limitations.

Gait
It refers to the way a person walks. A bouncy purposeful walk usually carries a
message of wellbeing. A less purposeful, shuffling gait often indicates sadness or
discouragement. Certain gaits are associated with illness e.g. a patient recovering
from abdominal surgery usually walks slightly bent over and slowly may need
assistance of handrails or another person.

Gestures
Gestures using different parts of the body are capable of carrying numerous
messages e.g. thumbs up means victory whereas thumbs down means something
negative; kicking an objects usually indicates anger; wringing the hands or tapping a
foot often denotes anxiety or anger etc. Gestures are used extensively when two
people speaking different languages attempt to communicate with each other.

General Physical Appearance

Most illnesses at least cause some alterations in general physical appearance.
Observing for changes in appearance is an important nursing responsibility in
detecting a particular illness or in evaluating effectiveness of care and therapy. For
example, the person with an insufficient intake of fluids has dry skin that wrinkles
easily, eyes that may be sunken and dull in appearance, and poor muscle tone.

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Mode of Dressing and Grooming
A person’s clothing and grooming carry significant nonverbal messages. Healthy
people with good self-esteem tend to pay attention to details of dress and grooming
whereas those with low self-esteem show much less interest in them. Also people
feeling ill often demonstrate little interest in personal appearance, and it is often a
sign of returning health when interest in mode of dress and appearance resume.

Sounds
Crying, moaning, gasping, and sighing are oral but nonverbal forms of
communication. Such sounds can be interpreted in numerous ways e.g. a person may
cry because of sadness or joy. Gasping often indicates fear, pain, or surprise.

Silence
Periods of silence during communication often carry important nonverbal messages.
The silence between two people may indicate complete understanding of each
other, or it may mean they are angry with each other.

Body Language and Nonverbal Communication

Observing and Reflecting Nonverbal Behaviour

Throughout the day, we witness many behaviour but few of us put our observations
to use. For example, when someone wears dark glasses whether or not they are in
sunlight, we can safely assume that the explanation is out of the ordinary. Perhaps
the person has an eye condition or a headache that is triggered by light. Perhaps he
is self-conscious about how his eyes look. He might have red, infected looking eyes,
severely disfigured eyes etc. Some famous people wear dark glasses to help them
hide their identities. Others wear them as a neurotic attempt to hide from the world
and hide their feelings from the world.

As nurses, we must be careful with our interpretations. We must learn to recognize

universal neutral behaviours and to use this information to better understand our
patients (a neutral position or behavior is the body’s natural position e.g. hands at
sides in a neutral position).

In a hospital or clinical setting, you will learn a great deal by observing the people.
Some people sit with their backs straight whereas others sit with their feet on the
chair in front of them; some sit close together whereas others place themselves
apart. Many others reveal much through their facial expressions: they may sit alone
and frown at seemingly nothing at all while others may exhibit a faint pleasant smile.
Just by these observations we can begin to formulate opinions about others and
react to them according to our impression.

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Making Sense of Nonverbal Behaviours
Once individuals begin to interact, verbal behaviours, mannerisms such as nail biting,
pen flicking, and eye contact enter the picture. For example a person who holds your
gaze and speaks to you in a pleasant, expressive tone makes a better impression than
does the individual who speak in a quavering voice while staring at the floor.

You cannot always be sure of what certain behaviours indicate. For example, if you
observe a patient sitting with arms folded across the chest, you must take care not to
misinterpret the position. Perhaps the patient wants to protect herself from other, is
hugging herself as a form of comfort, is self-conscious about her figure, or is simply
cold and trying to warm up.

To understand the nonverbal communication of individuals, you must follow your

observations with a question about what that behavior means to that individual. For
example:

“I see you have turned away from me and your arms are folded across your chest”.

“I’m wondering what that means to you” or “I guess you are feeling a little alone and
frightened”.

Either of these responses may be correct. The second, however, would be

recommended only if you had already established rapport with the client.
Remember, first you make a strictly behavioural observation (nonjudgmental) such
as “I see your arms are folded across your chest”. Then you want to identify
accurately what this non-neutral behavior means to the client.

Another benefit to making these observations relates to conflicting messages. Often

a patient will verbalize one message while indicating the opposite with his body. For
example, a person may smile broadly while telling you how much pain he suffers
from. By reflecting this obvious conflict back to the patient you will be better able to
appreciate what he is feeling.

“What does it mean to you when you are smiling while talking about your pain?”

“I wonder if you are smiling because that helps mask the pain you are feeling”.

Behavioural observation may also be the only tool we have for communicating with
patients who are speech impaired or are unwilling to speak with us. For example, an
adolescent may sit grimly and silently in the consultation office after being dragged in
by a parent. The nurse may find that the adolescent meets most verbal approaches

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with more silent resistance. But, if the following approach is used, the patient may
decide to talk simply because someone has conveyed understanding.
“You have been sitting on my couch for nearly 20mins now without saying a word.
You have kept your eyes on your hands and your whole body is leaning forward. I’m
getting the message that you don’t want to speak with me” or

“You haven’t spoken in 20mins and you won’t even look at me. Perhaps you are
angry with your mother for bringing you here. If I were you I’d probably feel the
same way”

Again, the second approach involves some risk because it brings in more feelings.
You should use feeling words with patients only when you are confident that you
understand the emotional issues involved.

Sending Nonverbal Messages

The most obvious nonverbal message we send is our appearance. Good hygiene – a
clean body and neat, clean clothing coupled with a pleasant or benign odour is ideal.
Heavy perfumes or aftershaves are inappropriate in a work setting.

A less obvious consideration is facial expression. Few people realize how they look in
random or candid moments. Generally we prepare our faces subconsciously for a
moment before we look into a mirror. Try to observe objectively what you see in
those candid shots of yourself.

Sometimes, due to chronic pain or worry, an individual carries a sad or sour face into
the world even long after those difficulties have been resolved. Others may look
tough and unapproachable even though they are warm and friendly. Your colleagues
and patients will observe you beyond the time you spend with them directly. They
may form an opinion of you just by observing how you walk down a hallway.

Professional apparel is also part of the nonverbal message you send. If you came to
work dressed for a night out, your patients probably won’t feel a great deal of
confidence in you. You may feel comfortable yourself but you may make your
patients uncomfortable.

The kind of body language that makes us comfortable with others makes others
comfortable with us. If you want to encourage your patients to talk openly, then you
must offer them open approachable nonverbal as well as verbal cues. The rushed
and tense health practitioner does not stimulate dialogue nor escape detection. It is
therefore not enough to recognize patient’s nonverbal messages: we must send the
right nonverbal messages ourselves.

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Creating an Environment for Communicating
The final aspect of nonverbal communication training entails creating the best
environment for communication to take place.

Firstly, health practitioners and patients should not be separated by great distances
or large barriers such as desks or machines. An arm’s length apart is culturally
acceptable in most cultures. The distance is close enough for intimate conversation
without making most people feel that their personal space is being violated.

Secondly, hospital environments can pose barriers or distractions that are less than
ideal. The lack of privacy in most hospitals will require the nurse to do some creative
rearrangement when she needs to deal with sensitive questions. If she doesn’t do
this, the patient’s need and right to privacy will become a stumbling block to
communication.

With respect to nonverbal skills and settings an ideal environment for

communication will have the following:

 A professionally attired nurse sitting approximately an arm’s length from the

patient.
 The room would be privately occupied for at least the duration of their
interaction.
 The nurse’s facial expressions and vocal tone would be friendly and
interested; eye contact would be held throughout most of the interaction.
 The nurse would focus attention on the body language of the patient,
reflecting out loud any aspects that didn’t agree with what was being said. She
will also reflect back to the patient and analyse any body language of the
patient that appears to carry a message of its own (e.g. tightly closed legs or
clenched fists)

DEVELOPMENT OF THERAPEUTIC COMMUNICATION SKILLS

The knowledge needed to exchange messages is useful and has to be provided in

nursing education so that nurses develop therapeutic communication skills.

Effective Communication Techniques

Since communication takes on many forms depending on different situations, if
effective techniques are used appropriately, nurses can enhance the quality and
purpose of any communication. However, this should not supersede nurse-client
relationship.

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Conversational Skills
Conversation is the exchange of verbal communication and is a social interaction. As
social beings, humans learn as children to converse with others. However, nurses can
improve this skill by doing the following:

 Control the tone of our voice so you convey exactly what you mean to say and
not a hidden message. The tone should indicate interest, patience,
acceptance, not boredom, anger or hostility.
 Have enough and accurate knowledge on the topic of discussion. If the topic is
unfamiliar, the nurse should tell the client so.
 The nurse should be flexible. She may have selected a subject to discuss but
the client wishes to discuss something else. It is better to follow the client’s
lead where possible and return to the subject in due time.
 Be clear and concise and make statements as simple as possible. Clients are
often anxious and fail to receive the nurse’s message unless the conversation
is geared to al level the client understands.
 Avoid words that may be interpreted differently. Even when two people speak
the same language, some words e.g. love, hate, freedom, and liberty etc. may
have different meanings.
 Be truthful because the client will soon distrust the nurse if given false
information. It is better to admit not knowing than giving false information.
 Keep an open mind. An attitude of “I know better than the client” is quickly
discerned by the client. The nurse should know that clients can make valuable
contributions to their care.
 Take advantage of available opportunities. During most care giving situations,
the nurse can facilitate conversation that will make even the most routine task
meaningful.

Listening Skills
Listening is a skill that involves both hearing and interpreting what is said and
requires attention and concentration to sort out, evaluate, and validate clues so that
a person better understands the true meaning of what is being said. The nurse
should therefore develop the following skills:

 Whenever possible sit when communicating with a client and avoid crossing
your arms and legs because this nonverbal cue conveys a message of being
closed to the client’s comments.

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  Be alert but relaxed and take sufficient time so that the client feels at ease
during the conversation. Keep the conversation as natural as possible, an
avoid sounding too eager.
 Maintain eye contact in a face-to-face with the client without staring because
this conveys interest. However, where it culturally unacceptable, the nurse
should avoid eye contact.
 Use appropriate facial expressions and body language to show you are
listening to the patient. However, the nurse should be attentive to her own
and the client’s verbal and nonverbal communication.
 Think before responding to the client because impulsive responding tends to
disrupt communication and listening.
 Do not pretend to listen. Only very few clients are not sensitive to this attitude
of feigned attention or to boredom and apathy.
 Listen for themes in the client’s comments. The following questions can help
you detect these themes: what are the repeated themes in the person’s
speech and behavior? What topics does the client tend to avoid? What
subjects tend to make the client shift the conversation to other subjects? etc.

The foundation of developing listening skills is paraphrasing. To paraphrase, you

listen to a speaker and then repeat what they have said. Although you can repeat
exactly what they said, it is helpful to put it in your own words (rephrase it) e.g.

Speaker: “I am so tired of working with Sandra. Every time I think she

understands the importance of not skipping meals or taking laxatives
she turns around and gets herself into trouble”

Listener: “it sounds as though Sandra persistently ignores your helpful advice
and therefore creates dangerous situations for herself”

Reasons for Paraphrasing

 Paraphrasing is a Check for the Listener: it allows the listener to immediately

check out his or her understanding
 It is a Check for the Speaker: it allows the speaker to hear what his words
sound like. People often do not mean things exactly as they come out.
Hearing your own words reflected back by a listener helps to clarify what you
really meant to say.
 It Builds Rapport: it shows the speaker that he or she is actually being listened
to which effectively builds rapport.

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  It focuses on the Patient: it is possible that the listener may end up talking
about herself. Listening and paraphrasing will eliminate this danger. Sticking
with what the patient wants to convey prevents the nurse from missing vital
information or possibly offering impossible solutions.
 It Keeps the Patient Talking: If we are to get as much objective information as
possible, we want the speaker to keep talking as leas in the first few
encounters. Once we begin asking questions we take the lead.

Silence
The nurse can use silence appropriately by taking the time to wait for the client to
initiate or continue speaking. During periods of silence, the nurse has the
opportunity to observe the client without having to concentrate simultaneously on
the spoken word. This period of silence may mean any of the following:

 The client may be demonstrating comfort and contentment in the nurse-client

relationship.
 The client may be trying to demonstrate strength and the ability to cope
without help.
 The client may be exploring inner feelings, and conversation would disrupt
these thoughts. In this situation, the client is really saying, “I need some time
to think”
 The client may be fearful and use silence as an escape from a threat.

The nurse must later find out the meaning of silence to the patient in order not to
speculate on possible meaning.

Interviewing Techniques
The purpose of any interview is to obtain accurate and thorough information. In
nursing the interview is a major tool for collecting data during the assessment step of
the nursing process. Interviews are equally a therapeutic interaction and may be an
essential part of the orientation phase of nursing interventions. This makes
developing interviewing skills an important aspect of the nurse’s learning.

All interviews should begin with an explanation of the purpose of the interview.
During the interview the nurse can use various techniques to obtain information, but
must be flexible. Techniques here include: open and close ended question, validating
questions or comments, clarifying questions or comments, reflective question or
comment, sequencing question or comment, directing question or comment. Open
ended and close-ended questions are discussed below.

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The Role of Open – Ended Questions
Once you have established rapport and a clear understanding of the patient’s issues
through paraphrasing, you can proceed to empathic responses. These permit you to
communicate your understanding of the patient’s feelings and to expand on the
content of what the patient had said. While at this, you also want to expand the
patient’s expanding of the issues in which he or she is involved.

The only kind of question that lends itself to paraphrasing and empathizing is the
open-ended question (a question that can’t be answered with a simple ‘yes’ or ‘no’,
but encourages further discussion). It is the only type of question you should use
during such encounters e.g.

Speaker: “if you ask me to do anymore of those leg lifting exercises I’m never coming
back.’’

Response: “so you’re pretty bothered by the leg lifts and you want me to understand
how hard they are for you?’’

Such a question relates directly to what the patient has said and does not lead the
patient away from discussing his or her needs or problems.

Remember that open-ended question encourage the patient to discuss issues

further. Can you distinguish the open-ended questions listed below?

1. Can you tell me how you feel?

2. How did it feel to be on a strict diet when you were only 9?
3. What can you describe as contributing to your problem?
4. Have your parents been divorced long?
5. Did anyone else in your family have high blood pressure?

2 and 3 are correct. The others could be answered with a single word (especially yes
or no). Close questions do not allow us to learn any substantiating information. Also,
the way we ask closed questions can determine the answers we receive. Remember
that many people may respond to questions that threaten them in any way, you will
get the easiest answers they can come up with. Something as simple as “Did you eat
breakfast this morning?” may cause them to feel defensive and cover the truth.

The key to asking open-ended questions is to remember two little words: How and
What. In general, you should avoid asking questions that they may be no real
answers to them. Further, many questions come across as threatening and
confrontational:

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 1. “Why didn’t you call for help?”
2. “Why don’t you take your medicine?”

Questions like this sound threatening and generally go unanswered or are answered
dishonestly.

The Role of Closed Questions

There are times that you may need to get very specific information from the patient
and closed questions may be more appropriate. These are questions designed to
elicit a short, focused answer like “Yes”, “No”, “5years”, or “sometimes”.

It is important to know when you can ask open-ended and when to ask closed
questions. For example a nurse could start a patient history with a questions such as
“Tell me about yourself” or “Why you are here?” But if the nurse has a four – page
questionnaire to fill out in 15mins, she will not have much time for such open –
ended question.

On the first meeting with the patient, even if you are allowed only 15mins with him
or her, it is often advisable to allow the patient to ramble for a least a couple of
minutes. These ramblings may contain the seeds of the person’s problems, which 2
hrs of direct questioning might not bring out. According to one old rule, if you listen,
the patient will tell you the diagnosis.

Other important therapeutic communication skills are Touch, Humour, Interpersonal

Competencies and Assertive Skills (Students should do this).

Receiving and Giving Feedback

There are four steps to follow in receiving feedback:

Thank the Giver

By thanking the person who gives you feedback, you set a receptive tone. In essence
you are saying “I am glad to have your input so I can benefit from what you see”

Paraphrasing
It will do two things: first it will allow you to be sure you have heard the feedback
correctly. Even the best communicators can be ambiguous at times; secondly it gives
the speaker a second chance to correct his message if necessary.

Seeking Further Clarification

You may need to clarify certain points after paraphrasing has occurred. Here you are
asking specifically what the evaluator is suggesting you do. For example:

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 Evaluator: “You are spending too much time with your patients”.

Student: “Do you mean I am working too late?”

Evaluator: “No I mean you should limit the time you spend with each patient,
so that you can see all patients by noon. If there is a special needs case you
can return to it once you have received the needs of all the patients”.

Discussing How to Correct Weakness

Once you understand precisely what needs work, you can discuss how to make the
necessary change e.g.

Evaluator: “I wonder whether I can speak with you in private. I have been
getting complaints about your notes in the charts”.

Student: “Thank you for bringing this to my attention. It sounds like my notes
aren’t up to hospital standards (paraphrase). What do I need to change?”
(Seeking clarification).

Evaluator: “You need to give more details when reporting your conclusions.
Otherwise no one knows why you are picking up various particular problems
the rest of us have not seen”.

Student: “If I take a few extra minutes with each patient I should be able to
describe the patient’s comments or behavior with which I am concerned.
Would that take care of it?” (Discussion of what can be corrected).

Evaluator: “Yes, that sounds very helpful”.

Giving Feedback
In summary, the rules for giving feedback are

 Begin with something positive

 Be specific about what you mean
 Focus on behavior
 Be certain your motive is to be helpful
 Be immediate
 Be private

The Basics of Learning

There are three steps to follow in providing effective and efficient learning.

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  You must assess your clients by finding out who they are, what they know,
and what their expectations are. You will need to consider your clients
educational level, literacy level, wellness, type of illness, and cycle of
treatment.
 You must now set the stage for learning by creating a positive environment
and maintaining a friendly and supportive attitude. Use language that your
client understands and define any terms you use.
 Finally organize the learning experience so it goes from the simple to the more
complex. Plan experiences that influence attitudes, develop skills, and
increase knowledge.

Keep in mind that some individuals learn best by listening (auditory learning), some
by seeing (visual learning) and others by doing or physically manipulating textures,
shapes and outlines (kinesthetic learning). To compensate for these different styles
you should use a combination of teaching methods that incorporates them all.

INTERDISCIPLINARY COMMUNICATION

Intra-disciplinary communication is communication between members of the same

health specialty e.g. nurse and nurse.

Interdisciplinary communication is communication between different health

practitioners e.g. when a nurse speaks to a physician.

The language you speak and the role you assume are affected by whether you are
communicating with someone who works within your own discipline and your
relative positions within the hierarchy of command.

Modes of Interdisciplinary Communication

In general, health practitioners communicate with one another through case
conferences; telephone calls; letters; forms; and notes; and the medical record,
either written or electronic.

Case Conferences
Multiple case conferences improve patient care and time efficiency. Ideally
interdisciplinary communication is best conducted through a case conference. But to
assemble six health professional for one hour to discuss one patient means there
must be reasonable expectations that something will come out of the meeting.

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Generally case conferences are held only when a patient cannot be adequately cared
for without them. They should be held routinely with specific diseases states like
burns or renal failure. Everyone must be highly specific and agree on a common focal
point.

Telephone Calls
It must be specific. It is not only important in communicating with health
practitioners but also in dealing with patients. If possible answer the phone within
three rings, greet the caller and identify your department and yourself.

Because the telephone permits no nonverbal cues, it is especially important that you
project your attitude (which should friendly and professional). Smile and make the
same facial expressions as you would during face-to-face communication, so that
your pauses and comments are properly timed. Being a good listener here is even
more important because you cannot look the caller in the eye, it is important to use
the caller’s name.

If you cannot do what the caller asks, be sure to ask what should or can be done e.g.
“I’m afraid I can’t see you tomorrow, but would the next day be alright?”

Letters, Forms and Notes

Written communication should be brief and specific. Because letters or referral
document communication in writing, it may actually be less time consuming to write
a letter than to use the telephone. It is unprofessional to make a referral without
specific communication as to why the patient has been referred. Both the reason for
and the answer to the reason should be communicated through accepted channels
for every consultation, collaboration or referral.

Medical Record
For hospitalized patients the medical record is the major form of interdisciplinary
communication. Unfortunately many physicians (and nurses) do not take time to
document the patient’s progress adequately on the chart. On the other hand, nurses’
notes are so lengthy that they discourage good communication. An ideal medical
record is clear, concise, brief, legible and all accessible in one easily available chart.

Read: Examples of healthcare teams.

COMPILATION: NEMLACKSAM 2022 33

 DEVELOPING A PLAN FOR COMMUNICATION
Developing a communication plan can help focus your message and
reach your target audience. A plan can also influence the efficiency
and simplicity of your communication methods. This section looks at
what a communication plan entails, how and when to create one,
and how to use a communication plan to raise awareness about your
issue or project.

WHAT DO WE MEAN BY COMMUNICATION?

Communication is the process of transmitting ideas and information.

For a grass roots initiative or community-based organization, that
means conveying the true nature of your organization, the issues it
deals with, and its accomplishments to the community.

Communication can take many forms, including:

 Word of mouth
 News stories in both print and broadcast media
 Press releases and press conferences
 Posters, brochures, and fliers
 Outreach and presentations to other health and community
service providers, community groups, and organizations
 Special events and open houses that your organization holds

To communicate effectively, it helps to plan out what you want from

your communication, and what you need to do to get it.

WHAT IS A PLAN FOR COMMUNICATION?

Planning is a way to organize actions that will lead to the fulfillment

of a goal.

Your goal, in this case, is to raise awareness about your initiative's

long-term benefits to your community.

COMPILATION: NEMLACKSAM 2022 34

To develop a plan for communication, you have to consider some
basic questions:

 Why do you want to communicate with the

community? (What’s your purpose?)
 To whom do you want to communicate it? (Who’s your
audience?)
 What do you want to communicate? (What’s your
message?)
 How do you want to communicate it? (What communication
channels will you use?)
 Whom should you contact, and what should you do to use
those channels? (How will you distribute your message?)

The answers to these questions constitute your action plan, what

you need to do to successfully communicate with your
audience. The remainder of your communication plan involves three
steps:

 Implement your action plan. Design your message and

distribute it to your intended audience.
 Evaluate your communication efforts and adjust your
plan accordingly.
 Keep at it.

Communication is an ongoing activity for any organization that

serves, depends upon, or is in any way connected with the
community. The purpose, audience, message, and channels may
change, but the need to maintain relationships with the media and
with key people in the community remain. As a result, an essential
part of any communication plan is to continue using and revising

COMPILATION: NEMLACKSAM 2022 35

your plan, based on your experience, throughout the existence of
your organization.

WHY SHOULD YOU DEVELOP A PLAN FOR

COMMUNICATION?

 A plan will make it possible to target your communication

accurately. It gives you a structure to determine whom you
need to reach and how.
 A plan can be long-term, helping you map out how to raise
your profile and refine your image in the community over time.
 A plan will make your communication efforts more efficient,
effective, and lasting.
 A plan makes everything easier. If you spend some time
planning at the beginning of an effort, you can save a great
deal of time later on, because you know what you should be
doing at any point in the process.

WHEN SHOULD YOU DEVELOP A PLAN FOR

COMMUNICATION?

As soon as your organization begins planning its objectives and

activities, you should also start planning ways to communicate
them; successful communication is an ongoing process, not a one-
time event.

Communication is useful at all points in your organization's

development - it can help get the word out about a new
organization, renew interest in a long-standing program, or help
attract new funding sources.

HOW DO YOU DEVELOP A PLAN FOR

COMMUNICATION?

Planning for communication is an eight-step process. The steps are:

COMPILATION: NEMLACKSAM 2022 36

 1. Identify the purpose of your communication
2. Identify your audience
3. Plan and design your message
4. Consider your resources
5. Plan for obstacles and emergencies
6. Strategize how you will connect with the media and others who
can help you spread your message
7. Create an action plan
8. Decide how you will evaluate your plan and adjust it, based on
the results of carrying it out

1. IDENTIFY YOUR PURPOSE

What you might want to say depends on what you’re trying to

accomplish with your communication strategy. You might be
concerned with one or a combination of the following:

 Becoming known, or better known, in the community

 Educating the public about the issue your organization
addresses
 Recruiting program participants or beneficiaries
 Recruiting volunteers to help with your work
 Rallying supporters or the general public to action for your
cause
 Announcing events
 Celebrating honors or victories
 Raising money to fund your work
 Countering the arguments, mistakes, or, occasionally, the lies
or misrepresentations of those opposed to your work.

COMPILATION: NEMLACKSAM 2022 37

  Dealing with an organizational crisis that’s public knowledge –
a staff member who commits a crime, for example, or a lawsuit
aimed at the organization.

2. IDENTIFY YOUR AUDIENCE

Who are you trying to reach? Knowing your audience makes it

possible to plan your communication logically. You'll need different
messages for different groups, and you'll need different channels
and methods to reach each of those groups.

There are many different ways to think about your audience and the
best ways to contact them. First, there’s the question of what
group(s) you’ll focus on. You can group people according to several
characteristics:

 Demographics. Demographics are simply basic statistical

information about people, such as gender, age, ethnic and
racial background, income, etc.
 Geography. You might want to focus on a whole town or
region, on one or more neighborhoods, or on people who live
near a particular geographic or man-made feature.
 Employment. You may be interested in people in a particular
line of work or in unemployed people.
 Health. Your concern might be with people at risk for or
experiencing a particular condition – high blood pressure,
perhaps, or diabetes – or you might be leveling a health
promotion effort – “Eat healthy, exercise regularly” – at the
whole community.
 Behavior. You may be targeting your message to smokers, for
example, or to youth engaged in violence.
 Attitudes. Are you trying to change people’s minds or bring
them to the next level of understanding?

COMPILATION: NEMLACKSAM 2022 38

Another aspect of the audience to consider is whether you should
direct your communication to those whose behavior, knowledge, or
condition you hope to affect, or whether your communication needs
to be indirect. Sometimes, to influence a population, you have to
aim your message at those to whom they listen – clergy, community
leaders, politicians, etc.

For instance, in the 1970s, advocates wanted to stop Nestle from

selling baby formula and paying doctors and nurses to recommend it
to parents in the developing world. Most parents couldn’t afford
formula after the free samples ran out, and many didn’t have clean
water to mix with it, so the practice led to large numbers of
unnecessary infant deaths. Rather than target Nestle or the medical
professionals who were selling the formula, advocates aimed at
Nestle’s customers around the world, instituting a boycott of Nestle
products that lasted for over ten years. Ultimately, the company
agreed to change its practices.

3. THE MESSAGE
When creating your message, consider content, mood, language,
and design.

Content
In the course of a national adult literacy campaign in the 1980s,
educators learned that TV ads that profiled proud, excited,
successful adult learners attracted new learners to literacy
programs. Ads that described the difficulties of adults with poor
reading, writing, and math skills attracted potential volunteers. Both
ads were designed to make the same points – the importance of
basic skills and the need for literacy efforts – but they spoke to
different groups.

COMPILATION: NEMLACKSAM 2022 39

You should craft your message with your audience in mind; planning
the content of your message is necessary to make it effective.

Mood
Consider what emotions you want to appeal to.

The mood of your message will do a good deal to determine how

people react to it. In general, if the mood is too extreme – too
negative, too frightening, trying to make your audience feel too
guilty – people won’t pay much attention to it. It may take some
experience to learn how to strike the right balance. Keeping your
tone positive will usually reach more people than evoking negative
feelings such as fear or anger.

Language: There are two aspects to language here. One is the

actual language – English, Spanish, Korean, Arabic – that your
intended audience speaks. The other is the style of language you
use – formal or informal, simple or complex, referring to popular
figures and ideas or obscure ones.

You can address the language people speak by presenting any

printed material in both the official language and the language(s) of
the population(s) you’re hoping to reach, and by providing
translation for spoken or broadcast messages.

The second language issue is more complicated. If your message is

too informal, your audience might feel you’re talking down to them,
or, worse, that you’re making an insincere attempt to get close to
them by communicating in a way that’s clearly not normal for you.
If your message is too formal, your audience might feel you’re not
really talking to them at all. You should use plain, straightforward
language that expresses what you want to say simply and clearly.

Channels of Communication

COMPILATION: NEMLACKSAM 2022 40

What does your intended audience read, listen to, watch, or engage
in? You have to reach them by placing your message where they’ll
see it.

 Posters
 Fliers and brochures - These can be more compelling in places
where the issue is already in people’s minds (doctors’ offices
for health issues, supermarkets for nutrition, etc.).
 Newsletters
 Promotional materials - Items such as caps, T-shirts, and mugs
can serve as effective channels for your message.
 Comic books or other reading material - Reading material that
is interesting to the target audience can be used to deliver a
message through a story that readers are eager to follow, or
through the compelling nature of the medium and its design.
 Internet sites - In addition to your organization's website,
interactive sites like Facebook, Twitter, and YouTube are
effective mediums for communication
 Letters to the Editor
 News stories, columns, and reports
 Press releases and press conferences
 Presentations or presence at local events and local and
national conferences, fairs, and other gatherings
 Community outreach
 Community or national events - The Great American Smokeout,
National Literacy Day, a community “Take Back the Night”
evening against violence, and other community events can
serve to convey a message and highlight an issue.
 Public demonstrations
 Word of mouth
 Music

COMPILATION: NEMLACKSAM 2022 41

  Exhibits and public art - The AIDS quilt, a huge quilt with
squares made by thousands of people, commemorating
victims of the HIV epidemic, is a prime example.
 Movies - Since the beginnings of the film industry, movies have
carried messages about race, the status of women, adult
literacy, homosexuality, mental illness, AIDS, and numerous
other social issues.
 TV - TV can both carry straightforward messages – ads and
Public Service Announcements (PSAs) – and present news and
entertainment programs that deal with your issue or profile
your organization.
 Theater and interactive theater - A play or skit, especially one
written by people who have experienced what it illustrates, can
be a powerful way to present an issue or to underline the need
for services or change.

Several interactive theater groups in New England, by stopping the

action and inviting questions and comments, draw audiences into
performances dramatizing real incidents in the lives of the actors, all
of whom are staff members and learners in adult literacy programs.
They have helped change attitudes about adult learners and bring
information about adult literacy and learning into the community

4. RESOURCES

What do you have the money to do? Do you have the people to
make it possible? If you’re going to spend money, what are the
chances that the results will be worth the expense? Who will lose
what, and who will gain what by your use of financial and human
resources?

Your plan should include careful determinations of how much you

can spend and how much staff and volunteer time it’s reasonable to

COMPILATION: NEMLACKSAM 2022 42

use. You may also be able to share materials, air time, and other
goods and services with individuals, businesses, other organizations,
and institutions.

5. ANTICIPATE OBSTACLES AND EMERGENCIES

Any number of things can happen in the course of a communication

effort. Someone can forget to e-mail a press release or forget to
include a phone number or e-mail address. A crucial word on your
posters or in your brochure can be misspelled, or a reporter might
get important information wrong. Worse, you might have to deal
with a real disaster involving the organization that has the potential
to discredit everything you do.

It’s important to try to anticipate these kinds of problems, and

to create a plan to deal with them. Crisis planning should be part of
any communication plan, so you’ll know what to do when a problem
or crisis occurs. Crisis plans should include who takes responsibility
for what – dealing with the media, correcting errors, deciding when
something has to be redone rather than fixed, etc. It should cover as
many situations, and as many aspects of each situation, as possible.

6. STRATEGIZE HOW YOU’LL CONNECT WITH THE

MEDIA AND OTHERS TO SPREAD YOUR MESSAGE

Establishing relationships with individual media representatives and

media outlets is an essential part of a communication plan, as
is establishing relationships with influential individuals and
institutions in the community and the population you’re trying to
reach. You have to make personal contacts, give the media and
others reasons to want to help you, and follow through to sustain
those relationships to keep communication channels open.

The individuals that can help you spread your message can vary
from formal community leaders – elected officials, CEOs of

COMPILATION: NEMLACKSAM 2022 43

prominent local businesses, clergy, etc. – to community activists and
ordinary citizens. Institutions and organizations, such as colleges,
hospitals, service clubs, faith communities, and other health and
community organizations, all have access to groups of community
members who might need to hear your message.

7. CREATE AN ACTION PLAN

Now the task is to put it all together into a plan that you can act on.
By the time you reach this point, your plan is already done, for the
most part. You know what your purpose is and whom you need to
reach to accomplish it, what your message should contain and look
like, what you can afford, what problems you might face, what
channels can best be used to reach your intended audience, and
how to gain access to those channels. Now it’s just a matter of
putting the details together – composing and designing your
message (or messages, if using multiple channels), making contact
with the people who can help you, and getting everything in place to
start your communication effort. And finally, you'll evaluate your
effort so that you can continue to make it better.

8. EVALUATION

If you evaluate your communication plan in terms of both how well

you carry it out and how well it works, you’ll be able to make
changes to improve it. It will keep getting more effective each time
you implement it.

And there’s really a ninth step to developing a communication plan;

as with just about every phase of health and community work, you
have to keep up the effort, adjusting your plan and communicating
with the community.

Online Resources

COMPILATION: NEMLACKSAM 2022 44

Communications Planning: Getting the Right Messages
Across in the Right Way, by Mindtools.com, will help you through
the preparation steps as well as create an audience-focused
communication plan that is sure to get your message heard.

Creating a Communications Action Plan, from via Sport in

British Columbia.

Developing a Communication Plan, by the Pell Institute and

Pathways to College Network, is an excellent, simple resource
providing information on how the communication plan should be
designed as well as questions to be answered in order to develop a
working and effective plan.

MED Communication Handbook. This 119-page PDF booklet was

prepared by Pinnacle Public Relations for the European Territorial
Cooperation MED Programme, 2007-2013.

Media Advocacy by Sandra A. Hoover

Newsworthy elements, from the Berkeley Media Studies Group,

includes a checklist of questions by category to help you prepare
and focus your story.

Planning Before You Communicate. This helpful tool developed

by the Public Health Foundation will help you to address and
organize essential factors of communications planning, execution,
and evaluation. Doing this preparation work before you
communicate will save you valuable time and resources when and
where they are needed most.

Strategic Communications Planning

Worksheet: Crafting your media advocacy plan, from the

Berkeley Media Studies Group, can help you identify key moments in
the political process or opportunities — such as holidays,

COMPILATION: NEMLACKSAM 2022 45

anniversaries or other key dates — far enough in advance that you
can prepare and act effectively.

Principles of good communications objectives are

They focus your activity, so there should not be too many of them. Aim for five
or less. The more specific and measurable you make them, the more focused
and efficient your communication can be.

SETTING COMMUNICATIONS OBJECTIVES

Your communications strategy and communications plan should

focus on delivering the communications objectives you set.
Principles of good communications objectives are; they derive from
your wider project objectives. The two key questions in this process
are “what is our project trying to do?” and “how can our
communications help do it?”

They focus not just on outputs (how many leaflets, posters or pieces
of media coverage are produced) but also on outcomes (the
behaviour or action you wish to see in your colleagues, funders,
patients, etc.). They focus your activity, so there should not be too
many of them. Aim for five or less. The more specific and
measurable you make them, the more focused and efficient your
communications can be. Be realistic about what communications
can achieve. Below are some examples of what communications can
help with in a health care setting:

 Increase the intended audience’s knowledge and awareness of

a health issue, problem or solution.
 Increase the intended audience’s awareness of a project,
department or organisation.
 Influence perceptions, beliefs, and attitudes that may change
social norms.

COMPILATION: NEMLACKSAM 2022 46

  Prompt action.
 Demonstrate or illustrate skills or best practice.
 Reinforce knowledge, attitudes or behaviour.
 Show the benefit of behaviour change.
 Advocate a position on a health issue or policy.
 Increase demand or support for health services.
 Refute myths and misconceptions.

SETTING COMMUNICATIONS OBJECTIVES

Setting communication goals and objectives creates several benefits. It

lets people know what is expected of them, it lets others know what is
planned, it helps to quantify the resources that are needed and when, it helps
to improve communication between the participants, and it creates
measurable results.

Should an emergency occur, countries will need to develop a set of communication

objectives. If countries have explored qualitative and quantitative studies about
household behaviors, cultural and social norms that govern behaviors, traditional
beliefs, and health seeking practices, knowledge about key health information and
media habits in advance, and expanded that information base with data about the
emergency, then developing these objectives will be fairly straightforward. As
indicated previously, communication objectives concisely describe desired changes in
the audiences as a result of seeing, hearing, participating in or having heard about a
specific SBCC intervention. Behavioral factors that influence these changes include
(but are not limited to) knowledge, thoughts, beliefs, feelings or practices.
Communication objectives should be developed according to the audiences’
communication needs linked to the emergency and should address the factors most
likely to contain the outbreak as determined by the program objectives. Unit 2: Rapid
Needs Assessment, Unit 4: Audience Analysis & Segmentation and Unit 5: Audience
Profiling can help you develop appropriate, evidence-based communication
objectives.

COMPILATION: NEMLACKSAM 2022 47

Communication objectives need to be SMART. The acronym SMART, described
below, is used to highlight some important criteria that help focus the objective and
monitor progress.

Specific: The objective should clearly define the expected outcome and should answer
questions such as who is involved what will be achieved and where. A specific
objective will help define activities.
Measurable: The objective should include an indicator of progress and should answer
questions such as how often or how much. This will determine whether the objective
is achieved.
Attainable: The expected change defined in the objective should be realistic within the
given timeframe and with the available resources.
Relevant: The objective should contribute to achieving the overall program goal. This
will support developing activities that are important to the program.
Time-bound: The objective should include a timeframe for achieving the desired
change.
An easy way of developing measurable communication objectives is to ask the
following three questions:

 What do you want your audience to do?

 When do you want your audience to do it?
 What is the benefit to the audience if they do what you want them to do?
Use the following prompt questions to help draft your
communications objectives
Which of your project’s objectives need communications input to
succeed?
Taking each one of these project objectives in turn, use the following
prompt questions to help draft your communications objectives. You
can record these objectives in the Communications strategy
template. Broadly, what will your communications need to do to
deliver this objective? Who will you need to engage to achieve this

COMPILATION: NEMLACKSAM 2022 48

objective? Even at this early stage, before you have identified or
prioritised audiences, try to be as specific as possible. Avoid very
broad categories like ‘the public’ or ‘healthcare professionals’. What
will you want that audience to do?

Awareness
Prompt knowledge, build understanding, and gain recognition.

Action
Join, visit, sign up to, attend, disseminate, accept, support.

Engagement
Create information exchange, change practice, change behaviour or
beliefs.

How will you know you have succeeded? Within what timeframe will
we do it?

What targets or indicators can show that we have achieved the

above?

When will we do this by? Raise awareness? Prompt action? Impart

knowledge?

Win support for different ways of working? Stimulate a want or

desire?

Examples of Objectives
We will raise awareness in audience A of the risk of dispensing
(sample medication) to (type of audience) by building understanding
of (a specific issue). Leading to an X% drop in (medical condition)
cases between 2016 and 2018. We will gain and demonstrate
recognition of the X issue among Y audience by recruiting X network
members between December 2015 and September 2016.
Remember: Developing objectives is an iterative process: at this
stage you will be able to establish your objectives in broad terms. As

COMPILATION: NEMLACKSAM 2022 49

you work through the detail of your communications strategy, it may
be possible to be more specific about audiences, targets you wish to
meet, etc.

BASIC IEC PRINCIPLES

IEC Planning: Eight State-of-the-Art-Principles

For the purpose of staying in line with the dictates of IEC

Principles, the Eight-State- of-the-Art is a model that has
been generally recommended by great health
communication experts which include:

 Policy and Resource Check (Decisions/financial, human

and material)
 Assessment (Critical evaluation upon observations
with valid statistics)
 Audience Analysis (Target audience needs and
potentials)
 Strategy Design (Communication strategy should be
most suiting)
 Message Research and Pre-Testing (Framing
appropriate messages)
 Participation and Feedback (All inclusive
involvement/follow-up)

COMPILATION: NEMLACKSAM 2022 50

  Management (Sustenance projections/running cost
from beginning to end)
 Evaluation and Collaboration (Stock taking which
informs health team on successes and failures and
possible partnerships-WHO, UNDP, WFP and others)

SOCIALISING IN A HEALTHCARE ENVIRONMENT

Anthropology views humans as socio-political beings. As social beings, humans

(healthcare providers) are bound to network, socialize, interact, relate and
communicate with their clients, colleagues, caregivers, relations and all other
human beings they meet or who cross their paths. This explains why is often
argued that “no man is a social island”.

No matter how good or bad your attitude and character is, you will always have
those who cherish you on the one hand and those who hate you for now genuine
reasons whatsoever on the other. Hence, as humans, we are bound to socialize in
the multiple social settings where we find ourselves. This lesson on socialising
has the following projections to advance:

- As long as there is human existence, there will always be conflicts,

misjudgements and misunderstandings of various forms. Nevertheless,
our potential ability to manage the numerous social networking barriers
that show their faces and overcome them accordingly is what makes us
excellent social networkers.
- Social networking therefore is an art that needs to be learned. This means
we should be aware that there is a standard pattern of human and social
interaction that all humans in general and healthcare professionals in
particular must consciously follow, so that the obvious social networking
challenges that come their way can be overcome with relative ease.

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- In social networking, you must first of all understand who you are, before
struggling to know who others are; this is so because when you
understand who you are, it is very normal that you will be able to rapidly
identify or notice common differences in behaviour and attitude in others
and act consciously. For example, you must know who you are (whether
you are an introvert or an extrovert), and capitalize on your social
interactive strengths, while doing all you can to improve on your social
weaknesses.
- As a result of the fact that health workers meet people from diverse
backgrounds or walks of life, it is important that they avail themselves
with the necessary social interactive skills that will help them flow in
their respective disciplines. The following skills are presented to serve as
guide in this very challenging activity called socialising or social
interaction:

A. The Healthcare Provider and Clients/Caregivers, Relatives and

Others
1. Courtesy
2. Respect
3. Empathy
4. Sympathy
5. Endurance/perseverance
6. Support
7. Professionalism-privacy, confidentiality, etc.
8. Love
9. Passion in the discharge of your role as a healthcare provider
10.Patience
11.Comprehension/understanding
12.Forgiveness and tolerance

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 13.Dynamism, flexibility/elasticity
14.Sociable and nature-friendly

B. The Healthcare Provider and Colleagues/Other Health Workers

They say don't mix business with pleasure, but not socialising with your
colleagues can be very bad for your career and mark you out as a loner or
some incontinence one who does not care. Any form of socialising with
co-workers outside of the office can be positively useful - and fun. After
all, you are all working together so it helps you build relationships and
perhaps get to see people - and situations in a different perspective away
from deadlines and work.
Everyone has a personal life as well. Getting to know a little bit about
those people can help make the day go by much faster. When you work,
you spend a large portion of your time with co-workers. In many
instances, more time than you do with your own family.

- All the above social skills or tips (For A above which relate to
Nurse/Patient…)
- Tolerance
- Being one another’s keeper
- Team work
- Respect for hierarchy
- Leadership skills (top-bottom or bottom-top)
- Fairness and love

It should be noted that all healthcare providers who master the above social
networking skills to their fingertips will excel in their interactive processes and
rise to the status of social networkers par excellence.

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 Socialising Strategy (or Socializing strategy)

Phil Jones | Updated 4 Jan, 2018 | Communicating & Socialising Strategy,

Socialising strategy

Our clients love the idea of socialising strategy, rather than merely
communicating their strategy. They understand the distinction between
socialising and communicating strategy. When they are socialising their
strategy, it makes a big difference to how they think about, talk about and test
their strategy.

How does socialising strategy differ from communicating strategy?

Well let’s start with the phrase “Socialising strategy” (Or “socializing
strategy”). It’s interesting how this immediately puts a different emphasis on
what is happening. It is no longer about getting the message out
(Communicating). It is about the social impact and the conversation within
groups, and amongst people, about the strategy.

Socialising strategy suggests that the strategy becomes part of a conversation

amongst people that has a life of its own. Individuals own a part of it, talking to
each other about it and adopting and adapting what it means for them.

Socialising strategy also suggests that it becomes part of the social fabric. It is
part of the way people work, what they do, what they say, how they behave, and
what they believe.

Socialising strategy suggests it has a life of its own amongst those people

Socialising strategy is far more than repeated communication

So you told them about your strategy, told them again, and then again once
more for good measure.

COMPILATION: NEMLACKSAM 2022 54

But here is the rub – they still don’t get it. Their behaviours, language, actions
still are not reflecting the new behaviours, language or actions that you were
hoping for.

Now I could trot out clichés about the biggest mistake in communication is
thinking that you have already communicated. However, all that would happen
is that you would tell them again. Now, how is that going to help? If that
worked they would have got it the first time.

So what do excellent executives do at this point?

They focus on something completely different. They think about “socialising
their strategy”.

Now, just for a moment think what that means. Your purpose is not simply to
communicate your strategy. You have to socialise it? It has to become part of
the social fabric of the organization. It becomes a way of thinking and acting.
It becomes how people talk about it.

Imagine the strategy being discussed, debated and explored on Facebook,

LinkedIn or next to the coffee machine. Imagine people posting their thoughts
about it on their websites. Discussing it with their friends.

Imagine you wanted to change your neighborhood. How would you go about
it? Imagine you wanted to change the way people interacted? What would you
do?

 Socialising your strategy is a shift of emphasis and a change in the way

people think.
 Socialising strategy demands that you do something deeper and more
significant than merely talk.

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  Socialising strategy requires a more thorough, intensive and even obtuse
approach to getting the message out.
 Socialising strategy causes executives to change how they think about the
problem.

Just try it for a while – I think you will be surprised what a difference
socialising strategy your will make. You can read more about how to socialise
your strategy.

Socialising strategy is not (simply) about social media: With all the emphasis
on social networking, Facebook, LinkedIn, WhatsApp, etc., the phase on
everyone’s lips is “Social networking”. But this is such a narrow view of
socialising strategy that it just confuses and obscures what is important about
socialising strategy.

So how does socialising an idea apply to socialising strategy?

It is interesting how this phrase seems to convey so much more than
communicating strategy. It also gets beyond the glib phrase “Culture” to a far
more specific meaning than, “We want our strategy to reflect our culture” or
“We want our culture to drive our strategy” With “socialising strategy”, we are
describing how it becomes a part of the way people work, think and behave.

It is also a more explicit instruction to management. Rather than suggesting

managers need to “Communicate the strategy” (which is an action for them),
they are responsible for “socialising the strategy” which is a response from
other people. In other words, instructing a management team to “Socialise their
strategy” means that the emphasis is not just on communication, but on how
people respond to the communication and behave as a result.

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I write a lot about socialising strategy in my book, Communicating strategy: On
reflection, I should have called that book “Socialising Strategy” in the first
place, but you can’t change a title once you have an ISBN Number.

Things to think about when considering socialising your strategy

So here are some questions.

1) How would you test whether your strategy has been socialised?

2) What will you see and experience if your strategy is socialised?

3) Who are the key influencers in the social fabric of your organisation?

4) What social networks and social systems should you exploit?

5) How do you get across the compelling emotional and rational story of the
strategy?

6) What do you now have to do to socialise your strategy?

PhilJones; Author Communicating Strategy

A Look at Protocol and Data Sheet in

Health
A. A. Protocol system.... In a healthcare setting,
a protocol, also called a medical guideline, is a set of
instructions which describe a process to be followed to
investigate a particular set of findings in a patient, or the
method which should be followed to control a certain
disease.

A computer based protocol system is a paradigm providing a

set of tools which allow health care providers access to current

COMPILATION: NEMLACKSAM 2022 57

guidelines which they can apply in practice.[1] Studies have
shown that protocols can aid in optimising patient care.[2] There
are two types of protocol systems: passive and active.

In a healthcare setting, a protocol, also called a medical

guideline, is a set of instructions which describe a process to be
followed to investigate a particular set of findings in a patient, or
the method which should be followed to control a
certain disease.

Passive Protocol Systems

Passive protocol systems are a source of information which

health care providers have the freedom to choose to consult or
not; they are not intrinsically incorporated into the healthcare
process. The purpose of a passive protocol system is to give
healthcare providers access to information which may remind
healthcare providers of steps during patient care which may
otherwise be forgotten or changed.

Active Protocol Systems

Active protocol systems are specific guidelines for healthcare

providers to follow. They are a central way which healthcare is
delivered. Examples of active protocol systems include trigger-
automated order entry systems and appointment scheduling.
Active protocol systems may provide an explanation function

COMPILATION: NEMLACKSAM 2022 58

which offers background information, definitions, risks, and the
rationale that supports specific recommendations.

B. Data Sheet
A datasheet, data sheet, or spec sheet is a document that
summarizes the performance and other technical
characteristics of a product, machine, component, material, a
subsystem or software in sufficient detail that allows design
engineer to understand the role of the component in the overall
system. Wikipedia.
Internet of Things Protocols and Standards
cse.wustl.edu

127196762 RFID Transponders Datasheets...

mouser.com

Communication between nurses...

sciencedirect.com

Internet of Things Protocols and Standards

cse.wustl.edu

Artificial intelligence in healthcare...

svn.bmj.com

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Clinical Decision Support Systems
healthitanalytics.com

Artificial intelligence in healthcare...

svn.bmj.com

Long-Term Potentiation by Theta-Burst...

researchgate.net

Chemical Spill Procedures | Office of...

ehs.princeton.edu

Safety Data Sheets: Information that...

acs.org

Standards - IEEE Future Networks

futurenetworks.ieee.org

Artificial intelligence in healthcare...

svn.bmj.com

Level 1: Plot setup & data collection...

mainefig.org

Prevention and Control of Infection...

nhmrc.gov.au

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Artificial intelligence in healthcare...
svn.bmj.com

Internet of Things Protocols and Standards

cse.wustl.edu

Infection Control in Health-Care...

cdc.gov

Prevention and Control of Infection...

nhmrc.gov.au

Artificial Intelligence for Health and...

healthit.gov

Healthcare in Pakistan - Wikipedia

en.wikipedia.org

Material Safety Data Sheet (MSDS ...

study.com

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Safety Symbols and Their Meanings...
dcmgroup.ca

Artificial intelligence in healthcare...

svn.bmj.com

Personal data protection: data subject...

COMPILATION: NEMLACKSAM 2022 62

i-scoop.eu

What is Risk Management in Healthcare...?

catalyst.nejm.org

Artificial intelligence in healthcare...

svn.bmj.com

COMPILATION: NEMLACKSAM 2022 63

Teledyne LeCroy Protocol Analyzers...
mouser.com

Infection Control in Dental Health-Care...

cdc.gov

Material Safety Data Sheet (MSDS ...

study.com

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Safety Data Sheet (SDS) Information...
hsa.ie

Infection Control in Dental Health-Care...

cdc.gov

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