Communication and nurse patient relationship

COMMUNICATION AND NURSE
PATIENT RELATIONSHIP
CHAPTER: IV
By,
Ms. Ekta S Patel

• Communication is a dynamic (constant change)
process that takes place around us all the time.
• In fact we spend 70% of our time receiving and
sending messages.

• Communication word derived from
• Latin - commūnicāre,
• meaning "to share"

• It is exchange of ideas, fact,
feelings, thoughts, opinions and
information which is vital in
facilitating human interaction
through (written or spoken) words,
symbols or actions.

• Communication is simply
the act of transferring
information from one
place to another/ one
person to another
person.

• It is imparting or exchanging of information by
speaking, writing, or using some other medium.

• Communication is a process in which a message is
transferred from one person to other person through a
suitable media and the intended message is received
and understood by the receiver.

• “A process by which two or more people exchange
ideas, facts, feelings or impressions in ways that each
gains a ‘common understanding’ of meaning, intent
and use of message”
- Paul Leagens.

• “Communication is a two way process of sharing and
transmitting ideas, information and message between
two or more individuals.”

• Extrapersonal communication1
• Interpersonal communication2
• Intrapersonal communication3
• Organizational communication4
• Mass communication5

Extrapersonal Communication:
• Communication is a process that takes place with
human entities and non-human entities as well.
• When communication is done with non-human entities
it is called to be extra personal communication.

• The perfect coordination and understanding
between human and non—human entities results to
extra personal communication.
• In this communication one participant of the
communication process uses sign language and the
other is verbal.

• For example, the bark of a pet dog when something
happens to the master, wagging of the tail when
master shows bone to the pet dog, licking of cheek at
the returning of master from the work field, chirping of
birds when a stranger is at the door, Parrot calling the
name of the master in the morning, etc

Interpersonal Communication:
• It involves two parties-a sender and a receiver who
use common language to transit message either
through oral communication or written
communication.

lntrapersonal Communication:
• Intrapersonal communication is all about talking to
ourselves.

• Prefix ‘intra’ means
‘within’ hence
intrapersonal
communication is ‘self
talk’.

Organizational Communication:
• In a team-based business organization,
communication becomes its lifeblood where people
communicate with one another.

• The flow of communication inside an organization
may filter in up, down and horizontal directions.

• Besides internal communication companies
depend on external communication also.
• Companies exchange messages with people
outside the organization through external
communication.

Mass Communication:
• Newspapers, magazines and periodicals, the means
of mass communication are frequently used for oral or
written communication.

• Besides, technologies such as the intemet,
e-mail, voicemail, faxes, audiotape,
teleconferencing, videoconferencing and
closed circuit televisions have increased
options for internal and external
communication.
• These fast means help people from all
parts of the world to work together.

› There are seven elements of communication:
› Source idea
› Message
› Encoding
› Channel
› Receiver
› Decoding
› Feedback
ELEMENTS:

› The Source idea is the process by which one
formulates an idea to communicate to another
party.
› This process can be influenced by external
stimuli such as books or radio, or it can come
about internally by thinking about a particular
subject.
› The source idea is the basis for the
communication.
1. Source idea:

› The Message is what will be communicated to
another party.
› It is based on the source idea, but the message is
crafted to meet the needs of the audience.
› For example, if the message is between two
friends, the message will take a different form than
if communicating with a superior.
2. Message:

› Encoding is how the message is transmitted to
another party.
› The medium of transmission will determine the
form of the communication.
› For example, the message will take a different form if
the communication will be spoken or written.
3. Encoding:

› The Channel is the medium of the communication.
› The channel must be able to transmit the message
from one party to another without changing the
content of the message.
› The channel can be a piece of paper, a
communications medium such as radio, or it can be an
email.
› The channel is the path of the communication from
sender to receiver.
4. Channel:

› The Receiver is the party receiving the
communication.
› A receiver can be a television set, a computer, or a
piece of paper depending on the channel used for
the communication.
5. Receiver:

› Decoding is the process where the message is
interpreted for its content.
› It also means the receiver thinks about the
message's content and internalizes the message.
6. Decoding:

› Feedback is the final step in the communications
process.
› This step conveys to the transmitter that the
message is understood by the receiver.
› The receiver formats an appropriate reply to the
first communication based on the channel and
sends it to the transmitter of the original message.
7. Feedback:

› The flow of communication is one way from the
communicator to the audience.
1. One-way communication:

› Drawbacks are:
› Knowledge is imposed.
› Learning is authoritative.
› Little audience participation.
› No feedback.
› Does not influence human behavior.

› In this both the communicators and the audience
take place.
› The process of communication is active and
democratic.
› It is more likely to influence behaviour than one way
communication.
2. Two way communication:

– It is officially organized channels of
communication and it is delayed
communication.
– It is authoritative, specific, accurate and reaches
everybody.
– The medium of formal communication may be
department meeting, conferences, telephone
calls, interviews, circular etc.
3. Formal communication:

› Gossip circles such as friends internet group, like
minded people and casual groups.
› Communication is very faster here.
› The informal channels may be more active.
4. Informal network:

› It is a stimulus received by the body immediately
the brain receives the information and transmits to
the respective organs through the nervous, where it
has to be passed.
5. Physiological communication:

› Extra sensory perception occurs, i.e something
which will occur in future.
› The person pertains and predicts that in advance
is called psychic communication.
6. Psychic communication:

› Person to person the message will be passed line a
chain.
› Sender passes the message to one person, then
that receiver passes information to other and so on.
7. Serial communication:

› Good communication requires awareness of
symbolic communication, the verbal and nonverbal
symbolism used by others to convey meaning.
8. Symbolic communication:

› The visual form of communication comprise charts
and graphs, pictograms, tables, maps, posters etc.
9. Visual communication:

› The traditional way of communication has been by
word of mouth language is the chief vehicle of
communication.
› Through it, one can interact with other can be
passes through.
› Direct verbal communication by word of mouth.
10. VERBAL COMMUNICATION:

› Communication can occur even without word.
› Non-verbal communication is message
transmission through body language without using
words.
› It includes bodily movements, positive, facial
expression.
› Silence is non verbal communication
11. NON VERBAL COMMUNICATION:

› By using mechanical devices the communication
will be sent.
› For e.g. internet, radio, T.V. etc.
12. MECHANICAL COMMUNICATION:

› Listening
› Broad openings
› Restating
› Clarification
› Reflection
› Focusing
› Sharing perceptions
› Silence
› Humour
› Informing
› Suggesting

› An active process of receiving information.
› The complete attention of the nurse is required
and there should be no preoccupation with
oneself.
1. Listening:

› Listening is a sign of respect for the person who is
talking and a powerful reinforce of relationships.
› It allows the patients to talk more, without which the
relationship cannot progress.

› These encourage the patient to select topics for
discussion, and indicate that nurse is there,
listening to him and following him.
› For e.g. questions such as what shall we discuss
today? ―can you tell me more about that‖? ―And
then what happened?‖
› From the part of the nurse encourages the patient
to talk.
2. Broad openings:

› The nurse repeats to the patient the main thought
he has expressed.
› It indicates that the nurses is listening.
› It also brings attention to something important.
3. Restating:

› The person‘s verbalization, especially when he is
disturbed or feeling deeply, is not always clear.
› The patients remarks may be confused, incomplete
or disordered due to their illness.
› So, the nurses need to clarify the feelings and ideas
expressed by the patients.
4. Clarification:

› The nurses need to provide correlation between the
patient‘s feeling and action.
› For example ―I am not sure what you mean ―?
―Could you tell me once again?‖ clarifies the
unintelligible ideas of the patients.

› This means directing back to the patient his ideas,
feeling, questions and content.
› Reflection of content is also called validation.
› Reflection of feeling consists of responses to the
patient‘s feeling about the content.
5. Reflection:

› It means expanding the discussion on a topic of
importance.
› It helps the patient to become more specific, move
from vagueness to clarity and focus on reality.
6. Focusing:

› These are the techniques of asking the patient to
verify the nurse understands of what he is thinking
or feeling.
› For e.g. the nurse could ask the patient, as ―you
are smiling, but I sense that you are really very
angry with me‖.
7. Sharing perceptions:

› This involves identifying the underlying issues or
problem experienced by the patient that emerges
repeatedly during the course of the nurse-patient
interaction.
› Once we identify the basis themes, it becomes easy
to decide which of the patient‘s feeling and thoughts
to respond and pursue.
8. Theme identification:

› This is lack of verbal communication for a
therapeutic reason.
› Then the nurse‘s silence prompts patient to talk.
› For e.g. just sitting with a patient without talking,
non verbally communicates our interest in the
patient better.
9. Silence:

› This is the discharge of energy through the comic
enjoyment of the imperfect.
› It is a part of nurse client relationship.
› It is constructive coping behavior, and by learning to
express humor, a patient learns to express how he
feel.
10. Humor:

› This is the skill of giving information.
› The nurse shares simple facts with the patient.
11. Informing:

› This is the presentation of alternative ideas
related to problem solving.
› It is the most useful communication technique when
the patient has analyzed his problem area, and is
ready to explore alternative coping mechanisms.
› At that time suggesting technique increase the
patient‘s choices.
12. Suggesting:

The two main ways it is used in communication are:
• verbal,
• non-verbal

• Both spoken (type words and tone of voice,
speed),
• written (words and the meaning they convey),
• timing
• and clarity of the message.
Verbal communication

› body language,
› facial expressions,
› posture,
› gait (manner of walk)
› gestures,
› nods, etc.
Non-verbal communication

• Effective communication involves either a personal
(face to face) communication or some means of an
encounter that requires the following four necessary
components:
• a sender,
• a message,
• a receiver
• and a response.

› Sender may one, two or a group of people with a
message to send/convey and a system of sign(s) or
symbol(s) (code, i.e. – language, etc.) to use in
transmission/sending (encoding) it.
Sender

• Message (from sender) and (from receiver) =
contents or meaning, language (words arrangement
and use) and the tone which the message is meant
to convey.
Message

• Receiver is the recipient/listener of the message
decodes (i.e. – relates to or understands message)
and returns communication.
Receiver

› Response is the message or feedback (non-verbal
cues, i.e. winks, nods, etc.) that the receiver sends
back to the sender.
Response

› Definition of Attending Skills
› Attending is a skill that involves the nurse observing
client verbal and nonverbal behaviours as one way of
understanding what clients are experiencing, and
displaying effective nonverbal behaviours to clients.
› Egan (1994) elaborates upon these two major aspects
of attending, which he refers to as “psychological
attending,” and “physical attending,” respectively.
1. Attending Skills
.

› The attending cluster consist of the following Skills:
› A Posture of Involvement
› Appropriate Body Motion
› Eye Contact
› Creating a Non distracting Environment

› Bolton, in his book People Skills (1979), describes
attending as giving all of your physical attention
to another person.
› The process of attending, whether you realize it or
not, has a considerable impact on the quality of
communication that goes on between two people.
› For example, by attending you are saying to the
other person "I am interested in what you have to
say", however, a lack of good attending
communicates that "I really don't care about what
you have to say."

› The body can be used as a tool to facilitate good
communication. This is done through positioning the
parts of the body so that they invite and hold an
interpersonal relation. A relaxed alertness
expressed by body posture seems best suited for
fostering good communication

› Bolton offers these suggestions to establish a posture
of involvement:
› Lean toward the speaker. This will communicate
energy and attentiveness.
› Face the other squarely (i.e., your right shoulder to
the speakers left). This communicates your
involvement. It is especially important for you to
position yourself so that you are at eye level with the
speaker if you are seen as a authority figure. This will
circumnavigate feelings of threat and can greatly aid
in forming an interpersonal relationship.

› Maintaining an open posture is also important for
fostering interpersonal relatedness. A closed
posture (i.e., crossed arms and or legs) often
communicates coldness and defensiveness.
› You also need to be aware of your proximity to the
speaker. We all have a concept of "personal space."
When those boundaries are crossed it puts the
other on the defensive and makes them feel
uncomfortable. However, to much distance
communicates aloofness and disconectedness.

› Body motion, it's a funny thing! Have you ever paid
attention to what your hands were doing during the
course of a conversation? Some of us simply shove
them in our pockets or let them hang aimlessly by
our sides.
› Then there are others, like me, who tend to fling
them around as if to place some kind of emphasis
on each word! There is such a thing as too little and
too much.

› Body motion is good but it can be over done if you
are not careful.
› The purpose of gesturing when you are listening is
to encourage the speaker to continue speaking.
This can most easily be done with a periodic head
nod. A good listener moves his or her body
in response to the speaker.

› Effective eye contact says that you are visually
attuned to what the speaker is saying.
› Good eye contact involves focusing on the speakers
face and occasionally shifting the focus to other parts
of the body.
› The key is that the other is aware that they have your
attention because your eyes are "on them".
› Good eye contact should seem natural to the other
person. What ever you do, don't "stare them down."
This makes you seem anxious and sometimes critical
of them.

› The environment where the communication takes
place is also an important factor in whether an
interpersonal relationship can be formed.
› It is not always possible to move the conversation
into a private room or office, but every attempt
should be made to reduce the number of
distractions that are present.

› In his book, The Skilled Helper (1998), Gerad
Egan offers what he has labelled the Micro Skills
of Attending.
› The are very close to the information presented
above from Bolton's People Skills.
› S - face the client squarely
› O- have an open posture
› L- lean into the conversation
› E- eye contact
› R- be relaxed

› What Is Rapport?
› Rapport forms the basis of meaningful, close and
harmonious relationships between people.
2. Report building relationship

› According to researchers when you have a rapport
with someone, you share:
› Mutual attentiveness: you're both focused on, and
interested in, what the other person is saying or
doing.
› Positivity: you're both friendly and happy, and you
show care and concern for one another.
› Coordination: you feel "in sync" with one another,
so that you share a common understanding. Your
energy levels, tone and body language are also
similar.

› How to Build Rapport?
› Rapport must be a two-way connection between
people, so it's not something that you can create by
yourself.
› You can, however, learn how to stimulate it by
following these six steps.

› 1. Check Your Appearance
› First impressions count , and your appearance
should help you to connect with people, not create
a barrier.
› A good rule of thumb is to dress just a little "better"
than the people you're about to meet.
› However, if you arrive and see that you're
overdressed, you can quickly dress down to suit the
situation.

› 2. Remember the Basics
› Always remember the basics of good
communication :
› Be culturally appropriate.
› Smile.
› Relax.
› Remember people's names .
› Hold your head up and maintain a good posture.
› Listen carefully and attentively .
› Don't outstay your welcome.

› 3. Find Common Ground
› Identifying common ground can help to establish
rapport, so use small talk to find something that
you both share.

› 4. Create Shared Experiences
› Rapport can't grow without human interaction, and a
great way to interact is to create new, shared
experiences.
› Shared experiences can be as simple as attending the
same conference session together, or as complex as
cooperating on a new management process.
› Working collaboratively to define problems, devise
solutions, and design strategies, for example, can help
to bring you and the other person closer.

› 5. Be Empathic
› Empathy is about understanding other people by seeing
things from their perspective, and recognizing their emotions.
› So, to understand and share another person's perspective,
you need to learn what makes him tick.
› You need to really hear what they say, so that you can
respond intelligently and with curiosity. So, it's important to be
a good listener, and to fine-tune your emotional
intelligence. You can also use Perceptual Position – a
technique for seeing things from other people's perspectives

› 6. Mirror and Match
› Research shows that we prefer people who we
perceive to be just like ourselves.
› Mirroring and matching are techniques for building
rapport by making yourself more like the other
person.

techniques to build rapport:
› Watch the other person's body language , including
gesture, posture and expression.
› Adopt a similar temperament. If the other person is introverted
or extroverted, shy or exuberant, you should behave in the
same way.
› Use similar language . If he uses simple, direct words, then
you should, too. If he speaks in technical language, then match
that style. You can also reiterate key or favourite words or
phrases.
› Match the other person's speech patterns, such as tone, tempo
and volume. For ex, if he speaks softly and slowly, then lower
the volume and tempo of your voice.

› Re-Establishing Rapport
› It takes time to rebuild rapport when it has been lost.
› First, address why you lost rapport in the first place.
› Be humble and explain honestly and simply what
happened. If you need to apologize , do so.
› Next, focus on ways of repairing any broken trust. Put
in extra work if you need to, and keep your word.
› Transparency and genuine concern for the other
person's needs will go a long way to rebuilding trust
and re-establishing rapport.

› Empathy is the ability to accurately put yourself "in someone
else's shoes"– to understand the other’s situation,
perceptions and feelings from their point of view – and to be
able to communicate that understanding back to the other
person.
› Empathy is a critical skill for you to have as a leader. It
contributes to an accurate understanding of your employees,
their perceptions and concerns.
› It also enhances your communication skills because you can
sense what others want to know and if they are getting it from
you or not.
3. Empathy skill

› Guidelines to Develop Empathy
› 1. Experience the major differences among people.
› 2. Learn to identify your own feelings – develop
some emotional intelligence.
› 3. Regularly ask others for their perspectives and/or
feelings regarding a situation.

› By using empathy in our interactions with clients will:
Build the relationship
Stimulate self-exploration
Check understanding
Provide support
Assist communication
Focus attention on the client

› what a counsellor should and should do when
using empathy with challenging clients
› A counsellor should:
› Give themselves time to think, take time to listen
and understand the client’s perspective
› Use short responses
› Gear your response to the client — but be yourself.
e.g. using appropriate language
› Always respond

› A counsellor should refrain from:
› Asking inappropriate questions
› Using clichés
› Making interpretations or judgements
› Giving advice
› Pretending 7032+22 to understand — clarify the
facts rather than misinterpret
› Parroting or using the client’s exact words
› Using sympathy and agreement

FACTORS THAT
INFLUENCE
COMMUNICATION

› It helps in modifying both the message and the
response.
› Example: a message to an astronaut requires
modification if sent to either a lay person or a ten
years old child.
Development –

› It is male and female develop differently and so
have some difference communicate, even in
adulthood.
Gender

› The standards (personal, communal and
societal) that influence behavior – therefore,
personal value traits and experiences do
influence the perception of communication
and behaviors of others as well as the response
to them.
Values

› Perception is a personal view of any situation,
which in effect, influences the perception and
response to events.
Perception

› Attitude = caring, concern, interest, etc.,
› They are portrayed or betrayed by either good or
bad mood.
Attitude

• Roles = student/teacher, father-mother/son-
daughter, roles etc.
Roles

• Relationships = this is a similar role as the
teacher/student relationship above.
Relationships

• The environment = a comfortable
surrounding with controlled temperature, and
noise-free, etc.
The environment

› Congruence (agreement or harmony) = this refers
to compatibility of verbal and non-verbal messages
– that they both match and not seen as giving two
or more different messages.
Congruence

Barriers to communications occur principally
as a result of non-therapeutic
communication. Good examples to this failure
include:
• Wrong or improper decoding of the
message.
• Poor choice of words.
• Wrong tone – raised voice, etc.

• Failure to listen – not listening by looking
away or doing other things as a sign of
disinterest.
• Wrong environment or poor environmental
control – noisy surrounding or environment.
• Wrong timing – while or when client is eating
or doing something or in pain.
• Inconsideration by the nurse or health
professional- client eating or sleeping, with
nurse not willing or ready to wait.

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