Communication

Mrs. Sunita
UPUMS
Faculty of Nursing
 Introduction
• Communication is the giving, receiving or exchanging of information,
opinions or ideas so that the message is completely understood by
everybody involved. A two-way process,
 Definition
• Communication is a process by which information is exchanged
between individuals through a common system of symbols & signs of
behavior.
- Webster’s Dictionary
• Communication is interchange of thoughts, opinions or information by
speech, writing or signs.
- Robert Andersion
 Meaning of Communication
Communication as:-
A process through which individuals mutually exchange their ideas,
values, thoughts, feeling & actions with one or more people.
 The transfer of information from the sender to the receiver so that it is
understood in the right context.
 The process of initiating, transmitting & receiving information.
 The means of making the transfer of information productive & goal
oriented.
 The process of sharing information, ideas & attitudes between
individual.
 Elements of Communication
Referent
• A referent motivates the sender (or receiver) to share information
(message, objects, sounds, sights, time schedule, ideas, perceptions,
sensation, emotion, odour, etc.) that may initiate communication.

• For example, a nurse, sighting a patient with difficulty in breathing

may serve as a referent to the nurse promoting her to initiate
communication with the patient.
 Sender:
• A sender is a person who encodes & sends the message to the
expected receiver through an appropriate channel.

• A sender is the source of the message that is generated to be delivered

to the receiver after appropriate stimulus from the referent.
 Message:
• The message is the content of communication & may contain verbal,
nonverbal or symbolic language.

• Perception & personal factors of the sender & receiver may sometimes
distort this element & the intended outcome of communication may not
be achieved. For ex, the same message may be communicated or
perceived differently by two individuals.
 Channel
• A channel is a medium through which a message is sent or received
between two or more people.
• Several channels can be used to send or receive the message, i.e
seeing, hearing, touching, smelling, & tasting.
• While selecting channels of communication, several factors must be
considered: availability of channel()s , purpose, suitability, types of
receivers, types of message, preference of sender & receivers,
communication skills of the sender, cost, etc.
 Classification of channel of
communication
• Visual channel: Facial expression, body language, posture, gestures,
pictures & written words, electronic mails, mass media, etc.
• Auditory channel: Spoken words, sounds, telephone or mobile
communications, delivering audio content (radio, voicemail), etc.
• Tactile channel: Touch sensations, therapeutic touch, etc.
• Combined channel: Audiovisual media, consoling a person with
touch & spoken words.
 Receiver
• Receiver is an individual or a group of individuals intended to
receive, decode & interpret the message sent by the sender/source of
message.

• A receiver also known as decoder.

• He is expected to have the ability & skills to receive, decode &

interpret the message.
 Feedback
• It is a return message sent by the receiver to the sender.
• It is most essential element of the communication process as it shows
that the receiver has understood the primary message sent by the sender
& the communication process is now consider complete.
• A successful communication must be a two-way process where the
sender sends the message & receives feedback from the receiver.
• These feedback could be verbal & nonverbal.
 Confounding Elements
• These elements are not a direct part of the flow of the communication
process but influence the communication process significantly in
directed.
• These elements are interpersonal variables of the sender & the receiver
& the environment where the communication process take place.
• Interpersonal variables such as perception, beliefs, values,
sociocultural background, educational & developmental levels, emotion,
gender, physical & mental health, etc. may significantly affect the
communication process.
 Purposes Of Communication

– To obtain information
– To influence others
Purposes of Communication In Nursing
 To collect assessment data
 To initiate intervention
 To evaluate outcome of intervention
 To initiate change which helps in promoting health
 To improve nurse-patient relationship
 To take measures for preventing legal problems associated
with nursing practice.
 To analyze factors affecting the health team.
Important Characteristics of Communication:

It is a two-way process.

Communication process happens between or among two or more parties.
Communication involves exchange of ideas, feelings, information, thoughts, and
knowledge.
Communication involves mutuality of understanding between Sender and
Receiver.
Communication is a continuous process.
 Types of Communication
I. Based on Relationship
(i) Formal communication: It is the communication between officials on
various positions in any organization or institution, e.g between nursing
superintendent and staff nurse.
 It occurs officially, e.g. in the hospital, company, college, school etc.
 It occurs in formal way. i.e. formal language is used and it is done
for the welfare of organization.
 It involves transmitting official message within or outside the
organization.
 Line of authority and unity of command are maintained.
 It involves also communication between the departments.
(ii) Informal Communication: It is the communication between two
people, may be in social system or in organization.
e.g. Interaction between two close friends.
It is very simple.
 This is very informal talk with the people.
e.g. Gossiping, back-biting etc.
 There is no formality in delivering the message among people.
 The message is enalic and no one can be held responsible.
 II. Based upon Flow
(i) Upward communication : Communication occurs from bottom to the
top. It may be in the form of suggestions, complaints, report etc.
– It can be verbal or in written form.
e.g. 1. Application for leave.
2. Suggestions from staff nurses to Nursing Suprintendent for
improving the quality care in Hospital.
3. Incidental report given by staff nurse regarding wrong medication.
4. Written complaint by staff nurse to the Director/President regarding
the misbehavior of the Nursing Suprintendent/Doctor.
(ii) Downward communication
• * It is the communication which occurs from top to bottom such as
communication from superior to subordinate.
• e.g. From Nursing superintendent to staff nurses.
• Downward communication is done to:-
• – Convey information (in the form of circular), instructions (policy,
rule and regulations), orders (transfer, promotion etc.) which are
related to organizational activities and policies.
• e.g. Information conveyed by President to Nursing superintendent
regarding Hospital policies, promotion of employees etc.
(iii) Horizontal communication: The communication flows horizontally among
same hierarchical levels.
e.g. Communication among colleagues.
— Communication among lecturers.
— Communication among staff nurses
— Communication among clinical instructors.
* This kind of communication helps to improve the understanding among group.
(a) One way communication : It is the flow of communication from sender to
receiver only.
 It always flows in one direction.
There is no feedback i.e. sender will not receive response from receiver.
* No participation of receiver.
e.g. Lecture delivered by Teacher in class room.
(b) Two way communication :
– It is the flow of communication from sender to receiver and again
from receiver to sender.
–There is participation of the receiver or learner/listener
– It flows in two directions i.e. forward and backward.
– Here the message passes from sender to receiver and from receiver to
sender in the form of feedback example : Group discussion.
– Receiver may add something or raise questions.
– It involves active learning.
 III. Others :
(i) Visual Communication : In this communication message is
conveyed using symbols in the form of charts, maps, posters, painting
etc. Also known as symbolic communication.
e.g. Displayed models in exhibition.
Displayed posters on the wall.
(ii) Telecommunication : It is the process of communicating in distant
places with help of electromagnetic appliances.
e.g. Television, Radio, Internet etc.
(iii) Meta Communication : This communication occurs in deeper sense.
It conveys message within a message
e.g. Saying “ Just kidding” after telling a joke.
Or Laughter nervously after some funny movement over one’s.
* In such communication client’s verbal and non verbal cues may/may
not match.
 Modes of Communication
Mode means the way by which communication occurs. The message
can be sent verbally (talking) or non verbally (gestures).
Mode of communication: There are two modes of communication, i.e.
Verbal and Non verbal. These are described as follows:
 Verbal Communication
It includes all the words, the speaker speaks. Talking is most common
activity. It is the primary tool of instruction while speaking.
Source/sender communicates beliefs, values, perception, meaning,
interest and also understands it. The various aspects of verbal
communication are following:
(i) Vocabulary : For the effective communication, sender as well as
receiver should have similarity in language, understanding. Because
person belonging to different culture, ethnic group may find difficulty to
understand and interpret the message.
(ii) Pacing: Using pause at right time in order to make communication
effective. Sender must speak slowly, clearly and use pauses to stress
particular point. Giving pause helps the listener to understand. If sender
talks rapidly, using pauses at awkward time, speaking very slowly, using
slurred speech, can convey an unintended message. Even long pause,
shifting to another topic may give wrong impression of telling lie.
(iii) Dennotative and Connotative meaning: The Dennotative meaning
is shared by individuals who use common language.
e.g. Punjabi people using language “Punjabi”.
(iv) Simplicity: For effective verbal communication, sender must use
simple language, easily understood words, brevity and complete words.
Language/message conveyed by nurse should be so simple that it could
be interpreted easily by a layman.
(v) Clarity and Brevity: Conveyed message should be very simple and
clear, short to minimize confusion. Sender uses simple words and
directs to make communication effective. Brevity means using few
necessary words for making message easily understood.
(vi) Timing and Relevance: If the message conveyed is in simple
language, less time will be consumed for understanding it. Even the
timing for interaction also matters.
(vii) Adaptability-Spoken message should be modified as per client’s
behavioral clues. This adjustment is known as Adaptability. For example
: Nurse must know how to speak and express her gestures while
interacting with an elated client or depressed client. As per client’s
behavior, nurse should alter her tone of speech and expression.
(viii) Credibility: Credibility means worthiness of belief, trust
worthiness, reliability. Nurse fosters credibility by being consistent,
dependable and honest. For this nurse must be knowledgeable as well as
skilful and should provide accurate information to client. By doing so
she can gain trust of client.
(ix) Humor : Humor is useful in case, client finds loneliness in
Hospital/having painful situation. Humor helps in promoting a sense of
well being.
 NON VERBAL COMMUNICATION
Non verbal communication includes use of body language such as
gestures, gait, use of touch, physical appearance. It helps in expression
of feelings better than the spoken words.
(i) Physical Appearance: Clothing, dressing, grooming, hygiene provides
information regarding social, financial status, culture, religion, group association
and even the self-concept. Change in client’s dressing sense gives a clue
regarding his health status. Nurse can validate this by asking the client.
(ii) Body Language; Posture and Gait : ‘‘Actions speak more than words’’ is a
well known saga. Body movements, posture, gait of client depicts client’s current
mood, health status as well as about his self concept. Erect posture, purposeful
stride reveals a healthy well being. Whereas slouched posture and a slow
shuffling gait suggests depression or physical discomfort. Tense posture, rapid
movements reflects anxiety. After observing body language, nurse verifies her
interpretation by asking to client.
(iii) Gesture: Gestures means use of hands, body parts in explaining the things.
Gestures are invaluable way of communication for client with deafness,
tracheostomy, intubated. Client may blink his eyes or move his eyes side by side
to convey his “Yes” or “no” response.
(iv) Eye contact: Eye contact maintenance during interaction shows the
confidence and willingness of client to listen. Lack of eye contact may
reflect anxiety, discomfort in communication. Even eye movements reveal
feelings and emotions. Wide eyes express frankness, terror. Raised upper
eyelids reveal displeasure. Constant staring may be associated with hatred
or coldness. Looking down on a person establishes authority while
interacting at the same level indicates equality in relationship.
(v) Observable Autonomic Physiological Responses such as increased
respiration, sweating, pupil dilatation, blushing, paleness also reflect
client’s mental as well physical health status.
Physical characteristics such as height, weight, physique, complexion,
blueness of lip, nail reflects the lack of O2 in tissues. Weight and muscle
tone reflects the weakness level. Paleness reflects anaemia/anxiety level
of client.
(vi) Voice related behavior : Voice Tone (happy – good), pitch level
(high pitch – aggressiveness, hyperactivity), intensity of voice (high in
pain), stuttering (in anxiety), pause (can’t express), silence (not
interesting), fluency – reflects hyperactivity among client.
Facial expression: Frown, smile, grivances , yawn, pursed lip, tongue
movement.
 FACTORS INFLUENCING
Communication Process
(1) Development/Age of the client influence the communication: As
per the developmental stage of life, needs of client vary. For example : A
child can learn effectively through a story or by using dolls, games.
Adolescent needs more explanations as he is curious. With age, body
changes also occur. Such as vision problem, hearing problem etc.
Knowledge of client’s development stage helps the nurse how to and
what message to be conveyed him.
(2) Gender : One same message can be interpreted differently by the
male and the females. Girls used to communicate for confirming
message, establishing intimacy, whereas boys communicate to establish
independence and status within a group.
(3) Values and Perceptions : Values are the standards that influence behavior
and perceptions are the mental image of an event. Every human being perceives
and interprets message according to his personality trait, values, experience. It is
very important for nurse to understand the client’s values and perception. She
can verify it from client to avoid creating barriers in the nurse- client
relationship.
For example : In Hospital, nurse restricts the visitors entry to avoid infection
occurrence. but a burn patient may perceive it other way i.e. because of defect in
her physical appearance, her family members are not visiting her. Here
understanding values and perceptions of client are very important.
(4) Personal space : Personal space is the distance maintained by persons in
interaction with others. Professional nurse maintains good interpersonal
relations and by observing client’s health status, also maintains personal space.
For example : When a client is emotionally very upset, or child is crying. She
acts as mother, friend. For a normal client, she maintains a professional distance.
(5) Territoriality is a concept of the space and things that an individual
considers as belonging to the self. For example As client is admitted in
Hospital, he is getting bed, locker, chair, utensils etc. Client considers
all these things as his territories while taking any thing from client,
nurse must sought permission from the client to remove or rearrange or
to borrow.
(6) Roles and Relationships : The role and relationship between sender
and receiver affect significantly the communication process. A girl will
interact differently with her father, teacher, friend, sister, nurse, strange
person. Thus the content of message, choice or words, sentence
structure and tone of voice varies from role to role.
(7) Environment : A conducive and therapeutic environment is the
necessity for the effective communication. So, the environment should
be noise free, well- ventilated and have temperature within normal
range. Lack of privacy, light also affect the communication.
(8) Congruence is to what extent verbal and non verbal expressions are
similar or match to each other. Perception of congruence in
communication is very important for effective communication. Because
if nurse’s verbal and non verbal message does not match, client will
loose trust and avoid interacting with a nurse.
For example : While doing care of AIDS patient, if nurse is making
disgusting expressions, client will does not want to disclose his
information with Nurse.
 (9) Interpersonal Attitudes : Attitude reflects the beliefs, thoughts and
feelings about people and events. Attitude such as caring, warmth,
respect and acceptance facilitates communication. Thus nurse having
such attitude will develop good interpersonal relations with client and
collegues where as the lack of interest, coldness inhibit the
communication and ultimately relationship.
 SKILL FOR EFFECTIVE
COMMUNICATION
In order to communicate effectively, one should have following skills :
I. Confidence : Confidence is very important for developing and
maintaining a trust with others. Nurse will be confident if she has upto
date knowledge, skilful and as well as having the self concept.
II. Critical thinker : Nurse must have this quality for the effective
communication. She must collect the information, analyze it, then
interpret it. Nurse must think critically about the message she wants to
communicate.
III. Analytical : means ability to examine the impact of message on
listener/receipients. For effective communication, nurse must be able to
examine the verbal, non verbal response of client.
IV. Open mindness: An open minded communication will explore the
information by entering in the situation.
V. Active listener is the best quality of a good communicator. This can
be done by nodding the head, maintaining eye contact, saying “Yes”
“No” in between the conversation.
VI. Empathetic: Empathy means perceiving the client’s feelings. Being
empathetic, enable the nurse to help the client. Simultaneously, Client
also develop trust on the nurse.
 VII. Honest: Honesty is very important in any of communication
whether it is formal, informal, interpersonal or intrapersonal.
VIII. Confidentiality: To keep the information secret and use it for the
particular purpose (welfare of client) confidentiality is important skill.
Nurse must maintain confidentiality of client (psychiatry client, AIDS,
HBS+ve).
IX Knowledgeable: Having a professional knowledge, is important skill
in effective communication. Knowledge regarding what to ask and how
to ask is also essential. Along with this, knowledge about the client’s
values, perception, beliefs, feelings, developmental age, culture, ethnic
group is very important to initiate communication.
X Systematic: Being systematic is important because good
communicators tend to seek and provide information in an organized
and focused way. Communication must be proceeded from simple to
complex manner.
XI Tactfulness: is the povital quality for effective communication. How
to convey message and get response is the essential quality of a good
communicator.
 BARRIERS OF COMMUNICATION
If nurse does not give importance to the factors affecting
communications and communication skills, these all will be considered
as the barriers of communication. Along with the above mentioned
barriers, following points also interfere to communication process.
1) Physiological Barriers :
* Difficulty in Hearing
* Difficulty in vision
* Difficulty in expression
* Difficulty in Palpitations
 When there is sensory deficit, auditory deficit, visual deficit etc. message will not
be conveyed or received.
2) Psychological Barriers :
* Emotional disturbance (Crisis, Anxiety, Severe stress).
* Neurosis.
* Level of intelligence.
* Fear.
* Ego centricity, superior or inferior complex.
3) Environmental Barriers :
* Lack of ventilation. *Lack of light.
* Extreme temperature. *Extreme noise.
* Lack of privacy. *Congestion etc.

4) Cultural Barriers :
* Level of knowledge and understanding. * Personality traits.
* Customs. * Beliefs.
* Religion. * Attitude.
* Language.
 Importance of Communication in
Health
1) Information : One of the significant purpose of communication is to
inform others i.e. convey message. In health system, primary function of
communication is to provide information to public about prevention of
Diseases and promotion of health.
e.g. Through advertisement on television, newspaper, poster, public is to
make aware of protecting their children from “Polio”.
2) Education : It is very important to educate the client regarding discharge
planning, precautions to be taken, dietary management, life style
modification. Education on these points is conveyed by direct
conversation/communication with client.
e.g. Teaching mother to give breast feed to newborn.
 3) Motivation : Motivation is the power which drives person to do
from within / inside. Client can never recover from illness, until he is
motivated internally. Motivation to modify life style is given only
through communication.
e.g. 1) Motivating obese client to reduce body weight.
2) Motivating Hypertensive client to modify dietary pattern and
sedentary life style.
4) Persuasion : Persuasion means convincing, influencing the person.
One of the important purpose of communication is to influence others.
Communication helps the person to understand values, behavior of
another individual.
e.g. Persuading the drug addict client to leave this habit and join De
addiction centre for this purpose.
5) Counselling : Counselling brings change in the behavior of person.
Therapeutic Nurse - client interaction helps him to better understand and
deal with problem. Counselling provides support at time of crisis and
helps in changing the behavior.
e.g. Counselling helps the client with suicidal thought to omit such
thoughts from mind.
6) Brings Peace : Communication/interaction between two person
helps in ventilating the feelings. Many times we want somebody should
listen to our feelings. Once these feelings are shared or expressed, we
get satisfied. Thus, communication either verbal or non verbal helps in
mental catharsis and brings peace in mind.
7) Reduces Stress/Tension : Ventilating the feelings through verbal and
non verbal modes of communication helps the client to get relief from
stress.
8) Health Promotion : Above all mentioned functions of
communication leads to promote the health.
Importance of Non verbal Communication in
Health Care
Non verbal communication fulfills several purposes of communication process such
as
— To express feelings.
— To regulate interaction.
— To validate verbal messages.
— To maintain self image.
— To maintain relationship.