King Saud University

College of Nursing
Medical surgical Nursing
Module 3 -123
Prepared By
Lecturer/ Magda Bayoumi
Lecturer/ Magda Bayoumi
t t!e end of t!is lecture t!e student "ill #e a#le to$
%efine communication
List im&ortance of communication
Mention element of communication
'(&lain level of communication
%iscuss modes of transmission)
'(&lain factor influencing communication
List &rinci&le of communication
*dentify #loc+s and #arrier of effective communication
%iscuss t!era&eutic communication)
Lecturer/ Magda Bayoumi Page
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%efine communication $
Communication is the transmission and receiving information, feeling and or attitudes
with the overall purpose of having understood producing a response. It is a process of
passing messages, idea, facts, opinions, attitudes, information and understanding from
one person to another. Communication is an enabling process that allows information
to be transferred and ideas to be translated into action .
Communication is the basic element of human interaction that allows people to
establish, maintain and improve contacts with others .
*m&ortance of Communication $
Communication skills help the nurse in many ways :
Communication skills help to generate trust between the nurse and patient.
Communication skills provide the nurse with professional satisfaction, i.e:
provide job satisfaction.
Communication is also a means for bringing about change i.e. nurse listens,
speaks and acts to negotiate change that promotes clients wellbeing.
Communication is the foundation of all relationship between the nurse and
other member of the health team. It induces human being to put forth greater
efforts in their worm performance.
Communications serve as a lubricant fostering in smooth operation of the
management process, i.e. it helps promotion of managerial efficiency.
Communication provides basis for leadership action.
It provides means of coordination.
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'lement of Communication$
!" Sender" refers to a person who initiates and transmits message. #he sender is
also called the encoder.
$" Massage" refers to information, opinion, effect that are directed to a target, i.e.
the information that is sent or e%pressed by the sender.
&" Signal" refers to sign that symboli'ed message contents.
(" Channel" refers to route through which a messages, such as through, visual,
auditory, and tactile senses.
)" Receiver" refers to an intended perceiver interpreter of message. #he receiver
also is called the decoder.
*" Noise" refers to an information relayed from later to earlier stage. +eedback
helps to reveal whether the meaning of the messages received.
,, ,,, ,,,, ,,, -eed#ac+ ,, ,,, ,,,, ,,
. .
Sender ,, /Noise0 ---- Message,,, /Noise0 ---- 1eceiver
. .
.,, , , ,,, ,,, -eed#ac+ ,,, ,,, , ,, ,.
Level of communication
Communication occurs at t!e intra&ersonal2 inter&ersonal2 and &u#lic levels)
Intrapersonal communication:
,ccur with the individual. It is self"talk or an internal dialogue that occurs
constantly and consciously.
#he sender motivation is transmitting a message and the receivers mind"set in
interpreting the messages are conditions by a continuous stream of self"talk.
For example: nurse supervisor can detect intrapersonal messages that insulate a
worker from supervisor" initiated messages by asking workers opinion about
controversial work issues.
Interpersonal communication:
Is the interaction between two people or in a small group. -ealthy
interpersonal communication allows problem solving, sharing of idea, decision
making, and personal growth.
In administration challenges the nurses ability to e%press idea clearly and decisively.
Interpersonal communication in the heart of nursing practice.
Public communication:
is interaction with large groups of people, e.g. giving lecture to students and speaking
to a consumer group on health education.
Modes of transmission$
.essages are communicated in a number of ways, i.e/ verbal, nonverbal.
Verbal communication:
Is e%change of information using words and include both spoken and written word.
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0ords are signs or symbols used to e%press ideas or feeling, emotional responses, or
describe objects, observations, memories and influences. 0ords may also be used to
convey hidden meanings, test the others interest or degree of concern, or e%press
hostility of fear.
1erbal communication depends on language.
Is used tentatively by nurse when speaking with patients, giving oral reports to
others, writing care plans and recording nursing progress notes.
#o make a message clear, the nurse uses effective verbal communication
techni2ues/ clear and concise phasing of words, a proper pacing of statements,
and understandable vocabulary.
" clarity and brevity 3using e%ample can make an e%planation easier to
understand4
" 1ocabulary/ instead of using purely technical words, use local words for better
understanding.
" 5enotative and connotative meaning: a denotative meaning is one shared by
individuals who use a common language that is used to define a word ao that it
means the same to everyone. #he connotative meaning of a word is the
thought feelings of ideals that people have about to word.
" Pacing: verbal communication is successful when e%pressed at an appropriate
speed or pace.
" #iming and relevance: timing is critical to reception. +or e%ample/ if the
supervisor6manager is in bad mood, the time is wrong to ask for a raise. 7nd
relevance is also important, i.e that communication is most likely to have an
impact when messages pertain to an individual interest and needs.
" -umor: it can be a powerful tool in promoting all aspects in management, and
also for well being.
3!e 4ritten communication must #e #ased on four essential item
" Clear
" Correct
" Com&lete
" Concise
It should be written in such a language as it becomes easily intelligible to those fore
shown words and familiar phrase and avoid official jargons or ambiguous terms.
Nonverbal communication:
Is the e%change of information without use of words/ it is what not said, i.e
actions often speak louder than words. 8o non verbal communication is
transmission of messages. It is one of the powerful ways people convey
messages to others. It is usually motivated by subconscious feelings and
therefore a more reliable indication of true feeling than spoken word.
,bservation of nonverbal clue is an important skill. 9onverbal cues add
meaning to the verbal message.
#he nurse need to be alert to nonverbal messages accompanying verbal
message sent to clients.
.eta communication is a massage within a message within a message that
convey a senders attitudes toward the self and the message and the attitudes,
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feeling and intentional toward the listener. It can e%plicit 3verbal4 statement or
an implicate 3non verbal4 demonstration of feelings.
+or e%ample/ when a nurse greets a client, maintaining eye contact and speaking in a
calm voice can relay a sense of security to the client.
-orms of nonver#al communication$
Personal appearance.
It is one of the first things noticed during an interpersonal encounter. #his time
general impression formed of another person influences the response to that
person. People form an impression about another person with $: seconds to (
minutes.
#he impression is based mostly on appearance, physical characteristics,
dress, grooming and the presence of jewellary and adornment provide clues
to the persons physical wellbeing, personality, social status, occupation,
religion, culture and self concept. Paying attention to ones appearance can
contribute to positive ;image and professional image.
7 persons clothing and grooming 3makeup, combing hair4 practices easy
significant non verbal messages.
.ost of illness causes at least some alterations in general physical
appearance. ,bserving for changes in appearance. ,bserving for changes
appearance is an important nursing responsibility in detecting a particular
illness or in evaluating such as the condition of hair, color, of skin, weight,
energy level and the presence of physical deformity, also communicate
information about level of health. #he nurse physical appearance influences
the clients perception of care received. <ach client has a preconceived image
of a nurse. #he traditional uniform can be a symbol of cleanliness and
competence.
Intonation:
#he tone of speakers voice can have a significant effect on a messages
meaning.
It is important for nurses to be a wear of how they are sending message.
1oice tone can be a cue to a clients emotional state and energy level. +or
e%ample, cry indicates joy and sadness/ grasping indicates fear, pain or
surprise.
Period of silence during communication often carry important nonverbal
messages. #he silence between two people may indicate complete
understanding of each other, or it may mean they are angry with other.
Facial expression:
#he face is the most e%pressive part of the body and it has rich
communication potential. Communication often begins with eye contact.
<yes are windows to personal soul.
<ye contact suggests respect and willingness to listen and to keep
communication open. 7bsent of eye contact means many things.
<ye contact is an important facial e%pression.
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9urses need to learn some control over their own facial e%pressions. =ack
of eye contact or looking away may indicate embarrassment dislike,
withdrawal or possibly an attempt to remember of process what is being
said.
Posture and gait:
Body movement or motion may add significant meaning to a verbal statement
or total communication. #otal body movement or posture may indicate strong
emotions.
Posture and gait reflect attitudes, emotions, self concept and physical wellness
9urses can receive useful information by observing client posture and gait,
specific illness can cause identifiable gait, e.g/ neuromuscular disorder/ gait
mat be alter by many physical factors such as pain, drugs or fractures.
estures:
#here are used to illustrate an idea that is difficult or inconvenient to describe
in words.
>estures using various parts of the body are capable of carrying numerous
messages .e.g: thumbs up means victory whereas thumb down carries
negative connection.
>estures may reveal specific meaning or with other communication, they may
send message e.g/ kicking in object often e%press anger/ writing hands or
tapping foot usually indicates an%iety or anger, a waving hand serves to back
on someone to come, or if waved in another way signified that someone
should leave. #he hands and arms may indicate openness. 7rms that are rigid
with hands clenched indicate anger, tension to e%plosiveness.
!each:
It is a powerful e%pression of communication. It is a meaningful personal
mode of communication and its meaning is different to different people.
#each can convey warmth and interest. #each e%presses personal behavior,
various messages, such as affection, emotional support, encouragement,
tenderness, security and personal attention, are conveyed through touch.
#each is the important part of the nurse"client relationship but it must used
with discrimination because strong social norms govern its use.
#he nurses must always be aware of appropriate use of teach in varied
situations of touch in varied situations and sittings. 9urses rely on teach when
carrying out intervention.
Factor in"luencing communication:
#$ %evelopment& the rate of speech and language development various and is
directly related to neurological and intellectual development. #o communicate
effectively with children, the nurse must understand the influence of
development of languages and thought process.
'$ Perception:
<ach person senses, interprets and understands event differently.
Perception is the personal view of events.
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Perceptions are formed by e%pectations and e%periences.
5ifference in perceptions between people who are interacting, can
be a barrier of communication
($ Values: value are standards that influence behavior. #hey are what the person
considers important in life and thus influence e%pression of thoughts and
ideas. 1alues also affect interpretation of messages. Because values are a
general guide to behavior, it is important for a nurse to develop awareness in
them, knowing and clarifying values are important to clinical decision making
and interaction. 7 nurse does not allow personal values to interferes with
professional relationship.
)$ *motions: the degree to which people are physically comfortable and
mentally free to engage in interaction will also influence communications.
<motions are personal subjective feelings about events. 9urses can assess
clients emotions by observing their interaction with family, physician, or other
nurses. 0hen the nurses care for clients they must be aware of their own
emotions. It is helpful or nurses to develop sensitivity to the physical, mental,
emotional barriers to effective communication.
+$ Sociocultural in"luences: culture is the sum total of learned ways of doing
feeling and thinking. It is a form of conditioning that shows itself thought
behavior. =anguage, gestures, values, and attitudes reflects cultural origin.
9urses need to develop skills in recogni'ing ways in which culture, economic
condition, and overall life style influence a clients preferred mode of
communication.
,$ ender: men and women demonstrate different communication styles and
each influences the communication process, or may give different
interpretation to the same conversation. #he nurses need to be aware of this
difference when working with clients of opposite se%.
-$ .no/ledge: it is very difficult to communicate when the person
communicating have different levels of knowledge. 9urses communicate with
clients and professional, who have different levels of knowledge. 7 common
language is essential when communicating across different levels. 9urses
assess client knowledge, by noting their response to 2uestions, abilities to
discuss health problems and 2uestions that they ask. 7fter that, nurses use
terms and phrases that client understand to promote attention and interest.
0$ Roles and Responsibilities: a persons occupation may give the nurse a general
idea of his or her abilities, talents, interests, and economic status. People
communicate in a style appropriate their roles, relationship and
responsibilities. 7s a nurse"client relationships develops and client gains
confidence in relating idea and feelings communication is more effective when
the participants remain aware of that roles in a relationship and challenge for
the nurse caregiver is to respect the role and responsibilities of the clients,
especially in their influence, their preferred manner of communicating without
denying the client needed care.
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1$ Space and territorialit2: territoriality defines the meaning of a persons right to
an area of space and surroundings. People are generally most comfortable in
areas they claim as their own. #erritory is important because it provides people
with a sense of identify, security and control.
#3$ *nvironment: communication happens best when the environment facilitates
an easy e%change of needed information. People tend to communicate better in
a comfortable environment. 7 worm room, free of noise and distractions is
best. 9oise and lack of privacy or space may create confusion, tension or
comfort.

Principle o" communication:
#he principle of communication which are helpful and useful for communication
are as follows:
8ystematic analysis of the message.
8election and determine of appropriate language and medium of
communication in accordance with the purpose of communication.
#iming, physical sitting, and the organi'ation climate for communication
need to be appropriate to convey the desired meaning of the
communication conveyed by words.
Consultation with other for planning of communication.
#he basic content and overtones of messages as well as the receptiveness
to the viewpoint of the receiver influences effectiveness of
communication.
#he messages should convey something of value to the receiver in the
light of his needs and interests, whenever possible.
+eedback from receivers, follows"up of communication through
e%pression of the receivers, reactions and their performance review help
in effective communication.
Communication while meeting the needs of immediate situations should
be consistent with long"term goals and interest of the organi'ation.
#he communication action following a communication is important in
effective communication as this speaks more than his words.
#he sender has to understand the receivers attitude and reaction by
careful, alert and proper listening to ensure that the desired meaning of
the message has been comprehended by the receiver.
Bloc+s and #arriers of effective communication:
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7sking why: when people disagree with or fail to understand others, they are
tempted to ask why the other believe or have acted in such away. ?egardless
of clients perceptions of the nurses motivation why 2uestions can cause
resentment, insecurity and mistrust.
Changing the subject inappropriate: it might be harmful. 7 nurse might
inadvertently stop client from discussing a subject of importance by changing
subject. 7bruptly interpreting conversation is rude and shows a lack of
empathy. It is important to avoid changing the subject during assessment.
<%cessive 2uestioning: it lace too much pressure on the client and upsetting
particularly when more than one 2uestion is asked at a time. it becomes an
interrogation rather than an interaction.
.aking judgment: it labels a client as good or bad and dose not accept him as
individual. 7 client needs to be encouraged to make independent decision.
>iving opinion: it takes decision making away from the client. It inhibits
spontaneity stalls problem solving and creates doubt. ,ften client simply
needs an opportunity to e%press feelings giving opinion the client from
developing solutions to problem. 7t the time client may re2uire suggestion.
,ffering false assurance: it is non factual information that makes the nurse
feel good but may harm the client. >enuine and truthful reassurance is
important and helps validate a client self worth and sense of hope.
Being defensive: defensiveness: is response to criticism, suggest that the client
has no right to an opinion. 0hen the nurse becomes defensive the clients
concerns are often ignored.
8tereotyping: every one uni2ue/ stereotyping inhibit uni2ueness and over
simply the situation. 8tereotyping and generali'ed beliefs held about people.
#he use of 8tereotyping inhibits communication and can threaten nurse"
client relationship.
@sing highly emotional words 3angry, cra'y, hostile and guilty4 these should
be avoided because many clients will not admit to having these strong
feelings.
8howing approval or disapproval e%pressing: e%cessive approval can harmful
to a nurse"client relationship, as stating disapproval. ,ffering e%cessive praise
implies that the behavior being praised is only acceptable one. often the client
shares a decision with the nurse, not in an effort to seek approval but to
provide a means to discuss feeling.
+ocusing on self: it is one way/ some nurses maintain distances from client.
In addition the language differences, deafness, stuffering, muteness, and
blindness, are the physical barrier to communication.

3!era&eutic communication
Promotes understanding and can help establish a constructive relationship
between the nurse and the client.
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