nursing

1. COMMUNICATION SKILLS IN
NURSING
DR.C. B. BELLO

2. COMMUNICATION
• Communication is the exchange of information
between individuals.
• It is a means of exchanging information or
feelings between two or more people.
• It is a basic component of human relationship,
including nursing.
• Communication is a process and it has two main
purposes;
• To influence others and to obtain information
• The intent of any communication is to obtain a
response

3. Communication Process
• During the communication process
• An individual, sometimes called the sender
• develop an idea & transmit it in the form of a
message to another person or receiver.
• The receiver perceives the message, {the
sender’s transmitted idea and interprets it}
• Once the receiver interprets the meaning,
• the receiver formulates a response &
transmits it back to the sender as feedback

4. Encoding & Decoding
• Encoding is the process of formulating a
message for transmission to another person.
• To encode an idea, the sender has to choose
the word, body languages, signs or symbols
that would be used to convey the message.
• Decoding is the process of recording through
one’s memory, experience, & knowledge based
to determine the meaning of intended message.

5. Encoding & Decoding
• To communicate successfully, the client must be
able to accurately decode the message the
nurse sent.
• Communication may break down, if the nurse
uses the words the client does not understand or
present a behavior that is frightening.
• Communication may also break down,
• if the nurse fails to decode the client’s message,
accurately by not listening actively and
attentively.

6. PROCESS OF COMMUNICATION
• FACE-TO-FACE-
• Involves a sender, message, a receiver and a
response or feedback.
• Communication is a two way process,
involving the sender and the receiver of the
message.

7. SENDER
• it is a person or group who wish to convey a
message to another,
• Can be considered as the source encoder.
• The person sending the message has an idea or
reason for communicating & must put the idea
or feeling into a form that can be transmitted.
• When transmitting a message, the nurse must
not only deal with the dialect& foreign languages
• but also differentiate between communication
with a lay person & the health professionals.

8. MESSAGE
• It is what is actually said or written,
• the body language that accompanies the
word & how the message is transmitted
• {the medium used to convey the message is
the channel, &
• it can target any of the receiver sense.
• The intent of the message should be clearer.
• Talking face to face with a person may be
more effective in some instances than
• telephoning or writing message

9. MESSAGE Cont’d
• Recording messages on tape or
communicating by radio or television may be
more appropriate for large audience.
• Written communication often appropriate for
long explanation are for a communication that
needs to be preserved.
• Non-verbal channel or touch is often highly
effective.

10. RECEIVER
• it is the listener who must listen, observe and
attend.
• This individual or person is the decoder,
• who must perceive what the sender interned
{interpretation}.
• Perception uses all of the senses to receive
verbal and non-verbal messages.
• Ineffective communication occurs when the
message sent is misinterpreted by the
receiver.

11. RESPONSE
• This is the message that the receiver returns
to the sender,
• it is also called feedback.
• Feedback can be either verbal,
• nonverbal or both.
• Non verbal examples are a nod of the head or
a yawn.

12. LEVELS OF COMMUNICATION
• Communication occurs at
• the intra personal,
• interpersonal and
• public levels.

13. INTRAPERSONAL
• Communication occurs within an individual,
• it is the way people consider their thoughts
internally,
• so they can express themselves appropriately
to others. Also called self-talk.
• The goals of intrapersonal communication is
self awareness which is influenced by self
concept & feeling of self worth.

14. Interpersonal
• This is an interaction between two people
only or a small group.
• Problem solving, sharing of ideas, decision
making and personal growth are outcomes of
effective interpersonal communication.
• Through interpersonal communication,
• nurse interacts with client, family members,
physicians, fellow nurses and other health
care provider
• to develop strategies that brings about
positive changes in a client’s health status

15. PUBLIC
• It is the interaction with large group of people.
• The nurse often has opportunity to speak with
group of client or consumers in health related
topics.
• It requires special aids such as posters and
voice inflections to communication.

16. BASIC CHARACTERISTIC OF COMMUNICATION
• 1. More than one person must be involved.
• 2. The sender & the receiver must participate
simultaneously through verbal & non-verbal
communication.
• 3. Communication must be continuous and
reciprocal.

17. BASIC CHARACTERISTIC Cont’d
• 4. Exchange messages require knowledge.
• 5. Communication is influenced by the way
people feel about themselves, the subject
matter etc.
• 6. The person’s position within a social cultural
system may influence the process of
communication

18. INTERACTIONAL SKILLS
• These are actions that are used during the
encoding process to obtain and disseminate
information,
• develop relationship and promote
understanding of self and others.
• Nurses use a variety of interactional skills,
during the communication process

19. INTERACTIONAL SKILLS cont’d
• to gather assessment data from clients,
family,
• significant others and health care personnel’s
• The nurse uses this interactional technique
• to help the client communicate information
thoroughly &also
• to confirm that the nurse has understood the
client’s communication correctly

20. 1. LISTENING SKILL
• Paying individual attention to what the client
say and successful listening,
• involve taking in the client’s whole message
• by hearing the words as well as interpreting
body language.
• Not only the words that the client speaks that
the nurse should take note of,
• but also the tone of voice and even what the
client does not say.

21. 2. ATTENTION
• It is giving full attention to verbal and non
verbal messages.
• Body languages or non verbal messages
• provide significant information that the nurse
might otherwise overlook and
• signals information that the client may have
omitted intentionally or unintentionally.
• Body language can send messages such as
hostility, defensiveness or confusion,

22. ATTENTION cont’d
• The nurse must tune into the client’s non-
verbal as well as verbal messages.
• Non-verbal communication of client, such as
• postures, eye contact, make up, dress,
accessories and items in the clients
environment {books, rosary, photograph etc.}
• tells a significant story and add more depth to
the intended messages.

23. 3. PARAPHRASING
• It means that the nurse restate the client’s
basic message.
• Communication skills include
• checking to make sure that the nurse has
understood the client accurately by
paraphrasing.

24. 4. LEADING
• Nurses use leading skills to encourage open
communication.
• These skills are most effective when starting
an interaction or
• when trying to get the client to discuss health
concerns.
• Leading skills are especially helpful in getting
clients to explore their feelings and
• to elaborate on areas already introduced in
the discussion.

25. LEADING cont’d
• Leading techniques that nurses commonly use
when interviewing a client includes
• direct leading,
• focusing and
• questioning

26. a. Direct leading
• This means that the nurse decides the areas
she wants to ask questions.
• The nurse asks directly what the client’s
complaints are
• so as to get accurate information from the
client.
• It is also good to ask about what happened &
• the degree of complaints e.g. Severe pains

27. Focusing & Questioning
• 5. Focusing:- Total focusing is essential, the
nurse should note detail from the original/real
point that client is complaining of.
• 6. Questioning:- it is a very direct way of
speaking with client to obtain subjective data
for decision making and planning care.
Questioning technique include closed and
open ended question.

28. Questioning cont’d
• Closed questions limits the client’s response
to Yes, No or one word answer
• e.g. “were you feeling angry when your
mother said that?”
• open ended questions are purposely general
and encourage the client to provide additional
information
• e.g. “what brought you here today”.

29. REFLECTING
• 7. REFLECTING:- repeating the client verbal or
non-verbal message for the client benefit.
• It is a way of showing the client that the nurse
empathizes or
• is in tune with the client’s thought, feelings
and experiences.

30. 8. SUMMARIZING
• It is the process of gathering the ideals,
feelings that clients have discussed
throughout the interview and restating them
in several general statements.
• It is a useful tool because it shows client that
the nurse had listened and understood their
concern.
• It allows client to know that progress is being
made in resolving their health concerns and
signals closure of the interview

31. MODES OF COMMUNICATION
• This is generally carried out in two different
ways:-
• Verbal communication.
• Non-communication.

32. 1. VERBAL COMMUNICATION
• It uses the spoken or reading aloud written
words and it constitutes only about 7% of the
communicated messages.
• It is used extensively by nurses to share
information with client and other health
workers.
• It is largely conscious, because people choose
the words they use,
• the words used varies among individual
according to culture, socio-economic
background, age and education

33. VERBAL COMMUNICATION Cont’d
• The way ideals are exchanged depends on
countless possibilities that exist.
• When choosing words to say or write,
• nurses need to consider simplicity,
• timing, pace and intonation, clearly and
• brevity, relevance, adaptability, credibility and
humor.

34. 1. PACE AND INTONATION
• manner of speech as in pace or rhythm and
intonation, will modify the feeling and impact
of the message.
• The intonation can express enthusiasm,
sadness, anger or amusement.
• Pace of speech can indicate interest, anxiety,
boredom or fear
• e.g. speaking slowly or softly to an excited
client may help calm the client.

35. 2. SIMPLICITY
• It include the use of commonly understood
words, brevity and completeness.
• Nurse need to learn to select appropriate,
• understandable terms based on the age,
knowledge,
• culture and education of the client
• e.g. instead of saying

36. SIMPLICITY Cont’d
• “the nurses will catheterize you tomorrow for
a urine analysis”
• it may be appropriate and understandable to
say,”
• tomorrow, we need to get a sample of your
urine and
• we will need to insert a small tube into your
bladder in the process”.

37. CLEARITY AND BRIEFITY
• Message that is direct and simple will be more
effective
• clarity is saying precisely what is meant and
brevity is using the fewest words necessary.
• To ensure clarity in communication, nurses
needs to speak slowly and enunciate carefully.

38. TIMING AND RELEVANCE
• No matter how clearly or simply words are
stated or written,
• the timing needs to be appropriate to ensure
that words are heard.
• It involves sensitivity to the client’s needs and
concern.

39. ADAPTABILITY
• Spoken messages need to be altered in
accordance with behavior cues from the
client.
• What the nurse says and how it is said must
be individualized and carefully considered.
• It is important for the nurse to then modify
his tone of speech and express concerns in his
facial expression while moving towards the
client.

40. CREDIBILITY
• It means worthiness of belief, truth
worthiness and reliability.
• Nurses foster credibility by been consistent,
dependable and honest.
• He or she needs to be knowledgeable about
what is being discussed and to have accurate
information.

41. CREDIBILITY Cont’d
• Nurses should convey confidence and
certainty in what they are saying,
• while been able to acknowledge their
limitation
• e.g. “I don’t know the answer to that,
• but l will find someone who does.”

42. HUMOUR
• Use of humor can be positive & powerful tool
in the nurse-client relationship,
• but must be used with care, it can be used to
help client adjust to difficult and painful
situations.
• Physical act of laughter can be an emotional
and physical release,
• reducing tension by providing a different
perspective and promoting a sense of well
being.

43. NON-VERBAL COMMUNICATION
• It uses other forms such as gestures or facial
expression and touch.
• It makes up the other 93% of communication.
• Majority of communication is non-verbal.
• Another form of communication has evolved
with technology and that is electronic
communication and
• the most common form of electronic
communication is E-Mail where an individual
can send a message by computer.

44. NON-VERBAL COMMUNICATION
• When the verbal and non-verbal messages are
congruent,
• then the messages is more easily encoded and
clearly understood.
• If the verbal and non-verbal messages are
conflicting, the non-verbal message is the
most reliable.
• It is relatively easy for one to tell lies with
verbal message {words}
• but non-verbal communication tend to be
unconscious and more difficult to control

45. NON-VERBAL COMMUNICATION Cont’d
• It is sometimes called body language.
• It is the exchange of information without the
use of words.
• There are various ways in which information is
exchanged through non-verbal
communication and
• it is a general belief that it expresses more of
the true meaning of the message than verbal
communication.

46. NON-VERBAL COMMUNICATION Cont’d
• Nurses must be aware of both verbal and non-
verbal messages they send, and non-verbal
messages they receive from client.
• It includes gestures, body movement, use of
touch, and physical appearance including
adornment.
• Non-verbal communication often tells others
more about what a person is feeling than
what is actually said,
• because non-verbal behaviour is controlled
less consciously than verbal behaviour.

47. NON-VERBAL COMMUNICATION Cont’d
• Observing & interpreting the client non-verbal
behaviour is an essential skill for nurses to
develop.
• To observe non-verbal behaviour efficiently
requires a systematic assessment of the
person’s overall physical appearance,
• posture,
• gait,
• facial expressions and gesture

48. PERSONAL PHYSICAL APPERANCE
• Choice of apparel is highly personal,
• it may convey social and financial status,
culture, religion, group, association and self
concept.
• Charms and amulets may be won for
decorative or for health protection purposes.

49. POSTURE AND GAIT
• the ways people walk and carry themselves
are often reliable indicators of self concept,
• current mood, and health, erect posture and
active purposeful stride suggest a feeling of
well-being.
• Slouched posture and a slow, shuffling gait
suggest depression or physical discomfort.
• Tense posture and a rapid determined gait
suggest anxiety or anger.
• Posture of people when they are sitting or
lying can also indicate feelings.

50. FACIAL EXPRESSION
• Feelings of surprise, fear, anger, disgust,
happiness and sadness can be conveyed by
facial expression.
• Face may express the person’s genuine
emotion and facial expressions convey a
universal meaning.
• Nurses should be aware of their own
expression and what they are communicating
to others,
• control expressions of feeling such as disgust
or fear in some circumstances.

51. GESTURES
• Hand and body gesture may emphasize and
clarify the spoken word.
• Or they may occur without words to indicate
a particular feeling or to give a sign.
• Gestures using various parts of the body are
capable of carrying numerous messages
• e.g. thumbs up, which means victory where as
thumbs down means negative connotation.

52. Factors influencing communication
process
• Language, intellectual and psychosocial
development
• Gender
• Values and perceptions
• Personal space
• Territoriality
• Roles and relationships
• Environment

53. THANK YOU
FOR LISTENING