Lesson 1, Topic 1
In Progress

Overview of Communication

May 1, 2021

Communication is one of the most important aspects of care in nursing. Some form of communication occurs each time an interaction takes place. Interactions occur between two parties, such as the nurse and the patient or the nurse and a family member, a physician, or a coworker, or any number of other combinations. Remember that the message that is intended is not always the message that is received. The nurse should strive at all times to communicate effectively and minimize miscommunication.

Communication is a reciprocal process in which messages are sent and received between people (Balzer Riley, 2012). Communication takes both verbal and nonverbal forms and conveys a variety of mes­sages (e.g., information, emotions, humor, acceptance, rejection). Many variables influence the effect of the message.

Overview of Communication

For communication to occur, a sender and a receiver of a message are both necessary. The sender is the one who conveys the message, whereas the receiver is the person or people to whom the message is conveyed. The individual who receives the message is sometimes the intended receiver and sometimes an unintended receiver. Consider the following scenario:

The night nurse, reporting to the day nurse outside Ms. B.’s room: “Ms. B. was on her call light all night. She’s a real complainer!”

Ms. B. overhears the exchange.

The day nurse is the intended receiver, or the one with whom the night nurse means to communicate with regarding Ms. B.’s behavior. Because Ms. B. also hears the statement, she becomes an unintended receiver. Consider the possible effect of this message on the relationship between Ms. B. and the night nurse. Negative consequences for the relationship between Ms. B. and the day nurse are another possible outcome, if Ms. B. believes that the day nurse shares the night nurse’s view of her.

Both one-way and two-way communication is possible, and which type of communication actually occurs depends partly on the roles of the people in the interaction. One-way communication is highly structured; the sender is in control and expects and gets very little response from the receiver. A lecture to a large audience is an example of one-way communication. One-way communication has very little place in the nurse-patient relationship. Two-way communication requires that both the sender and the receiver participate in the interaction. It allows for exchange between the nurse and the patient, and its purpose is to meet the needs of both the nurse and the patient and to establish a trusting relationship. The licensed practical/vocational nurse (LPN/LVN) should always strive to seek and accept the patient’s input and feedback rather than simply talk to the patient.

Verbal Communication

Verbal communication involves the use of spoken or written words or symbols. The LPN/LVN might think that there is little room for misunderstanding or misinterpretation of the intended message as long as the receiver understands the words and symbols being used. Frequently this is not the case. Sometimes words have very different meanings, or connotations, for different people. The connotative meaning of a word is subjective and reflects the individual’s perception or interpretation. The nurse should be aware of the potential for miscommunication that lies in such subjective variation. Take, for example, the word stable. If the nurse informs family members that their loved one’s condition is stable, they perhaps may understand that for the moment, the patient’s condition is not deteriorating. On the other hand, they may hear a different message, and not the one that was intended: namely that the patient is doing well and is out of danger.

Denotative meaning refers to the commonly accepted definition of a particular word. For example, the word telephone means essentially the same thing to anyone who is familiar with the English language. The key word here is familiar. No guarantee exists that both parties know the word, let alone assign the same definition to it. Consider the situation in which the nurse asks the patient when he last voided or had a stool. Although these terms and phrasing are familiar to health care professionals, the patient may have no idea that the nurse is asking when he last urinated or had a bowel movement. This is an example of the nurse using hospital jargon. Jargon is commonplace “language” or terminology unique to people in a particular work setting, such as a hospital, or to a specific type of work, such as nursing. It is as though the nurse and the patient have different dictionaries for what is thought to be a shared language. The LPN/LVN must be cautious of the terminology used when communicating with patients.

Nonverbal Communication

Messages transmitted without the use of words (either oral or written) constitute nonverbal communication. Nonverbal cues include tone and rate of voice, volume of speech, eye contact, physical appearance, and use of touch (Table 4-1). Some degree of nonverbal communication usually accompanies verbal commu­nication.

Voice

Aspects of the voice affect nonverbal messages, among them tone and volume and the rate of speech. Characteristics of people’s voices vary depending on such things as their emotions, their familiarity with a situation, confidence, and geographic and cultural influences. Meaning cannot be accurately interpreted on the basis of tone, rate, and volume alone. For example, a high-pitched, loud voice and rapid speech may indicate that an individual is frightened, but people also speak that way out of excitement or enthusiasm. In fact, some people always tend to use this speech pattern, and thus, no conclusions are appropriate at all. The nurse should consider the voice characteristics in the context of the situation as a whole so that interpretation of the message is accurate.

Eye Contact

Eye contact is responsible for much communication and miscommunication. Generally, eye contact communicates an intention to interact. However, the nature of the interaction and the results of eye contact are not necessarily always positive. Extended eye contact sometimes implies aggression and arouses anxiety. On the other hand, the person who maintains eye contact for 2 to 6 seconds during interaction helps involve the other person in what is said without being threatening or intimidating. An absence of eye contact communicates many things: shyness, lack of confidence, disinterest, embarrassment, or hurt, or in contrast, deference and respect. Sensitivity to one’s own eye contact and that of others helps with perceiving what is actually occurring in an interaction. Culture significantly affects how people interpret eye contact. Americans view eye contact in a positive manner, whereas some cultures, such as persons of Arabic or Native North American descent, view eye contact as impolite, aggressive, or improper (Maier-Lorentz, 2008).

Physical Appearance

The physical appearance of the participants in an interaction has the potential to greatly influence the perceptions they form of each other. Physical appearance includes attributes of size, color of skin, dress, grooming, posture, and facial expression. Although often these attributes have absolutely nothing to do with any messages the sender intends to convey, they can have a major impact on the receiver’s interpretation. Take for example, the patient with a personal bias against individuals with numerous tattoos or body piercings. The patient may have difficulty in establishing a trusting and therapeutic relationship with a nurse that has tattoos or piercings.

A professional appearance conveys pride and competence. How the nurse chooses to dress while on duty sends a strong message to the patient. The LPN/LVN who chooses to wear wrinkled uniforms or soiled shoes may risk sending the message that the patient is not worth the time it would take for the nurse to look professional. This may lead the patient to view the nurse as uncaring or incompetent.

Many health care facilities have adopted specific dress codes to convey professionalism in the workplace. Scrubs of one design or color are often worn by specific personnel as a means of communicating to the patient the role of that professional. In some facilities, the nurse may wear one color of scrubs, and the unlicensed assistive personnel (UAP) may wear another. Jewelry, piercings, tattoos, and hair may also be addressed in dress codes within health care facilities.

Gestures.

Gestures are movements people use to emphasize the idea they are attempting to communicate. Gestures also play a useful role in clarifying. A patient is often better able to express where pain is on the body by pointing to a particular area than trying to describe it in words. However, many gestures affect communication negatively. For example, a nurse who frequently looks at a watch while interviewing a patient conveys disinterest in what the patient is saying or that the nurse has a limited amount of time to spend with the patient. Also, gestures often have very different meanings from individual to individual and from culture to culture. It is essential to be constantly aware of gestures the participants use during interactions and to consider the implication of gestures used.

Posture.

The way that an individual sits, stands, and moves is called posture. Posture has the potential to convey warmth and acceptance or distance and disinterest. A person is considered to display an open posture when taking a relaxed stance with uncrossed arms and legs while facing the other individual. A slight shift in body position toward an individual, a smile, and direct eye contact are all consistent with open posturing and convey warmth and caring (Balzer Riley, 2012). Closed posture is a more formal, distant stance, generally with the arms, and possibly the legs,

tightly crossed. A person often interprets closed posture as disinterest, coldness, and even nonacceptance. Standing at the bedside looking down at the patient in the bed places the nurse in a position of authority and control. The patient is likely to experience this as intimidating and condescending. Whenever possible, the nurse should be at the same level as the patient during conversations; this is especially important with pediatric patients. Sitting at the bedside in a relaxed and open posture is one example (Figure 4-1).