Lesson 1, Topic 1
In Progress

Styles of Communication

May 1, 2021

Consistency of Verbal and Nonverbal Communication

No definitive studies prove what percentage of communication is verbal or nonverbal; however, most people and communication experts believe that nonverbal communication is often more accurate and makes up the largest percentage of our communication. Nonverbal communication is very powerful. If nonverbal cues are inconsistent or incongruent with the verbal message, the nonverbal message is most likely the one received. At the very least, this incongruence is frequently the cause of misinterpretation and misunderstanding. The following scenario is an example of incongruence between what the nurse is stating and what she is demonstrating.

Nurse M. has been having a very busy morning. While trying to get Ms. D. ready to go to surgery, Nurse M. has been interrupted several times by staff members asking for help or advice. Now Mr. R., a patient also assigned to Nurse M., has put on his call light. As she enters Mr. R.’s room in an obvious hurry, Mr. R. states, “I’m very sorry

Box 4-1 Assertive Communication for Nurses

Communicating assertively means:

•Being skilled in a variety of communication strategies and able to express your thoughts and feelings in a way that simultaneously protects your rights and those of others.
•Having a positive attitude about communicating directly and honestly.
•Feeling comfortable and in control of anxiety, tenseness, shyness, or fear.
•Feeling confident that you can conduct yourself in a self-respecting way while still respecting others.
•Honoring the fact that you and the other person both have rights.

An assertive nurse:
•Appears self confident and composed.
•Maintains eye contact.
•Uses clear, concise speech.
•Speaks firmly and positively.
•Speaks genuinely, without sarcasm.
•Is unapologetic.
•Takes initiative to guide situations.
•Gives the same message verbally and nonverbally.

From Balzer Riley J: Communication in nursing, ed. 7, St. Louis, 2012, Mosby.

to bother you, but could you refill my water pitcher?” Nurse M. grabs the pitcher from the bedside stand and takes it to the sink, while muttering through tight lips, “It’s no bother, Mr. R. I’m happy to do it!”

The words Nurse M. used are quite appropriate. However, Nurse M.’s nonverbal cues are “speaking” much louder than her words, and Mr. R. is sure to pick up on her anger and frustration from her posture, tone of voice, and facial expression. How is it possible for him to really believe that he has not been a bother and that Nurse M. is “happy” to help him?

Styles of Communication

The manner, or style, in which a message is communicated greatly affects the mood and the overall outcome of an interaction. Every time an interaction occurs between a nurse and a patient the tone is set for the nurse-patient relationship. The style of communication the nurse demonstrates is often what makes the difference between a positive or negative interaction.

Assertive Communication

Assertiveness is one’s ability to confidently and comfortably express thoughts and feelings while still respecting the legitimate rights of the patient. An assertive communication style is interaction that takes into account the feelings and needs of the patient, yet honors the nurse’s rights as an individual (Box 4-1). It makes interactions more even sided and has positive benefits for all involved (Balzer Riley, 2012).

Aggressive Communication

Aggressive communication occurs when an individual interacts with another in an overpowering and forceful manner to meet one’s own personal needs at the expense of the other. Aggressive communication is destructive and nontherapeutic. In the situation just described, Nurse M. responds to Mr. R. in an aggressive manner. Neither party benefits from such an interaction. After the fact, Nurse M. most likely feels guilty and disrespectful for having responded to Mr. R. in this harsh manner, and Mr. R. undoubtedly feels humiliated and unworthy.

Unassertive Communication

Another choice for Nurse M., although not a favorable one, was to respond unambiguously to Mr. R. but in an unassertive communication style. In this style, the nurse agrees to do what the patient requests, even though doing so creates additional problems for the nurse. Use of this style sacrifices one’s legitimate personal rights to the needs of the patient, and there is a price to pay: resentment.

Imagine that Nurse M. had responded like this to Mr. R.’s request to have his water pitcher refilled:

“Well, I’m really busy right now, but … well, I guess I can do it if I hurry. I just don’t know how I’m ever going to get my other patient ready for surgery in time. Here, give me your pitcher.”

This interaction is much like the previous one, although more out in the open. The problem with this interaction is that no one really benefits from the interaction. Mr. R. now has fresh water but probably feels like he has imposed on the nurse unduly. Perhaps he even feels angry thinking that his needs are not as important as those of another patient. Nurse M. now is even further behind than before and is likely to feel resentment toward Mr. R. and as guilty or ashamed as before for giving Mr. R. the impression he is a “bother.”

The most effective way for Nurse M. to address the situation is with an assertive communication style. Perhaps the interaction sounds like this:

“Mr. R., if you don’t mind waiting about 10 minutes, I will be glad to fill your water pitcher with fresh ice and water. If you need it filled before that, I can ask one of the nursing assistants to fill it for you now.”

With assertive communication, the needs of both Nurse M. and Mr. R. can be met, with neither of them feeling unworthy, belittled, resentful, or guilty.