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CHAPTER 2 - INTE

Chapter 1
Review of Communication Process
1. INTRODUCTION
Communi cati on i s the acti v i ty of conv ey i ng i nf or mati on.
Communi cati on has been der i v ed f r om the Lati n wor d communi s,
whi ch means to shar e. Communi cati on r equi r es a sender , a
message, and an i ntended r eci pi ent. Howev er , the r ecei v er need not
to be pr esent or be awar e of the sender 's i ntent to communi cate at
the ti me of communi cati on; thus, communi cati on can occur acr oss
v ast di stances i n ti me and space. Communi cati on r equi r es that the
communi cati ng par ti es shar e an ar ea of communi cati v e
commonal i ty . The communi cati on pr ocess i s compl ete once the
r ecei v er has under stood the message of the sender . Feedback i s
cr i ti cal f or ef f ecti v e communi cati on between par ti es.

Words are the most powerful drug used by mankind
Rudyard Kipling
Communi cati on i s par t and par cel of our day -to-day pr of essi onal
as wel l as soci al l i f e. It i s i nter wov en i n al l nur si ng acti v i ti es and
i s an i nsepar abl e par t of the nur si ng pr ocess. The nur se has to
communi cate pati ent i nf or mati on and other f acts to the member s
of heal th car e team to achi ev e heal th-r el ated goal s of the pati ent.
Si mi l ar l y , she has to communi cate wi th the pati ents whi l e
assessi ng, pl anni ng, i mpl ementi ng, and ev al uati ng nur si ng car e.

Example: Mr s. Radhi ka i s a newl y appoi nted staf f nur se
who got her f i r st posti ng i n Cor onar y Car e Uni t. She i s
assi gned to Mr . Anjuman who i s suf f er i ng wi th
congesti v e hear t f ai l ur e and was admi tted two day s
bef or e. At the ti me of r outi ne war d r ound, the doctor
pr escr i bed tabl et di gox i n 0.25 mg OD. Unf or tunatel y ,
the doctor 's handwr i ti ng was v er y poor and he di d not
menti on 0 (zer o) bef or e .25. Mr s. Radhi ka mi sunder stood
i t as 25 mg and admi ni ster ed the same dose (25 mg) to the
pati ent. Al though, she was i n doubt about the
cor r ectness of the dose, but she di d not cl ar i f y i t wi th
the doctor or wi th a seni or col l eague because of some
r eason. The pati ent dev el oped sev er e br ady car di a and
dy sponea af ter 20 mi nutes of admi ni str ati on of the dr ug.
For tunatel y , he sur v i v ed because of i mmedi ate
tr eatment pr ov i ded to hi m f or di gox i n tox i ci ty and
br ady car di a. In thi s si tuati on, the questi on ar i ses that
why al l thi s happened to Mr . Anjuman? The answer : i t
happened due to l ack of communi cati on between the
nur se and doctor . When i n doubt due to poor
handwr i ti ng of doctor , she must v er i f y the dose f r om the
concer ned doctor or seni or staf f . The doctor al so
r equi r es i mpr ov ement i n hi s handwr i ti ng so that thi s
ty pe of medi cati on er r or s can be av oi ded.
In Indi a, thi s i s the par ti cul ar ski l l that needs to be emphasi zed
among al l nur ses as av ai l abl e ev i dences suggest that major i ty of
the Indi an nur ses ei ther ar e poor i n communi cati on ski l l s or ar e
not usi ng i t ef f ecti v el y as a pr of essi onal nur se due to a v ar i ety of
r easons.

Communication and Nursing Education


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Communi cati on i s a ski l l that can be l ear ned i n the same way as
other nur si ng ski l l s. Indeed, i t wi l l r equi r e some tr ai ni ng si mi l ar
to other nur si ng ski l l s to l ear n i t ef f ecti v el y . In the contex t of
nur si ng educati on, communi cati on i s consi der ed as a teachi ng ski l l .
Wi thout communi cati ng the i ntended l ear ni ng outcomes and
contents ef f ecti v el y to the l ear ner s, l ear ni ng cannot take pl ace. So,
to del i v er ef f ecti v e teachi ng, a nur se-teacher must be a good
communi cator , whi ch r equi r es the under standi ng of the pr ocess
and techni ques of communi cati on.
2. DEFINITION
Communi cati on can be def i ned as the ex change of opi ni on, i deas,
i nf or mati on, f acts, f eel i ngs, and v al ues between two or mor e
per sons (sender and r ecei v er /s) wi th the hel p of some channel s to
accompl i sh the desi r ed pur pose.
Vestal (1995) def i ned communi cati on as the ex change of
meani ngs between and among i ndi v i dual thr ough a shar ed sy stem
of sy mbol s (v er bal and nonv er bal ) that hav e the same meani ng f or
both the sender and r ecei v er of the message.
Murphy and Hildebrandt def i ned communi cati on as a pr ocess of
tr ansmi tti ng and r ecei v i ng v er bal and non-v er bal messages that
pr oduce a r esponse.
Joseph A. Devito menti oned that communi cati on r ef er s to the act
by one or mor e per sons of sendi ng and r ecei v i ng messages that ar e
di stor ted by noi se, occur wi thi n a contex t, hav e some ef f ect, and
pr ov i de some oppor tuni ty f or f eedback.
Communi cati on i s a cy cl i c pr ocess that i nv ol v es i ni ti ati on,
tr ansmi ssi on, and r ecepti on of i nf or mati on. The r ecepti on of
i nf or mati on i s f ol l owed by the f eedback, whi ch i n tur n can r epeat
the cy cl e of communi cati on.

Communi cati on i s r epr esented by :
10%wor dswhat we say v er bal l y
30%soundstone of v oi ce
60%body l anguagehow we say i t (nonv er bal )

Figure 1.1 Factor s that Inf l uence Ver bal Communi cati on
3. PROCESS, ELEMENTS, AND CHANNELS OF COMMUNICATION
3.1. Process of Communication
Communi cati on i s a cy cl i c pr ocess that star ts when the sender f eel s
that ther e i s a need to communi cate wi th the r ecei v er f or a
par ti cul ar r eason (pur pose).
The sender cr eates a message ei ther i n the wr i tten or i n v er bal or
nonv er bal f or m. The message i s di spatched to the r ecei v er wi th the
hel p of channel s of communi cati on. The r ecei v er takes the
del i v er y of the message and pr ov i des f eedback to the sender . The
sender gets the f eedback and deter mi nes whether the r ecei v er has
r ecei v ed the same message and meani ng that the sender had
i ntended to communi cate wi th hi m; i f the sender f eel s that the
r ecei v er has not r ecei v ed the same message and meani ng, he/she
agai n i ni ti ates the cy cl e of communi cati on (r ef er Fi gur e 1.2).


Figure 1.2 Communi cati on Pr ocess
3.2. Elements of Communication
On the basi s of Fi gur e 1.2, the el ements of communi cati on ar e as
f ol l ows:
1. Sender
2. Message
3. Channel of communi cati on
4. Recei v er
5. Feedback
1. Sender: The sender i s the per son who i ni ti ates the
pr ocess of communi cati on. Whenev er the sender f eel s
that ther e i s a need to communi cate some i nf or mati on
to the other per son (r ecei v er ), he/she star ts the pr ocess
of communi cati on. The sender must be awar e of the
pur pose of the communi cati on and the r ecei v er 's
abi l i ti es to under stand the message i n ter ms of
l anguage, i nter est, etc.
2. Message: The message i s cr eated by the sender to
conv ey the i nf or mati on, f acts or opi ni on to the
r ecei v er . The message shoul d be cl ear and si mpl e so
that the r ecei v er can under stand i t i n the same way as
the sender desi r es. Whi l e cr eati ng a message, the sender
shoul d take car e of wor ds, l anguage, and meani ng of the
message i f the message i s to be communi cated i n v er bal
or wr i tten f or m or he/she shoul d take car e of body
l anguage and f aci al ex pr essi on i f the message i s to be
communi cated i n nonv er bal f or m, al ong wi th the
abi l i ti es and pr of essi onal competenci es of the
r ecei v er .
3. Channels of communication: Communi cati on channel s
ar e the medi um thr ough whi ch the message i s
communi cated to the r ecei v er . Channel s of
communi cati on pl ay an i mpor tant r ol e i n the pr ocess
of communi cati on. If the sender sel ects an appr opr i ate
medi um or channel of communi cati on, ther e ar e mor e
chances that the r ecei v er wi l l r ecei v e the same
message; or el se, ther e ar e chances that the message may
get di stor ted. In thi s hi -tech er a, ther e ar e a number of
channel s that can be used to communi cate message, e.g.,
mobi l e, e-mai l , v oi ce mai l , per son, r adi o, TV, Inter net,
bl ogs, etc. Thr ough pr oper channel i s a common
phr ase used among the nur se admi ni str ator s/manager s
that si gni f i es the i mpor tance of communi cati on
channel s. For ex ampl e, a student of B.Sc nur si ng, II
y ear , wants to communi cate hostel pr obl ems to the
di r ector of the i nsti tute. In or der to r each to the
i ntended r ecei v er f i r st, he/she shoul d communi cate
hi s/her message i n the f or m of wr i tten appl i cati on to
the cl ass teacher ; the cl ass teacher wi l l f or war d the
appl i cati on (message) to the pr i nci pal and f i nal l y the
pr i nci pal wi l l f or war d the appl i cati on to the di r ector .
That i s how communi cati on thr ough pr oper channel
takes pl ace. In thi s case, the cl ass teacher and pr i nci pal
wer e the channel s of communi cati on thr ough whi ch
the message was communi cated to the r ecei v er
(di r ector ).
4. Receiver: The r ecei v er i s the per son who r ecei v es the
message. The r ecei v er may be a si ngl e per son or a gr oup
of per sons. The r ecei v er under stands the meani ng of the
message and pr ov i des f eedback to the sender . The
r ecei v er shoul d hav e the same l anguage abi l i ty ,
compr ehensi on, and cul tur al backgr ound as the sender .
If not, i t may l ead to di stor ted under standi ng of the
meani ng of the message by the r ecei v er .
5. Feedback: It i s the most cr uci al el ement of
communi cati on. It i s pr ov i ded by the r ecei v er to the
sender . Recei v i ng f eedback i s i mpor tant f or the sender
to know that the r ecei v er has r ecei v ed the message and
i nter pr eted the meani ng of the message i n the desi r ed
way . Wi thout f eedback, the pr ocess of communi cati on
cannot be compl ete. For ex ampl e, when y ou send a
mobi l e SMS to y our f r i end, y ou get f eedback i n the f or m
of del i v er y r epor t that i nf or ms y ou whether y our
message has been del i v er ed or not to the i ntended
r ecei v er ; i t al so happens i n the same way i n the case of
e-mai l .
4. TYPES OF COMMUNICATION
Communi cati on may be of di f f er ent ty pes dependi ng upon the
contex t i n whi ch the ter m communi cati on i s used. The i mpor tant
ty pes of communi cati on ar e shown i n Fi gur e 1.3.


Figure 1.3 Ty pes of Communi cati on
4.1. Verbal Communication
When the sender conv ey s i nf or mati on, f acts, and opi ni on ei ther
v er bal l y or i n wr i ti ng to the r ecei v er usi ng di f f er ent channel s of
communi cati on, i t i s known as v er bal communi cati on. The sender
shoul d sel ect appr opr i ate wor ds and l anguage to communi cate the
message to the r ecei v er . Fi gur e 1.4 hi ghl i ghts the gui del i nes that
shoul d be f ol l owed to make the v er bal communi cati on ef f ecti v e.


Figure 1.4 Gui del i nes f or Ef f ecti v e Ver bal Communi cati on
4.2. Nonverbal Communication
Nonv er bal communi cati on takes pl ace wi thout the use of wor ds.
Nonv er bal communi cati on i nv ol v es the unconsci ous mi nd acti ng
out emoti ons r el ated to the v er bal content, the si tuati on, and the
env i r onment. The sender uses the body l anguage, f aci al ex pr essi on,
hand mov ements, ey e mov ements, etc. to conv ey the f eel i ngs,
emoti ons, and other i nf or mati on to the r ecei v er . Thi s ty pe of the
communi cati on can be usef ul when both the sender and the
r ecei v er dont hav e an under standi ng of a common l anguage. Thi s
techni que of communi cati on i s especi al l y usef ul when y ou ar e
deal i ng wi th a cl i ent who i s deaf and dumb.
Knapp and Hall (2002) pr ov i ded a l i st of the way s how nonv er bal
messages accompany v er bal messages (Fi gur e 1.5).


Figure 1.5 Nonv er bal Way s to Accompany Ver bal Communi cati on
(Kappa and Hal l , 2002)

The i nter esti ng f act about nonv er bal communi cati on i s that i t
r ef l ects a mor e accur ate descr i pti on of one's tr ue f eel i ngs because
nonv er bal r eacti ons cannot be contr ol l ed easi l y by the peopl e.
Nonv er bal communi cati on may i ncl ude:
Vocal cues
Gestur es
Postur e
Phy si cal appear ance
Di stance or spati al ter r i tor y
Posi ti on or postur e
Touch
Faci al ex pr essi on
4.3. Meta Communication
Meta communi cati on i s an i mpor tant and usef ul tool f or the
ef f ecti v e i nter per sonal i nter acti on. It i s communi cati on about
communi cati on so that the deeper message wi thi n a message can
be uncov er ed and under stood (Wood, 1999). Thi s ty pe of method i s
usef ul among a gr oup of ex per ts i n a par ti cul ar ar ea.
4.4. Formal Communication
For mal communi cati on i s a ty pe of communi cati on whi ch i s used i n
the contex t of or gani zati on wher e a l ar ge gr oup of empl oy ees wor k
together to accompl i sh goal s of or gani zati on. For mal
communi cati ons usual l y take pl ace i n the f or m of wr i tten
communi cati on, whi ch f ol l ows the l i nes of author i ty or scal ar
chai n of command.
4.5. Informal Communication
Inf or mal communi cati on r ef er s to the gossi p or i nf or mal tal ks that
take pl ace among the v ar i ous gr oups of peopl e wor ki ng i n an
or gani zati on that dont f ol l ow or gani zati onal l i ne of author i ty or
hi er ar chy .
4.6. Therapeutic Communication
Ther apeuti c communi cati on i s a ty pe of communi cati on that takes
pl ace i n the heal th car e env i r onment between nur se and pati ent.
Ther apeuti c communi cati ons i s a pl anned, del i ber ate, and
pr of essi onal act that uses communi cati on techni ques to achi ev e a
posi ti v e r el ati onshi p and shar ed under standi ng of i nf or mati on f or
the desi r ed pati ent-car e goal s. The pur pose of ther apeuti c
communi cati on i s to ex pl or e the cl i ent's pr obl ems, pl anni ng the
i nter v enti ons al ong wi th the cl i ent and i mpl ementi ng these
i nter v enti ons. Dur i ng ther apeuti c communi cati on, the nur se
encour ages the cl i ent to communi cate f ear , anx i eti es, ex pectati ons,
and sel f -car e def i ci t needs. The nur se uses speci al techni ques whi l e
engagi ng i n the ther apeuti c communi cati on wi th the cl i ent, e.g.,
acti v e l i steni ng, aski ng open-ended questi ons, par aphr asi ng, etc.
5. LEVELS OF COMMUNICATION
Lev el s of communi cati on ar e deter mi ned on the basi s of the number
of peopl e i nv ol v ed i n the pr ocess of communi cati on as wel l as on
the pur pose of communi cati on. These l ev el s of communi cati on ar e
depi cted i n Fi gur e 1.6.


Figure 1.6 Lev el s of Communi cati on
5.1. Intrapersonal Communication
Intr aper sonal communi cati on r ef er s to communi cati on wi th the
sel f . It may be si l ent or v er bal ty pe of communi cati on.
Intr aper sonal ty pe of communi cati on appr ox i mates wi th the
thi nki ng pr ocess, i n whi ch the per son consci ousl y sends
i nf or mati on to hi msel f /her sel f i n or der to anal y ze a si tuati on. Thi s
communi cati on str ategy i s par ti cul ar l y usef ul when someone has
to make i mpor tant l i f e deci si ons or i s f aci ng a conf l i cti ng
si tuati on. Posi ti v e sel f -tal k i s a ty pe of i ntr aper sonal
communi cati on that can be used as a tool to i mpr ov e the nur ses or
cl i ent's heal th and sel f -esteem.
5.2. Interpersonal Communication
It r ef er s to one-to-one i nter acti on between two per sons that of ten
occur s f ace to f ace. The pur pose of i nter per sonal communi cati on i s
to shar e i nf or mati on, opi ni on, i deas, and so on (Fi gur e 1.7 ).
Inter per sonal communi cati on can be f ur ther di v i ded i nto thr ee
ty pes:


Figure 1.7 Ty pes of Inter per sonal Communi cati on
5.2.1. Assertive Communication
It i s a ty pe of i nter per sonal communi cati on that has the f ol l owi ng
char acter i sti cs:
Conf i dentl y ex pr essi ng what y ou thi nk, f eel , and bel i ev e.
Rai si ng v oi ce f or y our r i ghts whi l e r especti ng the r i ghts of
other s.
Conv ey i ng meani ng and ex pectati ons wi thout humi l i ati ng
or degr adi ng other s.
Based upon r espect f or y ou and r espect f or other peopl e's
need and r i ghts.
It i s notewor thy her e that, unf or tunatel y most of the nur ses ar e
not usi ng asser ti v e communi cati on i n thei r pr of essi onal l i f e
because of so many r easons. Ther e i s a need to change the cur r ent
si tuati on, and the r esponsi bi l i ty l i es on y oung buddi ng nur ses so
that the pr of essi onal i mage of the nur ses can be i mpr ov ed i n Indi a.
5.2.2. Nonassertive Communication
Nonasser ti v e communi cati on i s char acter i zed as f ol l ows:
Inabi l i ty to ex pr ess consi stentl y what y ou thi nk, f eel , and
bel i ev e.
Al l owi ng other s to v i ol ate y our r i ghts wi thout chal l enge.
Ref l ecti ng l ack of r espect f or y our own pr ef er ences.
Other s can easi l y di sr egar d y our thoughts, f eel i ngs, and
bel i ef s.
It cannot be consi der ed a good communi cati on str ategy f or a
pr of essi onal nur se.
5.2.3. Aggressive Communication
Aggr essi v e communi cati on takes pl ace when someone ex pr esses
hi msel f /her sel f i n way s that i nti mi date, demean, or degr ade
another per son, pur sui ng what y ou want i n way s that v i ol ate the
r i ghts of another per son. It i s consi der ed as an unsui tabl e
communi cati on techni que f or a pr of essi onal nur se.
5.3. Transpersonal Communication
Communi cati on that occur s wi thi n a per son's spi r i tual domai n i s
r ef er r ed as tr ansper sonal communi cati on. The pur pose of
tr ansper sonal communi cati on i s to r eal i ze sel f -hood, enhance
spi r i tual i ty , and answer the questi ons that ar e spi r i tual i n natur e.
5.4. Small-group Communication
Thi s ty pe or l ev el of communi cati on takes pl ace wi thi n a smal l
gr oup. The pur pose of smal l -gr oup communi cati on i s to
communi cate i nf or mati on that i s of common i nter est to gr oup
member s or someti mes to know the opi ni ons of gr oup member s to
ar r i v e at a deci si on.
5.5. Public Communication
Publ i c i s usual l y consi der ed as a l ar ge gr oup of peopl e or
l ay per sons wi th a v ast di f f er ence i n a number of f actor s, e.g.,
soci oeconomi c status, l i ter acy l ev el , occupati on, and habi tat.
Communi cati on to publ i c ser v es some pur poses that benef i t the
common man (e.g., heal th educati on) or someti mes to make r equests
or to get f av or s f r om the publ i c i n gener al el ecti ons. Publ i c
communi cati on r equi r es speci al communi cati on ski l l s as the si ze
of the gr oup i s v er y l ar ge wi th so many di f f er ences among the
gr oup member s as descr i bed ear l i er . Ther e i s a need to mai ntai n
di f f er ent ty pes of ey e contact wi th the publ i c, gestur es, and v oi ces,
and medi a mater i al s shoul d be used to communi cate messages
ef f ecti v el y .
5.6. Social Communication
Soci al communi cati on takes pl ace i n the soci al contex t. Bei ng a
soci al ani mal , human bei ngs establ i sh r el ati onshi p wi th other
peopl e to accompl i sh sev er al pur poses thr oughout thei r l i f e span.
In or der to keep these soci al r el ati ons al i v e and bei ng soci al , one
has to communi cate wi th other s. Good mor ni ng. How ar e y ou?
How ar e y our chi l dr en? Thi s ty pe of communi cati on i s one's
soci al obl i gati on to communi cate wi thi n hi s/her soci al gr oup to
whi ch he/she bel ongs.
6. FACTORS INFLUENCING COMMUNICATION
Ther e ar e cer tai n f actor s that i nf l uence the pr ocess of
communi cati on, whi ch ar e descr i bed br i ef l y her e.
6.1. Attitude
Atti tude i s r ef er r ed to the i nter nal pr edi sposi ti on of a per son to
act i n a cer tai n way towar d a si tuati on. The atti tude of a per son
towar d the gi v en si tuati on i s i nf l uenced by the peer s, par ents,
env i r onment, l i f e ex per i ences, per cepti on, and i ntel l ectual
pr ocesses. A per son may hav e the atti tude of accepti ng, pr ejudi ced,
judgmental , negati v e, open and cl ose, etc.
A per son wi th negati v e atti tude may r espond wi th Im sur e i t i s
of no use, i t wi l l not wor k ul ti matel y . On the other hand, a per son
wi th posi ti v e atti tude wi l l r epl y come on guy s, l et us tr y i t, we
hav e nothi ng to l ose.
6.2. Sociocultural Background
Var i ous cul tur es and ethni c gr oups di spl ay di f f er ent
communi cati on patter ns. For ex ampl e, peopl e of Fr ench or Ital i an
her i tage of ten ar e gr egar i ous and tal kati v e and wi l l i ng to shar e
thoughts and f eel i ngs. Peopl e f r om Southeast Asi an countr i es such
as Thai l and or Laos ar e qui et and r eser v ed. They appear stoi c and
r el uctant to di scuss per sonal f eel i ngs wi th per sons outsi de thei r
f ami l i es.
6.3. Past Experiences
Pr ev i ous posi ti v e or negati v e ex per i ences i nf l uence one's abi l i ty
to communi cate. For ex ampl e, teenager s who hav e been cr i ti ci zed
by par ents whenev er attempti ng to ex pr ess any f eel i ngs may
dev el op a poor sel f -i mage and f eel that thei r opi ni ons ar e not
wor thwhi l e. As a r esul t, they may av oi d i nter acti ng wi th other s,
become i ndeci si v e when asked to gi v e an opi ni on, or agr ee wi th
other s to av oi d what they per cei v e to be cr i ti ci sm or conf r ontati on
(nonasser ti v e).
6.4. Knowledgeof Subject Matter
A per son who i s wel l -educated or knowl edgeabl e about cer tai n
topi cs may communi cate wi th other s at a hi gh l ev el of
under standi ng. The r ecei v er who i s r el ati v el y l ess knowl edgeabl e
of the topi c under di scussi on may be unabl e to compr ehend the
message or consi der the sender to be an ex per t. As a r esul t of thi s
mi sper cepti on, the r ecei v er may negl ect to ask questi ons and may
not r ecei v e the cor r ect i nf or mati on. For ex ampl e, nur ses ar e
r equi r ed to communi cate wi th the pati ent i n a l anguage that i s
under standabl e to the pati ent (pati ent's nati v e l anguage). She i s
al so r equi r ed not to use jar gons whi l e del i v er i ng heal th educati on
or some other usef ul i nf or mati on to the pati ent. The educati onal
status of the pati ent must be taken i nto consi der ati on whi l e
communi cati ng wi th the pati ent.
6.5. Ability to Relatewith Others
Some peopl e ar e natur al -bor n tal ker s who cl ai m to hav e nev er
met a str anger . Other s may possess an i ntui ti v e tr ai t that enabl es
them to say the r i ght thi ng at the r i ght ti me and r el ate wel l to
peopl e. I f eel so comf or tabl e tal ki ng wi th her , She i s so easy to
r el ate to, and I coul d tal k to hi m f or hour s ar e just a f ew
comments made about peopl e who hav e the abi l i ty to r el ate wel l
wi th other s. These per sons ar e consi der ed as good communi cator s.
6.6. Interpersonal Perception
Inter per sonal per cepti ons ar e mental pr ocesses by whi ch
i ntel l ectual , sensor y , and emoti onal data ar e r e-or gani zed l ogi cal l y
and meani ngf ul l y , whi ch deter mi ne how we per cei v e other s.
Inattenti v eness, di si nter est, or l ack of use of one's senses dur i ng
communi cati on can r esul t i n di stor ted per cepti ons of other s. Sati r
(1995) war ns of l ooki ng wi thout seei ng, l i steni ng wi thout hear i ng,
touchi ng wi thout f eel i ng, mov i ng wi thout awar eness, and speaki ng
wi thout meani ng. The f ol l owi ng passage r ei nf or ces the i mpor tance
of per cepti ons: I know that y ou bel i ev e y ou under stand what y ou
thi nk I sai d, but Im not sur e y ou r eal i ze that what y ou hear d i s not
what I sai d.
6.7. Environmental Factors
Env i r onmental f actor s such as ti me, pl ace, number of peopl e
pr esent, and noi se l ev el can i nf l uence communi cati on between
peopl e i n that par ti cul ar sur r oundi ng. Ti mi ng i s i mpor tant dur i ng
a conv er sati on; a v er y wel l -ti med r esponse catches the attenti on of
other s. The pl ace i n whi ch communi cati on occur s, as wel l as the
number of peopl e pr esent and noi se l ev el , has a def i ni te i nf l uence
on i nter acti ons among peopl e )Fi gur e 1.8).


Figure 1.8 Factor s Inf l uenci ng Communi cati on
7. BARRIERS OF COMMUNICATION
Communi cati on pl ay s a major r ol e i n dev el opi ng a r el ati onshi p. It
can al so af f ect the r el ati onshi p among f ami l y member s or
management i n any i nsti tute. Mor e speci f i cal l y , communi cati on
i nf l uences the ef f ecti v eness of i nstr ucti on, per f or mance
ev al uati on, and the handl i ng of di sci pl i ne pr obl ems.
Communi cati on shoul d be str ai ghtf or war d. What can make i t
compl ex , di f f i cul t, and f r ustr ati ng ar e the bar r i er s. Some bar r i er s
of communi cati on ar e the f ol l owi ng.
7.1. Physiological Barrier
Phy si ol ogi cal bar r i er s to communi cati on ar e r el ated wi th the
l i mi tati ons of the human body and the human mi nd (memor y ,
attenti on, and per cepti on). Phy si ol ogi cal bar r i er s may r esul t f r om
i ndi v i dual s per sonal di scomf or t, caused by i l l -heal th, poor ey e
si ght, or hear i ng di f f i cul ti es.
7.1.1. Poor Listening Skills
Li steni ng to other s i s consi der ed a di f f i cul t task. A ty pi cal speaker
say s about 125 wor ds per mi nute. The ty pi cal l i stener can r ecei v e
400600 wor ds per mi nute. Thus, about thr ee-f our th of l i steni ng
ti me i s f r ee ti me. The f r ee ti me of ten si detr acks the l i stener . The
sol uti on i s to be an acti v e r ather than passi v e l i stener . A l i stener 's
pr ematur e f r own, shaki ng of the head, or bor ed l ook can easi l y
conv i nce the other per son/speaker that ther e i s no r eason to
el abor ate or tr y agai n to communi cate hi s/her ex cel l ent i dea.
7.1.2. Information Overload
Nur ses ar e sur r ounded wi th a pool of i nf or mati on. It i s essenti al to
contr ol the f l ow of the i nf or mati on, el se the i nf or mati on i s l i kel y
to be mi si nter pr eted or f or gotten or ov er l ooked. As a r esul t,
communi cati on may get di stor ted.
7.1.3. Inattention
At ti mes, we just do not l i sten but onl y hear . For ex ampl e, y our boss
i s i mmer sed i n hi s/her v er y i mpor tant paper wor k sur r ounded by
so many f i l es on the tabl e and y ou ar e ex pl ai ni ng hi m/her about an
ur gent of f i ce pr obl em. In thi s si tuati on, due to the i nattenti on, the
boss wi l l not l i sten to y ou (he/she wi l l onl y hear y ou); hence,
he/she may not get what y ou ar e say i ng and i t may l ead to
di sappoi ntment.
7.1.4. Emotions
The emoti onal state of a per son at a par ti cul ar poi nt of ti me af f ects
hi s/her communi cati on wi th other s as i t has an i mpact on the body
l anguage (nonv er bal communi cati on). If the r ecei v er f eel s that the
sender i s angr y (emoti onal state), he/she can easi l y i nf er that the
i nf or mati on bei ng obtai ned wi l l be v er y ter r i bl e. Emoti onal state
causes some phy si ol ogi cal changes i n our body that may af f ect the
pr onunci ati on, pr essur e of the speech, and tone of the v oi ce of the
sender as wel l as the per cepti on, thi nki ng pr ocess, and i nf or mati on
i nter pr etati on of the r ecei v er dur i ng v er bal communi cati on.
7.1.5. Poor Retention
Human memor y cannot f uncti on bey ond a l i mi t. One cannot al way s
r etai n al l the f acts/i nf or mati on about what i s bei ng tol d to
hi m/her especi al l y i f he/she i s not i nter ested or not attenti v e. Thi s
l eads to communi cati on br eakdown.
7.2. Physical and Environmental Distractions
Phy si cal di str acti ons ar e the phy si cal thi ngs that get i n the way of
communi cati on. Ex ampl es of such thi ngs i ncl ude the tel ephone, an
uncomf or tabl e meeti ng pl ace, and noi se. These phy si cal
di str acti ons ar e common i n the hospi tal setti ng. If the tel ephone
r i ngs, the usual human tendency wi l l be to answer i t ev en i f the
cal l er i s i nter r upti ng a v er y i mpor tant or ev en del i cate
conv er sati on. Di str acti ons such as backgr ound noi se, poor l i ghti ng,
uncomf or tabl e si tti ng, unhy gi eni c r oom, or an env i r onment that i s
too hot or col d can af f ect peopl e's mor al e and concentr ati on, whi ch
i n tur n i nter f er e wi th ef f ecti v e communi cati on.
7.3. Psychological Barrier
Psy chol ogi cal f actor s such as mi sper cepti on, f i l ter i ng, di str ust,
unhappy emoti ons, and peopl e's state of mi nd can jeopar di ze the
pr ocess of communi cati on. We al l tend to f eel happi er and mor e
r ecepti v e to i nf or mati on when the sun shi nes. Si mi l ar l y , i f
someone has per sonal pr obl ems such as wor r i es and str ess about a
chr oni c i l l ness, i t may i mpi nge hi s/her communi cati on wi th
other s.
7.4. Social Barriers
Soci al bar r i er s to communi cati on i ncl ude the soci al psy chol ogi cal
phenomenon of conf or mi ty , a pr ocess i n whi ch the nor ms, v al ues,
and behav i or s of an i ndi v i dual begi n to f ol l ow those of the wi der
gr oup. Soci al f actor s such as age, gender , soci oeconomi c status, and
mar i tal status may act as a bar r i er to communi cati on i n cer tai n
si tuati ons.
7.5. Cultural Barriers
Cul tur e shapes the way we thi nk and behav e. It can be seen as both
shapi ng and bei ng shaped by our establ i shed patter ns of
communi cati on. Cul tur al bar r i er to communi cati on of ten ar i ses
when i ndi v i dual s i n one soci al gr oup hav e dev el oped di f f er ent
nor ms, v al ues, or behav i or s to i ndi v i dual s associ ated wi th another
gr oup. Cul tur al di f f er ence l eads to di f f er ence i n i nter est,
knowl edge, v al ue, and tr adi ti on. Ther ef or e, peopl e of di f f er ent
cul tur es wi l l ex per i ence these cul tur e f actor s as a bar r i er to
communi cate wi th each other .
7.6. Semantic Barrier
Language, jar gon, sl ang, etc., ar e some of the semanti c bar r i er s.
Di f f er ent l anguages acr oss di f f er ent r egi ons r epr esent a nati onal
bar r i er to communi cati on, whi ch i s par ti cul ar l y i mpor tant f or
mi gr ati ng nur ses. Use of jar gon and sl ang al so act as bar r i er to
communi cati on. For ex ampl e, whi l e del i v er i ng heal th educati on to
a car di ac pati ent, i f a car di ac nur se uses jar gons such as cor onar y
ar ter y di sease, anti coagul ants, and homocy stei ne and C-r eacti v e
pr otei ns, the pati ent wi l l l i sten attenti v el y as he/she cannot
under stand these medi cal jar gons. Ther ef or e, she i s r equi r ed to use
si mpl e wor ds hear t ki nadi ki bi mar i , khoon patl a kar ne ki
dawai , and cer tai n chemi cal s i n our body so that the pati ent can
under stand what the nur se i s supposed to communi cate wi th
hi m/her .
7.7. Linguistic Barriers
Indi v i dual l i ngui sti c abi l i ty may someti mes become a bar r i er to
communi cati on. The use of di f f i cul t or i nappr opr i ate wor ds i n
communi cati on can pr ev ent the peopl e f r om under standi ng the
message. Poor l y ex pl ai ned or mi sunder stood messages can al so
r esul t i n conf usi on. The l i ngui sti c di f f er ences between the peopl e
can al so l ead to communi cati on br eakdown. The same wor d may
mean di f f er entl y to di f f er ent i ndi v i dual s. For ex ampl e, consi der a
wor d f ace.
He i s f aci ng a pr obl em
What i s the f ace v al ue of thi s shar e bond?
Your f ace i s ov al shape
Face means di f f er entl y i n di f f er ent sentences. Communi cati on
br eakdown occur s i f ther e i s wr ong per cepti on of the meani ng of
the message by the r ecei v er .
7.8. Past Experience
If someone has awf ul ex per i ences i n the past r el ated to some
par ti cul ar si tuati on, then he/she wi l l tr y to av oi d communi cati on
i n that si tuati on. For ex ampl e, a staf f nur se who, whi l e pr ov i di ng
detai l ed i nf or mati on r egar di ng the pati ent car e at the ti me of
r outi ne cl i ni cal r ound to her boss, i s al way s f aci ng negati v e body
l anguage and di scour agi ng wor ds f r om her boss wi l l ul ti matel y
l i mi t her communi cati on to the boss at that ti me.
7.9. Organizational Barriers
Uncl ear pl anni ng, str uctur e, i nf or mati on ov er l oad, ti mi ng,
technol ogy , and status di f f er ence ar e the or gani zati onal f actor s
that may act as bar r i er s to communi cati on.
7.9.1. Technological Failure
Message not del i v er ed due to techni cal f ai l ur e (e.g., r ecei v er was
not i n mobi l e networ k ar ea and the sender has not acti v ated
del i v er y r epor t i n message setti ng).
7.9.2. Time Pressures
Of ten, i n or gani zati on the tar gets hav e to be achi ev ed wi thi n a
speci f i ed ti me per i od, the f ai l ur e of whi ch may hav e adv er se
consequences f or the empl oy ee. In a haste to meet deadl i nes,
usual l y an empl oy ee tr i es to shor ten the f or mal channel s of
communi cati on that can l ead to conf usi on and mi sunder standi ng
among the v ar i ous l ev el s of super v i sor s, hence l eadi ng di stor ted
communi cati on. Ther ef or e, suf f i ci ent ti me shoul d be gi v en f or
ef f ecti v e communi cati on.
7.9.3. Complexity in Organizational Structure
Gr eater the hi er ar chy i n an or gani zati on (i .e., the mor e the number
of manager i al l ev el s), mor e ar e the chances of communi cati on
getti ng destr oy ed. Onl y the peopl e at the top l ev el can see the
ov er al l pi ctur e whi l e the peopl e at l ow l ev el just hav e a
knowl edge about thei r own ar ea and a l i ttl e knowl edge about other
ar eas of the or gani zati on.
7.10. Barriers Related with theMessage
7.10.1. Unclear Messages
Ef f ecti v e communi cati on star ts wi th a cl ear message. Uncl ear
messages i n ter ms of meani ng, gr ammar , and wor ds may act as a
bar r i er to communi cati on because the r ecei v er may not be abl e to
i nter cept the actual meani ng of the message.
7.10.2. Stereotypes
Ster eoty pes ar e bel i ef s or gener al i zati ons about char acter i sti cs or
qual i ti es that ar e f el t to be ty pi cal of a par ti cul ar gr oup (Funk &
Wagnal l s, 1966). Ster eoty pi ng i s a bar r i er to communi cati on
because peopl e wi th ster eoty pe thoughts ei ther wi l l not r ead the
message compl etel y or wi l l not r ead i t at al l because of thei r
thi nki ng that they al r eady know ev er y thi ng (Fi gur e 1.9).


Figure 1.9 Bar r i er s to Communi cati on
7.10.3. Inappropriate Channel
Var i ati on of channel s hel ps the r ecei v er under stand the natur e
and i mpor tance of a message. Whi l e maki ng a choi ce f or a channel
of communi cati on, the sender needs to be sensi ti v e to such thi ngs as
the compl ex i ty of the message; consequences of a mi sunder standi ng;
knowl edge, ski l l s, and abi l i ti es of the r ecei v er ; and i mmedi acy of
acti on to be taken f r om the message.
7.10.4. Lack of Feedback
Feedback i s the mi r r or of communi cati on. Feedback mi r r or s what
the sender has sent. Wi thout f eedback, communi cati on cannot be
consi der ed compl ete. Both the sender and the r ecei v er can pl ay an
acti v e r ol e i n usi ng f eedback to make communi cati on tr ul y two-
way .
7.11. SomeOther Blocks to Communication
Fai l ur e to l i sten: Communi cator may or may not f eel abl e to
speak f r eel y to the l i stener , i f the l i stener i s not l i steni ng
car ef ul l y or not r espondi ng.
Conf l i cti ng v er bal and nonv er bal messages.
Fai l ur e to i nter pr et wi th knowl edge.
Changi ng the subject: A qui ck way to stop conv er sati on i s to
change the subject.
Inappr opr i ate comments and questi ons: Cer tai n ty pes of
comments and questi ons shoul d be av oi ded i n most
si tuati ons because they tend to i mpede ef f ecti v e
communi cati on, e.g., cl ose-ended questi ons and usi ng
comments that gi v e adv i ce.
8. METHODS OF OVERCOMING BARRIERS OF COMMUNICATION OR FACILITATING
COMMUNICATION
Ov er comi ng the communi cati on bar r i er s r equi r es a v i gi l ant
obser v ati on and thoughts of potenti al bar r i er s i n a par ti cul ar
i nstance of communi cati on. State al l the anti ci pated bar r i er s that
may hav e i mpact on y our day -to-day communi cati on. Str ategi es to
ov er come bar r i er s wi l l be di f f er ent i n di f f er ent si tuati ons
dependi ng upon the ty pe of bar r i er s pr esent. Fol l owi ng ar e some of
the i mpor tant gener al str ategi es that wi l l be commonl y usef ul i n
al l the si tuati ons to ov er come the bar r i er s of communi cati on.
Taki ng the r ecei v er mor e ser i ousl y
Cr y stal cl ear message
Del i v er i ng messages ski l l f ul l y
Focusi ng on the r ecei v er
Usi ng mul ti pl e channel s to communi cate i nstead of r el y i ng
on one channel
Ensur i ng appr opr i ate f eedback
Be awar e of y our own state of mi nd/emoti ons/atti tude
8.1. Facilitators of Communication
In addi ti on to r emov al of speci f i c bar r i er s to communi cati on, the
f ol l owi ng gener al gui del i nes may be hel pf ul to f aci l i tate
communi cati on:
Hav e a posi ti v e atti tude about communi cati on.
Def ensi v eness i nter f er es wi th communi cati on.
Wor k at i mpr ov i ng communi cati on ski l l s. The
communi cati on model and di scussi on of bar r i er s to
communi cati on pr ov i de the necessar y knowl edge to
i mpr ov e communi cati on. Thi s i ncr eased awar eness of the
potenti al f or i mpr ov i ng communi cati on i s the f i r st step to
better communi cati on.
Incl ude communi cati on as a ski l l to be ev al uated al ong
wi th al l the other nur si ng ski l l s f or under gr aduates.
Make communi cati on goal or i ented. Rel ati onal goal s come
f i r st and pav e the way f or other goal s. When the sender and
r ecei v er hav e a good r el ati onshi p, they ar e much mor e
l i kel y to accompl i sh thei r communi cati on goal s.
Ex per i ment wi th communi cati on al ter nati v es. What wor ks
wi th one per son may not wor k wel l wi th another . Use
di v er se communi cati on channel s, l i steni ng and f eedback
techni ques.
Accept the r eal i ty of mi scommuni cati on. The best
communi cator s f ai l to hav e per f ect communi cati on. They
accept mi scommuni cati on and wor k to mi ni mi ze i ts
negati v e i mpacts.
Use of si mpl e and cl ear wor ds shoul d be emphasi zed. Use of
ambi guous wor ds and jar gons shoul d be av oi ded.
Noi se i s the mai n communi cati on bar r i er i n most of the
heal th car e setti ngs, whi ch must be handl ed on pr i or i ty
basi s. It i s essenti al to i denti f y and el i mi nate the sour ce of
noi se.
Li sten attenti v el y and car ef ul l y . Ther e i s a di f f er ence
between l i steni ng and hear i ng. Acti v e l i steni ng means
hear i ng wi th a pr oper under standi ng of the message. By
aski ng questi ons, the speaker can ensur e whether hi s/her
message i s under stood or not by the r ecei v er i n the same
manner as i ntended by hi m.
The or gani zati onal str uctur e shoul d be si mpl e to f aci l i tate
communi cati on between v ar i ous hi er ar chy l ev el s. The
number of hi er ar chi cal l ev el s shoul d be opti mum, and
ther e shoul d be an i deal span of contr ol wi thi n the
or gani zati on. Si mpl er the or gani zati onal str uctur e, mor e
ef f ecti v e wi l l be the communi cati on.
The manager s shoul d know how to pr i or i ti ze thei r wor k.
They shoul d not ov er l oad themsel v es wi th the wor k, shoul d
spend qual i ty ti me wi th thei r subor di nates, and shoul d
l i sten to thei r pr obl ems and f eedbacks acti v el y .
Ther e ar e 6 C's of ef f ecti v e communi cati on, whi ch ar e
appl i cabl e to both wr i tten and or al communi cati on. They ar e as
f ol l ows:
1. CompleteThe message must be compl ete i n al l
r espect and shoul d conv ey al l f acts r equi r ed by the
r ecei v er . Incompl eteness of the message may l ead to
mi sunder standi ng or i ncompl ete under standi ng and
conf usi on between the sender and the r ecei v er . It i s the
r esponsi bi l i ty of the sender to make sur e (bef or e
mai l i ng the message) that the i nf or mati on pr ov i ded i n
the message i s compl ete as per the pur pose of the
communi cati on.
2. ClearCl ar i ty i n communi cati on makes under standi ng
easi er and enhances the meani ng of a message. A cl ear
message uses ex act, appr opr i ate, and concr ete wor ds
and av oi ds ambi guous wor ds.
3. CorrectnessCor r ectness i n communi cati on i mpl i es
that ther e ar e no gr ammati cal and spel l i ng er r or s i n
communi cati on.
4. ConciseConci seness means el i mi nati ng wor di ness and
communi cati ng what y ou want to conv ey i n l east
possi bl e wor ds wi thout f or goi ng the other C's of
communi cati on. Conci seness i s a necessi ty f or ef f ecti v e
communi cati on.
5. ConsiderationConsi der ati on i mpl i es steppi ng i nto
the shoes of other s. Ef f ecti v e communi cati on must
take the r ecei v er /s i nto consi der ati on (i .e., the
audi ence's v i ewpoi nts, backgr ound, mi ndset, educati on
l ev el , etc.). The sender shoul d make an attempt to
under stand the audi ence, thei r r equi r ements, emoti ons,
as wel l as pr obl ems. Ensur e that the sel f -r espect of the
audi ence i s mai ntai ned and thei r emoti ons ar e not hur t.
6. CourtesyCour tesy i n message i mpl i es that the
message shoul d show the sender 's ex pr essi on as wel l as
r espect to the r ecei v er . The sender of the message
shoul d be si ncer el y pol i te, judi ci ous, r ef l ecti v e, and
enthusi asti c (Fi gur e 1.10).


Figure 1.106 C's of Communi cati on
9. TECHNIQUES OF EFFECTIVE COMMUNICATION
Ef f ecti v e communi cati on techni ques ar e usef ul to make the
communi cati on ef f i ci ent and meani ngf ul . Ther e ar e sev er al
techni ques of ef f ecti v e communi cati on, whi ch can be used as per
the contex t and ty pe of communi cati on. For ex ampl e, mai ntai ni ng
ey e-to-ey e contact wi th the l i stener i s essenti al f or ef f ecti v e
communi cati on whi l e communi cati ng wi th a si ngl e per son or a
smal l gr oup of peopl e. Howev er , the techni que of ey e-to-ey e
contact has to be used i n a di f f er ent way whi l e communi cati ng
wi th a l ar ge gr oup of audi ence. Si mi l ar l y , some peopl e ar e
consi der ed ex per ts to communi cate bi tter i nf or mati on qui te
comf or tabl y , wher eas, other s may f eel di f f i cul ty because they
dont know how to communi cate i n such a si tuati on. Li kewi se, some
peopl e communi cate the message str ai ghtf or war d wi thout
pr ov i di ng unnecessar y detai l ed backgr ound i nf or mati on, wher eas,
other s may pr ov i de detai l ed backgr ound i nf or mati on bef or e
communi cati ng the mai n f act. Techni ques of communi cati on used
by an i ndi v i dual ar e deter mi ned by the f ami l y env i r onment,
cul tur e, l i f e phi l osophy of the per son, and v ar i ous other f actor s.
Bei ng a nur se, y ou must l ear n how to communi cate wi th the pati ent
and the member s of heal th car e team ef f ecti v el y . Communi cati on
techni ques ar e of ten the key to cl i mb up the pr of essi onal l adder ,
and the buddi ng nur ses shoul d master the ski l l s ear l i er i n thei r
car eer to be a successf ul nur se. Gi v en bel ow ar e some of the
communi cati on techni ques that shoul d be used by nur ses i n a
heal th car e setti ng.
9.1. Listening Actively
To listen closely and reply well is the highest
perfection we are able to attain in the art of
conversation
La Rochefoucauld
Li steni ng acti v el y means to be attenti v e to what the other per son
i s say i ng v er bal l y and nonv er bal l y . Acti v e l i steni ng i s an
ef f ecti v e communi cati on ski l l f or ther apeuti c communi cati on,
whi ch must be pr acti ced and master ed by ev er y pr of essi onal nur se.
Sev er al nonv er bal behav i or s can f aci l i tate the ski l l of acti v e
l i steni ng whi ch ar e as f ol l ows:
1. Si t squar el y f aci ng the other per son, establ i sh ey e-to-
ey e contact.
2. Keep the postur e open.
3. Lean f or war d towar d the cl i ent.
4. Be r el ax ed.
5. Concentr ate on what the other per son i s say i ng.
6. Restati ng what the other per son sai d and showi ng hi m
that y our e l i steni ng.
9.2. UseSilence
Si l ence dur i ng communi cati on pr ocess can car r y a v ar i ety of
meani ngs. It pr ov i des an oppor tuni ty to the communi cator to
ex pl or e hi s/her i nner thoughts or f eel i ngs comf or tabl y that wi l l
be r equi r ed to f aci l i tate the communi cati on.
9.3. ObserveNonverbal Behavior of theClient
Nonv er bal cues ar e mor e i mpor tant than the v er bal message
because 60 per cent of the i mpact f r om ev er y conv er sati on y ou
hav e comes f r om y our nonv er bal cues. These i ncl ude ey e contact,
y our postur e, and the gestur es y ou make.
The nonv er bal cues i ndi cate what y ou thi nk, ev en i f y our wor ds
say somethi ng el se enti r el y . Some peopl e dont l i ke to be touched,
and i nv asi on to thei r per sonal space i s one nonv er bal cue y ou can
easi l y av oi d to f aci l i tate communi cati on. Nonv er bal cues ar e just
as i mpor tant as any other communi cati on techni que y our e tr y i ng
to master .
9.4. Toneand Words
It i s obser v ed by communi cati on ex per ts that 30 per cent of what
y ou actual l y mean whi l e communi cati ng somethi ng i s deter mi ned
by the tone of y our v oi ce. For ex ampl e, i f y ou say that Youl l be
happy to sacr i f i ce thi s oppor tuni ty f or someone, but y our e
y el l i ng when y ou say i t, the other per son wi l l cl ear l y noti ce that
y our e actual l y not happy to do i t. Onl y 10 per cent of the r eal
meani ng of y our conv er sati on i s usual l y deter mi ned by the actual
wor ds y ou use. Ther ef or e, hav i ng a bi g v ocabul ar y i s l ess
i mpor tant to the communi cati v e pr ocess than hav i ng the r i ght
hand si gnal s and f aci al ex pr essi ons.
9.5. BeConsistent Verbally and Nonverbally
Inconsi stency i n v er bal and nonv er bal communi cati on by the
sender may l ead to conf usi on and mi sunder standi ng of the message
on the par t of the r ecei v er (Fi gur e 1.11).


Figure 1.11 Deter mi nants of Ver bal Communi cati on
9.6. AskOpen-ended Questions
Open-ended questi ons encour age the cl i ent to communi cate mor e
and mor e, wher eas, cl ose-ended questi ons di scour age the
communi cati on. For ex ampl e, What ar e y our f ood pr ef er ences? i s
an open-ended questi on, wher eas, Do y ou l i ke Dal i a Khi chdi ? i s a
cl ose-ended questi on.
9.7. UseLanguageUnderstood by thePatient
The pati ent wi l l not r espond unti l and unl ess y ou ar e not usi ng the
same l anguage as under stood by the pati ent. For ex ampl e, y ou ar e
not supposed to use Tami l whi l e communi cati ng wi th a pati ent who
bel ongs to Kar nataka.
9.8. Restating
Let the cl i ent know whether an ex pr essed statement has or has not
been under stood. For ex ampl e, You tol d me that, y ou ar e
consti pated si nce the l ast two day s.
9.9. Reflecting
Thi s di r ects questi ons or f eel i ngs back to cl i ent so that they may be
r ecogni zed and accepted.
9.10. Focusing
Thi s takes noti ce of a si ngl e i dea or ev en a si ngl e wor d. For
ex ampl e, You tol d me that, y our f ather was suf f er i ng f r om a
chronic illness, whi ch ty pe of chronic illness i t was? Her e, the
nur se i s f ocusi ng on chr oni c i l l ness as menti oned by the cl i ent
about hi s f ather .
9.11. Exploring
Thi s del v es f ur ther i nto a subject, i dea, ex per i ence, or
r el ati onshi p. For ex ampl e, You tol d me that y our f ather was not a
good per son, why do y ou thi nk so?
9.12. Giving Broad Openings
Thi s al l ows the cl i ent to sel ect the topi c.
9.13. Offering General Leads
Thi s encour ages cl i ent to conti nue.
9.14. Making Observations
Ver bal i ze what i s obser v ed or per cei v ed.
9.15. Encouraging Description of Perceptions
Ask the cl i ent to v er bal i ze what i s bei ng per cei v ed.
9.16. Encouraging Comparison
Ask the cl i ent to compar e si mi l ar i ti es and di f f er ences i n i deas,
ex per i ences, or i nter per sonal r el ati onshi ps.
9.17. Seeking Clarification and Validation
Str i v e to ex pl ai n what i s v ague and sear ch f or mutual
under standi ng.
War mth and f r i endl i ness, openness and r espect, and pr ov i di ng
per sonal space ar e some other i mpor tant communi cati on ski l l s.
CHAPTER HIGHLIGHTS
Communi cati on i s a ski l l that can be l ear ned i n the same
way as other nur si ng ski l l s. Indeed, i t wi l l r equi r e some
tr ai ni ng to l ear n and master thi s ski l l .
Communi cati on can be def i ned as ex change of opi ni on,
i deas, i nf or mati on, f acts, f eel i ngs, and v al ue between two or
mor e per sons (sender and r ecei v er /s) wi th the hel p of a
v ar i ety of channel s to accompl i sh the desi r ed pur pose.
The el ements of the communi cati on ar e sender , message,
channel of communi cati on, r ecei v er , and f eedback.
The i mpor tant ty pes of communi cati on ar e v er bal
communi cati on, nonv er bal communi cati on,
metacommuni cati on, f or mal communi cati on, i nf or mal
communi cati on, and ther apeuti c communi cati on.
Lev el s of communi cati on i ncl ude i ntr aper sonal
communi cati on, i nter per sonal communi cati on,
tr ansper sonal communi cati on, smal l -gr oup communi cati on,
and publ i c communi cati on.
Atti tude, soci ocul tur al backgr ound, past ex per i ence,
knowl edge of subject matter , abi l i ty to r el ate wi th other s,
and env i r onmental f actor s may i nf l uence the
communi cati on pr ocess.
Bar r i er s of communi cati on can be categor i zed i nto
psy chol ogi cal bar r i er s, soci ocul tur al bar r i er s, semanti c
bar r i er s, l i ngui sti c capaci ty , phy si cal i l l ness, technol ogy
f ai l ur e, env i r onmental bar r i er s, and or gani zati onal
bar r i er s.
For ef f ecti v e communi cati on, the message shoul d be cl ear ,
concr ete, conci se, and cor r ect.
Acti v e l i steni ng, usi ng si l ence, obser v i ng nonv er bal
behav i or , appr opr i ate tone and wor ds, r estati ng, f ocusi ng,
and ex pl or i ng ar e some of the ef f ecti v e communi cati on
ski l l s.
EVALUATE YOURSELF

Q 1: Whi ch one of the f ol l owi ng i s not an el ement of
communi cati on?
1. Sender
2. Feedback
3. Recei v er
4. Contex t
Q 2: Communi cati on i s r epr esented by _______
1. 25%of the wor ds
2. 60%of the nonv er bal
3. 45%of the tone of v oi ce
4. Al l of the abov e
Q 3: Inter per sonal communi cati on occur s ______
1. Between two per sons
2. Wi thi n the per son
3. Between per son and the env i r onment
4. None of the abov e
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Q 4: Whi ch of the f ol l owi ng statements i s not tr ue f or
communi cati on?
1. Communi cati on i s ex change of i nf or mati on between two
per sons
2. Communi cati on i s i nf l uenced by env i r onmental f actor s
3. Communi cati on i s a goal -di r ected acti v i ty
4. Acti v e l i steni ng i s not a par t of ther apeuti c
communi cati on
Q 5: Whi ch one of the f ol l owi ng i s not a char acter i sti c of good
message?
1. Cl ear
2. Concr ete
3. Conci se
4. Vague
Q 6: Ex pl ai n the bar r i er s of communi cati on (BFUHS, 2009; MGR
Uni v er si ty , 2010; RGUHS, 2010).
Q 7 : What ar e the channel s of communi cati on? (NTR Uni v er si ty of
Heal th Sci ences, 2010)
Q 8: Wr i te a shor t note on communi cati on ski l l s (NTRUHS, 2007 ).
Q 9: Ex pl ai n nonv er bal communi cati on (NIMS, 2008).
Q 10: What ar e the f aci l i tator s of communi cati on? (NIMS, 2010)
Q 11: Ex pl ai n the techni ques of ther apeuti c communi cati on (RUHS,
2008, 2010; RGUHS, 2009).
Q 12: What ar e the el ements of communi cati on pr ocess? (BFUHS,
2007 ; RUHS, 2008, 2010; RGUHS, 2009)
Q 13: Ex pl ai n the bar r i er s of communi cati on and the techni ques to
ov er come these bar r i er s?
REFERENCES/FURTHER READINGS

1. Jean C. Br adl ey , Mar k A. Edi nbur gh. Communi cati on i n the
nur si ng contex t, 2nd edi ti on.
2. Sandr a J. Sundeen. Nur se cl i ent i nter acti on, i mpl ementi ng the
nur si ng pr ocess, 5th edi ti on, Mosby .
3. Kagan C. Pr of essi onal i nter per sonal ski l l s f or nur ses, pr i nt
1995, Chapman &Hal l Publ i sher s.
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