COMM SKILLS.pptx. Use it for students of any study level

COMMUNICATION
SKILLS
Wanjala
2 March 2024

COURSE OUTLINE
 Definition of communication
 Goals & functions of communication
 Types of communication
 The Communication process
 Barriers to effective communication
 Essentials of good communication
 Report writing & counselling
 Therapeutic communication
2 March 2024

Introduction
 Communication is very essential for human beings.
 It helps humans relate with each other
 Communication helps us meet our needs, find
happiness and attain personal fulfillment.
 The purpose of this unit is to help you communicate
effectively and understand better the different ways
of communicating as human beings and as nurses.
2 March 2024

Definitions
1. Communication is transfer of information from
one person to another, whether or not it elicits
confidence. But the information transferred must be
understandable to the receiver
2. It is a desirable or accidental transfer or conveying
of meaning
3. It can, therefore, be concluded that communication
is the transfer of meaningful information and the
establishment of commonality with the audience.
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Communication goals
 To change behavior
 To get action
 To ensure understanding
 To get and give information
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Functions of communication
1. Understanding and insight:- we depend on
communication to develop self-awareness. It helps us
in self-other understanding. It enables us have an
insight into ourselves and others.
2. Meaningful relationships:- it enables us satisfy our
needs for inclusion, control and affection
3. Influence and persuasion:- in every communication,
people have ample chances to influence each other
subtly and overtly. We spend time trying to convince
each other to think as we do, like as we like.
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What is communication in nursing?
 In nursing, communication involves sharing of health-
related information between a patient and a nurse,
with both participants as sources and receivers.
 The information shared may be verbal or nonverbal,
written or spoken, personal or impersonal, issue-
specific, or even relationship-oriented, e.t.c.
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Why effective communication is critical
to nursing practice
 It is the vehicle used to establish a therapeutic
relationship.
 It is the means by which people influence the
behavior of another leading to the successful
outcome of nursing intervention.
 Without it, therapeutic nurse relationship is
impossible.
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Types of Communication
 On the basis of organization relationship:
– Formal
– Informal
 On the basis of flow:
– Vertical
– Horizontal
 On the basis of expression:
– Oral
– Written
– Gestures

Formal Communication
 Involves any official method of communicating with
people (employees) in an organization.
 The communication may be passed orally or in written
form & the message flows from top to bottom, following
the hierarchy or chain of command in the particular
organization.
 Formal communication mainly involves giving instructions
to be followed and clarifying the roles of staff in the
organizations.
 Formal communication flows in three directions, namely:
– Downward communication
– Upward communication
– Horizontal communication

Forms of formal communication
1. Downward Communication
 This is where the communication flow comes from
top management to the lowest level.
 The communication channels used include oral
messages, telephone calls, written communication in
the form of circular letters, memoranda, pamphlets
or posters.
 The main advantage of downward communication is
that it is received immediately and is not distorted.
 The main disadvantage of downward communication
is that it is unidirectional, that is, there is no return
path for communication, this delays feedback.
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2. Upward Communication
 This type of communication flows from staff at lower
and middle levels to the top management.
 This provides feedback regarding organizational
progress, a consultative forum to improve the quality
of service and a means for staff to request
clarification of goals and/or additional resources.
 Practically, however, this very rarely happens and it is
important to encourage staff at lower levels to
participate
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 The main advantage of this type of
communication is that it helps to maintain the
discipline of staff at lower levels. It also
protects the seniority of staff at the middle
levels.
 The main disadvantage is that the middle level
staff management may refuse to forward the
grievances coming from the lower level staff.
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3. Horizontal Communication
 In horizontal communication, the communication
flow occurs between heads of departments or
supervisors who are at the same level.
 The supervisors at the same level exchange ideas on
common goals in order to improve the quality of
patient care.
 The supervisors may discuss the common problems
affecting their departments with a view of getting
solutions to recommend to the top management for
approval.
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 The main advantage of this type of communication
are that it encourages free communication by all staff
in the departments all the time and ensures that staff
do not fear each other, thus improving interpersonal
relationships.
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Informal Communication
 Informal communication is an unofficial form of
communication between groups of people in the organization.
 The messages are discussed casually and are not recognized by
the management.
 Informal communication is also known as the 'grapevine'.
 The grapevine is a form of information containing some half-
truths and may emanate from the staff at the lower or middle
levels in the organization, common in organizations where a
certain cadre of staff feels that their needs are not being
addressed or where top management fails to clarify issues or
communicate effectively with the middle and lower level staff.
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Unconscious Communication
 Unconscious communication is where a wrong
meaning has been transferred because of the way the
communication has been conveyed unconsciously to
the receiver.
 Usually the sender of the message is unaware that
their behaviour is sending the wrong signals.
 Therefore, it is important for health workers to be
aware of unconscious communication when handling
clients.
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The Communication Process
SENDER
(encodes)
RECEIVER
(decodes)
Barrier
Barrier
Medium
Feedback/Response
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Elements of the Communication
Process
 The communication process can easily be
defined as the passing of information from the
sender to the receiver.
 The elements/ components of the
communication process can be remembered
using the acronym “MSCREFS” which stands
for:
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 M - Message
S - Source
C - Channel
R - Receiver
E - Effects
F - Feedback
S - Social settings
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The elements of communication process

 The sender: Is the originator of the message.
 The message: Is the information transmitted. It is the
subject matter of the communication.
 Encoding: the conversion of the subject matter into
symbols such as words, actions or pictures
 The receiver: Is the perceiver of the message.
 The feedback: Is the verbal or behavioral response of
the receiver to the sender.
 The context: It is the setting in which the
communication takes place.
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Channel of communication
 Channels of communication include speaking, writing,
video transmission, audio transmission, electronic
transmission through emails, text messages and faxes
and even nonverbal communication, such as body
language.
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Decoding
 Decoding of the message
means mentally processing
the message into your own
understanding as the receiver.
 If you can't decode, the
message fails.
 For example, sending a
message in a foreign language
that is not understood by the
receiver probably will result in
decoding failure.
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The Communication process
 A sender encodes information
 The sender selects a channel of communication by
which to send the message
 The receiver receives the message
 The receiver decodes the message
 The receiver provides feedback to the sender
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Barriers to communication
 There are many barriers to communication and these
may occur at any stage in the communication
process, which may lead to information being
distorted.
 Effective communication involves overcoming these
barriers and conveying a clear and concise message
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i) Physical barriers
Communication is usually shorter over shorter
distances as more communication channels are
available and less technology is required.
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ii) Language barrier
 The way people talk differ and also the difficulty in
understanding unfamiliar accents.
 Variance in expression is common even among those
who speak the same language.
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iii) Cultural barriers
 Culture barriers go beyond language.
 How people think, react and see the world can vary
widely because of culture.
 Also the norms of social interaction vary greatly in
different cultures as do the way emotions are
expressed
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iv) Emotional barriers
 Because of people’s childhood, self confidence, self
esteem issues and just their natural predisposition,
they may not be strong in communication.
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v. Poor listening skills
 Somebody who is not keen to listen is likely not to
have effective communication skills.
 The mere act of hearing does not necessarily mean
that somebody is listening.
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Hearing Vs Listening
Hearing – Physical process,
natural, passive
Listening – Physical as well
as mental process, active,
learned process, a skill
Listening is hard.
You must choose to participate in the process of
listening.
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vi)Encoding Barriers
 The process of selecting and organizing symbols to
represent a message requires skill and knowledge.
 Obstacles listed below can interfere with an effective
message:
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a) Lack of Basic Communication Skills.
 The receiver is less likely to understand the message
if the sender has trouble choosing the precise words
needed and arranging those words in a
grammatically-correct sentence.
b) Insufficient Knowledge of the Subject.
 If the sender lacks specific information about
something, the receiver will likely receive an unclear
or mixed message.
2 March 2024

c) Information Overload.
 If you receive a message with too much information,
you may tend to put up a barrier because the amount
of information is coming so fast that you may have
difficulty comfortably interpreting that information.
d) Emotional Interference.
 An emotional individual may not be able to
communicate well.
 If someone is angry, hostile, resentful, joyful, or
fearful, that person may be too pre-occupied with
emotions to receive the intended message.
2 March 2024

vii) Transmitting Barriers:
 Things that get in the way of message transmission are
sometimes called “noise.”
 Communication may be difficult because of noise and some of
these problems:
a) Physical Distractions.
 A bad cellular phone line or a noisy area can destroy
communication.
 E.g. If an E-mail message or letter is not formatted properly, or
if it contains grammatical and spelling errors, the receiver may
not be able to concentrate on the message because the
physical appearance of the letter or E-mail is unprofessional.
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b) Conflicting Messages.
 Messages that cause a conflict in perception for the
receiver may result in incomplete communication.
 For example, if a person constantly uses jargon to
communicate with someone from another country
who has never heard such expressions, mixed
messages are sure to result.
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viii) Channel Barriers.
 If the sender chooses an inappropriate channel of
communication, the communication may cease.
 Detailed instructions presented over the telephone,
may be frustrating for both communicators as the
telephone is not an appropriate channel for detailed
messages.
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Always think ahead about what you are going to say.
Use simple words and phrases that are understood by every body.
Increase your knowledge on all subjects you are required to speak.
Speak clearly and audibly.
Check twice with the listener whether you have been understood accurately or not
In case of an interruption, always do a little recap of what has been already said.
Always pay undivided attention to the speaker while listening.
While listening, always make notes of important points.
Always ask for clarification if you have failed to grasp other’s point of view.
Repeat what the speaker has said to check whether you have understood
accurately.
ESSENTIALS OF COMMUNICATION
Dos

ESSENTIALS OF COMMUNICATION
Don'ts
Do not instantly react and mutter something in anger.
Do not use technical terms & terminologies not understood by majority of
people.
Do not speak too fast or too slow.
Do not speak in inaudible surroundings, as you won’t be heard.
Do not assume that every body understands you.
While listening, do not glance here and there as it might distract the speaker.
Do not interrupt the speaker.
Do not jump to the conclusion that you have understood everything.

THERAPEUTIC COMMUNICATION
DESCRIPTION:
 This is a face to face process of interaction between
the nurse and the patient in which the nurse
consciously influences a client or helps the client to a
better understanding of themselves through verbal or
nonverbal communication in order to advance their
physical & emotional well being.
 It involves the use of specific strategies that
encourage the patient to express feelings and ideas
and that convey acceptance and respect.

 Communication can either facilitate the
development of therapeutic relationship or serve as
a barrier to it.
 Nurses use therapeutic communication techniques
to provide support and information to patients.
 It may be necessary to use a variety of techniques
to accomplish nursing goals in communicating with a
patient.
2 March 2024

TECHNIQUES OF THERAPEUTIC
COMMUNICATION
i) Using Broad Opening Statements
 The use of a broad opening statement allows the
patient to set the direction of the conversation.
 Such questions as “Is there something you’d like to
talk about?” Gives the patient an opportunity to
begin expressing himself.
2 March 2024

ii) Using General Leads
 Using General Leads during the conversation, such as
“yes” or simply the “uh hum” will usually encourage the
patient to continue.
 General leads, just like broad opening statements, leave
the direction of the conversation to the patient.
 They also convey to him that the nurse is listening and
that he/she is interested in what he will say next.
 This can be accomplished verbally or non-verbally, by
nodding or through facial expressions, which
demonstrate attentiveness and concern.
2 March 2024

iii) Reflecting
 In reflecting, all or part of the patient’s statement is
repeated to encourage him to go on.
 If he says, “Everyone here ignores me” the nurse
might reply, “ignores you?” Letting him hear all of
what he has said, or part of what he has said may lead
him to more fully consider and expand upon his
remark. However, do not over-use reflecting as it may
annoy the patient.
 Selective reflecting can be used once the nurse has
begun to understand what the patient is driving at.

iv) Sharing Observations
 Here, the nurse shares with the patient her
observations regarding behavior in order to invite the
patient to verify, correct or elaborate on her
observations.
 The patient who has a need is often unaware of the
source of this distress, or reluctant to communicate it
verbally, the nurse should find out the meaning of this
behavior rather than assuming.
 However, the tension or anxiety created by his need
creates energy which is transformed into some kind of
behavior, nail biting, scratching, hand clenching, or
general restlessness.

v) Acknowledging the patient’s
Feelings
 The nurse helps the patient to know that his feelings
are understood and accepted and encourages him to
continue expressing them.
 If he were to say, “I hate it here. I wish I could go
home”, the nurse might respond, “It must be difficult
to stay in a place you hate.”
 When a patient talks about something that is
upsetting to him or expresses a complaint or
criticism, the nurse can convey acceptance by
acknowledging the feelings he is expressing without
necessarily agreeing or disagreeing with them.

vi) Using Silence
 In certain circumstances, an accepting, attentive
silence may be preferable to a verbal response as it
allows the nurse to temporarily slow the pace of the
conversation and gives the patient an opportunity to
reflect upon, then speak further about his feelings.
 Also, silence allows the nurse to observe the patient
for non-verbal clues and to assemble his/her own
thoughts.
 Silence also gives the patient time to reflect upon the
topic being discussed.
2 March 2024

vii) Giving Information
 A major cause of anxiety or discomfort in hospitalized
patients is lack of information or misconceptions
about their condition, treatment, or hospital
routines.
 The nurse can help to establish an atmosphere of
helpfulness and trust in her relationship with the
patient by providing information as he/she prudently
can, admitting and finding out what he/she doesn’t
know, or referring the patient to someone who can
assist him.
2 March 2024

viii) Clarifying
 If the nurse has not understood the meaning of what
the patient has said, she clarifies immediately. She
can use such phrases as “I’m not sure I follow…” to
request that the patient make his meaning clear to
her.
 This prevents misunderstanding from hindering
communication & also, her efforts in clarifying
demonstrate her continued interest in what the
patient is saying. Thus, the use of this technique can
help motivate him to go on.
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ix) Verbalizing Implied Thoughts and
Feelings
 The nurse voices what the patient seems to have
fairly obviously implied, rather than what he has
actually said.
 For example, if a patient has said, “It’s a waste of time
to do these exercises’ she might reply, “You feel they
aren’t benefiting you?”
 The nurse should be careful to verbalize only what the
patient has fairly obviously suggested so that she does
not get into the area of offending interpretations—of
making conscious that which is unconscious.
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X) Voicing Doubt
 Statements like the following express uncertainty as
to the reality of the patient’s perceptions:
– “Isn’t that Unusual?”
– “Really?”
– “That’s hard to believe.”
 Such expression permits the patient to become
aware that others do not necessarily perceive events
in the same way or draw the same conclusions that
he/She does.
 This does not mean that he will alter this point of
view, but, at least he will be encouraged to
reconsider and re-evaluate what has occurred.
2 March 2024

BLOCKS TO THERAPEUTIC
COMMUNICATION
(what you should not do)
1. Using Re-assuring Clichés e.g.,
– “Everything will be all right,”.
– “You don’t need to worry,”.
– “You’re doing just fine”
 These are reassuring clichés which are often given
automatically, or may sometimes be used when a
person has difficulty knowing what to say.
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 When a patient who has expressed apprehension is
told, “Everything will be alright” he is likely to feel
that the nurse is not interested in his problem and
thus will refrain from discussing it further.
 Reassuring clichés tend to contradict the patient’s
perception of his situation, thus implying that his
point of view is incorrect or unimportant.
 When there are facts that are reassuring, the nurse
can, give genuine reassurance by communicating
them to the patient.
2 March 2024

2. Giving Advice
 By telling the patient what he should do, the nurse
imposes his/her own opinions and solutions on his,
rather than helping him to explore his ideas so that he
can arrive at his own conclusions.
 Even when a patient clearly asks for advice, the nurse
should be cautious in her response, and supply only
pertinent information that may give him a better basis
for decision-making.
2 March 2024

3. Giving Approval
 Although conceivably a useful response when the
nurse wishes to motivate or encourage a patient,
giving approval can sometimes create a block by
shifting the focus of the discussion to the nurse’s
values or feelings, and by implying standards of what
is and what is not acceptable.
 The nurse’s approval of a patient’s statement such as
“I know I shouldn’t let it get me down” makes it
difficult for him to admit that it is getting him down
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4. Requesting an Explanation
 Patients who cannot answer “why” questions
frequently invent answers.
 The nurse should avoid asking “why” questions
except when asking simple, direct questions
pertaining to patient care
 In general, the nurse is of more assistance, however,
if she assists the patient to describe his feelings.
 There are two types of questions the nurse can ask in
order to get descriptive information; closed and open
questions.
2 March 2024

 A closed question is phrased so that a yes or no
answer is indicated, e.g.,
– “Did you sleep well last night?” or so that a specific choice
of answers is given within the questions, e.g.
– “Do you want this injection in your right or left arm?”
 Although this type of question does not encourage
the patient to express himself or give him the lead, it
can be useful in eliciting specific information needed
to assist the patient once his need has been
identified.
2 March 2024

5. Agreeing with the Patient
 When the nurse introduces her own opinions or
values into the conversation, it can prevent the
patient from expressing himself freely.
 By agreeing with the patient, she can make it difficult
for him to later change or modify the opinion he has
stated.
 Rather than stating her own views, the nurse should
accept the patient’s statements and encourage him
to elaborate on them by using responses such as
General leads or reflecting.
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6. Expressing Disapproval or
arguing with the patient.
 When the nurse indicates that she disapproves of the
patient’s feelings or actions, she imposes her own
values, rather than accepting the patient’s.
 Negative judgment may intimidate or anger the
patient, and will often block communication.
2 March 2024

7. Belittling the Patient’s Feelings
 Because the patient is usually primarily concerned
with himself and his own problems, telling him that
others have experienced or are experiencing the same
feelings will rarely do much to comfort him.
 This devalues the patient’s feelings, implying that his
discomfort is common place and insignificant.
 The nurse should communicate understanding,
acceptance, and interest in him as an individual.
2 March 2024

8. Defending
 In defending herself, others, or the hospital in
response to criticism from a patient, the nurse not
only communicates a non-accepting attitude to him,
but also, in becoming defensive, may lead to believe
that his criticism is justified.
 Thus, this response may reinforce rather than change
the patient’s point of view.
 By acknowledging the patient’s feelings, without
agreeing or disagreeing—for example, “It must be
difficult for you to feel this way” – the nurse avoids
putting herself in opposition to the patient.

9. Making Stereotyped
Comments
 E.g.
– “How are you feeling?” “Isn’t it a beautiful day?”
– “It’s for your own good,”
– “You’ll be home in no time.”
 By using social clichés or trite phrases, the nurse may
lead the patient to reply in a like manner, thus
keeping the conversation at a superficial level.
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10. Challenging
 Often, the nurse feels that if she can challenge the
patient to prove his unrealistic ideas; he will realize he
has no proof. She forgets that the patient’s ideas and
perceptions serve a purpose for him, that they
conceal feelings and meet needs that are real.
 When challenged, the patient tends only to
strengthen and expand his misinterpretations as he
seeks support for his point of view
2 March 2024

11. Changing the Subject
 Especially where the nurse is uncomfortable with the
main topic of discussion, in an attempt to divert the
patient’s mind.
 E.g. patient says:
– “I’d like to die”
 Nurse:
– “Don’t you have visitors this weekend?” or “by the way…” or
“That reminds me…”
 Generally, the nurse changes the subject to avoid
discussing a topic which makes her uncomfortable
(consciously or unconsciously) or to initiate discussion of
a topic which she is more interested.
2 March 2024

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