Transcript Principles of communication….

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Introduction…
 Each of you have probably left a conversation at
sometime thinking “ what did s/ he mean by that?”
 You are trying to understand the process and make it
more meaningful
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“you can not, not communicate”
 Then “all human behavior” is communication…

We often assume that that words and phrases are
stable and consistent )‫(واضح و ثابت‬, yet meaning is
arbitrary and subjective )‫ (عشوائي و شخصي‬.
e.g:
when we say I “like” you for the speaker “like” might
mean do not dislike, while the listener it is almost love.
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Communication theories….
Linear theory:
This model refer to three components: Sender: source that
encode the message (information) into verbal and, or
nonverbal symbols that convey ideas (knowledge, feelings,
personal agendas, past experiences).
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Message: consist of verbal and nonverbal expressions of
thoughts or feelings. Receiver: the recipient of the
message that decode (translate or interpret) the message to
make meaning.
Channels of communication: refer to sensory receptors
that transmit information (one or more of the five senses)
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Circular transactional theoretical
models
This model expands the linear model to include context of
communication, feedback loops and validation.
the sender and receiver construct a mental picture of the
other which influences the message and includes others
perceptions, attitudes and potential reaction to the
message.
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Components of communication…
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 Receiver: both receives and interprets the message
 Encoding and decoding processes: refer to our ability
to select symbols that most effectively convey our
thoughts and feelings to another
 Filter: some models will show a filter as the place
where meaning is assigned and symbols are selected to
share, the size of your vocabulary can impact your
ability to select appropriate symbols ( encoding) and
understand the meaning of symbols used by others
(decoding)
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Modes of communication…
verbal
nonverbal
 Refers to the spoken words
 It includes elements such as
that encompass the symbols
of language
 It is largely conscious because
people choose words they
use.
 Splits of tongue.
tone of voice, hand and body
movements, facial
expressions
 It is less consciously
controlled than verbal.
 Called body language
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 Many wards or phrases have
slang meaning or have
developed new meanings
 Involves 5 senses , adds to
the meaning of the verbal
message by expression of
feelings, the contradiction
or validation of verbal
message often tells more
about what a person is
feeling than what actually
said.
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Nonverbal communication….

Is believed to be the most important part of any
message.
 nonverbal cues involve all five senses.
 Functions of nonverbal cues / communication
1. add to the meaning of verbal messages
2.expression of feelings (contradiction or
validation of verbal message)
3. preservation of both ego and the relationship
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Nonverbal cues are grouped into
four groups:
 Body cues (kinesics)
 Space (proxemics)
 Touch
 appearance
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Body cues…
 Facial expressions, reflexes, body posture, hand
gestures, eye movement mannerisms, gait of an
individual
 Paralinguistics (paralanguage) behavior includes any
audible sound that is not a spoken word (voice tone,
inflection, word spacing, rate, groaning, coughing,
laughing, crying, grunting, moaning, along with silent
cues.
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Space …
 Is the study of distance between people in their
interaction
 Personal space: is the distance people prefer in
interaction with others
 Communication is affected by four distances:
• Intimate
• Personal
• Social
• public
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Intimate distance…
 Around 30 cm to 45 cm.
 Communication is characterized by body contact.
 Heightened sensations of body heat and smell.
 Vocalization is low.
 Nurses very often are required to violate personal space.
 However it is important to be aware when this will occur and
foreworn the client.
 The nurse can respect a person’s intimate space, in other
instances nurse may come within intimate distance to
communicate care and warmth.
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Personal distance….
 Around 45cm to 122 cm.
 Less overwhelming .
 Voice tones are moderate.
 Physical contact is possible.
 More of the person is perceived at a personal distance.
 Facilitate sharing of thoughts and feelings.
 Can create tension if the distance encroaches upon
other’s personal space.
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Social distance…

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122 cm to 300 cm.
Clearer visual perception of the whole person.
body heat and odor are imperceptible.
Vocalization is loud.
Communication is more formal.
Limited seeing and hearing.
Allows more activity and movement.
Person is protected and out of reach of touch.
Several people at the same time or within a short time.
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Public distance….
 400 cm and more.
 Faces and forms of people might be seen but
individuality is lost.
 The perception is of the group of people or
community.
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Territoriality…
 Is a concept of the space and things that an individual
considers as belonging to self.
 The human tendency to claim territory must be
recognized by all health care workers.
 Clients often feel the need to defend their territory
when it is invaded by others.
 So… nurses need to take permission from clients to
remove, rearrange, or borrow objects in the hospital
area.
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Touch…
 Is a nonverbal method of communication that may
convey many and messages
 Handshaking, holding hands, hugging, all
demonstrates positive feelings
 Nurse should use caution when touching a client
 For touch to convey warmth, the nurse should be
comfortable with it
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Appearance…
 Refers to the way an individual uses clothing, makeup,
hairstyle, jewelry, glasses, as well as grooming and
hygiene
 It communicates a particular image as well as mental
status
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 Therefore it is important for the nurse to
observe and consider the client’s entire
message, both verbal and nonverbal, before
arriving at a conclusion
 Nurse must try to interpret a clients nonverbal
behavior when evaluating the verbal content
 These observations need to be incorporated
in the assessment and plan of care
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Factors influencing communication
 Environmental factors (Time, Place, Noise, Privacy,
Comfort, temperature)
 Relationship between sender and receiver
 Context or circumstances in which the message is
given
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 Attitude (past experiences, level of openness,
socioeconomic class,
 Knowledge
 perception
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Types of communication….
 Intrapersonal communication
 Interpersonal communication (social, theraputic)
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Intrapersonal communication
 Self-talk: is language use or thought internal to the
communicator. It can be useful to imagine
intrapersonal communication occurring in the mind
of the individual in a model which contains a sender,
receiver, and feedback loop.
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Interpersonal communication
Is a dynamic two-way circular process in which all
types of information are shared between two or
more people and their environment.
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Social
therapeutic
 Friends, family, acquaintances
 Helper and client
 Home, away from work
 Clinical setting
 Mutual sharing of information,
 Promote growth and change in
thoughts, feelings to maintain
relationship
 Spontaneous, superficial, light,
focuses on both
clients
 Learned skills, purposeful, client
focused.
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Therapeutic communication…
 a process in which the nurse consciously influences a
client or helps the client to a better understanding
through verbal or nonverbal communication.
 Therapeutic communication involves the use of
specific strategies that encourage the patient to
express feelings and ideas and that convey acceptance
and respect.
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 an interactive process between nurse and client that is
goal-directed to help the client overcome temporary
stress, to get along with other people, to adjust to the
unalterable, and to overcome psychological blocks
which stand in the way of self-realization .
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In summary it has 3 essential
purposes:
To allow the client to express thoughts, feelings,
behaviors and life experiences, and life experiences
in a meaningful way in order to promote healthy
growth
2. To understand the significance of the client’s
problems and the role of the client and the
significant people in his or her life
3. To assist in the identification and resolution
processes of the client’s problem areas
1.
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Personal elements important
for therapeutic communication.
 The nurse’s use of self is a primary tool in the
therapeutic relationship
 All of the elements essential to help another individual
are within the nurse.
 Therapeutic use of self begins with knowing oneself
 Knowing the self is a complex lifelong learning process
 It is essential to have selfknowledge for a better use of
therapeutic self
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 Helps to Build a sense of Healthy Self-Concept as a
person and nurse.
 Becomes more open Ability to accept patient as they
are, rather than how nurses may want Them to be.
 Self- acceptance , Self-Knowledge , Self-understanding
, understanding of patients.
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 Self- tolerance, tolerance to patients.
 *Comfort with self and Liking self.
Liking self # Thinking one is all good, without Fault
or Failings
Self-Liking = Knowing both strengths and areas for
improvement and what exists is acceptable.
 *Helps to take into account the effects nurses
themselves have on patients.
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The core of self knowledge is:
 the nurse’s ability to correctly identify negative or
unresolved issues of the self
 What values and beliefs the nurse’s hold
 Important to know and understand own family
background (dynamic and cultural) and social issues
(values, biases and prejudices)
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Since therapeutic communication occurs for the
purpose of helping others, it is vital that nurses
understand what motivates them to help others
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the nurse needs to be able to conduct a periodic
self evaluation to her/his responses to the client:
 Am I open or closed minded regarding …….
 Am I accepting
 Am I being supportive
 Am I objective
 Am I remaining calm, what are my true feelings
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Johari Window model…
 The Johari Window model is a simple and useful tool
for illustrating and improving self-awareness, and
mutual understanding between individuals within a
group.
 Johari Window actually represents information ,
feelings, experiences, views, attitudes, skills,
intentions, motivation, etc - within or about a person in relation to their group, from four perspectives,
which are described below.
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The Johari Window's four regions, (areas, quadrants, 
or perspectives) are as follows, showing the quadrant
numbers and commonly used names:
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1 . open : Known to self and others 2. Blind : Unknown to self and
Known to others
Trust, acceptance, understanding, confrontation, feedback
warmth, caring, genuine, respect
3. hidden : Known to self and not
Known to others
self disclosure, (communication
skills needed: building trust,
exploring, expressing feelings,
finding alternatives) catharsis,
confidentiality
4. unknown to self and not Known to
others
defence mechanisms, resistance,
transference, repressed memories,
new experiences
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The Johari Window model is also referred to as
a 'disclosure/feedback model of self awareness', and by
some people an 'information processing tool'. The
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1.what is known by the person about him/herself and is
also known by others - open area, open self, free area,
free self, or 'the arena'
2.what is unknown by the person about him/herself but
which others know - blind area, blind self, or
'blindspot'
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3.what the person knows about him/herself that others
do not know - hidden area, hidden self, avoided area,
avoided self
4.what is unknown by the person about him/herself and
is also unknown by others - unknown area or unknown
self
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How become more Self- aware?
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1. Listing to your self (Introspection)
 Introspection = Trusting oneself = Being honest with
oneself = Accepting self = Challenging oneself.
 Its paying attention to your thoughts and Feeling , let
them come into awareness.
 Do not push them out of awareness.
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2.Listing to others/ ( Feed back ) In put from others /
Interactive Reflection)
 It opens area # of the self ( Blind )
 Therapeutic Confrontation: communication by which the person or
nurse has the intent to raise patient’s awareness of incongruities in
feelings, attitudes, beliefs and behaviors. Timing and trust are
important in confrontation. Also it must be immediate, specific, nonaccusatory, and non-interpretive to be effective.
 The purpose is to bring the maladaptive behaviour to conscious level.
 Feedback by the teacher to students,
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3. Telling others about self and letting others to listen to
you.
 ( self- sharing ) ( self- disclosure)
 In order to become open an atmosphere of trust,
caring, understanding, acceptance, empathy, respect,
warmth, genuine, must be insured to make both
persons psychologically safe to disclose self and receive
feedback, and change behaviour.
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Roles of the nurse in
therapeutic communication
 The nurse acts as teacher, socializer, technician,
advocate, counselor, and therapist
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Traits of therapeutic
communication…
 These characteristics allow the nurse to influence
growth and change in others because they incorporate
verbal and nonverbal behaviors, as well as attitudes,
beliefs, and feelings behind the communication. Thus
they are necessary for therapeutic communication to
take place
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Traits of therapeutic
communication…
Genuineness
Positive regard
Empathy
Trustworthiness
Clarity
Responsibility
Genuineness…
 Consistent verbal and nonverbal behavior implies that
the nurse is open, honest, and sincere
 Trust is built when the nurse does not appear
mechanical but rather responds with sincerity
 Does not mean disclosing personal information or
relating to client in social manner
 Nurses cannot expect a client to be open and honest if
they do not display these characteristics themselves
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Positive regard…
 Refers to respect and acceptance to show that nurses
view their clients as worthy (addressing clients by
names they prefer)
 Conveyed by sitting and listening ,expressing
appropriate emotion about events affecting a client,
validating the client’s feelings, effectively responding
to a client’s inappropriate behavior
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 Part of it being nonjudgmental, labeling behaviors
based on own value system is not useful (stereotyping)
 The nurse should help clients explore their behavior by
discussing the thoughts and feelings that determine
the behavior
Empathy…
 Empathic understanding, it is the nurse’s ability to see
things from the client’s viewpoint and communicate
this understanding to the client
 It can be natural or trained
 Should not be confused with sympathy
 Closely aligned with empathy is active listening
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Trustworthiness…
 Being responsible and dependable
 Adhere to commitments (keep promises)
 Respect the client’s privacy, rights and the need for
confidentiality
 Information client’s share must not go beyond the
health care team
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Clarity…
 Selecting concise words when speaking and asking
questions to clarify meaning
 Nurses need to make a conscious effort to speak at a
level the client will understand
 Avoidance of abstract lengthy explanations is also
necessary
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Responsibility…
 Being accountable for the outcome of one’s
professional interactions
 Nurses need to be responsible for their part in the
interaction and ensure that all messages are received
and interpreted correctly
 Responsibility language involves the use of I statments
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Assertiveness…
 Is the ability to express thoughts and feelings
comfortably and confidently in a positive, honest, and
open manner that demonstrate respect for self while
respecting others
 Learn to use responsibility language
 Non verbal assertive language includes eye to eye
contact while speaking
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