Includes messages sent through the language of the body, without using words.
(Examples: Facial expressions, vocal cues, eye contact, action cues -- gestures, posture, touch, odor, physical appearance, dress, silence, and the use of time.)
Nonverbal communication often reveals true feelings, because you have less control over nonverbal reactions.
(Example: A patient who says he feels fine but frowns while moving and holds his body rigidly is probably in pain.)
Nonverbal behaviors add meaning to verbal communication and help you judge the reliability of verbal messages.
Nonverbal behaviors vary in different cultures.
Be sure your (the nurse) nonverbal and verbal messages match.
(Example: If you say a patient is getting better but wear an expression of doubt, you will not relieve a patient's anxiety.)
[Forms of Communication]
The face, the most expressive part of the body, reveals emotions such as surprise, fear, anger, happiness, and sadness.
The sender's facial expressions often become the basis for judgments by the receiver. However, because of the diversity in facial expressions, meanings are often misunderstood.
Facial expressions reveal, contradict, or suppress true emotions.
People are often unaware of the messages their expressions send.
When facial expressions are unclear, seek verbal feedback about the sender's intent.
(Example: A patient who frowns after receiving information may be confused, angry, disapproving, or simply concentrating on a reply. In this case, say, "I notice you're frowning," and encourage clarification of the patient's response.)
Patients watch nurses closely.
(Example: Consider the effect your facial expression has on a patient who asks, "Am I going to die?" The slightest change in the eyes, lips, or face will reveal your true feelings.)
Learn to avoid showing overt shock, disgust, dismay, or other distressing reactions in the patient's presence.
Americans generally maintain eye contact to signal a readiness to communicate, regardless of social class.
By maintaining eye contact during conversation, you communicate respect and a willingness to listen.
Eye contact also allows you to observe another closely.
(Example: Lack of eye contact indicates anxiety, defensiveness, discomfort, or a lack of confidence in communicating.)
However, some cultures, such as Asian and Indochinese, Native American, and Appalachian, consider eye contact to be intrusive, threatening, or harmful and minimize its use.
Always consider the person's culture when interpreting the meaning of eye contact.
Eye movements communicate feelings and emotions.
(Example: Wide eyes express frankness, terror, and innocence.
Downward glances show modesty.
Raised upper eyelids reveal displeasure, and a constant stare may be associated with hatred or coldness.
Looking down on a person establishes authority, whereas interacting at the same eye level indicates equality in the relationship.
You appear less dominant and less threatening when interacting at the patient's eye level.
Rising to the same eye level of an angry person helps establish your independence.)
Territoriality is the need to gain, maintain, and defend one's exclusive right to space
Territory is separated and made visible to others, such as a fence around a yard. Personal space is invisible, individual, and travels with the person.
During interpersonal interaction, people consciously maintain varying distances between themselves, depending on the nature of the relationship and situation.
When personal space is threatened, people respond defensively and communicate less effectively.
You must frequently move into patients' territory and personal space because of the nature of caregiving.
Convey confidence, gentleness, and respect for privacy, especially when actions require intimate contact.
Knock before you enter a room.
As you leave, ask if the patient wants the door open or closed.
Ask if you can reposition the bed table and what items the patient wants close by.
Health issues may limit communication.
(Example: Facial trauma, cancer of the larynx or trachea, aphasia after a stroke, breathing problems, Alzheimer's disease, high anxiety, and heavy sedation.)
(Psychoses and depression cause patients to have flight of ideas, constant verbalization of the same words or phrases, or a slow speech pattern)
Review patient's medical record for relevant information describing any physical barriers to speech, neurological deficits, and pathophysiological conditions affecting hearing or vision.
Medication (Examples: Opiates, antidepressants, neuroleptics, hynotics, or sedatives) cause patients to slur words or use incomplete sentences.
communicate directly with patients and family members to fully assess communication difficulties and build a plan to enhance communication.
When caring for patients from diverse cultures, recognize how to adapt your communication approach.
Show respect for all persons whatever their age, gender, religion, socioeconomic group, sexual orientation, or ethnicity.
Recognize and attend to any personal biases or prejudices that might interfere with patients' care.
Take cultural issues into account, and work to be culturally sensitive.
Accept patients' rights to adhere to cultural customs and norms.
Persons of different cultures use different types of verbal and nonverbal cues to convey meaning.
Make a conscious effort not to interpret messages through your own cultural perspective; instead consider the context of the other individual's background.
Avoid stereotyping persons from other cultures or making jokes about them.
Cultural insensitivity in communication takes many forms. (Example: including making fun of another's culture, ethnicity, language, or dress).
Telling jokes that make fun of specific cultures, stereotyping, patronizing, and incorrectly interpreting culturally based behavior are culturally insensitive.
Do not behave in ways that offend the cultural practices of others.
Gender influences how we think, act, feel, and communicate.
There are differences in male and female communication patterns.
Males grow up using communication to achieve goals, establish individual status and authority, and compete for attention and power.
Females grow up using communication to build connections and cooperate with others. Females also communicate to respond to, show interest in, and support others and are more likely to discuss feelings and personal issues.
Men tend to communicate in a more task-oriented fashion and more directly express disagreements and what they want done.
A male nurse might say to his colleague, "Help me turn Jeremy."
A female nurse might say, "Jeremy needs to be turned," expecting her colleague to understand the implied request for help.
Men use more banter, teasing, and playful "put-downs."
They sometimes hesitate to ask questions for fear of appearing unknowledgeable, whereas women ask questions to elicit information. Men usually want others to know of their accomplishments; women tend to downplay their achievements.
It is important for you to recognize a patient's gender communication pattern.
Gender-insensitive communication means a nurse of one gender misinterprets or reacts to messages differently from that intended by the other gender.
Being insensitive can block any attempt at forming a therapeutic nurse-patient relationship.
Is the nursing diagnostic label to describe the patient who has limited or no ability to communicate verbally.
This diagnosis is useful for a wide variety of patients with special problems and needs related to communication.
It is defined as "decreased, delayed, or absent ability to receive, process, transmit, and use a system of symbols".
A patient with this diagnosis will have defining characteristics such as the inability to articulate words, difficulty forming words, and difficulty in understanding.
The related factor for a diagnosis should focus on the cause of the communication disorder. In the case of impaired verbal communication, a related factor might be physiological, mechanical, anatomical, psychological, cultural, or developmental.
Be accurate in choosing a related factor so that the interventions you select will effectively resolve the patient's problem.
Do not impose your own attitudes, values, beliefs, and moral standards on others while in the professional helping role.
People have the right to be themselves and make their own decisions.
Avoid using terms such as should, ought, good, bad, right, or wrong.
Agreeing, disagreeing, or sharing your personal opinion sends the subtle message that you have the right to make value judgments about patient decisions.
Instead, offer options and help the other person anticipate the consequences of decisions.
The problem and its solution belong to the patient, not the nurse.
(Example: Pt: "I really want to go visit my uncles in New York, but I'm not sure I'm up for the trip."
Nurse: "I don't think it's a good idea to try to travel that far."
A better response is, "It sounds like you miss your family. Let's talk about your options for maintaining contact.")
[Nontherapeutic Communication Techniques]
Is the concern, sorrow, or pity you feel for the patient when you personally identify with the patient's needs.
Unlike empathy, which tries to understand the patient's experience, sympathy takes a subjective look at the patient's world.
Sharing sympathy with another feels good, creates a bond, and minimizes differences, but it can prevent effective problem solving and impair good judgment.
When you share the patient's needs, you are assuming the patient's feelings are similar to your own and you are unable to help the patient select realistic solutions for problems. (Example: In response to the patient's statement about his pain the nurse had said, "Oh I know just what you mean, I hate feeling drugged up," the patient would not have had a chance to clarify his feelings and the nurse would miss an opportunity to get a deeper understanding of his perception of the situation.)
[Nontherapeutic Communication Techniques]
Is based on a philosophy of protecting individual rights and responsibilities.
It includes the ability to be self-directive in acting to accomplish goals and advocate for others.
An assertive response promotes self-esteem and upholds personal and professional rights. (Examples: Feelings of security, competence, power, and professionalism characterize assertive responses.)
Assertive statements convey a message without resorting to sarcasm, whining, anger, blaming, or manipulation.
Assertive responses are good tools to deal with criticism, change, negative conditions in personal or professional life, and conflict or stress in relationships.
Assertive responses often contain "I" messages, such as "I want," "I need," "I think," or "I feel."
Simple assertive messages are usually stated in three parts, referencing the nurse, the other individual's behavior, and its effect.
(Example: Nurse to nurse: "When you are late for work, I have to stay late and that makes me late picking up my children from the babysitter.")
Humor is a coping strategy that adds perspective and helps you and the patient adjust to stress.
The Association for Applied and Therapeutic Humor defines therapeutic humor as "any intervention that promotes health and wellness by stimulating a playful discovery, expression or appreciation of the absurdity or incongruity of life's situations."
Laughter is a diversion from stress-related tension.
It provides a sense of well-being and more of a feeling of control or mastery.
Humor helps provide emotional support to patients and humanizes the illness experience.
Laughter provides both a psychological and physical release for you and the patient; promotes open, relaxed interaction; and illustrates our shared experience in being human.
You assess whether humor is appropriate by noticing if patients use humor in their conversations.
Start with small doses to see if this is helpful. To offer positive humor, share humorous incidents or situations, offer a clown nose to someone who could use a laugh, or share puns or simple jokes that are not offensive. Positive humor is associated with hope, love, and joy with the intent to bring people closer. Avoid negative humor, which is inappropriate. Ethnic, religious, sexist, ageist, or put-down humor creates distance.
Realize that humor sometimes backfires; not everyone will appreciate a humorous approach because of negative moods, stress, or physical discomfort.
Humor is often a signal for closer attention. When a patient preparing for surgery quips, "Well, I won't die from it," gently explore concerns of the patient.
Sometimes health care providers use dark, negative humor after difficult or traumatic situations to survive a situation intact and to relieve tension and stress.
This "coping humor" may seem callous or uncaring by those not involved in the situation.
Avoid using "coping humor" within earshot of patients or their loved ones.
Understand that humor is a release, but timing, content, and receptivity are important in the use of therapeutic humor.
Is one of the nurse's most potent forms of communication.
Nurses are privileged to experience more of this intimate form of personal contact than almost any other professional.
Touch conveys many messages, such as affection, emotional support, encouragement, and personal attention.
Comfort touch, such as holding a hand, is important for vulnerable patients who are experiencing severe illness with its accompanying physical and emotional losses.
(Example: A nurse rubbed a patient's shoulders to soothe and comfort her.)
The nurse enjoyed providing this comfort and savored this moment of caring connection. She valued this as part of the art of nursing, which is sometimes left out due to the emphasis on the high-tech nature of our work.
Sometimes touch is misinterpreted.
Always be sensitive to the patient's response to touch.
(Examples of inappropriate and appropriate use of touch:
Inappropriate touch: In a cancer support group, the wife of a patient had her arms wrapped around herself as if she were "holding herself together." The nurse moved too quickly and tried to hug the wife without permission. The wife backed off and struggled to hold back tears.
Appropriate touch: The nurse says, "I see you are distressed. Would a hug help?" The woman is then free to decline this well-intended act that might trigger tears that would embarrass this very private person.)
Another concern is the confusion about the use of touch with culturally diverse patients. Some risk is involved.
You must look for cues that a patient would welcome touch.
We use touch to awaken patients, to get their attention, or to add emphasis to explanations. Touch may also convey understanding better than words or gestures.
Therapeutic touch is a special form of alternative touch therapy used by specially educated nurses for health assessment, pain reduction, and relaxation by influencing a patient's body energy fields.
In therapeutic touch, specially educated nurses pass their hands over the body without actually touching to balance the energy fields and provide an environment for optimal health.
Because much of what you do involves touching, learn to use touch wisely.
Touch delivered in the social or consent zones is less anxiety producing than touch delivered in the vulnerable or intimate zones. Students initially find giving intimate care stressful, especially with patients of the opposite sex.
Shift your focus from personal discomfort to your role as a caregiver with the intent to provide sensitive nursing care.
Trust that you will become more comfortable with experience.
Remember that the patient who is ill and dependent must permit closer physical contact than is normally tolerated and may be uncomfortable with touch.
Remain sensitive to your own responses and to patients' feelings.
If a patient refuses to hold your hand while in pain or pulls away from physical contact, this signals that the patient is uncomfortable with being touched.
People perceive touch negatively when it is given without consent; used within a hostile or mistrusting relationship; and delivered to a vulnerable, intimate, or painful area of the body.
Your touch should never be angry, rough, violent, overly stimulating, threatening, overly tentative, sexual, or unnecessarily painful.
(Examples of special needs patients: hearing and visually impaired, persons suffering from a stroke or late-stage Alzheimer's disease, and persons with autism or schizophrenia who respond to internal stimuli and misinterpret external stimuli.)
The person who does not speak or understand English and the patient with learning disabilities and limited vocal skills will challenge you to accommodate their special needs.
In addition, unresponsive or heavily sedated patients are sometimes unable to send or receive verbal messages.
The patient who cannot communicate effectively has difficulty expressing needs and responding appropriately to the environment and requires special thought and sensitivity.
Such persons benefit greatly when you adapt communication techniques to their circumstances.
When caring for a patient with impaired verbal communication related to a language barrier, you may provide a table of simple words in the patient's language.
The patient's use of the table will meet the expected outcome of the patient communicating basic needs such as food, water, toileting, rest, and pain relief. Collaborate with team members to design the best communication strategies.
Good communication improves the quality of your patient's interpersonal relationships and well-being.
If the patient uses ineffective communication techniques that interfere with coping or interpersonal relationships, intervene to help your patient send, receive, and interpret messages more effectively.
Be a communication role model and teacher to help patients express needs, feelings, and concerns.
Help patients develop social interaction skills and communicate thoughts and feelings clearly.
This will help them interpret messages sent from others, increasing their autonomy and assertiveness.
Communication with a child requires special considerations to develop a working relationship with the child and family. Because contact between parent and child is usually close, assume the information communicated by parents is reliable, although some parents may exaggerate. Offer a child toys or materials so the parent gives full attention to your information gathering.
Give periodic attention to infants and younger children as they play to include them.
An older child can be actively involved in communication.
Consider the influence of development on language and thought processes.
Children, particularly the young, are especially responsive to nonverbal messages.
Sudden movements or gestures can be frightening.
Remain calm and gentle, and, if possible, let the child make the first move.
Use a quiet, friendly, confident tone of voice. The child feels helpless in most situations involving health care personnel.
When it is necessary to give explanations or directions, use simple, direct language and be honest.
To minimize fear and anxiety, prepare the child by explaining what to expect.
Avoid staring, and meet the child at eye level.
Drawing and playing with young children allows the child to communicate nonverbally (making the drawing) and verbally (explaining the picture)
Use a child's drawing as a basis for beginning a conversation.
In communicating with older adults, the primary goal is to establish a reliable communication system that all health care team members easily understand. Ideally, an interdisciplinary model delivers effective care for older adults.
Communication with older adults requires special attention.
Be aware of the physical, psychological, and social changes of aging.
Use the following interventions to assist with impaired communication with older adults:
• During conversation, maintain a quiet environment that is free from background noise.
• Avoid shifting from subject to subject; allow time for conversation.
• Be an attentive listener. Use explorative questions to facilitate conversation (e.g., "How do you feel?").
• Avoid long sentences to explain the subject. Try to keep it short, simple, and to the point.
• Allow the older adult the opportunity to reminisce. Reminiscing has therapeutic properties that increase the sense of well-being.
• If you are experiencing problems understanding the patient (e.g., dysarthria), let the patient know and facilitate methods that help the patient speak more clearly. Consult with a speech therapist if necessary.
• Include the patient's family and friends in conversations, particularly in subjects known to the patient.
• Be aware of cultural differences among patients.
6th EditionKarin VanMeter, Robert Hubert
11th EditionRebecca J. Donatelle
10th EditionRebecca J. Donatelle
13th EditionRebecca J. Donatelle