COMMUNICATION

 
 
 
OBJECTIVES
At the end of this class you will be able to:

1. Define communication.
2. Describe different kinds of communication.
3. Communicate with people using empathy, respect, caring and other therapeutic ways.
4. Detail some special ways to communicate when the person has a problem.

WHAT IS COMMUNICATION?
Communication is the one and only way that human beings share thoughts, ideas and feelings with others.
The purpose of communication is to send a message from one person to another. This has been done since the beginning of time. We would not be able to express our feelings and thoughts or ask a question without it. We could not relate to others, as a social being, without it. We need it in our work life and in our personal life. We can satisfy our needs with it. All people want to be heard and needed, so respect is a very important part of it.
TYPES
A message can be sent with spoken words, by writing and with the person's body and body signs.
Communication can be done with:

• writing,
• oral words,
• sign language,
• body language,
• touch, and
• eye contact.

Some examples of written communication are letters, notes and signs, like the ones you see on the street. Nurse's notes, Christmas cards, birthday cards and e-mail messages are all examples of this type.
Some examples of spoken, or oral, communication are:

• talking,
• singing a song,
• videos and
• TV shows

Sign language uses hand gestures and signs to communicate with people who are deaf or hard of hearing. This type has to be learned by both the sender and the receiver of the message.
Body language is the use of one's body to send a message. This type is often not conscious or done on purpose. It most often tells a person's about the feelings of the other person. Some people say that this language sends an even stronger signal than the spoken word.
Some examples of this kind of communication are:

• A person that has a sad face is sending a message to another that they are unhappy. A smile means that the person is happy.
• Tight teeth may tell you that the person is angry or in pain.
• When a person grunts or taps their table with their hand, they may be trying to get you to look at them.
• When you stand in front of a person with your arms crossed in front of you or on your hips while you tap your foot on the floor, you are telling the person that you are in a hurry. You do not even have to say one word. The person may know right away that you are in a hurry with the signs that your body is sending to them.

The use of touch also sends a message. You communicate caring when you touch a person gently on their shoulder or their cheek.
Eye contact and how your eyes look also send another person a message. Your eyes can send feelings like understanding, caring, anger, hatred and love.
 

All communication has a:

• sender of the message,
• receiver of the message and
• a message.

The sender is the one who gives the other person information or asks the other person a question. The receiver is the person who gets the information or the question from the sender. The message is the information that is sent.
The sender of the message has the job of making the other person understand what they are trying to say to the other person. The other person has the job of trying to understand exactly what the other person is trying to communicate to them.
THE BASIC RULES OF COMMUNICATION

1. Be polite and use respect at all times.
2. Use simple words that the other person can understand.
3. Stay calm and without emotion.
4. Be a very active and good listener.
5. Give the person feedback. Tell them what you think you heard from them. Ask the person to repeat the message in another way if you do not understand what the person is trying to tell you. Ask the person a question when you have to.

THERAPEUTIC COMMUNICATION

Therapeutic communication requires these three things:

1. Empathy
2. Respect and
3. A positive sense of self

Empathy is understanding the other person's feelings, attitudes, beliefs and values. You are able to "walk a mile in someone else's shoes". You must be objective and listen actively. You have to keep your own feelings out of it so you are really able to understand the other person's feelings, even if you think they are wrong. These feelings are VERY real to the person.
Respect involves unconditional:

• caring,
• warmth,
• interest, and
• no judgments about the person or their feelings.

You must accept the person for who they are and what they think, even if you do not agree with it. You must NOT label the patient. Do NOT call the client, "the diabetic" or "room 233". People are people. They are not a room number and they are not their illness. They are human beings. Always call a person by their name.
Call the person by their first name if they are a child. Call the adult man or lady by Mr. or Mrs. unless they ask you to call them by their first name. NEVER call a person "honey" or "dear" or "mom" or "pop". These labels do not show respect.
You must look in the mirror and look at yourself to develop a positive sense of self. You must know about yourself. You must know your own values, attitudes and beliefs in order to communicate with others in the best way.
GOOD COMMUNICATION TECHNIQUES

 
 
 
These things help to promote good communication:

1. Know your patient.
2. Establish trust in the relationship. Keep it open and trusting.
3. Ask open-ended questions, rather than "yes" or "no" questions. You get much more information with open questions like, "Tell me about how your day has been so far." When you ask a question like, "Are you OK", you may only get a yes or no answer with no details.
4. Offer yourself to the person. Ask the person if there is something that they would like to talk about. Say something like, "Tell me about your life" or your jobs, especially when the person appears bored or seems agitated.
5. Listen well.
6. Use silence when that is the right thing to do. Say, "I would like to sit here with you for awhile". Use silence when the person has a concern but they are not yet able to talk about it.
7. Use body language that shows caring, respect and patience.
8. Ask the person to repeat something if you do not understand what they are trying to tell you.
9. Ask the person questions if you do not know what they are trying to say. Ask, for example, "Did I hear you say that you are afraid of falling?", if you are not sure what the person is saying and you heard some things about their fears that may be related to falling. Do not answer a person's question or give the person any advice until you know exactly what the person is asking of you or trying to tell you.
10. Reflect the person's feelings. Say, "You look sad today" if the person has a sad face. This may help the person to speak about their feelings and maybe they will feel better. This also lets the person know that you care about them and their feelings.

Some communication stoppers are:

1. Reassurance. Do NOT reassure a person when they have a concern. A person must be able to air their concerns. If you say something like, "You have a good doctor so do not worry" , the person will not want to talk anymore about their concern. They will stop telling you about their fears and concerns.
2. Rejection. Do NOT argue with a person when they are talking about their feelings or beliefs even if you feel that their beliefs and feelings are not true. They must be able to air their own feelings. Do NOT judge the person. These things will stop a person from talking.
3. Probing. Do NOT force the person to speak about things that they are not ready to talk about. People like to keep some personal things to them self. They will stop talking when they do not feel comfortable.
4. Poor body language. Look open and interested in what the person wants to say. A person will stop talking if you look like you are not listening or you look like you are in a hurry or bored.

SPECIAL COMMUNICATION
Nursing assistants, and other people who take care of patients and residents, must be able to send and get messages from the people that they take care of.
The sender of the message must send the message in a way that the receiver of the message understands it. Our patients must be able to understand the message that we are trying to send to them.
We must also be able to understand a message that a patient or resident is trying to send to us. We must be able to understand what our patients are trying to tell us, even when they are confused and/or not able to speak. We must be a good receiver of the message.
Sending and getting a message with a confused, sleepy or unconscious person is not always easy. It takes special skills. It also takes special skills when a person has a mental problem or illness. You must use simple, plain words that a person can understand. Do not use words like "hospital", "NPO", "ambulate" or "void" if the person does not know what these special healthcare words mean. You should say, "You can not eat or drink anything after 12 midnight", instead of saying "NPO". You may want to ask the person if they "would like to walk", instead of asking them if they "would like to ambulate". Also, use the word "urinate" or show the male patient the urinal, instead of using the word "void" unless the person understands that word.
Some of the other things that you should do to help are:

• include the family and friends in the communication when a patient or resident is not able to understand what you are trying to say; 
   
• ask the family and friends how the person can be helped to communicate with you; 
   
• speak in a plain way, using words that are simple. For example, instead of asking if the person is hungry, ask, "Would you like to eat some eggs?"; 
   
• talk to patients and residents in a place that is quiet and that does NOT have a lot of distractions. Turn off the radio and TV while you are talking to the person, after you ask them if you can; 
   
• make sure that the person can see you. Turn on the lights if the room is too dark; 
   
• keep the message as short and simple as you can. Many people do best with short talks rather than long ones with a lot of information at one time. It is better to talk for a couple of short sessions, rather than one or two long ones; 
   
• discuss one thing at a time; 
   
• repeat the message as often as needed; 
   
• ask one question at a time and listen to or observe for the answer; 
   
• draw pictures or write things down for the person if this helps them understand what you are trying to say; 
   
• let the patient draw a picture or write things down for you if this makes it easier for them to tell you what they want or need; 
   
• ask "yes" or "no" questions. For example, if you want to know if a patient wants to eat fruit, ask "do you want an apple or a pear?", instead of "do you want to eat a piece of fruit?"; 
   
• use real objects whenever you can. For example, show the person the real object, like an apple, if you are asking the patient if they would like to eat it. 
   
• speak slowly and in a clear way; 
   
• talk with a low pitch, not with a high pitched voice; 
   
• face the person that you are talking to; 
   
• make eye contact with the person 
   
• listen to the person; 
   
• look at the person's face. Is the person trying to tell you something? Do they look like they are in pain? Are they holding a part of their body, like their hand or their head? Do they look sad? Do they look angry?; 
   
• give the person their eyeglasses and hearing aid, if they wear them; 
   
• always show respect and caring; and 
   
• communicate with touch and a calm voice when you want to tell a person that you care and they can not understand the spoken word.

SUMMARY
Communication is necessary in order for human beings to interact with others. Communication is not as simple as it may seem. People that work with others in health care and all other places must develop the skills necessary to communicate well and with respect at all times.
REFERENCES
Berman, Audrey, Shirlee Snyder, Barbara Kozier and Glenora Erb. (2010). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. 8th Edition. Pearson Prentice Hall.
 

Hockenberry, Marilyn J. and David Wilson. (2010).Wong's Essentials of Pediatric Nursing. 8th Edition. Elsevier Mosby.

Monahan, Frances Donovan and Wilma J. Phipps (2007). Phipps’ Medical-Surgical Nursing: Health and Illness Perspectives. 8th Edition. Elsevier Mosby.
Nettina, Sandra M. (2009). The Lippincott Manual of Nursing Practice. 7th Ed. Lippincott, Williams and Wilkins.
Wikipedia Encyclopedia. (2010) "Communication" [online]. http://en.wikipedia.org/wiki/Communication
Copyright © 2010 Alene Burke