Communication Skills in the Practice of Nursing

Introduction

Nursing in practice does not only entail the biophysiological portion of health care but also addresses the spiritual being of patients. This aspect of health demands nurses to possess special skills and ideal abilities intellectually and technically in addition to the scientific knowledge they have. Thus, communication is one of the skills that nurses need to have. All the areas of nursing practice require the skill of communication from the provision of education on the prevention of disease to the implementation of therapy to the patients.

This unique requirement makes communication a fundamental element in the practice of nursing. There are many forms of communication used in this regard. This paper will focus on the nonverbal forms of communication (Kourkouta and Papathanasiou 2014. P. 65).

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General Communication

Communication is the process of exchanging thoughts, feelings with the information amongst individuals. This exchange can be made in the form of a speech or other mediums. It has remained an essential part of every activity that is done in the workplace, learning places, and leisure activities. Despite the significance of communication in other institutions, it is of paramount importance in the institution of health care. The effectiveness of care given to a patient in a health care facility depends on the quality of communication between the patient and the specialist (Kourkouta and Papathanasiou 2014, p. 66).

The process of health care therapy involves two entities in communication. The nurse, who is the specialist, on the one end, and the individual seeking health care or a relative on the other end. This process is always verbal in nature but not restricted to the speech alone. Here, the patient expresses the information about his/her health condition to the nurse, while the nurse seeks to produce an appropriate diagnosis for the patient.

The effectiveness of this process depends on the ability of the nurse to comprehend the experiences expressed by the patient and the provision of an acceptable diagnosis to the patient. In order to effectively convey these skills of communication, it is crucial to have knowledge of the principles of communication (Kourkouta and Papathanasiou 2014, p. 66).

The Principles of Communication

Communication is an inbuilt character of human beings that enables all people to communicate. The vital components of communication are the content and value of the information being conveyed. The content includes the words said in the speech and is dependent on the way it is being said. The value of communication, on the other hand, is the amount of information conveyed to the recipient as per the desire of the sender.

Similarly, this aspect is dependent on the sequence of communication between the two parties. In a communication set up, the sender of information becomes the recipient of the reply and vice versa. This condition ensures that all the entities involved occupy the position of the sender and the recipient interchangeably (Kourkouta and Papathanasiou 2014, p. 66).

The message sent by a speaker is not always the same when it is decoded by the recipient. The ability to decode a message is always dependent on an individual’s attitude and perception of the subject. The interpretation of a message is not dependant on the sender but on the recipient. It is this aspect and feedback that institute communication. Therefore, it is essential that in any communication, the information expressed by the sender is decoded by the recipient as accurate, just like the sender expects it to be. It means nurses need to ascribe to the use of terms that are easily understood by their patients. When terminologies that prove to be difficult for the patient in terms of understanding are used, the process of effective communication is hindered (Kourkouta and Papathanasiou 2014, p. 66).

Communication without the use of words happens. This type of communication is referred to as non-verbal communication. This form of communication involves more sensitive modes of communication that include body posture, gestures, physical distance, facial expressions, and movements of body parts. There is a close relationship between verbal and non-verbal communication which dictates that they communicate the same message. This aspect of communication is of paramount significance, where the speaker is unable to communicate verbally. This makes non-verbal communication a critical part of the nursing practice (Kourkouta and Papathanasiou, 2014, p. 67).

Therefore, good listening skills are an essential part of communication. The decoding of a message from a sender by a receiver depends on the information that reaches the receiver successfully. Listening is highly essential in this process of gathering the information. During the practice of health care, it is crucial that the nurses gather both verbal and non-verbal information by remaining attentive, keen and sensitive and also wary of how they communicate with the patient in either of the two ways. This enhances the ability of a nurse to carry out an effective diagnosis (Kourkouta and Papathanasiou 2014, p. 67).

Communication demands the expression of good speaking habits. Normally, the speaker affects the mood of a communication set up and influences the recipient’s response. A good speaking skill should be able to arouse feelings, trust, and confidence in the recipient to encourage correct feedback. This principle of communication is essential in health practice since it influences the sincerity and openness of the patient (Kourkouta and Papathanasiou 2014, p. 67).

Communication is Practiced in Nursing

The communication relationship between a nurse and a patient begins when the two meet and continue until the end of the therapy. It is critical to a considerable degree that the nurse gets the mind of the patient and influences the manner, in which they need to communicate. This is crucial because the nurse needs the information from the patient which is essential for the diagnosis and therapy are given. For this to happen successfully, the appropriate conditions need to be set by the nurse. It is, therefore, essential for the nurse to express kindness and courtesy (Robert 2013, p. 36).

The nurses must try to ensure that the patients are comfortable with them during the period of health care. This aspect is achieved by influencing the environment to ensure that peace and concentration are maintained. Environments that have constant distractions impair the free expression of the patients.

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Communication between a nurse and a patient also requires adequate time, since the ability of individuals to express the information varies from one individual to another. The process of creating a free environment between a patient and a nurse may also take a substantial amount of time. It is, therefore, required that the patient feels the freedom of space as often as possible. The patients also require enough time to be listened to before responding.

The communication between a nurse and a patient also has its success dependant on the openness and honesty of the patient. It is crucial that everything is revealed by the patient to the nurse to enhance efficiency. This process needs the combination of both the verbal and non-verbal skills of communication in order to succeed. During the diagnosis of the therapy, the nurse also needs to show honesty and be open with the patient (Perry, Potter and Ostendorf 2013, p. 28).

Practitioners need to know that, in nursing practice, the nurse dictates the manner, in which the communication is conducted. Though the communication is in both directions, the patient is mostly already affected by the illness and expectations from the visit. This physical and emotional disturbance affects the patient’s communication abilities. The nurse is, therefore, in a discrete position to stabilize the mood of the patient. It is also significant to recognize the needs of an individual during a communication process by the nurse. This is a skill that nurses master and use when they recognize a need. Some patients require patience to understand them; others are more inquisitive, while some patients also need extensive explanations of the therapy. This aspect of communication affects the therapy and its effectiveness in terms of the nursing practice (Riley 2015, p. 91)

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Non-verbal Communication Skills

During interactions between individuals, there is the exchange of signals that occur without any necessary inclusion of words, referred to as non-verbal communication. These non-verbal signals exchanged always bear a message. This type of communication entails the use of signals such as gestures, facial expressions, and body movements (Neese 2015). In communication, the non-verbal signals should express what the verbal communication conveys for effective communication to take place. However, this is not often the case in all communication setups. In some cases, the message conveyed verbally is totally different from the message expressed non-verbally. In such situations, it is the responsibility of the listener to choose the message to believe. Furthermore, non-verbal messages are mostly always true, since they are triggered unconsciously.

In this regard, the manner, in which a message sender looks, listens to the recipient, makes body movements, and reacts to comments, expresses the level of care given to the subject. It also demarcates the level of truth expressed in the spoken words and how careful one is listening. When the non-verbal and verbal messages express the same message, the truthfulness of a message increases. This also increases the level of trust and openness during the communication process.

The role of non-verbal communication is to clarify the repetition of the verbal message. It also expresses any possibility of contradiction in the message being conveyed. Moreover, non-verbal communication can substitute verbal communication in cases, where it is impossible to communicate verbally. It can also complement the verbal message being spoken. These messages also accent the verbal message being conveyed. It is this uniqueness of non-verbal communication that makes it relevant in the nursing practice.

Types of Non-Verbal Communication and Application in Nursing Practice

The types of non-verbal communication skills and signals include:

Facial Expressions

The presentation of the face of a speaker dictates the mood of the message. The different presentations of the human face are referred to as facial expressions. They are universal in nature, dictating, and giving information about the general mood of an event. This type of non-verbal communication is supported by the expressive nature of the human face. The face expresses the emotions of an individual without the utterance of a word. This form of the non-verbal communication skill is applied by nurses in confirming the congruency of the non-verbal communication with the content expressed during the verbal communication. The nurse can use this detected facial expression and verbalize it in order to gain information from the patient. An example is “you look very angry today, but you said that everything was fine” (McCabe and Timmins 2013, p. 19).

Body Posture and Movements of the Body

This type of non-verbal communication is dependent on the effect of the inward perception of an individual or a situation on body posture. These body movements include the placing of hands on the head, standing up, the way one sits, and the way one walks. The manners, in which an individual carries himself or herself, express a lot of information about the individual. Body positions, such as crossed legs and crossed arms over the chest, signify a threatening environment, while the upright posture with parallel hands and legs signifies acceptance and trust.

The nurse is able to assess the response of a patient towards a therapy by considering the body posture and movements during their interaction. The body movements enable the nurse to know the degree of understanding and listening of the patient to instructions. On the other hand, a patient recognizes the attention of the nurse by observing the body movements of the nurse.

Gestures

The use of gestures has become a part of the daily life activities that people perform unconsciously. They include the use of hands when speaking, pointing, waving, and beckoning. These expressions give the information even without speaking. The type of gestures used by an individual is usually related to the cultural background of an individual. This varies based on culture is the basis of the variability between the meanings of a given gesture (Daley 2013, p.19).

Eye Contact

This type of non-verbal communication is only applicable to individuals who can use their eyes for the vision. It is of paramount significance since it expresses aspects like affection, attraction, interest, and even hostility. In the maintenance of continuous feedback communication, nurses must know that eye contact is essential. It expresses the level of concentration of the listener to the communicator.

Touch

This type of non-verbal communication entails activities such as hugging, handshaking, patting off the back, and even tapping of the shoulders. The manner, in which these touches are done, communicates a lot of information even without the utterance of any speech. This non-verbal type of communication varies with the cultural background in terms of conveying various information. It is crucial to practice it with substantial care lest the meaning is lost.

The use of physical touching in the practice of nursing varies to a considerable degree among the patients. It is mostly used to comfort the patient and give encouragement to the patient. The feedback of patients towards touch is always varied. It is, therefore, crucial for the nurse to consider the response in order to determine the appropriateness. The challenge of the nurse is the ability to determine whether a touch is needed or not and the response of the patient towards the touch. The use of touch by nurses should depend on their age, gender, cultural associations, and body part to touch (Sully and Dalcus 2010, p. 45).

The Physical Space between the Communicators

This type of non-verbal communication is dependent on the mood of the communication set up. When the mood is good, the physical space between the communicators is decreased, while when the mood is tense, the physical space increases. Nurses must know that the variations in the physical space are able to signify dominance, intimacy, aggression, and even affection.

Voice

The manner, in which a voice is projected, gives the hidden information about the mind of an individual. Similarly, the variation of tones in a communication context can be helpful in the determination of confidence, truth, affection, and anger. This tool is helpful to the nurse in the setting of the environment to enhance communication with the patient (Segal, Smith, Boose and Jaffe 2016).

Physiological Changes

This type of non-verbal communication is intrinsic. It is mostly stimulated by a hormonal change in the body. These hormonal changes, in turn, influence the body physiology, resulting in changes like sweating, increased heart and breathing rate, and accelerated rate of blinking. It is easy for a nurse to recognize these physiological changes that help in the diagnosis and therapy of the patient. This scientific mode of expression of the information is free from the challenges surrounding the other types (Baillie 2014, p.48).

Challenges of Non-verbal Communication

The greatest challenge of non-verbal communication in the practice of nursing is the cultural background of the patient. The interpretation of these gestures, touch, physical distance, eye contact, and body movements vary from one culture to the other. It is crucial that some of these body language aspects are not misinterpreted, since their incorporation in the health care services is aimed at enhancing productivity. A misinterpretation of such skills may undermine the practice of nursing (Videberk 2011, p. 99).

The Non-verbal Communication Skill in Practice

The Plan and Evaluation Process

The plan that I used in teaching my fellow nurses on the significance of communication was divided into three categories, each taking a maximum of one hour. In all the categories, there was one participant who was me. The three colleagues were the interviewers who took the position of the nurses determining my medical history. The first category was to interview the patient without the ability to recognize any non-verbal communication. This happened in different rooms and was a phone call interview based on medical history. The second category of interview by the second colleague had a minimal observation of the non-verbal communication skills. This happened in the same room, but with the interviewee facing away from the interviewer. The third category allowed full expression of the non-verbal communication skills. It happened in one room around a table with the interviewer and interviewee facing each other and at close proximity.

This plan of teaching non-verbal communication skills was then evaluated by comparing the reports that the three different interviewers had compiled from the information they had gathered after examining my medical history. The main point of the evaluation was based on the accuracy and amount of information they gathered compared to the correct record of my medical history.

The Outcome and Recommendations

The outcome of the reports was significantly varying. The report that was compiled without any evaluation of non-verbal communication skills was less accurate and had a minimal amount of information. The report that involved a minimal evaluation of non-verbal communication skills had moderate details of the medical history with relatively higher accuracy. The report compiled from the evaluation of all non-verbal communication skills was more accurate and detailed. In fact, it was substantially close to being accurate (>95%).

From this experiment, it is recommendable that nurses should be effectively trained to understand and interpret non-verbal communication in conjunction with verbal communication. The environment, where nurses interact with the patients, should be conducive for communication. It is crucial that the communication process is done in privacy without destruction. This will enhance the process of communication and the value of the output.

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Conclusion

Communication is a vital element of people's daily lives. It is one of the major determinants of the success of the day to day activities. The art of communication revolves among many aspects dominated by verbal communication. The use of verbal communication independently results in ineffective communication. However, effective communication requires a combination of both verbal and non-verbal communication skills. This element of communication has proved to be relevant to the practice of nursing. The ability of a nurse to interpret the information about the patient being dealt with is vital in terms of the care given by the nurse. It is, therefore, demanding that the nurse recognizes and gather the information that is beyond the verbal aspects since the ability to master and use non-verbal communication skills has proved to be a necessary tool in the practice of nursing.

The non-verbal communication is relevant in the confirmation of the verbal message in communication. It should always reflect the verbal message conveyed. Since non-verbal communication is mostly determined by intrinsic, unconscious sections of the brain, it is always believed to be accurate. This makes it the primer of the accuracy of the information conveyed. Although it is helpful, non-verbal communication is also challenged by cultural backgrounds. Finally, the experimentation in regard to the use of this skill in my workplace provided encouraging results prompting the recommendation of the inclusion of non-verbal communication skills in nursing practice.

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