Introduction to communication skills

Adapted from a presentation by Hugh PalmerUniversity of Hull

The Process of Communication

• Context of communication• Personal history of those involved• The environment• The purpose of the communication• Differences in expectation and purpose• Culture• Sympathy and empathy

Definition: CommunicationA continuous, transactional process involving participants who occupy different but overlapping environments and create relationships through the exchange of messages, which are affected by external, psychological and physiological ‘noise’(Adler & Proctor, 2007)

• Message – what you are conveying• Channel – verbal, written, telephone, txt• Feedback – both verbal and non verbal• Noise – anything that interferes with the process• Context – where you are, the environment, the time,

what else is happening

Sender Receiver

Feedback

Message andChannel

Feedback Context

Noise

Principles of Communication

• Communication principles:– We communicate “with”, not “to” others

• Like dancing, it requires cooperation, coordination and sensitivity to the partner

• You communicate uniquely with each partner– We mutually influence each other

• Example: over time, low self-esteem brings about a similar effect in our partner.

Communication principles– Communication can be intentional or

unintentional• ?? We cannot “not” communicate• ?? No ”breakdown of communication,” only

unsatisfying communication– Communication is irreversible

• Cannot “take back” or “un-receive” something– Communication is unrepeatable

• Tied to the specific event and who you are “today”

Nonverbal Communication

What is nonverbal communication?

Nonverbal Communication

• Up to 93% of the emotional content of a message

• What is nonverbal communication?– Everything except words

• It’s impossible to “not” communicate• Intentional and unintentional• Practical advantages to nonverbal competency

Nonverbal Communication

• Tied to culture– Distance, eye contact,

speed, silence etc.– We judge others based on

our preferences• Some nonverbals are

universal– Smiles, frowns, laughter,

crying etc.– But the reasons we do them

vary widely

I’m angry!

Yah boo, sucks to you!

Nonverbal Communication

• Serves communication functions– Repeating: pointing while saying– Substituting: use instead of words– Complementing: signals attitudes

• Illustrators: support words (head scratch)– Accenting: emphasizes “it’s your idea”– Regulates: end of statement, silence, question,

volume, pitch, etc.– Contradicts: “I’m not angry!” double messages

Types of Nonverbal Communication

– Kinesics: body position and motion• Body orientation, posture, gestures (kinesics), • Facial expressions, eye movement (oculesics)

– Paralanguage (voice)– Touch (haptics)– Physical appearance and clothing– Proxemics and territoriality

Kinesics• Body orientation:

– Position of body, feet and head• Posture:

– Slump, straight, lean forward, back etc.– Tenseness a sign of threat, status,

vulnerability • Gestures:

– Ambiguous and unambiguous, too many or too few

– Preening behaviors, fidgeting, etc.

Kinesics• Face and eyes:

– Extremely complex, wide variety of expressions

– Basic emotional expressions easy to read

– Affect blends: more than one expression

– Microexpressions– Eye contact: involvement,

dominance, submission• Dilation: signal interest, arousal

Paralanguage

• Pitch, rate, volume, pauses• Disfluencies: uh, um, er etc.• More impact on meaning than words

– When in conflict with words, paralanguage wins• We tend to comply with and like those who speak at

our rate• Sarcasm: paralanguage opposes words• Affects how others perceive us: confident, weak,

attractive, age, intelligence, unsure etc.

Touch (haptics)

• Can be:– Functional/professional, social/polite,

friendship, sexual arousal, aggression • Often ambiguous: causes problems• Boosts compliance, improves image• Necessary for human survival

Clothing

• Sends many messages: social position, education, morals, economic position etc.

• Affects persuasiveness • First impressions in particular

(time sensitive)

Professional appearance

Who would you want to care for your child?

Proxemics and Territoriality

• Proxemics: how we use space– Every communication event has a window of

acceptable distance between communicators– Culture bound– Intimate, personal, social and public distance

• Territoriality:– Stationary space we claim as our own– Our room, seat on a bus, desk etc. Those

with higher social status get more

Other aspects

• Physical environment:– Interior design, physical setting, possessions

Using nonverbal communication

• Posture (standing or sitting)– Relaxed, ‘open’ posture, mirroring the patient

• Orientation and proximity– Face to face or at an angle, leaning towards the

patient, appropriate distance• Facial Expression

– Appropriate eye contact• Gestures and touch

– Sensitivity to the patient

Mind your Language

• Use terms understandable by the receiver– Education, ability, culture, non-native speaker,

avoid jargon• Consider the content

– Relevant, unambiguous, correct amount of detail• Think about the delivery

– Use appropriate volume, tone, and rate

Parental anxiety

Davies (1984):• Correlation between

maternal and child anxiety in hospital.

• Children less anxious when parents resident

• Staff did appreciate parent's anxiety

• Mothers most worries about operation and anaesthetic

Cause of parental anxietyWood (1988) • poor support given to parents, • often due to low staffing

Williamson and Williamson (1987) parental stress caused by:

• noise at night• routine generalized care• lack of information and concern for

child's welfare

Cocks (1990) personal experience:• petty and unnecessary restrictions

(anaesthetic room)• uncomfortable bed at night• nurses having no time to stay with child,

unable to leave• non individualized care and routine

Parents’ positive experienceWilliamson and Williamson (1987)

positive experience linked to:• single room accommodation

(parent and child room)• relaxed atmosphere• Facilities and promotion of

children's play• getting to know staff as friends ..

most enjoyable

O'Toole (1990) describes positive experience of being able to go into the anaesthetic room

Benefit of ‘own’ nurse

Skipper, Leonard and Rhymes (1968) parents benefited from 'special' (key) nurse

Mahaffy (1965) used 'key' nurse:• children recovered more quickly (tonsillectomy)• significant differences on physiological measures• better fluid intake, less vomiting, less crying• fewer post discharge complications

Information

Meadow (1969):• 25% of parents had been told too little• parents 'longed for' information (about

operation)• hospital boring and claustrophobic• being resident caused them to worry less• parents worried unnecessarily because of

poor info

InformationKnox and Hayes (1983):• parents wanted preadmission info.

for themselves• anxiety decreased when

information given• parents lacked confidence in

carrying out care• parents were uncertain about their

role in hospital• parents longed for the opportunity

to talk openly to staff• fathers felt 'left out' and ignored

by staff

Information

Mishel (1982):• parents stress correlated with uncertainty• parents likely to interpret child's condition as

unduly serious

Lynn (1986) the more parents were able to anticipate events the less anxiety was experienced

Recommended reading

• Adler, R. B. & Proctor, R. F. (2007). Looking Out: Looking In, 12th Edn. Belmont, CA: Wadsworth Publishing Company.

• Arnold, E. and Boggs, K. (2007) Interpersonal relationships: professional communication skills for nurses (5th Edn) Philadelphia PA : WB Saunders.

• McDonald, W. (2009) Communication. In Docherty, C. & McCallum, J. (2009) Foundation clinical nursing skills. Oxford: OUP pp 163- 203.