Verbal and nonverbal communication

Family Planning Fellowship

Outline

Verbal communication: definition, types, how to improveNonverbal communication: definition, types, how to improve

Verbal Communication

• Verbal communication is the use of words to exchange thoughts, feelings, and information

• denotative meanings (standard dictionary definitions) (( باشا يا

• connotative meanings (all of the associations, implications, and suggested meanings) (( يا باشا

classes of verbal behavior

1. Provider gathers information from clients (asks questions)

2. The Provider listens to the client

2. Provider responds to the patient’s experience

Questioning skillsThe health care provider asks questions that encourage the

client to talk about herself/himself.

Types of Questions: Closed-ended question (Yes –No), (Who-Whom-When-where-How often-

How many-Does.)

Open-ended questions (What-Describe-How-Why-explain-Discuss)Open-ended questions cannot be answered by ''Yes'' or ''No'' or a one word

response. Such questions are therefore richer and more informative than close-ended questions, because they give the opportunity for a full answer.

Examples: How do you feel about that? How do you feel about having chemotherapy? Tell me how this accident happened?

Types of questions Probing questions to Clarify and to understandExamples:Do you mean (repeat the counselee message)Am I understanding you correctly, you do not see any purpose in

taking your medication? Are you saying that ( repeating the counseled message)

Justify: what makes you think of that.

Check accuracy: you definitely took three tablets/day

Confirmatory questions: Please tell me what you understood. Unacceptable is Leading questions

How TO IMPROVE Your QUESTIONING SKILLS:

1- Conduct the interview in a private place.2- Help the client feel at ease.3- Do not ask interrogative questions e.g. did you try to induce

abortion?4- Use a tone of voice that shows interest, concern and

friendliness.5- Ask only one question at a time, and then wait for an answer.6- Ask the same question in different ways if you think the client

has not understood.

Continued 7- Start with open ended questions to get story from the client's perspective

e.g. '' tell me, how did the bleeding start?''

8- Follow with closed- ended questions to get more specific information e.g. was the bleeding light, heavy or moderate?

9- Avoid leading questions e.g. of course you will have the delivery at the hospital, right?

10- Use facilitations to encourage the client to talk e.g. nodding, uhmm, yes….etc.

11- Ask the patient his/her interests: health, needs, and fears12- Respect and deal with feelings: shyness, worry, fear.

Listening skills

Listening is an active process.

Conscious effort to listen to the words to be aware of the feeling shown and of the attempts to hide feelings.

Observation of the nonverbal messages

Nonverbal gestures during listening (ROLES)

R: Relax (avoid nervous movements).O: Be Opened Flexible.L: Lean Forward Towards The Clients.E: Maintain Eye ContactS: Show you are listening (head nodding…)

ELEMENTS HELPING GOOD LISTENING:

Choosing private and comfortable place. Giving the client a chance to think. Observing her voice tone and body

movements. Speaking in a moderate speed. Repeating what the client has said from time

to time.

Effective responding skills

• Empathy• Validation• Restating• Reflecting• Clarifying• Summarizing

EmpathyEmpathy is the ability to perceive accurately the feelings of

another person and to communicate this understanding to the person.

• Sample empathic response: Patient: “I was terribly disappointed when I was told that I had to

have the operation and stay in the hospital. I was hoping I could have had outpatient surgery.”

Provider: “You became disappointed when you heard you would need surgery? And were you also frightened? Was it important to you to recover at home with your family?”

begin with phrases such as “You sound,” “You look,” and “You seem”

ValidationValidation is the act of obtaining feedback from a patient to

discover whether the empathic response is an accurate perception.

• Sample validating response: Patient: “I really can’t afford a babysitter for the 5 days I will be

in the hospital....” Physician: “I know how important it is for you to be at home with

your family and that it will require child care. Let’s try to think of some solutions.”

The validation affirmed the patient’s wishing to be at home with her/his children and elicited her/his concern about the expense of childcare.

RestatingRestating is repeating to the patient, almost verbatim, what the provider

believes is the main thought, idea, or feeling being expressed.57Tells the patient that the provider is listening. In addition, restating can serve

to validate interpretation of the message.58

• Sample restating response: Patient: “I have a yellow discharge after I urinate. It must have been about 2

weeks ago when I first noticed it, just after I started using a diaphragm instead of condoms. It feels uncomfortable and bothers me.

” Physician: “You noticed the discharge after you started using the diaphragm?”

Patient: “Yeah and I started to feel itchy.”By restating the patient’s message, the provider indicates that she/he is

attentive, verifies that she/he understood what was being said, and encouraged the patient to contribute additional information.

ReflectingReflecting is the process of directing back to patients their ideas, feelings, and

questions.Reflecting is done by paraphrasing stated or implied feelings and values and

examining the reason for the feelings.Reflecting helps to clarify the patient’s message and helps the patient to

recognize and get in touch with her/his ideas, feelings

• Sample reflecting response: Patient: “I’ve been able to go back to work now, but right after the

miscarriage I felt really tired all the time, and now when I go home I just want to sleep. I just can’t seem to get anything done, and I’ve been getting headaches often lately. Maybe I’m just not eating right.” Provider: “You seem to feel emotionally and physically upset by the loss of your baby.”

Patient: “Yes. I guess I am.”

ClarificationClarification is the attempt to understand what a patient is reporting by

asking for additional information.61

Clarification indicates to the patient that the provider is trying to understand her/him.

Gives the provider an opportunity to make sure she/he understands the patient

Builds common expectations between patient and provider

• Sample clarification response:

Patient: “I’ve been taking these pills for 1 week, and I still don’t feel well.”Provider: “Have you been taking 1 tablet after each meal for the past week?”Patient: “No, 1 each day.”Phrases that can be used include “I’m not sure I understand; would you

explain it to me again?” and “Maybe I didn’t make this clear; let me go over it again.”

SummarizingSummarizing means going over the main points of a discussion

to organize the focus and content of the information being conveyed.

• Sample summarizing response: Patient: “So, I really think the pill would be the best way for me

to keep from getting pregnant. My husband doesn’t always want to wear a condom.”

Physician: “So a birth control method you have control over is a better choice for you. Have you thought about how you will protect yourself from sexually transmitted diseases?

This summarizing response sums up what the patient has said and elicits additional pertinent information.

Factors Impairing the verbal communication

• Discipline-specific jargon (( البوبينة و الكتاوتجانبية آثار فعالية مخطط غير حمل

• Use “Job Aids”

• Volume of information presented in an encounter with a physician must be suitable (THREE MAIN POINTS IS YOUR LIMIT)

• Give written information in addition to the verbal information

Impairing verbal communications

Do NOT

Give Orders Attack Be Aggressive Advise Ridicule

NON VERBAL COMMUNICATION

DEFINITION

Nonverbal communication includes all of the conscious or unconscious unspoken gestures, behaviors, and actions that express thoughts, feelings, and information.

 

How important????

Body Language 55%Tone of Voice 38%Actual Words 7%

Functions

• Express emotions

• Express attitudes

• Establish, develop, and maintain social relationships

• Support verbal communication

CATEGORIES OF NON-VERBAL COMMUNICATION

Body movements, way of walking, posture.

Facial expressions and eye contact.

Gesture; movements of hands, legs, arms and feet

Head nodding.

Space and distances: (at same level)o -Intimate (45 cm).o -Personal (45-120 cm).o -Social (120-360 cm).o -Public (>360 cm).

Touch.

Personal appearance and effective utilization of Time

Para Language:-Vocal characteristics.-Vocal interferences.

Ways of Improving Non-verbal Communication

Sit facing the client. Look directly to the client but not continuously. Use encouraging movements as nodding and leaning

forward. Speak in voice tone showing care. Observe the non verbal expressions shown by the

patient. Avoid the movements that cause distraction as

looking at the watch or papers or around the room.

Observing Nonverbal Communication

Assess nonverbal communication

A client whose words and actions do not align may indicate distress and the need to explore feelings that are not being expressed directly.

 

 

A patient who says “I appreciate your assistance” with eyes averted and a tense facial expression

Analyzing and Interpreting Communication

• Observe • Interpret.• Validate

Sight

• Facial expressions• Gestures• body postures• physical appearance

Meanings

• Averted eyes may convey humility, avoidance, or fear.

• Erect posture and leaning toward the speaker• leaning away from the speaker• Muscle tension or rapid breathing

Sound. SighsCriesvoice inflectionsvoice pitchHesitationsSilence

Touch. CaringIntrusiveThreatening Be aware of the patient’s response and reaction

to touch. .

• Anger: Aggressive speech patterns Loud voice toneShort answersIncreased muscle tensionIncreased heart rate

• Anxiety: Rapid speechRestlessnessInattentionIrritabilityincreased muscle tensionincreased heart rateDiaphoresisDry mouth

Depression: poor eye contactlack of spontaneityslowed speech and movement difficulty concentrating

Manipulation: Lyingexcessive flatteryHelplessnessIntimidation suicide threats

BOTTOM LINE

Maintain the comfort level while providing care to your patients

أسئلة

أنا أسأل طيب

• What are the classes of verbal communication• What are the components of nonverbal

communication• What are the nonverbal communication

components of an efficient provider• What are the manifestations of a problem

during counseling????