Good communication is the basis of all effective relationships. The better we communicate, the greater the quality of our relationships.
Learning to use our words skillfully is important. However, research has shown that our non-verbal communication speaks louder than words. When congruence
exists between what we say both verbally and non-verbally, we communicate to others that we care and that we’re being truthful. This increases trust, clarity and rapport between the speaker and listener.
Understanding the importance of non-verbal communication will equip us to be better communicators overall because it will enable us to be more sensitive to body language (ours and others) as well as non-verbal cues so that we can more easily tune into the thoughts and feelings of others.
This enables us to be far more empathetic in our responses, which further improves our communication and relationships. On the other hand, when verbal and non-verbal communication is incongruent, it generates confusion, mistrust and tension.
A. Non-Verbal Communication
There are many types of therapeutic non-verbal communication. We will have a look at eight ways in which we communicate non-verbally:
1. Physical Appearance: this gives an insight into the mental, emotional and psychological states of a person. Our physical appearance also provides information about our personal style and taste as well as culture and religion. For example, a depressed person may not take the time to bathe or groom. As a nurse or caregiver, our neat, groomed appearance conveys the message that we take pride in who we are and what we do.
2. Body movement and posture can be open or closed. A closed posture is one where the arms and/or legs are crossed. This type of posture conveys defensiveness, insecurity, anger, disinterest or coldness and non-acceptance. An open body posture is relaxed, with arms and legs uncrossed, facing the person being communicated with. This kind of posture conveys warmth, caring and a willingness to communicate, which is a skill we need to develop as nurses and caregivers.
3. Facial expression is universal to all cultures. We communicate our emotions through various facial expressions. The most universally appealing facial expression is a smile from the heart, i.e. when the eyes and mouth are both smiling. A frown is universally indicative of annoyance, anger, discontent or disapproval. As nurses and caregivers, it is important for our facial expressions to be congruent with the emotion we are trying to express so that we do not send mixed messages.
4. Gestures: Many of us use our hands when we speak to add emphasis to what we’re saying. The Italians, for example, use a great deal of hand movement when they speak. The more reserved British, on the hand, use far less. Fiddling with fingernails, wringing hands in anxiety, picking at the skin or scalp are often subconscious gestures that convey anxiety. Learning to be more intentional with our hands prevents us from sending confusing, incongruent messages.
5. Eye contact: In western culture, making direct eye contact conveys confidence, openness and honesty. However, in many eastern cultures, direct eye contact is seen as being bold and flirtatious or too familiar, lacking respect for the person and their boundaries. Too much eye contact, even in western culture, can also make someone feel uncomfortable. No one likes to be stared at or feel scrutinized. Therefore, in western culture, eye contact needs to be relaxed, friendly and unintimidating. As nurses and caregivers, we need to be culturally sensitive and use eye contact appropriately.
6. Tone and volume of voice: A loud voice can convey excitement, confidence, aggression, anger or simply someone who cannot hear very well. A soft voice can convey shyness, timidity, insecurity and a lack of self-confidence. We all know when we hear an “edge” in someone’s voice – that it conveys anger or disapproval – and we all have experienced the soothing effects of a calm and gentle tone. Our voice tone and volume can convey much information beyond our words. Therefore, it is important to be aware of what our voice conveys when we speak.
7. Touch: A touch can be gentle, soothing and comforting when used appropriately, respectfully and warmly and can be used to convey genuine caring. A touch can be highly therapeutic when used at the right time in the right way. However, we need to be aware that some people do not like to be touched at all, especially those who suffer from the mental disorder of schizophrenia. Being sensitive to the preferences and body language of others will provide clues to the nurse and caregiver when and if a touch is appropriate.
8. Silence: Our attitudes and feelings can be projected into silence. When we’re giving someone the “silent treatment” or the “cold shoulder”, our silence and body language conveys anger, resentment, dislike and even hostility. Fortunately, silence can be used in a positive way too. Nothing is more comforting than someone who respects the space and privacy of others and can convey caring simply by being present. Silence is a powerful communicator and therapeutic tool that nurses and caregivers can learn.
Verbal Communication in Active Listening
We previously looked at the importance of non-verbal communication and how it is used to foster a trusting, therapeutic relationship. In this section, we will look at the art of active listening.
Understanding the power of non-verbal communication will help us to become excellent active listeners. An active listener is one who gives the speaker their full attention, being actively present and engaged in what the speaker is saying. Knowing how to use non-verbal language is useful when we want to communicate to the speaker that we care and that what they are saying is important to us. Active listening is one of the most powerful forms of communication and a highly therapeutic skill worth acquiring if we, as nurses and caregivers, want to build successful and effective relationships with our clients, our colleagues and other members of the interdisciplinary team.
Power to Change (a Christian Ministry) puts it this way: “Listening makes (others) feel worthy, appreciated, interesting, and respected. Ordinary conversations emerge on a deeper level, as do our relationships. When we listen, we foster the skill in others by acting as a (role) model for positive and effective communication…Greater communication brings greater intimacy. Parents listening to their kids help build self-esteem. In the business world, listening saves time and money by preventing misunderstandings. And we always learn more when we listen than when we talk.”
Non-verbal signs of active listening include:
1. Squarely face the speaker and lean forward: this shows the speaker that you are attentive and interested in what they are saying.
2. Maintain an open and relaxed posture: this puts the speaker at ease. When we are relaxed, we are expressing that we have the time to listen and that we are not in a hurry to end the conversation and get going.
3. Maintain eye contact to the degree that everyone remains comfortable as no one wants to feel scrutinized. This shows interest in the person and what they are saying.
4. Stay focused and pay attention: nothing is worse than speaking to someone whose gaze wanders and focuses on other things or someone whose eyes glaze over and become dull. This conveys that the listener has lost interest and is no longer engaged in listening to the speaker. The speaker realizes that what they are saying is no longer being heard and feels slighted or rejected.
5. Offer listening cues to the speaker: respond appropriately to show that you understand without looking like you are ready to jump in and take over the conversation. Use facial expressions, nodding, short verbal cues, and prompts such as “…and what happened then?” or “So how did that make you feel?” or “…that’s really interesting – tell me more”.
Barriers to active listening are: being preoccupied and distracted; personal insecurity; too much information; communication beyond the level of the listener; external noise and distractions; psychological and physical discomfort; and unusual speech and mannerisms that can be distracting.
B. Verbal Communication
We have already looked at some important non-verbal therapeutic communication techniques. Let us now have a look at some verbal therapeutic techniques:
1. Empathy: this is a communication technique that reassures the speaker that you have heard what they are saying and understand what they are experiencing and feeling. It is a way of acknowledging the speaker’s point of view without passing judgement. It is a wonderful way of conveying to the speaker that they are accepted. This provides relief and a feeling of freedom to the speaker because he/she is then relieved of the burden of struggling to get their point of view across and having to justify their feelings.
In the nursing practice of clinical empathy, two very important qualities to consider are accuracyand specificity. Our goal is to offer a verbal response that is accurate, without exaggerating or minimizing what we have been told. The words we use need to match the tone and strength of the feelings that have been expressed. This brings us to another therapeutic communication technique – that of paraphrasing.
2. Paraphrasing: when we paraphrase, we express in our own words what we heard the speaker say. This includes both their verbal and non-verbal communication. This technique is not simply a parroting of the exact words the patient has used. Paraphrasing requires sensitivity to the feelings of others and a way of “hitting the nail on the end” when it comes to “summing up” what the patient is trying to communicate. We should use fewer words than the sender and be careful not to “put words in the client’s mouth”, i.e. saying things that they have not expressed. Paraphrasing shows the sender that you are listening, that you understand and, thereby, promotes further communication.
3. Asking questions: being effective in asking questions is essential to nursing assessment and in building a successful therapeutic relationship. A professional nurse spends about half her working time asking questions of clients as well as colleagues. It is therefore important to develop this skill and to remember to listen for what is said as well as what has been left unspoken. Competency in asking questions will save the nurse and others a great deal of time. In addition, the more relevant and useful the information that is collected the more effective the interviewing experience. Open questions are used when more information is required. It invites clients to share information about their ideas, thoughts and feelings. Examples of good open questions are: “How did you feel when that happened?” or “Tell me more about what you experienced when you were growing up?” or “What would you like to see happen?”
Closed questions are used when very specific information is required or the patient is unable to give or process large amounts of information. Closed questions elicit a “yes” or “no” or one word response.
Finally, let’s have a look at some non-therapeutic communication techniques to help us better understand how to be more therapeutic in our communication approach. Some of these would be: giving false reassurance (e.g. “Don’t worry about your aggressive cancer; I’m sure you will get better soon.”); focusing on the nurse instead of the client (e.g. “The sunshine is good for my roses; I have a beautiful rose garden.”); overloading the patient with too much information and talking too fast; making value judgements (e.g. “You shouldn’t do that; it is wrong!”); underloading by remaining unresponsive by not picking up on cues and failing to give feedback; giving advice; making assumptions and jumping to conclusions without first clarifying; defending yourself and others; being opinionated; showing disapproval and so forth. Using non-therapeutic communication shuts down communication and hinders the nurse-client relationship which ultimately affects the successful outcomes of nursing interventions.
Therapeutic communication requires skills that must be learnt and applied intentionally to foster effective relationships between the nurse, her clients and her colleagues in order to ensure successful outcomes of the nursing interventions, which are always client-centered. For a nurse who cares, the client’s wellbeing and journey to better health is her primary goal. Therefore, the more she learns how to effectively communicate, the more she will achieve her goal. This will lead to far greater job satisfaction through a sense of accomplishment as well as meet the nurse’s need for self-actualization, i.e. becoming a highly effective nurse who influences and impacts the lives of others for the better.
Our Angels are chosen for their ability to listen well. We work hard at hearing from those we serve and their families.
Riley, Julia Balzer (RN, MN, AHN-BC, CET®), Communication in Nursing (6th Ed), Mosby, 102007
Jeanne Segal (Ph.D.), Melinda Smith (M.A.), and Jaelline Jaffe (Ph.D.) (2011), Nonverbal Communication,www.helpguide.org/mental/eq6_nonverbal_com
Polan, Elaine & Taylor, Daphne (2007) Journey Across the Lifespan, Human Development and Health Promotion, (3rd Ed) Philadelphia: F.A. Davis
Susie Michelle Cortwright (2011), 10 Tips to Effective & Active Listening Skills www.powertochange.com/students/people/listen/
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