Introduction to communication skills Adapted from a presentation by Hugh Palmer University 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: Communication A 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 and Channel Sender Noise Feedback Feedback • • • • • Receiver Context 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 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 I’m angry! – Smiles, frowns, laughter, crying etc. – But the reasons we do them vary widely 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 anxiety Wood (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 experience Williamson 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 Information Knox 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.