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LESSON 18

June 9, 2024

LESSON 18

BARRIERS IN COMMUNICATION

Theme: Communication Styles of Nurse Practitioners.

v Styles of communication.

v Testing your communication style.

v Communication Styles of Nurse Practitioners.

Introduction

Communication is the basic element of human interactions that allows people to establish, maintain and improve contacts with others.

Nursing is a communicative intervention and is founded on effective communication.

The word communication originates from ‘communis’, a Greek word, meaning ‘to make common’.

It is the transmission and receiving information, feelings and or attitudes with the overall purpose of having understood producing a response.

Definition

“Communication is a means of persuasion to influence the other so that the desired effect is achieved.’Aristotle

Communication is “a process by which two or more people exchange ideas, facts, feelings or impressions in ways that each gains a ‘common understanding’ of meaning, intent and use of a message.” Paul Leagens

The communication process

It has the following main components:

Sender (source)

Message (content)

Channel (s) (medium)

Receiver (audience)

Feedback (effect)

Major Dimensions of Communication

Content (what type of things are communicated)

Source (by whom)

Form (in which form)

Channel (through which medium)

Destination/Receiver (to whom)

1. Sender

The sender (communicator) is the originator of the message.

Sender formulates, encodes and transmits the information which he/she wants to communicate.

The impact of the message will depend on sender’s communication skill, social status (authority), knowledge, attitude and prestige in the community.

2. Message

A message is the information/desired behaviour in physical form which the communicator transmits to his audience to receive, understand, accept and act upon.

The message may be in the form of words, pictures or signs.

Components of message are:

Message code-any group of symbols that can be structured in a way that is meaningful to same person, eg., language.

Message contentthe material in the message i.e., selected by the source to express his purpose.

Message treatmenti.e, decisions which the communication source makes in selecting, arranging both codes and contents.

A good message must be:

In line with the objectives

Meaningful

Based on felt needs

Clear and understandable

Specific and accurate

Timely and adequate

Fitting the audience

Interesting

Culturally and socially appropriate

3. Channels of Communication

By channel is implied the “physical bridge” or the media of communication between sender and the receiver.

Channels can be:

Interpersonal (face to face communication) may be verbal or non-verbal, or

Mass media TV, radio, printed media etc.

Every channel of communication has its advantages and limitations.

The proper selection and use of channels results in successful communication.

4. Reciever

Who receives messages from the sender, decoding, interprets the meaning and giving feedback.

5. Feedback

It is the flow of information from receiver to the sender, the reaction to the message.

Theories of communication

Model 1 Communication can be described also as processes of information transmission governed by three levels of semiotic rules

Syntactic (formal properties of signs and symbols)

Pragmatic (concerned with the relations between signs/expressions and their users) and

Ssemantic (study of relationships between signs and symbols and what they represent).

Model 2 Communication is information or content (e.g. a message iatural language) is sent in some form (as spoken language) from a sender/encoder to a destination/receiver/decoder.

Model 3 Theories of co-regulation describe communication as a creative and dynamic continuous process, rather than a discrete exchange of information.

Types of Communication

One-way Communiaction (didactic) the flow of communication is “one-way” from the communicator to the receiver. Eg. Lecture method.

Advantages

Considerable faster than two-way communication

Appears neat and efficient to an outsider observer.

Sender is more psychologically comfortable

Plan-fullness, order, systemization are associated with.

Disadvantages

knowledge is imposed

Learning is authoritative

Little audience participation

No feedback

Little influence on human behaviour.

Two-way Communiaction (Socratic) both sender and receiver take part.

The process of learning is active and democratic.

It is more likely to influence behaviour than one-way communication

Mode of Communication

Verbal communication

Non-verbal communication

Verbal Communication

the traditional way of communication byf mouth.

Language is the chief vehicle of communication.

“Effective verbal communication techniques” include

Clarity and brevity

Vocabulary

Denotative and connotative meaning

Pacing

Timing and relevance

Humour

Verbal communication also involves written words.

Non-verbal communication

communication occur otherthan words.

facial expression, gesture, touch and vocal tone

Metacommunication

a comment on the literal content and nature of the relationship between the person involved.

It is the message that conveys the sender’ attitudes, feelings and intentions towards listener; may be verbal or non-verbal.

Principles of communication:

Communication should have objective and purpose.

Should be appropriate to situation.

Systematic analysis of the message, i.e., the idea, the thought to be communicated, so that one is clear about it.

Selection and determination of appropriate language and medium of communication according to its purpose.

Organizational climate, including appropriate timing and physical setting to convey the desired meaning of the communication.

Consultation with others for planning of communication; involves special preparation.

Message should convey something of value to the receiver in the light of his needs and interests.

The communication action following a communication is important in effective communication as this speaks more than his/her words.

The sender has to understand the receivers attitude and reaction by careful, alert and proper listening to ensure that the desired meaning of the message has been comprehended by the receiver.

Credibility is very important.

Communication programme should make use of existing facilities to the great extent possible and should avoid challenging them unnecessarily.

Factors influencing communication:

Perceptions

Values

Emotions

Socio-cultural background

Knowledge

Role and relationships

Environment

Space and territoriality

Barriers of communication:

Physical/environmental barriers

Personal barriers

Physiological barriers

Psychological barriers

Cultural barriers

Background barriers

Importance of Communication in Nursing

· A critical component of nursing practice

· Good communication

Generate trust betweeurse and clients.

Provides professional satisfaction.

Is a means for bringing about change, i.e. nurse listens, speaks and acts to negotiate changes that promotes client’s well-being.

Is the foundation of the relationship between the nurse and other members of the health team.

Helps to promote managerial efficiency.

Provides basis for leadership action.

Provides means of co-ordination.

Conclusion

Communication is really an important aspect of our life.

Every one communicate with others but for effective, productive and interesting communication, proper communication skill has to be developed.

Every individual needs to communicate in one or the other way. It takes many forms such as writing, speaking and listening. Communication is the life blood of every organization and its effective use helps build a proper chain of authority and improve relationships in the organization.

Communication is a process of transferring information from one entity to another. Communication processes are sign-mediated interactions between at least two agents which share a repertoire of signs and semiotic rules. Communication is commonly defined as “the imparting or interchange of thoughts, opinions, or information by speech, writing, or signs”. Although there is such a thing as one-way communication, communication can be perceived better as a two-way process in which there is an exchange and progression of thoughts, feelings or ideas (energy) towards a mutually accepted goal or direction (information).

Communication is a process whereby information is enclosed in a package and is channeled and imparted by a sender to a receiver via some medium. The receiver then decodes the message and gives the sender a feedback. All forms of communication require a sender, a message, and a receiver. Communication requires that all parties have an area of communicative commonality. There are auditory means, such as speech, song, and tone of voice, and there are nonverbal means, such as body language, sign language, paralanguage, touch, eye contact, and writing.

Language Barriers

The possibility of miscommunication increases when the nurse and patient speak different first languages. Idioms and frames of reference can carry shades of meaning in one language that may not exist in another. Mispronunciation or incorrect signing can mislead the provider or patient. A translator can improve the situation when a nurse who speaks the language is unavailable.

Ethnic Barriers

Differences in ethnic background and mores can create communication problems. Societal expectations about the human body and its exposure to others can interfere with a nurse performing her duties and explaining follow-up care for a patient. What one culture considers a normal condition may camouflage illness. Learning about cultural differences can reduce many of these barriers.

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Staffing Shortages

Effective communication takes time: time to determine the patient’s condition, time to explain and educate, time to confirm that the patient understands. The shortage of nurses in many medical settings can lead to lack of time. Without enough nurses on staff, the amount of time available for each patient declines.

Assumptions

A nurse who makes assumptions about a patient based on a case diagnosis risks missing important cues. Open-minded communication between patient and nurse permits better assessment and more accurate care plans.

Distractions

Nurses in a medical facility care for multiple patients at a time, creating a situation ripe for distractions and interruptions. Situations outside the workplace also can create distractions. Effective communication requires committed attention, something nurses may find more difficult to give with the increasing demands on them.

Jargon and “We” Speak

Nurses can intimidate or confuse patients with the use of medical jargon. Use common terms with a patient to simplify the conversation. The chart entry may read “singultus“; the patient will understand “hiccups” more readily. Adding a simple “which is” explanation after a medical term can improve the patient’s understanding: “I’m giving you an injection of hydromorphone hydrochloride, which is a medication the doctor ordered for your pain.”

Also, a nurse’s use of plural pronouns can create unintended barriers. “How are we feeling today?” “Did we eat our breakfast?” Phrases such as these can alienate a patient rather than connecting with him. Save the plural pronouns for when they apply: “When you get back from therapy, we’ll talk about your progress.”

Misdirection

The temptation to address the caregiver of a juvenile or uncommunicative patient may result in the patient feeling slighted. Include the patient as well as the caregiver in oral communication if the patient is present. Sometimes a patient chooses not to communicate because she feels ignored while her caregiver talks about her with medical personnel.

When effective communication is at work, what the receiver decodes is what the sender sends (Zastrow, 2001). A breakdown in the communication process may occur if the intended message was not encoded or decoded properly. Comments may be taken the wrong way, a compliment may be taken as an insult, or a joke might be interpreted as a put-down. There may also be barriers in the transfer process; these barriers may include:

Noise, static

Multiple communications

Fatigue, stress

Distractions

Incomplete message

Ambiguous wording

Lack of credibility

Lack of rapport

Think in personal terms

Jargon

Boring

Building relationships is central to nursing work and communication skills can be improved by avoiding jargon and ensuring patients are not labelled, says Sarah Collins

The importance of communication in health care hit the headlines recently at the British Medical Association’s annual consultants’ conference earlier this month. Jargon, said the doctors, could harm patients’ care.

The following anecdote from my own experience illustrates the dangers of poor communication:

John*, a man in his 30s, is in bed on a coronary surgery ward. Older men occupy the other beds. It is Christmas Day. The nurses are having a party; their office door opens in snaps of laughter. The man in the bed next to him has no visitors. John wonders if he’d like to play cards, but the nurses have not offered to play. John’s mouth has been fixed in a tight line since his family came bearing presents; he cannot smile for fear of crying. He holds a morphine pump in one hand, and the phone in the other. The nurse in charge has not succeeded in persuading the doctor to come, so John is trying himself. The man opposite is calling out, but the nurses avoid him, and when John points out that he wants someone, a nurse replies: ‘He’s just demented.’

Discussions with colleagues help to alleviate jargon, and allow barriers to communication to be viewed and addressed

Without exception, patients’ experiences are influenced by how care is delivered. Through communication, a patient can: be reassured; be put at ease; be taken seriously; understand their illness more fully; voice their fears and concerns; feel empowered; be motivated to follow a medication regimen; express a desire to have treatment (or not); be given time and treated with respect.

Effective communication is, therefore, more than delivering quality, patient-centred care. It is also the vehicle through which patients’ involvement is optimised.

Communication is therapeutic. Building relationships is the cornerstone of nursing work, particularly with patients with learning disabilities; communication is a prerequisite to that process. It can also be life-saving. If a patient is informed about what symptoms to mention, a cancer is more likely to be diagnosed and treated in time.

Nurses’ role

Nurses spend the most time and have most contact with patients, doing ‘connecting work’ that complements doctors’ consultations. Nurses provide the ‘glue’ – escorting a patient into the consulting room; identifying with challenges in adhering to lifestyle changes by reporting their own experience; allowing patients to disclose concerns not shared with doctors; being chatty; sharing a joke; and providing explanations where doctors’ communication has failed.

The following example from my own research, where a nurse spoke about communication, illustrates this last point about doctors: ‘I watch my patients in a ward round, and they sit there and go “Yes doctor, no doctor, yes doctor”, and then I make a point of going and saying: “Have you understood?” “No, I didn’t understand a word of that, nurse, I’m really worried”, and the whole story comes out.’

Nurturing these qualities requires understanding of the essential ingredients of communication. Making meaningful use of ‘communication skills’ demands appreciation of the contexts in which skills are enacted in practice, to be able to translate them.

Environments are challenging: a busy hospital ward, a crowded waiting room, a lounge with the television constantly on. Language can be a barrier: labels attached to individuals such as ‘just demented’ crystallise judgemental attitudes, standing in the way of getting to know patients.

How caurses improve their communication, and maintain its effectiveness? Jargoeeds to be acknowledged, so that it can be avoided, or where necessary, explained to patients. Discussions with colleagues help to alleviate jargon, and allow barriers to communication to be viewed and addressed. Most of all, talking with patients, for the sake of conversation and company, aids well-being and recovery.

One of the basics of good nursing is good communication with patients. Failure to communicate well with a patient right away will destroy the delicate nurse/patient relationship and mean the patient does not trust the nurse.

Poor communication can even be dangerous as misunderstandings and people getting their wires crossed can lead to misdiagnosis and even medication errors.

But this area is one of the main sources of complaints made to the health service ombudsman every year and some believe training in communication should be a separate module iurse training instead of being subsumed into the general curriculum.

The barriers to good communication skills are many and include time pressures so busy nurses may not be able to get time to sit and talk with patients; lack of privacy; skills mix on the wards can mean there is a shortage of qualified nurses who are available to talk to patients; lack of training; and different languages.

Useful things to remember in having good communication include being prepared to know what you are going to say; having the right information to hand for when patients ask questions; maintaining eye contact and observing the patient’s body language; listening properly; picking up on the non-verbal signs as well as the verbal ones; avoiding the use of medical jargon; and in cases of breaking bad news, being prepared emotionally, trying to find the right environment, and being sensitive, honest and compassionate.

Essence of Care – the government’s strategy to improve the quality of the fundamental aspects of nursing care – has communication as one of its 10 key benchmark areas.

The initiative provides a process for sharing and comparing practices and enables nurses to identify best practice or develop action plans to remedy practice that is identified as needing improvement

For the benchmark on communications, many factors are included. These include inter-personal skills; opportunity for communication; assessment of communicatioeeds; information sharing; resources to aid communication and understanding; coordination of care; empowerment to communicate needs; valuing the patients and/or carers’ expertise and contribution; and training needs

By using the communication benchmark, some trusts have identified gaps and rectified those by introducing dedicated rooms for patients and relatives to talk privately, making communication skills part of nurses’ appraisals and producing patient information leaflets on specific topics such as stroke.

Good communication skills can also be particularly helpful when patients complain. Patients usually see nurses as more approachable than doctors if they have a problem they want to discuss.

Nurses can often deal with complaints quickly and effectively before they are taken further and prevent what was initially a minor problem from becoming a long, drawn-out formal complaint.

6. Barriers in communication

Breakdowns of communication channels, is a frequent challenge that managers face. Communication problems signify more deep-rooted problems than those that appear prima facie. The barriers may exist either at the transmission stage or at the feedback stage. It may so happen that the sender is unable to properly channelise the message, or it may also be wrongly received. The important point is to understand the barriers that a manager faces at various stages so that they can be properly dealt with.

1. Faulty Planning:

The prerequisite of effective communication is accurate planning. The message should be properly planned and then delivered. Which channel links are to be adopted needs to be planned out in advance. The contents of the message should be drawn after considering all the aspects. A poorly designed message looses all its worthiness. Besides, the purpose of the message also needs to be clearly stated. Hence, faulty planning leads to breaking up of communication lines.

2. Vague Presumptions:

The non-communicated assumptions that underline the message are extremely dangerous. The sender presumes a certain part and accordingly forwards the message. It is not necessary that the receiver shall also presume things in the same manner. This may lead to confusion and chaos. Unclarified and vague presumptions lead to greater dangers. For example, a senior officer gives a call to the junior stating that on certain days he will be out of town assuming that the junior shall make necessary staying arrangements for him. The junior receives this message assuming that senior manager is simply informing him of his absence so that he can take over the responsibility and that all staying arrangements were already taken care of by the senior.

Semantic Distortion:

A single word conveys lots of different meanings. Each word is understood in reference to the context of the sentence as well as place and situation it is used at. Semantic Distortion can be deliberate or accidental. When it is deliberate, it is intended so but the one that is accidental hinders the progress of communication. It renders ambiguity to the message and every different individual may come to his own conclusion in the end.

Status Effect:

This occurs when one person is considerably higher in the hierarchy than another. The person at the top gives the message. People at the bottom take it literally and follow it as an order. The top people may not have intended to pass it on literally. This leads to confusion.

Poorly Expressed Contents:

The sender of the message may be clear about the thought in his mind but poorly chosen words or omission of important links, leads to misunderstandings in the group. The message that is simple and straightforward tends to be easily accepted and interpreted in the team. But the simplicity should not be achieved at the cost of misrepresentation of the crux.

Loss during transmission and poor retention:

When the message moves from one person to the other, it becomes less accurate. Different individuals tend to add their perception to it. Besides, the message may not be retained thoroughly in the memory. Hence it is advisable to repeat the message and also use more than one channel to communicate the same message.

Poor listening and instant interpretations:

Listening requires patience. It demands full attention and self-discipline. It also requires that the listener avoid premature evaluation of what another person has to say. Usually, people have a tendency to judge what is said, whether they agree to it or disagree. This is a common notion. There are hardly few people who are good listeners. Besides, when the message is long, after a while people start-loosing interest and hence stop listening. Due to this tendency, the message transmission gets hindered. Hence, listening with empathy should be practiced in the organization to have effective communication.

Threat, fear and distrust:

In an environment of threat, fear and distrust, effective communication cannot be expected. People become defensive and close-minded. They remain always on their guard, which hinders the movement of communication. People acting under threat or fear, do not take the decisions rationally but rather, the decisions are made under pressure. Moreover, they do not actually care about the consequence of a faulty message as they are always under the grip of some fear. For making communication effective, a climate of trust, honesty and integrity is needed.

Insufficient time period:

Whenever the communication is made, sufficient time period, to understand and digest the message needs to be given. Moreover, communication may bring in changes. These changes affect different people in different manner. Besides, realization of the whole implication of the message is time consuming. However, managers are usually pressed for time. This leads to breakage in the communication channel.

Physical distractions:

In the organization that is filled with people all around, a lot of noise, improper lighting, frequent physical movements of people, the messages that come-get distracted. People are not relaxed in such climate and tend to receive the communication haphazardly.

Improper feedback

Though one way communication is quick, two way communication is more accurate. It is always advisable to have some interactions between the receiver and the sender. This clears the doubts and misconceptions of both the parties. If a proper feedback system is not installed, then in such a case two way communication becomes difficult.

Other barriers:

People tend to have selective percetion as far as information is concerned. They hear that part of the information, which they like best and tend to ignore other parts. This does not allow the whole message to get through.

Attitude and reactions to different situations, by individuals as unit and by individuals collectively or in group vary. Hence, different individuals react differently to the same message.

7. Communication Styles

Every time we speak, we choose and use one of four basic communication styles: assertive, aggressive, passive and passive-aggressive.

Assertive Communication

The most effective and healthiest form of communication is the assertive style. It’s how we naturally express ourselves when our self-esteem is intact, giving us the confidence to communicate without games and manipulation.

When we are being assertive, we work hard to create mutually satisfying solutions. We communicate our needs clearly and forthrightly. We care about the relationship and strive for a win/win situation. We know our limits and refuse to be pushed beyond them just because someone else wants or needs something from us. Surprisingly, assertive is the style most people use least.

Aggressive Communication

Aggressive communication always involves manipulation. We may attempt to make people do what we want by inducing guilt (hurt) or by using intimidation and control tactics (anger). Covert or overt, we simply want our needs met – and right now! Although there are a few arenas where aggressive behavior is called for (i.e., sports or war), it will never work in a relationship. Ironically, the more aggressive sports rely heavily on team members and rational coaching strategies. Even war might be avoided if we could learn to be more assertive and negotiate to solve our problems.

Passive Communication

Passive communication is based on compliance and hopes to avoid confrontation at all costs. In this mode we don’t talk much, question even less, and actually do very little. We just don’t want to rock the boat. Passives have learned that it is safer not to react and better to disappear than to stand up and be noticed.

Passive-Aggressive Communication

A combination of styles, passive-aggressive avoids direct confrontation (passive), but attempts to get even through manipulation (aggressive). If you’ve ever thought about making that certain someone who needs to be “taught a thing or two” suffer (even just a teeny bit), you’ve stepped pretty close to (if not on into) the devious and sneaky world of the passive-aggressive. This style of communication often leads to office politics and rumour-mongering.

Communication Styles by Christopher L. Heffner, M.S.