copyright 2008 Cheryl K. Hosken, BSN, MS Psych.
Using Communication to Interact with Others
People can be hard to understand, but they do not have to be a mystery if you talk with them and listen to their stories. When you interact with persons you care for, you learn many things about them that help you understand them better. To do this well, understanding communication and how it works and how to use it effectively will help you.
Your ability to send and receive messages helps other people understand you and makes it possible for you to understand others. You may think that communication takes place only when you talk or write, but much communication takes place in the expressions on your face, the grip of your handshake, or the tilt of your head.
You probably know from personal experience how common it is for people to misunderstand one another. When you talk and someone misunderstands you, you may react by thinking, "What is wrong with her? Why didn't she understand me? What I said was so clear!" Effective communication requires more than just one person talking or providing information. There are five important elements of communication that work together to get a message from one person to another.
Communication Element Description of the Element 1. Channel The way the message is sent - verbally, nonverbally, or in writing 2. Sender The person who wants to communicate information 3. Receiver The person to whom the message is sent 4. Message The information the person sends 5. Confirmation The way the receiver lets the sender know he has received the message
Meditate Word By Word On These Verses:
Matthew 20:29-34
If these five elements work together for clear communication, why do people misunderstand one another? Sometimes the message itself is not clear. Other times, the sender may be using the wrong channel. For example, a man who talked to a doctor about the surgery his mother had was so upset that he did not make sense when he spoke. His message might have been better understood if he had calmed down before he spoke or if he had communicated through a different channel such as a letter.
Other times, misunderstanding occurs when the receiver does not confirm the message to the sender by telling the sender what he thinks the message means. If you are the receiver, confirm the message by repeating, in your own words, what the sender said. If you are the sender and you have to ask the receiver for confirmation, ask an open-ended question, not a close-ended question. For example, the man who was talking with a doctor about his mother could have said, "Do you understand?" (a close-ended question) and the doctor could have said "Yes", even if she didn't understand. However, if the man had said, "what do you understand about the situation I just explained?" (an open-ended question) the doctor would have answered by repeating the man's message in her own words if he truly understood him.
Good communication requires much thought, careful attention, skill, and cooperation. It also has many benefits, including increased understanding among people.
Question:
1. If you see someone crying, what should you do to make her feel better?
(Select the best answer.)
Say, "Cheer up! You'll get over it!"
Slap her on the face and say, "Stop crying!"
Put your arm around her shoulder and gently ask, "What's the matter?"
Choosing Communication Channels
We use three channels of communication. Verbal communication is words spoken for the receiver to hear, nonverbal communication is actions for the receiver to observe, and written communication is words or symbols written on paper or some other medium for the receiver to read. The channel that you choose to send you message depends on the message and the receiver. For example, you would choose verbal communication to send a message to someone who is blind. In certain situations, you might use more than one channel to send your message. For example, you could explain something (verbal communication) and then write it down (written communication) as a reminder. Or you could demonstrate a skill (nonverbal communication) and describe what you are doing (verbal communication) at the same time.
Verbal Communication
Verbal communication has two important parts: (1) what you say and (2) how you say it. Effective verbal communication requires that you have useful information to share, speak clearly, and express your thoughts well.
When you talk with a person in your care, use the following verbal communication skills:
- Get the receiver's attention before you start talking. If the person is doing something and your message is not urgent, it may be better to talk to the person later.
- Use words that the receiver understands. When communicating with people in your care, use terms that are familiar to them. Medical terms can be confusing. Because some people may feel shy about asking what you mean, they may not understand your message.
- Choose the right volume. Speak loudly enough to be heard, but not too loudly. The loudness of your voice depends on how well the receiver can hear, how much noise there is around you, and whether you are discussing personal information. If a person is having trouble hearing you, move closer.
- Speak slowly and clearly. Talk slowly enough to express your thoughts clarly and give the receiver time to hear and think about what you are saying. Let him respond to what you say.
- Be aware of your tone of voice. Listen to how you sound to be sure your tone of voice matches what you are trying to say. Sometimes when you are in a hurry or have something else on your mind, you say things in a tone of voice that is not appropriate for the situation. for example, if you are thinking of an unpleasant conversation you had on the bus today, your voice may be angry when you talk with the person in your care.
- Listen to the receiver. By asking receivers to respond and by listening to what they say, your receive confirmation they understand your message. If they don't understand, you may have to send the message again in a different way.
Nonverbal Communication
A performing mime never speaks. He uses only actions - nonverbal communication - to send a message. Information and feelings are often shared through body movements and facial expressions. Sometimes these actions are called body language.
To communicate effectively, you need to understand two different elements of nonverbal communication: receiving and sending information. When you look at people, you notice their facial expressions and how they hold their bodies. The information you receive from their faces and bodies affects how you interpret their messages. If you talk to a woman whose arms are tightly folded across her chest, you may think she is angry or upset about something. The way a person holds his mouth or uses the muscles around his eyes can tells us something about how a he feels. We interpret this message from the body, not by what is said but by the way the body is held or used. However, the woman about may have her arms folded because she is cold. A person's background and culture can also affect nonverbal expression. For example, looking a person in the eye is a form of respect in some cultures, but it is offensive in others. When you receive information through nonverbal communication, ask the sender if you are interpreting it correctly.
Question:
2. Your client has had many visitors during the weekend. At the beginning of the week, she seems sleepy and does not want to eat. Several people near her have had colds. What other observations and questions can you use to help you assess her true situation?
(One or more of the following answers may be correct.)
Measure her temperature and blood pressure.
See if her nose is running, or if she is coughing.
Ask her if she has already eaten, or just isn't hungry.
Ask her if one of her visitors said something that upset her.
You need to be careful about the information you send. Sometimes you have to keep your feelings inside so that they don not show on your face. For example, when you care for someone who is not easy to look on, you must keep a calm look on your face so that the person does not feel afraid or rejected. If a situation really upsets you, you may need to excuse yourself, get a breath of air, and return. Be aware of how you are holding your body and what you are doing so that you communicate the right message. For example, if you are pleased about something, make sure your facial expression (perhaps a smile) and body (standing erect) as well as your words, communicate your pleasure.
The same nonverbal clue can signal many possible messages, which the receiver needs to check on. Consider the following aspects of nonverbal communication:
- Personal Appearance. When you look as if you are in order, you look professional. You also send a message that you care about yourself and the people you work with.
- Facial Expressions. The meaning of facial expressions can vary. For example, a smile can be a sign of welcome or a sign of approval. A frown can suggest unhappiness or annoyance. The look in a person's eyes can show understanding or confusion.
- Touch. A caring touch such as a hand on the shoulder or a pat on the back is often a way to make someone feel special or emphasize what you are saying. Touching is not appropriate in all cultures however. Also, some people simply do not like to be touched. Sometimes, because of how you feel, it is not appropriate to send a message by touch. If you feel angry, tense, or impatient, you may want to grab the person or push him. This creates an angry response and less cooperation from the person you are trying to help.
- Body Position. People we care for communicate how they feel physically and emotionally by the way they move, sit, or stand. For example, person who usually sits straight may be hunched in his chair today. His posture may reveal that he is in pain, tired, or depressed.
You also send messages when you move, stand, sit, or walk. Move toward people slowly so that you don't startle them and they do not think you are in a hurry. Where you stand or sit in relation to another person is also important. Every person has a comfort zone, or space near a person where one feels comfortable. Your comfort zone may allow you to stand very close to others, but some people in your care may find that closeness uncomfortable and back away. Or you may need a lot of personal space, but one of your clients may think that your distance from him means that you do not like him. Be aware of each person's comfort zone and find a distance that is right for both of you.
Written Communication
You will also communicate in writing perhaps for a doctor, other co-worker, or the family of your client. Before you write a message, be sure that the person receiving it will be able to read it. Perhaps the person may speak well, but the his ability to read may be limited for various reasons: limited eyesight, disease processes, or a different nationality. Use the following skills when you write:
- Choose the best size and colors for your letters. If you write for a person with limited eyesight, use large letters and black or blue ink on a white sheet of paper.
- Draw Pictures. Sometimes a picture is worth more than words, and it gives a better idea of what you want to say.
- Choose simple words. Use the simplest words you can to get the message to the person.
- Be specific. Give the exact time of day or exact process of what you want do and in correct order.
- Check your message twice. Check to make sure that what you have written is clear to you and to the person you wrote it for.
Question:
3. What are the three channels of communication? How do you use each?
Using Communication in Special Situations There are times when we must communicate with people about certain topics that are not comfortable for us. We may also communicate with people who cannot see or hear well, with persons who speak different languages, and with children.
Communicating about difficult subjects The people in your care and their families may look to you for answers to their questions and talk to you about difficult situations. Most of the time you can probably provide the answers. Sometimes you may not know how to respond.
When you have a good relationship with the person in your care, that person may trust you enough to express private and personal thoughts. For example, a person may say, "My family doesn't care about me anymore." A family member may say, "I wish she would just die!" These messages may make you feel uncomfortable. You may feel nervous, afraid, or unsure about how to respond. Sometimes these conversations are so uncomfortable that you may want to do something, such as leaving the room quickly, change the subject, or tell a small lie in hopes that the person will feel better. You may also make the comment such as, "Don't be so silly!" or "You really don't mean that."
Question:
4. What subjects are difficult for you to talk about? How do you think you could overcome them?
While these responses may relieve you from responsibility, they cut off communication with the person who is sending the message. Because part of our work as Christian professionals is to listen and talk with the person in your care, it is important to keep communication open even if you feel uncomfortable with the message you heard. The suggestions below may help with difficult messages:
- Pause for a few moments. To calm yourself, stop to figure out how you feel and why you feel that way. Then, instead of focusing on you feelings, think about the feelings of the sender and how he is trying to communicate with you.
- Nonverbally show your interest. Show the person that you care about his feelings by stopping what you are doing, giving full attention, and making eye contact. If he feels your interest and concern, your silent support can sometimes help more than words.
- Verbally encourage the person to talk. Ask a question to confirm the person's message such as, "What makes you say that your family doesn't like you?" Or confirm the message by repeating it in your own words: "It seems that your family doesn't come to see you very often anymore."
- Listen. Sometimes, all a person needs is someone who listens. If he needs answers that you are unable to provide, rather than a listening ear, ask some other person for help. Tell your client that you will talk with someone who may be able to give you answers. Then be sure to do as you say.
Question:
5. Mr. Ivanov's two children argue loudly in his room about what type of treatment he should receive. Their voices get louder and louder. Mr. Ivanov looks more and more upset. What could you do to ease the situation?
(Select the best answer.)
Shout at them, "Stop arguing! You're going to kill your father!"
Tell them firmly, "You must leave the room now. The patient needs to rest."
Ask them, "Please, speak a little more quietly."
Communication with People Who Are Visually Impaired
You may help people who have difficulty seeing. Some people need glasses only for reading, while others may be blind. Visual impairment can be caused by many factors. Cataracts are the result of the aging process, disease, or injury. The person may feel that he has a film over her eyes. Diabetes is a common cause of cataracts.
Imagine what it must be like for persons with poor vision. They cannot move about freely because they cannot see what is in front of them. They are unable to read or to watch programs on television. When planning care for the person with visual problems, you must consider his safety and communication by remembering that he may not see you, by being sensitive to his apartment furniture and surroundings, and by using your voice, words and touch to help him see.
When you enter his room, knock on the door or tell him immediately that you are there. He will not be startled by your entrance. Stand where he may be able to use what vision he has and call him by name. Then tell him who you are.
If a visually impaired person wears eyeglasses, keep them clean and within his reach. Keep the room well lighted by opening the curtains and turning on lights in early evening. Describe his surroundings to him and tell him what you want him to do. Describe people or events in a way that helps him create a picture in his mind, such as, "Mr. Dobrynin, today is city day. There are banners on the streets and buses. Mayor Luzhkov will give a speech at the city hall and there will be music in Manezh Square. Tonight there will be fireworks in every region of the city." Keep furniture and belongings in the same place all the time to help him have a mental picture of where things are and to avoid mishaps. If he goes to a hospital, point out the raised numbers or symbols on doors and elevators that may assist him to orient himself.
Use your voice, words and touch to help a visually impaired person to see. Describe what you are going to do: "It is time for dinner and I am going to help to with knowing what you will eat. When serving food, describe the items on the table or tray by location, using a clock as a reference point. for example, "Your meal is chicken, potatoes, and cabbage salad. The chicken is at the 12 o'clock on your plate, the potatoes are at 16 o'clock, and the salad is at 20 o'clock. Identify the placement of food or drinks that are not on the plate. "Here is your hot tea. I am putting it at the 13 o'clock position at the edge of your plate."
If the person is in an unfamiliar place, let him hold onto your arm just above the elbow for support, describe where you are going and the things that are in your path: "We are going up three steps now." When using a piece of equipment to move a person or help him in some other way, describe it to him and let him touch it if appropriate.
A vision problem is often a chronic condition that does not go away. Keep your focus on safety and using good communication so that your client's life is as pleasant as you can make it.
Communicating With People Who Are Hearing Impaired
Sometimes the hearing impaired person is depressed about loss of hearing. His speech may change because he cannot hear himself talking. He may be self-conscious of his limitations and not want to be around people. Sometimes he is embarrassed because he answers wrongly to a question due to his lack of hearing.
Some people who are hard of hearing may be deaf, while others have problems with certain sounds. Hearing aids improve some hearing problems. But if someone has a hearing aid, that does not mean he hears well. A hearing aid magnifies the other noise in the room, making it harder for some people to distinguish speech of another person. Today, there are implants that are attached to the scalp. A wire runs from the battery on the scalp to the inner ear. When there is sound, the wire causes vibrations of the bones of the ear and the message is sent to the brain via the nerves for interpretation. This method eliminated much of the background noise so that the person hears clearly. We need to learn what people in our care can hear. We can improve communication by remembering that the person may not hear us at all or may hear some of what is said, by being sensitive to the physical surroundings of the person, by using your face, hands, body, and words to help him understand.
Gently touch the arm of a hearing impaired person to gain his attention before speaking. Always approach from the front, and face him so that he can see your moving mouth and facial expressions. Make sure the batteries of a hearing aid are working properly and be sure the person wears it. Usually, I have seen the hearing impaired person keep the hearing aid and the batteries in the same place so that it is put on every day just as clothes are put on.
Try to reduce the noise around the person as much as possible, because radio or television noises can be distracting. Avoid laughing in front of him unless he is included in the conversation because he may think that you are laughing about him.
Use your hands, face, body and words to help a hearing impaired person hear. If the person doesn't seem to understand what you say, change your words, not the volume of your voice unless you may have spoken too softly. Shouting sometimes causes more distress for the person. Don't cover your mouth when speaking because the hearing impaired person may have learned to read lips and relies on watching your mouth move. Don't look down or turn your head away while you're talking: this decreases the amount of sound coming to his ears. Pronounce the words slowly and clearly without saying words unnaturally. Speak in short sentences.
If the hearing impaired person hears more clearly in one ear than the other, find out which is better and position yourself near that ear. Gestures and body movements help explain what you are saying. Watch deaf persons on transport and to see how they use gestures and movements to express themselves. You may have to write messages on paper. Make sure that you ask if the person understands you. You may also want to learn the appropriate sign language for communication.
Remember that men often lose hearing of high tones and therefore, it is especially important for women to remember to use a lower tone of voice.
Question:
6. What communication impairment is most bothersome to you? Why?
Communicating With Children
Children communicate in various ways depending on many factors such as their ages and physical conditions. Sometimes it can be easier to communicate with children than adults because children will tell you exactly how they are feeling and what they want. A child may not trust you, thoug,h when he is sick or hurt because he is even more afraid and confused about his situation. You can improve communication if you gain their trust and give them clear verbal and non-verbal messages.
Learn about the child
Learn what he likes to talk about or his interests. Ask parents to tell you about their children. They may be able to tell you how their child communicates in everyday situations. For example, a child may use certain expressions for toileting or a drink of water. He may have certain routines for his day that make him feel more comfortable. He may have a favorite toy or stuffed animal that gives him comfort at night or when he is in a new place.
Be sure to physically get down to the child's level when you speak to him. Sitting beside him may help to gain his trust. Provide short, simple explanations and few details. If the child asks questions, he is probably curious to know more. Give him a little information at a time, then pause and ask for confirmation that he understands. If the child seems confused, say it again in another way. The child deserves the same attention as an adult when you communicate with him.
Question:
7. What method of communication can you use with people who have trouble communicating?
(One or more of the following answers may be correct.)
If they are hard of hearing, speak slowly and clearly, or use pictures and written communication.
If they are blind or have vision problems, use your voice, words and touch to help them to see.
Whatever the problem with communication, simply talk louder.
If they are children, sit or kneel at their level and speak simply and clearly.
Communicating With People Who Speak A Different Language
People who do not speak your language have the same needs and desires as anyone else. In fact, if they are sick, their needs may increase because they have few people they can talk with. Additionally, they may not have material in their own language to read. You will need to use non-verbal messages.
Try to find out how much of your language the person understands and speaks. Be understanding about the mistakes they make when they speak. Give him encouragement when you understand what he has said.
Nonverbal messages can be communicated in pictures and facial expressions. Have the person point to what is wanted or show you location of a place on his body. Hopefully, there will be a person who can translate the needs of the person who does not understand your language. When you have a translator, make sure that both the person and the translator understand what you are saying.
Question:
8. How do you communicate with someone who does not know your language?