Communication in a Nursing Environment This Research

Communication in a Nursing Environment This research paper deals with the subject of ensuring effective communication between nursing staff, their patients, and the patient's family. It is proposed that understanding and utilizing body language would be an effective way for a nurse to improve communication. The nature of communication and of the importance of body language in the communication process was researched, with a focus on how this can be used to assist in communication.

Based on the research, it is seen that body language can be used by nursing staff to ensure they send the right message to patients and their families and also to ensure the real message and the real state of patients can be understood. From the research and its application to nursing and the environment of nursing, it can be seen that body language could be an effective tool in improving communication processes.

In turn, this improvement in communication processes improves the quality of care given to both patients and their families. PROBLEM STATEMENT One of the problems a nurse must deal with is how to communicate effectively with patients. Making this more difficult is the fact that in a hospital situation patients are often agitated or distressed. This type of strain means that their communication may not always be effective.

There is a need here for a nurse to be empathetic to the patient and to take extra care in understanding how they are feeling, what they are needing and what they are saying. Under pressure and in a hospital environment it is recognized that patients may not always say what they mean, the nurse must look beyond the words to ascertain the real meaning and the real state of the patient.

This can also be related not only to speaking with the patient but also with speaking to the patient's relatives who may be distressed and uncertain with the situation. PROPOSED SOLUTION One solution to the problem is to ensure that nursing staff are trained in communicating effectively with patients and especially with determining real meaning, real needs and real emotions. One of the key ways that this can be determined is by taking note of a person's body language.

Body language is capable of communicating the real state of the patient or family. If a nurse is better able to understand a patient or relative then they are better able to meet their needs, including both their medical needs and their emotional needs. It is proposed that by providing nurses with an understanding of body language, they will be better able to understand the needs of the patients and their relatives, and thus better able to meet their medical and their emotional needs.

Also of importance, is how a nurse may use body language to communicate to a patient or a patient's relative. It is recognized that the patient and relatives may be looking for clues in the nurse's behaviour, such as clues that indicate the situation is worse than they are being told.

This awareness by the patient and their family, means that the nurse must be aware of their body language and also may be able to adjust their body language to effectively communicate the required message to the patient or family. RESEARCHING THE SOLUTION The research will deal with body language, specifically in relation to the communication process. Firstly we will introduce why communication is so important and also introduce the nature of communication and the part that body language plays in communication.

We will then explain why body language is even more important in a hospital environment, where the nature of the relationship between nurse and patient means that hidden meanings may be expected. We will then describe how nurses can use body language effectively in their communications with patients and their families.

This will include describing the different types of body language which include: Posture Facial expressions Body motion Eye contact Illustrators, regulators, adapters and affect displays Paralanguage Finally, we will conclude by explaining how a nurse can use these body language clues by being aware of their own body language and by being aware of their patients and their patient's families body language. THE COMMUNICATION PROCESS Communication can be defined as the process of creating understanding between two individuals or between an individual and a group.

It is important to realize that communication is a transactional process, where a transactional process is defined as, "a process in which two or more people exchange speaker and listener roles, and in which the behaviour of each person is dependent on and influenced by the other" (Friedrich, O'Hair, Weimann & Weimann, 1995, p.11). The important point here is that in any communication, the participants are effected by each other.

They interpret what the other person says, and why they say it and respond based on what they see the meaning as. Each person does not necessarily say what they think, they may say what they think is appropriate or what they believe the other person wants them to say. The next important thing to note is that people do not interpret only what they hear, they also subconsciously pick up other information from each other. This information comes from body language.

In most cases, people will pick up more from your body language than they do from your words, "body language often speaks louder than words" (Bolton, 1987, p. 34). It is therefore important to understand what message your body language may be sending. We have already noted that people do not always say what they mean. If you listen to the words only, you will only understand half the meaning.

If you are aware of the body language of others, you can 'read between the lines' and understand the reasons for what they are saying. If there is underlying hostility you can pick this up. If their words are based on a need to please, not a need to tell the truth, you can pick this up. Recognizing the body language is an important tool in really understanding what other people say.

Their words can be seen as just the tip of the iceberg, underneath those words are their motivations for them, their fears and their true feelings. If you can look beneath the words, new meaning can be given to the words. UNDERSTANDING BODY LANGUAGE Body language involves: posture, facial expressions, body motion, eye contact, the use of illustrators, regulators, adapters, affect displays and paralanguage.

Posture Posture is often regarded as one of the first clues people gain about you and offers important information about you, as well as telling you how people may respond to you. Each region of the body can be oriented in such a way that it invites, facilitates, or holds an interpersonal relation. Or it can be oriented in order to break off, discourage, or avoid involvement" (Ashcroft & Scheflen, 1976, p. 42). Bolton (1987, p.

34) describes the best communication as occurring where "the listener demonstrates a relaxed alertness with the body leaning slightly forward, facing the other squarely, maintaining an "open" position and situating himself at an appropriate distance from the speaker." It is also described how body language communicates certain things. An engaged party will be leaning forward with an open body. Tilting of the head, nodding, eye contact and a high blink rate indicate someone who is listening. Staring into space, slumped or foot tapping indicate a bored listener.

While finger tapping, foot tapping and staring indicate that someone is combative and wants their turn to speak. Applying this to a nursing environment, this is most relevant for how the nurse is percieved by the patient and their families. If the nurse appears impatient by foot tapping or uninterested by closed body language, the patient may not feel comfortable telling the nurse of their problems. In the same way, this may give the impression that the nurse does not care, causing the patient's relatives undue concern.

It is important here, that the nurse appears as open as possible to ensure the patients feels comfortable and tells the nurse the truth about how they are feeling and any medical problems. Facial Expressions It has been said that "the expression one wears on one's face is far more important than the clothes one wear's on one's back" (Carnegie, 1981, p. 95). Facial expressions are the prime way that people express their emotions, although it is recognized that facial expressions are not always easy to read.

One of the difficulties with facial expressions is that most people are aware of them and aware of what they represent. Just as people may say what they feel you want them to say, they are also likely to give what they think is the appropriate facial expression. Friedrich et al. (1995, p. 201) describes four ways facial expressions are controlled: intensification; deintensification; neutralization; and masking. Intensification is where what is felt is simply exaggerated.

An example may be where a joke is told, while the person may not find it that funny, they smile to give the impression that they did. Deintensification is just the opposite. If a nurse gives a patient bad news, the patient may downplay their disappointed look. The danger here is that the nurse believes everything is fine when it is not. Neutralization is when one eliminates all expression from their face, this may be to not give away how one is feeling.

Masking is when an expression showing true feelings is replaced by one showing what the person feels is expected of them. An example may be when a patient is feeling unwell. They may feel concerned about this and even guilty about it, and replace an expression showing their true feelings with a happier face. For the nurse, care must be taken not to assume that the expression on one's face is a true indication of how they are feeling. Body Motion Bolton (1987, p.

36) reports that a listener who remains still is seen as controlled, aloof, and reserved while a listener who is more active is seen as friendly, warm and as not acting in a role. This body motion is usually lesser when the person is listening and more when they are speaking. Body motion should however, not be like fidgeting. Effective body motion involves blinking, nodding and occasionally gesturing. It is also noted that a still listener is generally viewed as one who is not listening. Body motion also refers to gestures.

These can be either obvious or less so. Stroking one's chin is an obvious gesture, showing a person is thinking or considering something. Folding your arms is also another gesture that may indicate you are disturbed about something. This can also include nervous habits such as playing with one's hair or playing with one's ring. All these offer some indication of how a person is reacting. From a nursing perspective, a nurse must be aware of what their gestures communicate.

A nurse who has nervouse habits, may indicate to a patient that there is something wrong, causing them to worry unnecessarily. Instead, a nurse should make use of enough body motion that they appear interested, but not too much that they appear nervous. Body motion can also be an effective tool for analyzing how a patient is feeling. If the patient is smiling and saying they are fine, it would at first appear that they are fine.

But if they are also fidgeting and showing nervous habits, it is a sign that they are concerned.This is a sign that the nurse should question the patient further to ensure they are comfortable. Eye Contact Eye contact is an indicator of involvement (Friedrich et al., 1995, p. 202), it expresses interest and a desire to listen (Bolton, 1987, p. 36). Bolton (1987, p.

36) describes effective eye contact as "focusing one's eyes softly on the speaker and occasionally shifting the gaze from his face to other parts of the body, to a gesturing hand, for example, and then back to the face and then to eye contact once again." Poor eye contact would be either not looking at the speaker at all, staring at the speaker or making darting eye movements.

It is also noted that "the eye area is one of the least controllable regions of your face, and as a result, your eyes can expose your emotional state" (Friedrich et al., 1995, p. 202). As we have seen, facial expressions can be fakes to hide true emotions, but looking at a person's eyes is one way you can establish their true feelings. From a nursing perspective this is an important tool for assessing the patient's state.

While they can adjust their facial expressions, their eye movements are capable of communicating how they are really feeling. Illustrators, Regulators, Adapters and Affect Displays All non-verbal messages can be broken down into categories based on what they are meant to achieve (Friedrich et al., 1995, p. 197). An illustrator is a movement that goes along exactly with what is being said, such as saying 'the fish was big' and moving one's hands to show exactly how big.

Regulators are meant to regulate the conversation in some way, usually by sending the message 'I'd like to speak now.' Raising your hand or clearing your throat are two examples. Adapters are the next kind, they are gestures that indicate some need. They may include rubbing your eyes, which indicates tiredness or moving in your chair to indicate you have been sitting too long. Affect displays are indicative of emotional state. These are usually unintentional and give an insight into the true feelings of others.

Unlike many gestures, these are subtle and are usually not even noticed by those doing them. This means that the person will not intentionally adjust them. Being aware of affect displays is an important tool to gaining understanding into how the other person is really feeling. Affect displays can be used by nursing staff as a clue to determining the patient's real emotional state. Just as with eye contact, these are useful as identifiers because they are not intentionally controlled by the patient, they are more like natural emotional indicators.

Paralanguage Paralanguage refers to how something is said (Friedrich et al., 1995, p. 203). The tone of voice you use when saying something can mean as much as what you say. Consider a simple example of asking someone how their day was. They could answer 'fine' in many different tones, some meaning that they are fine and others meaning the opposite. The tone can also indicate a person's emotional state, such as a wavering voice conveying nervousness.

It is also worth noting that the tone can also often express a person's true feelings. In a nursing situation, a nurse must be aware of their own tone and how patients and their families may interpret their tone. A.