Body language as a tool for improving nursing communication

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.

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 nurse must also be aware of a patient's tone. A tone may indicate that the patient is nervous, depressed or distressed.

BEING AWARE OF YOUR BODY LANGUAGE

The first way that a nurse can use body language is to be aware of their own. In dealing with patients they should appear both interested and attentive. They should lean back to encourage open conversation, keep their body open to ensure the patient feels free to speak and make gestures that show they are listening. In speaking to the patient they should also make sure they use appropriate tone and that their body language matches what they say.

This is important as it will allow the patient to feel comfortable and express their real needs and feelings.

The worst case scenario may be if a nurse appears impatient, causing the patient to decide not to tell them they are in pain. This could lead to distress for the patient and even to potential problems not being diagnozed and acted upon. In the worst case scenario, health complications could result.

Making the patient feel comfortable enough to speak freely, is the best way to ensure that the patient communicates fully with the nurse. The better the communication process, the better the hospital can meet the needs of the patient.

BEING AWARE OF OTHER'S BODY LANGUAGE

Even more important as a tool, is the ability to understand the body language of others. An effective communication is one where both sides understand each other. In the nurse-patient communication this becomes even more important as the nature of the situation means that the patient may be uneasy and may not say what they are really feeling.

This can lead to major problems if a nurse accepts that a patient is fine, when in fact they are distressed.

When listening to a patient, a nurse can gain insight into their real thoughts by looking them in the eye, by taking note of their posture, by listening to their tone and taking note of any affect behaviour. It is also important to keep in mind that what appears on the surface does not always represent real feelings. There is a need to look beyond what is a surface smile and look to body language for clues about real feelings. Once you are aware of these feelings you can then discuss them and rectify any problems by taking appropriate action.

FEASIBILITY OF THE SOLUTION

From the research, we can see that body language is an important part of communication and has great effect on communication. From the nursing perspective, we have seen how it can be used to determine the patients and their families real state. We have also seen how the body language of the nurse can be used to ensure that the patients and their family feel comfortable enough to speak freely and communicate the truth.

By training and ensuring that nurses are aware of body language, effective communication can be better established. This is especially important because the nature of the situation means that understanding the patient's state is critical to providing them with correct treatment and also because the nature of the situation means that the patient may not necessarily speak honestly about their conditions.

Training nursing staff in the importance of body language would allow them to better communicate with the patients and their families and this in turn, would increase the quality of care that could be delivered, with the quality relating to personal needs as well as medical needs.