This reflection paper examines four major theoretical frameworks — Kolb's Experiential Learning Theory, Birdwhistell's kinesics and non-verbal communication, Shannon's mathematical information theory, and Berlo's SMCR therapeutic communication model — and applies them to the author's extensive career as a nurse case manager. The paper first introduces each theory, explaining its core principles and relevance to education and communication. It then connects these frameworks to real-world nursing practice, emphasizing how therapeutic relationships, non-verbal cues, reflective learning, and structured communication all contribute to effective patient care and positive health outcomes.
I am a registered nurse currently pursuing a Bachelor of Science in Nursing. At present, I work as a nurse case manager at Mercy Home Health in Pittsburgh, Pennsylvania, where I extend nursing care to clients at home and attend to their educational requirements in collaboration with a multidisciplinary team and physicians. I also coordinate with staff on patient care and document reimbursement requirements. I additionally function as a disease case manager at McKesson Health Solutions in Broomfield, Colorado. In this role, I educate health plan members on the disease process and its management, document and input findings into their health plans, make referrals, and coordinate individual needs with treatment providers and the health plan.
From 1989 to 2004, I held a variety of roles across healthcare settings: workers' compensation case manager at AIG/HDI in Pittsburgh, Pennsylvania; disease case manager for American Healthways; physical and behavioral healthcare coordinator at APS Healthcare in North Huntingdon; case manager at Forbes Regional in Monroeville; managed care analyst at Gateway Health Plan in Pittsburgh; case manager at UPMC-Magee Woman's Hospital, at Southwest Women's Council in Uniontown, at Three Rivers Health Plan in Monroeville, and at HIS of Greater Pittsburgh in Greensburg; utilization review coordinator at Medi Home Health in Monroeville; nurse manager at In Home Health in Greensburg; patient care coordinator at Family Home Health; field staff nurse at Key Care Home Health Services; and staff nurse at Saint Mary's Hospital in Richmond, Virginia, and at Frick Hospital in Mount Pleasant, Pennsylvania. I was honored with the Case Manager of the Week award at AIG/HDI.
David Kolb and fellow theorists in the early 1980s suggested that all learning lies in the way a person processes experience, or in the critical reflection of experience (Kelly, 1997). They saw learning as beginning from experience, continuing with reflection, and leading to action — which, in turn, translates into another experience for reflection. Kolb first refined the concept into two separate learning activities — perceiving and processing — and then added a third stage: abstract conceptualization. While the critical reflection stage raises questions about the experience in relation to previous and similar or related experiences, the abstract conceptualization stage attempts to find answers to those questions. In this stage, generalizations, conclusions, and hypotheses are drawn about the experience. It provides a kind of interpretation for the action stage, where the hypotheses are tested. Learning at this stage utilizes logic and ideas rather than feelings to understand problems or situations, and relies on systematic planning to form theories and ideas that solve problems.
Kolb believed that a preferred learning style enables a person to understand his areas of weakness, increase his proficiency, and realize his strengths in certain situations — such as deciding on a career (Kelly, 1997). This is of greater value to educators than to learners, as it re-emphasizes experience as a critical part of learning. Kolb noted that even in current times, most education remains essentialist, placing little weight on learner experience. Most teachers tend to focus more on introducing information than on students' need to reflect on it. His theory can be integrated into one's teaching style — for example, a teacher might give students a few minutes to reflect on what has been introduced, taught, or explained, particularly when the material is difficult. The theory stresses that the internal processes of learning are just as important as the external (Kelly, 1997).
Ray L. Birdwhistell focused on non-verbal communication and derived most of his studies from kinesics (Kirby, 2003). He studied and analyzed the way people interacted with one another by watching films. He observed that people appeared to transfer information through speaking, eye movements, facial expressions, and gestures. He noticed that these forms of non-verbal communication often occur without the participants' awareness. Deeply fascinated by his findings, he co-produced the film TRD 009 — an 80-minute, 16mm black-and-white sound film — with Jacques van Valck. The film depicted an English pub scene in a middle-class London hotel and provided a tool for observing the behavior of listeners and their relationship with speakers (Kirby, 2003).
Claude Shannon believed that the basic elements of any general communications system should include a transmitting device that transforms information into a form suitable for a particular medium of transmission (New York University, 2005). He also argued that information has less to do with its inherent message or meaning and more to do with a degree of order or non-randomness — something measurable and treatable mathematically, much like mass, energy, or other physical quantities. A generalized communication system is characterized by the rate at which information is produced at the source, the capacity of the medium to handle or transfer that information, and the average amount of information contained in a message of a given type. Shannon added that most techniques used in information theory are derived from the mathematical science of probability (New York University, 2005).
O. K. Berlo writes about the Leary Model and therapeutic communication (Plattsburgh, 2005). His framework grows out of the concept that communication is a reciprocal process in which the sender and receiver of a message participate simultaneously. People who send and receive messages daily are influenced by past experiences, values, beliefs, knowledge, culture, education, the content of the message, and how they feel about themselves and others. These factors can — and often do — disrupt the sender's intended meaning before it reaches the recipient. It therefore becomes important to evaluate and validate the message.
People also engage in self-talk, known as intrapersonal communication — the way one communicates with oneself. A staff nurse, for example, who has just had a difficult encounter with her nurse manager may carry that anger into her self-talk, making unpleasant or resentful internal comments about the manager. That self-talk will also influence her subsequent communication with other staff members. Becoming trapped in routine tasks and procedures, or in social and environmental distractions, can similarly interfere with nurse-client communication.
"Information theory and measurable communication elements"
"SMCR model and therapeutic nurse-client relationships"
"Personal synthesis of all four communication theories"
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