Each of you have probably left a conversation at

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Each of you have probably left a conversation at sometime thinking “ what did s/ he mean by that?”

You are trying to understand the process and make it more meaningful

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Introduction…

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“you can not, not communicate”

Then “all human behavior” is communication…

We often assume that that words and phrases are stable and consistent ( واضح و ثابت) , yet meaning is arbitrary and subjective ( عشوائي و شخص ي) .

e.g:

when we say I “like” you for the speaker “like” might mean do not dislike, while the listener it is almost love.

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Communication theories….

Linear theory:

This model refer to three components: Sender: source that

encode the message (information) into verbal and, or

nonverbal symbols that convey ideas (knowledge, feelings,

personal agendas, past experiences).

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Message: consist of verbal and nonverbal expressions of

thoughts or feelings. Receiver: the recipient of the

message that decode (translate or interpret) the message to

make meaning.

Channels of communication: refer to sensory receptors

that transmit information (one or more of the five senses)

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Circular transactional theoretical models

This model expands the linear model to include context of

communication, feedback loops and validation.

the sender and receiver construct a mental picture of the

other which influences the message and includes others

perceptions, attitudes and potential reaction to the

message.

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Components of communication…

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Receiver: both receives and interprets the message

Encoding and decoding processes: refer to our ability to select symbols that most effectively convey our thoughts and feelings to another

Filter: some models will show a filter as the place where meaning is assigned and symbols are selected to share, the size of your vocabulary can impact your ability to select appropriate symbols ( encoding) and understand the meaning of symbols used by others (decoding)

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Modes of communication…verbal nonverbal

Refers to the spoken words that encompass the symbols of language

It is largely conscious because people choose words they use.

Splits of tongue.

It includes elements such as tone of voice, hand and body movements, facial expressions

It is less consciously controlled than verbal.

Called body language

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Many wards or phrases have slang meaning or have developed new meanings

Involves 5 senses , adds to the meaning of the verbal message by expression of feelings, the contradiction or validation of verbal message often tells more about what a person is feeling than what actually said.

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Nonverbal communication…. Is believed to be the most important part of any

message.

nonverbal cues involve all five senses.

Functions of nonverbal cues / communication

1. add to the meaning of verbal messages

2.expression of feelings (contradiction or validation of verbal message)

3. preservation of both ego and the relationship

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Nonverbal cues are grouped into four groups: Body cues (kinesics)

Space (proxemics)

Touch

appearance

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Body cues… Facial expressions, reflexes, body posture, hand

gestures, eye movement mannerisms, gait of an individual

Paralinguistics (paralanguage) behavior includes any audible sound that is not a spoken word (voice tone, inflection, word spacing, rate, groaning, coughing, laughing, crying, grunting, moaning, along with silent cues.

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Space … Is the study of distance between people in their

interaction

Personal space: is the distance people prefer in interaction with others

Communication is affected by four distances:

• Intimate

• Personal

• Social

• public

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Intimate distance… Around 30 cm to 45 cm.

Communication is characterized by body contact.

Heightened sensations of body heat and smell.

Vocalization is low.

Nurses very often are required to violate personal space.

However it is important to be aware when this will occur and foreworn the client.

The nurse can respect a person’s intimate space, in other instances nurse may come within intimate distance to communicate care and warmth.

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Personal distance…. Around 45cm to 122 cm.

Less overwhelming .

Voice tones are moderate.

Physical contact is possible.

More of the person is perceived at a personal distance.

Facilitate sharing of thoughts and feelings.

Can create tension if the distance encroaches upon other’s personal space.

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Social distance… 122 cm to 300 cm.

Clearer visual perception of the whole person.

body heat and odor are imperceptible.

Vocalization is loud.

Communication is more formal.

Limited seeing and hearing.

Allows more activity and movement.

Person is protected and out of reach of touch.

Several people at the same time or within a short time.

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Public distance…. 400 cm and more.

Faces and forms of people might be seen but individuality is lost.

The perception is of the group of people or community.

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Territoriality… Is a concept of the space and things that an individual

considers as belonging to self.

The human tendency to claim territory must be recognized by all health care workers.

Clients often feel the need to defend their territory when it is invaded by others.

So… nurses need to take permission from clients to remove, rearrange, or borrow objects in the hospital area.

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Touch… Is a nonverbal method of communication that may

convey many and messages

Handshaking, holding hands, hugging, all demonstrates positive feelings

Nurse should use caution when touching a client

For touch to convey warmth, the nurse should be comfortable with it

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Appearance… Refers to the way an individual uses clothing, makeup,

hairstyle, jewelry, glasses, as well as grooming and hygiene

It communicates a particular image as well as mental status

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Therefore it is important for the nurse to observe and consider the client’s entire message, both verbal and nonverbal, before arriving at a conclusion

Nurse must try to interpret a clients nonverbal behavior when evaluating the verbal content

These observations need to be incorporated in the assessment and plan of care

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Factors influencing communication

Environmental factors (Time, Place, Noise, Privacy, Comfort, temperature)

Relationship between sender and receiver

Context or circumstances in which the message is given

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Attitude (past experiences, level of openness, socioeconomic class,

Knowledge

perception

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Types of communication…. Intrapersonal communication

Interpersonal communication (social, theraputic)

Intrapersonal communication

Self-talk: is language use or thought internal to the communicator. It can be useful to imagine intrapersonal communication occurring in the mind of the individual in a model which contains a sender, receiver, and feedback loop.

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Interpersonal communicationIs a dynamic two-way circular process in which all

types of information are shared between two or

more people and their environment.

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Social therapeutic

Friends, family, acquaintances

Home, away from work

Mutual sharing of information, thoughts, feelings to maintain relationship

Spontaneous, superficial, light, focuses on both

Helper and client

Clinical setting

Promote growth and change in clients

Learned skills, purposeful, client focused.

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Therapeutic communication… a process in which the nurse consciously influences a

client or helps the client to a better understanding through verbal or nonverbal communication.

Therapeutic communication involves the use of specific strategies that encourage the patient to express feelings and ideas and that convey acceptance and respect.

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an interactive process between nurse and client that is goal-directed to help the client overcome temporary stress, to get along with other people, to adjust to the unalterable, and to overcome psychological blocks which stand in the way of self-realization .

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In summary it has 3 essential purposes:1. To allow the client to express thoughts, feelings,

behaviors and life experiences, and life experiences in a meaningful way in order to promote healthy growth

2. To understand the significance of the client’s problems and the role of the client and the significant people in his or her life

3. To assist in the identification and resolution processes of the client’s problem areas

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Personal elements important for therapeutic communication. The nurse’s use of self is a primary tool in the

therapeutic relationship

All of the elements essential to help another individual are within the nurse.

Therapeutic use of self begins with knowing oneself

Knowing the self is a complex lifelong learning process

It is essential to have selfknowledge for a better use of therapeutic self

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The core of self knowledge is:

the nurse’s ability to correctly identify negative or unresolved issues of the self

What values and beliefs the nurse’s hold

Important to know and understand own family background (dynamic and cultural) and social issues (values, biases and prejudices)

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Since therapeutic communication occurs for the purpose of helping others, it is vital that nurses understand what motivates them to help others

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the nurse needs to be able to conduct a periodic self evaluation to her/his responses to the client:

Am I open or closed minded regarding …….

Am I accepting

Am I being supportive

Am I objective

Am I remaining calm, what are my true feelings

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Johari Window model… The Johari Window model is a simple and useful tool

for illustrating and improving self-awareness, and mutual understanding between individuals within a group.

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The Johari Window model is also referred to as a 'disclosure/feedback model of self awareness', and by some people an 'information processing tool'. The Johari Window actually represents information -feelings, experience, views, attitudes, skills, intentions, motivation, etc - within or about a person - in relation to their group, from four perspectives, which are described below.

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The Johari Window's four regions, (areas, quadrants, or perspectives) are as follows, showing the quadrant numbers and commonly used names:

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Johari window…

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1.what is known by the person about him/herself and is also known by others - open area, open self, free area, free self, or 'the arena'

2.what is unknown by the person about him/herself but which others know - blind area, blind self, or 'blindspot'

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3.what the person knows about him/herself that others do not know - hidden area, hidden self, avoided area, avoided self

4.what is unknown by the person about him/herself and is also unknown by others - unknown area or unknown self

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Roles of the nurse in therapeutic communication The nurse acts as teacher, socializer, technician,

advocate, counselor, and therapist

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Traits of therapeutic communication… These characteristics allow the nurse to influence

growth and change in others because they incorporate verbal and nonverbal behaviors, as well as attitudes, beliefs, and feelings behind the communication. Thus they are necessary for therapeutic communication to take place

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Traits of therapeutic communication…Genuineness

Positive regard

Empathy

Trustworthiness

Clarity

Responsibility

Genuineness… Consistent verbal and nonverbal behavior implies that

the nurse is open, honest, and sincere

Trust is built when the nurse does not appear mechanical but rather responds with sincerity

Does not mean disclosing personal information or relating to client in social manner

Nurses cannot expect a client to be open and honest if they do not display these characteristics themselves

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Positive regard… Refers to respect and acceptance to show that nurses

view their clients as worthy (addressing clients by names they prefer)

Conveyed by sitting and listening ,expressing appropriate emotion about events affecting a client, validating the client’s feelings, effectively responding to a client’s inappropriate behavior

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Part of it being nonjudgmental, labeling behaviors based on own value system is not useful (stereotyping)

The nurse should help clients explore their behavior by discussing the thoughts and feelings that determine the behavior

Empathy… Empathic understanding, it is the nurse’s ability to see

things from the client’s viewpoint and communicate this understanding to the client

It can be natural or trained

Should not be confused with sympathy

Closely aligned with empathy is active listening

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Trustworthiness… Being responsible and dependable

Adhere to commitments (keep promises)

Respect the client’s privacy, rights and the need for confidentiality

Information client’s share must not go beyond the health care team

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Clarity… Selecting concise words when speaking and asking

questions to clarify meaning

Nurses need to make a conscious effort to speak at a level the client will understand

Avoidance of abstract lengthy explanations is also necessary

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Responsibility… Being accountable for the outcome of one’s

professional interactions

Nurses need to be responsible for their part in the interaction and ensure that all messages are received and interpreted correctly

Responsibility language involves the use of I statments

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Assertiveness… Is the ability to express thoughts and feelings

comfortably and confidently in a positive, honest, and open manner that demonstrate respect for self while respecting others

Learn to use responsibility language

Non verbal assertive language includes eye to eye contact while speaking

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