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2. 2 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 2 Introduction…

3. 3 “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 شخصي ). e.g: when we say I “like” you for the speaker “like” might mean do not dislike, while the listener it is almost love.

4. 4 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). 4

5. 5 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) 5

6. 6 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. 6

7. Components of communication… 7

8. 8 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)

9. 9 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 9

10. 10 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.

11. 11 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 11

12. 12 Nonverbal cues are grouped into four groups: Body cues (kinesics) Space (proxemics) Touch appearance

13. 13 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.

14. 14 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 14

15. 15 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.

16. 16 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.

17. 17 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.

18. 18 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.

19. 19 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.

20. 20 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

21. 21 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

22. 22 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

23. 23 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 23

24. Attitude (past experiences, level of openness, socioeconomic class, Knowledge perception 24

25. 25 Types of communication…. Intrapersonal communication Interpersonal communication (social, theraputic)

26. 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. 26

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31. Interpersonal communication Is a dynamic two-way circular process in which all types of information are shared between two or more people and their environment. 31

32. 32 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. 32

33. 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. 33

34. 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. 34

35. 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 35

36. 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 36

37. Helps to Build a sense of Healthy Self-Concept as a person and nurse. Becomes more open Ability to accept patient as they are, rather than how nurses may want Them to be. Self- acceptance, Self-Knowledge, Self-understanding, understanding of patients. 37

38. Self- tolerance, tolerance to patients. *Comfort with self and Liking self. Liking self # Thinking one is all good, without Fault or Failings Self-Liking = Knowing both strengths and areas for improvement and what exists is acceptable. *Helps to take into account the effects nurses themselves have on patients. 38

39. 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) 39

40. Since therapeutic communication occurs for the purpose of helping others, it is vital that nurses understand what motivates them to help others 40

41. 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 41

42. 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. Johari Window actually represents information, feelings, experiences, views, attitudes, skills, intentions, motivation, etc - within or about a person - in relation to their group, from four perspectives, which are described below. 42

43. The Johari Window's four regions, (areas, quadrants, or perspectives) are as follows, showing the quadrant numbers and commonly used names: 43

44. 1. open : Known to self and others Trust, acceptance, understanding, warmth, caring, genuine, respect 2. Blind : Unknown to self and Known to others confrontation, feedback 3. hidden : Known to self and not Known to others self disclosure, (communication skills needed: building trust, exploring, expressing feelings, finding alternatives) catharsis, confidentiality 4. unknown to self and not Known to others defence mechanisms, resistance, transference, repressed memories, new experiences 44

45. 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 45

46. 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' 46

47. 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 47

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49. How become more Self- aware? 1. Listing to your self (Introspection) Introspection = Trusting oneself = Being honest with oneself = Accepting self = Challenging oneself. Its paying attention to your thoughts and Feeling, let them come into awareness. Do not push them out of awareness. 49

50. 2.Listing to others/ ( Feed back ) In put from others / Interactive Reflection) It opens area # of the self ( Blind ) Therapeutic Confrontation: communication by which the person or nurse has the intent to raise patient’s awareness of incongruities in feelings, attitudes, beliefs and behaviors. Timing and trust are important in confrontation. Also it must be immediate, specific, non- accusatory, and non-interpretive to be effective. The purpose is to bring the maladaptive behaviour to conscious level. Feedback by the teacher to students, 50

51. 3. Telling others about self and letting others to listen to you. ( self- sharing ) ( self- disclosure) In order to become open an atmosphere of trust, caring, understanding, acceptance, empathy, respect, warmth, genuine, must be insured to make both persons psychologically safe to disclose self and receive feedback, and change behaviour. 51

52. Roles of the nurse in therapeutic communication The nurse acts as teacher, socializer, technician, advocate, counselor, and therapist 52

53. 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 53

54. Traits of therapeutic communication… Genuineness Positive regard Empathy Trustworthiness Clarity Responsibility

55. 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 55

56. 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 56

57. 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

58. 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 58

59. 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 59

60. 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 60

61. 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 61

62. 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 62