The process by which information, meaning and feelings are shared by persons through the exchange of verbal and non verbal messages (Brooks and Health, 1985, p8)

Or

Communication is when two or more people exchange messages using verbal and non verbal language.

Therefore communication is key to every aspect of our lives and plays an important role in building and strengthening our relationship with each other.

By way of definition, a process is a set of steps taken to achieve a task. It is important to understand that communication occurs over time and it is useful to appreciate it as a process that seeks to reduce uncertainty. The communication process will be explained with the use of a shorthand expression/acronym known as MS-CREF.

• M - Message
• S - Source
• C - Channel
• R – Receiver
• E - Effect
• F – Feedback

Explain each step of communication as below:

This is the content of the information, the idea or thoughts that the sender passes on to another person or group of persons.

The person who passes on or sends the message is known as the Source. The Source is also called the Sender.

The path chosen for the transmission of the message.

The person who gets the information is the receiver.

The impact of the message on the receiver is called the effect. Sometimes the intended effect is not achieved because of the style of presentation. There are times when the communicator has something in his mind (latent content) and ends up saying something else.

What the receiver ends up doing as a result of the message he/she receives is called feedback. It is the assessment of the impact of the message. A feedback can either be positive and/or negative. It is positive if the receiver has the reaction intended by the sender. If he/she does not do what is intended, the feedback is negative. Feedback may be spontaneous (elicited immediately) or delayed.

Every face to face communication involves verbal and non verbal messages usually these messages are matching, so if a person is saying that he/she appreciates something you have done she/he is smiling and expressing warmth non-verbally.

Communication problems arise when person’s verbal and non verbal messages contradict each other. Non verbal communication includes the use of facial expressions, hands, posture, eyes, gestures etc. to communicate a message.

If a person is saying one thing but sending a different message non verbally, it is often a sign that what the person is saying is not entirely true. It is important to pay attention to both verbal and non verbal messages and ask direct questions so that you can get open honest responses.

Little communication actually takes place verbally, non verbal communication form most of our communication and are a graphic part of our culture and language.

NON VERBAL COMMUNICATION	ASSOCIATED FEELING
Smile	Happy
Frown	Unhappy
Does not sit still on the seat	Un comfortable
Moving legs up and down	Tense
Cannot keep hands still	Tense
Eyes widen	Afraid
Scratches head	Unsure of her/him self
Eye contact	Serious, paying attention
Nodding the head	Understanding
Sitting close by	Relaxed
Leaning towards	Interested/ encouraged to continue
Eyes wide open, mouth agape	Disgusted

Studies (communication, 22.8.07) show that during interpersonal communication, 7% of the message is verbally communicated, while 93% is non verbally transmitted.

• 93% non verbal communication
  • 38% is through vocal tones
  • 55% is through facial expressions

With this in mind it is useful to consider the different forms of non verbal communication that are exchanged between those involved in the communication process.

Having effectively gone through verbal and non verbal communication, let us now discuss the common barriers to communication.

• Semantics
• Poor choice of channels
• Physical distraction
• Perception
• Poor listening
• Absence of feedback
• Noise

The major elements in communication are:

• Message
• Sender
• Channel
• Receiver
• Feedback
• Effect

Noise in the communication process is anything that affects the communication process. Noises are sometimes referred to as barriers to communication. These barriers may not always be a regular noise, like the horn of a car or the shouts from a motor park. Noise can come in through the various elements in the communication process. Examples of noise include:

• Language barrier
• Ambiguity in message
• Distorted or incomplete information
• Sender’s mannerisms
• Long sentences
• Wrong pronunciation or a difference in accent
• A sender’s or receiver’s state of mind, such as whether they are anxious or nervous
• Age
• Culture, e.g., mode of dressing
• Interruptions

To neutralize noise and promote effective communication, the sender must take into consideration some essential bridges such as:

• Choosing a good time to talk
• Understanding the context in which the message is set or sent
• Developing active listening skills and other communication skills
• Being patient
• Seeking feedback
• Accepting the rights of others to hold values and come from cultures different from yours

To communicate effectively, a person or group has to try to see and feel as the other person or group of people sees or feels. This does not mean that they will always agree, but rather that they understand the others’ point of view and listen to one another.

Factors that influence communication can be divided into:

1. Positive factors
2. Negative factors

A person who communicates positively will have the following skills (Gibb, 1961):

1. Openness - this means a willingness to disclose information, react honestly to a situation, acknowledge information and assume responsibility for one’s own thoughts and actions.
2. Empathy - this means seeing things from another person’s point of view without judgement or losing one’s one identity.
3. Being supportive – this means maintaining a non-threatening, non-judgemental attitude.
4. Remaining positive – this means you have an optimistic attitude to yourself, others and your interaction with others.
5. Practising equality – this means acknowledging that each individual is valuable and should be heard.

Trust between the nurse and the patient is essential to good communication and must be encouraged. Factors that enhance the development of trust include openness on the part of the nurse, honesty, integrity and dependability which can be achieved by:

• a) Communicating clearly and in non-technical language
• b) Keeping promises
• c) Protecting confidentiality
• d) Avoiding negative communication techniques such as blocking and false reassurance
• e) Being available to the patient

The need for trust is not only limited to the nurse/midwife to patient relationship, but is useful in all aspects of the workplace. Care is more effective when the nursing team and the interdisciplinary team share the essential element of trust.

The use of ‘I messages’ is a fundamental component of acceptable communication. Consider the following scenario:

Florence: You make me so angry, James.
James: I don’t mean to make you angry.
Florence: Well you do. You never think about how I feel. You know I hate it when you leave a patient’s room as untidy as Room 20.
James: You don’t have the least idea what went on here last night! That’s what I hate about you – always so quick to judge. You are so critical – you must think that you are perfect!

Let us look at this scenario. When a comment starts with ‘you’, the person you are speaking to will often feel defensive. The use of ‘you’ in such a context sounds and is probably meant to be accusatory; notice how emotions quickly escalate. Also notice that although the receiver initially tries to sound conciliatory, he soon begins to respond in a similar accusatory way.

Instead of using accusatory and defensive language, the sender should frame the comment in terms of how it makes him feel. Consider the alternative:

Florence: James, I feel so upset when I find a patient’s room as untidy as Room 20 at the beginning of my shift. I feel as if I am already behind when I start my shift of work.

The difference is obvious when ‘I messages’ are used as it is much less likely to sound accusatory. By using such an opening, the sender allows the receiver to respond to the true message rather than start to feel defensive. It also allows for more effective communication because the receiver is more likely to offer an explanation such as the following:

James: I’m really sorry about Room 20, Florence, our shift started last night with a patient in heart failure right after he arrived from the emergency room. He had no family here and it took us time to find them and then support them through the shock. About the time things settled down, another patient’s condition worsened. It was quite a night.

When you look and study this scenario carefully, the ‘I message’ enhances communication by giving James the opportunity to address the real concern. In addition, if Florence is a perceptive nurse or midwife, she has a wonderful opportunity to support her colleague by voicing appreciation for the work he had done. Most people respond gratefully to recognition and communication.

As previously mentioned, avoiding eye contact can be interpreted in a number of different ways. Lack of eye contact may show that the person is shy, scared, insecure, preoccupied, unprepared and dishonest to name just a few. By making direct eye contact, the nurse gives undivided attention to the patient and the patient is likely to feel valued and understood by the nurse. Fundamentally, eye contact says ‘I am wholly available to you, and what you are saying is important to me’. Eye contact is also equally important in communication with co-workers and other professionals, and the impact of it is lost in telephone conversations and written communications.

Keep in mind that the use of direct eye contact is a Western value. In some cultures avoidance of eye contact is considered more appropriate social behaviour. By careful observation, the nurse will quickly recognise whether direct eye contact is interpreted as inappropriate or disrespectful. Nurses and midwives must make every effort to be sensitive to the cultural values of the client or patient and their co-workers in order to enhance effective communication.

Now think for a minute, how does your culture interpret eye contact?

It is commonly known that keeping promises builds lasting trust between two people, for example, between husband and wife. Little else can destroy the fragile trust developing in any interpersonal relationship as quickly as making and then breaking promises.

The qualities of honesty and integrity are at the centre of promise keeping. Once a commitment is made, every effort must be taken to fulfil the agreement. Sometimes the request is impossible to satisfy and if this happens, the nurse must explain the situation or circumstances. The fact that the client or patient understands that the nurse has made an effort to meet his or her needs or desires is often more important than whether the goal is accomplished. For example, if the nurse responds ‘I’ll check on that’, and then finds the request impossible to fulfil, but never returns with an explanation, the patient or colleague will not view the nurse as dependable.

Empathy has been explained in depth, but it is helpful to remind ourselves of what it means. What is empathy? Check your answer with the one given below:

Empathy is the ability to mentally place oneself in another person’s situation to better understand the person and to share the emotions or feelings of the person involved. Empathy is not feeling sorry for another, rather, it is understanding the feelings of the other person, and it is integral to the therapeutic relationship. The nurse or midwife should be able to perceive and address the needs of the patient without emotional involvement to the point of becoming inappropriately immersed in the situation.

If you have got the answer/explanation correct, congratulate yourself with a pat on the back!

Welcome to this part of communication which you have already covered and practically practised.

Certain styles of phrasing questions and statements lead themselves to obtaining more information. Using open-ended questions or statements that require more information than ‘yes’ or ‘no’ can help gather enough facts to build a more complete picture of the circumstances. Questions or statements that are phrased to require only one or two word responses may lead the nurse to miss key information.

You can go back and revise more of these types of question which gave more examples.
Thank you for being such a good and independent student.

Both communicants have a responsibility to clarify anything that has not been understood. The person giving information should ask for feedback to be certain that he or she is being clear. The person receiving information should stop the giver of information anytime the message becomes unclear and should provide feedback regularly so that misinterpretation can be identified quickly.

Phrases such as ‘what I hear you are saying is...’ or ‘Am I right in saying that you mean...’ help to communicate to the sender what is being perceived. Other techniques of clarification include using easily understood language, giving examples, drawing a picture, making a list, and finding ways to stimulate all the senses to enhance the ability to understand.

You are doing too well, let us move on. Thank you for that self drive.

Body positioning and movement send loud messages to others. The nurse can imply openness that facilitates effective communication by awareness of body posture/ position and movement. In addition to eye contact, effective communication is enriched through an open stance such as holding one’s arms at the side or out towards the client/ patient, rather than crossed or leaning toward the patient as if to hear more clearly, or away from the patient.

Most people have a fairly well defined personal space. It is important for the nurse/ midwife to be sensitive to each patients/ clients personal preference and cultural differences in terms of touch. However, for many people, a gentle touch can scale mountains in terms of demonstrating genuine interest and concern.

A pat on the back, a hand held, a touch on the shoulder, these are all behaviours that indicate availability and accessibility on the part of a nurse/ midwife.

Having looked at the positive factors that influence our communication, let us now look at the negative communication techniques.

Several negative communication techniques have been brought out previously during the different section discussions. Closed communication styles, such as asking yes or no questions or making inquiries or statements that require other single-word answers, potentially limit the response of the person and may prevent the discovery of pertinent facts.

Closed body language also can hinder effective communication. Crossed arms, hands on the hip, avoidance of eye contact, turning away from the person and moving away all impose a sense of distance in the therapeutic relationship. Three other techniques that are detrimental to good communication are blocking false assurance and conflicting messages.

Occurs when the nurse / midwife responds with non committal or generalised answers.

For Instance:
Patient (Mr. Kato): “Nurse, I have never had surgery before, I am afraid I might not wake up.”
Nurse: “Oh, Mr. Kato, many people feel that way. It will be okay.” (The nurse smiles brightly, pats his hand, picks what she had come to pick and walks out of the room.)

Does Mr. Kato feel re-assured? Not likely. Will Mr. Kato feel like discussing the subject with this nurse again? Not likely and probably not.

The nurse has incorporates some important aspect of positive communication into her response – cheerfulness and touch, but she has not surely communicated. She has effectively blocked Mr. Kato’s attempt to get the re-assurance he wanted from her. He may be too intimidated to ask anyone else, assuming that his fear is invalid.

By generalizing in this way, the nurse has blocked Mr. Kato’s concerns. He is not “many people”. He needs to be validated as an individual experiencing difficult concerns and feelings.

Can you now give a different approach which this nurse should have used for communication to Mr. Kato so that his concerns are put into perspective?

Nurse: What makes you think you might wake up Mr. Kato?
Mr. Kato: My wife’s cousin had some type of surgery about 25 years ago and he never woke up.
Nurse: What kind of surgery did he have?
Mr. Kato: It was some kind of heart surgery and he had another heart attack on the table and he died right away.
Nurse: It sounds like his condition was critical going into surgery.
Mr. Kato: Yes, he had been sick for a long time.
Nurse: It is not uncommon to feel afraid of having anaesthesia, especially if you have never had surgery before. There are rare cases in which complications do occur during surgery. That is why individuals consent after proper explanation of what to be done the advantages and disadvantages of the surgery and its possible outcomes. Thankfully though, most surgeries are without such drastic problems. Although your problem has made you uncomfortable, you are otherwise in good health. The investigations and tests done show that you are healthy and should be able to do well with anaesthesia. That drastically reduces the chance for complications in your case. I would be glad to answer any other question that you have or to ask the anaesthetist to come and talk with you some more.

In this case, the nurse has validated Mr. Kato’s feelings and concerns, provided an explanation with reasonable reassurance and offered to explore the issues with him further or to have someone else talk with him.

This is just an example of how the nurse could have responded to Mr. Kato rather than blocking him.

Some things are difficult to talk about with another. The dying patient may want to talk about how he or she feels, ask questions or perform a life review. A nurse / midwife who is uncomfortable with such topics may consciously or unconsciously block communication through generalising or closed responses.

Avoidance of the blocking technique requires a good understanding of oneself. If unable to provide the open communication the patient obviously needs, the nurse should access other personnel who are more comfortable in the situation.

Let us now look at another negative communication technique which is; false assurances.

These are similar to blocking and have about the same effect. When someone is trying to get real answers or express serious concerns, an answer such as “don’t worry” or “it will be okay” sends several unintended messages. Such answers can be interpreted by the patient as placting or showing lack of concern or lack of knowledge.

The patient might even conclude that the nurse/ midwife is being neglectful through the way she/ he communicates about an issue that is important to him/her.

In this case, of false assurance, the nurse/ midwife has neither recognised the need the patient has expressed nor provided validation.

Our next discussion is about conflicting messages...

These are another form of negative communication technique.

If a person professes pleasure at seeing someone but draws back when that person extends a hand of greeting, the non verbal message speaks louder than the words spoken. If a nurse/ midwife enters a room and goes through the routine greeting by rote (even with a smiling face and a bouncing step) a patient can quickly perceive this and consider the midwife as less approachable.

Let us look at this scenario:

The nurse’s/ midwife’s statement that the patient’s condition is important to him/ her but followed by failing to answer the call bell in a timely manner or by forgetting to bring items promised to the patient, sends a double message. Such behaviour can leave the patient confused, frustrated or angry.

Carrying through with a commitment no matter how unimportant it may seem is a premier method of saying to the person, “You are important to me”.

1. Listen attentively to your own conversation over the course of the next few days. Focus on your use of questions. This awareness can prove valuable in improving your communication skills.
2. Make a list of the negative messages you frequently hear yourself making. Realise how these messages affect your daily communication.
3. To explore your ease in sharing your idea and speaking for yourself, complete the following sentences;
   • a) “I would like to talk to you about.......”
   • b) “You and I need to discuss......”
   • c) “I need you to.......”
   • d) “Let me clarify by saying....”
   • e) “I want to know that.....”
4. Non verbal communication or body language sends positive and negative signals. What message are you sending if;
   • a) Someone is presenting a new idea and you are frowning?
   • b) You are dressed casually at an important meeting?
   • c) You are looking at other things in a room when someone is speaking to you?
   • d) You keep moving closer to a person who is backing away from you?
   • e) During a disagreement you start speaking loudly?

1. Verbal Communication
   This is the exchange of ideas through spoken or written expression (word).
2. Non-verbal Communication
   This involves the expression of ideas, thoughts or feelings without the spoken or written word. This is generally expressed in the form of body language that includes gestures and facial expressions.
   Both verbal and non-verbal form the basis of inter-personal communication, discussed below. Communication could also be divided into intra-personal, inter-personal and mass media.
3. Intra-personal Communication
   This is talking within oneself. It is the thought going on within a person. This form of communication takes place before any other form of communication. Before anybody talks to any type of audience or takes any action, he/she must think about it. It follows therefore, that conflict within oneself can negatively influence one’s communication with another person or one’s perception of another person’s messages.
4. Interpersonal Communication
   Interpersonal communication is the face-to-face verbal and non-verbal exchange of information, ideas or feelings between individuals or groups.
5. The mass media
   This involves communicating with a large group of people through specialized media such as electronic media (television, radio, etc.) and print media (newspaper, magazines, posters, etc.). Although these media can reach a large audience, they may be inappropriate for counselling, as this does not allow for feedback. Where feedback is possible, as in radio and television phone-in programs, they are costly and not widely accessible.

Let us now look at the 4 (four) main communication skills.
For health care provider to communicate effectively, they need the skills of:

• i) Listening
• ii) Checking understanding
• iii) Asking questions
• iv) Answering questions

The first and perhaps the most important skill is to be a good listener. We have to be able to listen in order to understand.

Nature gave man two ears but only one tongue, which is a gentle hint, that he should listen more than he talks. (Davis, 1972)

The following acronyms ROLES can help you to remember the key points about suitable body language that indicate paying attention. And they are listening skills to show that the counsellor is listening attentively

• R - Relax have time and interest in attending/ helping the patient while keeping an open body posture.
• O - Open (Being open)
• L - Lean forward
• E - Eye contact i.e. keep eye contact with the client(s) you are talking to.
• S - Sit /stand close to the client/person/ patient.

• What are the four skills needed by a nurse/counsellor for effective communication?
• What does the acronym ROLES mean?

Check your answers if they are correct. Thank you and congratulation.
Let us now look at the different techniques for effective listening.

CLARIFY
This means an act of seeking clearer and more information so as to understand something better.
The purpose is to:

• To get additional facts
• To explain all sides of the problem
• Understand more
• Help the client personalize the problem

Example:

• “Can you clarify this?”
• “Do you mean this?”
• “Are you saying that….”

RESTATE
This means to hear and use the same words to speak back what someone has said, it is different from paraphrasing.
The purpose is to:

• To check if counsellor interpretation coincides with that of the client/ patient
• To show that the counsellor is understanding what the client is saying
• To help counsellors analyze other aspects of the problem to discuss with the client
• Help the counsellor appreciate emotions involved.

EXAMPLES:

• “As I understand it your idea is……………………”
• “This is what you have decided to do and the reason is….”
• “So what you have said is………………”

NEUTRAL
This means standing in the middle of two positions so as to ensure objective understanding of the issue.
The purpose is to:

• To show that you are listening and interested
• To encourage the client to continue talking

Example:

• “I see”
• Uh huh
• That is interesting
• I understand
• Is that so

REFLECTIVE

• to show that the counsellor understands the feelings expressed by the client
• to help client/patient evaluate and moderate his/her feelings as expressed by the counsellor

Example:

• “So it is a shocking thing as you said ……”
• “You felt you were not taken seriously…..”
• “You felt you were not treated fairly… ”

SUMMARIZING
This means picking the main issues from the story as told by the client/ patient that are relevant to addressing the problem. It also involves prioritizing.
Purpose:
To wrap up bring the discussion to focus.

Example:

• “These are the key ideas that you have expressed”
• “If I understand you correctly you feel …..”

• Encourage the person to talk and keep on nodding your head or us an appropriate facial expression
• Do not yawn fidget, look around or out of the window or do anything that indicate boredom or impatient.
• Observe the person’s non verbal communication and reactions, this can help interpret the person’s feelings
• Use silence constructively sometimes the person may stop talking he/she may be thinking about the situation, do not hurry them to talk
• It is very important not to interrupt the person when he/she is talking
• Listen and try to understand what the person is saying verbally
• Remember accurately what the person has said
• Listen with empathy (put yourself in their shoes and not judge them).

• Distractions: phone ringing, people coming in the room
• Judgmental fixations: judging client/patient by imposing own values/morality (often religious)
• Filtered listening: interpreting what you are hearing through your own experiences culture and background.
• Prejudice and preconceived bias: judge someone by the way they dress, their tribe gender, religion, profession.

Outline tips to active listening.

• Dos in listening
  • Show interest
  • Be understanding
  • Listen for cause of problem
  • Encourage speaker to believe that he/her can solve the problem
  • Know when to remain silent

• Don’ts in listening
  • Don’t argue
  • Don’t interrupt
  • Don’t pass judgment too quickly
  • Don’t give advice unless clients asks for it
  • Don’t jump to conclusions

• Tips to active listening
  • ROLES
  • Stop talking
  • Remove distraction, e.g. phones, fiddling around with objects, quest environment
  • Concentration
  • Look interested (maintain good eye contact)
  • Check that you are understanding what you hear (time to time repeating and summarize)
  • Use probing questions
  • Be patient
  • Be non-judgmental

Let us now look at checking understanding. Only check for understanding if content is not clear or when you feel that is important to summarize.

• It lets the person know we have been listening carefully
• It lets the person know we are trying to understand
• It gives an opportunity to the person to think again the problem
• It help the person to think about how to cope with the problem

Paraphrasing: what the person has said at key points during the conversation, by using words like,

• “you have told me that….”
• “If I heard correctly….”
• “What you seem to be saying…”
• “This sounds as though….”
• “Did I hear you say….”

Clarifying: when talking to a patient there circumstances when certain issues are not clear to either party (patient/client or health worker). By checking you (counsellor) have understood correctly, using words like “so you mentioned you are worried about three things but school fees is the bigger problem, is that right?”

Reflecting: by identifying the feelings of the person using words like, “it seems you are very worried about this”

Summarizing: this happens during and at the end of the conversation. Expressing in brief by highlighting the key point of the story the person has told.

List the ways we check understanding:

• Paraphrasing
• Clarifying
• Reflecting
• Summarizing

If you have got the answer, thank you. A pat on your left shoulder, please.
Let us move to the 3rd skill of effective communication which is
Asking questions

• To help the person explore his/her problem more fully and hence give more information
• To help the person think more about his/her situation and perhaps find a way of coping with the problems.
• To help the person explain what he/she already knows or understand about situation i.e. facts about HIV/AIDS, cancer.
• Questions can help prioritize problems and thus help to focus the session
• Question can help the session to move at the person’s own pace and enable dialogues between the counsellor and the person seeking help.
• Questions clarifying a point
• Question help confirm what we have heard e.t.c.

There are two types of questions; Open ended questions and Close ended questions.

These are questions which invite a person to talk and explain more about their concerns. Usually open ended questions begin with; what, where, when, how? E.g. “how did you know your wife was pregnant?” “What is the composition of your family?” “How did you feel when you were told your diagnosis?”

Asking open ended questions give clients/patient an opportunity to express themselves freely and make it easier for the counsellor to identify their needs and priorities. Open ended questions are useful in starting a dialogue, finding a direction and for exploring a client concerns.

Using a non directive approach when discussing behaviour change one should avoid such directive statements such as “You have to use a condom every time you have sex!” instead you can put responsible in the client/patient hand (a “buffet” approach) give the client patient control over decision that meet his/her need by asking for instance, “what do you think you could do to protect yourself?”

Open ended questions permit the person to choose how to respond and examines the situation more clearly.

These require specific answers these questions usually receive no more than a “Yes” or “No” answer.
For example “Are you married?” “No” “Do you have pain?” “Yes”.

These types of questions do not invite a person to talk more. Sometimes closed questions can seem very threatening if a person is feeling ill and vulnerable. It can sound as if the communicator (counsellor) is interrogating the person.

Thank you; tick yourself if you have got it correct, congratulations.

Points to remember when asking questions: It is helpful to use a mixture of questions that is both open ended and close ended questions.
Closed questions help to structure the session and identify facts, while open ended questions help the client/patient to express feelings, options and experiences.
It is confusing to ask so many questions hence ask one question at a time. Use key words from the person’s explanation to phrase another question.

Be tactful when asking personal or sensitive questions because it takes time to develop trust. Such questions can be asked later use simple and clear language when asking questions.

Let us now look at the 4th skill of communication.

When answering questions:

• Use simple, clear, age-appropriate language
• Provide accurate and complete information
• Be honest acknowledge when you do not know the answer to a client’s/patient’s question and it is alright to say, “I don’t know” note that some questions do not have answer.
• After giving information, check whether the person has understood and ask the person what he/she intends to do about the situation.
• Avoid answering “Yes” or “No” because it does not help the client to understand the situation.
• When answering the client’s questions, concern, give information rather than advice or false reassurance.
• Avoid suggesting to the client’s what to do, but put forward a suggestion for discussion by the client.

There are four basic elements of communication; imparting information, listening, information gathering and presence & sensitivity.
Realistic these elements do not occur in a linear fashion but may occur concurrently.

As nurses our role is to impart information this include teaching and educating about an illness and providing general information about treatment, which include diagnosis and treatment options within the appropriate centre of educational level development level, stress level and time constraints.

Listening is an active process that requires full presence and attention specifically; one both listens to the words and interprets non verbal gestures often it is very helpful to hear the client’s/patient’s story in his/her own words because this allows better understanding of the problem/situation.

Information gathering from clients/patients is by the use of open ended questions which allow the person to tell his/her story in narrative. Closed ended questions limit the person’s answers and there by inhibit elaboration, explanations and clarifications. Open ended questions promote richness in hearing which express issues of importance and priorities of care.

Sensitivity is another term for cultural competence, include issues pertaining to religions, spiritual, cultural ethnic, racial, gender and language issues and it is a very important element of communication. Not only is it important to appreciate verbal cues, but also it is critical to interpret non verbal cues. Communication varies in different cultures in many situations beneficiaries takes precedence over autonomy. Disclosure and non disclosure must be viewed within the content of the patient and the family, with understanding of and respect for their values and beliefs.

The source (sender) must:
KISS, i.e.

• Keep
• It (the language)
• Simple and
• Sensible.

• Avoid semantic noise, i.e. use of words that is meaningless to the receiver. Have a good manner of speech in terms of coherence, presentation and use of gestures/expressions that animate the scene.
• Accord respect to the receiver (target audience).
• Avoid changing topics unnecessarily.
• Be lively and confident. By so doing, he/she can establish good rapport.
• Be a good listener as well.

• The message must:
  • Be clear
  • Be brief
  • Be straight to the point.

• The medium must be:
  • Clear. An unclear medium causes distractions (channel noise).
  • Accessible.

• The receiver must be:
  • Both a good listener and speaker. It is good for her/him not to interrupt a speech for this will make the speaker lose key points.
  • Able to maintain eye contact.

During a counselling session, person-to-person communication is used to motivate, educate and counsel clients in every area of health, from Family Planning to HIV/AIDS prevention and management.

Counselling should be used in primary healthcare service delivery. A woman with special problems, constraints and fears about getting HIV or AIDS, for example, needs encouragement and empathetic treatment of other STIs in addition to information.

The way in which a healthcare provider interacts with her can have a major effect on whether or not she carries out desirable health practices (such as limiting the number of partners or using condoms).

In HIV/AIDS counselling, the counsellor’s objective is to give the power of informed choice to a client, who is then free to choose behaviours that will reduce her/his risk of becoming infected or to manage the illness if she/he already has AIDS.

HIV/AIDS is far more sensitive than other primary healthcare issues. HIV/AIDS counselling may use the same skills as other types of primary healthcare counselling but it requires much more awareness of personal values and preferences, the inviolable nature of client confidence and trust, and the difference between professional guidance and personal persuasion.

Interpersonal counselling is used in all areas of healthcare provision. All healthcare staff, whether in the clinic or in the community, rely on person-to-person communication. For this reason, good interpersonal counselling skills can make the difference between success and failure in any healthcare program.