Metacommunication:

• Combination of verbal and nonverbal behaviours conveying messages about how to interpret communication.

• Hidden within verbalizations or expressed through nonverbal gestures.

• Studies show increased compliance when accompanied by metacommunication, asking for a response to the appropriateness of a request.

Style Factors:

• Verbal Style: Includes pitch, tone, and frequency, influenced by age, race, education, gender, and context.

• Nonverbal Style: Facial expressions, gestures, posture, eye contact, and distance indicate personal communication styles.

• 70-90% Nonverbal Messages: Most communication is conveyed nonverbally; understanding personal styles enhances relationships.

Verbal Communication:

• Words as Symbols: Verbal communication influenced by culture, background, and experiences.

• Meaning: Denotation (generalized meaning, impact of culture) and connotation (personalized meaning); influenced by culture and context.

• Feedback for Mutual Understanding: Verify mutual understanding to ensure effective communication.

• Factors That Influence Word Choice: Age, Race, Socioeconomic group, educational background, Gender, Situation in which the communication is taking place

Verbal-Style Factors:

• Moderate Pitch and Tone: Paralanguage (voice inflection) impacts interpretation; mismatch with content causes misinterpretation.

• Vary Vocalizations: Cultural variations in sound patterns need orientation to diverse voice tones.

• Encourage Involvement: Shift from paternalistic styles to partnership for promoting patient responsibility.

• Validate Patient's Worth: Caring styles affirm patient worth and autonomy; confirming responses validates feelings.

• Advocate for the Patient: Assertive communication style to secure optimal care or services.

• Provide Needed Information Appropriately: Timely, accurate information in manageable amounts; maintain goal-focused communication.

Nonverbal Communication:

• Comprises the majority of person-to-person communication, enhancing the interpretation of verbal messages.

• Includes tone of voice, facial expressions, body language, and gestures, conveying emotional meanings and context.

• Nonverbal cues are vital in building rapport and clarifying the purpose or context of a message.

Aspects of Nonverbal Style in Nurse-Patient Communication:

• Silences: Therapeutic use of silence allows time for reflection and processing in nurse-patient interactions.

• Congruent Nonverbal Behaviors: Nonverbal cues should align with verbal messages to avoid misinterpretation.

• Facilitative Body Language:

  • Posture: Leaning forward demonstrates interest and openness; avoid turning away or using aggressive stances.

  • Facial Expression: Open, friendly expressions without being overly cheerful; avoid negative facial cues.

  • Eye Contact: Direct eye contact (without staring) generally signifies interest and positive engagement.

  • Gestures: Affirmative gestures aid communication; avoid gestures that may convey negative messages.

  • Touch: Affective touch can convey care and comfort but must align with patient cultural preferences and boundaries.

  • Proxemics: Cultural perceptions of personal space affect nurse-patient interactions; maintain appropriate distance.

  • Attend to Nonverbal Body Cues:

    • Posture: Body stance reflects emotions and confidence levels; attentive posture conveys engagement.

    • Facial Expression: Frowning, smiling, and other facial expressions complement verbal messages.

    • Eye Contact: Direct eye contact indicates confidence and credibility; gaze aversion may suggest dishonesty.

Communication Accommodation Theory:

• Proposed by Giles and Ogay (2007), it emphasizes people adjusting their speech, vocal patterns, dialect, word choice, and gestures to accommodate others.

• Convergence: Adapting speech patterns to align with conversational partners, aiding interaction, acceptance, trust, and rapport.

• Divergence: Deliberately choosing a distinct style, for instance, using assertiveness with a child or matching a patient's speech cadence for better understanding.

• Convergence by a more powerful individual might be perceived as patronizing.

Effects of Sociocultural Factors on Communication:

Age Cohort and Generational Diversity:

• Differing views, work motivations, values, attitudes, and communication styles across different generations can lead to workplace conflicts if ignored.

• Intergenerational communication issues and ageism stereotypes can impact healthcare interactions.

• Preferences for communication methods, digital or face-to-face, vary across different age groups.

Gender:

• Traditional gender stereotypes in communication patterns are being revised.

• Women were often characterized as more person-centred, warmer, and better decoders of nonverbal cues.

• Men were considered more task-oriented, direct, and assertive, preferring less verbal communication in interpersonal relationships.

• Studies show differences in eye contact, gestures, vocal patterns, and conversation approaches between genders.

• Gender differences in communication can influence interactions in healthcare settings.

Location:

• Rural healthcare settings might offer more consistent provider-patient relationships, impacting communication style.

• Urban areas might suffer from poorer communication due to overcrowding and lack of privacy in healthcare facilities.

Perceptions in Communication:

• Patients might interpret verbal and nonverbal messages differently, impacting trustworthiness, empathy, and overall perceptions of the communicator's message.

Knowing your communication style

Influence of Communication Style on Patient Outcomes:

• An aggressive style tends to create hostility; an assertive, empathic style leads to better outcomes.

• The passive style lacks active involvement; the persuasive manner waits to listen before making points.

• Poor communication dissatisfaction surpasses other care aspects for patients.

Recognizing and Modifying Your Communication Style:

• Your innate communication style influences patient interactions.

• Simulation exercises can help identify and modify your technique for various patients' needs.

• Empathic communication, considering nonverbal factors, is essential for effective nursing care.

• Comparing your style to others and video recording interactions can reveal communication tendencies.

• Be aware of alternative techniques comfortable for different situations or patient requirements.

• Consider factors like age, race, socioeconomic status, or gender influencing patient responses.

• Continual updates in communication competencies are necessary due to increasing digital communication in healthcare settings.

Interpersonal Competence and Communication Skills:

• Higher anxiety levels affect communication; understanding cognitive, behavioural, and cultural factors is crucial.

• Good communication skills are identified as attributes of expert nurses with clinical credibility.

• Social cognitive competency involves understanding patients' perspectives and goals, which is especially vital when their communication ability is impaired.

• Message competency uses language and nonverbal behaviours strategically to influence patients positively in the intervention phase of nursing care.

• Communication skills are tools to help patients maximize their adaptation to situations like self-injecting insulin.

Factors in Communication

Nonverbal-Style Factors:

• Proxemics: Understanding spatial distance in communication.

• Haptics: Therapeutic use of touch conveying comfort and reassurance.

• Kinesics: Body language encompassing various body movements that give meaning.

• Posture: Significance of different poses in communication.

• Facial expression: Expressions such as a pleasant, smiling, alert face indicating interest.

Verbal-Style Factors:

• Vocalics: Tone, volume, pitch, and rhythm in speech affect message meaning.

• Slang and Jargon: Varied interpretations of words based on age groups, cultural backgrounds, and professional terminology.

• Responsiveness of Participants: Reciprocity in communication influences relationships and health outcomes. We are encouraging responsiveness through active listening and empathy.

• Respect: Strategies like acknowledging difficulties, praising efforts, and encouraging multiple communication routes to demonstrate interpersonal sensitivity.

• Roles of Participants: Influence of sender-receiver roles on message interpretation. Power dynamics influencing communication styles.

• Context of the Message: Impact of environment, situation, psychological, social, and cultural characteristics on communication.

• Involvement in the Relationship: Communication changes over time in evolving relationships. Healthcare workers must respond to patients' concerns, not just focus on physical care.

• Use of Humor: Association of humour with stress relief, conflict resolution, learning enhancement, and improved communication in nurse-patient relationships.