NONVERBAL COMMUNICATION SKILLS
Nonverbal communication is the behavior a person exhibits while
delivering verbal content. It includes facial expression, eye contact, space,
time, boundaries, and body movements. Nonverbal communication is as important
as, if not more so than, verbal communication. It is estimated that one third
of meaning is transmitted by words and twothirds is communicated nonverbally.
The speaker may ver-balize what he or she believes the listener wants to hear,
whereas nonverbal communication conveys the speaker’s actual meaning. Nonverbal
communication involves the unconscious mind acting out emotions related to the
ver-bal content, the situation, the environment, and the rela-tionship between
the speaker and the listener.
Knapp and Hall (2009) listed the ways in which non-verbal messages
accompany verbal messages:
·
Accent: using flashing eyes or hand
movements
·
Complement: giving quizzical looks,
nodding
·
Contradict: rolling eyes to demonstrate
that the mean-ing is the opposite of what one is saying
·
Regulate: taking a deep breath to
demonstrate readiness to speak, using
“and uh” to signal the wish to continue speaking
·
Repeat: using nonverbal behaviors
to augment the ver-bal message, such as shrugging after saying “Who knows?”
·
Substitute: using culturally determined
body move-ments that stand in for words, such as pumping the arm up and down
with a closed fist to indicate success
The human face produces the most visible, complex, and sometimes
confusing nonverbal messages. Facial move-ments connect with words to
illustrate meaning; this con-nection demonstrates the speaker’s internal
dialogue. Facial expressions can be categorized into expressive, impassive, and
confusing:
·
An expressive face
portrays the person’s moment-by-moment thoughts, feelings, and needs. These
expres-sions may be evident even when the person does not want to reveal his or
her emotions.
·
An impassive face is
frozen into an emotionless deadpan expression similar to a mask.
·
A confusing facial
expression is one that is the opposite of what the person wants to convey. A
person who is verbally expressing sad or angry feelings while smiling is
exhibiting a confusing facial expression.
Facial expressions often can affect the listener’s response. Strong
and emotional facial expressions can persuade the listener to believe the
message. For example, by appearing perplexed and confused, a client could
manipulate the nurse into staying longer than scheduled. Facial expressions
such as happy, sad, embarrassed, or angry usually have the same meaning across
cultures, but the nurse should identify the facial expression and ask the
client to validate the nurse’s interpretation of it—for instance, “You’re
smiling, but I sense you are very angry” (Sheldon, 2008).
Frowns, smiles, puzzlement, relief, fear, surprise, and anger are
common facial communication signals. Looking away, not meeting the speaker’s
eyes, and yawning indicate that the listener is disinterested, lying, or bored.
To ensure the accuracy of information, the nurse identifies the non-verbal
communication and checks its congruency with the content (Sheldon, 2008). An
example is “Mr. Jones, you said everything is fine today, yet you frowned as
you spoke. I sense that everything is not really fine” (verbalizing the
implied).
Body language (gestures, postures,
movements, and body positions) is a
nonverbal form of communication. Closed
body positions, such as crossed legs
or arms folded across the chest,
indicate that the interaction might threaten the listener who is defensive or
not accepting. A better, more accepting body position is to sit facing the
client with both feet on the floor, knees parallel, hands at the side of the
body, and legs uncrossed or crossed only at the ankle. This open posture
demonstrates unconditional positive regard, trust, care, and acceptance. The
nurse indicates interest in and acceptance of the client by facing and slightly
leaning toward him or her while maintaining nonthreatening eye contact.
Hand gestures add meaning to the content. A slight lift of the hand
from the arm of a chair can punctuate or strengthen the meaning of words.
Holding both hands with palms up while shrugging the shoulders often means “I
don’t know.” Some people use many hand gestures to demonstrate or act out what
they are saying, whereas others use very few gestures. The positioning of the
nurse and client in relation to each other is also important. Sitting beside or
across from the client can put the client at ease, whereas sitting behind a
desk (creating a physical barrier) can increase the for-mality of the setting
and may decrease the client’s willing-ness to open up and communicate freely.
The nurse may wish to create a more formal setting with some clients, however,
such as those who have difficulty maintaining boundaries.
Vocal cues are nonverbal sound signals transmitted along with the
content: voice volume, tone, pitch, intensity, emphasis, speed, and pauses
augment the sender’s mes-sage. Volume, the loudness of the voice, can indicate
anger, fear, happiness, or deafness. Tone can indicate whether someone is
relaxed, agitated, or bored. Pitch varies from shrill and high to low and
threatening. Intensity is the power, severity, and strength behind the words,
indicating the importance of the message. Emphasis refers to accents on words
or phrases that highlight the subject or give insight into the topic. Speed is
the number of words spo-ken per minute. Pauses also contribute to the message,
often adding emphasis or feeling.
The high-pitched rapid delivery of a message often indicates
anxiety. The use of extraneous words with long, tedious descriptions is called circumstantiality. It can indicate the
client is confused about what is important or is a poor historian. Slow,
hesitant responses can indicate that the person is depressed, confused and
searching for the correct words, having difficulty finding the right words to
describe an incident, or reminiscing. It is impor-tant for the nurse to
validate these nonverbal indicators rather than to assume that he or she knows
what the client is thinking or feeling (e.g., “Mr. Smith, you sound anxious. Is
that how you’re feeling?”).
The eyes have been called the mirror of the soul because they often
reflect our emotions. Messages that the eyes give include humor, interest,
puzzlement, hatred, happi-ness, sadness, horror, warning, and pleading. Eye contact, looking into the other
person’s eyes during communica-tion, is used to assess the other person and the
environ-ment and to indicate whose turn it is to speak; it increases during
listening but decreases while speaking (DeVito, 2008). Although maintaining
good eye contact is usually desirable, it is important that the nurse doesn’t
“stare” at the client.
Silence or long pauses in communication may indicate many different
things. The client may be depressed and struggling to find the energy to talk.
Sometimes pauses indicate the client is thoughtfully considering the question
before responding. At times, the client may seem to be “lost in his or her own
thoughts” and not paying attention to the nurse. It is important to allow the
client sufficient time to respond, even if it seems like a long time. It may
confuse the client if the nurse “jumps in” with another question or tries to
restate the question differently. Also, in some cultures, verbal communication
is slow with many pauses, and the client may believe the nurse is impatient or
disrespectful if he or she does not wait for the client’s response.
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