The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [137]
Communication
Definition
Communication is a universal word with many definitions, many of which describe it as a transfer of information between a source and a receiver (Kennedy Sheldon 2009). In nursing, this communication is primarily interpersonal: the process by which information, meanings and feelings are shared through the exchange of verbal and non-verbal messages between two or more people (Brooks and Heath 1993, Wilkinson 1991).
Anatomy and physiology
Physiologically being able to produce speech and to hear are the two dominant physical processes in respect of communication.
The human voice is produced by exhaled air vibrating the vocal cords in the larynx to set up sound waves in the column of air in the pharynx, nose and mouth. Pitch is controlled by the tension on the vocal cords: the tighter they are, the more they vibrate and the higher the pitch. The sounds produced are amplified by the physical spaces of the pharynx and nose and modified by the lips, tongue and jaw into recognizable speech. The muscles of the face, tongue and lips help us to enunciate words (Tortora and Derrickson 2009) (Figure 5.1).
Figure 5.1 Movement of the vocal cords.
Reproduced from Tortora and Derrickson 2009.
The ear contains receptors for sound waves and the external or outer ear is designed to collect them and direct them inward. As the waves strike the tympanic membrane, it vibrates due to the alternate compression and decompression of the air. This vibration is passed on through the malleus, incus and stapes of the middle ear. As the stapes vibrates, it pushes the oval window. The movement of the oval window sets up waves in the perilymph of the cochlea that ultimately lead to the generation of nerve impulses that travel to the auditory area of the cerebral cortex (Tortora and Derrickson 2009) (Figure 5.2).
Figure 5.2 Events in the stimulation of auditory receptors in the right ear.
Reproduced from Tortora and Derrickson 2009.
The physiological process of communication is, however, much greater than just speech and hearing. The central nervous system is central to both verbal and non-verbal communication. Not only does it continually receive information but it also selects that which is important to respond to, so that overstimulation is avoided. Communication issues may arise if any of these processes are altered.
Related theory
There are many theories about interpersonal communication and nurses are encouraged to consider Heron’s (2001) Six Category Intervention Analysis (Box 5.1) to reflect upon their own and other health professionals’ communication. The main aim is to support and maintain the patient’s optimum level of communication while remaining aware of the impact of their disease and its management on the patient’s ability and/or motivation to speak. We need to be aware of different coping styles and attitudes of the patient and key people in their lives, other co-morbidities, disease progression, fluctuating cognitive abilities and treatment side-effects. All these factors demand a flexible approach when supporting communication throughout the length of the patient pathway (White 2004).
Box 5.1 Heron’s six category intervention analysis (2001)
Authoritative
1. Prescriptive. A prescriptive intervention seeks to direct the behaviour of the client, usually behaviour that is outside the practitioner–client relationship.
2. Informative. An informative intervention seeks to impart knowledge, information and meaning to the client.
3. Confronting. A confronting intervention seeks to raise the consciousness of the client about some limiting attitude or behaviour of which he is relatively unaware.
Facilitative
4 Cathartic. A cathartic intervention seeks to enable the client to discharge or abreact painful emotion, primarily grief, fear and anger.
5 Catalytic. A catalytic intervention seeks to encourage self-discovery, self-directed learning, living and problem