Highlight the importance of communication when establishing a good patient nurse relationship, the effects that communication can have on this relationship and the problems that can arise from ineffective communication.

2. COMMUNICATION

"Communication is the basic element of human interaction that allows people to establish, maintain and improve contact with others." (Heath 1995 pg 275).

There are two schools of thought in communication, process and semiotic or sign schools.

Process is concerned with the transmission of messages. It focuses on how the message is sent and received. It concentrates on the way in which messages are transmitted and the channels of communication used i.e. touch, hearing, sight etc. Whereas the semiotic school is concerned with how the message is interpreted. Emphasis is on creative meaning and also that the message is dynamic not static i.e. the message sent is not necessarily the one received.

3. MODELS AND THEORIES OF COMMUNICATION

" A model provides the student nurse with a framework for observing, understanding and predicting what occurs as two people communicate." (Heath 1995 pg 276)

a simple model of communication is as Darley (2002) suggests the sender, receiver message model. The sender is the person who begins the interpersonal communication, the message is the information being sent, be it verbal or non-verbal. The receiver is the person to whom the message is sent. During successful communication the role of the sender should switch between the participants of the communication.

In this scenario the student nurse must make sure any message she communicates is clearly understood by Mr Smith. She must be aware that the age difference between herself and her patient may be a barrier as the vocabulary she uses may be different to that of Mr Smith's. She must avoid the use of medical jargon and allow time for Mr Smith to absorb what is being said.

4. VERBAL COMMUNICATION

Verbal communication as Heath (1995) suggests involves spoken or written words. Words can be used to convey feelings or emotions but also hidden meaning such as fear or anxiety. Language can be defined as words, which are only effective if every person involved within the interaction understands them. There are a number of aspects important for effective verbal communication such as questioning, response, denotative and connotive meaning, clarity and brevity, language and paralanguage, all of which are explained in greater detail below.

4.1 QUESTIONING

Questioning is an essential technique that nurses must become good at. It is used to gain information, to allow patients the opportunity to express feelings. Questions can also help initiate communication when the nurse and patient first meet (Sieh and Brentin 1997). There are two types of questions that could be used. First open questions which allow the patients answer to be as long or short as they like. It may be useful for the student nurse to ask open questions to allow Mr Smith to express his fears and feelings, possibly alleviating some of his confusion.

The second type of question is a closed question, these almost limit the patients answer to a yes or no i.e. specific answers. The student should use closed questions only when she is seeking specific information such as medical history, as closed questions don't allow the freedom of speech that open questions do. (Northouse and Northouse 1998).

4.2 RESPONSE

response is as important as the question being asked. The student can assess Mr Smith by his responses, both verbally and non-verbally. She can assess whether he is scared, confused or agitated.

The way the student responds to questions can effect the patient. If her non-verbal responses don't match her verbal response it gives the impression of insincerity and may cause distrust.

4.3DENOTATIVE AND CONNOTIVE MEANING

The student nurse should be aware that a single word may have several meanings. A denotative meaning is a meaning shared by people who speak the same language. A connotive meaning is a word that has a variety of different meanings depending on where a person is from or how the person interprets the word. (Heath 1995).

The student must be aware when giving information or explanation to Mr Smith that he fully understands what is being said.

4.4 CLARITY AND BREVITY

To achieve clarity the sender of the message must speak slowly and clearly, without being patronising. Clear pronunciation of words is important (Northouse and Northouse 1998).

The student can read Mr Smiths non-verbals to make sure he understands the message. Repeating important parts of the message to Mr Smith may make communication clearer.

Berevity is achieved by using simple, clear phrases and avoiding the use of jargon (Heath 1995).