Running head: NONVERBAL COMMUNICATION 1. The Impact of Nonverbal Communication Within The Provider and Patient Dyad.

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1 Running head: NONVERBAL COMMUNICATION 1 The Impact of Nonverbal Communication Within The Provider and Patient Dyad Alhanouf Alghamdi Marywood University 2017 Overview

2 NONVERBAL COMMUNICATION 2 In order to communicate more effectively and clearly with patients, healthcare providers must able to comprehend the patients non-verbal communication skills, in addition to having actual communication skills. Effective communication is not only verbally sending a message; however, it is more about understanding the emotions and intentions behind the conveyed message. According to "7%,38%,55%" rule by Mehrabian (1967), non-verbal communication conveys either feelings or attitudes. Therefore, non-verbal communication is of paramount importance in the healthcare industry since misunderstanding can be ensued from poor communication. Many implicit messages are expressed through non-verbal behaviors. Hence, healthcare providers should be attuned to the non-verbal signs that their patients show simultaneously with verbal messages. Rationale The importance of non-verbal communication in healthcare industry Non-verbal communication plays a significant role in the health communication process particularly in establishing a good rapport with patients. Normally, non-verbal cues are involuntary and more difficult to fake: consequently, it is more credible. For instance, doctors can get important and useful information through non-verbal signals,which patients emit, for diagnosis and treatment. On the other hand, patient outcomes can be affected by the physician non-verbal behaviors such as patient satisfaction. I. Non-verbal communication functions A. Conveying the meaning of verbal communication It is a primary function of non-verbal communication by reinforcing, substituting for, or contracting verbal communication. Together better means non-verbal communication and verbal

3 NONVERBAL COMMUNICATION 3 communication often work side by side to convey the meaning. As a result, either healthcare providers and patients can understand each other and the communication process will be unambiguous. Non-verbal communication may add a redundancy to verbal communication in order to reinforce the message. For instance, when a patient drinks a drug, he would say it tastes bad and simultaneously makes a facial expression that shows disgusting. Sometimes, non-verbal communication becomes integral to substitute verbal communication in case of either speech impairment or language barriers. Consequently, both practitioners and patients will be relying more on non-verbal communication to send the message.as an example, nurses regularly assess the presence of pain for each inpatient by asking the patients whether they feel pain or not. However, the patients who do not speak the same language as do the healthcare providers will be responding by nodding head to say yes or no. Furthermore, in some situations verbal communication cannot be possible, and therefore verbal communication must be substituted with non-verbal communication. For example, nonverbal signals will be used between dentist and his patient during the treatment since the patient may be unable to engage in any conversation. It is also useful to use non-verbal signals in crowded places when both communicators could not hear or receive the verbal message of each other. Interestingly, close friends like replacing verbal with non-verbal communication n order to hide something and keep it secret like one blinks at his friend to prank their other friend. Contracting verbal message might happen due to non-verbal cues. A discrepancy between nonverbal and verbal communications can obviously emit a mixed message. The ambivalence could be confusing, but nevertheless non-verbal communication is more believable and credible. Body

4 NONVERBAL COMMUNICATION 4 somewhat refuses the incompatibility of what mouth has said with what body has felt. Hence, the body is like a defense attorney for its sake. If we feel tired, afraid, agitated, or even stressed, our bodies will show many expressions designate what we have really felt. Even though the mouth says something different, the body never lies. For instance, when a patient says that he is not stressed while shrugging his shoulder, a good practitioner will realize the patient stress by reading his body language. B. Influencing others The non-verbal communication of healthcare providers is quite essential for patients because they become so sensitive to how the information and messages are conveyed. Likewise, patients intuitively believe in the veracity of non-verbal cues. Therefore, the way that providers communicate leads patients to either trust or distrust them. In other words, non-verbal behaviors of providers may improve patients outcomes such as the patient s adherence to treatment regimens. Providers, however, cannot convince and influence patients unless they pay more attention to their non-verbal behaviors(nalini& Robert,1998).Eye contact, for example, can be effective to make patient have their medication. C. Regulating the conversational flow Non-verbal signals could be very useful to regulate the flow of the conversation; otherwise, people would end up interrupting each other. Pitch, for instance, helps audience recognize that the speaker is finished his conversational turn. Moreover, non-verbal signals help prevent an awkward silence that might occur in the end of the speech(hargie, 2011). In healthcare industry, the relationship between practitioners and patients depends on an understandable conversation,

5 NONVERBAL COMMUNICATION 5 consequently, whether raising and falling pitch or eye contact willabsolutely help both parties to have a potent conversation. II. Non-verbal communication types A. Body movements (kinesics) Kinesics was coined by the anthropologist Ray Birdwhistell ( ) as a positive alternative to non-verbal communication. It is defined as the study of human movements as culturally patterned visual communication. It does include gesture, posture, eye contact, and facial expression. 1. Gestures Gestures fall into three main types which are adaptors, emblems, illustrators (Andersen, 1999). Adaptors are non-verbal behaviors especially touching behaviors that may indicate uneasiness, uncomfortable, and anxiety. Adaptive behaviors can be self touching which is done subconsciously such as twirling hair and fidgeting. For instance, some patients fidget on their chair while talking with doctors about their health issues due to insecurity feelings. Emblems are gestures that have the same specific meaning as do words. It is a gesture of word replacement such as thumbs-up sign which means ok.emblems are very common and internationally recognized; however, they may differ in some other culture contexts. Pediatricians, for example, usually use this kind of gesture to deal with pediatrics and make a trustful bond. So, pediatrics will do what doctors have said without complains. Illustrators are non-verbal signals that accompany words to give a visual clarification and then illustrate the verbal message. Healthcare providers like dietitians typically use their hands to

6 NONVERBAL COMMUNICATION 6 manifest the amount of food that patients should have per mealand to illustrate how the formula must be prepared. 2. Head movements and posture Head movements and posture are used to communicate interest or attentiveness. Head movements such as a head nod is a universal sign of acknowledgement in some cultures while a head up indicates a neutral attitude(pease&pease,2004). Human postures are divided into four general categories standing, sitting, squatting, and lying down (Hargie,2011). During a patient consultation, healthcare professional should have a neutral and comfortable posture. Nonetheless, in some situations like delivering bad news, leaning forward toward the patient is really recommended. Therefore, healthcare providers can exhibit concern and attentiveness to patients sorrows and troubles (Hardip,2016). However, being too close to the patient whilst speaking with him could be considered as disrespectful and intrusive of the patient s personal space. Moreover, sitting up straight indicates an assertiveness that makes patients trust the practitioner. 3. Eye contact (oculesics) Eye contact in non-verbal studies called oculesics which is really important branch of nonverbal communication. Eye contact shows that the healthcare provider is genuinely interested in listening and speaking with the patient. Moreover, it indicates how much information the patient will be revealing to the healthcare provider. Eye contact is very essential for both practitioner and patient due to many reasons such as regulating interaction, monitoring communication,

7 NONVERBAL COMMUNICATION 7 expressing engagement, conveying intimidation, and establishing rapport. On the other hand, eye contact must be disengaged at the end of each sentence to avoid inappropriate staring at the patient. 4. Facial Expression Faces are the most exposed and expressive part of our bodies so any expression can be caught in any moment. In spite of the variety of different cultures, facial expression seems universal across the world. Consequently, either the healthcare provider and patient can easily discern the true feelings of each other (Nalini& Robert,1998). 5. Haptics (Touch) Healthcare providers must ask patients for a permission before touching them whether it is a diagnostic or therapeutic touch and moreover, they should explain for them the medical purposes of the procedures. Healthcare providers, however, should be considerate of gender appropriateness, and the religious and cultural background of the patient as well. B. Paralanguage (Vocalics) paralanguage includes the vocal attributes that go along verbal messages, such as pitch, volume, rate, vocal quality, and verbal fillers (Andersen, 1999). Vocalics helps the conversation go flow between the healthcare provider and patient and convey the meaning. Even though it has been learned through observation and practices, it gives a precise and concise verbal message. For instance, the practitioner could recognize an indecisiveness throughout the patient's voice.

8 NONVERBAL COMMUNICATION 8 C. Closeness or Personal Space (Proxemics) Promxemics has an obvious influence on the communication. in some cultures, leaning forward toward the speaker could be intruding the personal space while in other cultures it sounds normal. As it mentioned before, healthcare providers should take into consideration the religious and cultural background. D. Physiological Changes They are recognizable signs that designate intimidation, anxiety, and stress such as sweating or blinking more when nervous. III. Active Listening Active listening is a fundamental technique in interpersonal communication skills. It improves a mutual understanding in counseling and healthcare industry. Rather than just passively hearing some sounds, active listening means focusing fully on the speaker and showing interest cues. Active listening can be acquired and developed with either practice and patience. In addition, providing non-verbally feedback to the speaker such as smiling, maintaining eye contact, and nodding head demonstrates an attentive and active listening which makes the speaker feels valuable. Summary Non-verbal communication plays an effective role in the communication process especially in the healthcare industry. It helps convey the meaning of the verbal messages, influence others, and regulate the conversational flow. Hence, both practitioners and patients could have a comprehensive conversation and communicate more easily. Non-verbal communication types fall into four main categories which are body movements, paralanguage, personal space, and

9 NONVERBAL COMMUNICATION 9 physiological changes. Most of non-verbal signals can be internationally recognizable, therefore healthcare providers can clearly notice the true feelings of the patients. Likewise, an effective listening is an important technique that must be used in counseling which can be shown by nonverbal signals. Conclusion As a healthcare provider, I do believe that non-verbal communication is a very important for healthcare providers because it could help them to understand how the patient feels and accordingly deal with him. Furthermore, non-verbal communication skills may indicate the professionalism of the healthcare provider since poor communication contributes to poor adherence to the treatment. It may be laborious to control non-verbal communication signals; however, non-verbal communication skills could be improved and enhanced. Finally, non-verbal communication is mostly on a subconscious level and seemingly more genuine.

10 NONVERBAL COMMUNICATION 10 References Amy, L. (2010). The Importance of Verbal & Non Verbal Communication. Livestrong. Retreived from Andersen, P. A., Nonverbal Communication: Forms and Functions (Mountain View, CA: Mayfield, 1999), 17, 36. Hardip, S. (2016). The art of non-verbal communication in healthcare. Star2. Retrieved from Hargie, O., Skilled Interpersonal Interaction: Research, Theory, and Practice, 5th ed. (London: Routledge, 2011), 47, 63. Nalini, A., Robert, R. (1998). Nonverbal Communication. Harvard University. Retrieved from Pease, A. and Barbara Pease, The Definitive Book of Body Language (New York, NY: Bantam, 2004), 121.

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04/991 Chaplain Gordon Robertson, LBSW, BCC Houston Hospice - Texas Medical Center 1905 Holcombe Blvd. Houston, Texas 77030 Never document again: Patient refuses Chaplain or Social Work visit Patient has