For this assignment I have been asked to produce an essay explaining the importance of verbal and non-verbal communication skills whilst working in a health care setting for example: a hospital/clinic. I am going to discuss communication barriers which may affect a person communicating effectively; a communication barrier could include many different aspects including different languages, different beliefs and cultural backgrounds. This essay will identify and discuss critically the range of barriers to effective interpersonal communications, with possible steps to address them. These will look at cultural, personal and environmental issues. The role of available support services that are accessible to individuals, with the restrictions on available services will be evaluated. The effectiveness with which the skills of communication are given and received will also be evaluated.

There are many barriers to communications between a vast range of people and cultures. Barriers to communications, because of cultural differences, can arise because of the lack of understanding between each culture; this could cause a clash between people. For example in some African languages there are no words for ‘sorry’ which could make people from other cultures think the Africans individual is rude. Cultural differences can be difficult when there is not respect between cultures. If a religion such as the Sikhs religion requires that they must wear their turbans at all times, this must be respected even if in a sterile situation.

For example, a patient in hospital will wish to observe their religion even whilst having surgery. Staff supporting these individuals must be made aware of religious differences and how to treat them to show the dignity and respect that each person is entitled to. On the job, training should be given about these issues to eliminate distress and embarrassment for all to who are involved.

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Patients and visitors are treated with dignity and respect at all times. The hospital and health care professionals ensure there is no unlawful or unfair discrimination in the quality of care provided to individuals. (The Human Rights Act 1998, The Race Relations Act 1976, The Disability Discrimination Act 1995, Employment Equality Regulations Act 2003) There are many more!

Nurses must also remember that there is a great deal of diversity between different cultures and that this is also important when communicating. For example in a number of oriental cultures the appropriateness of interaction distance is determined by status. Because of the cultural teachings of humility, modesty, and the subordination, too close proximity would indicate insubordination. Similarly, people from Asian cultures indicate respect by allowing more space, keeping their heads low and adverting their eyes.

Understanding and communicating with people who have hearing-impairments is hard to achieve, it could involve the use of Makaton or British sign language. This can be accessed through employers or local support groups. It can give people a sense of belonging and involvement within the community that they live in, it can also break down the communication barrier and open a new world for the persons involved, people with learning difficulties, accents and disabilities, all need to be communicated with, this is achievable on any level. The way in which it is received can be a positive step towards knowledge and independence.

Environmentally there could be a fear of areas in certain cities, which hold a possibility of threat. This could be towards any age person not just elderly people. This could be because of high numbers of reported crime. These things deposit bad thoughts and negative feelings towards those areas. There could be a lack of public transport for all individuals to access, this lack could be increased if you are disabled and are restricted to a chair. If you have little or no support you would find public transport unavailable for use. Other barriers will then appear like being cut off from normal things able bodied people take for granted such as access to the shops, social events and so on. These factors can then develop other stress symptoms such as mental health symptoms, depression and can exacerbate lack of self-esteem, confidence and personal skills can lead to the development of barriers to communication that can grow into bitterness and resentment. Local authorities need to be aware of the fears within their local communities, local police officers could start to walk on foot patrols within the areas as before, and the police could draw up local interest to protect the local people and bring into the community neighbourhood watch schemes, and produce an awareness of their presence in the community.

Overall, barriers to communications can be a contributing factor in neglectful situations. People may suffer and be excluded because of other people’s neglect or omissions to report such barriers. It is especially important in the caring profession, that we are aware and do all that we can to overcome these barriers to communication

When communicating effectively with staff or patients there are two types of interactions we use they are called formal and informal methods. Formal communication means to communicate in an official capacity representing your organisation. When communicating informally you can interact in a personal capacity. Skilled communicators are able to remain in their role, and communicate in a way that is genuine and personal. The essential part of any interpersonal relationship is communication, not at least of all in the professional relationship between the nurse, the patient, and the patient’s family and friends. A huge part of that relationship involves face-to-face contact and interaction, and professionals are expected to have appropriate knowledge of and expertise in, communication skills. Hargie (1986) refers to these as social skills, which are a set of goal orientated, inter-related, situationally appropriate social behaviours which can be learnt and which are under control of the individual.

‘Communication is so much more than just talking to one another. It is how people respond to each other in many different ways’ (Langs 1983).

Communication is not just about giving people information; we go through a process or ‘cycle’ while we talk: the cycle includes hearing what the other person says, watching the other person’s non verbal messages, and having emotional feeling. Below is a diagram of the communication cycle.

Verbal communication occurs when a person speaks. Their verbal communication and interaction is structured and governed by rules. For example the way people begin conversation with a standard greeting. In health care settings we use verbal communication as an everyday occurrence and can come in different forms. We use verbal communication effectively when we respond to patient’s questions and distress, overcoming second language problems and we also use this method when providing support to relatives and friends. It is vital we use effective verbal communication skills whilst dealing with patients who have hearing and speech impairments or young patients such as children. Each of these specific needs require health care workers to have practical skills to initiate and maintain effective verbal communication with others. The effectiveness or success of communication is influenced by a number of interpersonal and environmental factors. Practitioners can often overcome interpersonal and environmental barriers by being aware of possible problems and solutions associated with each factor, adapting their interaction and making simple modifications to physical environment, of the health care settings. There are a number of factors that can both enhance and inhibit the effectiveness of communication in health care setting. They can be classified under the following headings

Physical factors


*A person’s appearance and grooming, a patient may make first impressions and judgements on your appearance, it’s always important to comply by your setting’s dress code. Whilst working with young children sometimes wearing less formal clothing i.e. brighter colour’s helps the child feel more relaxed and less stressed, this makes the child able to open up and shows you are communicating effectively to meet that child’s specific needs,

*his or her non verbal behaviour, sometimes just a smile can help a patient who is feeling scared or not at ease, to help them relax. There are many different types of non-verbal methods that help a patient communicate more effectively who is finding it difficult to explain how they are feeling with words.

*the use of touch and proximity, for example if a patient who has just had a surgical operation needs alot of care, but is in too much pain to talk or communicate, a simple gesture such as holding their hand, or sitting near can show them reassurance.

Physical surrounding:

Background noise: sounds that intrude upon environment, which are not under control of the people who want to communicate.

Quality of light: dark and gloomy rooms are likely to reduce people’s ability to pick up details of facial expressions, too bright will have the same effect, e.g. back to window.

Comfort: the extent to which patients communicate can be affected by their level of comfort; this can be restricted by poor use of space, the layout of room, types of seating and furniture and even the decor

Dialect and accent are features of verbal communication that may have some effect on relationships between people in health care settings. A dialect is a form of language spoken in a particular area. It usually involves the use of some words, which have a specific local meaning.

An accent is a style of pronunciation that is distinctive to a local nation or social group. The same word would be used but with a different pronounce.

Some people find it difficult to communicate with people who have a different accent; this is because they can’t understand the change in their voice and the way it is said. People also find it difficult to understand different dialects this is the words they speak, the same word can have a different meaning. Whilst working in a health care setting it is important to act in a professional manner and use little dialect and accent as possible, this could become a communication barrier when working with patients with different accents and dialects to those we use. Before people feel comfortable with the person caring for them they already have a first impression of what they are like from the way they speak, just because of their use of accent or dialect.

Listening is a feature of the communication process. It requires the individual to pay active attention to the linguistic, paralinguistic and non verbal messages of another person’s communication. Effective listening is a skill that takes time to develop. Listening can be enhanced by using SOLER behaviours, minimal prompts and active attending skills.

Health care workers use non-verbal communication skills to help promote effective communication. Non verbal skills include:



*body movements

*body position/posture



*tone of voice

*muscle tension

The ability to listen or read non verbal of physical features of communication enables health and social care workers to do their jobs effectively in several ways:

*to monitor the effects of their communication, care interventions and behaviour to others. For example a patient might show pain in his or her facial expression after a physical procedure has been carried out without saying anything, or body language to demonstrate that they have been reassured after a chat,

* to check whether their verbal messages have been understood. For example, a person’s physical response to bad news generally reveals whether the person understood what has been discussed,

* to confirm the truth of the verbal statements made by another person. For example, a colleague who says that he or she is OK while crying is a distressed way may not be telling the truth about his or her feelings,

* to convey trust, warmth and support to others, especially through the sensitive use of touch and physical contact,

* to respond sensitively to the way a patient is feeling, the ability to interpret emotions through non-verbal behaviour may make the difference between responding sensitively and insensitively to a person in distress.

The human face is very expressive and an important source of non-verbal communication. They typically reveal people’s feelings, many people control

facial expressions to disguise their feelings and present what they see as a socially acceptable face.

When reading a person’s face we look at particular features these include:

Eyes – are pupils dilate or contract. Pupils tend to suggest interest or excitement. We can look at a patients eyes to suggest how they are feeling, eye contact can be used to let someone know you wish to talk to them, it can often offer trust and reassurance. People’s eyes, like facial expressions, are a good indicator of a person’s feelings and emotions. The type of eye contact that you make with another person communicates a particular form of non-verbal message. It is important for care workers to be aware that people’s use of eye contact is influenced by their cultural background.

Skin tone – we can sometimes tell how a person is feeling by their skin tone; sometimes the person can blush or sweat, if they are nervous or feeling intimidated.

Mouth – this is an important factor we look at when reading patients facial expressions, the person could be smiling or frowning. They could also get a dry mouth which suggests nervousness.

Facial muscles – you can tell if a person is feeling relaxed by their facial muscle

if the person is feeling anxious their facial muscles will tend to tighten.

We can also look at a patient’s body language to suggest how they are feeling, we use certain types of body language these include:

Gesture – health care workers need to be aware that some people use their hands very expressively, this usually is a deliberate movement mainly of the hands, which could be described as a simple form of sign language.

Posture – this includes the way a person sits or stands, closed posture such as crossed arms and legs suggests defensiveness or tension. Open posture such as loose arms and leaning forward slightly can indicate the patient is relaxed and comfortable. Posture is important particularly when performing a patient assessment or one and one counselling.

Proximity ; touch – this means the physical closeness to a patient, it can depend on personal up brining/ cultural background and type of relationship the patient has with you.

Non-verbal messages are an important feature of communication during interpersonal interactions and health and social workers gradually develop and improve their non-verbal communication skills through training and experience

Communication can become blocked if individual difficulties are not understood. There are main ways that communication becomes blocked:

* A patient who cannot see, hear or receive messages may not understand the verbal communication being used this is where sign language skills can be used. Learning basic sign language would be of use and help to stop this communication barrier. Also the use of sounds and tone of voice would help a person who has hearing difficulties as they could detect a pacific tone change in the voice with a particular emotion.

* A patient who has misunderstood the message because of second language difficulties. Each person speaks differently to everyone else; most people may not understand the way people speak in jargon, slang and dialect. People who come from different places around the world all have different backgrounds and have other ways of using verbal and non-verbal communication.

Emotional barriers to communication:

Service users often have a serious amount of emotional needs. They maybe scared or depressed because of the stresses they are experiencing. Sometimes service users may lack self-awareness or appear to be shy or aggressive. Sometimes carers may not listen to service users to avoid unpleasant feelings.

Emotion can create barriers because care workers:

*They are tired, because listening takes mental energy

*don’t have time to communicate

*are emotionally stressed

*react with negative emotions

*make assumptions about others

It is important that nurses are aware about the barriers to communication and can assess their impact on patients and create meaningful and effective care packages. There are many consequences of not communicating properly. For example, one of these consequences could be neglect, due to not listening or not being able to understand the patient and their needs, the end result of incorrect or insufficient communication could have dire effects.

Empathy comes within relationship where one person has deep understanding involving intellectual and emotional understanding of another person. And empathizing is the skill of communicating accurate understandings of the feelings that he/she has. It helps on building relationship as it shows other that we have caring attitude. Service users have to go through different difficulties so it is necessary that the service provider shows empathy but not sympathy. Service providers have to be tough enough to deal with any of the problems. And also have patience to cope with the problem that service users have.

For the relationship between the nurse and the patient to be a quality helping relationship, it needs to contain elements such as empathy, warmth and understanding and unconditional positive regard. These qualities will be portrayed through attending, listening and responding. Burnard (1991) refers to this as staying awake and to be fully present in the moment that is being lived.

In Conclusion, health care workers, who are good at communication, are calm, courteous and turn up on time, speak directly to the service users, they listen and really hear and accept what patient’s are saying. Good nurses explain what is happening and why they are doing what they say they are going to do, and don’t over-promise. They make enough time to communicate with disabled patients and recognize the loss of dignity people experience when approaching hospital services for the first time, and respond sensitively and don’t assume anything about a patient’s abilities simply because of a disability or illness. They understand the importance of privacy, peace and quiet, they know that closed questions can be easier for patients with communication difficulties to answer and they check out that they’ve been understood, and find a mode of communication that works. They remember that young people may prefer to talk while doing something else.

Health care workers with good communication build trust, empathy and warmth and work in organizations that help them to do all these things. All health care workers work with the Code of Ethics to ensure service users are respected and prevent service users from misconduct or exploitation. This includes upholding the rights of the patient and promoting their independence whilst protecting them as far as possible from danger or harm.


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