Nonverbal Communication

Nonverbal Communication

Overview • Words are not the only way by which pharmacists communicate. Interpersonal communication involves both verbal and nonverbal expression. Words normally express ideas, whereas nonverbal expressions convey attitudes and emotions. A large measure of how you relate to others and how they relate to you is not based on what is said, but on what is not said. You may not speak or even have the desire to communicate, and yet be engaged in a communication process. You are constantly providing “messages” to those around you by your dress, facial expression, body movements, and other aspects of your appearance and behavior.

Nonverbal versus Verbal Communication • Nonverbal communication involves a complete mix of behaviors, psychological responses, and environmental interactions through which we consciously or unconsciously relate to another person. It differs from verbal communication in that the medium of exchange is neither vocalized language nor the written word.

Nonverbal communications are unique for three reasons. • First, they mirror innermost thoughts and feelings. This mirror effect is constantly at work, whether or not you are conscious of it. • Second, nonverbal communication is difficult, if not impossible, to “fake” during an interpersonal interaction. • Third, your nonverbal communication must be consistent with your verbal communication or people will be suspicious of the intended meaning of your message. This lack of congruence between your verbal and nonverbal messages may result in less than successful interpersonal communication

In nonverbal communication, we perceive and interpret a given nonverbal message or “cue” in a personal manner. Various interpretations emerge from the different social, psychological, cultural, and other background variables of the senders and receivers of nonverbal messages. For example, a simple nod of the head or a specific hand gesture may mean something to one person but something completely different to another. Therefore, nonverbal “cues” can and often do have multiple interpretations. However, within a given society, groups of nonverbal cues or “cue clusters” generally result in interpretations that are usually universally agreed upon.

Cue clusters are combinations of nonverbal acts that communicate certain global messages. For example, a patient who gives you a friendly handshake, a pleasant-sounding “thank you,” and a warm smile at the end of your interaction is probably more pleased with the interaction than a patient who abruptly turns around and quickly walks away mumbling something under his breath. Without a doubt, cue clusters contribute significantly to what is being communicated nonverbally.

However, you do not know whether the cause is distress over something you said, discouragement at being ill, dismay over the cost of the medication, a desire to hurry to get back to work, or a myriad of other things that may be on the patient’s mind that would explain his or her behavior.

When analyzing nonverbal communication, avoid focusing on just one cue. Look at all the nonverbal cues that you are receiving and use verbal communication to fully understand the meaning of the nonverbal behavior.

CONGRUENCE BETWEEN VERBALAND NONVERBAL MESSAGES • The meaning of the message may be somewhat unclear if the receiver senses incongruence between the verbal and nonverbal messages. That is, the meaning of a verbal message is not consistent with the meaning of a nonverbal message. To avoid this incongruence, as a sender, you must be aware of the nonverbal messages as well as the verbal messages. As a receiver, you must point out to the sender that you are receiving two different messages.

Examples of Incongruent Messages • • A red-faced agitated patron comes into the pharmacy, raises a fist, and loudly proclaims, “I’m not angry, I’m just here to ask about a prescription error.” • • A disappointed pharmacist has tried, so far without success, to convince a physician to change an obviously inappropriate medication order. When asked how he is feeling, he meekly replies, “Oh, I’m just fine.” • • A patient hands a pharmacist a prescription for a tranquilizer, then bursts into tears. The pharmacist asks if anything is the matter, and the patient responds, “No, I’m okay, it’s nothing at all.”

Elements of Nonverbal Communication Important nonverbal elements include: • kinesics (body movement), • proxemics (distance between persons trying to communicate), • the physical environment, and • potential distracting elements of nonverbal communication.

KINESICS • The manner in which you use your arms, legs, hands, head, face, and torso may have a dramatic impact on the messages that you send. In general, individuals from various societies use different body movements to communicate certain messages. In this country, for example, it is common for two men to shake hands when meeting each other. A handshake is a way by which we nonverbally indicate friendship or acceptance of the other person. The handshake stems from much earlier times when a man who extended his hand to another was communicating the fact that he held no weapon to do harm. However, in some cultures it is more appropriate to bow to each other rather than shake each other’s hand.

As a health care professional, you need to generate a feeling of empathy and commitment to the helping of others. It is apparent, therefore, that your body movement or kinesics should complement this role. An open stance can nonverbally communicate sincerity, respect, and empathy for another person. The classic example of an open posture is standing (or sitting) with a full frontal appearance to the other person. As an open communicator, you should also have your legs and arms comfortably apart (not crossed), and a facial expression that expresses interest and a desire to listen as well as speak.

A closed stance occurs when you have your arms folded in front of your chest, legs crossed at the knees, head facing downward, and eyes looking away from the patient. If you hold this posture during an interaction, the other person may respond in a similar non-communicative manner or may break off the interaction altogether. Communication from a closed posture may shorten or halt further productive interactions. Sometimes it is appropriate to use a closed posture, for example, when you want to limit the interaction with an overly talkative person.

The key is to be aware of your tendency to close off communication through your body movements. For example, if during a consultation you suddenly have the impression that the patient is no longer interested in speaking with you, examine your body position to see whether it appears to be defensive.

Key Components of Kinesics • • Varied eye contact (consistent, but not a stare) • • Relaxed posture • • Appropriate comfortable gestures • • Frontal appearance (shoulders square to other person) • • Slight lean toward the other person • • Erect body position (head up, shoulders back)

PROXEMICS • The distance between two interacting persons plays an important role in nonverbal communication. Proxemics, the structure and use of space, is a powerful nonverbal tool. Behavioral scientists have found that the quality of interactions can vary depending upon the distances between the communicators.

In many cultures, people reserve the most protected space (within 18 inches from their bodies) for others with whom they have close, intimate relationships. When someone else ventures into this space during a conversation, people may experience anxiety and perhaps anger at the trespass of their intimate zone.

Most people in the United States tend to be more comfortable when a distance of 18 inches to 48 inches is maintained between other individuals. At this distance, casual personal conversations normally take place. Interpersonal distances of more than 4 to 6 feet are generally reserved for public rather than private communication. Further distances would not be appropriate for patient counseling, especially if other individuals are within earshot of the conversation.

Thus, you must consider the distance factor whenever you consult with patients. You want to stand close enough to ensure privacy, yet at the same time provide enough room so that the patient feels comfortable. You do not want to invade a patient’s intimate zone nor conduct the counseling session in the public zone. Patients usually indicate nonverbally whether they feel comfortable with the distance by either stepping backward or leaning forward.

ENVIRONMENTAL NONVERBAL FACTORS • A number of environmental factors play important roles in communicating nonverbal messages to patients. For example, the colors used in the pharmacy’s decor, the lighting, and the uses of space all have been documented as important nonverbal communication factors.

Within the community practice setting, the use of the prescription counter is an important environmental factor. • The counter and related shelving serve to keep the prescription dispensing process from the public’s view. However, they can also serve as communication barriers if they inhibit your interaction with your patients.

When appropriate, step to the side of the prescription counter or from behind the counter to communicate a genuine interest in talking with patients about their medications. • In addition, the presence of a private consulting area may indicate to your patients that you are interested in counseling them in a private manner.

The general appearance within the pharmacy setting conveys nonverbal messages to patients. Dirt, clutter, and general untidiness carry negative nonverbal messages. These messages influence patient perceptions about your professional role and your level of interest in serving your patients.

For example, counseling around I.V. boxes in a room that doubles as a storage room in an outpatient clinic will likely be perceived by a patient to be a very unprofessional encounter.

Distracting Nonverbal Communication • One of the most distracting nonverbal elements is lack of eye contact. It is frustrating to talk to somebody who is not looking at you. Unfortunately, many pharmacists unconsciously do not look at patients when talking to them. Their tendency is to look at the prescription, the prescription container, the computer screen, or other objects while talking.

This behavior may indicate to patients that you are not totally confident about what you are saying or that you really do not care about speaking with them. Not looking at the patient also limits your ability to assess whether the patient understands the information. In other words, lack of eye contact limits your ability to receive feedback from the patient about the messages that you are giving.

For instance, does the patient have a questioning look, an expression of surprise, or an expression of contentment and understanding?, good eye contact is also essential for effective listening. If you do not look at patients while they are talking, they may get the impression that you are not interested in what they are saying. • Using good eye contact does not mean that you continually stare at patients, because that may make them feel uncomfortable as well. The key is that you spend most of the time looking at them.

Another potentially distracting nonverbal element is facial expression. An inadvertent facial expression may send a message that you did not intend to transmit. For example, if you roll your eyes as a patient explains something to you, you may be communicating a feeling of disinterest or lack of concern toward the patient. This is especially damaging when your facial expressions are not consistent with your verbal expressions.

For example, if you say, “Go ahead I am listening, tell me about it!” but your eyes are distracted by something else in the pharmacy, you may be communicating mixed messages. The patient hears you say that you are interested, but your nonverbal behavior communicates otherwise. In these situations, people would tend to believe your facial expression and other nonverbal messages more than the verbal aspects of your communication.

In addition to facial expression, body position can be somewhat distracting. Most patients will judge your willingness to talk to them based on their perception of your body position. For example, a closed stance with folded arms or a body position that is slouched forward or tilted to one side may be communicating reluctance on your part to talk with them. You must be aware of your body position. Does it project your sincere desire to talk with your patients or does it show a lack of concern or interest?

Another potential distraction to communication may be your tone of voice. People interpret the message not only by the words you use, but also by the tone of voice you use. For example, a comment in a sarcastic or threatening tone of voice will produce a different effect than the same phrase spoken with an empathic tone. In addition, conveying a message in a dull, monotone voice may convey a lack of interest on your part. An inappropriate tone of voice may create an entirely different meaning from the one intended.

Nonverbal Communication