LS CH 2 Communication PDF

7589_Ch04_043-052 29/08/17 12:04 PM Page 43 CHAPTER 4 Communication Key Words Chapter Outline feedback listening message method nonverbal communication receiver sender social communication therapeutic communication verbal communication The Communication Process Types and Styles of Communicatio...

7589_Ch04_043-052 29/08/17 12:04 PM Page 43 CHAPTER 4 Communication Key Words Chapter Outline feedback listening message method nonverbal communication receiver sender social communication therapeutic communication verbal communication The Communication Process Types and Styles of Communication Eight Modes of Nonverbal Communication Personality Types Passive or Unassertive Aggressive Assertive Social Versus Therapeutic Communication Styles Therapeutic Communication Six Components of Therapeutic Communication Three Phases of Therapeutic Communication Orientation Phase Working Phase Termination Phase Factors Affecting Communication Congruence Time and Setting Proxemics Biases Physical Handicaps Blocks to Communication Techniques Used to Enhance Communication Summary Critical Thinking Multiple-Choice Questions Student Activity Learning Objectives A t th e e n d of th i s ch ap te r , y ou s h ou l d b e ab l e to: • • • • • Define communication. Describe the difference between verbal and nonverbal communication. Distinguish between social and therapeutic communication. List responses that block effective communication. Name techniques for effective communication. 43 7589_Ch04_043-052 29/08/17 12:04 PM Page 44 44 Journey Across the Life Span Communication is an interaction between two or more persons—an exchange of information, ideas, feelings, or emotions. Communication is complex, dynamic, and ongoing. In the health care setting, communication serves as a vital link among patients, families, nurses, physicians, and other health care workers. The development of communication is a continuous process. Communication begins during infancy and is a necessary part of our existence. Communication and language acquisition will be further explored in the chapters that follow. THE COMMUNICATION PROCESS The communication process (Fig. 4.1) consists of five parts: message, sender, method, receiver, and feedback. The message is the expression of your thoughts and feelings in words, symbols, or body language. The sender delivers the message by initiating the conversation. Factors that determine how the message is developed are varied. These include the sender’s knowledge base—his or her past experiences. The method used to convey the message is determined by the sender and can be words or symbols or a combination of both. The receiver is the person to whom the message is sent. The receiver must interpret and reconstruct the message. How the receiver interprets the message will be influenced by his or her age, knowledge, and past experience. Age, feelings, attitudes, and emotions also shape how the message is sent and received. Feedback is the response to the message. Feedback is necessary because it serves to verify that the message was received as intended. FIGURE 4.1 The communication process. TYPES AND STYLES OF COMMUNICATION There are two basic types of communication— verbal and nonverbal. Verbal communication transmits attitudes, thoughts, and feelings using spoken or written words. Much of the meaning of words depends on the person’s understanding of the words, how the words are used, and the individual’s emotional state. Culture may influence the meaning of words. Nonverbal communication is also referred to as body language. Individuals may choose to use body language to emphasize their thoughts or feelings, and they may use gestures without being aware of doing so. The nonverbal method of communication is partly learned and partly instinctive. It is the most accurate method of sending a message. Eight Modes of Nonverbal Communication The eight modes of nonverbal communication include the following: 1. Physical appearance and dress. The way a person appears may give information about his or her mental, physical, and emotional states. Dress may also indicate a person’s work role, culture, or religion. For example, seeing a young man wearing a collar sends the message that he is a clergyperson. A person’s choice of colors or adornments such as jewelry, lipstick, and perfume, or the lack thereof, may reveal additional information. Persons who are depressed rarely take interest in their appearance or wear makeup. A nurse whose appearance is professional communicates competence and pride, whereas a caregiver whose appearance is unkempt may communicate incompetence and a lack of care. 2. Body movement and posture. Body movement and posture can convey many different messages. The way in which individuals position their bodies when they sit, stand, or move communicates messages such as self-esteem and attitude. • A person whose posture is open sits relaxed, with hands and legs uncrossed, facing another individual. This open posture communicates warmth, caring, and willingness to communicate. • A closed posture is best demonstrated by a person who sits with arms and legs tightly crossed. This position generally communicates 7589_Ch04_043-052 29/08/17 12:04 PM Page 45 Communication 3. 4. 5. 6. 7. coldness, disinterest, and nonacceptance. Other postures, such as standing over someone, may convey authority and control. A slumped posture with head and eyes cast downward can suggest low self-esteem. Anger or anxiety is implied by a tense posture. Facial expression. Next to speech, facial expression is the primary source of human communication and is universal to all cultures. Facial expression communicates sadness, happiness, anger, fear, and surprise. Facial expression serves to complement or qualify feelings. Children can often tell if their mother is angry or upset just by looking at her facial expression. Gestures. Moving body parts can indicate feelings. For example, one of the first things babies learn and understand is the simple gesture of waving good-bye or shaking their head for yes or no. Pain and anxiety can be communicated by the wringing of one’s hands or pacing. Eye contact. The eyes are referred to as the “windows to the soul.” Eye contact can suggest a willingness to communicate. To show respect, some cultures avoid direct eye contact. Staring can cause anxiety and is usually used to register disapproval or power, whereas lack of eye contact can suggest shyness, embarrassment, or nervousness. Tone and volume of voice. Tone and volume of voice can express enthusiasm, sadness, annoyance, or anger. Speaking in a low volume may give the impression of hesitancy or lack of interest. Speaking loudly can be used to overcome the listener’s hearing impairment. However, it is best to use low- rather than high-pitched tones for most hearing impairments. Touch. Touch is a powerful communication tool that elicits positive or negative reactions. Touch is basic and primitive. It begins in infancy and helps an infant feel comforted immediately after birth. Touch is one of the most important tools we use to convey human emotions. Kissing, hugging, and patting the hand or cheek are several ways of showing affection (Fig. 4.2). It is important that touch be used appropriately in each situation. Hugging or touching can be an appropriate greeting for someone you know but inappropriate for a stranger. Sudden touching can be threatening. Inappropriate touch can be viewed as an invasion of privacy or as a sexual advance. Children should be taught at an early age what is appropriate or inappropriate touching. 45 FIGURE 4.2 Touch conveys human emotions. 8. Silence. Silence conveys different messages depending on the accompanying gestures and body posture. Silence between individuals can provoke thought or anxiety. Silence can indicate acceptance, evasion, fear, uncertainty, anger, rebelliousness, or rejection. Some individuals think that they must always have something to say, making periods of silence uncomfortable. However, short periods of silence can be used to put thoughts and feelings into perspective. Personality Types Passive or Unassertive Individuals with the passive or unassertive personality type are unable to share their feelings or needs with others. They have difficulty asking for help. They often feel hurt or angry and that others are taking advantage of them. They use apologetic words; have weak, soft voices; make little eye contact; and are often fidgety. They usually are compliant, ask for nothing, and get little attention. They usually sacrifice their rights to meet the needs of others. Aggressive An aggressive personality style is very destructive. These individuals use angry vocalization to dominate H E L P F U L Listening Is • • • • Sensing Interpreting Evaluating Responding H I N T S 7589_Ch04_043-052 29/08/17 12:04 PM Page 46 46 Journey Across the Life Span and harm other people. They may lack concern for others and often put their own needs first. They are demanding and manipulative. Assertive Persons who are assertive are empowered. They express confidence and are comfortable sharing their feelings. They use a firm voice with appropriate eye contact. They take responsibility for the consequences of their actions and behave in a manner to enhance self-respect. Assertive types encourage listening and reflect on the feelings of others. Social Versus Therapeutic Communication Styles Individuals can engage in two levels of communication in their interactions with others: interpersonal and intrapersonal. They may exist together or they may be used alone. Intrapersonal communication occurs when one is thinking to himself or herself. The purpose of these thoughts is to help control an emotional response. What a person is thinking affects how he or she will interact with others. Negative thoughts can result in negative interactions and may affect the individual’s relationships. Positive thoughts can help make our responses more pleasant and optimistic. Interpersonal communication occurs between two or more individuals. Communication at this level varies with the type of relationship. In the nurse–patient setting the interpersonal communication is goal directed and purposeful, whereas between friends the communication is less purposeful. These two styles of communication are known as social and therapeutic. Social communication is used in everyday life between family, friends, and coworkers. It serves the needs of participants (Fig. 4.3). It is sharing of thoughts, feelings, needs, and desires. Social communication is light and superficial. Therapeutic communication is the type used in professional nursing care, and it is discussed in detail in the next section. THERAPEUTIC COMMUNICATION FIGURE 4.3 Social communication. patient and among the nurse, patient, and/or family members. Six Components of Therapeutic Communication 1. Listening and observing. Messages are sent in the cognitive or affective domains, or both. The cognitive domain is the message expressed in words. The affective domain expresses feelings through the tone of words. Listening can be active or passive and involves the interpretation of the spoken word. Listening also requires more than just hearing the words spoken. It requires that the listener consider both the verbal and nonverbal message. Distraction occurs when the listener is not concentrating. Active listening is outlined in Box 4.1. 2. Warmth. Warmth is a feeling of cordiality and acceptance that makes the person feel relaxed and secure. 3. Genuineness. Genuineness is being yourself— open and truthful. It is important to be honest B O 4.1 Therapeutic communication is purposeful and goal oriented. It promotes trust and good rapport with others. It is open until the goals are reached. Health care professionals use this style of communication in their work interactions. Therapeutic communication is used between the physician and • • • • • X Co mpo nents o f Activ e L istening Sitting squarely facing the patient Using an open posture Leaning forward toward the patient Establishing eye contact Relaxing and concentrating 7589_Ch04_043-052 29/08/17 12:04 PM Page 47 Communication and say you do not know or are not sure of the answer. Being genuine means being caring. 4. Attentiveness. Attentiveness is concentrating on what the other person is saying to demonstrate that he or she has your full attention. 5. Empathy. Empathy shows that you understand a person’s feelings and view the world as he or she does. Empathy is different from sympathy; in the latter, you adopt the other person’s feelings. You lose your objectivity when you are sympathetic instead of empathic. Showing empathy allows you to stay in control of the interaction and act with confidence. This can be reassuring to the other party. 6. Positive regard. Positive regard is demonstrated by accepting the patient exactly as he or she is. This requires you to be nonjudgmental. The other person must be valued and respected. Positive regard may be another term for caring. It serves to make a person feel secure. Showing such acceptance does not mean you need to agree with the other person. Functions of therapeutic communication are listed in Box 4.2. contract is established. The goal is to build trust. Trust is built slowly. Working Phase In the working phase the nurse determines the type of coping mechanisms that the client is using and what support systems exist. The nurse can then develop a plan of care and establish realistic goals. The plan of care is implemented to promote independence and optimal functioning. The client has a fundamental right to expect confidentiality from all members of the health care team. The client must be assured that the information shared will not go beyond the members of staff directly involved in his or her care. If this phase is successful, the client can share and explore thoughts and feelings and work toward a change in behavior or possible solution. Termination Phase The termination phase is the end of a relationship. Ideally it involves evaluating and synthesizing what has occurred and preparing for separation. At the termination phase, it is important to think and ask yourself, “Has the person been helped?” Three Phases of Therapeutic Communication FACTORS AFFECTING COMMUNICATION Orientation Phase In the orientation phase both the nurse and client will initially experience some anxiety. As a nurse, you can reduce this anxiety by introducing yourself and giving your title. This can be followed by a broad opening statement that helps set the tone and allows for an exchange of words. During the orientation phase, you learn about the individual and his or her initial concerns and needs. You listen to the patient and learn by observing. At the same time, the patient learns about you and your role, and a Congruence B O 4.2 X F u n c t i on s of T h er ap eu t i c C om mu n i c at i on • Create an understanding with the individual to effect a change. • Decrease anxiety by allowing others to talk about themselves and their feelings. Individuals cope with their feelings in different ways. Communication must be modified to meet each individual’s needs. • Provide information. • Develop trust and show caring by answering questions honestly. 47 Congruence implies an agreement between the verbal and nonverbal language. It is important that the spoken word match the nonverbal communication. When congruence occurs, the message is clear to the receiver. H E L P F U L H I N T S Rules of Listening • • • • • • • • • • • • Do not talk while listening. Assume an open, relaxed posture. Focus on what the person is saying. Listen to understand rather than to respond. Secure a quiet environment, free of distraction. Show caring and understanding. Validate the other person’s feelings. Do not criticize. Accept the person as he or she is. Be nonjudgmental. Ask open-ended questions. Rephrase questions to help verify the accuracy of the conversation. 7589_Ch04_043-052 29/08/17 12:04 PM Page 48 48 Journey Across the Life Span Time and Setting Time is very important in most Western cultures. Time is concerned with what precedes and follows an interaction. It is important not to promise that something will occur within an unrealistic time frame. Setting includes the physical environment in which communication takes place. Setting should be private and free from noise and distraction. Individuals should be comfortable in the setting used for meaningful conversation. Always ask for permission to have someone else present during an interview or private conversation. Proxemics Proxemics refers to how close a person can get to another individual before he or she begins to feel uncomfortable. Individuals need their own personal space. The amount of personal space varies with a person’s age, sex, and culture. B O 4.3 X M ulticultural Co mmunicatio n • Have the individual define his or her health care practices and beliefs. • Respect cultural traditions and dignity of others. • Listen to the language and words and provide a translator as needed. • Avoid stereotyping. • Recognize the individual as unique with individual needs. • Help individuals make informed choices. • Keep one’s personal beliefs to oneself. • Be open and aware. • Identify the level of comprehension. • Request feedback to gauge level of understanding. • Give written handouts in the person’s primary language. • Remember, nonverbal communication may be understood by all. Biases Common blocks to communication include the following: Bias is a word used to describe a prejudice or a negative belief about someone or something. Most often these types of beliefs are not based on fact or evidence but rather on ignorance. To avoid biases you must know yourself and gain insight into your personal feelings. This process is called becoming selfaware. Achieving self-awareness is a lifelong process. Ask yourself what motivates your interest in helping others. Determine how you feel about other people’s cultures. Learn to respect all cultures. Always try to look at things from the other person’s cultural perspective. Box 4.3 offers suggestions for multicultural communication. • Belittling is using a statement that dismisses or mocks a person’s beliefs or fears. For example, a 3-year-old child says he is afraid of monsters. His mother responds by saying, “You’re acting like a baby. There are no monsters.” Or a patient says, “I won’t leave here alive.” The nurse responds, “That’s ridiculous. You shouldn’t even think that way.” • Disagreeing is giving a response that indicates you believe the other person is incorrect. When you disagree with someone, it causes the person to feel angry and become defensive. For example, a teenage girl tells her mother that her boyfriend is terrific. Her mother replies, “I think he’s a loser. You can do better.” Or a patient says, “Why am I here? Nothing is being done for me, and I’m not getting any better.” The nurse responds, “You are getting better.” • Agreeing is using a statement to show that you believe what the person is saying is correct. This technique cuts off the conversation, making the other person’s concern seem unimportant. For example, a person tells her neighbor that she is thinking of divorcing her husband. The neighbor replies, “I’d get rid of him too.” Or the patient says, “I am afraid the doctor won’t send me home tomorrow.” The nurse responds, “I am sure you are correct. I doubt he will let you go home so soon.” • Defending is responding with a statement of justification or a counter-reply to a verbal attack. Physical Handicaps Physical handicaps, such as problems with sight, hearing, or illness, can interfere with an individual’s ability to properly communicate. When communicating with a patient who is visually impaired, tell the patient where you are and what you are doing before touching him or her. When communicating with an individual who is hearing impaired, it is best to speak slowly, face the person, and use sign language to emphasize the message. BLOCKS TO COMMUNICATION Blocks to communication are words or actions people use to obscure the messages they are sending. 7589_Ch04_043-052 29/08/17 12:04 PM Page 49 Communication • • • • • For example, a teenage boy says he doesn’t get as much allowance as his friends do. His father replies, “I do the best that I can.” Or the patient says, “I had my call light on for 15 minutes.” The nurse responds, “I am doing the best I can. You are not the only patient here.” Stereotyping is offering an insincere statement. It is using clichés that keep the conversation superficial or never looking for any additional information or clarification. For example, a person says, “I know what is happening to you” or “All 2-year-old children are terrible.” Or the patient says, “I am really worried about the children. I came to the hospital so quickly and didn’t get to see them. They just won’t understand. I wish I could talk to them.” The nurse responds, “I know exactly what you are going through. I know what’s happening to you.” Giving false reassurance is offering a statement of reassurance without sincerity or justification. This technique causes the other person to feel unimportant and unworthy of your concern. Reassurance is most effective when it is valid and appropriate. For example, someone says, “Don’t worry. Everything will be all right. You will feel better soon.” Or the patient says, “What will I do if this is malignant?” The nurse responds, “Don’t you worry. Everything will work out just fine.” Giving advice is telling another person what you think they should do. By giving advice, you are implying that you know what is best for the individual, thereby making it more difficult for the person to know what is right for himself or herself. An example of giving advice is saying, “If I were you . . .” or “Why don’t you . . .” or “I think you should . . .”. Or the patient says, “I broke my arm when I fell off a skateboard.” The nurse says, “At your age, I would suggest you give up skateboards.” Changing the subject minimizes the significance of the speaker’s feelings by introducing a new topic. This makes the other person feel that his or her concern is unimportant. For example, a patient says, “They are doing a biopsy tomorrow. I hope it isn’t cancer.” The nurse responds, “Are these pictures of your children? They are such a nice-looking family.” Asking closed-ended questions should be avoided in therapeutic communication because they encourage a one-word answer of yes or no. This technique does not allow the individual to further explore concerns or feelings. 49 • Asking “why” questions often increases a person’s uneasiness by demanding an immediate answer. Sometimes individuals will make up an answer to a “why” question to get off the hook. They simply tell you what they think you want to hear. • Probing is questioning that seeks information beyond what is necessary. It can be very invasive and threatening. TECHNIQUES USED TO ENHANCE COMMUNICATION • Giving information helps the patient know who you are, what you are doing, and what you need from him or her. The information explains the purpose of the communication process and decreases the patient’s anxiety. • Validating is making a statement or question that attempts to verify your perception of the person’s verbal and nonverbal message. In essence, you are determining whether the person’s needs have been met. An example is saying, “Has the diarrhea stopped?” • Clarifying is clearing up possible misunderstandings or seeking information necessary for your understanding. Clarification can help keep another person on the topic. The nurse should never pretend he or she understands what the patient is saying if the message is not clear. An example is asking, “Could you explain?” or saying, “I am not sure I understand.” You might need to ask, “Who are ‘they’?” A patient says, “There is no point in asking for pain medication.” The nurse responds, “Are you saying no one gives you medication when you have pain, or do you mean the medication doesn’t help your pain?” • Reflecting is stating your perception of another person’s message in the affective (feeling) domain. This puts the patient in control and promotes self-esteem by allowing him or her to get in touch with feelings and find solutions for problems. Reflecting on, repeating, or restating other people’s words helps make them aware of the mood, affect, or feeling being expressed. Reflecting is also referred to as flashback. However, it is best to avoid negative comments or those that can reinforce guilt, hostility, or depression. For example, a patient says, “My sister won’t help with our mother’s care.” The nurse responds, “You feel angry. Have you discussed this with her?” 7589_Ch04_043-052 29/08/17 12:04 PM Page 50 50 Journey Across the Life Span • Paraphrasing or restating is using similar words for what the other person just said. This technique is used to determine whether you understand what the other person means. It can reflect part of or the whole theme that was originally expressed. For example, a patient says, “I was awake most of the night.” The nurse replies, “You have trouble sleeping.” Or the patient states, “I couldn’t eat supper last night.” The nurse responds, “You had difficulty eating.” • Asking broad questions is using open-ended questions. These questions are used to encourage individuals to share their feelings about a specific topic. An example is saying, “Would you like to tell me about it?” or “Is there something you would like to talk about?” • Using general leads is giving one- and two-word responses to encourage the person to continue talking. Examples are, “Go on,” “And then?” or “You were saying.” • Stating or making an observation helps to acknowledge and verbalize thoughts and feelings. This technique is similar to clarification. Examples are “You seem tense” or “You are trembling.” • Offering self when the patient will not talk or when the situation is highly emotional and words cannot adequately convey the message being transmitted is accomplished by listening in silence or touching. The nurse might sit with the patient. Other examples are saying, “I’d like to understand” or “I’ll stay awhile if you’d like.” • Focusing is a way of directing the conversation to a specific topic when you are seeking more information on a poorly defined topic. It requires total concentration on what the patient is saying without preoccupation or a wandering mind. • Using humor that does not demean can serve to decrease anxiety, help a person face stress, increase a person’s tolerance to pain, and build a trusting relationship. Laughter, the best medicine, also shows the nurse as human. Studies have shown that laughter can improve mood, decrease pain, lower blood pressure, and enhance the immune system. H E L P F U L H I N T S Interpersonal Skills • Use good judgment in choosing humor. The same joke is not for everyone. • Avoid cultural, ethnic, sexual, or religious jokes. • Use humor sparingly until you know the person. Tips for Good Communication Skills • • • • • • Approach the individual with a positive attitude. Minimize distraction and interruption. Face the person conversing with you. Position yourself at eye level. Lean forward as you listen. Use body language that shows interest, such as nodding. • Rephrase as needed. • Clarify to keep the focus. • Use touch and silence as needed. SUMMARY 1. Communication is an interaction between two or more persons. It is the exchange of information, ideas, feelings, or emotions. 2. The communication process consists of five parts including the message, sender, method, receiver, and feedback. 3. There are two basic types of communication— verbal and nonverbal. 4. There are eight modes of nonverbal communication: • Physical appearance and dress • Body movement and posture • Facial expression • • • • • Gestures Eye contact Tone and volume of voice Touch Silence 5. A person with a passive or an unassertive personality style is unable to share his or her feelings or needs with others. 6. The aggressive personality style is very destructive. These individuals use angry vocalization to dominate and harm other persons. 7. Assertive persons are empowered and are comfortable expressing their feelings. 7589_Ch04_043-052 29/08/17 12:04 PM Page 51 Communication 8. There are two styles of communication— social and therapeutic. 9. There are six components of therapeutic communication: • Listening and observing • Warmth • Genuineness • Attentiveness • Empathy • Positive regard 51 11. Several factors influence communication, including congruence, time and setting, proxemics, biases, and physical handicaps. 12. Blocks to communication are words and actions people use that tend to obscure their messages. 10. The three phases of therapeutic communication are the orientation phase, the working phase, and the termination phase. 13. The techniques that are used to enhance communication include validating, clarifying, reflecting, paraphrasing or restating, asking broad questions, using general leads, stating or making an observation, offering self, focusing, and using humor. CRITICAL THINKING Therapeutic Nontherapeutic Using general leads Focusing Reflecting Clarifying Giving advice Stereotyping Belittling Disagreeing Using this list, identify which communication technique is being described: “You’re in love with that man?” ______________________________________________ “Continue. I’m listening.” ___________________________________________________ “You’re saying that you are not happy about . . .”________________________________ “What about school is troubling you?” ________________________________________ “All women in their 40s feel that way.” ________________________________________ “Perhaps you can describe how you felt when . . .” ______________________________ “You better drop out of college before it’s too late.” _____________________________ MULTIPLE-CHOICE QUESTIONS 1. When communicating with a patient from a different culture, the health care worker should: a. Limit the time spent with the patient b. Know that less emphasis should be placed nonverbal messages c. Keep personal beliefs to oneself d. Encourage the patient to change cultural practices and beliefs 2. One of the goals of communicating with a hospitalized patient is to: a. Help the patient make informed decisions b. Make medical decisions for the patient c. Act as a conduit for information between the patient and family d. Teach the coping methods and behavior expected of inpatients 7589_Ch04_043-052 29/08/17 12:04 PM Page 52 52 Journey Across the Life Span 3. Communication is the: a. Last step in the nursing process b. Most vital link between diagnosis and disease c. Exchange of information and ideas d. Basis for all thinking processes 4. A health care worker’s professional appearance should communicate: a. Incompetence b. Lack of concern c. Knowledge d. Acceptance 5. Which of the following describes nonverbal behavior? a. Written word b. Spoken word c. Tone of voice d. Aggressive style 6. Periods of silence during the communication process allow the health care worker to: a. Redirect the client b. Observe nonverbal behavior c. Relieve the client’s anxiety d. Minimize rejection 7. Assertive personality types are described as: a. Unable to share their feelings b. Making little eye contact c. Putting their own needs first d. Acting confident and being responsible for their actions 8. Gaining insight into your personal feelings is an example of: a. Empathy b. Bias c. Proxemics d. Self-awareness 9. You overhear Jane telling her mother that she is “afraid to ride over the bridge.” Jane’s mother responds, “Don’t be silly. Let’s go.” This statement is an example of: a. Stereotyping b. Belittling c. Giving advice d. Giving false reassurance 10. You are the nurse assigned to a well-baby clinic. A mother comes with her 6-month-old infant for a well-baby checkup. The mother has been a resident in the United States for only a short time, and she speaks and understands very little English. The best action for you to take is to: a. Speak very slowly b. Attempt to use a foreign language dictionary c. Assume she understands if she does not ask any questions d. Arrange for a translator for the next visit Visit www.DavisPlus.com for Student Resources. Student Activity Communication Observation Listen to and observe 10 minutes of an interchange between two adults speaking to one another at school, church, or work. Answer the following questions after your observation. 1. What verbal or nonverbal behavior, or both, did you observe? 2. Based on your observations, what feelings were expressed? 3. What inconsistencies did you observe between the verbal and nonverbal communication during the exchange?