Perception is a process by which the meanings of messages are interpreted. The way messages are perceived is related to a combination of a person’s social and cultural influences, gender, educational background and knowledge, and past experiences (Schuster 2010). This complex mix of influences means that no two people are likely to perceive the same message in exactly the same way. Some of the strongest influences on the way messages are sent and their meanings perceived are the attitudes, values and beliefs that individuals hold (Van Der Molen & Gramsbergen-Hoogland 2005). Clinical Interest Box 6.1 demonstrates communication in process. Attitudes, values and beliefs
Attitude is the way one person behaves towards another. A person’s attitude can be positive, or negative and unpleasant. An unpleasant attitude in the workplace makes other people feel uncomfortable and it is detrimental to the wellbeing of clients (Pullen 2007). Attitude can be influenced by what is happening in a person’s life. For example, a fight with a friend may create feelings of anger or distress. Such feelings can be reflected in a negative, even hostile, attitude towards others, which can change the way messages are transmitted and received. Nurses have a professional responsibility to maintain a positive attitude towards clients at all times, so every effort must be made to put personal concerns and feelings aside when communicating with clients, relatives and other health professionals in the workplace (Thomas et al 2009). Attitude towards others is also related to the values and beliefs that a person holds about the ideas or practices of other people in society, and they are not always consciously recognised.
For example, cultural values commonly lie outside conscious awareness and are often simply taken for granted as being the right values (Ellis 2009). It is natural for people’s values and beliefs to differ within and across social and cultural groups. Nurses will encounter many situations in which their own cultural values and beliefs differ from those of clients (see Ch 8). Tolerance and understanding of differences in views and cultural practices helps to facilitate therapeutic relationships between nurses and their clients (Pullen 2009). For example, a nurse who holds strong values and beliefs about no sex without marriage will need to demonstrate acceptance that personal views are not shared when caring for a pregnant, single, female client.
If the nurse is unable to accept this and put personal views to one side, it will be difficult to communicate with the client in a therapeutic manner (Pullen 2009). While a nurse’s personal values can create interference in therapeutic relationships if they are imposed on clients or used in judgment, they can also serve to enhance therapeutic effects. For example, a nurse who holds beliefs that all people have positive qualities and that every individual is a worthwhile person will find that such beliefs enhance the establishment of effective therapeutic relationships (Schuster 2010). Differences in knowledge
When the level of knowledge between two people is different, communication can be difficult. For example, an individual’s level of knowledge may be so far above that of the person being spoken to that the meaning of the message may be lost entirely (Ellis 2009). The nurse must take care to express messages in words and phrases that will be understood. For example, a nurse who is familiar with nursing or medical language, especially jargon, may forget that a client may not be, and if words or phrases are used that are not part of the client’s vocabulary the message may be misinterpreted. The use of specific language that is familiar to members of a subculture or profession may confuse, frighten or alienate people who are not part of that subculture or profession. For example, not every male client will know what the nurse means when asked, ‘Do you need a bottle?’ The word bottle is nursing jargon used to describe a portable male urinal but it could easily be perceived as meaning something entirely different. Past experiences
Past experiences can have a powerful effect on a person’s perceptions of the meaning of messages. For example, a client who has had a previous traumatic and painful experience in hospital may discount, distrust or disbelieve messages from the nurse that pain after surgery will be controlled. The nurse can help by talking with the client about the past experience and explaining fully every measure that will be implemented to ensure adequate pain relief (Schuster 2010). Emotions
Emotions strongly influence how a person relates to other people, and the power of emotion in communication should not be underestimated (Schuster 2010). Nurses must also be aware that if they become too emotionally involved with the suffering experienced by a client, they may be unable to effectively meet that client’s needs. This aspect is one of the most difficult situations faced by nurses, as on the one hand nurses must become emotionally involved to assist clients, while on the other hand personal emotions cannot be allowed to adversely affect client care (Bach & Grant 2009). All nurses need to be aware of their emotions, and many find it helpful to talk with other experienced nurses about what they are feeling and experiencing. It is also important to realise that, if people cultivate ‘emotional distance’ in an interpersonal interaction, they prevent any deep sharing of meaning and may even arouse animosity.
For example, if a client feels that a nurse is treating them as an ‘interesting case’ or a ‘problem’ rather than as a person, they are likely to feel resentful, and therapeutic communication is not likely to occur. It is not unusual for clients to be anxious or upset, and strong emotions interfere with the ability to absorb the information in messages such as those given by medical officers or nurses. There would be little point, for example, in a medical officer informing a client about treatment plans immediately after telling her that her breast biopsy revealed a malignant breast tumour. It would not be surprising if the client’s anxiety level increased to such an extent on hearing the diagnosis that it prevented her from absorbing any of the following information about the proposed treatment. The nurse can help in this situation by ensuring the information is repeated when the client is less anxious or distressed and by providing the information in written form for the client to absorb more effectively at a later time (Schuster 2010).