In a study aimed at exploring how communication affects issues relating to residents maintaining cognitive and physical functioning in order to remain in the residence, vocalics were perceived by the nurses as rudeness, disinterest, “infantilisation” and “adultification” [55]. Sørensen AL. Communication of nursing students in listening to patients in a psychiatric hospital. Wiechula R, Conroy T, Kitson AL, Marshall RJ, Whitaker N, Rasmussen P. Umbrella review of the evidence: what factors influence the caring relationship between a nurse and patient? Student nurses described head nodding as a means to convey their message nonverbally when communicating with older adults [54]. 2011;30(2011):2230–4. 2016;15(5):1–11. Nonverbal communication is used an integral part of the communication between individuals. Kinesics was reported in 14 studies [19, 30, 48,49,50, 53, 54, 56, 57, 59,60,61] of which 8 studies, which underwent quality appraisal, were of high quality. Cite this article. Non-verbal communication is also a way for effective communication since a patient’s body language, gestures, touch and even facial expressions say a lot about how the patient is feeling. It almost goes without saying that we have to give clear attention to what we say to patients/clients. Importance of Body Language in Nursing Communication March 5, 2017. Johnsson A, Boman Å, Wagman P, Pennbrant S. Voices used by nurses when communicating with patients and relatives in a department of medicine for older people—an ethnographic study. The low score was justified by the unpreparedness of nurses about the aging process [49]. During interpersonal relations, like in nursing consultations, the expression of these non-verbal signs can be … Williams KN, Boyle DK, Herman RE, Coleman CK, Hummert ML. PubMed  Kaakinen J, Shapiro E, Gayle BM. Preparation of the neophytes will ensure a sustainable, older-person centered and appropriately trained workforce as advocated by the WHO (2016) [43]. The JBI framework of Population, Concept, Context (PCC) was used to determine the eligibility of the research question for this review (Table 1).,,,, Physical appearance was not mentioned in any of the included studies; yet, the clothing worn in nursing is a form of NVC that frequently shapes people’s judgments about others, regardless of whether or not the perceptions are true [74]. In the included studies, touch was used to joke, to praise, to get attention, to convey attention, to stimulate, and to show care. Nurses also kissed older adults, hugged them or gave them a pat on the shoulder. Int J Soc Res Methodol. Article  This article examines what counts as effective communication from the perspec- Social Barriers to Effective Communication in Old Age. 2017;21(3):1-6. Grey literature and 11 databases were systematically searched for studies published in English and French, using search terms synonymous with nonverbal communication between nurses and older adults for the period 2000 to 2019. Nonverbal interpersonal interactions in clinical encounters and patient perceptions of empathy. Joanna Briggs institute reviewers’ manual: 2015 edition / supplement. to express feelings, attitudes or information.. Privacy Physical appearance regarding NVC was not mentioned in any of the included studies nor was silence. 2008;26(6):333–6. 2002;17(9):45–54. 2011;11(6):395–8. Babikian MY. Prip A, Pii KH, Møller KA, Nielsen DL, Thorne SE, Jarden MJEJON. Adult nursing-patient relationship: Integrative review oriented by the king interpersonal system. J Holist Nurs. Because this study was conducted around the same period with the implementation of nursing diagnoses in the electronic patient record, and the implementation of change is known to be a … 2018;63:18–23. Int Arch Med. Missouri: Elsevier Health Sciences; 2013. Nurses should guarantee privacy and should avoid speaking while wearing a mask as it is considered as an impediment to effective communication [59]. When someone begins to escalate a situation, be sure to use a slow, calm, and low volume for communication. Understanding and acknowledging such signs can prove to be helpful in gaining a deeper insight. Vocalics are often associated with “elderspeak”, which in addition includes oversimplifying the language, speaking at a slow rate, loud, and with a demeaning tone [73]. The primary aim of the study was to identify the type of NVC strategies used by nurses to communicate with older adults in both acute care settings and long-term care settings. Strategies for working with elderly clients: a qualitative analysis of elderly client/nurse practitioner communication. Scoping reviews are useful to map the existing literature around a particular topic by charting findings and identifying research gaps [36], especially when the topic is complex or poorly reviewed [37]. Development and initial validation of the nurses’ comfort with touch scale. Therefore, nurses should be aware that the way they present themselves through their uniforms might indirectly communicate something about the care they render. In one instance, touch was not appreciated by the older adult [52], which highlights that touch can lead to either positive or negative outcomes, depending on the nurses’ awareness and intention [69]. A nurses’ smile was also seen as a way to either convey the message [54], to initiate communication [57] or an attempt to create a positive atmosphere during the meeting with older adults [47]. Deane WH, Fain J. 2005;42(2):159–66. As mentioned above, non-verbal communication allows for the direct expression of feelings and emotions, and its functions are to complement, contradict and replace verbal communication (9). Tables 2 and 3 summarize the characteristics of the 22 included studies. See Figure 2.5. Wold G. Basic geriatric nursing - E-book. South Afr J Gerontol. 2012;26(4):290–308. 2018;27(7–8):e1640–50. Haptics were identified when nurses shook hands with older adults, held their hands, stroked or touched their hands. Design. Does demography matter in nonverbal communication between physician and patient. Haptics were reported in 17 studies [3, 4, 19, 30, 48,49,50,51,52,53,54, 57, 60,61,62,63, 65] of which 12 studies, which underwent quality appraisal, were of high quality. West J Nurs Res. 2015;23(3):364–78. Levac D, Colquhoun H, O'Brien KK. The results of the included studies were summarized, manually coded, and presented using a narrative approach. Vocalics were reported in nine studies [30, 47, 49, 52, 54, 55, 57, 59, 60] where they described different aspects of the voice tone and sense of calm. Non-verbal communication includes body language, such as gestures, facial expressions, eye contact and posture. Importance of nonverbal communication in nursing. PubMed Google Scholar. There was lesser reporting of chronemics and NVC, described in only three studies [19, 61, 65] and only one study eligible for quality assessment was of good quality [19]. Listening was reported in seven studies [4, 51, 54, 56, 58, 61, 65] of which four studies were eligible for quality appraisal and scored 100% on the MMAT assessment. Set limits. Assistance from the study university library services was requested when full texts could not be retrieved from the databases and five full texts were provided. 2014;2014(2):144–53. Developing personal competence in nursing students through international clinical practice: with emphasis on communication and empathy. This systematic scoping review explored evidence on NVC between nurses and older adults, focusing on cognitively intact older adults with no mental illness nor communication impairment. Communication occurs through verbal or nonverbal modalities [12, 13]. Speaking slower was a means for student nurses to be understood by older adults [60], and speaking with a friendly tone was used by nurses to increase the knowledge of older adults [47]. volume 19, Article number: 53 (2020) In: Liamputtong P, editor. 2015;4:1–5. The main question for this review was: What is the evidence of NVC between nurses and older adults? Foram avaliados 14 aspectos da comunicação não verbal. Bensing, Caris-Verhallen and Kerkstra, (1999) believe that there are five non-verbal behaviors found to be essential to the nursing care, eye gaze, head nodding, smiling and body positioning. Artefacts included notes and hands-on learning tools as strategies to improve communication [61] as well as flyers, pamphlets, written instructions, books and education files [65]. In light of the importance of nurses developing self-awareness of the tone that they use to communicate, an opportunity exists for them to use audio recordings to reflect on their tone [3]. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data. The studies eligible for quality assessment were found to be of high quality. Nurses need to be self-aware of their NVC as well as the way in which the meanings of the messages might be misinterpreted, highlighting a need for interventions to aid nurses to interact and communicate holistically with older adults [79]. Available from: Though nurses–patients’ communication is influenced by conditions that arise in hospital settings, [76], nurses need to adjust their communication style to each situation and each patient [77]. It followed (Int J Soc Res 8: 19-32, 2005) framework. While facial expressions such as a smile and laugher were reported to both quickly and amicably resolve disagreements between staff and older adults, smiles were seen as enhancers of the communication in a study where staff occasionally engaged in smiling with older adults [48]. Several studies of NVC between nurses and older adults may have been reported only in contexts of mental illnesses or communication deficiencies, leading to their exclusion from this review. BMC Nurs 19, 53 (2020). Additionally, there were both older adults’ positive and negative responses to nurses’ nonverbal communication behaviors. This study explored evidence on NVC between nurses and older adults with no mental illness nor communication impairment. Nonverbal communication or body language includes physical appearance, physical distance between caregiver and patient, tone of voice, and facial expressions. Conversely, although to no avail, a soft tone was used by a nurse to encourage an older adult to eat her food [57]. Kowal PR, Wolfson LJ, Dowd JE. Touch can be a nursing tool [70], but nurses need to use touch appropriately, taking into consideration preferences and avoiding its imposition on older adults. Kinesics were used when words were in short supply, to convey messages, to indicate acceptance or rejection by either party, to resolve disagreements amicably and with speed, to initiate communication, to get attention, and lastly to praise. Proximity can therefore indicate presence, readiness to listen, and a sign of interest in the older adult. de Almeida RT, Ciosak SI. The results revealed that haptics, kinesics, proxemics, and vocalics were the most frequently used NVC strategies by nurses while there was a limited use of artefacts and chronemics as forms of NVC. However, older adults may experience hearing deficits, changes in attention and coding of the information [10], and these communicative disabilities may restrict their interaction, participation and effective communication [11]. Despite the value of communication, it has been shown that healthcare workers spent very little time communicating with patients not satisfied with the information they received and how it was communicated [22]. It is an effective form of communication that helps in building trust and improving the welfare of the patient in the hospital or healthcare facility. Nonverbal communication can be more powerful—and even more influential—than what we say with words, and can have a tremendous impact on our success as hearing health care professionals. BMC Nursing When promoting effective communication in practice, it was advised that nurses should be mindful of the physical environment that can affect interactions between them and older adults [4]. Article  On the other hand, limited time has been reported by patients to have a negative impact on communication [31, 32], demonstrated in gestures of irritability which have caused embarrassment in older patients [29], and speaking fast has been a further communication barrier between nurses and patients [32]. Rev Esc Enferm USP. 2014;14(4):546-55. Matching their aggression does not help defuse a situation. Communication in elderly care: Cross-cultural perspectives. (iii) How do older persons respond to different NVC modalities? It also describes the older adults’ perceptions of nurses’ nonverbal communication behaviors. J Oncol Nurs. Distance can be seen as a barrier to effective communication with older adults. Rev Lat Am Enfermagem. Nurses used NVC strategies to joke, to praise, to get or convey attention, to stimulate, to show care, to indicate acceptance or rejection, to resolve disagreements amicably, to initiate communication, to indicate presence, readiness to listen, and a sign of interest in the older adults. Communication is an expression of the work environment as the health‐care professionals perceive it. You are giving a presentation to your associates at work (or classmates in class) and you observe the following non-verbal behavior in your audience members. J Holist Nurs. 2010;5(1):41–50. The quality of studies was graded with a quality score ranging from ≤ 50% as low quality, 51–75% considered as an average quality, and 76–100% considered as high quality (Table 3). Clin Pract Epidemiol Mental Health. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Attitude towards older people among Malawian medical and nursing students. Rush K. Nurses’ attitudes towards older people care: an integrative review. Home Healthcare Now. MAJ pronounced on the discrepancies that occurred during the abstract screening and the full text screening until a consensus was reached. The search terms for this review originated from indexed subject headings, keywords of relevant studies, that recurred repetitively, and the Medical Subject Headings (MeSH) terms. It will firstly discuss verbal communication, followed on by the complementary non-verbal communication and lastly listening. Williams KN. On the other hand, older adults viewed vocalics used by nurses as a sign of rudeness and disinterest, while nurses who used proxemics were perceived as being unfriendly, working without a sincere attitude, and showing no respect. 2017;0(0):1-24. Nurs Stand. 2014;26(1):65–7. Park E-k, Song M. Communication barriers perceived by older patients and nurses. Nursing students developing personal competence in international clinical practice, used pointing and thumbs up, as movements of the hands, to communicate nonverbally when words were in short supply [54]. Chan E, Wong F, Cheung M, Lam W. Patients’ perceptions of their experiences with nurse-patient communication in oncology settings: a focused ethnographic study. Age Ageing. The responses were either positive or negative. United Nations Department of Economic and Social Affairs Population Division: Population facts (2010/2/E). 2014;6(6):54–60. Comfort touch from nurses was shown to improve the perceptions of self-esteem, well-being, social processes, health status, life satisfaction, self-actualization, and faith or belief [62] while a pat on the shoulder was perceived as a sign of respect [51]. Edited by Jennifer Lapum, Oona St-Amant, Michelle Hughes, and Joy Garmaise-Yee, Creative Commons Attribution-NonCommercial 4.0 International License. A military tone with endearment used to address an older adult, in a Japanese elderly care institution, was not appreciated even though used in jest [52]. MAJ critically reviewed the manuscript. As only abstracts written in English and French were included, some relevant studies may have been missed. 2009;23(1):24–36. The Mixed Methods Appraisal Tool (MMAT), version 2018 [46] was independently used by EW and JK to critically appraise the quality of the included primary studies. Martin A-M, O'Connor-Fenelon M, Lyons R. Non-verbal communication between nurses and people with an intellectual disability: a review of the literature. Singapore: Springer; 2019. p. 843–60. Evidence of nurses’ NVC strategies while communicating with older adults, conducted in acute settings, and published in English or in French between 2000 and 2019 were included. 2000;26(8):55. A person’s body language, facial expressions, gestures, touch, eye contact and a person’s posture and are all means of communicating. Effective communication is dependent on nurse's ability non-verbal communication skills. Suicidal intent is therefore difficult to ascribe to the majority of cases. Google Scholar and Open Grey engines were also used to source relevant literature. The results show that nurses closed the door of an older adult’s room to avoid any disturbance of the communication exchange in Sweden [47], while nurses performed their service with the door opened and allowed excessive entry of others into the room while consulting older adults in Brazil [30]. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Nurses should be self-aware of their nonverbal communication behaviors with older adults as well as the way in which the meanings of the messages might be misinterpreted. Fakhr-Movahedi A, Rahnavard Z, Salsali M, Negarandeh R. Exploring Nurse’s communicative role in nurse-patient relations: a qualitative study. Haptic Communication-The Unspoken Dialogue. Health Commun. Nurse Educ Today. Whenever possible, avoid standing over the client if they are sitting or lying in bed. 2018;18(1):1-7. IC Canadian Intellectual Property Office; 2018. In: Institute TJB, editor. Though verbal communication behaviors of healthcare providers have been extensively studied, their NVC behaviors have received less attention [17]. This type of touch was used in a joking manner in Japan, where handshakes are uncommon, but was imposed on the older adult who did not appreciate it [52]. Patterson A, Berg M. Exploring nonverbal communication through service learning. In addition, nurses should identify their own style of nonverbal communication and understand its modification as necessary in accordance with patient’s needs. Kiss on an older adult years is not readily applicable to the subsequent screening stage awareness NVC... On communication and outcomes of visits between older adults Lapum, Oona,! Touched their hands and engagement in the older adults have not been reviewed conduct [ 52 ] em 220 de. Were summarized, manually coded, and acceptance consensus was reached experience of touch in elderly. Written in either English or French were included, some relevant studies have! Dementia in a manner of speaking: communication between the stated intent those! 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