1communication Skills. Opt

NTA 04103
Communication
Skills
NTA Level 4 Facilitator s Guide for Basic

Certificate in Nursing
September 2013
United Republic of Tanzania

Ministry of Health and Social Welfare
Ministry of Health and Social Welfare
Department of Human Resources Development
Nursing Training Section
© Ministry of Health and Social Welfare 2013
Table of contents
Acknowledgement .................................................................................................................................. ii
Goals and Objectives of the Training Manual ........................................................................................ v
Overall Goal for training manual ........................................................................................................ v
Objectives for training manual............................................................................................................ v
Introduction............................................................................................................................................ vi
Module Overview .............................................................................................................................. vi
Who is the Module For? .................................................................................................................... vi
How is the Module Organized? ......................................................................................................... vi
How Should the Module be Used? .................................................................................................... vi
Module Sessions
Session 1: Components of Communication Process ........................................................................ 1
Session 2: Factors Influencing Communication............................................................................... 8
Session 3: Relationships with Patients/Clients and Co Workers....................................................13
Session 4: Verbal and Non-Verbal Communication ......................................................................18
Session 5: Listening, Observing and Questioning Skills................................................................22
Session 6: Non-Verbal Communication.........................................................................................25
Session 7: Collaboration with Health Care Team Members ..........................................................30
Session 8: Utilizing Appropriate Ways of Giving and Receiving Feedback .................................37
Session 9: Giving and Receiving Feedback to Patients..................................................................40
Session 10: Feedback in Communication ........................................................................................45
NMT 04103 Communication Skills NTA Level-4, Semester 1

i
Acknowledgement
The development of the training manuals for Certificate and Diploma in Nursing (NTA Level
4 to 6) has been possible and accomplished through involvement of different stakeholders.
The Ministry of Health and Social Welfare (MoHSW) through the Director of Human
Resources Development sends sincere gratitude to the stakeholders including the
coordinating team (Department of Nursing and Midwifery Training), TNI, through AIHA and
the WINONA state University for funding the activity.
The MOHSW would like to thank all those involved during the process for their valuable
contribution to the development of these training materials. The ministry of Health would like
to thank the Assistant Director for Nursing Training section Mr. Ndementria Vermand, and
Ms. Vumilia B.E Mmari (Coordinator for Nursing and Midwifery Training) who tirelessly
led this important process.
Sincere gratitude is expressed to main facilitator: Mr. Golden Masika, Tutorial Assistant
University of Dodoma for his tireless efforts and Mr. Nicolaus Ndenzako Programme
consultant of AMCA inter consultant in guiding participants through the process. Special
thanks go to the team of contributors representing the Health Training Institutions, hospitals
and Universities. Their participation in meetings and workshops and their inputs in the
development of the content for each module have been invaluable. It is the commitment of
these participants that has made this product possible.
These participants are listed with our gratitude below:
SN Name Title Institution

1. Mary S. Matembo Nurse Tutor Korogwe NTC
2. Elialilia M. Herman Nurse Tutor MT. Meru Hospital
3. Alice Chifunda Nurse Tutor Mbulu NTC
4. Lilian Wilfreda Nurse Tutor KCMC
5. Aselina Milinga Nurse Tutor KCMC
6. Veronica Mahela Nurse Tutor Kahama
7. Samwel Mwangoka Nurse Tutor Mbeya SOTM
8. Hamza S. Matagira Nurse Tutor Kahama NTC
9. Elikana Wallace Nurse Tutor Kolandoto S/Nursing
10. Anna Sangito Pallangyo Nurse Tutor Kahama NTC
11. David Abincha Nurse Tutor Bukumbi NTC
12. Leon S. Mgohamwende Nurse Tutor Tosamaganga NTC
13. Crescent D. Ombay Nurse Tutor Haydom S/Nursing
14. Kizito B. Tamba Nurse Tutor Ndanda S/N
15. Robert E. Moshi Nurse Tutor IMTU college of Nursing
16. Oresta Ngahi Nurse Tutor Muhimbili S/N
17. Aloyce Ambokile Nurse Tutor Kondoa District Hosp.
18. Helma A. Shimbo Nurse Tutor Mwambani NTC
19. Elizabeth G. Chezue PNO N Tutor MOHSW HIS & QAS
20. Hinju Januarius Obstetrian Dodoma Regional Hosp.
21. Manase Nsunza Principal HLT Singida HLTC
22. Ezekiel Amata IMC Facilitator Mpwapwa Hosp.

ii
23. Sostenes D. Ntambuto HLT Tutor SMLS MUHIMBILI
24. Anna Sangito Pallanyo N/Tutor Kahama SN
25. Naomi Kagya NT Muhimbili
26. Aloyce Amboikile Nurse Kondoa
27. Golden Masika Lecturer UDOM
28. Vumilia B.E. Mmari CD-NT MOHSW
29. Upendo kilume Nurse PHN
30. Fatuma Iddi Librarian MOHSW
31. Shango Nasania Nurse Newala
32. George Laisser C/Analyst MOHSW
33. Anande Mungure Nurse Tutor Mbulu NTC
34. Robert Masano Nurse Tutor Nkinga NTC
35. Ambokile Dodoma General Hospital
36. Nolasca Mtega Nurse Tutor Tukuyu School of Nursing
37. Asteria Ndomba Senior Lecturer CUHAS
38. Alfreda Ndunguru
39. Elizabeth Chezua MOHSW
40. Magwaza Charles
41. Ellen Mwandemele
42. Robert Mushi IMTU
43. Anna Mangula Nurse Tutor Mirembe NTC
44. Cesilia Mallya Nurse tutor Newala NTC
45. Helma Shimba
46. Kapaya Andrew TNMC
47. Ntambuto Sostenese
48. Joseph Nkungu
49. Anastazia Dinho
50. Eliaremisa Ayo Nurse Tutor MOHSW
51. Grace Mallya Paediatrician RCHS/GBV/VAC-MOHSW
52. Dr. Tecla Kohi Senior Lecturer MUHAS
53. Dr. Lilian Msele Lecturer MUHAS
Supporting staff:
Daniel Muslim Driver, Ministry of Health and Social Welfare
Fatuma Mohamed Health Librarian, Ministry of Health and Social Welfare
Mbaruku A. Luga Driver, Morogoro School of Public Health Nursing
Roselinda RugemaliraAdm. Secretary, Tanzania Nursing & Midwifery Council
Veronica Semhando Secretary Ministry of Health & Social Welfare
George Laizer System Analyst Ministry of Health & Social Welfare
Silvanus Ilomo System Analyst Ministry of Health & Social Welfare
Violet Mrema Adm. Secretary, Ministry of Health and Social Welfare
Walter Ndesanjo System Analyst, Ministry of Health and Social Welfare
Dr. Gozbert Mutahyabarwa

Ag: Director of Human Resource and Development,

iii
Background
In 2007 the Ministry of Health and Social welfare (MOHSW) started the process of
reviewing the nursing curricula at Certificate and diploma level. In 2008 refined and
developed NTA Level 4 to 6 Nursing Curricula and in the same year 2008 started the
implementation. The intention was to comply with the National Council for Technical award
(NACTE) Qualification framework which offers a climbing ladder for higher skills
opportunity. Advanced Diploma awards are not among the awards of the council and do not
conform to NACTE framework. Therefore, institutions offering Advanced Diploma in
nursing are required to either offer Ordinary Diploma (NTA Level 6) or develop its capacity
to offer Bachelor’s Degree (NTA Level 7&8).
These programs have been developed in line with the above consideration aiming at
providing a room for Nurses to continue to a higher learning and achieve advanced skills
which will enable them to perform duties competently. In addition, WHO advocates for
skilled and motivated health workers in producing good health services and increase
performance of health systems (WHO World Health Report, 2006). Moreover, Primary
Health Care Development Program (PHCDP) (2007-15) needs the nation to strengthen and
expand health services at ALL levels. This can only be achieved when the Nation has
adequate, appropriately trained and competent work force who can be deployed in the health
facilities to facilitate the provisions of quality health care services.
In line with these new curricula, the MOHSW supported tutors by developing quality
standardized training materials to accompany the implementation of the developed curricula.
These training materials will address the foreseen discrepancies in the implementation of the
new curricula. NTA level 8 training materials have been developed after Curricula validation
and verification.
This training material has been developed through writers’ workshop (WW) model. The
model included a series of workshops in which tutors and content experts developed training
materials, guided by facilitators with expertise in instructional design and curriculum
development. The goals of Writer’s Workshop were to develop high-quality, standardized
teaching materials and to build the capacity of tutors to develop these materials. This product
is a result of a lengthy collaborative process, with significant input from key stakeholders
(NACTE, MOHSW, AIHA and WINONA University) and experts of different organizations
and institutions. The new training package for NTA Level 4-6 includes a Facilitator Guide
and Student Manual. There are 28 modules with approximately 520 content sessions

iv
Rationale
The vision and mission of the National Health Policy in Tanzania focuses on establishing a
health system that is responsive to the needs of the people, and leads to improved health
status for all. Skilled and motivated health workers are crucially important for producing
good health through increasing the performance of health systems (WHO, 2006). With
limited resources (human and non-human resources), the MOHSW supported tutors by
developing standardized training materials to accompany the implementation of the
developed CBET curricula. These training manuals address the foreseen discrepancies in the
implementation of the new curricula.
Therefore, this training manual for Certificate and Diploma program in Nursing (NTA Levels
4-6) aims at providing a room for Nurses to continue achieving skills which will enable them
to perform competently. These manuals will establish conducive and sustainable training
environment that will allow students and graduates to perform efficiently at their relevant
levels. Moreover, this will enable them to aspire for attainment of higher knowledge, skills
and attitudes in promoting excellence in nursing practice.
Goals and Objectives of the Training Manual
Overall Goal for training manual

The overall goal of these training manual is to provide high quality, standardized and
competence-based training materials for Diploma in nursing (NTA level 4 to 6) program.
Objectives for training manual

• To provide high quality, standardized and competence-based training materials.
• To provide a guide for tutors to deliver high quality training materials.
• Enable students to learn more effectively.

v
Introduction
Module Overview
This module content has been prepared as a guide for tutors of NTA Level 4 for training
students. The session contents are based on the sub-enabling outcomes of the curriculum of
NTA Level 4 Basic Certificate in Nursing.
The module sub-enabling outcome as follows:
3.1.1 Describe the components of communication process
3.1.2 Explain the factors influencing communication
3.1.3 Establish and maintain good relationship with patient/client and co workers
3.2.1 Demonstrate proper use of verbal and non-verbal communication
3.2.2 Utilize listening, observing and questioning skills in clinical setting
3.2.3 Identify various ways in which people communicate non verbally
3.2.4 Collaborate with health team members in giving care
3.3.1 Select and utilize appropriate ways of giving and receiving feedback
3.3.2 Give and receive feedback to patients/clients appropriately
3.3.3 Describe factors influencing feedback in communication
Who is the Module For?

This module is intended for use primarily by tutors of NTA Level 4 to 6 in nursing schools.
The module’ sessions give guidance on the time and activities of the session and provide
information on how to teach the session to students. The sessions include different activities
which focus on increasing students’ knowledge, skills and attitudes.
How is the Module Organized?

The module is divided into 10 sessions; each session is divided into sections. The following
are the sections of each session:
• Session Title: The name of the session.
• Learning Tasks – Statements which indicate what the student is expected to learn at the
end of the session.
• Session Content – All the session contents are divided into steps. Each step has a heading
and an estimated time to teach that step. Also, this section includes instructions for the
tutor and activities with their instructions to be done during teaching of the contents.
• Key Points – Each session has a step which concludes the session contents near the end
of a session. This step summarizes the main points and ideas from the session.
• Evaluation – The last section of the session consists of short questions based on the
learning objectives to check the understanding of students.
• Handouts are additional information which can be used in the classroom while teaching
or later for students’ further learning. Handouts are used to provide extra information
related to the session topic that cannot fit into the session time. Handouts can be used by
the participants to study material on their own and to reference after the session.
Sometimes, a handout will have questions or an exercise for the participants. The answers
to the questions are in the Facilitator Guide Handout, and not in the Student Manual
Handout.
How Should the Module be Used?

Students are expected to use the module in the classroom and clinical settings and during
self-study. The contents of the modules are the basis for learning Communication Skills.

vi
Students are therefore advised to learn each session and the relevant handouts and worksheets
during class hours, clinical hours and self-study time. Tutors are there to provide guidance
and to respond to all difficulty encountered by students.

vii
viii
Session 1: Components of Communication Process
Total Session Time: 120 minutes

Prerequisites
• None
Learning Tasks
By the end of this session, students are expected to be able to
• Define communication
• Explain the concept and process of communication
• Describe barriers to effective communication
• Explain the components of the communication process
• Utilize the components of communication during patients/clients
Resources Needed
• Flipcharts, marker pens, masking tape
• Black / whiteboard and chalk/white board markers
• Projector
• Computer
SESSION OVERVIEW
Step Time Activity/Method Content

Presentation of Session Title and Lerning
1 05minutes Presentation
tasks
2 05 minutes Presentation Definition of Communication
3 25 minutes Presentation Concept and Process of Communication
4 15 minutes Presentation Barriers to Effective Communication
5 30 minutes Presentation Components of Communication Process
Presentation, Utilizing the Components of Communication

6 30 minutes During Patients/Client Care
Group Discussion
7 05 minutes Presentation Key Points
8 05 minutes Presentation Evaluation
NMT 04103 Communication Skills

NTA Level-4, Semester 1 1 Session 1: Components of Communication Process
SESSION CONTENT
Step 1: Presentation Of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read learning tasks and clarify
ASK students if they have any question before proceeding
Step 2: Definition of Communication (5 minutes)

Communication
• A two way process in which information, knowledge, ideas and meanings are transmitted
by any means from one individual or group to another individual or Group
Step 3: Concepts and Process of Communication (25 minutes)

Communication Flow/Process
• A sender creates a message for the receiver
• The sender uses a channel to relay the message
• The receiver and the sender use feedback to ask for more information, get answers and
find out whether the message is understood
Figure: 1.1: Communication Process
Sender Message Receiver
Feedback
Source: KMTC. (2009).
• Effective use of communication will play an important role in the nursing care career and
personal life.
• It is the foundation on which interpersonal relationship are built.
• The art of communication does not come naturally, you must learn it.
• Effective communication requires the ability of sender and receiver to:
o Listen
o Pay attention
o Receive what the other is trying to communicate
o Respond verbally or non-verbally (i.e. use feedback)

Skills for Effective Communication
• Telling or lecturing
o This is used in situations where new information is given to client (as in health
education sessions).
o Lecturing can be boring.
o To avoid boredom information should be clear, short, concise, complete and
convincing to get the attention of clients
• Asking
o Asking question during communication process is a skill which is vital to find out
if the message has been understood.
o It also assists in correcting misconceived ideas.
o Through questioning clients are involved in communication process.
• Listening
o A good educator should be a good listener.
o Listen help the educator to understand the client.
o When the health worker listens and gives correct answers these motivates client to
express their needs freely.
• Observing
o During communication process especially in a health education sessions clients
should be observed for the following reactions, smiling, yawning, sleeping, and
whispering to neighbors
o These reactions should be noted and identified because they tell how the clients
receive information being delivered.
Step 4: Barriers to Effective Communication (15 minutes)

Consequences of Negative Non-verbal Communication
• Information is not shared, understood
• The patient may ask fewer questions
• Problem may be difficult to understand
• Situation may be uncomfortable
• Lack of adherence to medical appointments and/or treatment
Barriers to Communication
• Messy desk, with other patients’ information all over the table
• Interruptions and distractions
• The door is open and there are people nearby who can hear their interaction, so there is no
privacy to ensure confidentiality
• Not looking directly at someone when he/she is talking. In this picture, the clinician is
taking a call on his mobile phone and not talking to the patient.
• Looking out the window
• Looking at the clock or watch
• Starting to speak to someone else
• Shuffling papers
Barriers from the Sender

• The sender has the primary responsibility for starting an effective communication flow:
o Talking too much, not giving patient time to express him or herself
o Being critical and judgmental

o Laughing at or humiliating the patient
o Showing signs of being upset
o Not listening or accepting feedback
Using an inappropriate channel
Not listening, not paying attention
Lack of knowledge on the subject of discussion
Using difficult or different language
Contradictory verbal information with non-verbal gestures
Barriers from the Receiver

• Using the inappropriate channel
• Not listening, not paying attention
• Interrupting before sender completes the message
• Not sending feedback
Step 5: Five Components of the Communication Process (30 minutes)

• Sender (encoder, source)
o Sender / Encoder is a person who sends the message.
o A sender makes use of symbols (words or graphic or visual aids) to convey the
message and produce the required response.
o Sender may be an individual or a group or an organization.
o The views, background, approach, skills, competencies, and knowledge of the sender
have a great impact on the message.
o The verbal and non-verbal symbols chosen are essential in ascertaining interpretation
of the message by the recipient in the same terms as intended by the sender.
• Message
o Message is a key idea that the sender wants to communicate.
o It is a sign that elicits the response of recipient.
o Communication process begins with deciding about the message to be conveyed.
o It must be ensured that the main objective of the message is clear.
• Medium or channel
o Medium is a means used to exchange / transmit the message.
o The sender must choose an appropriate medium for transmitting the message else the
message might not be conveyed to the desired recipients.
o The choice of appropriate medium of communication is essential for making the
message effective and correctly interpreted by the recipient.
o This choice of communication medium varies depending upon the features of
communication.
o For instance - Written medium is chosen when a message has to be conveyed to a
small group of people.
o Some of the Communication channels are as follow; Speaking, Writing, Body
language, Sign language, Telephone, Media (television, newspapers and radios)
• Receiver (decoder)
o Receiver / Decoder are a person for whom the message is intended / aimed / targeted.
o The degree to which the decoder understands the message is dependent upon various
factors such as knowledge of recipient, their responsiveness to the message, and the
reliance of encoder on decoder.
• Interaction/Feedback

o Feedback is the main component of communication process as it permits the sender to
analyse the efficacy of the message.
o It helps the sender in confirming the correct interpretation of message by the decoder.
o Feedback may be verbal (through words) or non-verbal (in form of smiles, sighs,
etc.).
o It may take written form also in form of memos, reports, etc.
Figure 1.2: Course of Communication Process
Person A Person B
Transmitter Message Receiver
Receiver Message Transmitter
Step 6: Utilizing the Components of Communication During Patients/

Clients Care (30 minutes)
• The components of communication can be effectively utilized during patients/client care

when there are people who originate the message (service provider) and the message
should be clear, selection of appropriate media, and a person who receives the message
(patient/clients) and lastly feedback which help the sender to confirm the correct of the
message.
Activity: Small Group Exercise (20 minutes)
DIVIDE students into small manageable groups.
ASK each group to select a speaker, a listener and an observer for the first round (speaker
and listener will switch roles for the second round so they are given a chance to play both
roles).
TELL the speakers to choose any topic that interests them, something that they feel they can
speak about for 2 minutes.

TELL the listener that s/he is not to speak during the 2 minutes but should concentrate on
using the non-verbal communication to ensure the speaker that s/he is listening.
TELL the observer to pay attention to both the speaker and the listener, in order to provide
feedback regarding both of their verbal and non-verbal communication skills.
ASK students if there is any question before beginning the exercise.

ALLOW 2 minutes for the first speaker, and then ask the students to switch roles and allow 2
minutes for the second and third speaker. The students will formally end their roles by “de-
rolling” before the large group discussion.
CONDUCT a large group discussion using the following questions after each student has
had a chance to be the speaker:
• How did you feel to speak for 2 minutes without being interrupted?
• Did you feel that your partner was listening to you? Why or why not?
• Did you feel that your partner understood you? Why or why not?
• How did you know that your partner was listening and understanding?
LEAD students to the possible answers: non-verbal tools: facial expression, body language,
posture, agreeing phrases (um-hum)
ASK questions for the observer: Did you think the listener was showing active listening?
Why or why not? What could he or she do better?
SUMMARISE the activity with the following points: This exercise demonstrates the impact
of verbal and non-verbal communication. Through this exercise we have learned the
necessity of being aware of both verbal and non-verbal communication in the healthcare
setting. Tell them that actions speak louder than words
• All the senses can be involved in communication.

• You see and hear other people through conversations; you sometimes touch others to
express concern or care.
• You smell or test to learn information
Step 7: Key Points ( 5 minutes)
• Communication process has five components which include sender, message, channel,
receiver and feedback.
• Effective communication is when there is shared meaning and understanding between
sender and receiver using the correct channel.
• Effective communication can be either verbal or non-verbal.
• Effective communication can be blocked by barriers from the sender and/or the
receiver.
• Effective communication enhances the working relationship between the patient and
the health care worker.

Step 8: Evaluation (5 minutes)
• What is communication?
• Name two barriers of communication
• Mention four skills for effective communication
References
• KMTC. (2009). Nursing Procedure Manual. (4th ed). Nairobi: Colorscapes media Ltd.
• Marquis, B. L. & Huston, C.J. (2009). Leadership Roles and Management Functions in
Nursing Theory and Application. (6th ed). New york: Lippincott Williams & Wilkins
• MHSW. (2000). Quality Assurance Training Guidelines for Health workers. Dar es
Salaam Tanzania: Ministry of Health and Social welfare
• Rosdahl, C.B. (1999). Textbook of Basic Nursing. (7th ed). New York: Lippincott
Williams & Wilkins

Session 2: Factors Influencing Communication
Prerequisites
• None
Learning Tasks
By the end of this session, students are expected to be able to:
• Describe the factors influencing communication
• Explain factors influencing effective communication
• Explain the advantages of proper communication at the work place
Resources Needed
• Projector
• Computer
SESSION OVERVIEW

Presentation, Presentation of Session Title and Lerning
1 05 minutes
Group Discussion Tasks
Presentation,
2 15 minutes Brainstorm, Factors Influencing Communication
Discussion
Presentation,
3 20 minutes Factors Influencing Effective Communication
Buzz
Advantages of Proper Communication at the
4 10 minutes Presentation
Workplace
SESSION CONTENT

READ the Learning Tasks to students

NTA Level-4, Semester 1 8 Session 2: Factors Influencing Communication
Step 2: Factors Influencing Communication Process (15 minutes)
• Effective communication results when there is a transfer of complete understanding

between the Sender and the Receiver.
• Factors influencing communication process include:
o Emotions
Emotions are a person’s subjective feelings.
The way person or communicates will be influenced by emotions.
A client who is angry will perceive nurses instructions differently than one who is
not angry.
Emotion influence the ability to receive information successfully, emotion can
also cause a person not to understand or hear a message.
o Knowledge
Communication can be difficult when a persons’ communicating have different
levels of knowledge.
A message will not be clear if the words or phrases are not part of the listener’s
vocabulary.
A common language is essential when communicating across different knowledge
levels.
o Roles and relationship
People communicate in a style appropriate to their roles and relationships.
Student talks differently with friends than they do with instructors, physician and
other professionals.
Words, facial expressions, tone of voice and gestures depend on the person
receiving the communication.
o Attention
A listening or attention barrier can occur because of lack of concentration
o Age
Age can be an advantage or disadvantage to effective communication.
Very young or very old clients may be unable to communicate fully because of
physical or intellectual development.
o Gender
Gender roles may influence nurse-client interactions.
For example, a nurse who believes men should be tough may find it difficult to
see a male client cry.
o Culture and subculture
Cultural norms and traditions influence the behaviors’ of all people including you.
Understanding and accepting differences are the keys to developing therapeutic
communication.
o Social factors
Social acceptance of a particular illness plays a role in a person’s reaction to the
illness.
For example sexually transmitted diseases may be more difficulty for the client to
cope with than influenza.
o Religion
Some of religious beliefs may directly conflict with the procedures and goals of a
health care facility (e.g.
Jehovah’s witnesses who do not believe in receiving blood transfusions
o History of illness

People who have never been sick may feel threatened or incapacitated by a sense
of loss of control.
They may react by becoming depressed, hostile or resistant to those who want to
help.
o Body Image
How clients feel about themselves and illness affects communication.
For example, the woman who has mastectomy may worry about her sexual appeal.
o The health care team
Health care team members may influence an individual’s attitude toward illness.
So as a nurse remember to put aside your personal need and anxiety.
Step 3: Factors Influencing Effective Communication (20 minutes)
Activity: Buzzing (5 minutes)
ASK students to buzz in pairs on ‘what are the factors influencing effective communication’
for 2 minutes
ALLOW some few pairs to share their responses in the classes
WRITE their responses on the board/flip chart paper
SUMMARIZE the responses leading them to correct answers and continue with content
below
Sender
• Sender wants to keep information back
• Sender does not know exactly what to say
• Sender is very much involved in his own affairs
• Sender speaks another language than the receiver
• Intensity, movements, repetition
• Non verbal communication is not according to the words
Receiver
• Knowledge and experience
• Feelings
• Attention
• Views, norms, values and culture
• Motivation
• Mood
• Physical condition
• Defense mechanism
Step 4: The Advantages of Proper Communication at Work Place (10

minutes)
• Effective communication is important in personal and professional settings.

• Being able to communicate effectively saves time by preventing the need for multiple
conversations.
• An effective communicator is more likely to get attention from his listener, because the
listener knows the communicated information will be concise and beneficial to them.
Advantages of Proper Communication at the Workplace
• Client Relations
o Effective communication enhances client relations, which are crucial to a company's

success.
o Employees are ambassadors of the company.
o If an employee effectively communicates with a client and answers her questions
clearly, it can raise the client's confidence in the company.
• Job Satisfaction
o Effective communication between an employee and his supervisor can boost an

employee's job satisfaction by making the employee feel he can make a difference.
o For a manager and employee to communicate effectively, the manager must be able to
convey objectives, and also be able to listen.
o Listening to the employee and implementing the employee's ideas will make the
employee feel he is a valued contributor.
o An employee who feels valued will be a more productive team member.
• Saving Time
o Time in business is crucial.

o Being able to choose the proper method of communication--phone, email, fax or face-
face conversation--can save a company a lot of time and money.
o If there is a time-sensitive issue, a face-to-face conversation or a phone call is often
the best choice.
• Clarity
o Communicating in an effective way will prevent confusion.
o If you think about a message before delivering it and anticipate any way it can be
misconstrued, you will be able to refine your message.
o The more clear and concise you are, the more effective your message will be
• Chances for Promotion
o If you are an effective communicator, you will appear more organized and
knowledgeable and increase your chances to be promoted.
o Others will notice.
• Conflict is reduced
o Most conflict is the result of misunderstood communication.
o When you become an effective communicator, you can resolve conflict and create
harmony by bridging the communication gaps that create conflict.
o You can even use your skills to mediate conflict between other people.
• Get more of what you want out of life.
o When you learn to communicate effectively in ways that people instinctively
understand, they will be delighted to help you and provide you with the resources that
you need to achieve your goals and dreams.
• Have stronger relationships.

o Effective communication builds strong business and personal relationships because
you learn to understand exactly what people want and how to give it to them.
o Learn to communicate your thoughts and emotions in ways that they instinctively
understand at an unconscious level.
• Help people to adopt your ideas
o Successful communication is not about "you" and getting what you want... it is about
discovering what other people want and need and then adapting your presentation to
match their needs.
o As you practice and develop your skills, you will find that people gladly adopt your
ideas because you have subtly helped them to discover them for themselves rather
than telling them about them.
Step 5: Key Points (5 minutes)
• There are 10 factors that are influencing communication process some of them are
attention, age, gender, social factors and body image.
• There are other factors that directly influence effective communication to the sender and
the receiver.
• Outline five factors that are influencing communication process.

• Name two factors that directly influence effective communication to the sender and the
receiver
References
Salaam Tanzania: Ministry of Health and Social Welfare
Williams & Wilkins

Session 3: Relationships with Patients/Clients and Co
Workers
Prerequisites
• None
Learning Tasks
• Explain the importance of good relationships with patients/clients and co workers
• Explain factors which create and maintain good relationship with patients/clients and co
workers
• Utilize the steps of creating and maintaining good relationship with patients/clients and co
workers
Resources Needed
• Projector
• Computer
SESSION OVERVIEW

Presentation of Session Title and Learning
Tasks
Presentation,
2 60 minutes Importance of Good Relationships
Role Play
Factors Creating and Maintain Good
Relationships
Steps to Create and Maintain Good
4 35 minutes Presentation Relationships

NTA Level-4, Semester 1 13 Session 3: Relationships with Patients/Clients and
Co Workers
SESSION CONTENT

READ or ASK the students to read the Learning Tasks and clarify
Step 2: The Importance of Good Relationships with Patients/ Clients and

Co Workers (60 minutes)
• Good relationship at work place encourage clients to express their thought and feelings
more effectively.
• Moreover it builds and maintains rapport within health workers.
• Healing requires more than medicine and treatment applications.
• Because illness affects the whole person, it is as important to discover the particular
personal meanings woven into the fabric of an illness as it is to address the physical and
psychological origins of the disorder.
• In health care, human connections are essential to the healing process and effective health
care delivery.
• The nurse becomes a ‘’skilled companion’’ on the illness journey, encouraging,
supporting and challenging the clients as needed.
Importance of Good Relationships with Patient /Client:

• Enhance client well being
• Promote recovery
• Support the self-care functioning of the client
• Patient is more satisfied with the service which they receive
• Patient are more inclined to comply with medical regimes and procedures, poor
• Communication is a major cause of patient dissatisfaction.
• The desired outcome of the nurse-client relationship is to find meaning in the illness
experience related to the specific health needs or problems for which a client is seeking
health care interventions.
Importance of Good Relationships with Co-workers

• Provides a unique opportunity to approach client care from a holistic perspective by
drawing on expertise of various disciplines such as psychiatry, medicine, dentistry, social
work, nutrition, physical and respiratory therapy.
• Caring commitment to developing constructive working relationship with other
professionals gives directions, form and substance to all nursing actions thereby providing
a recognizable pattern of professional nursing practice.
• Good communication among the health care team is vital for the effective care of patients
• Co- workers can experience almost instant kinship, because the essence of the group is
the idea that ‘’you are not alone.’’
• Co-workers can talk about their feeling and listen to the concerns of others, knowing they
all share this experience.

Co Workers
• The group atmosphere is generally one of acceptance, support, encouragement, and
caring.
• Many members acts as role model for new members and can inspire them to attempt tasks
they might consider impossible.
• The group provides the opportunity for people to help as well as to be helped (critical
component in restoring self-esteem)
Activity: Roles Play (40 minutes)
CHARACTERS:
MARY: A midwife who is newly employed at RCH clinic, not trained in Life Serving Skills
JANE: A graduate of advanced life saving Skills Training
HILDA: A graduate of Basic Life Saving Skill Training
JOYCE: A new RCH client who has come for service.
ASK students volunteer themselves for the role play, being roles of the names as above
JANE and HILDA are sitting in one corner of the clinic talking. MARY is sitting at the
registration table
JOYCE comes in and goes straight to MARY. When JOYCE is approaching MARY,
JANE bursts out in laughter while looking at JOYCE and says, ‘’You are going to a wrong
person.’’
MARY gets annoyed and walks out of the clinic.
Joyce become puzzled and stands in the middle of the clinic. After two minutes she also
walked out and says, ‘’What type of a clinic is this? I was told I was seeing the wrong person,
yet there is nobody to direct me to the right person. How long do you expect me to wait
here?’’
HILDA called JOYCE back and attended her. Then she went to assist MARY in difficulty
areas and they all become friends.
AFTER a role play, ask students what does the role play mean/teach?
ALLOW 3 minutes discussion in the class
SUMMARIZE the responses provided leading them to the correct answers
DE-ROLE the students who involved in the role play
Step 3: Factors Creating and Maintaining Good Relationship (10 minutes)

• Personal and professional characteristics of the nurse and the client
• Age, sex, appearance, diagnosis, education, values, ethnic and cultural background
• Personality
• Expectations
• Setting
• Good communication skills

Co Workers
• Sincere interest in the clients welfare
Step 4: Steps to Create and Maintain Good Relationship (35 minutes)
• Pre-interaction phase
• Introductory phase
• Working (maintaining phase) phase
• Termination phase
Pre-interaction Phase
• This is similar to the planning stage before an interview.
• In most situations, the nurse has information about the client before the first face-to-face
meeting.
• Such information may include the client’s name, address, age, medical history, and social
history.
Introductory Phase (Orientation)

• This is important because it sets the tone for the rest of the relationship.
• The client and the nurse closely observe each other and form judgments about the others
behavior.
• The three stage of this introductory phase are:
o Opening the relationship- the nurse may initially engage in some social interaction to
put the client at ease
o Clarifying the problem- The client initially may not see the problem clearly, the
nurses major task is to help to clarify the problem
o Structuring and formulating the contract- Nurse and client develop a degree of trust
and verbally agree about location, frequency and length of meeting, overall purpose
of the relationship, how confidential material will be handled, tasks to be
accomplished, duration and indications for termination of the relationship
Working (Maintaining) Phase

• Accomplishment of the tasks outlined in the introductory phase, enhance trust and
rapport to the nurse and client and finally develop caring process.
• The working phase has two major stages,
• Exploring and understanding thoughts and feeling- The client explores thoughts and
feelings associated with problems, develop the skill of listening, and gains insight into
personal behavior.
• Facilitating and taking action-The clients need to learn to take risk such as to accept that
either failure or success may be the outcome.
• The nurse needs to reinforce successes and help the client recognize failures realistically
Termination phase
• Nurse and client accept feeling of loss.
• The client accepts the end of the relationship without feelings of anxiety or dependence.

Co Workers
• The desired outcome of the nurse-client relationship is to find meaning in the illness
experience related to the specific health needs or problems for which a client is seeking
health care interventions.
• There are four stages for creating and maintaining good relationship these are:
o Pre-interaction phase
o Introductory phase
o Working (maintaining phase) phase
o Termination phase

• What are the importance of good relationship with client and co-workers?
• Name four factors which create and maintain good relationship
• Outline four steps for creating and maintaining good relationship
References
• Kozier, E.R.B. (2008).Fundamentals of Nursing, Concepts, Process and Practice. (5th
ed).New York: Lippincott Williams & Wilkins
Salaam Tanzania: Ministry of Health and Social welfare.
Williams & Wilkins

Co Workers
Session 4: Verbal and Non-Verbal Communication
Prerequisites
• None
Learning Tasks
• Explain verbal and non-verbal communication
• Explain advantages and disadvantages of verbal and non-verbal communication
• Use verbal and non-verbal communication when communicating with patients/clients and
co workers
Resources Needed
• Projector
• Computer
SESSION OVERVIEW
1 05 minutes Presentation Presentation of Session Title and Lerning Tasks
2 10 minutes Presentation Verbal and Non-Verbal Communication
Advantages and Disadvantages of Verbal and

3 15 minutes Presentation Non- Verbal Communication
Presentation, Application of Verbal and Non-Verbal

4 20 minutes Buzz Communication when Communicating with
Patients/Clients and Co Workers

READ the Learning Tasks to students

NTA Level-4, Semester 1 18 Session 4: Verbal and Non-Verbal Communication
Step 2: Verbal and Non-Verbal Communication (10 minutes)
Verbal Communication
• Sharing information through the written or spoken word. Nurses use verbal
communication extensively, they converse with clients , write care plans, document
information and assessments, charts and give oral or written change –of-shift reports.
• People reveal their education, intellectual skills, interests and ethnic, regional or national
backgrounds through verbal communication
Non-Verbal Communication
• Is sharing information without using words or language
• It is also called body language.
• The following are some of the common non-verbal ways of communication
Personal space
• Each person has an area around him or her varies from person to person and across
cultures. Try not to violate the outermost boundary of a person’s space.
• If you are too close, you invade the person’s space, if you are too far away, you risk
isolating the person.
Eye contact
• Eye contact means looking directly into the eyes of the other person.
• Lack of direct eye contact has various meanings among cultures.
Facial expressions
• Facial expressions convey messages of many emotions: joy, sadness, anger and fear.
Body movements and Posture

• A twitching or bouncing foot may indicate anger, impatience, boredom, nervousness, or
side effects of certain medications.
• Avoid making assumptions about these body language messages; however ask clients
what they are feeling if you are concerned with these or other visual cues.
Personal Appearance and Grooming

• Personal hygiene and general appearance relate information about clients.
• These nonverbal messages may convey clients true feelings about themselves, or they
may be misleading, especially in illness.
Therapeutic Use of Touch

• Touch can say ‘’I care’’.
• A firm touch can discourage a child from doing something dangerous; a light touch may
be all that a person needs to build confidence to walk down the hall.
• Be sensitive to the feeling of all clients.

Step 3: Advantages and Disadvantages of Verbal and Non-verbal
Communication (15 minutes)
Advantages
• You can communicate with someone who is hard of hearing or deaf.
• You can communicate at place where you are supposed to maintain silence.
• You can communicate something which you don't want others to hear or listen to.
• You can communicate if you are far away from a person. The person can see but not hear
you.
• Non-verbal communication makes conversation short and brief.
• You can save on time and use it as a tool to communicate with people who don't
understand your language.
Disadvantages
• You cannot have long conversation.
• Cannot discuss the particulars of your message
• Difficult to understand and requires a lot of repetitions.
• Cannot be used as a public tool for communication.
• Less influential and cannot be used everywhere.
• Not everybody prefers to communicate through non-verbal communication.
• Cannot create an impression upon people/listeners
Advantages of Verbal Communication

• The opportunity for immediate feedback to make sure the message was understood
• The opportunity to utilize nonverbal cues (tone, body language, inflection
• Oral communication allows for immediate feedback such as the opportunity to ask
questions when the meaning is not entirely clear.
• The sender is able to check and see whether if the instruction is clear or has created
confusion.
• Spoken instructions are flexible and easily adaptable to many diverse situations.
Disadvantages of Verbal Communication

• Poor presentation of the message or the instruction can result in misunderstanding and
wrong responses.
• Spoken communication is influenced by both verbal and non-verbal communication such
as tone or body language which may skew the meaning of your message in the mind of
the receiver.

Step 4: Use of Verbal and Non-Verbal Communication when
Communicating With Patients/Clients and Co Workers (20 minutes)
DIVIDE students in small manageable groups
ASK students to make pairs and tell a story to each other. You can choose the subject. While
the other is talking, don’t listen; you cannot run away but show in your behaviour that you are
not listening for 1 minute.
ASK students to discuss on how they feel when someone doesn’t listen to you and how it
does feel not to listen to the other for 3 minutes
SUMMARIZE the discussion leading to the correct answers and tell them that the aim of
this activity is to enable students to become aware of your feelings when one is not listening
to you or you don’t listen.
• There are two types of communication; verbal and non-verbal communication

• Verbal communication is sharing information through the written or spoken word.
• Nonverbal communication is sharing information without using words or language
• What is the difference between verbal and non-verbal communication

• Name 5 advantages of verbal communication
• Name 4 advantages of non-verbal communication
References
• MHSW. (2000). Quality Assurance Training Guidelines for Health workers, Dar es
Salaam.Tanzania: Ministry of Health and Social welfare
Williams & Wilkins

Session 5: Listening, Observing and Questioning Skills
Prerequisites
• None
Learning Tasks
• Define listening, questioning and observing skills
• Explain the importance of good listening, questioning and observing skills
• Demonstrate skills in listening, questioning and observation during communication
Resources Needed
• Projector
• Computer
SESSION OVERVIEW

Presentation of Session Tittle and Lerning
Tasks
Definition of Listening, Questioning and
Observing Skills
Importance of Listening, Questioning and
3 35 minutes Presentation Observing Skills
Demonstration of Skills in Listening,

Presentation, Questioning and Observation During
4 45 minutes
Group Discussion Communication
SESSION CONTENT

READ or ASK students to read the Learning Tasks and clarify

NTA Level-4, Semester 1 22 Session 5: Listening, Observing and Questioning
Skills
Step 2: Definitions of Listening, Questioning and Observing Skills (25
minutes)
• Listening is the ability to focus on the client and what client massages are about or paying
attention to the message they are sending
• Questioning skills is the ability of collecting information from the patient through
questions. E.g. open ended question.
• Observing skill is the ability of the nurse to collect information from the patient through
different senses. E.g. smell, hearing and touch
Step 3: Importance of Listening, Questioning and Observing Skills (35

minutes)
• Does not judge, pass opinion or give advice

• It involves empathy, warmth and respect
• Encourage an individual to talk and seek help
• Help the speaker to focus on the main problem
Importance of questioning skills

• Helps to provide much information which is useful
• It serves time when questioning client or patient
Importance of observing skills

• Helps to collect other kinds of assessment data
• It helps the nurse to determine the patients needs at the moment when meet with
• The patient or client
Importance of listening skills

• Eliminates barriers to effective communication
• The sender is encouraged to talk more
• Both the sender and receiver feel respected and expected.
• Avoids a lot of repetition thus saves time
• Enhance mutual relation
• Avoid wrong conclusion
Step 4: Demonstration of Skills in Listening, Questioning and Observation

during Communication (45 minutes)
Activity: Small Group Exercise (45 minutes)
DIVIDE students into small manageable groups
ASK one student from each group to tell a short story about his/her life; about growing up,
important people or events in the life.
ASK others to take notes on important issues as their fellow student is presenting a story.

Skills
NOTICE non-verbal behaviors accompanying the verbal message if they are consistent with
the verbal message of the sharer
WHEN the story is completed, each of the other students in the group shares his or her
observations with the sharer
AFTER all students have shared their observations, validate their accuracy with the sharer.
Discussion Guide:
Were the underlying themes recorded by the group consistent with the sharer’s
Understanding of his or her communication?
2. Were the interpretations of pertinent information relatively similar or significantly
different?
3. If they were different, what implications do you think such differences have for nurse-
Client relationships in nursing practice?
4. What did you learn from doing this exercise?
SUMMARIZE the responses from students leading to the correct answers and continue with
following content
• Listening is the ability to focus on the client and what client massages are about or paying
attention to the message they are sending
• Questioning is the ability of collecting information from the patient through questions.
E.g. open ended question.
• Observing is the ability of the nurse to collect information from the patient through
different senses. E.g. smell, hearing and touch

• What is listening?
• List the importance of listening, questioning and observing
References
Salaam, Tanzania: Ministry of Health and Social welfare
Williams & Wilkins

Skills
Session 6: Non-Verbal Communication
Prerequisites
• None
Learning Tasks
• List the cues of non-verbal communication
• Explain the importance of non-verbal communication with patients/clients
• Interpret the non-verbal communication from patients
Resources Needed
• Projector
• Computer
• Emotional card for non-verbal exercise
• Tutor Tool 6.1: Emotion Cards for Non-Verbal Exercise
SESSION OVERVIEW

Presentation Cues of Non-Verbal Communication
2 30 minutes
Importance of Non-Verbal Communication with
3 25 minutes Presentation Patients/Clients
Presentation, Interpreting the Non-Verbal Communication

4 50 minutes from Patients
Demonstration
SESSION CONTENT


NTA Level-4, Semester 1 25 Session 6: Non-Verbal Communication
Step 2: Cues of Non-Verbal Communication ( 30 minutes)
• Cue is an action or event that is a signal for somebody to do something

Non-Verbal Communication cues:
• Facial expressions
o The human face is extremely expressive, able to express countless emotions without
saying a word.
o And unlike some forms of nonverbal communication, facial expressions are universal.
o The facial expressions for happiness, sadness, anger, surprise, fear, and disgust are the
same across cultures.
• Body movements and posture
o Consider how your perceptions of people are affected by the way they sit, walk, stand
up, or hold their head.
o The way you move and carry yourself communicates a wealth of information to the
world.
o This type of nonverbal communication includes your posture, bearing, stance, and
subtle movements.
• Gestures
o Gestures are woven into the fabric of our daily lives.
o We wave, point, beckon, and use our hands when we’re arguing or speaking
animatedly—expressing ourselves with gestures often without thinking.
o However, the meaning of gestures can be very different across cultures and regions,
so it’s important to be careful to avoid misinterpretation.
• Eye contact
o Since the visual sense is dominant for most people, eye contact is an especially
important type of nonverbal communication.
o The way you look at someone can communicate many things, including interest,
affection, hostility, or attraction.
o Eye contact is also important in maintaining the flow of conversation and for gauging
the other person’s response.
• Touch
o We communicate a great deal through touch.
o Think about the messages given by the following: a firm handshake, a timid tap on the
shoulder, a warm bear hug, a reassuring pat on the back, a patronizing pat on the head,
or a controlling grip on your arm.
• Space
o Have you ever felt uncomfortable during a conversation because the other person was
standing too close and invading your space?
o We all have a need for physical space, although that need differs depending on the
culture, the situation, and the closeness of the relationship.
o You can use physical space to communicate many different nonverbal messages,
including signals of intimacy, aggression, dominance, or affection.
• Voice
o We communicate with our voices, even when we are not using words.
o Nonverbal speech sounds such as tone, pitch, volume, inflection, rhythm, and rate are
important communication elements.
o When we speak, other people “read” our voices in addition to listening to our words.
o These nonverbal speech sounds provide subtle but powerful clues into our true
feelings and what we really mean.

o Think about how tone of voice, for example, can indicate sarcasm, anger, affection, or
confidence.
Step 3: Importance of Non-Verbal Communication with Patients/Clients

(25 minutes)
• Message expressed through body postures, gestures, facial expressions, and other forms
of non-verbal behavior provides cues or suggestions to a person’s true feelings or beliefs
• ‘’Action’’ speaks louder than ‘’Words’’.
• For example a nurse may give a health talk to a patient about cleanliness and dangers of
smoking, when at the same time her uniform is dirty and smelling of cigarettes.
• It will be very hard for the patient to understand what the nurse is talking about
• Our deeds (actions) should always match with our words in order to gain the confidence
of our patients.
Step 4: Interpreting the Non-Verbal Communication from Patients (45

minutes)
Activity: Demonstration on Guess the Message (45 minutes)
YOU will require a timekeeper, a recorder and six volunteers who will be actors. Actors will
be given two minutes each
Refer to Tutor Tool 6.1: Emotion Cards for Non-Verbal Exercise
TELL students that this exercise will give students an introduction to non-verbal
communication through the interpretation of emotions.
REQUEST six students to volunteer to be “actors” who will portray one of the emotions
given to them on the card in tutor tool 6.1
DISTRIBUTE the 6 emotion cards to each of the actors.
HAVE each of the “actors” take an emotion card and tell him/her not to share it with the
audience.
EXPLAIN to students that volunteer actors will come in front of the group to act out an
emotion.
EXPLAIN that the volunteers will act out the given emotion using non-verbal
communication and without talking. The audience will guess what emotion the volunteer is
acting out.
COMPARE the audience guesses to the actual emotion after each volunteer acts out their
emotion.
ASK the volunteers to be seated after all the volunteers have completed their emotion.

CONDUCT a large group debrief and discussion with the following questions:
• Was it difficult to try to express a feeling without words?
• Was it difficult to determine how to express the emotion without a verbal explanation?
USE the following points to summarize the activity and make the connection between non-
verbal communication and the healthcare setting:
• Patients will use both verbal and non-verbal communication to express their feelings and
emotions.
• Sometimes when it is difficult to express them with words, they may use non-verbal
communication.
• This is why it is very important to be aware of and observe non-verbal communication
that the patient may be using.
• As a healthcare professional, it is also necessary to be aware of the non-verbal
communication you are communicating.
ASK students to think about effective communication skills that would be useful in these
situations.
WRITE down their answers on flip chart.
SUMMARIZE the responses leading them to the correct answers and continue with the
following content

• Be sure that your verbal and non-verbal communications give the same message to
clients.
• When verbal and non-verbal messages conflict, clients are more apt to believe the non-
verbal message.
Step 6: Evaluation (5 marks)
• What are the cues of non-verbal communication?
• What is the importance of communicating to patient/clients none verbally?
References
Salaam, Tanzania: Ministry of Social welfare and Tanzania
Williams & Wilkins

Tutor Tool 6.1: Emotion Cards for Non-Verbal Exercise
Anger Fear
Sadness Pain
Impatience Happiness

Session 7: Collaboration with Health Care Team
Members
Prerequisites
• None
Learning Tasks
• Identify health team members involved in rendering health services
• Explain the importance of having health team members
• Establish and maintain collaboration with health team members in providing health
services
• Describe the basics of interacting sensibly with other members of the health care team
• List the basics of interaction sensibly with other members of the health care team
• Describe critical thinking for problem solving of patient situations and own performance
• Describe a friendly and cooperative climate
• Identify opportunities for collaboration
• Establish cause-effect relationships in clinical situations
Resources Needed
• Projector
• Computer
SESSION OVERVIEW
1 05 minutes Presentation, Presentation of Session Title and Lerning Tasks

Health Team Members Involved in Rendering
2 10 minutes Presentation,
Health Services
3 10 minutes Presentation, Importance of Health Team
Presentation, Collaboration and Interaction with Health Team
4 45 minutes
Role Play Members in Providing Health Services
Basics of Interacting Sensibly with other
Members of the Health Care Team
Critical Thinking for Problem Solving of
Patient Situations and own Performance
7 05 minutes Presentation Opportunities for Collaboration
Establishment of Cause-Effect Relationships in
Clinical Situations

NTA Level-4, Semester 1 30 Session 7: Collaboration with Health Care Team
Members
SESSION CONTENT

Step 2: Health Team Members Involved in Rendering Health Services (10

minutes)
• Collaboration in health care is the health care professionals assuming complementary

roles and cooperatively working together, sharing responsibilities for problem solving and
making decisions to formulate and carry out plans for patient care
• Health team is a group of health personnel from different disciplines who coordinate their
skills to assist a client and /or support persons.
• Their mutual goal is to restore a clients’ health and promote health and promote wellness.
• A health team member involves the following:
o Nurse: The role of the nurse varies with the needs of the situation.
o Physician: Is a person who has successfully completed a course of medical studies
and is licensed to practice medicine in a particular jurisdiction.
o Dentist: dentists diagnose and treat dental problems
o Pharmacist: Pharmacist prepares and dispenses pharmaceuticals in hospital and
community settings.
o Nutritionist: is a person who has special knowledge about nutrition and food.
o Physiotherapist: The physiotherapist or physical therapist, assist clients with
musculoskeletal problems
o Occupational therapist: an occupational therapist assists clients with some impaired
functions to gain the skill to perform activities of daily living.
o Paramedical Technologists: Paramedical means having some connection with
medicine. These technologists have highly specialized skills and knowledge important
to client care. Kinds of paramedical technologists include Laboratory technologists,
radiologic technologist, and nuclear medicine technologists.
o Social Worker: A social worker counsels clients and support persons about social
problems, such as finances, marital difficulties, and adoption of children.
o Chaplains: Hospital chaplains serve as part of health care team by attending to the
spiritual needs of clients. In most facilities, local clergy volunteer their services on a
regular or ‘’on call’’ basis.
Step 3: Importance of a Health Team (10 minutes)
• Increase team member’s awareness of each other’s type of knowledge and skills leading
to continued improvement in decision making.
• The team work is governed by trust, respect and collaboration and they are working
toward achieving the same goals.

Members
• The plan of care takes into accounts the multiple assessments and treatment regimes, and
it packages these services to create an individualized care program that best addresses the
needs of the patient.
• The patient finds that communication is easier with the cohesive team, rather than with
numerous professionals who do not know what others are doing to manage the patient
• The knowledge and experiences of different persons are available and shared
• Various ideas/options can be contributed.
• Tasks can be divided among members and therefore less time used
• Members provide each other with support ( moral, materials and emotional ) to
accomplish results
• Sharing of resources is enhanced
• Critique of each other’s behavior is for the purpose of improving team spirit and
performance
Step 4: Collaborating with Health Team Members in Providing Health S

services (40 minutes)
Activity: Roles Play (40 minutes)
CHARACTERS:
MARY: A midwife who is newly employed at RCH clinic, not trained in LSS
JANE: A graduate of advanced life saving Skills Training
HILDA: A graduate of Basic Life Saving Skill Training
JOYCE: A new RCH client who has come for service.
ASK students volunteer themselves for the role play, being roles of the names as above
JANE and HILDA are sitting in one corner of the clinic talking. MARY is sitting at the
registration table
JOYCE comes in and goes straight to MARY. When JOYCE is approaching MARY,
JANE bursts out in laughter while looking at JOYCE and says, ‘’You are going to a wrong
person.’’
MARY gets annoyed and walks out of the clinic.
Joyce become puzzled and stands in the middle of the clinic. After two minutes she also
walked out and says, ‘’What type of a clinic is this? I was told I was seeing the wrong person,
yet there is nobody to direct me to the right person. How long do you expect me to wait
here?’’
HILDA called JOYCE back and attended her. Then she went to assist MARY in difficulty
areas and they all become friends.
AFTER a role play, ask students what does the role play mean/teach?
ALLOW 3 minutes discussion in the class
SUMMARIZE the responses provided leading them to the correct answers
DE-ROLE the students who involved in the role play

Members
Step 5: Basics of Interacting Sensibly with Other Members of the Health
Care Team (10 minutes)
• Open communication
• Non-punitive environment
• Clear direction
• Clear and known roles and tasks for team members
• Respectful atmosphere
• Shared responsibility for team success
• Appropriate balance of member participation for the task at hand
• Clear specifications regarding authority and responsibility
• Clear and known decision-making procedures
• Regular and routine communication and information sharing
• Enabling environment, including access to needed resources
• Mechanism to evaluate outcomes and adjust accordingly
Step 6: Critical Thinking for Problem Solving of Patient Situations and

Own Performance (10 minutes)
• Critical thinking refers to as reflective thinking in relation to evaluation and has a broader
scope than decision making and problem solving
• Critical thinking is a manner of thinking that moves from the general to specific ideas or
facts and never narrows the focus until the logic of both the questions and argument come
to the same conclusion.
• Problem solving is a systematic process that focuses on analyzing a difficult situation.
Components of Critical Thinking
• A set of information and believes generating and processing skills
• The habit based on intellectual commitment, of using those skills to guide behavior.
Steps of Problems Solving Approach
There are four steps of problem solving approach

Members
Step 1
ASK AND LISTEN
Step 4 Step 2
TAKE APPROPRIATE LOOK AND FEEL
ACTION
Step 3
IDENTIFY THE
PROBLEMS/ NEEDS
Ask and Listen:
• This is the first step that must be taken when a problem arise within the working place.
• It is important to identify the possible causes of the problem through history taking and
interviewing or look for likely complications and options which can be taken to solve the
problem.
Look and Feel

• This is the second step to be taken to overcome a difficult situation or a problem.
• You have to do analysis of the problem to identify hidden associated/ potential factors
relating to the problem
Identify Problem/Need
• This is the third step of the problem solving approach.
• Using information obtained from the first two steps the health care provider must identify
the problem.
• It is important that all identified problems should be taken care immediately
Take Appropriate Action

• This is the fourth step of the problem solving approach.
• You must decide what should be done to solve each problem or meet each need. Actions
should be considered for each problem or need, and you must decide on the priority
Step 7: Opportunities for Collaboration (5 minutes)
• To maintain the highest level of performance and inter-professional collaboration Health

• Teams may need to ensure:

Members
o The maintenance of a shared focus
o Regular re-appraisal of Health Team goals
o Regular on-going communication
o The resolution of difficulties or conflicts as they arrive
o Regular meetings where all feel involved
o Recognition of the contributions of all team members
o A recognition of the impact of the arrival and departure of team members
o Appropriate orientation of new team members`
o Opportunities for team members to meet for a social event
Step 8: Establishment of Cause-Effect Relationships in Clinical Situations
• A cause-effect relationship is a method of paragraph or essay development in which a

writer analyzes the reasons for the consequences of an action, event, or decision.
Cause- Effect Diagram

• A Cause-and-Effect Diagram is a tool that helps identify, sort, and display possible causes
of a specific problem or quality characteristic.
• It graphically illustrates the relationship between a given outcome and all the factors that
influence the outcome.
• Constructing a Cause-and-Effect Diagram can help your team when you need to
o Identify the possible root causes, the basic reasons, for a specific effect, problem, or
condition.
o Sort out and relate some of the interactions among the factors affecting a particular
process or effect.
o Analyse existing problems so that corrective action can be taken.
Figure: 7.1: Cause- Effect Diagram

Members
Benefits of constructing a Cause-and-Effect Diagram
• Helps determine the root causes of a problem or quality characteristic using a
structured approach.
• Encourages group participation and utilizes group knowledge of the
process.
• Uses an orderly, easy-to-read format to diagram cause-and-effect
relationships.
• Indicates possible causes of variation in a process.
• Increases knowledge of the process by helping everyone to learn more about the
factors at work and how they relate.
• Identifies areas where data should be collected for further study.
Benefits of Using a Cause-and-Effect Diagram

• Encourage group participation
• Helps to determine root cause
• Uses an orderly, easy-to-read format
• Indicates possible causes of variation
• Increases process knowledge
• Identifies areas for collecting data
Step 10: Key Points ( 5 minutes)
• Health team is a group of health personnel from different disciplines who coordinate their
skills to assist a client and /or support persons.
• Their mutual goal is to restore a clients’ health and promote health and promote wellness
• To maintain the highest level of performance and inter-professional collaboration Health Teams
may need to ensure there is maintenance of a shared focus and regular ongoing communication.
• Establishing cause-effect is difficult and critical; especially since the true cause and/or
how to measure it is often unknown.
Step 11: Evaluation ( 5 minutes)
• Name 6 members who are involved in a health care team

• Outline 4 importance of a health team
• List 2 components of critical thinking
References
Williams & Wilkins

Members
Session 8: Utilizing Appropriate Ways of Giving and
Receiving Feedback
Prerequisites
• None
Learning Tasks
• Define the term feedback in communication
• Explain the importance of feedback in communication
• Identify appropriate means of providing feedback
Resources Needed
• Projector
• Computer
SESSION OVERVIEW

Definition of Term Feedback in
2 05 minutes Presentation Communication
Presentation,
3 20 minutes Buzz Importance of Feedback in Communication
Presentation Appropriate Means of Providing Feedback

4 20 minutes
SESSION CONTENT
Step 1: Presentation of Session Title and Learning Tasks (5 minutes)


NTA Level-4, Semester 1 37 Session 8: Utilizing Appropriate Ways of Giving and
Receiving Feedback
Step 2: Definition of Feedback in Communication (5 minutes)
• Feedback means communicating with other person by providing information on how you
interpret his/her message
Step 3: Importance of Feedback in Communication (20 minutes)
ASK students to buzz in pairs on ‘the importance of feedback in communication for 2

minutes
ALLOW some few pairs to share their responses
WRITE their responses in the flip chart paper/board
SUMMARIZE the responses towards correct responses and continue with the following
content
• Support and confirms positive (desired) behavior.

• The other person is encouraged to keep behaving that way
• Can correct negative (undesirable) behavior.
• The other person is invited to change behavior
• Clarifies interpersonal relations; it increases understanding between people and assist in
improving their cooperation.
Step 4: Appropriate Means of Providing Feedback (20 minutes)
• Verbal or non- verbal

o ‘’I like this of you’’ can have the same meaning as a raised thumb or a nod of
approval
• Conscious or unconscious
o A remark like ‘’this is boring’’ is consciously made, yawning is mostly done without
being aware
• Spontaneous or on request
o Some people give their opinion on their own initiative while others have to be asked
what they think about it.
• Formal or informal
o Applause in a theatre is a form of formal feedback because it is part of the show. A
pat on the back is informal
• Feedback means communicating with other person by providing information on how you
interpret his/her message
• There are four ways of providing feedback such as verbal or non-verbal, conscious or
non-conscious, spontaneous or on request and formal or informal.

Receiving Feedback
• What is the definition of feedback?

• Mention three importance of feedback in communication
• Outline four ways of giving feedback
References
Williams & Wilkins

Receiving Feedback
Session 9: Giving and Receiving Feedback to Patients
Prerequisites
• None
Learning Tasks
• Explain the principles of giving and receiving feedback
• List the advantages of giving and receiving feedback to patients/clients
• Utilize the principles of giving and receiving feedback
Resources Needed
• Projector
• Computer
Session Overview
1 05 minutes Presentation Introduction and Overview of Lerning Tasks
2 35 minutes Presentation Principles of Giving and Receiving Feedback
Advantages of Giving and Receiving Feedback to

3 10 minutes Presentation Patients/Clients
Presentation, Utilizing the Principles of Giving and Receiving

4 60 minutes Feedback
Group Activity
SESSION CONTENT

ASK students if they have any question before continuing

NTA Level-4, Semester 1 40 Session 9: Giving and Receiving Feedback to Patients
Step 2: Principles of Giving and Receiving Feedback (35 minutes)
Principles of Giving Feedback
• Describe concrete behavior
o Feedback should always relate to concrete behavior.
o Describe the behavior as specifically and objectively as possible so that the other
person knows what you are talking about e. g. ‘’You never call when you say you will
call’’ is more concrete than ‘’You never keep appointments’’
• Tell how you feel about it
o Apart from describing facts it is also important to tell what you think and feel about
the facts, and the effects they have on you e.g.
o ‘’I have the feeling that all contacts come from one side, and I don’t like that’’ or ‘’I
don’t feel like making a phone call to him’’
• Good useful feedback
o Do not give feedback about behavior the other person will be unable to change
• Do not be exclusively negative
o If possible mention both negative and positive elements in your feedback.
o In this way you prevent the other person from thinking that he/ she only does things
wrong and it makes it also easier for the other person to accept the feedback
• Make suggestion for improvement
o This applies especially to negative feedback.
o Tell how you think improvements could be achieved
• Be as concise as possible
o Put your feedback as briefly and concisely as possible.
o The longer the story the bigger the chance the other person will miss the essence.
• Do not wait too long
o Feedback is most effective when it relates to the recent behavior or is connected with
concrete occurrence.
o If giving feedback is postponed too long, one or both parties might be unable to recall
the situation or the situation might no longer be important to the recipient
• Be inviting
o Giving feedback is not the same as venting your aggression.
o Inviting means that you do not become too emotional; that you make it clear that this
is your opinion and that is very well possible that the other person has a different
view.
• Ask for a reaction
o Ask for the reaction especially if the other person did not respond to your feedback.
o Ask him or her whether he/she understood what you meant.
• Pay attention to the other persons non –verbal behavior
o The other person’s non-verbal communication might give you an indication of how
your remarks are taken
• Dose your feedback
o Give you feedback in suitable amounts, especially if you know that the other person
will get annoyed.
• Take the other person’s resilience into account
o You should be able to balance between ‘’giving honest option’’ and ‘’not hurting’’.
o You have to adapt your words to the person.

Principles for Receiving Feedback
• Listen
o Try to listen as open-mindedly as possible.
o Don’t interrupt.
o Don’t start arguing or defending yourself immediately.
o Make it clear to the other person that you take the remarks seriously and that you are
prepared to accept feedback
• Check whether you understand the other person correctly
o Summarize the essence of what you have been told to make sure that you have
understood correctly.
• Ask for details
o Ask for descriptions of behavior or examples of situations in which the behavior
occurred.
• Ask what your behavior means to other person
o Ask the other person what your behavior means to him/her and what he/she thinks
about it.
• Ask from others
o Ask others whether they see your behavior the same way
• Show honestly and how it affects you
o Show what the feedback means to you.
o It may frighten you, annoy you or you might like hearing it.
o It is important that the other person hears these remarks
• Accepting is not the same as agreeing
o You can accept the others option and next reflect your own point of view.
• Determine for yourself if you want to change your behavior
o It is not a must that you change after feedback.
o It will depend on you. So be clear whether you consider changing or not.
Step 3: Advantages of Giving and Receiving Feedback to Patients/Clients

(10 minutes)
• Help receiver know about her/his performance, e.g. on skill acquisition during training or
instructions
• Enable the giver to express feelings, observations and recommendations
• Inform receiver about his/her behavior and how it may affect others
• Can correct negative (undesirable) behavior.
• Clarifies interpersonal relations; i.e. it increases understanding between people and is thus
assisting in improving their cooperation

Step 4: Utilizing the Principles of Giving and Receiving Feedback (60
minutes)
Activity: Small Group Activity (60 minutes)
DIVIDE students into a small manageable group
ASK them to give positive feedback to each other. To start one person gives feedback about a
good thing in the behavior of the other. Insist them to use the principles of feedback while
giving the feedback.
ASK students how they used the principles to give feedback and what effect the feedback has
on the receiver.
Giving and receiving feedback
A DIVIDE student in groups of 3 Person A is given a certain situation and gives feedback
to person B. Person C observes how the feedback is given and what the reactions of the
person receiving the feedback are. Person C can also interrupt when the principles of
feedback are no longer observed.
ROTATE positions so that everybody takes every position.

DISCUSS how the principles of feedback were used and what difficulties emerged.
ASK students how they feel after getting feedback. What are the advantages and
disadvantages of giving and receiving feedback?
SUMMARIZE the responses leading them to correct answers and continue with the
following content
• Effective giving and receiving feedback is governed by some principles

• One of the advantages of giving and receiving feedback is to correct negative
(undesirable) behavior.
• Name six principles of giving feedback

• State five principles of receiving feedback
• What are the advantages of giving feedback?

References
Williams & Wilkins

Session 10: Feedback in Communication
Prerequisites
• None
Learning Tasks
• Explain the factors influencing effective feedback in communication
• Explain the barriers for feedback in communication
• Utilize tips on how to overcome barriers of feedback in communication
Resources Needed
• Projector
• Computer
SESSION OVERVIEW
1 05 minutes Presentation Introduction and Overview of Lerning Tasks
Presentation Factors Influencing Effective Feedback in

2 20 minutes Communication
Presentation,
3 10 minutes Barriers for Feedback in Communication
Buzz
Presentation Utilizing tips on how to Overcome Barriers
4 15 minutes of Feedback in Communication
Step 1: Presentation Of Session Title and Lerning Tasks (5 minutes)

READ or ASK students to read the Lerning Tasks and clarify
Step 2: Factors Influencing Effective Feedback in Communication (20

minutes)
• Ability of the communicator.
o The person’s abilities to speak, hear, see and comprehend stimuli influence the
communication process.
o The receiver of a message also needs to be able to interpret the message.

NTA Level-4, Semester 1 45 Session 10: Feedback in Communication
o Even if a client is free of physical impairment, the nurse needs to determine how
many stimuli the client is capable of receiving in a given frame.
• Perceptions
o Each person has unique personality traits, values, and life experiences, each will
perceive and interpret messages differently.
o It is important in many situations to validate or correct the perceptions of the receiver.
• Personal space
o Personal distance is the distance people prefer in interactions with others.
Communication at a close personal distance can convey involvement by facilitating
the sharing of thoughts and feelings
• Territoriality
o This is a concept of the space and things that an individual considers as belonging to
the self.
o Clients often feel a need to defend their territory when it is invaded by others; for
example, when a visitor or nurse removes a chair to use at another bed, the visitor has
inadvertently violated the territoriality of the client whose chair was moved.
• Roles and Relationships
o The roles and relationship between sender and receiver affect the communication
process.
o Roles such as nursing student and instructor, client and physician, or parent and child
affect content and responses in the communication process.
• Time
o The time factor in communication includes the events that precede and follow the
interaction.
o The hospitalized client who is anticipating surgery or who has just received news that
a spouse has lost a job will not be very receptive to information.
• Environment
o Environmental distraction can impair and distort communication
• Emotions and self –esteem
o Most people have experienced overwhelming joy or sorrow that is difficult to express
in words.
o Emotions affect a person’s ability to interpret messages.
o Large parts of a message may be misinterpreted when the receiver is experiencing
strong emotions.
Step 3: Barriers for Feedback in Communication (10 minutes)
ASK students to buzz in pairs on ‘the barriers of feedback in communication for 2 minutes
ALLOW some few pairs to share their responses
WRITE their responses in the flip chart paper/board
CLARIFY and summarize using the content below
• The communication cycle may break down at the receiving end for some of these reasons
within health organizations:

• Lack of Interest.
o If a message reaches a reader who is not interested in the message, the reader may
read the message hurriedly or listen to the message carelessly.
o Miscommunication may result in both cases.
• Lack of Knowledge.
o If a receiver is unable to understand a message filled with technical information,
communication will break down.
o Unless a computer user knows something about the Windows environment, for
example, the user may have difficulty organizing files if given technical instructions.
• Lack of Communication Skills.
o Those who have weak reading and listening skills make ineffective receivers.
o On the other hand, those who have a good professional vocabulary and who
concentrate on listening, have less trouble hearing and interpreting good
communication.
o Many people tune out who is talking and mentally rehearse what they are going to say
in return.
• Emotional Distractions.
o If emotions interfere with the creation and transmission of a message, they can also
disrupt reception.
o If you receive a report from your supervisor regarding proposed changes in work
procedures and you do not particularly like your supervisor, you may have trouble
even reading the report objectively.
o You may read, not objectively, but to find fault.
o You may misinterpret words and read negative impressions between the lines.
o Consequently, you are likely to misunderstand part or all of the report.
• Physical Distractions.
o If a receiver of a communication works in an area with bright lights, glare on
computer screens, loud noises, excessively hot or cold work spaces, or physical
ailments, that receiver will probably experience communication breakdowns on a
regular basis.
Step 4: Tips on How to Overcome Barriers of Feedback in Communication

(15 minutes)
• Clarity of Purpose: The message to be delivered must be clear in the mind of sender.
o The person to whom it is targeted and the aim of the message should be clear in the
mind of the sender
• Completeness: The message delivered should not be incomplete.
o It should be supported by facts and observations.
o It should be well planned and organized.
o No assumptions should be made by the receiver.
• Conciseness: The message should be concise.
o It should not include any unnecessary details.
o It should be short and complete.

• Feedback: The feedback should be timely and in personal.
o It should be specific rather than general.
• Empathy: Empathy with the listeners is essential for effective verbal communication.
o The speaker should step into the shoes of the listener and be sensitive to their needs
and emotions.
o This way he can understand things from their perspective and make communication
more effective.
• Multiple Channels of communication: For effective communication multiple channels
should be used as it increases the chances of clarity of message.
o The message is reinforced by using different channels and there are less chances of
deformation of message.
• Factors influencing effective feedback in communication includes Ability of the

communicator, Perceptions, Personal space
• Barriers for feedback in communication include Lack of Interest, Lack of Knowledge,
Lack of Communication Skills, Emotional Distractions, and Physical Distractions.
• Outline 6 factors influencing effective feedback in communication

• Name 5 barriers for feedback in communication
References
Salaam, Tanzania: Ministry of Health and Social Welfare.
Williams & Wilkins


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NTA 04103

NTA Level 4 Facilitator s Guide for Basic

United Republic of Tanzania

Goals and Objectives of the Training Manual ........................................................................................ v

Overall Goal for training manual ........................................................................................................ v

Objectives for training manual............................................................................................................ v

Module Overview .............................................................................................................................. vi

Who is the Module For? .................................................................................................................... vi

How is the Module Organized? ......................................................................................................... vi

How Should the Module be Used? .................................................................................................... vi

Session 2: Factors Influencing Communication............................................................................... 8

Session 3: Relationships with Patients/Clients and Co Workers....................................................13

Session 4: Verbal and Non-Verbal Communication ......................................................................18

Session 5: Listening, Observing and Questioning Skills................................................................22

Session 6: Non-Verbal Communication.........................................................................................25

Session 7: Collaboration with Health Care Team Members ..........................................................30

Session 8: Utilizing Appropriate Ways of Giving and Receiving Feedback .................................37

Session 9: Giving and Receiving Feedback to Patients..................................................................40

Session 10: Feedback in Communication ........................................................................................45

NMT 04103 Communication Skills NTA Level-4, Semester 1

These participants are listed with our gratitude below:

SN Name Title Institution

NMT 04103 Communication Skills NTA Level-4, Semester 1

Dr. Gozbert Mutahyabarwa

NMT 04103 Communication Skills NTA Level-4, Semester 1

NMT 04103 Communication Skills NTA Level-4, Semester 1

Goals and Objectives of the Training Manual

Overall Goal for training manual

Objectives for training manual

NMT 04103 Communication Skills NTA Level-4, Semester 1

Who is the Module For?

How is the Module Organized?

How Should the Module be Used?

NMT 04103 Communication Skills NTA Level-4, Semester 1

NMT 04103 Communication Skills NTA Level-4, Semester 1

Total Session Time: 120 minutes

Step Time Activity/Method Content

3 25 minutes Presentation Concept and Process of Communication

4 15 minutes Presentation Barriers to Effective Communication

5 30 minutes Presentation Components of Communication Process

Presentation, Utilizing the Components of Communication

7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

NMT 04103 Communication Skills

Step 1: Presentation Of Session Title and Learning Tasks (5 minutes)

ASK students if they have any question before proceeding

Step 2: Definition of Communication (5 minutes)

Step 3: Concepts and Process of Communication (25 minutes)

Figure: 1.1: Communication Process

Sender Message Receiver

Source: KMTC. (2009).

NMT 04103 Communication Skills

Step 4: Barriers to Effective Communication (15 minutes)

Barriers from the Sender

NMT 04103 Communication Skills

Barriers from the Receiver

Step 5: Five Components of the Communication Process (30 minutes)

NMT 04103 Communication Skills

Figure 1.2: Course of Communication Process

Transmitter Message Receiver

Receiver Message Transmitter

Source: KMTC. (2009).

Step 6: Utilizing the Components of Communication During Patients/