physical capabilities (i.e., physical coordination, mental orientation, reduced eyesight). Medical management should be modified to accommodate the individual patient. Show genuine respect and warmth with the elderly. Avoid using terms like “gramps” or “granny.” You should always show the elderly respect by treating them as the adults they are. Give older patients the opportunity to control as many aspects of their self-care as possible. Allowing patients to self-pace their own care may take more time, but it will result in reducing their feelings of frustration, anger, and resentment. Listen to patients and allow them to reminisce if they wish to. The conversation can be used as a vehicle to bring today’s events into focus for the patient. Remember to involve family members, as needed, into the patient education process. Some of your elderly patients will require assistance from family members for their medical needs once they are back home. COMMUNICATION SKILLS LEARNING OBJECTIVE: Recognize communication techniques used in a healthcare setting. Communication is a highly complicated inter- personal process of people relating to each other through conversation, writing, gestures, appearance, behavior, and, at times, even silence. Such communications not only occur among healthcare providers and patients, but also among healthcare providers and support personnel. Support personnel may include housekeeping, maintenance, security, supply, and food service staff. Another critical communication interaction occurs among healthcare providers and visitors. Because of the critical nature of communication in healthcare delivery, it is important that you understand the communication process and the techniques used to promote open, honest, and effective interactions. It is only through effective communication that you are able to identify the goals of the individual and the Navy healthcare system. THE COMMUNICATION PROCESS The human communication process consists of four basic parts: the sender of the message, the message, the receiver of the message, and feedback. The sender of the message starts the process. The message is the body of information the sender wishes to transmit to the receiver. The receiver is the individual intended to receive the message. Feedback is the response given by the receiver to the message. Feedback, at times, is used to validate whether effective communication has taken place. Verbal and Nonverbal Communication The two basic modes of communication are verbal and nonverbal. Verbal communication is either spoken or written. Verbal communication involves the use of words. Nonverbal communication, on the other hand, does not involve the use of words. Dress, gestures, touching, body language, face and eye behavior, and even silence are forms of nonverbal communication. Remember that even though there are two forms of communication, both the verbal and the nonverbal are inseparable in the total communication process. Conscious awareness of this fact is extremely important because your professional effectiveness is highly dependent upon successful communication. Barriers to Effective Communication Ineffective communication occurs when obstacles or barriers are present. These barriers are classified as p h y s i o l o g i c a l , p h y s i c a l , o r p s y c h o s o c i a l . Physiological barriers result from some kind of sensory dysfunction on the part of either the sender or the receiver. Such things as hearing impairments, speech defects, and even vision problems influence the effectiveness of communication. Physical barriers consist of elements in the environment (such as noise) that contribute to the development of physiological barriers (such as the inability to hear). Psychosocial barriers are usually the result of one’s inaccurate perception of self or others; the presence of some defense mechanism employed to cope with some form of threatening anxiety; or the existence of factors such as age, education, culture, language, nationality, or a m u l t i t u d e o f o t h e r s o c i o e c o n o m i c f a c t o r s . Psychological barriers are the most difficult to identify and the most common cause of communication failure or breakdown. A person’s true feelings are often communicated more accurately through nonverbal communication than through verbal communication. Listening Listening, a critical element of the communication process, becomes the primary activity for the healthcare provider, who must use communication as a 2-7