Verbal And Non-Verbal Communication in Nursing

It is impossible to remain silent during an interaction. Even when we are silent, we transmit messages intentionally and unintentionally. When a patient enters a room, the nurse who stands and walks forward with a welcoming smile contrast sharply with the colleague who remains behind a desk looking over the patient’s notes.

The Code of the Nursing and Midwifery Council (NMC, 2015) recognizes non-verbal communication as a tool, stating that nurses should “use a range of verbal and non-verbal communication methods, taking cultural sensitivities into account, to better understand and respond to people’s personal and health needs.”

Verbal And Nonverbal Communication Skills in Nursing

Verbal communication in Nursing

Most nursing students wonder, “What is verbal communication in nursing?” Verbal communication encompasses what we say or write and how we say it: whether the tone or volume matches the message, whether friendly words are spoken in an irritable pitch, or whether one word or phrase is highlighted over others. Tone, pitch, volume, pauses, fluency, and speed of speech all contribute to the meaning of words, whether consciously or unconsciously.

Face-to-face communication is a two-way street involving spoken words and body language. These are ‘decoded’ by the listener, resulting in the receipt of both intended and accidental messages. You will read patients and interpret what they say and mean using body language and other non-verbal cues throughout your interactions. Patients, in turn, will consciously or unconsciously read you.

Non-verbal communication in nursing

While non-verbal communication is primarily about body language, other factors such as the layout or decoration of a room, or the clothing or appearance of another person, can also convey messages. A comfortable and welcoming waiting area sends a welcoming message; an untidy, unwelcoming reception area may send the opposite message.

Body language is the result of a complex interplay of factors, including the following:

  1. Position: how we position our bodies (by folding our arms or lowering our heads) and how we position ourselves in relation to others.
  2. Affective facial expressions such as smiles, frown, and raised brows;
  3. Eye contact: whether we make eye contact with others and how we make eye contact (staring; looking away, sideways, or over someone’s shoulder);
  4. Touch: the manner in which we interact with others and with objects (spectacles, clothing, or pens);
  5. Physical reactions such as sweating, blushing, or rapid breathing.

Each encounter is unique, and the impact of nonverbal communication will vary according to the circumstances. It may be influenced by:

  1. One’s reputation: people may be more tolerant of negative body language from someone perceived as brusque than from someone perceived as generally kind and helpful;
  2. The recipient’s sensitivities: some people are more sensitive than others, and sensitivities can change in response to circumstances;
  3. The situation: in emotionally charged situations, such as A&E, there may be a greater sensitivity to non-verbal communication.

Non-verbal communication can be used to:

  1. Supplement verbal communication;
  2. Reinforce or replace a verbal message:
  3. Undermine communication, as when non-verbal cues conflict with spoken words.

According to research, there is a correlation between non-verbal behavior and patients’ perceptions of clinicians‘ empathy. Montague et al. (2013) discovered that eye contact and social touch (a handshake or pat on the back) improved patients’ empathy perception of health professionals. Additionally, other studies have discovered that maintaining moderate, appropriate eye contact improved patient ratings of rapport (Harrigan et al., 1985). Montague et al. (2013) concluded that clinical environments should be designed in such a way that positive nonverbal interactions such as eye contact and social touch are facilitated.

Importance of non-verbal communication in nursing

It is critical to understand and utilize body language in order to:

  1. Facilitate communication;
  2. Avoid unconscious messages;
  3. Decode and appropriately respond to other people’s visual cues.

Body language is a valuable tool for reinforcing the spoken word and can assist you in determining how others truly feel. A patient who claims to be fine may exhibit contradictory body language or sit in a manner that suggests pain or discomfort. Being aware of your body language enables you to probe a little deeper than you might with verbal responses alone. It is just as critical to reading a patient’s body language as it is to observe clinical symptoms.

Tips on body language

  1. Avoid slouching (slumped shoulders suggest a lack of confidence, which may undermine professional credibility)
  2. Use positive body language when greeting others, such as smiling and maintaining appropriate eye contact.
  3. Avoid glancing at the clock/your phone/the door – this indicates that you wish to conclude a conversation. If you need to leave or end a session, use the following language: “I’m sorry, but we’ve run out of time for this week…” (Consider setting expectations early on: “We need to complete this by 2 p.m. today.”)
  4. Keep in mind that someone biting their lip may be anxious or concentrating. Confirm by asking open questions: “How are you feeling?”

Misreading body language

Be cautious of misinterpreting body language or relying solely on it for information. Examine discrepancies between what is stated and what is observed. It is critical to triangulate information from multiple sources in order to create a holistic picture. This can be accomplished by listening to what patients say and taking what you already know about them into account. Rather than focusing on a single indicator, consider clusters or combinations of behaviors (Borg, 2013). A sweating patient may be nervous – or simply hot – or experiencing menopausal symptoms. If the sweating is accompanied by hand-wringing and poor eye contact, it may be safer to conclude that it is nerves.

Cultural differences

The degree to which people stand or sit close to one another varies across cultures. Proxemics classifies personal space into distinct ‘distance zones’ based on the relationship’s nature: intimate, personal, social, and public. Frequently, we allow sexual partners and close friends to get physically closer to us than we would allow strangers.

Discomfort occurs when our personal space is ‘invaded’ or when the distance is perceived to be excessively large. Clinical situations may require you to enter a patient’s personal or intimate zone, which may cause discomfort or embarrassment regardless of cultural differences. Take this into consideration. Consider expressing how common that feeling is: “No one enjoys this, but it will pass quickly.”

In some cultures, direct eye contact is considered impolite; averting the eyes may indicate respect rather than deception or untruthfulness. Certain individuals with conditions such as Asperger’s syndrome may find eye contact uncomfortable and will keep their eyes down or their attention diverted away from the speaker. While body language varies by age group and gender, basic human emotions are often expressed through universal facial expressions regardless of culture, age, or social class. Consider obtaining consent before touching a patient, even for tasks such as taking blood pressure or pulse.


Non-verbal messages have the potential to be more powerful than verbal ones. As a nurse, it is critical to observe patients’ body language in addition to looking for clinical symptoms. To be a truly effective communicator, you must learn how to control your body language and how to read the body language of others.

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