INTRODUCTION:

Information, Education and Communication

INTRODUCTIONInformation, Education and Communication are inter-related to each other. Information is the knowledge derived from study, experience or instruction or it is a collection of facts or data and education is the both acquisition of knowledge and experience and as well as the development of skills, habits and attitudes which help the person to lead a full and worthwhile life in this universe and communication is the interaction between two or more persons that involve exchange of information between sender and receiver. So these three are related to health i.e. information of health related events, education to people regarding health and communicate this in proper way.

HEALTH EDUCATION

Health education is indispensable in achieving individual and community health. It can help to increase the knowledge and to reinforce desired behaviour patterns. But there is no single acceptable definition of health education. So the concept of health education as a process or as an activity for including behavioural changes are emphasized in the following definitions: Health education is the process that informs, motivates and help people to adopt and maintain healthy practices and life styles, advocate environmental changes as needed to facilitate this goal and conducts professional training and research to the same end. This definition is adopted by the National conference on preventive medicine in USA.

A process aimed at encouraging people to want to be healthy, to know how to stay healthy, to know what they can do individually and collectively to maintain health and seek health when needed. This definition is given by the declaration of Alma-Ata.(1978) According to Joha. M Last The process by which individuals and groups of people learn to behave in a manner conducive to promotion, maintainence and restoration of health.

HEALTH BEHAVIOUR

The behaviour to be adopted or modified may be that of individuals, groups such as families, health professionals, organizations or institutions or entire community.

Various strategies made to influence the behaviour of individual and groups will vary greatly and depending upon some specific concerned health problems and its distribution in the population as well as upon the characteristics and acceptability of available methods which help in preventing and controlling that health problem.

So it is clear that education is necessary, but education alone is insufficient to achieve optimum health. The target population must have access to proven preventive measures.PLANNING FOR HEALTH EDUCATION

Health education cannot be planned in a vacuum. It is planned in connection with a specific health programme or health service. Therefore the specifics of health education strategy in a group have to be formulated in accordance with its socio cultural, psychosocial, physical, economic and situational characteristics. The planner should be fully conversant with the health education needs of the particular programme for which health education is to be planned.

Health education planning follows the main steps in scientific planning which are:

1. Collecting information on specific problems as seen by the group.2. Identification of problem.

3. Decide priorities.

4. Setting goals and measurable objectives.

5. Assessment of recovers.

6. Consideration of possible solutions.

7. Preparation of a plan of action:I. what will be done?

II. when?

III. by whom?

8. Implementing the plan.9. Monitoring and evaluating the degree to which stated objectives have been achieved.

10. Re assessment of the process of planning. Planning and evaluation are essential for effective health education.CONTENTS OF HEALTH EDUCATIONHealth is the concern of everyone. Therefore health communication is an important area of communication for everyone. The term Health Communication is often used synonymously with health education which itself suggests out ward and downward communication of knowledge. Health education is the foundation of a preventive health care system.

Functions of health communication: Health communication has the following functions-

1. Information

2. Education

3. Motivation

4. Persuasion5. Counseling

6. Raising morals

7. Health development

8. Organization

SCOPE OF HEALTH EDUCATION

The scope of health education extends beyond the conventional health sector. It covers every aspect of family and community health. Health education has limited impact when directed from general education, most of needed information must be integrated into the educational system and must have young population as the principal target. The communicating health message may be divided into following divisions because no definite curricula can be purposed.

1. NUTRITIONThe aim of nutrition education is to guide people to optimum and balanced diets not to teach about the calories and biochemistry of the nutrients. Nutritional problems such as ignorance about the values of breast feeding beyond the first year of life, misconceptions about weaning, ignorance of the appropriateness of certain diets for infants and pregnant women ,traditional food allocation pattern within the families etc. can be best solved by nutrition education. In recent years the link between the dietry habits and certain chronic diseases of middle age.

2. HYGIENE

Hygiene has two aspects

Hygiene and environmental.

Personal hygiene.

I. Personal hygiene: The aim of personal hygiene is to promote standards of personal cleanliness within the setting of the condition where people live. Personal hygiene include bathing, clothing, washing hands and toilet, care of nails, feet and teeth ,spitting, coughing, sneezing, personal appearance and inculcation of clean habits in the young. Training in personal hygiene should begin at very early age and must be carried through school age.II. Environmental hygiene: It has two aspects; domestic and community.

Domestic hygiene comprises that of home, use of soap, need for fresh air, light and ventilation, hygienic storage of foods, hygienic disposal of water, need to avoid pets, rats, mice and insects. Improvement of environmental health is a major concern of many governments and related agencies throughout the world. In the developing countries the emphasis on the improvement of basic sanitary services, consisting of water supply, disposal of human excreta, other solid and liquid waste, food sanitation and housing which are fundamental to health.

An environmental sanitation programme should include health education. It is not enough to provide sanitary wells,latrines,and wastw collecting facilities. People will continue to suffer from the disease caused by poor sanitation. The people of middle age such as obesity, diabetes mallitus and cardio-vascular diseases has been established. Nutrition education is a major intervention for the improving the quality of life.

3. Family health: Health largely depends on the families social and physical environment and its life style and behaviour. The role of family in health promotion and in prevention of diseases ,early diagnosis and care of sick is crucial importance. One of the main tasks of health education is to promote familys self-reliance, especially regarding the family responsibilities in child bearing , child rearing ,self care and is influencing their children adopt a healthy life.4. Disease prevention and control: Drugs alone may not solve health problems without health education, a person may fall sick again and again from the same disease. The western countries shown the role of education in the eradication of cholera, typhoid .malaria and tuberculosis etc. education of the people about prevention and control of locally endemic diseases. Several national public health programme are in operation on a national scale to eradicate diseases such as malaria, tuberculosis ,leprosy, filarial, goiter etc. the recent experience of malaria eradication has indicated that anti-malarial spray with insecticides cannot solve the problem without health education.5. Mental health: Mental health problems occurs everywhere. They become more prominent when major killer diseases brought under control. There is a tendency to increase in the prevalence of mental disease when there is a change in the society from an agriculture to an industrial economy,and when people move from the warm intimacy of a village community to the isolation found in big cities. The aim of education in mental health is to help people to keep mentally healthy and to prevent a mental breakdown. People should enjoy their relationships with others and learn to live and work without mental breakdown,there are certain special situations when mental health is of great importance *like mother after child birth, childs entry into school for the first time, when entering the secondary school, decision about a future career, starting a new family and at the time of childhood. These are critical periods of life when external pressure tends to breakdown mental health. Health workers should help people achieve mental health by showing sympathy understanding and by social contact.6. Prevention of accidents: Accidents are a feature of complexity of modern life. In the developed countries they are taking an increasing toll of life and limb. Accidents occur in three main areas-the home,roads and the place of work. Safety education should be directed to these areas. It should be the responsibility of engineering department and police department to enforce rules of road safety. Accidents occur in workshop, factories,railways and mines. Management must provide a safe environment and promote general order and cleanliness. There should be a place of everything and everything should be in its place in the factory,in the home and in the office. The predominant factor in accidents is carelessness and the problem can be tackled through health education.7. Use the health services: Many people donot know what health services are available in their community. Studies indicate that the public attitude towards the health services is still apprehensive. There is a communication gap between the public and state health administration in the form feedback for further improvement of health services but the main aim of health education is to inform the people about the health services that are available in the community and how they can utilize them.Health education with individual group and communities and methods of health education:

The methods are divided into three main groups. Anyone or combination of these methods can be used selectively at different times, depending upon the objectives to be achieved, the behaviour to be influenced and available funds1. .

2. Mass approach (media for communities)Television

Radio

Newspaper

Printed material

Direct mailing

Posters

Health museums and exhibitions

Folk methodsInternet

INDIVIDUAL APPROACH

There are many opportunities for individual health education. It may be given in:

Personal interviews in the consultant room of the doctor. Health care center

The homes of the people

The individual comes to the doctor or health care center because of illness. So opportunity is taken in educating regarding diet, nature of illness, causes of illness and its prevention, personal hygiene, environmental hygiene. The nursing staff have also very important opportunities for undertaking health education. According to Florance Nightingale the nurse can do more good in the home than in the hospital. Public health nurses ,health visitors and health inspectors are visiting hundreds of homes, they have plenty of opportunities for individuals, it is the responsibility of health educator that he/she should maintain friendly relations with the individuals so it allows the individual to talk freely as much as possible.Advantages of individual health teaching:

We can discuss, agree and persuade the individual to change his behaviour.

It provide opportunities to ask questions in form of specific interests.

Limitations:

The only one most important, that the number we reach are small and health education is given only to those who come in contact with us.

GROUP APPROACH:

Group teaching is very effective way of educating a community. The choice of subject is very important in health teaching and subject must be the interest of the group. We have to select the suitable method of education like A.V.Aids for successful group health education. The method of group teaching are given below: Lecture : A lecture may be defined as carefully prepared oral presentation of facts , organized thought and ideas by a qualified person. The chalk and talk communication has still a very important place in small group education. Its effectiveness depends to a large extent on the speakers ability to write logically and to draw with chalk on the blackboard. The group should not be more than 30 and the talk should not exceed 15 to 20 minutes. If the talk is too long people may become bored and restless. The lecture method can be more effective by combining with A.V. Aids such as

Flip chart: consists of series of cards about 25 by 30 cm or more. Each card is flashed or displayed before a group as the talk is being given. The message on the cards must be brief and to the point. These cards are primarily designed to hold attention of the group and help the lecture to proceed.

Flannel graph: a piece of rough flannel or khadi fixed over a wooden board provides an excellent background for displaying cut out pictures, graphs, drawings and other illustrations. Flannel graph offers the advantage that pre arranged sequence of pictures displayed one after another helps maintain continuity and adds much to the presentation. The other advantage are that flannel graph is a very cheap medium ,easy to transport and promotes thought and criticism. Exhibits: objects , models, specimens, etc. convey a specific message to a viewer. They are essentially mass media of communication which can be use in group teaching.

Films and charts: these are mass media of communication. If used with discrimination they can be of value in educating small groups.

Disadvantages of lectures:

Students are involved to a minimum extent.

Learning is passive.

Donot stimulate thinking or problem solving capacity.

The comprehension of a lecture varies with the students.

Health behaviour of the listeners is not necessarily effected

Demonstrations : It is a carefully prepared presentation to show how to perform a skill or procedure. E.g. lumber puncture, disinfection of well is carried out step by step before an audience or the target group, the demonstrator ascertaining that the audience understands how to perform it. The demonstrator involves the audience in discussion.Demonstration as a means of communication has been found to have a high educational values in programmes like environmental sanitation.eg installation of a hand pump , mother and child health and control of diseases e.g. scabies. The clinical teaching in hospital is based on demonstrations. This method has a high motivational value. Group discussion: A group is an aggregation of people interacting in a face to face situation. Group discussion is considered a very effective method of health communication. It permits the individuals to learn freely by exchanging their knowledge, ideas and opinions. The group should not comprise less than 6 and not more than 12 members. The participants are all seated in a circle ,so that each is visible fully visible to all the others. In a group discussion ,the member should observe the following rules:

Express ideas clearly and concisely.

Listen to what others say.

Donot interrupt when others are speaking.

Make only relevant remarks.

Accept criticism gracefully.

Help to reach conclusion.

LIMITATIONS:

Those who are shy may not take part in discussion. Some may dominate the discussion. Thus there may be unequal participation of members in a group discussion, unless properly guided. Some members may deviate from the subject and make the discussion irrelevant.

Panel discussion: In panel discussion, 4 to 8 persons who are qualified to talk about the topic in front of a large group or audience. There is no specific agenda, no order of speaking and no set speaker. After the main aspect of the subject are explored by the panel speaker ,the audience is invited to take part. The discussion should be spontaneous and natural. Panel discussion can be extremely effective method of education, provided it is properly planned and guided. Symposium : It is a series of speeches on a selected subject, each person presents an aspect of the subject briefly. There is no discussion. In the end audience may raise questions. The chairman makes a comprehensive summary at the end of session.

Work shop: The work shop is the name given to a noble experiment in education. It consists of series of meetings usually four or more with emphasize on individual work ,within the group, with the help of consultant and divided into two groups and each group will choose a chairman and a recorder. The workshop provide each participant opportunities to improve his effectiveness as a professional worker.

Conference and seminars: It contains a large component of commercialize continuing education. The programme are usually held on a regional, state or national level. They range from once half day to one week in length and may cover a single topic in depth. They usually use a variety of formats to aid the learning process from self instruction to multimedia.

MASS APPROACH

Mass media are a one way communication. They are useful in transmitting message to people even in the remotest places. Mass media alone are generally inadequate in changing human behaviour. For effective health communication, they should be used in combination with other methods. The power of mass media is creating a political will in favour of health , raising the health conciousness of the people, setting the health norms , delivering technical messages. A brief account of mass media is given below:

Television Radio

Internet

Newspaper

Printed material

Direct mailing

Health museums Folk media

Media for communicating health message:

Educational material should be designed to focus attention to provide new knowledge to facilitate interpersonal and group discussion and to re enforce prior knowledge and behaviour.

Audio visual aids: No health education can be effective without visual aids. Modern science has made available an endless array of A V aids which can be classified into three groups:

1) Auditory aids: Radio, tape recorder, microphone,amplifier,earphones.2) Visual aids: chalk board, posters, charts ,flannel graph ,exhibits, models, specimen ,slider, film strips.

3) Combined A V aids: television, sound films, slide tape combination.

Principles of health education:

Health education brings the art and science of medicine, and the principles and practice of general education. Health education is composite of two main activities-teaching and learning. Teaching is ineffective without learning. Both educator and client are responsible for bringing about change in the health knowledge, health attitude and health behaviour. There are some fundamental principles of teaching learning process which need to be understood and implemented by community health nurse to conduct effective health education for her clients. These principles are as follows:Credibility:

It is the degree to which the message to be communicated is perceived as trust worthy by the receiver. Good health education is based on facts. That means it must be consistent and compatible with scientific knowledge and also with the local culture, educational system and social goals. Unless the people have trust and confidence in the communicator, no desired action will ensure after receiving message.

Interest:

It is a psychological principle that people are unlikely to listen to those things which are not to their interest. It is salutary to remind ourselves that health teaching should relate to the interests of the people. Health educators must find out the real needs of the people. Psychologists call them felt needs that is needs the people feel about themselves. If health programme is based on felt needs of the people they will actively participate in the programme and only then it will be a peoples programme.Participation :

Participation is a key word in health education. It is based on the psychological principle of active learning. Health education should aim at encouraging people to work actively with health workers and others in identifying their own health problems and also in developing solutions and plan to work them out. A high degree of participation tends to create a sense of involvement, personal acceptance and decision making. It provides maximum feedback.Motivation :

In every person , there is a fundamental desire to learn. Awakening this desire is called motivation. There are two types of motives:

a. Primary motivesb. Secondary motivesPrimary motives : e.g. sex, hunger, survival are driving forces initiating people into action, these are inborn desires.

Secondary motives : These are based on desires created by outside forces or incentives. Some of the secondary motives are praise, love, rewards and punishment and recognition. In health education, we make use of motivation to change behaviour. Motivation is contagious, one motivated person may spread motivation throughout the group.

Comprehension :

In health education , we must know the level of understanding ,education and literacy of the people to whom the teaching is directed. One barrier to communication is using words which cannot be understood. In health education we should always communicate in the language people understand and never use words which are strange and new to people. Teaching should be within the mental capacity of the audience.Reinforcement :

Few people can learn all that is new in a single period. Repetition at intervals is necessary. If there is no reinforcement, there is every possibility of individual going back to the reawakens stage. If the message is repeated in different ways, people are more likely to remember it.

Learning by doing :

Learning is an action process not memorizing one in the narrow sense. The Chinese proverb, if I hear,I forget,if I see, I remember, if I do ,I know illustrate the importance of learning by doing.Known to unknown :

In health education work , we must proceed from concrete to abstract, from particular to general , from simple to complicated, from easy to difficult. There are the rules an teaching. We start with where the people are and with what they understand and then proceed to new knowledge. New knowledge will bring about a new enlarged understanding which can give rise to an insight into the problem.

Setting an example :

The health educator set a good example in the things he is teaching. If he is explaining the hazards of smoking, he will not be very successful if he himself smokes. If he is talking about the small family norm he will not get very for if his own family size is big.Good human relations :

Sharing of information, ideas and feelings happen most easily between people who have a good relationships. Building good relationship with people goes hand in hand with developing communication skills.

Feed back :

Feedback is one of the key concepts of the system approach. The health educator can modify the elements of the system in light of feedback from his audience.

Leaders :

Psychologists have shown and established that we learn best from the people whom we respect and regard. We try to penetrate the community through the local leaders, the village headman, the school teachers or political workers. If leaders are first convinced about a given programme ,the rest of the task of implementing the programme will be easy.

COMMUNICATION

INTRODUCTION:

Communication is the process in which people affect one another through the exchange of information, ideas, and feelings. Interpersonal communication is basic to human interaction and essential for nursing practice. It refers to the reciprocal exchange of information, ideas, beliefs, feelings and attitudes between person or among a group of person.

Communication and education are interwoven. Communication strategies can enhance learning. The ultimate goal of all communication is to bring about a change in the desired direction of the person who receive the communication. This may be affective in terms of changing existing pattern of behaviour and attitude and it may be the psychomotor in terms of acquiring new skills.MEANING:

The word communication is derived from latin word communis,meaning common. Communication is an interaction between two or more persons that involves exchange of information between a sender and receiver.

DEFINITION:

Communication is a process through which individuals mutually exchange their ideas, values, thoughts, feelings and actions between one or more people.

Communication is the transfer of information from sender to receiver so that it is understood in its right context.

Communication is the means of making the transfer of information productive and goal oriented.

PROCESS OF COMMUNICATION:

Communication which is the basis of human interaction, a complex process. It requires SMCR where S stands for Source, M stands for Message, C stands for Channel and R is Receiver.1. SOURCE:

It is the sender or encoder who initiate the message. The message may be verbal or non-verbal. The sender needs to have similar communication skills, attitude, knowledge, understanding level social system and culture as the receiver or decoder.

2. MESSAGE:Message should have all the elements properly coded. Content should be clear from the source of the message or sender to receiver.

3. CHANNEL:

Various channels are used by the sender to communicate a message i.e. seeing, hearing, touching, smelling, and tasting.

4. RECEIVER:

Receiver is the person who is receiving the message and interpreting it. To interpret the message correctly the receiver needs to have similar communication skills, attitude, knowledge, social system and culture as the source or sender.

ELEMENTS OF COMMUNICATION:

SENDER

RECEIVER

MESSAGE

CHANNELS

FEED BACK

PURPOSES OF COMMUNICATION:

To generate and disseminate information. To promote socialization.

To develop human relations.

Therapeutic interaction to develop confidence in patients.

COMMUNICATION AND INTERPERSONAL RELATIONSHIPS:

At the core of nursing are relationships formed between the nurse and those affected by the nurses practice. Communication is the means to establish hese helping healing relationships. The caring nurse communicates with others in a manner that expresses awareness and respect for persons as individual. Nurses with expertise in communication can express caring by becoming sensitive to self and others ,promoting ,and accepting the expression of positive and negative feelings and developing helping trust relationships.

DEVELOPING COMMUNICATION SKILLS:Nurses who have developed good critical thinking skills make the best communicators. They are able to draw upon theoretical knowledge about communication and integrate this knowledge with what has been learned through personal experience. They can interpret messages received from others , analyse their ,make inferences about their meaning ,evaluate their effects, explain rationale for communication techniques used ,and self examine personal communication skills.

Being systematic is important, because good communicators tend to seek and provide information in an organized , focused and deligent way. Being a truth seeker is important in trying to understand or clarify the true meaning of what is communicated.

Being self confident is important because the nurse who conveys confidence and comfort while communicating can more readily can establish interpersonal helping trust relationship.

TYPES OF COMMUNICATION:

There are different types of communication: Verbal Communication

Non-verbal Communication

Two way Communication

One way Communication

Formal and informal Communication

Visual Communication

Tele Communication

1. VERBAL COMMUNICATION:

It occurs through the medium of words spoken or written. It is the traditional way of communication. It conveys factual information accurately and effectively. But it is less effective means of communication and expression.

2. NON VERBAL COMMUNICATION:

It includes everything that does not involve spoken or written words. It occurs without words. It includes all five senses and whole range of bodily movements, posture, gestures, facial expressions. Silence is non verbal communication. It can speak louder than words. The various forms of non verbal communication are: TOUCH:

Tactile sense has been studied seriously as a form of non- verbal communication. Touch is a personal behaviour and means different things to different people. Factors like age and sex also play a role in individual meaning associated with touch. Despite its individuality, touch is as viewed as one of the most effective non verbal ways to express feelings such as comfort, love, affection, security, anger, frustration, aggression, excitement and many others.

EYE CONTECT:

Communication often begins with eye contact. Eye contact also suggests respect and willingness to listen and to keep communication open. Its absence anxiety or defencelessness or avoidance of communication. The eyes themselves carry non verbal messages.

FACIAL EXPRESSION:

The face is the most expressive part of the body. It conveys anger ,joy, suspicion,sadness, fear etc. some people have extremely expressive faces whereas others mask their feelings, making it more difficult to determine what the person is really thinking.

POSTURE:

The way the person holds the body carries non verbal message. People in good health and with the positive attitude usually hold their bodies in good alignment. Depressed or tired people are more likely to slouch. Posture also provides non verbal clues concerning pain and physical limitation e.g. a rigid, stiff appearance may be good indicator of tension and pain.

GAIT:

A bouncy ,purposeful walk usually carries a message of well being. A less purposeful shuffling gait are associates with illness. GESTURE:

Gesture using various parts of the body can carry numerous messages e.g. thumbs up means victory ,whereas thumbs down carries negative connotation. Kicking an object express anger. Wringing the hand or tapping a feet usually indicates anxiety or anger ,a waving hand serves someone to come on or to leave.

General Physical Appearance : Most illnesses cause atleast some altrations in general physical appearance. On the other hand the person in good health tends to radiate his or her healthy status through general physical appearance.

Sound : Crying, moaning, gasping and sighing are oral but non-verbal forms of communicating. Such sound can be interpreted in numerous ways, e.g. a person can cry because of sadness or joy. Silence: Period of silence during a conversation often carry important non verbal messages.3. ONE-WAY COMMUNICATION: The flow of communication is one-way from the communicator to audience. The familiar example is the lecture method in the class room. The drawbacks of the methods are:

a) No feedbackb) Knowledge is imposed

c) Learning is authoritative

d) Little audience participation

e) Does not influence human behaviour

4.TWO-WAY COMMUNICATION: The two way method of communication is that in which both the communicator and the audience take part. The audience may raise questions and add their information , ideas,opinions to the subject. The process of leaning to the subject. The process of learning is active and democratic in two way communication.5. FORMAL AND INFORMAL COMMUNICATION:

Communication has been classified into formal and informal communication. Formal communication follows lines of authority and informal communication do not follow the lines of authority ,e.g.gossip. the information channel may be more active if the formal channel donot cater to the information need in any organization.

6. VISUAL COMMUNICATION:

Visual form of communication is charts, graphs, pictograms, tables, maps, posters, etc.

7. TELE COMMUNICATION

Tele communication is the process of communication over distance using electromagnetic instrument designed for the purpose.e.g. T.V.,Radio, Internet,etc.are mass communication media while telephone,telegraph are known as point-to-point telecommunication system. With the launching of satellite,a big explosion of electronic communication has taken place all over the world.

LEVELS OF COMMUNICATION:

Nurses use different levels of communication in their professional roles. The nurse communication skills need to include techniques that reflect competence in each level.

The levels of communication are:

A. INTRAPERSONAL COMMUNICATION:

It is a powerful form of communication that occurs within an individual. This level of communication is also called self talk, self verbalization, self instruction, inner thought and inner dialogue. Nurse should be aware of the nature and content of their thinking and try to replace negative, self- defeating thoughts with positive assertions. Positive self-talk can be used as a tool to improve the nurses or clients health and self esteem. Nurses and clients can use such type of communication to develop self awareness and a positive self concept that will enhance appropriate self expression. This communication is crucial because it effects the persons behaviour.B. INTER PERSONAL COMMUNICATION:

This type of communication occurs when two or more peoples interact and exchange their message or idea to each other and it occurs face to face. The nurses ability to communicate effectively of this level influences the nurses interpersonal sharings, problem solving, team building, and effectiveness in critical nursing role such as caregiver, teacher, counselor, advocate etc.C. SMALL GROUP COMMUNICATION:

It occurs when nurse interact with two or more individuals face to face or use a medium like a conference call. To be functional, the members must communicate with one another to achieve their goal e.g. a patient care conference, staff meeting or report, etc.D. ORGANIZATIONAL COMMUNICATION:

It occurs when individuals and groups with in an organization communicate to achieve a established goal.BARRIERS OF COMMUNICATION:

Communication plays a major role in developing a relationship. Communication also affects the relationship among family members or management in any institute. More specifically, communication influences the effectiveness of instruction ,performance evaluation and the handling of discipline problems. There are obvious roles of communication.Communication is straight forward, what makes it complex ,difficult, and frustrating are the barriers that we put in the way. Those barriers are:

I. PHYSICAL BARRIERS

II. PERCEPTUAL BARRIERS

III. EMOTIONAL BARRIERS

IV. CULTURAL BARRIERS

V. LANGUAGE BARRIERS

VI. GENDER BARRIERS

VII. INTERPERSONAL BARRIERS

VIII. MUDDLED BARRIERS

IX. STEREOTYPING

X. WRONG CHANNEL

XI. LACK OF FEED BACK

PHYSICAL BARRIERS:

Physical distraction is the physical thing that get in the way of communication. Example of such thing include the telephone, desk, an uncomfortable meeting place, noise etc. these physical distractions are some common dostractions in the communication. Physical barriers in the work place are closed office doors, barrier screens, separate areas for people of different status etc.

PERCEPTUAL BARRIERS:

The problem with communicating with others is that we all see the world differently. If we did not , we would have no need to communicate.

EMOTIONAL BARRIER:

One of the chief barriers to open and free communication is the emotional barrier. It is comprised mainly of fear ,worry ,anxiety ,suspicion, etc.

CULTURAL BARRIERS :

When we join a group and wish to remain in it, sooner or or later we need to adopt the behaviour pattern of the group. There are the behaviours that that the group accept as sign of belongingness. The rewards such behaviour through act of recognition ,approval and inclusion. In groups, which are happy to accept you and where you are happy to confirm, there is a mutuality of the interest and a high level of win-win contact. Evary culture have their own symbol of behaviour. If these symbols are not understand by an individual then there is a barrier in their communication.LANGUAGE BARRIER:

Language is the vehicle for communication. It is language which describes that what we want to say. In our terms may present barrier to others who are not familiar with our expressions, buzzwords and jargon. When we couch our communication in such language, it is a way of excluding others. In a globle market place the greatest compliment that we can pay another person is to talk in their language.GENDER BARRIERS:

There are distinct differences between speech patterns in man and there in women. A women speaks between 22,000 and 25,000 words a day whereas man speaks between 7,000 and 10,000. in child hood,girls speak earlier than boys and at the age of three, have a vocabulary twice that of boys. The reason for this lies in the wiring of mans and womens brains. When a man talks, his speech is located in the left side of the brain but in no specific areas. When a women talks her speech is located in the both hemispheres and in two specific locations.This means that men talks in a linear, logical and compartmentalized way and features of left brain thinking, whereas the women talks more freely mixing logic, emotions and features of both sides of brain. It also explain why women talk for much longer than men each day.

INTERPERSONAL BARRIERS:

a) Withdrawal : It is an absence of interpersonal contact. It is both refusal to be in touch and time alone.b) Rituals : These are the meaningless, repetitive routines devoid of real contact.c) Working: Activities are those task which follows the rules and procedures of contact but no more.d) Closeness: Is the aim of interpersonal contact where there is a high level of honesty and acceptance of yourself and others.8. MUDDLED MESSAGE:Effective communication starts with clear message. Muddled message is a barrier to communitation because the sender leaves the receiver unclear about the intent of the sender. Muddled message has many causes. The sender may be confused in his/her thinking. The message may be little more than a vague idea.

Feedback from the receiver is the best way for a sender to be sure that the message is clear rather than muddled. Clarifying muddled message is the responsibility of the sender.

9. STEREOTYPING:Stereotyping cause us to typify a person, a person a group, an event or thing, an oversimplified conception, beliefs or opinions. Stereotyping is a barrier to communication when it causes people to act as if they already know the message that is coming from the sender, as if no message is necessary because everybody already knows. Both sender and listener should countinuously look for and address thinking, conclusions and actions based on the stereotypes.

10. WRONG CHANNEL:Channels help the receiver to understand the nature and importance of message. Good Morning, an oral channel for this message is highly appropriate. Writing Good Morning,on the chalkboard is less effective than the warm oral greeting.11. LACK OF FEEDBACK:Feedback is the mirror of communication. Feedback morrors what sender has sent. Feedback is the receivers message sending back to the sender the message perceived. Without feedback communication is one way.

METHODS OF OVERCOMING BARRIERS OF COMMUNICATION:

The communication process starts with the sender who has a message for the receiver. Two or more people are always involved in communication. The sender has the responsibility for the message. The senders message travels to the receiver through one or more channels choosen by the sender. The channel may be verbal or non verbal. They may involve only one of the senses e.g hearing, or they may involve all of the five senses:hearing ,sight ,touch ,smell, and taste. The sending of message by an appropriate channel to receiver appears to have completed the communication process. The process of communication will not complete if there will be barriers. Following are some guidelines which may facilitate communication:

1) Have a positive attitude about communication. Defensiveness interferes with communication.2) Work at improving communication skills. It takes knowledge and work. The increased awareness of the potential for improving communication is the first step to better communication.

3) Include communication as a skill to be evaluated along with all other skill. Help other people to improve their communication skills by helping them to understand their communication problems.

4) Make communication goal oriented. When the sender and receiver have a good relationship ,they are much more likely to accomplish their communication goals.5) Approach communication as a creative process rather than simply part of chore of working with people. What works with one person may not work with other person like vary channels, listening techniques and feedback techniques.

6) Accept the reality of miscommunication. The best communication fail to have perfect communication. They accept miscommunication and work to minimize its negative impact.

7) Warmth and friendliness maintains the quality of communication process.8) An attitude of acceptance, frankness, respect and lack of prejudice help to improve communication.

9) Empathy is identifying with the way another person feels. An empathetic nurse is sensitive to the patients feelings and problems but remain objective enough to help towards positive outcomes.

10) Comfortable environment is that in which the communication takes place and should be trustable and safe.TECHNIQUES OF EFFECTIVE COMMUNICATION:

Although human is involved in communication virtually in all working moments, the therapeutic use of communication requires training and practice to develop the skills.

1) CONVERSATIONAL SKILL:

Conversation or the exchange of verbal communication is a social interaction. As social beings ,human learn as a children to how to converse with others. To more effective communication , the following things have to care:

a) Control the tone of your voice so that you are conveying exactly what you mean to say and not a hidden message.

b) Be knowledgeable about the topic of conversation and have an accurate information.

c) Be flexible.

d) Be clear and concise.

e) Avoid words that may be interpreted differently.

f) Keep an open mind.

g) Take advantage of available opportunity.

2) LISTENING SKILL:

Listening is a skill which involves both hearing and interpreting what others says. It requires attention and concentration to sort out, evaluate and validate clues in order to better understanding the true meaning of what is being said. The following recommended techniques may help to improve listening skill:

a) Whenever possible sit with a person. During communication ,donot cross your arms or legs because that body language conveys a message of being closed.b) Be alert but relaxed and take sufficient time so that the patient feels at ease during conversation.

c) Keep the conversation as natural as possible and avoid so overly eager.

d) If culturally appropriate ,maintain eye contact with the person.

e) Indicate that you are paying attention to what the person is saying by using appropriate facial expression and body gesture.

f) Think before feedback.

3) MAINTAIN SILENCE:

Silence during communication can carry variety of meaning. It provides the opportunity to communicator to explore his/her inner feelings comfortably. To develop the skill in effective communication, various techniques like observation ,listening, restating, validating, reflecting, pinpointing, questioning, focusing etc. are used. No single technique is complete. One should have combination of all these techniques in communication skills.BLOCK TO COMMUNICATION:

I. Failure to listen- Communicator may or may not feel able to speak freely to the listener, if the listener is not listening carefully or responding.

II. Inappropriate comments and questions- certain types of comments and questions should be avoided in most situations because they tend to impede effective communication.e.g.close ended questions, using comments that give advice.

III. Changing the subject- A quick way to stop conversation is to change the subject.

IV. Conflicting verbal and non verbal messages.

V. Failure to interpret with knowledge.

CONCLUSION: Thus, it is concluded that information., education and communication are interrelated to each other. If health professionals have some information regarding health issues then it is their responsibility to educate the community through different channels of communication. If we want that health information must be properly communicated to the community then we should know everything about communication.BIBLIOGRAPHY:

1) Dinesh Kumar, Communication and education Technology, 1st edition, published by Lotus Publishers, pp.8-142) K. Park. Textbook of Preventive and Social Medicine,17th edition,published by Banarsidas Bhanot, pp 618, 619

3) Nightingale Nursing Times, vol. 4, Issue 9,Dec 2008,pp 33,42

4) Potter Parry,Fundamentals Of Nursing,vol.1, 5th edition,pp 445,446.

Individual approach

Personal contact

Home visits

Personal letters

Group approach

Lecture

Demonstrations

Discussion methods

Group discussion

Pannel discussion

Symposium

Work shop

Confrences

Seminars

Role play

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