Nonverbal Communication for Pharmacy Communication Skills
Learning Objectives
After studying this chapter, the graduate pharmacy student should be able to:
- Differentiate between verbal and nonverbal communication components and their relative importance
- Identify and interpret key elements of nonverbal communication including kinesics, proxemics, and environmental factors
- Analyze how cue clusters provide more accurate information than isolated nonverbal signals
- Evaluate the impact of distracting nonverbal factors on pharmacist-patient communication
- Develop strategies to enhance positive nonverbal communication in pharmacy practice settings
- Apply techniques for detecting and responding to patient nonverbal cues, especially in sensitive situations
Introduction: The Power of the Unspoken
Nonverbal communication involves the complete mix of behaviors, psychological responses, and environmental interactions through which we consciously or unconsciously relate to others. Unlike verbal communication, the medium is neither vocalized language nor written words, making it more subtle yet often more powerful.
Key Research Finding
Behavioral scientists report that approximately 55% to 95% of all communication can be attributed to nonverbal sources (Mehrabian, 1971; Poytos, 1983). This underscores the critical importance of nonverbal awareness in pharmacy practice.
Definition: Nonverbal Communication
Nonverbal communication encompasses all messages transmitted without words, including facial expressions, body movements, posture, eye contact, tone of voice, personal space, and environmental factors that convey meaning in interpersonal interactions.
Unique Characteristics of Nonverbal Communication
Nonverbal communication possesses three distinctive characteristics that make it particularly significant in healthcare settings:
Three Unique Properties
- Mirrors Innermost Thoughts: Nonverbal behaviors often reflect true feelings and thoughts, operating consciously or unconsciously.
- Difficult to Fake: While people can control some nonverbal signals, genuine emotional expressions are challenging to fabricate consistently.
- Requires Congruence: Nonverbal messages must be consistent with verbal messages or people become suspicious of the intended meaning.
The Concept of Cue Clusters
Individual nonverbal cues can have multiple interpretations, but combinations of cues ("cue clusters") generally convey universally agreed-upon messages within a given society. For example, a friendly handshake, pleasant "thank you," and warm smile together communicate satisfaction more clearly than any single cue alone.
Key Elements of Nonverbal Communication
Nonverbal communication in pharmacy practice can be categorized into several key elements, each with specific implications for patient interactions.
Four Critical Nonverbal Elements
- Kinesics (Body Movement): Includes gestures, posture, facial expressions, and eye contact
- Proxemics (Use of Space): The distance between communicators and its meaning
- Environmental Factors: Physical setting, design, privacy, and professional appearance
- Distracting Factors: Elements that interfere with effective nonverbal communication
Kinesics: Open vs. Closed Posture
Open Posture: Standing or sitting with full frontal appearance, arms comfortably apart, direct eye contact, and facial expressions showing interest. This communicates sincerity, respect, and empathy.
Closed Posture: Arms folded across chest, legs crossed, head down, eyes averted. This may communicate defensiveness, discomfort, or reluctance to engage.
Proxemics: Zones of Interaction
- Intimate Zone (0-18 inches): Reserved for close relationships; invasion causes anxiety
- Personal Zone (18-48 inches): Comfortable for casual conversations; ideal for most pharmacy counseling
- Social Zone (4-12 feet): Appropriate for public interactions; too distant for private counseling
- Public Zone (12+ feet): Formal speaking distances; inappropriate for patient counseling
Distracting Nonverbal Factors in Pharmacy Practice
Certain nonverbal behaviors can significantly detract from effective communication if not managed properly.
Common Distracting Behaviors
- Lack of Eye Contact: Looking at prescriptions, computer screens, or other objects instead of the patient conveys disinterest or lack of confidence
- Inappropriate Facial Expressions: Eye-rolling, distracted looks, or expressions inconsistent with verbal messages create confusion
- Closed Body Position: Folded arms, slouched posture, or turned-away stance communicates reluctance to engage
- Poor Tone of Voice: Sarcastic, threatening, dull, or monotone voices alter message meaning
- Environmental Distractions: Clutter, noise, lack of privacy, and unprofessional appearance negatively impact communication
The Power Principle
When verbal and nonverbal messages conflict, observers typically believe the nonverbal message. This makes careful attention to nonverbal consistency essential for credible communication.
Detecting Nonverbal Cues in Patients
Pharmacists must develop sensitivity to patient nonverbal cues, which often reveal important information not expressed verbally.
Case Study 3.1: Parkinson's Misinterpretation
A pharmacy student noticed Mr. Stevens' hands shaking and commented, "I see you're a bit nervous today." He failed to recognize the Parkinson's disease symptoms (shuffled gait, head movement) and misinterpreted a single nonverbal cue. This illustrates the danger of jumping to conclusions based on isolated cues rather than considering cue clusters.
Strategies for Accurate Detection
- Observe cue clusters rather than isolated behaviors
- Consider medical conditions that might explain nonverbal behaviors
- Be aware of cultural differences in nonverbal expression
- Verify interpretations through gentle verbal inquiry
- Maintain awareness of your own nonverbal filtering based on personal biases
Dealing with Sensitive Issues Through Nonverbal Communication
Nonverbal sensitivity is particularly crucial when addressing embarrassing or sensitive health issues.
Harris Survey Finding
A Harris Survey (1997) found that embarrassment was the most common reason why consumers did not approach healthcare providers about sensitive issues including incontinence, sexual dysfunction, depression, menopause, and various cancers.
Tips for Sensitive Situations
- Observe Before Engaging: Watch patient behavior for clues about comfort levels before initiating sensitive discussions
- Create Private Environments: Ensure physical privacy through consulting areas or partitions
- Use Clear, Non-Threatening Language: Introduce sensitive topics with normalization ("Many patients have concerns about...")
- Monitor for Nonadherence Cues: Check medication refill patterns and observe patient behavior when discussing medication use
- Employ Open-Ended Questions: Use questions like "How do you feel about taking this medication?" to elicit both verbal and nonverbal responses
Environmental Nonverbal Factors in Pharmacy Design
The physical pharmacy environment sends powerful nonverbal messages about professionalism, patient care priorities, and accessibility.
Environmental Communication Elements
Research (Beardsley et al, 1977) documents that colors, lighting, space use, and design elements significantly impact patient perceptions and communication effectiveness.
Optimal Pharmacy Design Features
- Visible Pharmacists: Counters that allow patients to see pharmacy staff
- Consultation Areas: Private or semi-private spaces for confidential discussions
- Professional Appearance: Clean, organized, well-maintained spaces conveying competence
- Appropriate Distances: Layouts that facilitate comfortable personal zone interactions
- Minimal Barriers: Design elements that facilitate rather than inhibit communication
Application to Advanced Pharmacy Practice
For graduate pharmacy students, mastering nonverbal communication involves several advanced applications:
Advanced Practice Implications
- Therapeutic Relationship Building: Using congruent nonverbal behaviors to establish trust and rapport
- Patient Assessment: Interpreting nonverbal cues as part of comprehensive patient evaluation
- Interprofessional Communication: Applying nonverbal awareness in collaborations with other healthcare providers
- Leadership Development: Using nonverbal signals to convey confidence and competence in supervisory roles
- Cultural Competence: Adapting nonverbal communication to diverse patient populations
- Self-Monitoring: Developing awareness of one's own nonverbal communication patterns and their impact
Self-Assessment Exercise
Record yourself (with permission) during patient interactions to identify potential nonverbal inconsistencies. You may discover that you sound or appear different than you expected, providing valuable feedback for improvement.
