Evidence of nonverbal communication between nurses and older adults: a scoping review

Wanko Keutchafo et al. BMC Nursing (2020) 19:53 https://doi.org/10.1186/s12912-020-00443-9 RESEARCH ARTICLE Open Access Evidence of nonverbal communication between nurses and older adults: a scoping review Esther L. Wanko Keutchafo* , Jane Kerr and Mary Ann Jarvis Abstract Background: Communication is an integral part of life and of nurse-patient relationships. Effective communication with patients can improve the quality of care. However, the specific communication needs of older adults can render communication between them and nurses as less effective with negative outcomes. Methods: This scoping review aims at describing the type of nonverbal communication used by nurses to communicate with older adults. It also describes the older adults’ perceptions of nurses’ nonverbal communication behaviors. It followed (Int J Soc Res 8: 19-32, 2005) framework. Grey literature and 11 databases were systematically searched for studies published in English and French, using search terms synonymous with nonverbal communication between nurses and older adults for the period 2000 to 2019. Results: The search revealed limited published research addressing nonverbal communication between older adults and nurses. The studies eligible for quality assessment were found to be of high quality. Twenty-two studies were included and highlighted haptics, kinesics, proxemics, and vocalics as most frequently used by nurses when communicating with older adults; while studies showed limited use of artefacts and chronemics. There was no mention of nurses’ use of silence as a nonverbal communication strategy. Additionally, there were both older adults’ positive and negative responses to nurses’ nonverbal communication behaviors. Conclusion: Nurses should be self-aware of their nonverbal communication behaviors with older adults as well as the way in which the meanings of the messages might be misinterpreted. In addition, nurses should identify their own style of nonverbal communication and understand its modification as necessary in accordance with patient’s needs. Keywords: Nonverbal communication, Nurses, Older adults Background Communication is a multi-dimensional, multi-factorial phenomenon and a dynamic, complex process, closely related to the environment in which an individual’s experiences are shared [1]. Regardless of age, without communication, people would not be able to make their concerns known or make sense of what is happening to them [2]. Communication links each and every person to their environment [3], * Correspondence: Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, 71 Manor Drive, Manor Gardens, Durban 4001, South Africa and it is an essential aspect of people’s lives [4]. In healthcare settings, communication is essential in establishing nursepatient relationships which contribute to meaningful engagement with patients, and the fulfilment of their care and social needs [5]. Effective communication is a crucial aspect of nursing care and nurse-patient relationships [6–8]. In healthcare encounters with older adults, communication is important, in particular to understand each person’s needs and to support health and well-being [9]. However, older adults may experience hearing deficits, changes in attention and coding of the information [10], and these communicative © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Wanko Keutchafo et al. BMC Nursing (2020) 19:53 disabilities may restrict their interaction, participation and effective communication [11]. Communication occurs through verbal or nonverbal modalities [12, 13]. Nonverbal communication (NVC) is defined as a variety of communicative behaviors that do not carry linguistic content [14] and are the messages transmitted without using any words [15, 16]. NVC can act as a counter measure or an adjunct to verbal messages, in that it is more reliable if there is inconsistency between verbal and nonverbal messages [17]. Therefore, it is important that there is congruence between nonverbal and verbal messages [18], with research showing that patients are particularly alert to nurses and nurse-aids nonverbal behaviors [17, 19–21], especially when they are anxious and feel uncertain [14]. Despite the value of communication, it has been shown that healthcare workers spent very little time communicating with patients not satisfied with the information they received and how it was communicated [22]. Though verbal communication behaviors of healthcare providers have been extensively studied, their NVC behaviors have received less attention [17]. Scholars have varied in their estimations of the proportion of NVC in communication, with estimates as high as 93% [23], with other estimates of 60 to 90% [24]. Moreover, scholars have described different modalities of NVC, including artefacts (presence of physical and environmental objects), chronemics (use and perception of time), haptics (use of touch), kinesics (form of movement of the body), physical appearance (body type and clothing), proxemics (use of space and distance), vocalics (aspects of the voice), and silences [23, 25–27]. Concern needs to be directed on NVC and its different modalities as critical contributors to high quality care which plays a significant role in demonstrating respect for patients, fostering empathy and trusting providerpatient relationships [24]. A significant relationship exists between patient’s perceptions of empathy and eye contact and social touch [28], with touch, and gestures described as communication facilitators [27]. Nurses' positive facial expressions demonstrate signs of bonding, respect and affection towards older patients [29] while voice tones have contributed decisively to the success of interactions with older adults [30]. On the other hand, limited time has been reported by patients to have a negative impact on communication [31, 32], demonstrated in gestures of irritability w (...truncated)