Paralanguage, directly translated, means “around communication”. It is the non-verbal and vocal features that accompany speech and contribute to communication such as vocal quality, pitch, and tempo of voice. Paralanguage also includes facial expressions, touch, eye contact and the gestures that accompany language, (The American Heritage Dictionary, n.d.). What a nurse says through their non-verbally is louder to a patient then their verbal words. Positive paralanguage and positive verbal messages, together, fosters a beneficial, trusting communication which leads to patient education, comfort and care which is positively related to the patient's engagement in health seeking behaviors.
In order for a nurse to foster optimal trust and communication with a patient, the nurse's paralanguage must constantly coincide with their verbal communication and both forms must be positive, but never negative. We can lie verbally but only real feelings and thoughts are communicated by paralanguage, according to Hall (King, 1981). Lies are identified when a person's paralanguage says one thing and their verbal message says another (APA, 2000). Simply being with the patient, without judgments and with positive paralanguage is caring in its deepest form, according to Newman (Parker, 2006), and is the goal of nursing. For a patient to gain or maintain health they must be internally motivated to achieve health (Parker, 2006). According to Nola Pender and her Health Promotion Model, this motivation, so desperately required by ill patients, is cultivated by positive encouragement from outside sources, such as a nurse (Parker, 2006). So for a Nurse to establish a consistent positive nonverbal communication equivalent to the Nurses' positive verbal communication they can build trust, care and comfort in the patient which will augment the patient's health seeking behaviors.
Mehrabian, 1971, as noted in King's A Theory For Nursing, said that when we determine the feelings and attitudes of others 90 percent of the information used comes from paralanguage and other nonverbal behavior and only seven percent comes from what the person actually says. According to Birdwhistell (King, 1981), the only accurate information about a person's attitudes comes from their paralanguage. To him “man is a multidimensional being, occasionally he verbalizes” (Berdwhistell, 1970, p. 158, King, 1981). Facial expressions and the majority of gestures are universal, even though their stimuli are culturally learned (Ekman, 1970). Through these universal gestures we can increase trust, care, comfort, motivation and spiritual growth in our patient all to promote healing. Not using any hand motions when we talk indicates stiffness, uneasiness and nervousness and leads to negative communication (Knapp, 2002). The whole body is part of the communication and is constantly being interpreted by others (King, 1981), either subconsciously or consciously. By being aware of how Nurses affect their patients attitudes, and being aware of how attitudes affect healing, Nurses can optimize their communication to encourage healthy behaviors in their patients.
Nurses can optimize their communication through the tone and pitch of voice, eye contact, touch, facial expressions and gestures. Gestures are irreversible (King, 1981). When one gives a sign to another human being it cannot be withdrawn and occasionally gestures are given which are misinterpreted by the receiver. Paralanguage has the potential for misinterpretation (APA, 200, King, 1981). Distance is a culturally bound gesture (Ekman, 1970) the likelihood for distance vs. touch to be misinterpreted is much greater than a smile to be misinterpreted. For example, a nurse who stands in the doorway, blocking it, while giving a patient information can be viewed by the patient as distant, busy, aggressive, authoritarian and uncaring. Another patient could view this gesture as the Nurse being respectful of privacy. Knowing your patients culture helps the Nurse when using these culturally dependent aspects of paralanguage (Parker, 2006).
There is also a neutral side to communication that occurs only when the patient is not present, such as providing a clean room, changing the sheets, or emptying a bed pan. The patient may notice these things, and it does foster trust, but there is no direct communication between the nurse and the patient therefore it is considered neutral.
When the nurse is in the presence of the patient only positive and negative communication can ensue. No communication, where both parties are present, can be neutral. Even menial tasks are interpreted by the patient in a positive or negative light. For example, slapping a patients arm to find the optimal vein for an IV can be perceived positively or negatively by the patient. The patient may perceive the slap as the nurse trying to hurt him, especially if the nurse didn't tell the patient about each step in the procedure and the patient is mentally ill. If the nurse is only looking at the patients arm and not paying any attention, currently, to the paralanguage of the patient, the patient could perceive the nurse as being callus and non-caring, which leads to confusion and anger, which prolongs healing in the patient. The patient could instead perceive this situation as positive if the nurse smiles sympathetically, which is paralanguage, and informs the patient that “this may hurt a little”. Positive communication fosters a positive environment (APA, 2000, King, 1981, Watson, 2002) which promotes positive relationships that build trust and caring which in turn benefits the well being of the patient by motivating them towards health seeking behavior, (Parker, 2006).
Using paralanguage can help a nurse by fostering trust and communication but it can also help the Nurses' initial assessment of the level of health in a patient (Parker, 2006). When people are physically or mentally ill, posture and overall appearance show this poor health (APA, 2000). Even in 1872, Darwin had already figured out this concept, saying that when the brain is saddened or we are ill, preening and presentation are the first things to go. Therefore we can use a person's state of grooming to measure their level of health.
Optimal health will not be achieved by the patient unless they are motivated towards that goal through positive encouragement from a nurse they trust (Watson, 2002, King, 1981). For a patient to trust a nurse, the nurse must present themselves as sensible and continually trustworthy by relaying the same, positive messages in their paralanguage and their verbal communication.
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