Environmental Considerations

Environmental and Physical Barriers to Listening

Environmental factors such as lighting, temperature, and furniture affect our ability to listen. A room that is too dark can make us sleepy, just as a room that is too warm or cool can raise awareness of our physical discomfort to a point that it is distracting. Some seating arrangements facilitate listening, while others separate people. In general, listening is easier when listeners can make direct eye contact with and are in close physical proximity to a speaker. The ability to effectively see and hear a person increases people’s confidence in their abilities to receive and process information. Eye contact and physical proximity can still be affected by noise. Environmental noises such as a whirring air conditioner, barking dogs, or a ringing fire alarm can obviously interfere with listening despite direct lines of sight and well-placed furniture.

Physiological noise, like environmental noise, can interfere with our ability to process incoming information. This is considered a physical barrier to effective listening because it emanates from our physical body. Physiological noise is noise stemming from a physical illness, injury, or bodily stress. Ailments such as a cold, a broken leg, a headache, or a poison ivy outbreak can range from annoying to unbearably painful and impact our listening relative to their intensity. Another type of noise, psychological noise, bridges physical and cognitive barriers to effective listening. Psychological noise, or noise stemming from our psychological states including moods and level of arousal, can facilitate or impede listening. Any mood or state of arousal, positive or negative, that is too far above or below our regular baseline creates a barrier to message reception and processing. The generally positive emotional state of being in love can be just as much of a barrier as feeling hatred. Excited arousal can also distract as much as anxious arousal. Stress about an upcoming events ranging from losing a job, to having surgery, to wondering about what to eat for lunch can overshadow incoming messages. While we will explore cognitive barriers to effective listening more in the next section, psychological noise is relevant here given that the body and mind are not completely separate. In fact, they can interact in ways that further interfere with listening. Fatigue, for example, is usually a combination of psychological and physiological stresses that manifests as stress (psychological noise) and weakness, sleepiness, and tiredness (physiological noise). Additionally, mental anxiety (psychological noise) can also manifest itself in our bodies through trembling, sweating, blushing, or even breaking out in rashes (physiological noise)

You should also consider how to leverage the environment of the interview location and your position within the space. The client interview is often conducted in locations such as clinic rooms, hospital rooms, emergency rooms, and community spaces such as the client’s home. You should attend to the following principles:

• Create a quiet location so that both you and the client can hear and communicate. Some possible strategies to reduce sound may include closing the room door, closing the curtains, and turning off radios and televisions.
• Establish a welcoming environment, which may include offering the client a place to sit and avoiding physical barriers between you and the client such as a desk.
• Attend to the client’s physical comfort, which may include offering them a drink of water and inviting them to take their coat off or have a place for them to put their bag/purse. Additionally, if they are in bed, you should ensure that they are comfortable and ask if they want to sit up, if they are permitted.
• Create an inclusive space in which care partners are invited to be part of the interview based on the client’s wishes.
• Ensure a private space so that the client feels comfortable to share personal information and that this information is kept confidential. Sometimes it will not be possible to ensure a completely private space, such as when a curtain is the only barrier. In this case, try to avoid using the client’s name and other client information loudly so that others can’t overhear.
• Maintain professional boundaries  this facilitates a trusting and therapeutic relationship between nurse and client. You must understand your professional role and ensure that your relationship with the client does not become personal (e.g., meeting the client outside of work hours, disclosing personal information, or accepting/exchanging gifts).

In preparation for the client interview, you must first be aware of the legislation and nursing standards concerning privacy and confidentiality. The Health Information Act states that clients have the right to have their personal health information kept private, and healthcare professionals are legally required to keep this information confidential. You must emphasize that client data is kept confidential and only shared with relevant members of the healthcare team directly involved in the client’s care. You may want to re-emphasize confidentiality when addressing sensitive interview topics such as trauma and violence, sexual health, and substance use.