Nonverbal cues are also important during the introductory phase. They supplement words by complementing them or providing emphasis, and may also substitute for words in some instances. Feelings are expressed more often nonverbally than verbally, and the character of an interpersonal relationship and regulation of its conversation flow depend on nonverbal cues.

Thus Anne's placing of a chair for José at a suitable angle and distance from her own reinforced or added emphasis to the verbal invitation accompanied by a welcoming glance and friendly tone of voice. The importance of understanding nonverbal cues cannot be overstressed, for on these may depend much of the receiver's interpretation. Involved along with the verbal aspects of nurse-client interaction are eight categories of signal, namely:- 1 vocal cues - (including pitch, rhythm, quality and intensity);- 2 posture and body angles;- 3 movements or actions ;- 4 touch;- 5 space;- 6 ornamentation and adornment;- 7 body type; and 8 timing. ( Brilhart & Edwards ,1981, p61 )

Generally - if the body of one conversant is turned at 90 degrees or more from the other - one could infer that little interest or regard for the other is being shown, but in this case Anne was under necessity of entering information directly into the hospital networked database, and could only turn to face or glance at José from time to time when she wasn't typing. This did not appear to cause annoyance or inconvenience because much of the interview was just a formality needed only to check and confirm information already available on paper in the patient's notes. Concerning the 'proxemics' of the situation it was apparent that the interview here took place with both persons within about three feet distance of one another - which is to say in that range of space normally used for conduct of personal relationships, where a soft voice is sufficient. ( Hall , 1959, p184 )

Although other nearby nursing staff - (and also women clients placed in beds near the nurses station end of the ward) - might perhaps have been able with difficulty to overhear the conversation this did not appear to cause visible embarrassment to anyone. The effect of Anne's adornment ( i.e. a clean nurses uniform with belt, together with professional and name badges ) seemed reassuring to José.

José was dressed in casual every-day clothes , as is typical of clients admitted to this short stay elective orthopaedics ward. One of the first procedures undertaken for a client in consequence of admission is the measurement of blood pressure, pulse, respiration and temperature , - and this therefore naturally provided an opportune context for the first physical bodily contact of nurse touching the patient. Additional physical contact between nurse and client was again necessary on various occasions whilst the patient was on the ward, but not during the admission interview.

( Porritt , 1984, p9 )

In addition to interpersonal communication at verbal and nonverbal levels, there is also metacommunication - i.e. 'communication about communication' or instruction on how to interpret or decode what is being said. Metacommunication can tell a listener which of three representational systems - (auditory, visual or kinesthetic) - is the dominant mode of processing preferred by a particular client:- and neurolinguistic programming (NLP) evaluation of a client's body position, preferred verb forms and breathing can help the nurse determine the most favoured representational system for any individual client. Knowles (Knowles, 1983, 83:1011) believes that communication is best facilitated when nurse and client use the same representational system. A client's choice of eye-accessing cues, breathing pattern , or verbs, may be the best indicator of system preference; and the nurse might practise mirroring the behavioural mode of the client in order to improve interpersonal communication during an interview or other interaction. Eye movement - looking from side to side - together with even breathing and use of expressions such as 'can you tell me . . .' are characteristic of a preference for the auditory representational system, and this seemed applicable for both Anne and José during the interview. Apparently Anne adapts her interview style naturally to some extent from client to client, according to perceived need, but without much conscious thought about this.