Communication

What is Communication?

• The process of sending and receiving messages to share meaning between a sender and a receiver.
• Components:

Sender: initiates message

Receiver: person interpreting the message

Message: content being communicated

Medium/Channel: how the message is sent (spoken, written, electronic, nonverbal)

Feedback: the receiver’s response confirming understanding
• Example: A nurse gives discharge instructions (message), the patient nods and asks a clarifying question (feedback).

Circular Transactional Model of Communication

• Continuous and dynamic process involving both the sender and receiver simultaneously.
• Communication is influenced by internal and external factors like environment, perception, and context.
• Example: During a nurse-patient conversation, both parties send and receive cues (verbal + nonverbal) in real time.

Metacommunication

• Awareness of everything that influences communication — tone, posture, facial expression, gestures, environment, and cultural factors.
• Helps interpret the “meaning behind the message.”
• Example: A patient says “I’m fine” but avoids eye contact and frowns → the nurse interprets that the patient may not be fine.

Cultural Considerations in Communication

• Be aware of cultural differences in eye contact, personal space, gestures, and touch.
• Don’t assume — ask respectfully about preferences.
• Example: Some cultures avoid direct eye contact as a sign of respect.

Types of Communication

Verbal: spoken or written words.

Example: Giving report to another nurse.

Nonverbal: body language, facial expressions, posture, tone.

Example: Smiling, crossing arms, tone of voice.

Electronic: email, EHR messaging, telehealth.

Example: Sending secure updates through patient portals.

Written: charts, documentation, care plans.

Example: Recording vitals in the patient’s chart.

Documentation is Communication

• Written or electronic record that communicates patient care.
• Must be clear, concise, factual, and objective.
• Serves as a legal document — “If it wasn’t documented, it wasn’t done.”
• Example: Instead of writing “patient seemed upset,” write “patient crying and refused to eat lunch.”

HIPAA (Health Insurance Portability and Accountability Act of 1996)

• Federal law protecting patient privacy and medical information.
• Nurses must ensure confidentiality in all forms (verbal, written, electronic).
• Example: Don’t discuss patient info in public places or on social media.

Hildegard Peplau (1909–1999)

• Creator of the Interpersonal Relations Theory.
• Foundation of nursing as a therapeutic relationship between nurse and patient.
• Focuses on partnership, trust, and communication.
• Example: Nurse establishes rapport, sets goals, and supports the patient’s growth.

Phases of the Therapeutic Nurse–Patient Relationship

Orientation Phase: Introductions, establish trust, identify goals.

Example: “Hi, I’m your nurse today. Let’s talk about what brings you here.”

Working Phase: Nurse and patient work together toward goals.

Example: Teaching about medication adherence.

Termination Phase: Relationship closure; review progress and discharge plans.

Example: “You’ve learned how to manage your wound care—great work!”

Therapeutic Communication Techniques

• Active listening – being fully present and attentive.
• Silence – allows patient reflection.
• Open-ended questions – encourage expression. (“Tell me more about how you feel.”)
• Exploring/Clarifying – “Can you explain what you mean by dizzy?”
• Paraphrasing/Restating – “You’re saying the pain gets worse when you move?”
• Offering presence – “I’ll stay with you awhile.”
• Refocusing – bring conversation back to topic.
• Example: Patient says “I’m scared about surgery.” Nurse: “Tell me more about what worries you.”

Professional Nursing Relationships

• Nurse–Patient: Focused on care, trust, and communication.
• Nurse–Family: Educating and involving family in care.
• Nurse–Nurse/Healthcare Team: Collaboration for coordinated care.
• Nurse–Community: Health promotion and outreach.

Nurse–Healthcare Team Relationship: Steps for Collaboration

Identify the problem or issue.

Identify barriers to solution.

Agree on desired outcome.

Agree on plan and roles.

Evaluate effectiveness.
• Example: During rounds, the nurse and physician discuss adjusting meds for better blood pressure control.

Hand-Off Reports and SBAR

• SBAR = Situation, Background, Assessment, Recommendation.
• Used for consistent and effective communication during transitions.
• Example:

S: “Patient with chest pain.”

B: “History of heart disease.”

A: “BP 90/60, HR 120.”

R: “Recommend notifying cardiology and preparing ECG.”

Metacommunication: Verbal vs Nonverbal

• Verbal: spoken or written words.
• Nonverbal: tone, posture, gestures, facial expression.
• Congruent: message and behavior match (“I’m happy” + smiling).
• Incongruent: mismatch (says “I’m fine” while crying).
• Nonverbal often communicates more meaning than words.

Operations in the Communication Process

• Perception: how information is received/interpreted.
• Evaluation: assigning meaning.
• Transmission: how the message is sent.
• Influenced by environment, stress, noise, culture, and emotional state.
• Example: Misunderstandings occur when tone or context are misread.

Importance of Self-Awareness

• Understanding your own emotions, biases, and reactions affects communication.
• Helps prevent projection of stress or frustration onto patients.
• Example: Recognizing that you’re tired or irritable so you can remain professional.

Reflective Practice

• Actively analyzing one’s interactions to improve future communication.
• Encourages growth, empathy, and accountability.
• Example: After a tough patient encounter, reflecting on what went well and what could improve.

Causes of Communication Breakdown

• Failing to appreciate uniqueness
• Misinformation or assumptions
• Sensory deficits (hearing, vision)
• Conflicting messages / false reassurance
• Environmental distractions
• Value statements, clichés (“You’ll be fine”)
• Language barriers
• Timing issues / not actively listening
• Defensive or automatic responses
• Example: A nurse who interrupts a patient mid-sentence may miss key information.

Conflict Resolution Steps

Acknowledge the conflict.

Focus on the issue, not personalities.

Appreciate different perspectives.

Explore alternative solutions.

Be open to change.

Strive for win-win outcomes.

Maintain positivity.
• Example: Two nurses disagree on patient assignments; they discuss and compromise on fair workload distribution.

Interprofessional Collaboration: Nurse’s Essential Role

• Definition: Multiple healthcare professionals working together to deliver the best outcomes.
• IPE (Interprofessional Education): Training where students learn with, from, and about each other’s roles.
• QSEN Competency: Teamwork and collaboration.
• ANA Standard 11: Emphasizes interprofessional communication for safety and quality.
• Example: Nurses, doctors, and therapists collaborate on a discharge plan.

Barriers to Collaboration

• Intimidation by hierarchy.
• Lack of understanding of roles.
• Poor communication between disciplines.
• Time constraints.
• Workplace incivility.
• Example: A nurse hesitates to question a physician about a dosage error due to intimidation.

Benefits of Collaboration

• Better, patient-centered outcomes.
• Higher patient satisfaction.
• Multiple perspectives and shared expertise.
• Learning and professional growth.
• Stronger teamwork and job satisfaction.
• Example: Interdisciplinary teams preventing readmission through coordinated education.

Communication Styles

Aggressive: dominating, disrespectful; violates others’ rights. (“You must do this now!”)

Assertive: clear, confident, respectful; best professional style. (“I understand your concern, but here’s our policy.”)

Passive: avoids expressing opinions or needs; may lead to resentment. (“It’s fine, whatever you think.”)

Passive-Aggressive: indirect resistance, sarcasm, or subtle opposition. (“Sure, I’ll do it later,” but doesn’t follow through.)