communication theory

Intrapersonal

Internal self-talk. Influences a nurse's self-esteem, confidence, and mental readiness

Interpersonal

One-on-one interaction between the nurse and patient/colleague. The core of clinical practice.

Transpersonal

Interaction that occurs within a person's spiritual domain (e.g., discussing hope, values, or life meaning).

Small Group

Interactions within a small goal-directed team (e.g., shift handovers, care conferences).

Public

Interaction with an audience (e.g., community health presentations, public health education).

It’s not impossible to NOT communicate

every behaviour, including silence, posture, or avoiding eye contact, gives a message

Content vs Relationship dimension

content is the literal message (what is said). Relationship is how the message is delivered and interpreted based on trust, power and emotion 

Transactional

communication is reciprocal. Both sender and receiver continuously transmit, interpret and adjust messages together

Empirical Knowing

objective, scientific data, research evidence and clinical facts

Personal Knowing

self-awareness, connecting with the patient as a unique individual and authentic relationship building

Aesthetic Knowing

the “art” of nursing, tailoring care creatively based on patient cues, intuition and deep empathy

Ethical Knowing

aligning actions with moral obligations, professional codes of conduct and standards of practice

Providing Presence

“being there” (physical availability) and “being with” (emotional engagement)

Touch

the difference between task-oriented (procedures), caring

(emotional support or comfort) and protective (preventing harm)

Content themes

identifying underlying patterns, core concerns, or recurring topics across a patient narrative

Communication patterns

noticing if the patient shifts subjects, uses hyperbole, minimizes symptoms or acts defensive

Discrepancies

spotting conflicts between verbal statements and nonverbal cues (saying “I’m not in pain” while grumbling)

What is NOT being said

paying attention to hesitations, purposeful exclusions or avoided topics to pinpoint hidden distress

The SOLER Framework

•       S – Squarely face: position your torso directly toward the client to show complete attention

•       O – Open posture: keep arms and legs uncrossed to project warmth and a non-defensive demeanor

•       L – Lean forward: tilt your upper body slightly toward the client to demonstrate ongoing care and engagement 

•       E – Eye contact: keep steady, comfortable, non-staring eye contact to solidify therapeutic connection

•       R – Relaxed posture: maintain an even, calm bodily presence to deescalate anxiety within the room 

Open-Ended Questions

broad, unstructured narratives. Important for opening assessment interviews (“tell me more about how you’ve been managing at home”)

Focused Questions

narrow the conversation down to a specific issue while allowing room for detail (“can you describe the type of ache you feel in your left knee”)

Closed-Ended Questions

require single-word or short responses. Best used in emergency situations or for specific facts (“are you experiencing shortness of breath right now?”)

Summarizing

pulling together ideas or feelings expressed by the client into a single, concise statement to validate mutual understanding

Paraphrasing

re-stating the core message using the listener’s own words. It’s brief and focuses on facts and cognitive concepts. Intentionally leaving aside emotional feelings. It avoids parroting (blind repetition)

Clarifying by questioning

using open questions to investigate ambiguous or vague patient remarks (“could you share a bit more about what you mean when say things feel ‘completely different’ inside your chest”)

Empathy

an objective, therapeutic communication tool. The nurse accurately senses and understand the client’s internal emotional state without absorbing their emotional weight. This maintains therapeutic boundaries

Sympathy

A subjective, non-therapeutic emotional reaction. The nurse shares the client’s feelings directly, which can blur boundaries and impair clinical objectivity (ie. crying with the client)

Giving and Receiving Feedback (ABCD)

•       A – Attend: evaluate if the timing, environment, and readiness of the receiver is appropriate. Ask for permission first

•       B – Bridge: describe the specific behaviours objectively, acting like a camera. Use descriptive neutral “I” statements

•       C – Comment: explicitly share your clinical concerns, safety outcomes, or the specific impacts of the behaviour

•       D – Develop: collaborative problem solving. Offer actionable suggestions and invite mutual feedback or discussion 

Perception Process

regulated by 3 stages – Selection (what stimuli we notice based on motives/fatigue), Organization (grouping by schemas/stereotypes), Interpretation (assigning meaning based on past experiences)

Language Barriers

always allow extra time for processing. Use official hospital medical interpreter services rather than relying on family members for complex clinical instructions

Assertiveness

communicating clearly firmly and respectfully without violating the rights of others 

Refusing a request

when declining an unsafe assignment or inappropriate task, state your refusal clearly, firmly and nondefensively. Stand on your statement in professional policy, clinical safety and patient wellbeing 

Collaborating

high assertiveness, high cooperation. The gold standard for nursing care teams to resolve underlying clinical root causes

Compromising

finding a quick, mutually acceptable middle ground where both parties give up something

Accommodating

placing the other party’s needs entirely above your own 

Avoiding

postponing or withdrawing from the issue entirely

Competing

pursuing your own concerns at the explicit expense of the other party 

Mitigating Perceptual Distortions: The “Perception Check” 

Step 1: Objective Observation – inform the patient of the exact physical behaviour observed without applying any interpretation or judgement 

Step 2: Two Alternating Interpretations – provide two distinct plausible, non-accusatory explanations for that specific behaviour 

Step 3: Direct Request for Feedback – request that the client validate or clarify their true internal state

Asking Personal Questions

Asking questions that are curious or nosy rather than clinically relevant. It satisfies the nurse's curiosity rather than helping the patient.

Giving Personal Opinions

Injecting your own values, beliefs, or choices into the patient's situation. This takes away the patient’s autonomy and decision-making power.

Changing the Subject

Rudely or abruptly shifting the topic of conversation because the nurse is uncomfortable, busy, or uninterested. It invalidates what the patient is trying to express.

Automatic Responses

Using clichés, stereotypes, or trite phrases instead of a thoughtful, individualized answer. It minimizes the patient's unique experience

False Reassurance

Offering blanket reassurance that is not based on fact or reality. This trivializes the patient's anxiety and can damage trust if things don't turn out well.

Asking for Explanations (“Why” Questions)

Asking the patient to justify their thoughts, feelings, or behaviors. "Why" questions often sound accusatory and put the patient on the defensive.

Approval or Disapproval

Passing judgment on a patient's choices or actions by openly agreeing or disagreeing. This implies that the patient needs to please the nurse.

• Example (Approval): "I'm so glad you decided to undergo chemotherapy; that is definitely the right choice."

• Example (Disapproval): "I can't believe you are considering leaving against medical advice. That is a very bad idea."

Defensive Responses

Protecting oneself, staff, or the institution from criticism rather than listening to the patient's underlying concern

Passive or Aggressive Responses

Passive: Avoiding conflict, using sarcasm, or giving in to the patient at the expense of professional boundaries (often leading to resentment).

Aggressive: Confronting the patient in a hostile, threatening, or angry manner.

Arguing

Challenging or disputing a patient’s perceptions or statements. This invalidates their feelings and turns the interaction into a power struggle.