Chapter 24: Communication

COMMUNICATION AND NURSING PRACTICE

- As a nurse, you communicate with patients and families to develop meaningful
relationships
- Communication is the key to nurse-patient relationships and ability to deliver patient-
centered care
- Patient safety also requires effective communication among members fo the health care
team as patients move from one caregiver to another or from one care setting to
another

COMMUNICATION AND INTERPERSONAL RELATIONSHIPS

- Caring relationships formed among a nurse and those affected by nurse’s practice are at
the core of nursing
- All behavior communicates, and all communication influences behavior
- Nurse’s ability to relate to others is important for interpersonal communication
- Intention and behavior directly influence health gives nurses the ethical responsibility to
do no harm to those entrusted in their care

DEVELOPING COMMUNICATION SKILLS

- Nurses who develop critical thinking skills make the best communicators
- A self-confident attitude is important because a nurse who conveys confidence and
comfort while communicating more readily establishes an interpersonal caring
relationship
- An independent attitude encourages a nurse to communicate with colleagues and share
ideas about nursing interventions
- Integrity allows nurses to recognize when their opinions conflict with those of their
patients
- Each individual basis their perception about information received through:
o 5 senses
o Culture and education
o Perceptual biases/stereotypes
- Emotional Intelligence: assessment and communication technique that allows nurses to
better understand and perceive the emotions of themselves and others
o Allows nurse to use self-awareness, motivation, empathy and social skills to build
therapeutic relationships with patients
o Patient’s emotions can negatively impact self-care behaviors
o If nurse understands a patient’s perceptions and motivations, they can help
patient make healthy behavior changes

LEVELS OF COMMUNICATION
- Intrapersonal communication: powerful form of communication. Also called self-talk.
Used to develop self-awareness and a positive self-esteem that enhances appropriate
self-expression. Positive self-talk
 - Interpersonal communication: one-on-one interaction between nurse and another
person that often occurs face to face. Lies at heart of nursing practice
- Small group communication: usually goal directed and requires an understanding of
group dynamics. Communication should be organized, concise and complete
- Public communication: Interaction with an audience. Requires special adaptations in
eye contact, gestures, voice inflection and use of media material to communicate
messages effectively
- Electronic communication: use of technology to create ongoing relationships with
patients and their health care team

ELEMENTS OF THE COMMUNICATION PROCESS

- Communication is an ongoing and continuously changing process
- Circular transactional communication process model
o Shows situational contextual inputs, channels of communication, interpersonal
contextual concepts and factors affecting the sender and receiver
o Each person in the communication interaction is both a speaker and a listener
and can be simultaneously sending and receiving messages
o Both parties view the perceptions, attitude, and potential reactions to a sent
message
o Communication becomes a continuous and interactive activity
o Feedback from the receiver or environment enables the communicators to
correct or validate communication
o Role relationship of communicators = complementary (one above the other –
nurse teaching patient) and symmetrical (equal – group of patients talking)
o Referent, sender and receiver, message, channels, context or environment,
feedback, interpersonal variables
o Referent: Motivates on person to communicate with another.
 Sights, sounds, sensations, perceptions and ideas = cues that initiate
communication process; allows you to develop and organize messages
more efficiently
o Sender and Receiver: Sender = person who encodes and delivers a message;
receiver = person who receives and decodes message. Sender’s message acts as
a referent for the receiver. Transactional communication = role of sender and
receiver switching back and forth between nurse and patient. Active listening is
important to accurately decode and understand a message
o Message: content of communication. Contains verbal and nonverbal expressions
of thoughts and feelings. Personal perceptions may also distort the receiver’s
interpretation of a message.
o Channels: Means of sending and receiving messages through visual, auditory and
tactile senses
o Feedback: message a sender receives from the receiver. Indicates whether
receiver understood meaning of sender’s message. Occurs continuously between
sender and receiver
 o Interpersonal variables: factors within both the sender and receiver that
influence communication. Cultural sensitivity enables you to explore the
interpersonal variable such as educational and developmental level,
sociocultural background, values and beliefs, motions, gender, physical health
status, and roles and relationships that affect how a patient communicates. Pain
and anxiety also affect nurse-patient communication
o Environment: setting for sender-receiver interaction. Environmental distractions
common in health care settings and interfere with messages.

FORMS OF COMMUNICATION
- Messages are conveyed verbally and nonverbally; concretely and symbolically
VERBAL COMMUNICATION
- Vocabulary: communication is unsuccessful if senders and receivers cannot translate
one another’s words and phrases
- Denotative and connotative meaning: Denotative meaning: literal meaning;
connotative meaning: shade or interpretation of the meaning of a word influenced by
thoughts/feelings/ideas that people have about word
- Pacing: speak slowly and enunciate clearly
- Intonation: tone of voice dramatically affects meaning of message
- Clarity and Brevity: Older adults = fewer words results in less confusion. “You know?” or
“OK?” at the end of every sentence detract from clarity. Simple and direct
- Timing and relevance: Timing is critical. Patients report improved satisfaction,
understanding and perception of safety with RNs who provided a bedside hand-off and
communicate information about the plan of care
NONVERBAL COMMUNICATION (65%)
- Includes 5 senses and everything does not involve the spoken or written word
- More accurately indicates a person’s intended meaning than verbal
- All kinds of nonverbal communication are important but interpreting them is often
problematic
- Sociocultural background is a major influence on the meaning of nonverbal behavior
- Personal appearance: physical characteristics, facial expression, and manner of dress
and grooming  communicate physical well-being, personality, social status,
occupation, religion, self-concept
- Posture and gait: forms of self-expression. Leaning forward = attention; slumped
posture and slow shuffling gait = depression/illness/fatigue
- Facial expression: face is the most expressive part of body
- Eye contact: lack of eye contact may indicate anxiety, defensiveness, discomfort or lack
of confidence in communicating
- Gestures: emphasize, punctuate and clarify the spoken word. Alone carry specific
meanings, or they create messages with other communication cues
- Sounds: validate nonverbal messages with patients to interpret them accurately
- Territoriality and personal space: territoriality = need to gain, maintain, and defend
one’s right to space. Territory is important because it provides people with a sense of
privacy, identity, security and control
METACOMMUNICATION
- Broad term that refers to all factors that influence communication
- Awareness of influencing factors helps people better understand what is communicated

PROFESSIONAL NURSING RELATIONSHIPS

NURSE-PATIENT CARING RELATIONSHIPS
- Nurse assumes role of a professional who cares about each patient and his or her
unique health needs, human responses and patterns of living
- Therapeutic relationships promote a psychological climate that facilitates positive
change and growth and attainment of goals
o Goals = patient achieving personal growth related to personal identity, ability to
form relationships and ability to satisfy needs and achieve personal goals
o There is an explicit time frame, goal-directed approach and high expectation that
what you discuss together is kept confidential