CHAPTER 5

Communication and Nurse-Patient

Relationship
  Define communication.  Describe the methods and
 Explain the process and barriers of effective
elements of communication. communication.
 Enlist the types and modes of  Understand the concept of
communication professional communication.
 Explain the factors  Explain phases of nurse-
Learning Objectives influencing patient relationship
 communication.  Exhibit skills in
communicating effectively
with patient, families, and
team members.
  Communication.  Methods and barrier of
 Elements, process and effective
levels of communication/therapeutic
communication. communication
 Types, modes and techniques.
principles of  Professional
communication. communication.
CHAPTER  Factors influencing
communication.
 Phases of nurse-patient
relationship.
OUTLINE  Therapeutic
communication.
 Effectively
communicating with the
patient, families, and team
members
 MEANING OF COMMUNICATION

Concept: Definiton :
Communication is defined
Communication is the as a process of
base of community generating, exchanging,
because through understanding and
communication only the transmitting the
individuals are able to information between two
understand each other
appropriately individuals .
 • Sender: is the one who does the initiation of the
communication, it means the person who is starting the
information or thinking of sharing information
• Message: is the information which the sender wishesto
ELEMENTS share with another person.
& PROCESS • Channel of communication: It is the method how the
sender will deliver the message to anotherperson.
OF • Interference: It is any kind of disturbance created in the
COMMUNICATION environment, it can be a device that can distract the
receiver or which can distort the message
• Receiver: Receiver is the one who receives the message
to whom the sender intended to transfer the information.
• Feedback: Feedback is the return behaviour or response
of the receiver, which means the message is understood
by the receiver
LEVELS OF COMMUNICATION
LEVELS OF COMMUNICATION

Intrapersonal
Communication : also
known as self-talk. Interpersonal
Like we decide what Communication:
to wear. Similarly, includes the
nurses also do communication
intrapersonal between two or more
communication individuals and always
through which they have goal to exchange
enhance and focus messages.
toward positive
interaction.
 Group
communication

Interpersonal
Organizational Communication Public
communication communication

Mass
Communication
CLASSIFICATION OF COMMUNICATION
According to The Channel of Communication
1. VERBAL COMMUNICATION

Is the traditional way of communication

and language is
the channel of communication. Language
can be used in
the form of oral or written form.
 1. VERBAL COMMUNICATION- Types

Oral communication: Written communication

Refers to the Refers to the communication
communication that which involves use of words
involves the use of through letter or
Spoken words and done
by word of mouth. memo/report etc.
 Advantages & Disadvantages
Oral And Written Communication
2. NON-VERBAL COMMUNICATION

It is the type of
communication that
involves wordless
conversation, also
referred as body language.
2. NON-VERBAL COMMUNICATION - Types
3. ELECTRONIC COMMUNICATION

SOCIAL MEDIA:
popular methods of sharing
EMAIL AND TEXTS:
information is social media
Are effective ways of
liked what’s app, twitter,
communication within an
Facebook, etc. Even
organization. Emails and
official information is
texts should always be
being exchanged on these
specific and concise, while
platforms. But nurses must
drafting the message make
be aware about the privacy
sure the professional code
and confidentiality of
of conduct should be
information and adhere to
maintained
the policies of the
governing body.
CLASSIFICATION OF COMMUNICATION
According to The Style and Purpose of
Communication
1. FORMAL COMMUNICATION - Types

• It is the one that flows through the official channels normally used
within the organizational setup
Vertical Communication
• Flows upwards or downwards through formal channels.
• Upward communication flow of communication from a subordinate
to superior.
• Downward communication flows from a superior to a subordinate.
Horizontal Communication
• It is a lateral communication takes place among people having equal
authority.
2. INFORMAL COMMUNICATION

• It takes place without following the formal channels of

communication is said to be informal communication like talking to
friends.
CLASSIFICATION OF COMMUNICATION
Based on Flow of Information

TWO-WAY
COMMUNICATION:
ONE-WAY involves equal participation of
COMMUNICATION: sender and receiver also.
information is passed from one Communication is active and
side to another only like in democratic. Like discussion
lecture – teacher only teaches and brainstorming session
and student learns where teacher and students
freely expresses their facts and
opinion on said topic.
 Appropriateness: Suitable to the situation.

Clarity: Communication should always be

clear no ambiguity should rise with message
conveyed.
PRINCIPLES OF Channel of communication: It should be
COMMUNICATION chosen carefully so that the clarity is
maintained in the communication

Feedback: It should always be sought to

prevent ambiguity or doubts in the
information shared or conveyed.
 Attitude of nurse: Attitude sets the mood of nurse-client
relationship, like when working with positive attitude the
nurse will approach the patient in unhurried manner,
avoiding abrupt responses, making patient feel valued
and respected.

Cultural background: Nurse should be aware about the

different sociocultural beliefs and practices.

FACTORS
Gender: Men and women communicate differently and
INFLUENCING their perception and interpretation of information may
also differ.
COMMUNICATION

Status/Role: Patient’s role in society or occupation can

affect the nurse-patient relations.
 Environment/Space/Territory: Suitable area or
environment helps. Collecting patient history in
waiting area can cause patient to be uncomfortable
because it is a public space.

FACTORS Physical, Mental and Emotional state: Should be

assessed if found suitable then only communication
INFLUENCING can be effective
COMMUNICATION
Values - personal values of nurse and patient may
differ and may lead to disruption in communication.

Developmental stage: According to age the

understanding and perception changes, with this
intellectual and psychological development occurs.
So communication shall be as per age.
 “It is interpersonal interaction between
nurse and the patient for a specific
purpose or where nurse focuses on
patient’s unmet needs and aims to
collect information to promote health”.
THERAPEUTIC
COMMUNICATION “Therapeutic communication is
defined as the face-to-face process of
interacting that focuses on advancing
the physical and emotional well-being
of a patient”.
GOALS OF THERAPEUTIC
COMMUNICATION
 Methods of effective communication/ Therapeutic
Communication Techniques
Confirming/
Paraphrasing
Clarification
Sharing
Focusing
feelings

Sharing Broad ended

Information questions

Humor providing leads

Hope Offering self

Empathy Reflecting

Therapeutic
Active
Listening Communication Summarizing

Techniques
TECHNIQUES OF THERAPEUTIC
COMMUNICATION
TECHNIQUES OF THERAPEUTIC COMMUNICATION
TECHNIQUES OF THERAPEUTIC COMMUNICATION
BARRIERS TO EFFECTIVE COMMUNICATION
/NONTHERAPEUTIC COMMUNICATION
TECHNIQUES

Communication is the base

of nurse-patient
relationship; however, it can
be disrupted very easily due
to the following barriers”.
 BARRIERS TO EFFECTIVE
COMMUNICATION

Asking Personal Questions - questions that are not relevant to the situation is not
appropriate. Or the questions asked to satisfy personal curiosity is also not professional.

Giving personal opinion While communicating about nurse may come across the situation
where patient may share situation where decision making is needed. Then nurse should
refrain from giving any opinion or decision because it may divert or hinder the response of
the patient.

Changing the topic – While in conversation nurse should not change the topic or the subject,
this indicates that nurse is either uncomfortable or not interested in the conversation. This
impedes the communication and causes barrier

Cliché / automatic responses – for example, “everybody is afraid of needles” or

“administration is always money minded not employee supporter”. This kind of stereotype
or automated answers can cause barrier in the communication and therapeutic
communication because these replies reflect poor nursing judgement.

False reassurance – or false hope can be can be another barriers in communication. As the
nurse tells a terminally ill patient’s relative that “everything will be fine”, later the patient
deteriorates. This false reassurance or hope will cause mistrust and lead to the barrier..
 BARRIERS TO EFFECTIVE
COMMUNICATION

Sympathy - Expressing sympathy focuses on nurse’s feeling not on the patient. For example,
“I am extremely sorry for your amputation”. This shows that nurse is feeling sorry and
sympathize with patient. In this situation, patient stops expressing thoughts and wont share
feelings. Moreover, for nurse, sympathy clouds ability of clear thinking

Physical/ mental discomfort – Any pain anxiety or discomfort leads to barrier in

communication, as discussed in factors influencing communication. Nurse should make sure
of the comfort

Approval/Disapproval – As mentioned in the factors, patient may bring up situation where

nurse may have to express her opinion or give judgement. In this case, nurse must not
impose their personal attitude value or belief or being judgemental. . Agreeing or
disagreeing sends a message to the patient that information shared is right or wrong.

Jargon – Use of medical terminology or technical terms may lead to confusion in patient’s
mind and leading to lack of trust on nurse. Moreover, jargon will lead to inability to
understand what nurse is saying
 BARRIERS TO
EFFECTIVE
COMMUNICATION
Arguing – nurse must not argue with client, if a patient argues then nurse need to refrain
from it and understand the situation and calm the patient. Challenging or arguing may
leads to the defensive communication and revealing of incomplete true information

Gossip and Rumour – discussing patients details with other health team members for
non professional motive is unethical and should be avoided

Giving Advice - Similarly like opinion nurse should refrain from giving advice as it this
may cause defensive conversation or hiding of information which disrupts
communication

Time Constraints – is one of the key barrier because each nurse has multipole patients
due to which the expectation of patient may not be met due to time constraints, and
leading to disruption of nurse patient relationship.
 PNEUMONIC – BARRIERS IN COMMUNICATION
“J has opinion on personal topic and automatically reassures -
physical Sympathy, Arguing, gossiping, advising with time”

I. J - jargon
II. Opinion –Giving Personal Opinion
III. Personal – Asking Personal Questions
PNEUMONIC – BARRIERS IN IV. Topic – Changing the Topic
COMMUNICATION V. And – Approval/Disapproval Of information
VI. Automatically - Cliché/Automatic Response
VII. Reassures – false Reassurance
VIII. Physical – Physical/Mental Discomfort
IX. Sympathy - Sympathy
X. Arguing- Arguing with Patient
XI. Gossiping - Gossip and Rumour
XII. Advising -giving Advise
XIII. Time – Time Constraint
 • Professional communication refers to
oral/written, visual or digital form of
communication in workplace.
PROFESSIONAL • Professional communication is important in
COMMUNIICATION nursing too, because it helps in developing
rapport with patient and have trust among
health team members and between nurse
and patient. Professional communication
aids in achieving productivity and objectives
PROFESSIONAL COMMUNICATION

The distance
between two
individuals has
different zone of
communication.
PROFESSIONAL COMMUNICATION

Intimate Zone: close contact : interaction between

parents and children or partners or mother and child,
who desire close contact.

Personal Zone : distance maintained between close

friends

Social Zone: distance maintained while interacting with

acquaintances like with colleagues.

Public Zone: distance maintained while communicating

in meetings or public speaking reality”.
PRINCIPLES OF PROFESSIONAL COMMUNICATION
• it involves whole process of encoding, message sending , channel of communication
Communication is and influence of environment then receiving or the message and decoding then
reflecting the feedback by the receiver. All these activities and events is a process which
process allows interaction between two individuals.

Communication is not • This is because receiver when decodes the message provides the feedback through
which sender evaluates if the message has been perceived in the manner it was
linear but circular intended.

Communication is • as the message once received has a feedback as well as the response to it, like a
message is received and accordingly the reply is given and actions are taken. If in case
complex the message is not clear the sender provides further clarification based on the feedback

Communication is • Interaction once made cannot be reverted, for example the sender sends a message to
receiver then the message cannot be undone, this is why it is irreversible.
irreversible
• the communication is dependent on personality because a positive person would
Communication involves communicate in positive manner whereas personality who is dominating will have
commanding communication. Therefore it is said that communication involves
personality personality.
 “The nurse-patient relationship is
result of series of interaction
between the nurse and the patient
NURSE- over a period of time with the
nurse focusing on needs and
PATIENT problems of patient and his family
RELATIONSHIP while using the scientific
knowledge and scientific skills of
nursing profession”.
—Joyce Travelbee
Purposes of Nurse-
Patient
Relationship
 Altruism: A professional nurse should be
passionate about her services to the patients,
family or to community at large. ••

Ethics and Responsibility: Nurse should

practice in a professional manner where her
behavior, decisions, activities should reflect
professional ethics and accountability.
Elements of
Nurse-Patient Communication Skills: Nurse should be
skilful while communicating with the patients
Relationship and should have adequate knowledge of
verbal as well as nonverbal communication.
 Genuineness: Nurse should be sincere and
honest in therapeutic relation. She must have
clear and concrete in communications with
patient.

Respect: It is an unconditional positive regard to

the patients and her behavior towards client
should not depend on the patient’s behavior.
There are different ways to promote respect and
Elements of positive regard to the patient

Nurse-Patient Empathy: It is the ability of a nurse to accurately

Relationship understand the person’s current feelings and
their meanings, and to communicate this
understanding to the patient.
 Concreteness: Nurse must communicate information in a clear
language using specific terms, according to the patient’s level of
understanding.

Confrontation: It is a process of helping the client become

aware of inconsistencies in his or her feelings, attitudes, beliefs,
and behaviors. Effective confrontation is only possible with high
levels of empathy and respect toward patient.

Immediacy: Immediacy involves sensitivity to the patient’s

Elements of feelings and a willingness to deal with these feelings rather than
ignore them. (Focus on here and now).

Nurse-Patient Nurse self-disclosure: Nurse intentionally reveals personal

Relationship experiences about the self to the patient for the purpose of
emphasizing both the similarities and the differences of
experiences .
PHASES OF NURSE-PATIENT RELATIONSHIP
PRE-ORIENATION PHASE

In this phase nurse does a

preliminary work that is
becoming aware of her
This self-preparation
own personal feelings,
would allow nurse to
fears and worries,
approach patient with
planning how to approach
unbiased and
and interact with patient
unprejudiced manner.
and learning about the
disease condition patient
reports with.
 INTRODUCTORY PHASE

In this phase nurse Nurse collects general Pleasant greetings, eye-

introduces herself and information about to-eye contact and This phase is short and
orients the patient patient and seeks the acceptance of patient’s concise but with
about the hospital ideal time to talk to the behavior, also, being specific aim, but nurse
routine (if patient is patient in detail. This aware of patient’s should never show any
indoor patient), how to will be the first step of personal zone and not hurried gesture or
call for the help, this nurse showing respect intruding into it will behavior during this
reduces anxiety of and help patient to help to develop good phase.
patient. develop trust in her. rapport.
 ORIENTATION PHASE

Parameters of the
Nurse orients the relationship: The Confidentiality: The
patient about the patient needs to Formal or informal patient has a right to
purpose of the know about the contract: It is a know that how Termination: The
interaction and how nurse (who the nurse mutual agreement information provided time of the
long it may take, is and what the between the nurse will be shared with termination phase
family may be nurse’s background and patient regarding the others. The nurse should be clear and
involved as per is) and the purpose of their meeting and must be aware of the must be discussed
patient’s the meetings. Nurse their roles in meeting client’s right to from the beginning.
wish/consent. might provide the the treatment goals confidentiality must
following not be violated.
information.
 WORKING PHASE

In this phase nurse and

patient collaboratively work
This is the main phase, when together.
The different techniques of
the whole interaction and Nurse assumes different roles
therapeutic communication
communication occurs. During counsellor, teacher in order to
are utilized to maximize the
this phase nurse and patient motivate the patient so that
output of nursepatient
work together to meet the set the set goals are achieved.
relationship.
health goals. Patient starts from dependent
role to interdependent role to
independent role.
BARRIERS IN
WORKING
PHASE

REASONS FOR
TERMINATING
NPR
 TERMINATION PHASE

Once the patient

is ready for the This phase Reasons for
discharge or when This can also be involves the terminating the
the set goals are end of shift or summarization of nurse-patient
achieved then the patient getting the work done till relationship need
nurse-patient discharged. now and how to to be discussed
relationship must proceed further. with the patient
come to an end.
REASONS FOR
TERMINATING
NPR
 COMMUNICATING EFFECTIVELY WITH
PATIENT, FAMILIES AND TEAM MEMBERS

Assessment gathers all Identify the language

the information from spoken by the patient
patient using effective to avoid barrier in
communication skills. communication.
Before assessment Follow all the principle
nurse need to ensure of communication and
that patient does not techniques of effective
have any physical communication
limitation like hearing discussed earlier, other
problems or speech speaking and listening
issues. skills.
 COMMUNICATION WITH
VULNERABLE
GROUPS
Children - while communicating with children or minor, be playful and
approachable. Colored uniform shall be worn.

Women - be respectful, do not be judge-mental while communicating, while

discussing sensitive issues provide privacy

Physically and mentally challenged - be respectful to the challenge faced by

the patient. Mentally challenged patient shall always be accompanied by the
primary care giver and appropriate consent shall be gained.

Elderly - have patience while communicating, be sensitive to the sensory

deficits like hearing impairment or cognitive degeneration and communicate
accordingly
 • Communication is important aspect of nursing
because it helps in developing rapport not only
with patient but also with health team members

CHAPTER • Phases of nurse-patient relationship helps the

nurse to keep the nurse-patient boundaries and
yield the maximum output for therapeutic
FOCUS purpose.

POINTS • Different skills are needed while communicating

with vulnerable groups as well as team members
like speaking and listening skills
“Textbook of Foundation of
Nursing" by Jyoti Kathwal