VIJAYA COLLEGE OF NURSING

SUBJECT : NURSING MANAGEMENT

UNIT : VI

NAME OF THE TOPIC : DIRECTING -

COMMUNICATION

NAME OF THE STUDENT : MRS SOBHA BABU

NAME OF THE HOD : MRSSMITHAMOHAN

NAME OF TE EVALUATOR : MRS SMITHA MOHAN

HOURS ALLOTED : 3HRS

SUBMITTED ON : 30/10/2019

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Content

COMMUNICATION

INTRODUCTION
I
II I.
II. MEANING OF COMMUNICATION

III III.
IV. CONCEPT OF COMMUNICATION

IV V.
VI. DEFINITION OF COMMUNICATION

V
PURPOSES OF COMMUNICATION

VI
NATURE OF COMMUNICATION

VII
VII. IMPORTANCE OF COMMUNICATION

PROCESS/ CHANNEL OF COMMUNICATION

VIII

IXVIII. MODES OF COMMUNICATION

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 TYPES OF COMMUNICATION

COMMUNICATION SKILLS

I. COMMUNICATION STRATEGIES IN AN
ORGANIZATION

I. STEPS FOR MAKING COMMUNICATION

EFFECTIVE

II. BARRIERS OR GATEWAYS TO

COMMUNICATION

III. TECHNIQUES TO IMPROVE THE

COMMUNICATION

I. COMMUNICATION SYSTEMS USED IN

HOSPIITALS

II. COMMUNICATION PATTERN IN NURSING

APPLICATION OF COMMUNICATION IN
NURSING PROCESS

INTERPERSONAL RELATIONSHIP

I. DFINITION OF INTERPERSONAL
RELATIONSHIP

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 II. PURPOSE OF INTERPERSONAL RELATION

III. ELEMENTS OF PROFESSIONAL

COMMUNICATION:

IV. IMPORTANCE OF INTERPERSONAL

COMMUNICATION:

V. PRINCIPLES OF IPR IN MANAGEMENT

VI. INTERPERSONAL RELATIONSHIP SKILLS:

VII. PHASES OF INTERPERSONAL

COMMUNICATION:

I. PROCESS OF INTERPERSONAL RELATIONS

II. BARRIERS OF INTERPERSONAL

RELATION

III. ESTABLISHMENT OF IPR IN NURSING

IV. THEORIES OF INTERPERSONAL

RELATIONSHIP:

CONFIDENTIALITY
I.
II.
III. INTRODUCTION

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 IV. MEANING OF CONFIDENTIALITY

V. CONCEPTS CONCERING CONFIDENTIALITY

VI. DEFINITION OF CONFIDENTIALITY

VII. THINGS THAT SHOULD BE KEPT

CONFIDENTIAL

VIII. TYPES OF CONFIDENTIALITY

IX. IMPORTANCE OF CONFIDENTIALITY

X.

XI. PRINCIPLES OF CONFIDENTIALITY

CONFINDENTIALITY IN NURSING

XII. QUALITIES OF A NURSE IN

CONFIDENTIALITY

XIII. BREACH OF CONFIDENTIALITY

XIV. AGENCIES THAT MONITOR PATIENT

PRIVACY

XV. GUIDELINES FOR PROTECTING PRIVATE

AND CONFIDENTIAL INFORMATION
XVI.
PUBLIC RELATION
XVII.
I. INTRODUCTION

XVIII. DEFINITIIOM
XIX.

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 II. ELEMENTS OF PUBLIC RELATION:
XX.

III. FUNCTION OF PUBLIC RELATION

IV.

PUBLIC RELATION SKILLS

V. ROLES OF A PUBLIC RELATION OFFICER

VI. TOOLS OF PUBLIC RELATION

VII. FACTORS RESPONSIBLE FOR SUCCESSFUL

PUBLIC RELATION PROGRAMME
VIII.
IX. NURSE’S ROLE AS A PUBLIC RELATION
OFFICER
X.
XI. GUIDE LINES FOR GOOD PUBLIC
RELATIONS
XII.

XIII. ROLE OF ADMINISTRATOR/MANAGER IN

COMMUNICATION
XIV.
XV. SUMMARY

XVI. RESEARCH ABSTRACT

XVII.
CONCLUSION

BIBLIOGRAPHY

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 COMMUNICATION
I. INTRODUCTION

Communication is defined as the imparting or interchange of thoughts,

opinions, or information by speech, writing, or signs. Communication is
defined as interchange of information between two or more people.
Communication may be defined as a process concerning exchange of facts or
ideas between persons holding different positions in an organization to
achieve mutual harmony. Communication is the process of exchange of
ideas, views, facts, feelings, etc among people. As per literature, 75% of time
spent by members in an organization is on interpersonal interactions. One of
the causes for organizational problem is poor communication.

The art of getting message across effectively is a vital part of being a

successful manager. Whether want to make presentations with confidence or
to negotiate with ease, communicate clearly will help to improve
communications skills. From understanding body language to writing reports
and proposals all clearly explained. Also included is practical advice on
using public relations, advertising information technology, and media
techniques.

II. MEANING OF COMMUNICATION

Communication is a process of change. In order to achieve desired result, the

communication necessarily is effective and purposive.

III. CONCEPT OF COMMUNICATION

The word communication is derived from the Latin word ‘communis’ which
means common. If a person affects a communication, he has established a
common ground of understanding. Thus, communication involves imparting
a common idea and covers all types of behavior resulting therefrom. This
indicates that various factors enter into the process of communication. These

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 are the communicator or source of information, the receptor or receiver of
information, the content of communication and the manner of
communication. Thus, ‘communication· in its broad sense means both the
act of communicating something and the manner of communication such as
letter, notice or circular.

IV. DEFINITION OF COMMUNICATION

According to Ricky griffins Communication is the process of transmitting

information from one person to another.

According to Newman and Summer “Communication is an exchange of

facts, ideas, opinions or emotions by two or more person”.

According to invancevich, “Communication is the transmission of

information and understanding through the use of common symbols”.

V. PURPOSES OF COMMUNICATION

1. Recruitment process

Communication is needed in the recruitment process to persuade potential

employees of the merits of working for the enterprise. The recruits are told
about the company’s organization structure, its policies and practices

2. Orientation

Communication is needed in the area of orientation to make people

acquainted with peers, superiors and with company s rules and regulations.

3. Perform their function effectively.

Communication is needed to enable employees to perform their function

effectively. Employees need to know their Job’s relationship and
importance to the overall operation. This knowledge makes it easy for them
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 to identify with the organizational mission. If a nurse in a hospital knows
why she is to follow certain procedures with a patient and how this relates
to the total therapy programme for him, it is much easier for her to develop
an ideological commitment to the hospital.

4. Evaluation

Communication is needed to acquaint the subordinates with the evaluation

of their contribution to enterprise activity. It is a matter of some
motivational importance for the subordinates to know from their superior
how they stand and what the future may hold for them. This appraisal, if
intelligently carried out, boosts the subordinates morale and helps them in
building their career.

5. Teach employees:

Communication is needed to teach employees about personal safety on the

job. This is essential to reduce accidents, to lower compensation and legal
costs and to decrease recruitment and training cost for replacements.

6. Projecting the image

Communication is of vital importance in projecting the image of an

enterprise in the society. The amount of support which an enterprise
receives from its social environment is affected by the information which
elite groups and the wider public have acquired about its goals, activities
accomplishments.

7. Decision process

Communication helps the manager in his decision process. There is a spate

of varied information produced in an enterprise. The manager must make a
choice of useful and essential information which should reach him.

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8. Communication helps in achieving coordination.

In a large organization, working on the basis of division of labour and

specialization, there is need for coordination among its component parts.
This can be achieved only through communication. A good communication
system is the basis of all interdependent activities which we find being
carried out in different departments of an organization. By providing
information to each unit about the relevant activities of others, a good
system of communication makes the interdependence of each unit
acceptable to it. In the absence of communication, no unit would tolerate
this interdependence. This will make coordination difficult. In the words of
March and Simon, “The greater the efficiency of communication within the
organization, the greater the tolerance of a unit for interdependence.

9. Communication promotes cooperation and industrial peace.

Most of the disputes in an enterprise take place because of either lack of

communication or improper communication. Communication helps the
management to tell the subordinates about the objectives of the business
and how they can help in achieving them. Similarly, communication helps
the subordinates in putting forth their grievances, suggestions, etc. before
the management. Thus communication helps in promoting mutual
understanding. Cooperation and goodwill between the management and
workers.

10. Communication increases managerial efficiency.

It is said that the world of modern management is the world of

communication and the success of a manager in the performance of his
duties depends on his ability to communicate. Administrators in business
and industry reportedly spend between 75 and 95 per cent of their time
communicating (either sending or receiving messages.’) Naturally then, an
effective system of communication is very essential for the efficiency of a
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 manager. Benjamin Balinsky has rightly remarked that, “if there is any
shortcut to executive effectiveness, it is the mastery of the art of face to face
communication.

VI. NATURE OF COMMUNICATION

1. Communication is a two ways or reciprocal process involving exchange

of ideas, facts and opinions. The process is not complete unless the receiver
has understood the message and his/her response is known to the sender.
Communication involves both informational and understanding. It provides
for a feedback mechanism. It is a meeting of minds

2. Communication is a cooperative process involving two or more persons.

One person alone cannot communicate. The end-result of communication is
mutual understanding.

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3. The communication is continuous or never-ending process. A manager
has to be always in touch with his/her subordinates and superiors in order to
get things done. Communication is also a dynamic activity.

4. Communication is pervasive function. It applies to all phases of

management and all levels of authority. It travels up and down and also from
side to side.
5. The basic purpose of communication is to motivate a response and to
create mutual understanding. It seeks to achieve organizational goals by
creating right type of response. It is the basis of action and cooperation.

6. Communication includes all means by which meaning is conveyed from

one person to another. The popular means are written words, spoken
words, facial expressions, gestures, visual aids, etc.

VII. IMPORTANCE OF COMMUNICATION

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1. Promotes motivation

Communication promotes motivation by informing and clarifying the

employees about the task to be done, the manner they are performing the
task, and how to improve their performance if it is not up to the mark.

2. Source of information

Communication is a source of information to the organizational members for

decision-making process as it helps identifying and assessing alternative
course of actions.

3. Altering individual’s attitudes

Communication also plays a crucial role in altering individuals attitudes, i.e.,

a well informed individual will have better attitude than a less-informed
individual. Organizational magazines, journals, meetings and various other
forms of oral and written communication help in moulding employee’s
attitudes.

4. Controlling process

Communication also assists in controlling process. It helps controlling

organizational member’s behavior in various ways. There are various levels
of hierarchy and certain principles and guidelines that employees must
follow in an organization. They must comply with organizational policies,
perform their job role efficiently and communicate any work problem and
grievance to their superiors. Thus communication helps in controlling
function of management.

5. Foundation of Planning

Communication serves as a foundation of planning. A nurse manager can

receive suggestions and comments from subordinates at the time of

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 formulation of a rotation plan, assignment etc. who in turn communicate to
them f or implementation.

6. Decision Making

Communication facilitates decision making by providing right type of

information at right time to the decision makers.

7. Effective Coordination

Communication helps for achieving effective coordination in the nursing

organization. Top level nursing managers can communicate its policies,
objectives, programmes to their subordinates and can receive suggestions in
turn. This will help the management to keep in touch with the performance
of various nursing units in the health institutions.

8. Communication is the basis of organizational functioning

Communication is the basis of organizational functioning. It is only when

necessary communications are made to subordinates and operators, about
their jobs that action on their part is possible.

9. Communication as an aid to leadership

Communication is very basic to the process of exercising interpersonal

influence, through leadership. A leader communicates the objectives,
policies, rules and procedures of the enterprise to followers and also
communicates the necessary work-orders, instructions and guidance to
them, for the proper execution of the intended jobs, to be
performed by the group. The members of the group i.e. followers would
communicate their problems, needs and performance to the leader.

10.Communication helps building good public relations

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 Good public relations comprise, relations of the enterprise with outside
agencies, particularly consumers and the public at large. Many business
enterprises, now-a-days, maintain a separate ‘public relations department’;
which basically entertains problems, complaints of the public and assures
them of their solution.

VIII. PRINCIPLES OF COMMUNICATION

1. Principle of Clarity.

The beginning of all communication is some message· The message must be

as dear as possible. No ambiguity should creep in to it. The message can be
conveyed properly only if it is clearly formulated in the mind of the
communicator.

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2. Principle of Objective:

The communicator must know clearly the purpose of communication before

actually transmitting the message. The objective may be to obtain
information, give infonnat1on, initiate action, change another persons
attitude and so on. If the purpose of communication is clear it will I help in
the choice of mode of communication.

3. Principle of Understanding:

Understanding is the main aim of any communication. The communication

must create proper understanding in the mind of the receiver. Killian
advised, “Communicate with an aware of the total physical and human
setting in which the information will be received. Picture the place of work;
determine the receptivity and understanding levels of the receivers ; be aware
of social climate and customs ; question the information’s timeliness. Ask
what, when and in a similar environment and position.

4. Principle of Consistency:

The message to be communicated should be· “Consistent with the plans,

policies, programmes and goals of the enterprise. This will increase the
credibility of the message and promote better undemanding. The message
should not be conflicting with previous communications. It should not create
confusion and chaos in the organization.

5. Principle of Completeness.

The message to be communicated must be adequate and complete, otherwise

it will be misunderstood by the receiver. Inadequate communication delays
action, spoils good relations and affects the efficiency of the parties to
communication.

6. Principle of Feedback.
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 This principle calls for making communication a two-way process and
providing opportunity for suggestion and criticism. Since the receiver is to
accept and carry out the instructions, his reactions must be known to the
sender of message. The latter must consider the suggestion and criticism of
the receiver of information. But feedback principle is often given a back seat
by most managers which defeats the very purpose of communication.

7. Principle of Time.

Information should be communicated at the right time. The communicator

must consider the timing of communication so that the desired response is
created in the minds of the receivers.

IX. PROCESS OF COMMUNICATION

Communication is the process by which one person or one group conveys

meaning to another. Communication is a two way process. The elements of
communication process are:

M
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Feedback

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1. Sender: The person who sends the message is known as the source. He
initiates the process of communication. The sender may be a speaker, writer
or an actor.

2. Message: Is the subject-matter of communication. It may contain facts, ideas

or feelings. It exists in the mind of the reader symbols, signs or others.

3. Encoding: When the sender translates the message into words, symbols as
some other form He is using encoding skills. The symbols can be word,
sound, number, pictures and gesture, etc.

4. Channel: It is the media through which the message passes from the sender
to the receiver. Channel may be formal or informal.

5. Receiver: The person who receives the message is called the receiver. He
may be a listener or observer. Receiver is also known as communicating.

6. Decoding: The receiver interprets the message to draw meaning from it. He
converts symbols, signs or pictures in to meaning.

7. Feedback: It is the response, reaction or reply by the receiver. It is directed

to the sender. When the sender receives the feedback. The communication
process is said to be complete.

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X. CHANNELS OF COMMUNICATION:

Communication channels are the means through which people in an

organization communicate. Thought must be given to what channels are used to
complete various tasks, because using an inappropriate channel for a task or
interaction can lead to negative consequences. Complex messages require
richer channels of communication that facilitate interaction to clarity.

1. Face-to-Face:

Face-to-face or personal communication is one of the richest channels of

communication that can be used within an organization. Physical presence,
the tone of the s voice and facial expressions help of a message interpret that
message speaker intends. This is the best channel to use for complex or
emotionally charged messages, because it allows for interaction between
speaker and recipients to clarify ambiguity. A speaker can evaluate whether
an audience has received his message as intended and ask or answer follow-
up questions.

2. Broadcast Media:

TV, radio and loud speakers all fall within the broadcast media
communication. These types of media should be used when addressing a
mass audience. Businesses seeking to notify customers of a new product may
advertise or do promotions using a broadcast channel. Similarly, a CEO may
do a global company address by having a television feed broadcast across
global sites. When a message intended for a mass audience can be enhanced
by being presented in a visual or auditory format, broadcast channel should
be used

3. Mobile:

A mobile communication channel should be used when a private or more

complex message needs to be relayed to an individual or small group. A
mobile channel allows for an interactive exchange and gives the recipient the
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 added benefit of interpreting the speaker’s tone along with the message.
Some within an organization may opt to use this channel versus a face-to-
face channel to save on the time and effort it would take to coordinate a face-
to-face meeting.

4. Electronic:

Electronic communication channels encompass email, Internet, intranet and

social media platforms. This channel can be used for one on one, group or
mass communication. It is a less personal method of communication but
more efficient. When using this channel, care must be taken to craft
messages with clarity and to avoid the use of sarcasm and innuendo unless
the message specifically calls for it.

5. Written:

Written communication should be used when a message that does not require
interaction needs to be communicated to an employee or group. Policies,
letters, memos, manuals, notices and announcements are all messages that
work well for this channel. Recipients may follow up through an electronic
or face-to-face channel if questions arise about a written message.

XI. MODES / FORMS OF COMMUNICATION

1. Verbal Communication:

The spoken and / or the written words are the most modes for conveying
information one’s ideas, thoughts and feelings to others. The words used
vary among individuals according to culture, socio-economic background,
age and education. Examples written words are: notes, letters, records,
forms, news papers, books and magazines.

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 2. Non- Verbal communication:

It is exchange of a message without the use of words. About 80-90%

communication 1s non-verbal. It tells others more about what a person is
felling than what is actually said because it is controlled less consciously
than verbal behavior. Non-verbal communication either reinforces or
contradicts what is said verbally.

XII. TYPES OF COMMUNICATIONS

1) BASED ON THE MEANS OF DELIVERING THE MESSAGE

Communication may be broadly categorized into verbal, nonverbal,

symbolic and meta communication based on the means of delivering the
message from the sender to the recipient.

A. Verbal communication

Verbal communication occurs through the medium of spoken or written words.

A combination of several words is used and each word conveys a specific
meaning. It is a traditional way of communication to convey factual

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 information accurately and effectively. Some of the important elements of
verbal communication are language, vocabulary, denotative and connotative
meaning, pacing, intonation, clarity, conciseness, preciseness, comprehension,
brevity, timing and relevance. Verbal communication may be further classified
into the following subtypes:

a) Spoken communication: This is the most primitive method of verbal

communication; other methods of verbal communication were developed
with the advancement of human existence. In spoken communication, the
message is exchanged through spoken words face to face.

b) Written communication: This form of communication ensures the

exchange of facts, ideas and opinions through written means. The sender and
the recipient come in contact with each other through written means and
share meaning and understanding. It is the best method of verbal
communication stance between them distance between them.

c) Telecommunication: Telecommunication is carried out through the use of

specific electronic devices such as telephones, mobile phones, televisions,
videoconferencing facilities, etc. In this method verbal messages are
exchanged between the sender and the recipient with the help of specific
electronic devices based on availability and the purpose of communication.
Telecommunication is generally used when immediate communication is
desired and face-to-face verbal communication is not Recent developments
in science and technology have revolutionized telecommunication
availability of more and more advanced and sophisticated electronic devices
for faster and communication.

d) Electronic communication: Electronic communication has become more

popular recently because it is speedy, accurate and confidential and a large
number of messages can be exchanged at a faster speed. This is why
electronic mail (e-mail) communication has become a more popular means
of communication. Electronic communication is usually accomplished
through a computer and internet facility.

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B. Nonverbal communication

Nonverbal communication takes place without the use of spoken or written

words. It includes all five senses and the whole range of body movements,
posture, gestures and facial expressions (e.g. smile, raised eye-brow, frown,
staring and gazing) including silence. Nonverbal communication is a more
accurate way of communication because it conveys the true and intended
meaning of the message.

a) Touch: Touch is a personal behavior and means different things to different

people. Studies have that tactile experiences are largely shaped by families
and regional, class and cultural in fluencies. Factors such as age and sex also
play an important role in individual meanings associated with touch. Despite
its individuality, touch is viewed as one of the most effective nonverbal of
expressing feelings such as comfort, love, affection, security, anger,
frustration, aggression and excitement.

b) Eye contact: Communication often begins with eye contact Eye contact also
suggests respect, willingness to listen and keeps the communication open.

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 Absence of eye contact often indicates anxiety, defensiveness or an
avoidance of communication. In some cultures, however, young children and
are taught it is disrespectful to look an adult in the eyes. In others, people are
taught to avoid eye contact or not to make eye contact with elders. The eyes
carry a large number of nonverbal messages that can easily be assessed on
eye contact.

c) Facial expression: The face is the most expressive part of the body. Facial
expressions convey feelings such as anger, joy, suspicion, sadness and fear.
Some people have an extremely expressive face whereas others are able to
mask their feelings, making it difficult for others to determine what the
person is really thinking.

d) Posture: The way a person holds his or her body carries a nonverbal
message. People in good health and with a positive attitude usually hold their
bodies in good alignment. Depressed or tired people are more likely to
slouch. Posture also often provides nonverbal clues concerning pain and
physical limitations. For example, a rigid and stiff appearance may be a good
indicator of tension and pain.

e) Gait: A bouncy, purposeful walk usually carries a message of well-being. A

less purposeful, shuffling gait is associated with illness.

f) Gesture: A gesture using various parts of the body can carry numerous
messages. For example, thumbs up means victory and a thumb down carries
a negative implication. Kicking objects often expresses anger. Wringing
hands or tapping a foot usually indicates anxiety or anger, and a waving hand
signifies beckoning someone to come or leave, Gestures are used extensively
when two people speaking different languages communicate with each other.

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g) Physical appearance: Illnesses result in an alteration in the general physical
appearance. On the other hand, a person in good health tends to put it across
through general physical appearance.

h) Sound: Crying, moaning, gasping and sighing are oral but nonverbal forms
of communication. Such sounds can be interpreted in numerous ways. For
example, a person may cry because of sadness or joy.

i) Silence: A period of silence during a conversation often carries important

nonverbal messages. For example, someone sitting silently in a group
discussion suggests disinterest in the discussion or preoccupation with other
thoughts.

2) BASED ON THE PURPOSE OF COMMUNICATION

A. FORMAL COMMUNICATION

Formal communication, which officially by the management, is called

formal channels of communication. The authority and responsibility
relationships will also be formal. For example, the nursing superintendent of

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 a hospital will communicate with staff nurses through assistant nursing
superintendents, supervisors and ward-in-charge nurses. The channels of
communication may be more formal and active through the use of circulars,
memos and formal meetings in this method of communication.

a) Downwards communication:

Communication that flows from the top of the organization to the bottom of
the organization through the formal lines of authority is known as downward
communication. Managers Communicate to subordinate for assign job,
instruction, inform about policies and provide feedback.

(TOP LEVEL): NURSE MANAGER

(MIDDLE LEVEL):NURSE

OPERATIONAL LEVEL : STAFF NURSES

DOWNWARD COMMUNICATION

b) Upward communication:

It refers to the flows is from bottom to top from subordinates to superior. It

helps to provide feedback on the extent of effectiveness of downward

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 communication widely used upward communication devices include
suggestion boxes, group meeting, report to supervision etc.

(TOP LEVEL):

(MIDDLE LEVEL):NURSE
SUPERVISORS

OPERATIONAL LEVEL : STAFF

NURSES

UPWARD COMMUNICATION

c) Horizontal communication:

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 Horizontal communication refers to the flow of information between
departments or people of equal level in an organization structure, usually it is
used for coordination and interdepartmental problem solving.

HORIZONTAL COMMUNICATION

d) Diagonal communication:

Diagonal communication refers to interchange of message between the

managers and employees who are neither in the same department nor on the
same position, power, and authority of organizational structure.

DIAGONAL

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1) Informal communication

Informal communication, also called grapevine communication, takes place

through informal groups, existing inside or outside the formal organizational
structure. This communication has no formal manner of routing. It might
spread from any person to any person, in any manner and in any direction, like
the structuring of a grapevine.

Grapevine: It is information communication network.

The characteristics of grapevine are:

 It is not controlled by management

 It springs up and used irregularly within the organization
 It services self-interests of people within it.

The type’s grapevine can be:

SINGLE STAND: Each tells one another

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GOSSIP: One tells all

PROBABILITY: Each randomly tells other

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XIII. A COMPARISON BETWEEN FORMAL AND INFORMAL
COMMUNICATIONS

Informal
Basis of Distinction Formal Communication Communication
Speed l. Formal communication is slow. Communication
The rate of slowness of this type is very fast It
of communication, depends on the spreads like an
length of the scalar chain i.e. epidemic; as it
lengthier is the scalar chain, the might proceed
slower is the communication. As from any
such, this type of communication person to any
is not suitable in emergency person, in any
situations. manner and in
any direction.
As such, this
type of
communication
is highly
suitable for
transmitting
useful
information, in
emergency
situations.
Authenticity Formal communication is most Informal
authentic, as it takes place via the communication
official scalar chain. is least
authentic; as it
spreads in a
grape· vine
manner. A
possibility of
spreading
rumours is
often alto be
associated, with
this type of

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 communication
.
Nature Formal communication is Informal
impersonal and official. It is a communication
source of tension to individuals is personal and
in, many cases. unofficial. It is
socio-
psychological
in nature. It
relieves
individuals of
tension, in
many cases.
Planning This type of communication is pre This type of
planned. It helps people communication
understand their jobs; and is the is wholly
basis of smooth organizational unplanned. It is
life. Formal communication is contingent in
number 1, problem of nature i.e. the
management. ‘No circumstances
communication; no functioning of facing informal
organisation; is the adage groups decide
applicable to this type of what type of
communication. communication
is needed to be
communicated
to the members
of the informal
group.

Feedback Feedback to communication may Immediate

or not be there. In fact, people at I feedback is
lower levels might not be able to there. People
express themselves freely on can freely
many organizational issues. express their
opinions about
informal
communication,
without fear or
favour.
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 Formal communication is Informal
Control controllable by management. It communication
could be subject to modification, is wholly
subsequently. uncontrollable.
It could not be
subject to
modifications.
Subsequently;
as the source of
communication
may not be
known at all
Distortion · There are
Distortions in communication are distortions in
not possible; specially when it is informal
in writing. communication
according to the
whims and
prejudices of
individuals

Record-keeping Formal communication is mostly Informal

Records of communication could communication
be easily kept, future reference. is mostly oral.
No records of it
could be kept.
Differences and
conflicts over
the validity of
communication
could arise,
subsequently.
The source of communication is Source of
Fixation of responsibility known; responsibility for communication
communications could be easily is not easily
fixed on individuals. traceable; rather
it may be
untraceable as
to who initiated
33
 the
communication
process. As
such,
responsibility
for
communication
could not be
fixed on any
individual.
Formal communication being of Question of
Resistance ficial, usually meets with resistance to
resistance on the part of this type of
employees. communication
does not arise;
as it is social
and personal in
nature.

Secrecy of Confidential information does not Confidential

Confidential matters leak, in the formal system of com information
munication. , Formal could not be
communication in regard to kept
confidential matters could be kept confidential; as
restricted. the information
spreads in a
grapevine
manner, like an
epidemic.

Rigidity or flexibility Formal communication is based Informal

on the plans, rules and policies of communication
the organization which are quite is quite
fixed, at least, in the, short run. It flexible; as it is
is rigid in nature. based on the
personal likes
and dislikes of
individuals,
which are ever
34
 changing.

Mutual support Formal communication is done Informal

only for organizational purposes. I communication
It does not support informal supports the
communication. formal
communication.
It, in fact, fills
in gaps of
formal
communication.

2) BASED ON THE LEVELS OF COMMUNICATION

Communication may be categorized into intrapersonal, interpersonal,

transpersonal, small-group, public and organizational communication bared on
the levels of communication.

a) Intrapersonal communication

Intrapersonal communication takes place within an individual; we may also say

it is self-talk. It is crucial because it provides a person with an opportunity to
assess self and/or a situation, before acting on it, ultimately affecting the
person’s behavior.

35
b) Interpersonal communication

Interpersonal communication takes place whenever two or more people interact

and exchange messages or ideas. This is also one of the most common forms of
communication in our daily lives. Good interpersonal skills equip nurses with
sharing, problem solving, team building, health teaching, caring, counseling
and advocating for patients more efficiently. Interpersonal communication may
be further categorized into assertive, nonassertive and aggressive
communication.

c) Transpersonal communication

Transpersonal communication takes place within a person’s spiritual domain.

The purpose of transpersonal communication is to realize selfhood, enhance
spirituality and answer questions that are spiritual in nature.

d) Small-group communication

An example of a small-group communication is when nurses interact with two

z
ic
1
b
ti
e
t
p
s
r
g
l-
a
u
m
o
n
O
IP
or more individuals face to face or use a medium (like a conference call). To be

36
T
S
 functional, the members must communicate with each other to achieve their
goals. Patient-care conferences, staff meetings and reports are good examples
of small-group communication.

e) Public communication

Public is generally defined as a large group of people. Communication with

such a large group of people is known as public communication. In health care,
public communication becomes essential when a message needs to be
disseminated to a large group at once. Public communication requires essential
skills to influence people at large and media material to reach out to each
member of the public clearly and loudly.

f) Organizational communication

Organizational communication takes place when individuals and groups within

an organization communicate with each other to achieve established
organizational goals. The success of an organization depends largely on the
effectiveness of organizational communication.

3) BASED ON THE PATTERN OF COMMUNICATION

Communication may be categorized into one-way, two-way, one-to-one, one-

to-many and many-to-one communication based on the levels of
communication.

a) One-way communication

One-way communication takes place when messages are delivered to the

audience from the communicator only without constant feedback. A common
example of one-way communication is a lecture delivered in a classroom.
There are plenty of drawbacks in one-way communication including the
absence of constant feedback, the message being imposed on the receiver, the
delivery of message being authoritative and little participation of audience.

37
 E
N
O
W
Y
A
T
b) Two-way communication

Two-way communication takes place when both the communicator and

audience take part in the process. The audience may raise questions and add
information, ideas and opinions on the subject. In two way communication, the
process of learning is active and democratic.

c) One-to-one communication

Communication between one sender and one recipient at one time is termed as
one-to-one communication. A nurse providing discharge information to a
patient is an example of one-to-one communication. This method of
communication is used when a more focused and individualized method of
communication is required.

d) One-to-many communication

Where one person communicates with many people at the same time, it is
termed as one-to-many communication. A nurse providing health education to
a community is an example of one-to-many communication. In one-to-many

38
 communication, the communicator gets an opportunity to communicate to
communicate with a large number of people at the same time, saving money
and effort.

e) Many-to-one communication

Many-to-one communication takes place when several people communicate

with one person at the same time. A panel of experts taking an interview is an
example of many-to-one communication. This method is used when several
people want to explore a single individual extensively at the same time.

One-way communication Two-way communication

More accurate than one way
Considerably faster than two way communication.
communication
Appears neat and efficient to an More people in the audience
outside observer. understand better the communication.
Accuracy is less. The receiver is surer of them and
makes correct judgments of how right
or wrong they are.
Painfulness, systemization. Sender finds himself psychologically
Systemization is associated with one attack because his receivers pickup his
way communication. mistakes and oversights and let him
know about them.

Sender is more psychologically Relatively noisy and disorderly with

comfortable. people interrupting the sender and one
another.
There is no way by which the sender Two-way communication, thesender
will get instant return of feedback sends the message to receiver, with the
from the receiver e.g.;- radio, talk expectation that there will be a return
response or a reaction from the
receiver in acknowledgement of the
message.

39
III.

k
e
t
is
D
L
g
w
a
r
ln
COMMUNICATION SKILLS

The word skill means expertness or great proficiency in doing something

which comes from training and practice. Apart, from knowledge and
technical skill certain other skills are needed for communication (Fig.
communication

1. Human relation skills:

Human relation skills include acquisition of such distinct social traits like
courtesy, fact, friendliness, spokes-man ship, etc. these traits are acquired
by the individuals and by these traits interpersonal relationship and
adjustments, etc. are attained. It is not that, everyone possesses these
traits, But there is room for Improvement, if there are efforts on the part
of the individuals to recognize these as essential social qualities. Human
relation skill is not learned as such but is included during the formative
stages of learning.

40
2. Listening skills:

Listening skills means ability to listen others. It is an aural skill, and it

requires alertness, attentiveness, inquisitiveness, etc. as essential
qualities. One must listen well what is being said to him and recognize
what tone connotes, what is the meaning of accompanying gestures,
movements of the body, etc. listening is not simply hearing. A good
listener has to be a good observer. A good listener should have the
qualities such as, face person who talks.

3. Maintain good eye contact:

Maintain a natural, well relaxed posture that indicates your interest e.g.
leaning forward towards the other. If the listener repeatedly looks at the
watch indicates that she is neither interested in the talk nor relaxed.

4. Active listening:

Active listening is good listening and it means to be attentive listening to

what the client is expressing verbally and non verbally. Several
nonverbal skills have been identified to facilitate attentive listening and
presented the acronym

SOLER:
S-sit squarely facing the patient: This gives the message that the nurse
is there to listen and interested in what the patient has to say

O-Observe an open posture: Posture is considered open when arms

and legs remain uncrossed.

41
 L-Lean forward toward the patient: This conveys to the patient that
you are involved in the interactions, interested in what is being said and
making a sincere effort to be attentive.

E-Establish eye contact: It conveys involvement and willingness to

listen to what the patient has to say.

R-Relax whether sitting or standing during the interaction: The

nurse should communicate a sense of being relaxed and comfortable with
the patient. Restlessness and forgetting communicate a lack of interest
and a feeling of discomfort.

5. Writing and reading skills: To develop this one must know the
language and should have good vocabulary to clarify his/her thought
which are expressed through writing. The words chosen should be simple
but powerful to express the meaning correctly. Writing should be legible
and devoid of ambiguity. The writing skill requires reading skill also.
The tonal control, the pitch, etc. should be kept under control but audible.
A touch of emotionality and concern should be there in writing and
reading for appeal but in all the cases.

6. Drawing skill: Drawing skills requires control of the hand movement

and of fingers. Drawing should be simple with minimum of times and
maximum of force in the line. There should be meaning and justification
in selecting colors.

IV. COMMUNICATION STRATEGIES IN AN ORGANIZATION

Communication is one of the important functions of an organization whether

it is a small or very large organization. Even one-to-one communications can
be a challenge and sometimes bring misunderstandings. If the management
wants positive outcome and good interpersonal relationship it needs to think
about effective communication strategies in an organization. Some of the
strategies for effective communication is described below.

42
 p
c
w
s
v
r
l-
u
e
a
m
n
io
t
O
I
T
R
d
M
C
h
y
a) Open Communication

For the success of the organization, leaders opt for open communication
strategy in which the members of the organization irrespective to their level,
interact freely, discuss care and share their ideas communicate feedback of
their job done including criticism to the management. Committed leaders
practice open communication build an environment of a trust culture.

b) Inclusive Communication

Inclusive communication strategy refers that the management to ensure all

employees feel they are involved in decisions that affect their job. Secretive
an organization tends to bring poor participation of members in involving
major decision that in turn will affect managerial outcome. Employee
involvement is basic factor that affects employee satisfaction and success of
the organization.

c) Two-way Communication

Effective communication strategies involve two-way communication,

between members of the organization. Establishments whose managers

43
 successfully engage employees in communicating about their work, bring
out their ideas and their perspectives on issues related to, services, customers
and the work environment enhances a communication culture of
inclusiveness that brings better results of the organization.

d) Results-driven Communication

If we want the organizational communication to be effective, it should be

goal oriented, to achieve measurable results. Organizations need to respect
employees needs related to work environment job characteristics, effective
interaction with members and clients, and to serve as agent outside of the
organization.

e) Multi-channeled Communication

There is an individual difference among employees. The employer

must know these differences and use multi methods of communication
system that can be benefitted by all employees. Effective organizational
communicators aware of that messages need to be delivered multiple times,
in multiple ways to have the most impact. Employee communication needs
and preferences differ. Different messages require different methods
channeled communication and that brings effectiveness in an organization.

V. FACTORS AFFECTING COMMUNICATION:

In addition to the factors such as a person’s socio-cultural background,

language, age and education and limitations and attributes of nonverbal
communication, the following factors affects the communication process.

44
 D
C
E
N
Y
T
IL
B
U
M
O
R
P
A
S
H
F
1. Ability of the communicator:

2.

3.
The person’s ability to speak, hear, see and comprehend stimuli influences
the communication process. The receiver of a message also needs to be able
to interpret the message. Even if a client is free of physical how many stimuli
the client is capable of how many stimuli the client is capable of receiving in
a given time frame. The nurse must be careful not to talk too quickly or
present too many ideas at once, particularly when offering health
instructions.

Perceptions:

It is the personal view of events, i.e. each person’s sense, interprets and
understands the events differently. Perceptions are formed by experience and
expectations. It is important in many situations to validate or correct the ,
perceptions of the receiver.

Attitude:

45
 It is the tendency or predisposition to act in a particular direction to a thing,
a person or an event. Attitudes are communicated convincing and rapidly to
others. The attitude classified in to facilitating attitudes and inhibitive
attitudes.

a) Facilitating attitudes:

i. Caring and warming attitudes convey a feeling of emotional closeness,

in contrast to impersonal distance. Caring involves giving feelings,
thoughts, skills and knowledge.

ii. Respect is an attitude that emphasizes the other persons worth and
individuality. A nurse conveys respect by listening open-mindedly to
what the other persons is saying even if the nurse disagrees.

iii. Acceptance emphasizes neither approval nor disapproval. An

accepting attitude allows clients to express personal feelings freely and
to be themselves. The nurse may need to restrict acceptance in
situations where client’s actions are harmful to themselves or to
others.

b) Inhibitive attitudes:

i. Condensation: It is an attitude that conveys superiority over other

persons.

ii. Lack of interest: This also inhibits the communication by indicating a

lack of concern or a belief that what the person is saying is not important.
Lack of interest in the form of not listening to patient or skipping the care
to patient may be conveyed by the nurse.

iii. Coldness: This is the opposite of caring and warmth. Nurses convey this
attitude to clients by appearing more interested in the technical and

46
 procedural aspects of nursing than in concerns of the persons receiving
the therapy.

iv. Knowledge: Knowledge of handling different level persons is essential

for communication. An amount of knowledge a source has about the
subject matter will affect his message content materials be
communicated with maximum effectiveness.

v. Time: The time factor in communication includes the events that precede
and follow the interaction. Nurses’ use of time can facilitate or inhibit a
client’s communication. The hospitalized client who is anticipating
surgery or who has just received news that a spouse has lost a job will
not be very receptive to information.

vi. Personal space: Personal space is the distance between the people in
interactions others. Proxemics is the study of distance between people in
their interactions. Communication utters in accordance with four
distance. Each with close and a far phase, described by hall.
Intimate: physical contact to one and half feet.
Personal: one and half to four feet.
Social: four to twelve feet.
Public: twelve feet and beyond.

 Environment: People usually communicate most effectively in a

comfortable environment. Warm and comfortable environment facilitates
good communication. The setting also influences communication. If the
room lacks privacy or is hot, noisy or crowded, the communication
process can break down. Environmental distraction can impair and
distort communication.

 Territory: Territoriality is the drive to gain. An area of space. It

provides people with a an area of space. It provides people with a

47
 security and control. Client, often feels the need to defend their territory
when others invade it.

 Emotions: Emotions are person’s subjective feeling about events. The

way a person relates or communicates with others is. Influenced by
emotions. Emotions also affect a person’s ability to interpret massages.
When the client feeling great fear may not remember all post operative
instructions offered by the nurse.

 Self-esteem: Self-esteem also influences communication patterns people

whose self is high communicate honesty, with confidence and with
congruence (agreement or coinciding) between verbal and non-verbal
messages. Those with low self esteem or under high stress tend to give
double messages. The relationship between self concept and
communication is susceptible to change.

 Roles and relationships: The roles and the relationship between sender
and the receiver affect the communication process. Choice of words,
sentence structure and tone of voice vary considerably from role to role.
Communication is more effective when the participants remain aware of
their roles in a relationship.

 Socio-cultural background: Culture is the sum total of the learned ways

of doing, conditioning that shows itself through conditioning that shows
itself through behavior. Language, gestures, values, . attitudes reflect
cultural origin. The influence of cultural sets limits for the way people
act and communicate. In some culture, it is considered rude or distressful
to make direct eye contact. In some families the male members make all
the decisions.

48
  Values: These are standards the influence behavior. They are what
person considers important in life and thus influence expressions of
thoughts and ideas.

VI. STEPS FOR MAKING COMMUNICATION EFFECTIVE

When the communication is evaluated in the light of the criteria discussed

above and inadequacy is found, management must take appropriate actions
to make communication effective. While actions may be specific in the light
of the inadequacy, here, some general guidelines have been provided for
effective communication:

1) Clarity in Idea:

The communicator should be quite clear about what he wants to

communicate. Communication is a process starting with ideation which
includes generation of ideas meant for communication. This is the subject –
matter of communication and may include opinions, attitudes, feelings,
views, suggestions, orders, etc.

2) Positive Attitude.

There should be change in the attitudes of superiors and subordinates so that

there is open communication at all times between various levels. They
should overcome the status barrier to create understanding. The superiors
must keep the subordinates informed about the policies and programmes and
also be in touch with subordinates regarding their problems, suggestions etc.
This is necessary to achieve the organizational goals effectively.

3) Purpose of Communication:

Every communication has some purpose, the basic purpose any

communication being to get behavioural response from the receiver of the
communication. However, the ultimate objective may be extended further,

49
 for example, getting order accepted by the subordinate. The communication
should be directed towards this objective by the efforts of communicator.

4) Empathy in Communication.

The way for effective communication is to be sensitive towards receiver’s

needs, feelings, and perceptions. This is what psychologists call empathy in
communication, implying putting one’s legs in other’s shoes, or projecting
oneself into the Viewpoint of the other person. when the sender of the
message looks at the problems from receivers point of View, much of the
misunderstanding is avoided.

5) Two-way Communication:

Communication is a two-way traffic and this fact must be realized in

communication. Two-way communication brings two minds together which
is the basic core of any communication. It involves a continuous dialogue
between sender and receiver of the message. Upward communication can
become a reality in the organization and effective if this fact is recognized.

6) Appropriate Language:

The subject-matter of communication is transmitted by encoding it into some

symbols. Such symbols may be in the form of words, either spoken or
written, and gestures. If the words are used, the language used for
communication should be such which is understandable by the receiver.
Technical terminology and multisyllable words may be impressive looking,
but they can also be troublesome to the listener. One way of · making the
communication simple is to use repetitive language with which the receiver
is quite familiar.

7) Supporting Words with Action:

50
 Often it is said that action speaks louder than words. While
communicating, the sender may use the action to emphasize a point. This
enhances understanding as well as emphasizes the important point in
communication. Further, sender of the message must also follow in action
what he says to others. This will ensure the seriousness in communication.

8) Mutual trust and confidence:

Communication is an inter-personal process. Therefore, it can be made

effectively by developing mutual trust, respect and confidence among the
members of the organization.

9) Credibility in Communication:

One criterion for effective managerial communication is that it has

credibility or believability. The subordinates obey the order of the superior
because he has demonstrated through his competence that he is worthy of
trust. He must also maintain his trust and credibility. Thus. Any
communication which is based on this credibility will be followed by the
subordinates.

10) Open Mind.

The parties to communication must have open minds. They should not try to
withhold information just to serve their personal interests. They should be
able to interpret the information without any prejudice or bias. They should
also be receptive to new ideas that may any prejudice or bias. They should
also be receptive to new ideas that may come across. They should not react
before receiving and understanding the full message.

51
11) Receptive to New Ideas:

The employees should be prepared, to accept new ideas and change

themselves accordingly. They should be willing to receive information from
internal and external sources which calls for change in the organization.

12) Flexibility

A good system should be flexible enough to adjust to the changing

requirements. It should be able to carry-extra loads of information without
much strain. It should absorb new techniques of communication with little
resistance. Use of a wide range of media such as oral and written messages,
face-to-face contacts, telephonic calls, group meetings, etc. should be
encouraged without any hesitation.

13) Reliance on Feedback.

Feedback refers to transmission of information concerning the effect of any

act of communication. For example, the manager, who sends a direction to
his subordinate, should come to know the response of the latter. Feedback
information flows upward and downward. Its purpose is to reinforce or
correct the action implied in any act of communication. Feedback also
provides an opportunity for suggestion and criticism.

14) Good Listening

A communicator must be a good listener too. By this process, he is not only

giving chance to others to speak but he gathers useful information for further
communication. By concentrating on the speaker’s explicit and implicit
meanings, the manager can obtain a much better understanding of what is
being said. Managers suffer from some common habits of bad listening,
though much of their communication time is spent in listening. Newstrom
and Davis have suggested ten points which may be observed in listening.
These are stop talking, put the talker at ease, show the talker that you want to
52
 listen to, remove distractions, emphasize with the talker, be patient, hold
your temper, go easy on arguments and criticism, ask questions, stop talking.
They have emphasized stop talking because without stopping talking, one
cannot listen to.

15) Free Flow of Information.

The system of communication should be so designed that it has short lines

of information flows. There should be free movement of information both
vertically and horizontally. The rigid organization structure should not be
allowed to come in the way of smooth and speedy flow of information.
Moreover, delegation and decentralization of authority should be encouraged
to cut delays in decision making and speed up communication.

VII. BARRIERS TO COMMUNICATION

Barriers or obstacles to communication cause break downs, distortions
and inaccurate information. They plague the daily life of the managers who
must depend upon the accurate transmission of the orders and information
for efficient operations. Whenever a communication is made, there is always
a tendency on the part of the receiver to evaluate the message received and
then decide to approve or disapprove the Same. Another important barrier to
communication lies in the layers and spans of management.

The main barriers to communication are discussed below :

1) Barrier due to organisation Structure.

The organization structure has an important influence on the ability of the

members of the organization to communicate effectively. These days the
organization structure of most big enterprises is complex involving several
layers of supervision, and long communication lines. Organisation structure
creates problems because communication may break down at any level of
supervision due to faulty transmission.

53
2) Barrier is due to Relationship.

Status of an organizational member is determined by the position he holds in

the organization. This fact is quite apparent when the subordinate talks to his
superior. Obstacle in communication occurs when the psychological distance
between the two is created because of status symbols of the superior. Status
symbols include high quality furniture, separate room, facilities, etc. A sense
of inferiority complex in the mind of the subordinate does not allow him to
seek clarifications from the superior.

3) Semantic Barriers.

Semantic is the science of meaning. Words seldom mean the same thing to
two persons. Symbols or words usually have a variety of meanings. The
sender and the receiver have to choose one meaning from among many. If
both of them choose the same meaning, the communication will be perfect.
But this is not so always because of differences in formal education and
specific situations of the people. Strictly one cannot convey meaning, all one
can do is to convey words. But the same words may suggest quite different
meanings to different people, e.g., ‘Profits’ may mean to management
efficiency and growth, whereas to employees, it may suggest excess funds
piled up through paying inadequate wages and benefits.

4) Filtering of Information.

Sometimes, the sender screens the information for passing only such
information which will look favourable to the receiver. This is because of the
simple reason that no one likes to show his mistakes to someone else,
especially to his boss. The boss, on the other hand, wants to obtain
information about what is actually going on, especially those actions which
need his attention.

54
5) Perceptual Errors.

A person’s perception is determined by his needs, social environments, level

of education, cultural factor, etc. Every person tries to interpret the
information he receives from his own angle or point of view. This may
create complexities in the process of communication. Effective
communicaton requires the willingness to see things through the eyes of
others.

6) Closed Mind.

Premature evaluation by the listener also creates a hurdle in communication.

If the listener has closed mind, he will always evaluate the things from his
own point of view and will not be receptive to new ideas. Similarly, if a
listener is suffering from the mirage- of too much knowledge, he will be
rigid and dogmatic in attitude·

7) Lack of Ability to Communicate.

All persons do not have the skill to communicate. Skill m communication

may come naturally to some, but an average man may need some sort of
training and practice by way of interviewing, public speaking, etc.

8) Inattention.

The simple failure to read bulletins, notices, minutes and reports is a

common. Habit of many people. Similarly, verbal ccmmunication has the
impact on those who are preoccupied or unwilling to listen. If people do not
pay the required attention to listening and understanding messages they are
supposed to receive, communication will lose its purpose. Also, some people
are too quick in commenting on information as it is being received- from the
sender, without waiting for full information, This may drive the sender to
frustration and into a sense of. Futility. The sender may then learn to be
diffident in transmitting messages to such pre-mature evaluators.

55
9) Resistance to Change.

It is general tendency of human beings to maintain status quo. When new

ideas are being communicated, the listening apparatus may act as a filter
in rejecting new ideas. Thus, resistance to change is an important
obstacle to effective communication. Sometimes, organizations
announce changes which seriously affect the employees, e.g., changes in
timings, place and order of work, installation of new plant, etc. Changes
affect people in different ways and it may take some time to understand
the full meaning of the message. Hence, it is important for the
management not to force changes before people are in a position to
adjust to their implications.

10) Situational Factors.

Barriers may also arise due to specific situations, e.g., physical

conditions like noise or insufficient light, information overload, etc.
When there is a noise or a number of persons are speaking
simultaneously, communication can’t be effective. And if an executive is
overloaded with information and does not have time to organize the
information, he will not be able to communicate effectively.

11) Status and position:

Vertical communication is hampered by difference in the status and position

of the superior and subordinate. Status refers to the regard and attitude of
member of the organization towards a position and its occupant. Status arises
on account of formal position in the hierarchy, job title, salary and other
privileges. Supervisors tend to keep information to themselves they do not
want to listen to subordinates. Subordinates are reluctant to seek clarification
for fear of loss of prestige. Effective communication becomes difficult when
people become strong conscious of status and position. Subordinate tend to
tell the boss what is pleasant and withhold unpleasant information.

56
 12) Miscellaneous Barriers.

In addition to the above barriers, there may also be other barriers such as
unclarified assumptions by the sendor and receiver of message, emotional
reactions, irrelevant message, lack of etc.

VIII. TECHNIQUES TO IMPROVE THE COMMUNICATION

1) Listening

An active process of receiving information. The complete attention of the

nurse is required and there should be no preoccupation with oneself.
Listening is a sign of respect_ for the person who is talking and a powerful
reinforce of relationships. It allows the patients to talk more, without which
the relationship cannot progress.

2) Broad openings

These encourage the patient to select topics for discussion, and indicate that
nurse is there, listening to him and following him. For e.g. questions such
as what shall we discuss today? “can you tell me more about that? “And
then what happened?” from the part of the nurse encourages the patient to
talk.

3) Restating

The nurse repeats to the patient the main thought he has brings attention to
something important. It also brings attention to something important.

4) Clarification

The person’s verbalization, especially when he is disturbed or feeling

deeply, is not always clear. The patients remarks may be confused,
incomplete or disordered due to their illness. So, the nurses need to clarify
the feelings and ideas expressed by the patients. The nurses need to provide
57
 correlation between the patient’s feeling and action. For example “I am not
sure what you mean? “Could you tell me once again?” clarifies the
unintelligible ideas of the patients.

5) Reflection

This means directing back to the patient his ideas, feeling questions and
content. Reflection of content is also called validation. Reflection of feeling
consists of responses to the patient’s feeling about the content.

6) Focusing

It means expanding the discussion on a topic of importance. It helps the

patient to become more specific, move from vagueness to clarity and focus
on reality.

7) Sharing perceptions

These are the techniques of asking the patient to verify so that the nurse
understands or want he is thinking or feeling. For e.g. the nurse could ask
the patient, as “you are smiling, but I sense that you are really very angry
with me”.

8) Theme identification

This involves identifying the underlying issues or problem experienced by

the patient that emerges repeatedly during the course of the nurse-patient
interaction. Once we identify the basic themes, it becomes easy to decide
which of the patient’s feeling and thoughts to respond to and pursue.

9) Silence

This is lack of verbal communication for a therapeutic reason. Then the

nurse’s silence prompts patient to talk. For e.g. just sitting with a patient
58
 without talking, non verbally communicates our interest in the patient
better.

10) Humor

This is the discharge of energy through the comic enjoyment of the

imperfect. It is a socially acceptable form of sublimation. It is a part of
nurse client relationship. Ft is constructive coping behavior, and by learning
to express humor, a patient learns to express how others feel.

11) Informing

This is the skill of giving information. The nurse shares simple facts with
the patient.

12) Suggesting

This is the presentation of alternative ideas related to problem solving. It is

the most useful communication technique when the patient has analyzed his
problem area, and is ready to explore alternative coping mechanisms. At
that time suggesting technique increase the patient’s choices.

IX. COMMUNICATION SYSTEMS USED IN HOSPIITALS

 Periodic talks between employer and employees.

 Sign posts for the patient and general public.
 Staff conferences to get suggestions and for decision making.
 Social gatherings to improve interpersonal relationship.
 Employees consultation in problem solving.
 Sending orders and protocols.
 Handbook to provide general information
 Mannuals (policy, procedures, manuals)
 Bulletin boards
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  Suggestion systems, complain books.
 Hospital magazine, bulletin
 Annual reports
 Light signaling systems.
 Alarm systems in accident prone area.
 Telecommunication system, intercom paging system etc.
 Enquiry officer and public relation officer.
 Patient information booklet.
 Inserts in the pay rolls, attendance register.

X. COMMUNICATION PATTERN IN NURSING

Communication pattern in nursing varies from hospital to hospital in

India as well abroad. Evidence from abroad revealed that at one site,
linear communication i.e. vertical chain of command acts as a filter
that resulted in inefficient and disrupted information flow between
medical and direct care staff, limiting the flow and quality of
information available for clinical decisions open communication

To superiors

upwa
rd
To peers and To Patients family
health team community,
Horizontal NURSES outward
members workers, friends

Do
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To subordinates

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a) Communication of Nurse Administrator with Medical
Administrators
The nurse administrators communicate with medical administrators
for providing the information regarding tie census of the hospital,
health conditions of the critically ill patients, medico-legal cases and
admitted hospital staff every day. Also communicate verbally during
the rounds and informs about the problem arising in maintaining
sanitation. They write the requirements of material supply every month
and of condemnation of articles every three months or as per the policy
of the hospital.
b) Communication of Nurse Administrator with Subordinates

Nurse administrators receive verbal and written information from

night sisters and communicate to the evening sister about census
health condition of critically ill patients, medico-legal cases and
admitted hospital staff every day and during the rounds and also
varies from hospital to hospital.
c) Communication Pattern of Nurse Supervisors

The nurse supervisors usually report about sanitation with the nurse
administrators and about patients with bedside nurses and for
personal problems, they approach the nurse administrators.

d) Communication Pattern of Bedside Nurses/ Operational level

nurses

Communications of bedside nurses occur with doctors related to

patients and for sanitation, they report to nurse supervisor. They
attend social events almost with medical and nursing personnel.

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XI. APPLICATION OF COMMUNICATION IN NURSING
PROCESS:

Nursing Assessment: Assessment of client’s ability to communicate

includes gathering data about the many contextual factors that
influence communication. The context refers to all the parts of
something that help determine its meaning. Situations have several
aspects that influence the nature of communication, interpersonal
relationships and client needs. These include that the nature of their
relationship, the situation prompting communication, the environment
and socio cultural elements present.

Nursing diagnosis: Most individuals experience difficulty with some

aspect of directed toward those individuals who experience more
serious impairments m communication. The primary nursing
diagnostic label used to describe the client who has limited or no
ability to communicate verbally is impaired verbal communication.
The related factor for impaired verbal communication focuses on the
causes of communication disorder; these can be physiological,
mechanical, anatomical, psychological, cultural or developmental in
nature. For example deaf older adult with nursing diagnosis: impaired
verbal nursing diagnosis: impaired verbal hearing and inability to
articulate works hearing and inability to articulate works.

Planning: Once the nurse has identified the nature of the clients
communication dysfunction, several factors must be considered is the
care plan is designed. Motivation is a factor in improving
communication, and clients often require encouragement to try
different approaches that involve significant change. Expected
outcomes for the client with impaired communication are important to
identify. In general, effective nursing interventions will result in the
client experiencing a sense of trust in the and health team.

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At times nurses care for well clients whose difficulty in sending,
receiving and interpreting messages interferes with healthy
interpersonal relationships. Nurses can plan interventions to help such
clients improve their communication skills.

Implementation: It carry out plan of care, nurses need to use

communication techniques that are appropriate for the client’s
individual needs. The most basic nursing interventions used 1n
communication are therapeutic communication techniques. Therapeutic
communication techniques are specific responses that encourage the
expression of feelings and ideas and convey the nurse’s acceptance and
respect.

Evaluation: The nurse and client determine whether the plan of care
has been successful by evaluating the client communication outcomes
established during planning. Nurses can evaluate the effectiveness of
their own communication by making process recording, written records
of their verbal and non-verbal interactions with clients.

INTERPERSONAL COMMUNICATION

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 It is the interaction occurs between two people or in a small group. Healthy
interpersonal communication allows problem solving, sharing of ideas,
decision making, and personal growth. In administration, being a member of
nursing committee m hospital / institutions challenges the nurse’s ability to
express ideas clearly and decisively. Interpersonal communication is the
heart of nursing practice.

I. DFINITION OF INTERPERSONAL RELATIONSHIP

According to michael cody as the exchange of symbols used to achieve

interpersonal goals.

According to Tim Borchers, interpersonal relationship are social

associations, connections, or affiliations between two or more people. That
vary in differing levels of intimacy and sharing,implying the discovery or
establishment of common ground , and mat be centred on something shared
in common.

II. PURPOSE OF INTERPERSONAL COMMUNICATION

The purpose of an interpersonal communication is to actively and

continually facilitate the personal growth and development of each other as
individuals, to enjoy the process together as it unfolds, to maximize ease,
and to have fun doing it.

1. Gaining information

The reason to engage in interpersonal relation is to know about another

individual. We attempt to gain information about others so that we can
interact with them more effectively. We can better predict how they think,
feel and act if we know who they are. We gain this information passively by
observing them and actively, by having others engage them, or interactively,

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 by engaging them ourselves. Self disclosure is often used to get information
from another person.

2. Building a context of understanding

Helps us to better understand what someone says in a given context. The

words we say can mean very different things depending on how they are
said or in what context. Context messages refer to the surface level meaning
of a message. Relationship messages prefer to how a message is said. The
two are different simultaneously, but each affects the communication
differently. Interpersonal relations help us to understand each other better.

3. Establish identity

It helps in establishing an identity through the roles we play in our

relationships. So too does the face.

4. Interpersonal needs
 Inclusion needs: it is the need to establish the identity with others
 Control is the need to exercise leadership and prove one’s abilities.
Groups provide outlets for this need. Some individuals do not want to
be leaders. For them groups provide the necessary control over the
aspects of their lives.
 Affection is needed to develop relationship with people. Groups are
an excellent way to make friends and establish relationships.

III. ELEMENTS OF PROFESSIONAL COMMUNICATION:

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Elements which are present in the professional communication are:

1. Courtesy:

Common courtesy is part of professional communication. To practice

courtesy the nurse says hello and goodbye, knocks on doors before entering
and uses self-introduction. The nurse also states his or her purpose, addresses
people by name, says please and thank you to team members and apologizes
for inadvertently making an error or causing someone distress.

2. Use of Names:

Self introduction is important in communication. The nurse’s failure to give

a name, indicate status or acknowledge the can create uncertainty about the
interaction and convey an impersonal lack of commitment or caring.
Addressing other by name conveys respect for human dignity and
uniqueness. Avoid refining to clients by diagnosis, room number or other

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 attribute, which is demeaning and sends the message that the nurse does not
care enough to know the person as an individual.

3. Privacy and confidentiality:

Maintaining confidentiality is an important aspect of professional behavior.

It is essential that the nurse safeguard the client’s right to privacy by
carefully protecting information of a sensitive, private nature. Sharing
personal information or gossiping about others violates nursing ethical codes
and practice standards. It sends the message that the nurse cannot be trusted
and damages interpersonal relationships.

4. Trustworthiness:

Trust is relying on someone without doubt or question. Being trustworthy

means helping others without hesitation when help is needed. To foster trust,
the nurse communicates warmth and demonstrates consistency, reliability,
honesty and competence. Sometimes .it is not easy for a client to ask for
help. Trusting another person involves risk and vulnerability but it also
taster’s open, therapeutic communication and enhances the expression of
feeling, thoughts and needs.

5. Autonomy and Responsibility:

Autonomy is the ability to be self-directed and independent in accomplishing

goals and advocating for other. Professional nurses make choices and accept
responsibility for the outcomes of their actions. Communicate in a manner
that reflects what they communicate in a manner that reflects what they
really need and want. Autonomy can be beneficial to the client because
people who seek health care are often concerned about 1osing control of
decisions that influence how they live.

6. Assertiveness:

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 According to Darley, assertiveness comprises respect for others, respect for
yourself, self-awareness and effective, Assertiveness conveys a sense of self
assurance while also communicating respect for the other person. Nurses can
teach assertiveness skills to others as a means for promoting personal health.
Assertive people express feeling and emotions confidently, spontaneously,
and honestly. They make decisions and control their lives more effectively
than non assertive individuals. Assertive responses are characterized by
feelings of security, competence, power, optimism and professionalism.
They are a good tool for dealing with criticism, change, negative conditions
in personal or professional life and conflict or stress in relationship.

IV. IMPORTANCE OF INTERPERSONAL COMMUNICATION:

Human beings are innately social and are shaped by their experiences with
others. There are multiple perspectives to understand this inherent
motivation to interact with others.

1. Need of belonging:

According to Maslows hierarchy of needs, humans need to feel love

(sexual/nonsexual) and acceptance from social groups (family, peer groups).
In fact, the need to belong is so innately ingrained that it may be strong
enough to overcome physiological and safety needs, such as children’s
attachment to abusive parents or staying m abusive romantic relationships.
Such examples illustrate the extent to which the psychobiological drive to
belong is entrenched.

2. Social exchange:

Another way to appreciate the importance of relationships is in terms of a

reward framework. This perspective suggests that individuals engage m
relations that are rewarding in both tangible and intangible ways. Concept
fits into a larger theory of social exchange. This theory is based on the idea
that relationships develop as a result of cost benefit analysis. Individuals
seek out rewards in interactions with others and are willing to pay a cost for
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V.

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said rewards. In the best-case scenario, rewards will exceed costs, producing
a net gain. This can lead to “shopping around” or constantly comparing
alternatives to maximize the benefits or rewards while minimizing costs.

3. Relational self:

that consists of the feelings and beliefs that one has regarding oneself that
develops based on interactions with others. In other words, one’s emotions
and behaviors are shaped by prior relationships. Thus, relational self theory
posits that prior and existing relationships influence one’s emotions and
behaviors m interactions with new individuals, particularly those individuals
that him or her of others in his or her life.

PRINCIPLES OF IPCOMMUNICATION IN MANAGEMENT

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Relationships are also important for their ability to help individual develop a
sense of self. The relational self is the part of an individual’s self-concept

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1. Mutual benefit principle

Interpersonal relationship is a kind of mental relationship among people,

and it reflects a mentality that individual or group seeks for things to meet
its social needs. Therefore, change and development of interpersonal
relationship is subject to satisfaction degree of both parties’ social needs. If
during the communication, both parties obtain their respective satisfaction
of social needs, then close mental relationship can occur and be maintained
between them, which display a friendly affection; at the opposite Side,
relationship between them may be alienated. Interpersonal relationship of
various levels reflects the attraction, degree of mutual needs among people.

2. Credit Principle

Treat people with sincerity and insist on credit is the guarantee for extension
and deepening of interpersonal communication. During the communication
process, only with a motivation and attitude ,of sincere heart and kind
intention can people mutually understand, receive, trust and arise resonance
in sentiment, so that the communication relation can be consolidated and
developed.

3. Respect Principle

Although due to the influence of subjective and objective factors, people

may vary in temperament, character, ability, knowledge, etc. however, their
personality is equal. Only through respecting oneself and others and equal
positions of each party in interpersonal communication can be maintained.

4. Tolerance Principle

Tolerance displays that a person does not care much to minor issues, he can
treat others with tolerance, seek for common grounds while putting aside
differences and take revenge with lenience. Tolerance helps to enlarge
communication space, nourish interpersonal relationship and eliminate
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 interpersonal If someone pricks or hurts you, you keep dwelling on it and
hope to revenge, then it will necessarily lead to a vicious circle. On the
contrary, if you believe that people’s sentiments can be induced, majority of
people can be conscientious, open-minded and tolerant.

5. Moderation Principle

For communication shall be moderate. We shall be prevented from inputting

too much time and energy due to overemphasis of the importance of
communication. Distance for communication shall be moderate. It is very
necessary for friends to keep a certain distance among them, however, the
size of distance can be differentiated to friends with different intimacy.

VI. INTERPERSONAL COMMUNICATION SKILLS:

1.Verbal Communication: What we say and how we say it.

2.Nonverbal communication: What we communicate without words, body

language is an example.

3.Listening skills: How we interpret both the verbal and non-verbal messages
sent by others.
4.Negotiation: Working with others to find a mutually agreeable outcome.

5.Problem solving: Working with others to identify, define and solve problems.

6.Decision making: Exploring and analyzing options to make sound decisions.

7.Assertiveness: Communicating our values ideas, beliefs, opinions, needs and

wants freely.

VII. CHANNELS OF MANAGERIAL COMMUNICATION

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 There are four levels of managerial communication:

1. Downward communication.
2. Upward communication.
3. Lateral communication.
4. Diagonal communication.

Downward communication:

This is the traditional and most used communication, where the management
gives orders to the subordinates at the bottom level to carry out the orders as
per the organizational hierarchy. All the written and oral communication which
are carried out from the top management to the employees by various means in
order that the employees carry out their duties in the organization in achieving
its goals

MANAGEMEN
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SUBORDINATES SUBORDINATES

Upward communication:

Upward communication in the management levels from staff, lower and middle
management personnel and continuous up to the organizational hierarchy. It
provides a means for motivating satisfying personnel by encouraging
employees input.

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 MANAGEMENT

SUBORDINATES SUBORDINATES

Lateral communication:

Lateral or horizontal communication is referred to the departments or personnel

on the same level of the hierarchy.

MANAGEMENT

SUBORDINATES SUBORDINATES

Diagonal communication:

Diagonal communication occurs between two individuals or departments that

are not on the same level of the hierarchy. Common means are: unit in-charge
ordering diet for the patient, X-ray department informs appointments given to
patients in a particular unit, etc.

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 MANAGEMENT

MEDICAL NURING
MANAGEMENT DEPARTMENT

MEDICAL SURGICAL MEDICAL SURGICAL PEDIATRICS

PATHOGY
UNIT UNIT

LABORATORY X-RAY
LAUNDRY
CSSD

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VIII.

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PHASES OF INTERPERSONAL COMMUNICATION:

V. lnitial / opening phase :

Introduction and preparation of personal growth conditions occur in this

phase. In the opening phase of the relationship, the underlying goal of both
persons is to adapt to each other and to establish trust.
Orientation phase consists of introductions and an agreement between a
nurse and a client about their mutual roles and responsibilities. The first few
moments shared by the nurse and client are critical. What they see, hear,
touch and smell of each other during the initial engagement sets the tone for
how subsequent interactions will unfold.

The goal of this phase is to establish trust and rapport so that a realistic
understanding of a client’s problem and plan of action can be negotiated. As
the nurse and the client get to know each other, the initial anxiety of meeting

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 a stranger subsides, and trust increases, paving the way to a comprehensive
assessment.

VI. Working/developmental phase:

In this phase, relationship fosters growth and change, problem solving and
decision making. Throughout the working phase, both nurse and client strive
to maintain trust during stressful periods.

The nurse and the client get to know each other, the initial anxiety of
meeting a stranger subsides, and trust increases, paving the way to a
comprehensive assessment.

VII. Terminating/closing phase:

The closing of a successful relationship between nurse and client. The

closing phase requires to another care giver or by agreement that the client is
self-sufficient again.

The nurse and the client review the health changes and how the client has
dealt with physical and emotional responses. Discharge planning is a key
component in the termination process. For example the nurse- client
relationship can end when the client is discharged or the nurse is reassigned.
Be clear about termination. Continued contact beyond professional
responsibilities usually is not advisable and may violate professional and
ethical codes of conduct.

VIII. PROCESS OF INTERPERSONAL COMMUNICATION

The process of interpersonal relations includes several stages over an

extended life cycle. Communication scholar Mark Knapp has outlined one
useful framework for understanding the coming-together process. These
stages can be applied to personal friendships, romantic relationships,
business encounters, and many other types of interaction.
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1. The initial encounter:

Offers a first impression that can be full of communication data. Likes or

dislikes can be instantaneous, though many people have learned that first
impressions may be misleading.

2. Experimenting:

Is the second step in interpersonal communication. In this step, information

is exchanged on a variety of topics- general and “safe” at first, gradually
becoming more personal and more sett-revealing.

3. Intensifying:

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 Follows when the experimentation leads to positive mutual conclusions that
the relationship is worth pursuing.

4. Integration:

The fourth step in interpersonal communication is integration, in which

mutual decisions are made that the relationship is fulfilling. This is the stage
of intense friendships, close business partnerships, romantic commitments,
and so on.
5. Bonding:

Is the final stage, in which the relationship is sealed (often formally with
contracts or written agreements) and generally is publicized (such as
through announcements, friendship bracelets, gifts, commitment). ).

IX. BARRIERS OF INTERPERSONAL RELATION

1. Lack of sensitivity to Receiver:

A breakdown in relationship may result when a message is not adapted to

the receiver. Recognizing the receivers’ needs, status, knowledge of the
subject matter and language skills, assist an individual in living a healthy
relationship. If a customer is angry for instance, an effective response may
be Just to listen to the person’s vent, for a while.

2. Lack of Basic Communication Skills:

The receiver is less likely to understand the message, if the sender has
trouble with choosing the precise words and arranging these words in a
grammatically correct sentence.

3. Emotional distractions.

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 If emotions interfere with the creation and transmission of a message they
can also disrupt the reception. If receive a report from supervisor regarding
a proposed change in work procedure and do not particularly like
supervisor, may have problem reaching the report objectively. May find
fault by misinterpreting words for negative compressions, consequently,
they may be a strain relationship.

4. Tendency to evaluate:

A major barrier to the communication is the natural tendency to Judge the

statement of the person or other group. Everyone tries to evaluate others
from his own point of view or experience. Communication requires an open
mind and willingness to see things through the eyes of others. Some
intelligent brains even complimented him on his excellent style of
imagination.

5. Inattention:

The simple failure to read bulletins, notices, minutes and reports is a

common feature. With regard to failure to listen to oral communications, it
has been seen that non listeners are often turned off while they are
preoccupied with other affairs, like their family problems.

6. Unclarified assumptions:

This can be clarified by an illustration. A customer sends a message that he

will visit a vendor’s plant at particular time on some particular date. Then he
may assume that vendor will receive him and arrange for his lunch, etc.
whereas vendor may assume that the customer was arriving in the city to
attend some personal work and would make a routine call at the plant. This
is an un-clarified assumption with possible loss of goodwill.

7. Resistance to change:

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 Is the general tendency of human-being to maintain status quo. When new
ideas are being communicated, the listening apparatus may act as a filter in
rejecting new ideas. Thus, resistance to change is an important obstacle to
effective communication.

8. Closed minds:

Certain people who think that they know everything about a particular
subject also create obstacles in the way of effective communication.

X. ESTABLISHMENT OF INTERPERSONAL
COMMUNICATION IN NURSING

The head nurse is in key position for the establishment of good interpersonal
relationship among the personnel in her department. This will also involve
communication system existing between and within the hospital
departments. A warm friendly attitude of nurses is reflected in the clients
and other employees.

a) Every member should be kept informed about the job, any changes that are
taking place day to day.
b) Give personal reorganization to everyone by giving praise and showing
concern whenever they deserve.
c) Known each personnel working with you and accept them with their abilities
and limitations.
d) Any grievances should be dealt with promptly and appropriately.
e) Do not that do or say anything that will lower the status of the members in
your team.
f) Plan, organize and co-ordinate the activities of your team so that everything
gets done in the proper time and in the correct way.
g) Remember that every member in your team is working with you and not for
you or under you.

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XI.
everyone understands the work assigned to him /her.
i) Provide adequate supplies and equipment needed in the client care.
j) Except in case of emergency, avoid interrupting the personnel while they are
at work.

THEORIES OF INTERPERSONAL RELATIONSHIP:

The decibel theory:

It argues that the best way to get the message across is to state one ·s
point loudly and frequently. Its effectiveness over a period of time is nil,
but many of us still need to be reminded that shouting only makes poor
communication louder.

The Sell theory:

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It lays down that the total burden of communication is on the
communicator while the receiver is passive and pliable. One of the
problems created by this approach is that it tends to increase the barriers
between the individuals and thus reduces the chances of hearing each
other.

The minimet theory:

It assumes that the receiver probably is not much interested in what is

being communicated. By telling an individual what he needs to know, he
will have little to object and little to question.

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 CONFIDENTIALITY

I. INTRODUCTION

Confidentiality is mainly about privacy, meaning that any information write

down or tell someone about will be kept between you and that person. It is
common to confide in friends because you trust them. Keeping certain
things confidential is kind of an ‘unspoken rule’ in a friendship.
Confidentiality is practiced in many professions. It is of utmost importance
for the lawyers and the healthcare professionals. It is both a legal duty as
well as an ethical duty.
The ethical codes of healthcare profession also embrace confidentiality of
health information as a major principle. Confidentiality refers to the ethical,
professional and legal obligation of a physician not to disclose what is
communicated to him/her within physician-patient relationship. The basic
elements of the confidentiality includes respect for patient privacy and
autonomy, prevention of harm to patient fiduciary relationship between
patient and physician, service to common goods etc.
The essence of medical confidentiality is the nondisclosure of personal
information gathered in the course of the practice of medicine. Since,
medical practitioners deal with the most intimate physical and mental data
concerning the people they treat, it is not hard to understand why patients
would not want potentially embarrassing facts or conditions divulged to
others without their consent

Hippocratic Oath
“ …. Whatever in connection with my professional practice, or not in
connection with it, I see or hear in the life of men, which ought not to be
spoken of abroad, I will not divulge as reckoning that all such should be
kept secret. While I continue to keep this Oath unviolated, may it be
granted to me to enjoy life and the practice of the art, respected by all men,
in all times. But should I trespass and violate this Oath, may the reverse be
my lot.”

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 II. MEANING OF CONFIDENTIALITY

Confidentiality covers all medical records (including x-rays, lab-reports,

etc.) as well as communications between patient and nurse, and it generally
includes communication between the patient and other professional staff
working with the doctor.

III. CONCEPTS CONCERING CONFIDENTIALITY

1. Do no harm: In regard to gathering, recording and sharing verbal or

written information, “do no harm means that the resident and healthcare
provider will have an honest relationship in which sensitive data should be
and shall be disclosed at no risk to the resident or client that there will not
be a breach in confidential issues. In regard to privacy, “do no harm” means
that the resident/ client will not be unnecessarily exposed or intentionally
embarrassed while physically examined or treated.

2. Be honest: Deal honestly with residents and families, and also your peers.
Don’t be afraid to a mistake.

3. Use information proactively: Information shared will be used for the

sole purpose of being accurate in diagnosis, prescribing the best recommended
treatment, and providing the best care.

4. Irreversible: Information once shared cannot be unshared, erased, or

deleted. Think about what you are saying before words fall out of your mouth.

C- Creating trust with patient relationship.

O- Opening the details of patient to other after proper judgment.

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 N- Not revealing the documents of the patient to others.

F- Following the ethics of trust, faith in maintain the patients records.

I- Integrating sincerity, honesty, towards patient care.

D- Decision-making with nurse leaders before revealing the

confidential details of patient’s families.

E- Engaging the patient in all confidential matters of patient care.

N- Not openly taking to other coworkers about patient information.

T- Trustworthiness should create confidentiality; help to gain

cooperation to do quality patient care.

I- Intelligent way of handling the ethical issues will safeguard not

only the nurse but also the patient.

A- Alertness among the nurses are the expected quality during

recording the patients document.

L- Leading the entire nursing team abide the rules of confidentiality.

I- Interacting the patient’s details in the court is allowed for the nurse
to reveal the confidentiality

T- Thorough knowledge about ethics and importance of

confidentiality is needed for the nurse to give high quality care.

Y- Yelling and gossiping about patient’s problems inform of patients

and others should be avoided.

IV. DEFINITION OF CONFIDENTIALITY

Dimond (2002) defines confidentiality as one of the values of good care

practice that is concerned with protecting private information about the
patient and clients obtained during the period of professional practice.

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 “Confidentiality is something that is confidential and is meant to be kept
secret.” –Oxford dictionary.

Confidentiality has been defined by the International Standards

Organization (ISO) as ensuring that information is accessible only to those
authorized to have access.

V. THINGS THAT SHOULD BE KEPT CONFIDENTIAL

1. Name.
2. Age.
3. Sex.
4. Address.
5. Race.
6. Health information.
7. Health condition and problem.
8. Diagnosis or sickness.
9. Personal care issues.
10.Social Security Number.

VI. HIPPA

In 1996 congress enacted the HEALTH INSURANCE PORTABILITY

AND ACCOUNTABILITY ACT or H.I.P.A.A. The Primary purpose
of this act was to ensure the continuity of the health insurance when
one changes the jobs. But later it also provided standards for health
information transactions and confidentiality and security of patient
data. This portion of the act affects the day to day workflow among
physicians.

The Privacy Rule was Published in April 2001 and has been enforced
since April 2003 by the office of Civil Rights. Thus HIPAA requires
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 all professionals and organizations to guard the privacy of their patients
and customers. Individuals must provide written consent for any and
all releases of medical or health-relateo information. Employees at all
levels are required to maintain confidentiality.

There are civil penalties of Rs 100/violation up to Rs 25 .000/

violation. Criminal penalties are also possible including Rs
50,000/violation and/or l year in prison for wrongful disclosure or Rs
250,000 and 10 years in prison for the intent to sell information.

VII. PURPOSE OF CONFIDENTIALITY

1. Disclosure: Confidentiality allows the patient to feel free to make a

full and frank disclosure of information to the physician.

2. Diagnosing: Full disclosure enables the physician to diagnose

conditions properly and to treat the patient appropriately.

3. Right of patient: In return for the patient’s honesty, the physician

generally should not reveal confidential communications or
information without the patient’s express consent unless required to
disclose the information by law.

VIII. IMPORTANCE OF CONFIDENTIALITY

1. Protection: The major importance of confidentiality is to protect you

and the patient. It protects the patient in the sense that their personal
information is not getting out to random people and they won’t have to
be embarrassed about whatever they have. It also protects you from
possible lawsuits from sharing the information.

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 2. Trust and confidence: The ethical and legal principle of
confidentiality is anchored in a set of values and assumption about the
treatment relationship and the consequences of disclosing private
information. It is central to trust between the doctor and patient under
which the patient puts trust and confidence in doctor to act in faith for
his/hers best interest. Without assurance about the confidentiality, the
patient may be reluctant to give doctor the information they need in order
to provide best care.

3. Privacy of patient: The healthcare team involved in patient care is

ethically bound to respect the confidentiality of health information of
each patient because it is the natural desire of human being to be
protected from social embarrassment, disapproval, discrimination and
stigmatization. It encourages the free exchange of information which is
essential for effective medical intervention, public health and preventing
harm to others.

IX. PRINCIPLES OF CONFIDENTIALITY

1. Justify the purpose(s)

Every proposed use or transfer of patient identifiable information within or

from an organisation should be clearly defined and scrutinised, with
continuing uses regularly reviewed, by an appropriate guardian.

2. Don’t use patient identifiable information unless it is absolutely

necessary

Patient identifiable information items should not be included unless it is

essential for the specified purpose(s) of that flow. The need for patients to
be identified should be considered at each stage of satisfying the
purpose(s).

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3. Use the minimum necessary patient-identifiable information

Where use of patient identifiable information is considered to be essential,

the inclusion of each individual item of information should be considered
and justified so that the minimum amount of identifiable information is
transferred or accessible as is necessary for a given function to be carried
out.

4. Access to patient identifiable information should be on a strict

need-to-know basis

Only those individuals who need access to patient identifiable information

should have access to it, and they should only have access to the
information items that they need to see. This may mean introducing access
controls or splitting information flows where one information flow is used
for several purposes.

5. Everyone with access to patient identifiable information should be

aware of their responsibilities

Action should be taken to ensure that those handling patient identifiable

information – both clinical and non-clinical staff – are made fully aware of
their responsibilities and obligations to respect patient confidentiality.
 
6. Understand and complies with the law

Every use of patient identifiable information must be lawful. Someone in

each organisation handling patient information should be responsible for
ensuring that the organisation complies with legal requirements.

7. Principle of safety:

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 Confidentiality is central to trust between nurse and patients. Without
assurances about confidentiality, patients may be reluctant to seek medical
attention or to give nurse the information they need in order to provide
good care. But appropriate information sharing is essential to the efficient
provision of safe, effective care, both for the individual patient and for the
wider community of patients.

8. Principle of disclosure:

The nurse should make sure that information is readily available to patients
explaining that unless they object, their personal information may be
disclosed for the sake of their own care and for local clinical audit. Patients
usually understand that information about them has to be shared within the
healthcare team to provide their care. But it is not always clear to patients
that others who support the provision of care might also need to have access
to their personal information. And patients may not be aware of disclosures
to others for purposes other than their care, such as service planning or
medical research.

X. TYPES OF CONFIDENTIALITY

The actual meaning of confidentiality covers the secrets that you tell to a
service that must remain between you and the person being told. Different
types of confidentiality are recognized by the legal system.

1. Doctor-Patient confidentiality: Doctor-patient confidentiality goes as

far back as the Hippocratic Oath taken by doctors. The oath states that a
doctor will not disclose anything pertaining to a patient to any unauthorized
person. The Hippocratic Oath also states that those that are sacred shall not
be imparted on anyone other than persons that are sacred. In simpler terms,
a doctor will not discuss a patient’s condition or any medical background to

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 anyone other than a person that the patient has formally released
information by singing an authorization form.

2. Attorney-Client confidentiality: Attorney-client privilege is covered by

the American Bar Association, which outlines the ethical duty of attorneys
to their clients. Basically, an attorney withhold any information disclosed to
him by a client or prospective client. Any information garnered from the
client during interviews or during representation must not be released to
any other person without the written consent of the client.

3. Confidentiality agreements: Businesses require that most employees

working in confidential areas of the company sign confidentiality
agreements. These type of confidentiality agreements are primarily used
when a company has a secret ingredient, product in development or new
research on existing products in development. Toe protection of sensitive
technical information or other vital information that if disclosed will harm
the company, concerns this type of confidentiality agreement.

4. Pastoral confidentiality: One of the most unrecognized types of

confidentiality is the pastoral confidentiality that exists between a clergy
and congregation or person disclosing information to a clergy member in
private. A lot of states do not recognize this type of confidentiality but most
religious organizations do permit clergy members to withhold any
information told to them by individuals. In recent years, people have sued
clergy members for disclosing information given to them in private. Most
of these lawsuits have been won by the individual and not ne church.
Private conversations between individuals and their pastor, minister, priest
or clergyman must be kept confidential.

XI. BREACH OF CONFIDENTIALITY

There are two types of outcomes related to breach of confidentiality.

1. Positive Outcomes

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 a. Suspected abuse or neglect can be investigated.
b. Possible future abuse and neglect may be avoided or prevented.
c. A suicide or attempted suicide may be prevented.
d. Appropriate interventions may be initiated for a resident or client
to get help in appropriate related areas.

2. Negative Outcomes

a. The facility or agency may reprimand a healthcare worker, such as

disciplinary action against the employee for breaching
confidentiality related to patient care issues.
b. The resident or client may suffer embarrassment and emotional
distress.
c. Irreversible damage may be done to the caregiver/care receiver
relationship.
d. The resident or client may file charges against the healthcare
worker, staff, and facility. They may be able to sue and win
compensation for breach of confidential matters.

XII. AGENCIES THAT MONITOR PATIENT PRIVACY

1. Joint Commission on Accreditation of Healthcare Organizations

(JCAHO): This national organization accredits healthcare facilities
that meet ]CAHO standards. Patient confidentiality and privacy is an
important part of these standards. If JCAHO surveyors evaluate
organization, they will expect you to know your organizations mission,
your organizations policies for protecting confidentiality, what efforts
your department is making to improve patient privacy and
confidentiality, and how your job relates to all of these.

2. National Committee for Quality Assurance (NCQA): This

National organization evaluates managed care plans. It also accredits
managed care organizations. NCQA teamed up with to develop special

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 recommendations to help managed care organizations protect patient
privacy and confidentiality. Areas that these recommendations address
include: staff education, patient consent, and systems to ensure
confidentiality.

3. Health Care Financing Administration (HCFA): HCFA is a part

of the US Department of health and Human Services. It administers
Medicare, Medicaid and Child Health Insurance Programs. HCFA’s
responsibilities include: ensuring that Medicare, Medicaid and the Child
health Insurance Programs are properly run by state agencies. HCFA also
plays a part in evaluating healthcare facilities and services.

XIII. DISCLOSURE OF INFORMATION

Disclosure of the information should be done

a) With patients consent

b) For benefit of patient
c) Prevent harm to others
d) When required by law
e) Medical research or audit

1. Disclosure with patients consent

Consent should be attempted at all time possible. Patient understands

nature and effects of disclosure. Reports to third person (insurance,
employer) must always be with consent that is written consent

2. Disclosure for patients benefit

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 It should be done in time of emergency and if patient is in incompetent.
Implied consent when care is shared among professionals for the
benefit of patients care to prevent harm to patient like in child abuse.

3. Disclosure required by law

Order of court like medical litigation, criminal cases, compensation.

Providers must report cases of suspicious death or certain injuries such
as gunshot wounds.

4. Disclosure for medical audit, research, registries

It should be approved by ethics committee. And ensure it should be no

harm to patient. Registries operated under principle of medical
confidentiality ,where feasible obtain consent or inform patient

XIV. CONSEQUENCES OF BREACHING CONFIDENTIALITY

LAWS

a) TERMINATION: The first and most obvious result of a breach of

confidentiality is termination (fowlers 2016)

b) CRIMINAL PROSECUTION: violating the confidentiality laws can

result in both criminal and civil penalties can start at 100 up to Rs
25000.

c) IMPRISONMENT: anyone knowly to disclose personal health

information can be imprisonment up to one year

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XV. CONFINDENTIALITY IN NURSING

1. The code of conduct will define confidentialities importance to nursing

profession and professional code of conduct. It will further look at the
possible dilemmas that could arise in interaction between the nurse
colleagues and their relatives and how to ensure confidentiality and
legislation governing access to confidential information.

2. The term “confidential patient information” as used in this statement refers

to individually identifiable health and personal information, and recognizes
a patient’s expectation of and right limited to: information related to the
past, present or future physical or mental health of an individual and
treatment; and any information that identifies the individual or in which
there is a reasonable basis to believe that the information can be used to
identify the individual.

3. Patient privacy is important in the field of medicine, and nurses are

frequently the ones to maintain it. Maintenance of confidentiality affects
most aspects of nursing, including record keeping, discussing the medical
issues of patients with others, and the manner in which nurses interact with
the patients themselves. The nurse should inform patients of the limits of
confidentiality protections and allow the patients to decide whether
treatment outweighs the risk of the disclosure of sensitive information. A
patient expects to have his or her privacy respected by the physician and
should not be disappointed. If a record must be released, the patient should
sign an appropriate release authorizing the disclosure of information in the
medical record. General releases will not suffice for records containing HIV
or other sensitive material.

4. The nurse should become familiar with laws involving the duty to maintain
confidentiality. Any breach in confidentiality-even one that seems minor-
can result in mistrust and, possibly, a lawsuit and/ or disciplinary action.

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XVI. QUALITIES OF A NURSE IN CONFIDENTIALITY
Developing an environment of trust is another key factor. Trust develops
when patients see a facility’s commitment to protecting privacy and
confidentiality. Staff should handle medical records carefully. Be sure to
never leave them open or unattended in public areas where others can have
access to them. Seek informed consent whenever health information needs
to be released. This included Medication Administration Records (MARs)
and Treatment Administration Records (TARs), which need to be closed
when not in use, and removed from the tops of medication carts and
treatment carts when not in use as well.

a) Understand facility’s need to know policy. Healthcare staff should

only have access to information needed for their job. It is important to
keep evaluating what information really needs to be known.

b) Ask yourself, “Do I want to know this information or do I NEED to

know it?” “Do I have a right to know this information?”

c) Use Good Sense …. Along with following your facility’s policies and
procedures, using common sense is one of the most important ways to
help protect patient privacy and confidentiality.

d) For example: Think before you speak, Be aware of whether others

can over hear your conversation, If you think that certain information
might be confidential, treat it as such.

e) Show courtesy and respect: 1his is a key part of protecting patient

privacy and confidentiality. It is important to treat all patients with
respect, Handle patients medical records with the same care that you
would want your own medical records handled.
f) Respect every patient’s right to privacy.

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XVII. GUIDELINES FOR PROTECTING PRIVATE AND
CONFIDENTIAL INFORMATION

1. Discussing patient information only in a discrete place away from

individuals that are not authorized to receive the patients information.

2. It is important staff members only discuss a patients information with

authorized personnel. Staff members are not allowed to release a patients
information to media entities. If police personnel ask for an individuals
medical information, it is important that the staff members notify their
immediate supervisor before releasing this information.

3. Do not keep a copy or make copies a patient information

4. Any item with a patients name or identifying medical information should

never be placed in general trash receptacles. They should be shredded for
appropriate disposal of confidential information

97
 PUBLIC RELATION
I. INTRODUCTION

Public relations as a management concern in its present form emerged

during the 19th century in the Western Europe and America massive
urbanization. There were conflicts urbanization. There were conflicts
between agriculturalists and industrialists between manufacturers and
customers and different political ideologies which emerged during the time.
The society became complex. Interpersonal relationship became a difficult
phenomenon. Therefore it was inevitable to initiate proper understanding
among different groups, the facts about policies, products, organisations
etc.

II. DEFINITION
According to HERBERT M. BAUS Public relation is a combination of
philosophy, sociology, economics, language, psychology, journalism,
communication and other knowledges into a system of human
understanding.

According to INSTITUTE OF PUBLIC RELATION, public relation is the

deliberate, planned & sustained effort to establish the maintain mutual
understanding between an organization & its publics.

According to Baumeister (1995) all humans have a motivational drive to

form and maintain carrying interpersonal relationships

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III. ELEMENTS OF PUBLIC RELATION:

a) Human relation: Getting along with the people, both internal and external.
One should be aware of the other and interested. In his progress.

b) Empathy: Feeling with others.

c) Persuasion: Causing somebody to do something by reasoning with him,

compelling is against the principles of social contact.

d) Dialogue: Conversation with a purpose. It is used for influencing behavior,

selling goods or inspiring ideas. Conciliation making somebody less angry or
friendlier and compromise are involved in dialogue.

IV. FUNCTION OF PUBLIC RELATION

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1. Community relations:

Organization can implement various programs to improve community

relations on a regular or even ongoing basis. So, clearly, one of the major
functions of public relations is to bridge business/community gap. When
organizations support activities and programs that improve quality of life in
their communities their image and reputation will be enhanced.

2. Employee relation

The most importance that a company has are its employees and the
customer service they provide. The functions of public relations in regards
to the company’s among its employees is also another responsibility of
public relations in its function of employees of employee relation

3. Product public relations

When new products to the market the role that public relations plays is
crucial for creating awareness and differentiating the produce in the
public’s eyes from other similar products. When existing products need a
push public relations is often called on the improve product visibility.

4. Financial relations

This functions involves communication with the wide variety of individuals

and groups that the company deals with in the course of its operations. This
include the stockholders and investors but is not limited to them.

100
 V. PUBLIC RELATION SKILLS

a) Rapport Skills

Making a rapport with others itself is a skill The first impression makes a lot of
impact in starting an effective communication with others. Recognition can be
expressed verbally or non verbally. A pleasant smile, eye contact etc. form non
verbal strategies to impress the visitors. A public relation practitioner who can
use the strategies well can motivate the visitor to unfold his personality and to
initiate a meaningful interaction

b) Empathic Skills

Empathic skills denote the ability of a person to perceive the other effectively.
Empathic understanding will lead to meaningful action to solve the problem of
the visitor. It is not just like a might person is lending his helping. · hand to a
feeble person. It is the sharing of feelings and resources on the basis of
harmonious understanding of each other. It is very easily said but very difficult
to put into practice, due to the modern style of having which engages person
with hectic activities.

c) The Listening Skills

Listening skill is the capability every public relations practitioner should have to
perceive others effective ely. It is not just hearing a person. Listening should
mean that one is consciously listening should mean that one is consciously
aware of what the other person is saying. Often we hear what we want to hear. A
public relations practitioner should have a skill to listen constructively and,
picking out the important bits, and constructing has been said, trying to work out
the meaning and purpose of what the other person wanted to say.

VI. ROLES OF A PUBLIC RELATION OFFICER

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 a) Personal communication: Communication within an organization and the
clientele group

b) Printed communication: Communicating through mail, books, pamphlets,

press relations etc.

c) Visual communication: This communication can be by the means of

photographs, visual aids, films and television.

d) Audio communication: This communication can be through the radio

broadcasting.

e) Specialized communication: There can be special events that will require

special way of communication through special meetings with the external,
parties , government, international agencies etc.

VII. TOOLS OF PUBLIC RELATION

1) Advertising: It is drawing attention by big public announcement to a

commodity or service with the aim of selling it.

2) Publicity: It is the technique of telling the story of any organization. It

includes all the technique employed to get a story across to the public. It
includes advertising to. In this, the public is made aware of the functioning and
special services offered by an organization through information via
advertisement, workshops, conferences, video conferencing, mails, websites etc.
It is the most important aspect of public relations and has become must for any
large organization.

102
3) Propaganda: It is the political application of the publicity and
advertising on a large scale for selling an idea or candidate or both.

4) Diplomacy: It is the management of international relations by

negotiation. Diplomacy is the application of intelligence and action to conduct
maintains official relations.

5) Promotions: Promotion describes commercialization of publicity,

usually on a grand and coordinated scale to the end of selling product.

6) Campaigns: Campaigns consist of concerted single purpose publicity

programmes, usually on a more or less elaborate scale, employing coordinated
publicity through a variety of media, aimed at a number of targets, but focused
on specific objectives.

7) Lobbying: Lobbying means campaigning for legislative action. It is an

informal way of publishing strings. Lobbying entails the exaction of influence,
smooth pressure between the public and the management of an organization.

8) Public affairs: This may broadly be defined as a significant and

substantial concern and involvement by individuals, foundations, private
institutions and governments with the social, economic and political coerces that
singly or through interaction shape the environment in which the free enterprise
exists.

9) Public relation counseling: The PR professional first determines the

character of the company seeking his counseling then he weights the existing
status or image. Finally, he will be able to suggest what should be done to
freshen up the company’s image.

10) Public relation budget: A person or establishment desiring to run a P.R.

campaign should have a budget. The budget will depend upon the need of the
individual or establishment. It should be related to the sales turnover of the
company or its profiles.
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 11) Research and research division: The basic functions of this division is
to undertake basic research on the matters of publicity and to provide guidance
to build up a base of knowledge on important subjects.

VIII. FACTORS RESPONSIBLE FOR SUCCESSFUL PUBLIC

RELATION PROGRAMME

a) Identification of need: Identify the need of public to organize any

programme. It should be need based.
b) Careful planning: Determine what community wants, plan various methods,
the time and who all will be involved.
c) Get cooperation from all concerned, department, administration, public and
other agencies.
d) Observe ethical standards.
e) Implement the programme.
f) Evaluate the public reaction.
g) Revamp if required.

IX. PROBLEMS OF INTERPERSONAL RELATIONS

Generally, interpersonal problems lead individuals to resist each other and

each others influence in various overt but more often in covert ways.
Communication difficulties are primarily the result of interpersonal
difficulties.

1. Loss of motivation

Another expression of interpersonal problem is the loss of motivation to

work on a task. In innumerable ways, the individuals work becomes
ineffective because he lacks the desire to produce. Chronic absenteeism
or lateness is still another manifestation of interpersonal relationships.

2. Indiscriminate opposition

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 A symptom of bad relationship is resistant to suggestions. It may happen
that an individual in the group makes suggestion that are opposed by
other members regardless of the merit. This is of course not beneficial
from the standpoint of the group, because a very good suggestions may
be rejected for irrelevant personal problems.

3. Operational problems

There are several ailments of total group functioning that are

symptomatic of interpersonal difficulties. In most cases, the difficulty in
reaching decisions is a sure indication of interpersonal strife. This arises
because of inefficient division of labor.

4. Task distortions

Interpersonal problems are often worked out on some aspect of the task
that closely approximates the relationship that is of concern to the group.
Sometimes it may appear that the group is very task oriented, its work
may fact be quite inappropriate and ineffiecient at many points. A group
needs to work in consensus, i.e everyone in group feels that the group
understands a particular action should be taken by them, even though
they do not agree with it personally.

5. Authority problem.

Another group phenomenon that leads to reduced effectiveness concerns

the relationship of the group members to the leader of the group.

X. ROLE OF PUBLIC RELATIONS

a) Educational: To educate the public about the main functions of the

organization and the procedures concerning them.

b) Informative: To give information about the various existing services, proposed

services, various policies of the organization, etc.
105
 c) Towards Problem Solving: If any person comes with some problem faced by
him about the service being provided by the organization, the efforts of the
concerned employee should be to listen to him in detail and see how he can
help him in solving his difficulties.

XI. NURSE’S ROLE AS A PUBLIC RELATION OFFICER

A nurse can make efforts in maintaining good public relations and can play
various role in an organization:

a) Quality maintenance in patient care services.

b) Keeping up to date knowledge about the publications of the informational
booklets in organization and dissemination to the consumers.
c) Updating herself with the latest news of the health organization she is working
in.
d) Nurse can be the guide herself to the public for the right choice of treatment by
giving appropriate referrals.
e) Promoting nursing services in health care system by organizing health
programs for the media coverage.
f) Making her co-workers and other persons on the unit aware about the legal
aspects of nursing, consumers rights, nurses rights, rules and regulations
and employee’s grievances.
g) Keeping up to date knowledge in the institutional brochure, annual report,
new researches etc. so as to float this information in an organization to
make the people aware of it.

XII. GUIDE LINES FOR GOOD PUBLIC RELATIONS

The foremost way which has been utilized right from the olden days is
personal contact with the customer, the public. This can take shape of face
to face contact in an appropriate environment or across the table or across
the counter.

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a) Be Presentable: The person visiting the customer should be presentable.
Presentable personality does not mean that the person should have a
towering personality, dressed in kingly garments with royal gesture. He
should be just well dressed and equipped with the tools and accessories
required for the occasion.

b) Queries to be answered well: Queries of the customers should be

answered well. In case the question calls for some information which is
beyond the official scope of the officer visited, the visit in a person may be
given the name and address with telephone number of the appropriate
information beyond one’s scope is not only injurious but sometimes reads
to serious repercussion.

c) Avoid Loose talk: Whenever you speak, talk to the point and in an
impressive way. Avoid loose talk. The first impression is given by your
appearance and the second impression is given by your talk. Talk comprises
of two things listening to the other person (i.e; reception) and then tell him
your ideas (transmission). Therefore, be a good listener; give a cool hearing
to the visitor. Treat him as most important person, understand his problem
well and ask the questions to eliminate doubts. Even if he is excited and

107
 talks ill of the department or talks irrelevant, listen coolly as your aim is to
understand the problem correctly.

d) Affirmative Approach: The approach should be affirmative towards

customer problem solving. While listening to the customer or while talking
to customer, he should have the feeling that you have understood his
problem and want to help him sincerely. In sorting out his problem.

e) Knowledge about the department: The person should have full

knowledge about the working of his department, details of various aspects
of public concern, recent developments in the field of technology and
research and the stand of the department different aspects. In case you do
not some aspects about which the customer is enquiring, accept the fact,
collect the information and then pass on earliest at your initiative.

f) Feedback: The person should collect the feedback for his own use and
for passing that to the management. For this purpose has to keep his eyes,
ears and mind open. Public and dialogues of public are available
everywhere and anywhere and at all times, one has to only note the
expressions and feelings. Newspapers, T.V., magazines, direct talks, etc.,
are the different types of feedbacks. After collection feedback it is to be
analysed and discussed at appropriate levels and action may be taken
accordingly.

g) A good heart: Public relations practitioner needs a good and sympathetical

heart and one has to understand the view point and ideas of others and
appreciate them.

XIII. ROLE OF ADMINISTRATOR/MANAGER IN

COMMUNICATION
No Communication= No Leadership

Nurses work in an organization which have structure and objective where

leader, members, peers and the external environment are necessary linked by
the organizations and communication networks process. Communication
108
 conveys ideas. Opinions or decisions of leaders to subordinates at different
levels of the organizations and carries back information, suggestions or
responses from subordinates. Communicate on sets the employees in
individual jobs, regulates their flow of work, coordinates their efforts and
secure better and higher work accomplishment:

i. Promotes the managerial efficiencies.

ii. Aid to planning making.
iii. Strengthens and operation.
iv. Takes basic for leadership action.
v. Works as means of coordination.
vi. Works as provision of job satisfaction.
vii. Maintains person-to-person relationship.
viii. Keeps maximum productivity with minimum cost.
ix. Provides Morale-building democratic management

XIV. SUMMARY

Communication may be defined as a process concerning exchange of facts or

ideas between persons holding different positions in an organization to
achieve mutual harmony. Communication is the process of exchange of
ideas, views, facts, feelings, etc. People in organizations spend over 75% of
their time in an interpersonal interaction. The major cause for organizational
problems arising from poor communication. The communication process
involves the source, encoding, message, receiver, decoding and feedback.
There are barriers observed in communication such as badly expressed
message: semantic barriers, physical barriers, psychological barriers: faulty
transmission: cultural barriers organizational barriers gender barriers and
other barriers The various ways to overcome barriers are use proper of
channel of communication hit the right audience listen, speak louder than
words, give explicit message and follow-up action.

Whether formal or informal, the six steps of the communication process are:
ideation, encoding, transmission. Receiving, Decoding and acting. Encoding
is the process by which the sender converts the information to be transmitted

109
 into the appropriate symbols or gestures. Decoding is the process by which
the receiver interprets the message. If the decoding matches the sender’s
encoding, the communication has been effective.

Barriers to effective communication include badly expressed messages,

faulty organization, distrust of the communicator, restricting communication,
poor retention, different backgrounds, in-group language and inattention.
Many of these barriers can be overcome through the use of feedback and
simple language.

Inappropriate comments took place with disturbing frequency in the elevator

rides. These comments did not exclusively involve violations of patient
confidentiality, but encompassed a range of discussion that health care
employees must be careful to avoid. Patient confidentiality and privacy are a
very important aspect within our jobs in the healthcare industry. Maintaining
confidentiality will ensure quality care. Also legal issues are on rise these
days

XV. RESEARCH ABSTRACT

110
XVI. CONCLUSION

The management of an organization should realize the importance of

effective communication within the organization. The management should
find· from their senior managers and lower employees the difficulties
involved in communicating. They should know what information the
employees would like to know from the management and what they should
know from the employees through upward communication so that
unnecessary bottlenecks of communication may be eliminated in the interest
of the organization and for the free flow of communication. Since it is the
responsibility of the management to keep their house in order, they should
take the initiative and improve communication.

Communication is· the meaningful exchange and understanding of ideas,

statistical data, opinions or emotions from a source to receiver. Today
professional nurses are involved in human and labour relations, the
development of quality and quantity nursing service standards, the
assessment of nursing care and a whole list of other technical aspects of

health care operations. The nurse administrator’s effectiveness depends to a

degree on their awareness of communication concepts, their positive,
approach to communication and their skillful use of its mechanisms.

111
XVII. BIBLIOGRAPHY

1. Clement I.(2016). Management of nursing services and education. Elsevier

publication. Second edition. Haryana. Page no: 321-325, 363-374
2. Venketaraman Alamelu. (2017). Newer trends in management of nursing
services and education. First edition. Jaypee publication. Page no: 154-156
3. Goyal.C.R.(2007). Hospital administration and human resource Management.
Prentice-Hall of India Private Limited. Fourth edition. New Delhi. Page no:
265
4. Prasad M L.(2008). Principles and practice of Management. First edition.
Sultan Chand & Sons . New Delhi. Page no: 791-792
5. Chhabra.N.T. (2008). Principles and practice of management. Dhanpat rai and
co ltd. Ninth edition. Page no: 523-527.
6. Tripthy C P, Redddy N P.(2007). Principles of management. Tata McGraw-Hill
Publishing Company limited. Third edition. Page no: 272
7. Thapa Pramila. (2013). Leadership and management for nurses. Jaypee
Brothers Medical Publishers. First edition . page no: 85-89,95
8. Neelam kumari. (2015). Nursing services and administration. S.VIKAS
medical publishers. First edition. Page no: 356-357, 367
9. Masih Shabnam.(2014).Introduction to nursing service administration. Lotus
publishers. First edition.page no:192-195
10. Dr. kochuthresiamma Thomas . (2011). Nursing management and
administration. V. publishers. First edition. Page no: 229,233.
11. Clement I.(2016).professional trends and adjustments in nursing. The health
science publishers. Haryana. Page no:125-134
12. Dr. Clement I.(2016). Communication and educational technology. Emmess
medical publishers. Third edition. Page no: 3-41

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