FUNDAMENTALS OF NURSING PRACTICE
LECTURE 2/SECOND SEMESTER
NURSING AS AN ART: COMMUNICATING
BACKGROUND
 The art of nursing, in its earliest history, was rooted in
vocational norms related to motherhood and
homemaking. Evolving over time, the art of nursing has
been defined as the nurse’s ability to be
compassionate, caring, and communicative.
 These behaviors enable nurses to interpersonally
connect with patients, a skill which is critical to quality
patient-centered care and deeply valued by patients
and families.
 Communication is a vital element in Nursing in all
areas of activity and in all its interventions such as
prevention, treatment, therapy, rehabilitation,
education and health promotion.
 The nursing process moreover as a scientific method
of exercise and implementation of Nursing, is
achieved through dialogue, through interpersonal
environment and with specific skills of verbal
communication.
COMMUNICATION
 A critical nursing skill used to gather data, teach and
persuade, express caring and comfort.
 It is a two-way process wherein the message is
transmitted between two or more persons with the
intent of creating a shared understanding.
 Interchange of information, ideas, or feelings between
two or more people.
COMMUNICATION PROCESS
 The communication is a dynamic process that begins
with the conceptualizing of ideas by the sender who
then transmits the message through a channel to the
receiver, who in turn gives the feedback in the form of
some message or signal within the given time frame.
SENDER
 The source-encoder.
 A person or group who wishes to communicate a
message to another.
 The sender is the person who initiates the conversation
and conceptualized the idea that he intends to
convey to others.
 EX. Nurses serve as senders or encoders by initiating
communication with patients, families, and other
healthcare professionals. They convey information,
provide instructions, and offer emotional support.
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ENCODING
 Process of turning thoughts into communication
 Uses certain words or non-verbal methods such as
symbols, signs, body gestures, etc. to translate the
information into a message.
 During encoding, the sender translates their thoughts
into a format that can be easily understood by the
receiver. It involves choosing appropriate words and
expressions.
 EX. Nurses use their communication skills to encode
messages effectively. This involves choosing
appropriate language, considering cultural nuances,
and utilizing non-verbal cues to ensure clear and
empathetic communication.
MESSAGE
 The message itself
 What is said or actually written
 Once the encoding is finished, the sender gets the
message that he intends to convey. The message can
be written, oral, symbolic or non-verbal such as body
gestures, silence, sighs, sounds, etc. or any other signal
that triggers the response of a receiver.
 EX. The message in nursing encompasses health-
related information, treatment plans, educational
materials, and emotional support provided by the
nurse to the patient and their families.
CHANNEL
 This is the transmission or method of delivering the
message.
 The Sender chooses the medium through which he
wants to convey his message to the recipient. It must
be selected carefully in order to make the message
effective and correctly interpreted by the recipient.
The choice of medium depends on the interpersonal
relationships between the sender and the receiver
and also on the urgency of the message being sent.
Oral, virtual, written, sound, gesture, etc. are some of
the commonly used communication mediums.
 EX. Channels in nursing include face-to-face
interactions, written documentation in medical
records, electronic communication systems, and
team meetings. Nurses choose the most suitable
channel based on the nature of the message and the
needs of the recipients.
DECODING
 The interpretation of the message.
 Decoding is performed by the receiver.
 Here, the receiver interprets the sender’s message and
tries to understand it in the best possible manner. An
effective communication occurs only if the receiver
understands the message in exactly the same way as
it was intended by the sender.
 EX. Patients and healthcare team members decode
and interpret the information provided by the nurse.
Ensuring effective decoding is essential for patients to
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understand their treatment plans, medications, and
overall care.
RECEIVER
 The person who is getting or receiving the message.
 The receiver is the person for whom the message is
intended or targeted. He tries to comprehend it in the
best possible manner in order to attain the objective
of the communication. The degree to which the
receiver decodes the message depends on his
knowledge of the subject matter, experience, trust
and relationship with the sender.
 EX. Patients, families, and healthcare team members
act as receivers who decode the nurse's messages.
Nurses must be aware of the diverse backgrounds,
literacy levels, and emotional states of the recipients
to tailor their communication accordingly.
FEEDBACK
 Response
 Message that the receiver returns to the sender.
 The Feedback is the final step of the process that
ensures the receiver has received the message and
interpreted it correctly as it was intended by the
sender. It increases the effectiveness of the
communication as it permits the sender to know the
efficacy of his message. The response of the receiver
can be verbal or non-verbal.
 EX. Patient feedback is vital in nursing. Whether verbal
or non-verbal, it helps nurses gauge the effectiveness
of their communication. Understanding the patient's
response allows for adjustments in care plans and
addressing any concerns.
NOISE
 Anything that interferes with the interpretation of a
message.
 Psychological noise (internal), physical noise
(external), and semantic noise (understanding of
words).
 The Noise shows the barriers in communications. There
are chances when the message sent by the sender is
not received by the recipient.
 EX. Noise in nursing can manifest as physical (e.g.,
noisy environment), semantic (e.g., language
barriers), or psychological (e.g., patient anxiety).
Nurses must identify and address these barriers to
ensure accurate communication and prevent
misunderstandings.
SUMMARY
 The communication process has several components
that enable the transmission of a message. Here are
the various parts:
 1. The beginning of the communication process
involves the sender creating an idea that they plan to
send to another person or group of people.
 2. Once the sender develops an idea, they translate it
into a form that can be transmitted to someone else.
 3. Next, the sender decides how the message will be
sent. This involves selecting the most suitable medium
for the message they're relaying
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 4. After the medium is chosen, the message then
begins the process of transmission. The exact process
of this will depend on the selected medium.
 5. Once the message actually gets to the receiver, it’s
their job to decode it. In other words, they interpret it
and convert it into a thought.
 7. Lastly, unless it's a one-way communication, the
receiver will provide feedback in the form of a reply to
the original sender of the message.
 The noise can interfere in any part of the process that
may affect to the interpretation of a message.
Therefore, all possible measures are to be taken to
prevent the occurrence of any noise in order to make
a communication effective.
MODELS OF COMMUNICATION
 A communication model is a pictorial representation
of the communication process, ideas, thoughts, or
concepts through diagrams, etc.
 They can be considered to be systematic
representations of the process that help us understand
how communication can be carried out.
 Communication models help in understanding the
potential barriers to effective communication, roles of
different elements involved, and the importance of
feedback for successful communication.
 By applying the models of communication, individuals
& organizations can enhance their communication
skills & improve the interaction quality.
TRANSMISSION MODEL OF COMMMUNICATION
 describes communication as a linear, one-way
process in which a sender intentionally transmits a
message to a receiver.
 This model focuses on the sender and the
message within a communication encounter.
 Although the receiver is included in the model, this role
is viewed as more of a target or end point rather than
part of an ongoing process. In this case, one presumes
that the receiver either successfully receives and
understands the message or does not. As such, this
model is not representative of effective
communication for how messages are received.
 Because this model is sender- and message-
focused, responsibility is put on the sender to help
ensure the message is successfully conveyed. This
model emphasizes clarity and effectiveness, but it also
acknowledges that there are barriers to effectively
sending communication.
 Even if a speaker sends a clear message, noise may
interfere with a message being accurately received
and decoded. The Transmission Model of
communication accounts for environmental and
semantic noise.
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to have an emotionally laden discussion with a client

in a room where the beds are only separated by
curtains. You may be assessing a client in the
community where the lighting is dim. Whether it’s the
size of the room, the temperature, or other
environmental factors, it’s important to consider the
role that physical context plays in communication.
The physical environment sets the stage for how well
messages can be sent and received.

PSYCHOLOGICAL CONTEXT
 includes the mental and emotional factors in a
communication encounter.
 EX. Stress, anxiety, and emotions are just some
INTERACTION OF MODEL OF COMMUNICATION examples of psychological influences that can affect
 describes communication as a process in which communication. Now, think about the emotions you
participants alternate positions as sender and bring to a conversation. I
receiver and generate meaning by sending  f you're happy, your messages might be more
messages and receiving feedback within physical positive. If you're stressed, your tone might change.
and psychological contexts. The psychological context in the Interaction Model is
 incorporates feedback, which makes like the emotional backdrop. It recognizes that how
communication a more interactive, two-way you feel and the emotions you bring to the
process. interaction can significantly impact the
 The Interaction Model of communication is more communication process. Your mood, past
interaction-focused. In this model, communication experiences, and mental state shape the tone and
isn’t judged as effective or ineffective based on interpretation of your messages.
whether or not a single message was successfully
transmitted and received. In fact, this model TRANSACTION MODEL COMMUNICATION
acknowledges that because so many messages may  Transactional communication models view
be sent at one time, many of them may not even be communication as a transaction.
received. Some messages are also unintentionally  Meaning that it is a cooperative process in
sent. Thus, the model acknowledges that which communicators co-create the process of
communication is nuanced and complex. communication, thereby influencing its outcome
and effectiveness. In other words, communicators
create shared meaning in a dynamic process.
 describes communication as a process in which
communicators generate social realities within
social, relational, and cultural contexts.
 Aside from that, transactional models show that we
do not just exchange information during our
interactions, but create relationships, form cross-
cultural bonds, and shape our opinions. In other
words, communication helps us establish our realities.
 In this model, nurses don’t just communicate to
exchange messages; they communicate to:
 Create relationships.
 Form intercultural alliances.
 The Interaction Model depicts communication as a  Shape self-concept.
dynamic and interactive process, influenced by  Engage with others in dialogue to create
various factors such as encoding, decoding, communities.
feedback, noise, context, and individual  Transaction Model suggests that you
experiences. It recognizes that communication is not are simultaneously a sender and receiver.
a simple linear exchange but a continuous,
multidimensional interaction.

PHYSICAL CONTEXT
 Includes the environmental factors in a
communication encounter. The size, layout,
temperature, and lighting of a space influence your
communication.
 EX. Imagine the different physical contexts in which
the nurse-client encounter takes place and how this
can affect communication. You may be attempting

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 The Transaction Model also includes a THERAPEUTIC COMMUNICATION
more complete understanding of context. It Presents
communication as a more complex, non-linear, and
continuous process, emphasizing the co-creation of
meaning through simultaneous encoding, decoding,
and mutual influence. It Acknowledges a broader
view of context, encompassing both physical and
psychological elements, and emphasizes how social,
relational, and cultural contexts frame and influence
communication encounters.
SOCIAL CONTEXT
 refers to the stated rules or unstated norms that guide
communication.
 refers to the broader societal influences that shape
individuals' perspectives and behaviors. It includes
shared norms, values, and expectations within a
community or society.
 Ex. Being truthful during your conversations, being
patient and encouraging the client to speak,
demonstrating empathy.
 Social context influences how people perceive
various aspects of life, including healthcare. For
instance, societal attitudes towards health, illness,
and medical practices contribute to the social
context in a healthcare setting.
 As you are socialized into the nursing profession, you
learn rules and norms for communicating, which are
often referred to as communication strategies and
principles. Some common rules that influence social
contexts in nursing include being truthful during your
conversations, being patient and encouraging the
client to speak, demonstrating empathy, speaking
clearly, making eye contact, and so on.
RELATIONAL CONTEXT
 includes the previous interpersonal history and type
of relationship you have with a person. It considers
the roles and communication patterns within a
specific relationship, such as family, friends, or
colleagues.
 EX. In a healthcare setting, understanding the
relational context is essential as patients often involve
family members or close friends in their care
decisions. The dynamics between the patient and
their support system impact the healthcare.
CULTURAL CONTEXT
 includes various aspects of identity such as gender,
ethnicity, sexual orientation, class, and ability.
 Cultural context involves the shared values, beliefs,
traditions, and practices of a particular cultural
group. It encompasses the way people from a
specific culture perceive health, illness, and
healthcare.
 Cultural context significantly influences
communication styles, preferences for medical
treatment, and attitudes toward healthcare
providers. Recognizing and respecting cultural
context is crucial for providing culturally competent
and patient-centered care.
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 Foundation of the nurse-client relationship.
 It is different than the conversations you have with
friends, peers, family, and colleagues.
 Therapeutic communication has a specific
purpose within the healthcare context.
 It is intended to develop an effective interpersonal
nurse-client relationship that supports the client’s
wellbeing and ensures holistic, client-centred, quality
care.
 The word “therapeutic” is related to the word therapy:
it means having a restorative and healing effect on
the mind and body as well as doing no harm.
 It is important to consider how you communicate and
how this affects the client. Therapeutic
communication is a learned activity that requires
knowledge and continued practice and self-
reflection.
 Therapeutic communication in nursing consists of an
exchange between patient and nurse using verbal
and non-verbal cues.
 At the same time, they also encourage patients to
freely express their ideas and feelings in a relationship
of mutual respect and acceptance.
 It’s a process in which the healthcare professional
consciously uses specific techniques to help patients
better understand their condition or situation.
 The main goal of this communication style is to help
patients get through emotional and/or psychological
distress. Thus, it’s an invaluable approach to patient
interactions, making it one of the most important tools
in a nurse’s toolbox.
 The concept of therapeutic communication is by no
means a new one. Its benefits have been
acknowledged for centuries. In the late 1800s,
Florence Nightingale was one of the first to endorse
the importance of communication that develops
between nurse and the patient. In more recent times,
multiple studies have corroborated the importance
of the practice.
THERAPEUTIC COMMUNICATION TECHNIQUES
ACTIVE LISTENING
 We communicate both verbally and nonverballythat
we are interested in what the other person is saying
while also actively verifying our understanding with
them.
 For example, an active listening technique is to
restate what the person said and then verify our
understanding is correct. This feedback process is the
major difference between passive listening and
active listening
 SOLER is a mnemonic for establishing good nonverbal
communication with clients.
 S: Sitting and squarely facing the client
 O: Using open posture (i.e., avoid crossing arms)
 L: Leaning towards the client to indicate interest in
listening
 E: Maintaining good eye contact
 R: Maintaining a relaxed posture
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2. TOUCH
 Professional touch is a powerful way to communicate
caring and empathy if done respectfully while also
being aware of the client’s preferences, cultural
beliefs, and personal boundaries.
 Ex. Holding a patient’s hand during a painful
procedure
 For individuals with a history of trauma, touch can be
negatively perceived, so it is important to ask
permission before touching. Inform the person before
engaging in medical procedures requiring touch
such as, “I need to hold down your arm so I can draw
blood.”
ACCEPTANCE
 Acceptance acknowledges a client’s emotions or
message and affirms they have been heard.
Acceptance isn’t necessarily the same thing as
agreement; it can be enough to simply make eye
contact and say, “I hear what you are saying.”
EMPATHY
 Nurses express empathy by understanding and
sharing in the feelings of the patient. This helps create
a supportive environment and fosters a connection
between the healthcare provider and the patient.
OTHER TECHNIQUES
5. USING SILENCE – Allows client to take control of the
discussion, if he or she desire
6.GIVING RECOGNITION– Acknowledging, indicating
awareness
7.OFFERING SELF– Making oneself available
8. OPEN-ENDED QUESTIONS– Allows clients to select the
topic
9.MAKING OBSERVATIONS– Verbalizing what is
observed or perceived
10.SEEKING CLARIFICATION– Asking patients for
clarification when they say something confusing or
ambiguous
11.PLACING THE EVENT IN TIME OR SEQUENCE– Clarifies
the relationship of events in time
12. ENCOURAGING DESCRIPTIONS OF PERCEPTION–
Asking client to verbalize what is being perceived.
13. ENCOURAGING COMPARISONS- ENCOURAGING
them to make comparisons to situations they have
coped with before
14.RESTATING- Let client know whether an expressed
statement has or has not been understood.
15. REFLECTING- Directs questions or feelings back to
client so that they may be recognized and accepted.
16. FOCUSING- Taking notice of a single idea or even
single word
17. EXPLORING- Delving further into a subject, idea,
experience, or relationship.
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BACKGROUND
 Relationship can be defined as an interpersonal
process in which one person facilitates the personal
development or growth of another. The process
takes place over a period of time. It involves helping
the other person to mature, more adaptive, more
integrated and to open his or her own experience; or
to find meaning in his/her present situation.
HELPING RELATIONSHIP
 It refers to the relationship between a healthcare
professional and a client (or patient).
 It is an interaction process in which the nurse fulfills
his/her role by using professional knowledge and skill
in such a way that is able to help the patient
physically, socially and emotionally.
 It is an interaction process between two persons in
which nurse offers a series of purposeful activities and
practices that are useful to particular patient.
 A helping relationship is a supportive interaction that
moves a patient toward wellness. It's based on
rapport, trust, unconditional positive regard,
empathy, goal formulation, and humor.
PHASES OF HELPING RELATIONSHIP
PRE-INTERACTION PHASE
 Is a phase which a nurse goes through before actual
interaction with the patient. It begins when the nurse
is assigned a patient to develop therapeutic
relationship with the patient till the nurse goes to
patient for interaction. This involves preparation for
first encounter with the client.
 Tasks of pre-interaction phase is to obtain available
information about the client from his or her charts,
significant others or other health team members.
From this information the initial assessment are begun.
This initial information may also allow the nurse to
become aware of personal response to the
knowledge about the client.
INTRODUCTORY/ORIENTATION PHASE
 Begins when the nurse goes to the patient and
introduces himself/herself. The nurse and client get
acquainted (know someone slightly.). The orientation
phase ends when the nurse and he patient begin to
accept each other as a unique human being.
 Tasks of introductory or orientation phase is to
(1)Establishment of Contact (2)Nurse introducing
himself/herself to the patient(3)Build trust and rapport
by demonstrating acceptance and (4)Establishing a
therapeutic environment ensuring safety and
privacy.
WORKING PHASE
 Working Phase starts when the nurse and the patient
are able to overcome the barriers of orientation and
introductory phase. During this phase the nurse and
the patient actively work on meeting the goals which
they had establish during the orientation phase. The
characteristic feature of this phase is that the nurse is
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able to overcome anxiety and the patient’s fear of
unknown is also decreased.
 This phase helps the nurse to develop knowledge and
skill in nursing. Identifies strengths and weakness as a
nurse while interacting with patient. It enables the
nurse to achieve the goals which they have plan for
this phase. The end results lead the patient to
verbalize, socialize, identify and faces the problems
realistically.
TERMINATION PHASE
 The final step of the therapeutic relationship is the
termination phase. The nurse terminates the
relationship when they mutually agreed: the goals
are reached.
 The task of this phase is to bring a therapeutic end to
the relationship, review feelings about relationship,
evaluate progress towards goal, establish
mechanisms for meeting future therapy needs, and
summarize entire communication and follow up
treatments.
SUMMARY
 The helping relationship results from a series of
interactions between a nurse and patient over a
period of time. The nurse will focus on the needs and
problems of the person or family while using the
scientific knowledge and specific skills of the
profession. This helping relationship develops through
interest in, encounter with and commitment to the
person.
COMMUNICATION AND THE NURSING PROCESS
 Communication in nursing are often unseen and
undervalued. Nurse communication is just as much
an art as a science, where the art involves
establishing a human connection with the patient or
care team. In contrast, the science relates to the tool
and technology that facilitates connections.
 Communication is not only verbal; it can happen
without words and is an ongoing process. Non-verbal
communication includes facial expressions,
gestures, posture, and physical barriers, such as
distance.
 Nurses must analyze patient communication during
stressful situations and understand non-verbal cues to
ensure patient safety.
 Additionally, nurses must understand that no two
people communicate in exactly the same manner.
 Listening is vital in communication
 Listening lets a nurse assess a situation to formulate a
response for care.
BENEFITS OF EFFECTIVE COMMUNICATION IN
NURSING
 Immediate understanding of a patient’s condition
and needs
 Understanding the emotional state of patients
 Understanding the social determinants of health
 Tracking changes in care
 Identifying specialized needs
 Advocating for patients
NURSING PROCESS
 The nursing process is defined as a systematic,
rational method of planning that guides all
nursing actions in delivering holistic and
patient-focused care.
 The nursing process is a form of scientific
reasoning and requires the nurse’s critical
thinking to provide the best care possible to the
client.
NURSING PROCESS STEPS

 Communication in nursing defines as exchanging

information, thoughts, and feelings among people
using speech or other means.
 For example, the patient conveys their fears and
concerns to their nurse to help them make a correct
diagnosis. Thus, the benefits of nurses being able to
communicate effectively are very critical.
 Effective communication in nursing require an
understanding of the patient and the experiences
they express. This communication requires skills and
simultaneously the sincere intention of the nurse to
understand what concerns the patient.
 We as future nurses, must understand the patient’s
needs and convey the patient’s communicated
message back. It is a reflection of the knowledge of
the participants, the way they think and feel, and  The nursing process consists of five steps: assessment,
their capabilities. diagnosis, planning, implementation, and
 Likewise, (patient) communication can sometimes evaluation. ADPIE
be undirectional and the failure of nurses to  The acronym ADPIE is an easy way to remember
recognize two-way communication can lead to the components of the nursing process.
negative conclusions and attitudes.

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 The steps of the nursing process are not separate

entities but overlapping, continuing sub-
processes.
 The steps of the nursing process are:
 Assessment: “What data is collected?”
 Diagnosis: “What is the problem?”
 Planning: “How to manage the problem?”
 Implementation: “Putting the plan into action!”
 Evaluation: “Did the plan work?”
 When/If nurses communicate well, they can
gather essential data during the assessment
phase, understand the patient's perspective,
and build trust. Diagnosis are thoroughly
examined if the nurses communicate well with
the other healthcare professionals. In the
planning phase, clear communication helps in
developing personalized care plans that align
with the patient's goals and preferences. During
implementation, effective communication
ensures that treatments and interventions are
carried out correctly. In the evaluation phase,
feedback from patients, which is a form of
communication, helps nurses assess the
effectiveness of care and make adjustments as
needed.

COMMUNICATION AND THE NURSING PROCESS:

RELATION
 In nursing practice, communication is like the glue
that holds everything together. It's the key to a
successful and effective nursing process.
 Imagine a nurse trying to understand a patient's
needs or explaining a treatment plan without clear
communication – it would be like trying to solve a
puzzle with missing pieces.
 Communication is the bridge that connects nurses
and patients, enabling the exchange of crucial
information about symptoms, concerns, and
treatment options.
 Communication is woven into every step of the
nursing process, making it an indispensable tool for
providing quality and patient-centered care.
Communication plays a crucial role in the nursing
process by helping nurses understand and address
the needs of their patients.
 Good communication allows nurses to gather
important information about symptoms, medical
history, and how patients are feeling. It helps the
nurse get to know the patient better.
 As the nursing process moves forward,
communication remains essential. From the first
conversation with a patient to the ongoing
discussions about their care, communication is like a
helping hand that guides nurses through each step
of the nursing process, making sure patients receive
the best possible care.

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