Fundamentals of Nursing
Modes of Communication
COMMUNICATION & THE NURSING PROCESS
LEARNING OBJECTIVES:
At the end of the discussion, the learners will be able to:
1. Describe the communication process and identify
factors that influence communication
2. Discuss the professional responsibilities when using
electronic communication.
3. Describe the interrelation between communication and
the nursing process.
4. Identify the four phases of the helping relationship.
5. Describe the following disruptive behaviors and how
they affect the healthcare environment and client safety:
incivility, bullying, and workplace violence.
I. THE PROCESS OF COMMUNICATION
A. Communication
- is the process of exchanging information and
generating and transmitting meanings between two or
more people.
- it is the foundation of society and the most primary
aspect of a nurse patient interaction.
- also assists in meeting our psychosocial needs of
love, belonging, and self esteem.
- the ability to communicate is basic to human
functioning and well-being.
B. Communication process
- David K. Berlo (1960) is credited with the classic
description of the communication process, which involves
a source (encoder), message, channel, and receiver.
1. Sender
- the source-encoder
- a person or group who initiates or begins the
communication process.
2. Message
- actual communication product from the source.
- what is said or actually written
- channel of communication is the medium the
sender has selected to send the message.
- the message can be sent to the receiver through
the following channels:
a. Auditory - spoken words or cues
b. Visual - sight, observations, and perception
c. Kinesthetic - touch
- Nurses use all three of these channels to
communicate with patients and other health
providers.
3. Receiver
- the decoder, must translate and interpret the
message sent and received.
- This individual is the decoder, who must
perceive what the sender intended (interpretation).
- to be an effective communicator, the nurse
needs to be considerate of the receiver, and select a
message that appeals to the patient’s interests and that
requires minimal effort and time to decode.
4. Response
- Feedback is the message that the receiver
returns to the sender
C.
- the sending and receiving of messages is
accomplished through verbal and non-verbal
communication techniques.
- These can occur separately or simultaneously.
1. Verbal Communication
- an exchange of information using words,
including both the spoken or written word
- nurses use verbal communication extensively
when providing patient care, including verbal
interactions with patients and family, giving oral
reports to other nurses and health providers,
developing nursing care plans, and evaluating patient
progress.
2. Nonverbal communication
- transmission of information without the use
of words, also known as body language.
- nurses working with patients from diverse
cultural backgrounds should attempt to understand
cultural variations to avoid misunderstanding
nonverbal communication.
- body language may mirror or enhance what
is verbally communicated (gestures, facial
expressions, touch, and other forms)
a. Personal Appearance
- Clothing and adornments can be sources of
information about an individual.
- Although the choice of apparel is highly
personal, it may convey social and financial
status, culture, religion, group association, and
self concept.
- How an individual dresses is often an
indicator of how the individual feels. People
feeling ill often demonstrates little interest in
personal appearance.
b. Posture and Gait
-Posture provides non-verbal clues
concerning pain and physical limitation (e.g.
Rigid, stiff appearance might be a good indicator
of tension or pain).
- 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.
- Gait -manner of walking. Less purposeful,
shuffling gait often means the person is sad or
discouraged.
- certain gaits are associated with illness
(e.g. Shuffling gait - Parkinsons)
c. Facial Expressions
- the face is the most expressive part of the
body. Examples of the various messages facial
expressions convey are anger, joy, suspicion,
sadness, fear, and contempt.
- Nurses need to learn to control their own
facial expressions
d. Gestures
- Hand and body gestures may emphasize
and clarify the spoken word, or they may occur
without words to indicate a feeling or to give a
sign. Gestures using different body parts ( i.e.
Thumbs up, kicking an object - expresses anger,
wringing the hands or tapping foot - usually
indicates anxiety or anger)
 - crying, moaning, gasping, and sighing are
oral but nonverbal forms of communication
3. Electronic Communication
- the internet and a variety of social websites
provide new and challenging opportunities for nurses
to communicate and collaborate with other health
care providers.
- it is always necessary to follow facility policies
and adhere to your professional code of conduct.
- Advantages: fast, efficient; provides record,
can improve communication and continuity of care
- Disadvantages: Risk for violating patient
privacy and confidentiality.
a. Social Media
- allows nurses to share ideas, develop
professional connections, access educational
offerings and forums, receive support, and
investigate evidence based practices
b. E-mail and Text Messages
- efficient means to communicate with staff
members and, in some cases, patients.
D. Levels of Communication
1. Intrapersonal Communication
- self-talk, communication within a person.
This communication is crucial because it affects the
nurse’s behavior and can enhance or detract from
positive interactions with the patient and family.
- Example: Telling yourself, “Calm down, I can
handle this vs “There’s no way I can survive this
experience.”
- intrapersonal communication can help you to
work with patients and families whose negative self
talk affects their health and self-care abilities.
2. Interpersonal Communication
- communication occurs between two or more
people with a goal to exchange messages.
- communicating with patients, family members,
and members of the health care team.
3. Group Communication
- includes small-group and organizational
group communication
a. Small Group
- nurses interact with 2 or more people.
Includes staff meetings, patient care conferences,
teaching sessions, and support groups.
b. Organizational Communication
- people and groups within an organization
communicate to achieve established goals
E. Factors Influencing Communication
1. Development
- patient’s neurologic competence and
cognitive development.
- Nurse must understand language development and
the stages of intellectual and psychosocial development.
2. Gender / Biological Sex
- Men and women often have differing
communication styles and may give different
interpretations to the same conversation.
3. Values and Perceptions
- Values are the standards that influence behavior,
- Perceptions are the personal view of an event .
- It is important for the nurse to be aware of a client’s
values and to validate or correct perceptions to avoid
creating barriers in the nurse–client relationship.
4. Personal Space
- Personal space is the distance people prefer in
interactions with others.
- Proxemics is the study of distances that people
allow between themselves and objects or other people
- actual physical difference between the nurse and
patient during interaction is important.
a. Intimate ( 1 to 1 1/2 feet/18 inches) -
interaction between parents and children or people
who desire close personal contact.
b. Personal (18 inches to 4 feet) - distance
between close friends
c. Social ( 4 to 12 feet) - acquaintances such as in
work or social setting
d. Public (12 feet and beyond) - when speaking
to an audience or small groups.
5. Territoriality
- is a concept of the space and things that an
individual considers as belonging to the self.
- Nurses need to obtain permission from clients to
remove, rearrange, or borrow objects in their hospital area.
. 6. Roles and Responsibilities
- The roles and the relationships between the sender
and receiver affect the communication process.
- stereotyping a patient according to occupation, can
be misleading and should be avoided.
7. Environment
- People usually communicate most effectively in a
comfortable environment.
- Temperature extremes, excessive noise, and a
poorly ventilated environment can all interfere with
communication.
- Environment most conducive to communication is
one that is calm and nonthreatening.
8. Congruence
- In congruent communication, the verbal and
nonverbal aspects of the message match. Clients more
readily trust the nurse when they perceive the nurse’s
communication as congruent.
- Nurses are taught to assess clients, but clients are
often just as adept at reading a nurse’s expression or body
language.
9. Interpersonal Attitudes
- Attitudes are communicated convincingly and
rapidly to others.
- Attitudes such as caring, warmth, respect, and
acceptance facilitate communication, whereas
condescension, lack of interest, and coldness inhibit
communication.
- Caring conveys deep and genuine concern for the
individual, whereas
- Warmth conveys friendliness and consideration,
shown by acts of smiling and attention to physical
comforts.
 - Respect is an attitude that emphasizes the other
individual’s worth and individuality
- Acceptance emphasizes neither approval nor
disapproval. The nurse willingly receives the client’s
honest feelings. An accepting attitude allows clients to
express personal feelings freely and to be themselves.
II. NURSE-CLIENT RELATIONSHIPS
-Nurse–client relationships are referred to as
Interpersonal relationship, Therapeutic relationship,
Helping relationship.
- a helping relationship between the nurse and patient
sets the climate for participants to move toward common
goals. It is important to remember that helping
relationships are professional relationships.
A. Characteristics of the Helping Relationship
1. Is an intellectual and emotional bond between
the nurse and the client and is focused on the client.
2. Respects the client as an individual, including:
a. Maximizing the client’s abilities to participate
in decisionmaking and treatments
b. Considering ethnic and cultural aspects
c. Considering family relationships and values.
3. Respects client confidentiality.
4. Focuses on the client’s well-being.
5. Is based on mutual trust, respect, and
acceptance.
B. Goals of the Helping Relationship
1. Help clients manage their problems in living more
effectively and develop unused or underused opportunities
more fully.
2. Help clients become better at helping themselves in
their everyday lives.
3. Help clients develop an action-oriented prevention
mentality in their lives.
C. Keys to Helping relationships
1. Development of trust and acceptance
2. Underlying belief that the nurse cares about and
wants to help the client.
III. PHASES OF THE HELPING RELATIONSHIP
A. Preinteraction Phase
- Has information before the first face-to-face
meeting. Name, address, age, medical history, and/or
social history.
- Anxious feelings in the nurse
- Identifies specific information to be discussed.
- Positive outcomes can evolve
B. Orientation Phase
- Sets the tone for rest of relationship. Develop trust
and security. Getting to know each other. Resistive
behaviors may be displayed. Inhibit involvement,
cooperation, or change.
1. roles of the nurse and patient in the relationship
are clarified.
2. Agreement or contract about the relationship is
established.
- Agreement can be simple verbal exchange related to
goals and means of achieving them or occasionally a
written document.
3. The patient is provided with an orientation to
the health facility, its services , admission routines, and
any pertinent information the patient requires to decrease
anxiety.
C. Working phase
- is usually the longest phase of the helping
relationship
- the nurse works together with the patient to meet
the patient’s physical and psychosocial needs. Interaction
is the essence of the working phase. Help client plan a
program of action to meet preestablished goals.
1. Exploring and understanding thoughts and feelings.
- Empathetic listening and responding.
Empathy is the ability to experience, in the present,
a situation as another did at some time in the past.
Once caring develops, empathy increases.
- Respect. The nurse must show respect for the
client’s willingness to be available, a desire to work
with the client, and a manner that conveys the idea of
taking the client’s point of view seriously
- Genuineness. The ability to be real or honest
with another.
- Concreteness. The nurse must assist the client
to be concrete and specific rather than to speak in
generalities.
- Confrontation. The nurse points out
discrepancies between thoughts, feelings, and
actions that inhibit the client’s self-understanding or
exploration of specific areas. This is done
empathetically, not judgmentally.
2. Facilitating and Taking Action
- Client must make decision and take action
- The responsibility belongs to the client
- Nurse collaborates in these decisions, provides
support, may offer options or information.
D. Termination Phase
1. Nurse and client accept feelings of loss
2. Client accepts the end of the relationship without
feelings of anxiety or dependence.
IV. COMMUNICATION & THE NURSING PROCESS
A. Assessing
- the nurse should determine if the patient needs any
assistive devices in order to communicate effectively and
understand communications (e.g. Hearing aid, glasses, etc)
- Identify the patient’s preferred language and secure
an interpreter if one is needed.
1. Determine communication impairments or barriers
2. Communication style
3. Culture may influence when and how client speaks
4. Language varies with age and development
B. Diagnosing
- assessment of the patient may lead to the
development of one or more nursing diagnoses related to
alteration in communication.
1. Impaired verbal communication
2. Anxiety
3. Powerlessness
4. Situational Low Self-Esteem
5. Social Isolation
6. Impaired Social Interaction
C. Outcome Identification and Planning
- planning step requires communication among the
patient, nurse, and other team members as mutually agreed
upon outcomes are developed and interventions are
determined.
1. Determine outcomes
2. Plan ways to promote effective communication
 3. Impaired Verbal Communication
- Outcome is to reduce or resolve the factors
impairing the communication
4. Specific nursing interventions planned for the
stated etiology
D. Implementing
- Verbal and nonverbal communication methods
enhance basic caregiving measures and are used to teach,
counsel, and support patients and their families during the
implementation phase.
1. Manipulate the environment
2. Provide support
3. Employ measures to enhance communication
4. Educate the client and support person
E. Evaluating
-Nurses rely on verbal and nonverbal cues form the
patients to verify whether patient objectives or goals have
been achieved.
1. Client Communication
- Listen actively
- Observe nonverbal cues
2. Use therapeutic communication skills
3. Nurse Communication
4. Use of process recording
a. A verbatim account of a conversation
b. Analyzed in content and meaning of
interaction
V. COMMUNICATION AMONG HEALTH
PROFESSIONALS
-Effective communication among the health
professions is as important as the promotion of therapeutic
communication between the nurse and the client.
- Communication problems cause most of the client
errors.
A. Disruptive Behaviors
1. Incivility.
- Incivility consists of behaviors that are disrespectful,
rude, impolite, and promote conflict while increasing
stress. Examples include, but are not limited to, rolling of
the eyes, gossiping, spreading rumors, name calling, using
a condescending tone, sarcastic comments, interrupting
others when they are speaking, and using public criticism.
2. Bullying.
- “repeated, health-harming mistreatment of one or
more persons by one or more perpetrators” (The Joint
Commission, 2016, para 2).
3. Workplace Violence.
- The Occupational Safety and Health Administration
(OSHA) defines workplace violence as “any act or threat
of physical violence, harassment, intimidation, or other
threatening disruptive behavior that occurs at the work
site.
- It ranges from threats and verbal abuse to physical
assaults and even homicide” (OSHA, n.d., para 1)
- There are four types of violence that nurses may
come upon in the work setting, with types 2 and 3 being
the most common in healthcare:
a. Criminal intent. The perpetrator has no
relationship with the victim, and the violence is
carried out in conjunction with a crime.
b. Customer or client. This is the most common
healthcare environment–based assault, in which the
perpetrator is a member of the public with whom the
nurse is interacting during the course of the nurse’s
regular duties.
c. worker-on-worker. Commonly perceived as
bullying, in these instances, the perpetrator and
victim work together, although not necessarily in the
same role or at the same level.
d. Personal relationship. In these incidents, the
victim has been targeted as a result of an existing
exterior relationship with the perpetrator, with the
violence taking place in the workplace (ANA, n.d.;
ANA, 2017).
B. Nurse and Physician Communication
- There are guidelines for written documentation and
for nurses communicating with clients.
- However, few guidelines exist for the frequent
verbal communication that occurs between nurses and
physicians. This lack of guidelines or format may
contribute to medical errors because of communication
problems.
1. Communication Styles
- Nurses are descriptive in verbal and written
- Physicians are brief, to the point, and focused
on a problem.
- The Joint Commission and the Institute for
Healthcare Improvement have mandated that
healthcare organizations improve professional
communication. One model, called SBAR that
provides a standardized framework for
communicating important information.
2. Emotional Intelligence.
- is the ability to form work relationships with
colleagues, display maturity in a variety of situations,
and resolve conflicts while taking into consideration
the emotions of others.
3. Assertive Communication
- Promotes client safety by minimizing
miscommunication with colleagues.
- Honest, direct and appropriate
- Open to ideas
- Respecting the rights of others.
- Use of the “I” statements versus the “you”
statements. “You” statements place blame and put the
listener in a defensive position. “I” statements
encourage discussion.
4. Nonassertive Communication
- Two types of interpersonal behaviors are
considered nonassertive:
a. Passive.
- When people use a passive or submissive
communication style, they say nothing even when
they have been wronged.
b. Aggressive.
- Assertive communication is an open expression
of ideas and opinions while respecting the rights,
opinions, and ideas of others. Aggressive
communication is self-serving in that it is directed
toward what one wants without considering the
feelings of others (Beebe et al., 2019).
VI. REFERENCES
Potter, P., et.al, Fundamentals of Nursing. 10th ed. Elsevier
Inc. 2021
Berman, A., Snyder, S., & Frandsen, G., Kozier & Erbs’s
Fundamentals of Nursing. Perason Education, Inc., 11th ed.
2022
Prepared by: JOHN EMMANUEL C. MAGTIBAY, RN / NCM
103n LEC / 2nd sem , 2023-2024