NURSING FOUNDATION

UNIT IV

COMMUNICATION AND NURSE PATIENT RELATIONSHIP

MS.HILDA ROSE MARY

ASST.PROFESSOR
 LEARNING OBJECTIVES

• Describe the five levels of communication and

their uses in nursing.
• Describe the basic elements of communication
process
• Identify the four phases of nurse –patient
helping relationship.
• Discuss techniques of effective
communication
• Identify factors that affect communication.
 CONTENT OVERVIEW

• Introduction
• Definition
• Levels of communication
• Elements of communication
• Communication process model
• Types of communication
• Modes of communication channels of
communication
 INTRODUCTION
• Communication is a process involving the sorting,
selecting, and sending of symbols in such a way to
help the listener perceive and recreate in his/her own
mind the meaning contained in the mind of the
communicator.

• Communication enable us to grow, to learn, to be

aware of ourselves and to adjust to our environment.

• The word “communication” is derived from Latin word

communes' which means common.
DEFINITION

It is a process of giving and receiving

information, a form of interaction or transaction.

PURPOSE

• To transfer information between all classes of

employee to have common understanding
among them.
• To interpret and adopt policies in the
organization
• To induce motivation, cooperation and
coordination
• To improve employer- employee relationships
 CONT….
• To recruit, select, train and develop personnel in
the organization
• To encourage participation in decision making
• To delegate authority
• To ensure job satisfaction
• To improve public relation
• To get the feedback from the personnel
LEVELS OF COMMUNICATION

Intraperson
al
Interper
Small group sonal
LEVELS OF
COMMUNICATI
ON

Public
Electronic
INTRAPERSONAL COMMUNICATION

• It is a communication of internal use of

language or thought
• Nurse use intrapersonal communication to
develop self awareness and a positive self
esteem that enhances appropriate self
expression
INTERPERSONAL COMMUNICATION

• It is one to one interaction between a nurse

and another person that often occurs face to
face
• It is an exchange for information between two
or more people
CONT…

message

sender receiver

feedback
CONT….

• Meaningful interpersonal communication

results in an exchange of ideas, problem
solving, expression of feeling, decision making,
team building and personal growth
SMALL GROUP COMMUNICATION

• It is the interaction that occurs when a small

number of people meet.
• It is usually goal oriented
• It requires understanding of group dynamics
• Nurses work with other disciplines and
participate in patient care conference.
PUBLIC COMMUNICATION

• It is interaction with an audience

• It requires special adaptation in eye contact,
gestures, voice modulation and use of media
materials to communicate messages effectively
ELECTRONIC COMMUNICATION

• It is the use technology to create ongoing

relationships with patients and their health care
team
• Examples: E-mail, social media, text
messaging and electronic health records.
ELEMENTS OF COMMUNICATION

Interpersonal variables

Referent Referent
CHANNEL

SENDER RECEIVER

MESSAGE

FEEDBACK
REFERENT

• Motivates one person to communicate with

another
• In heath care setting:
Sights
Sounds
Sensation
Perception
Ideas
CONT…
• SENDER: It is the person who encodes and
delivers a message.
• The sender puts the message into verbal and
non verbal symbols that the receiver can
understand
• RECEIVER: the person who receives and
decodes the message
 CONT….

• MESSAGE: It is the content of communication.

It contains verbal and non verbal expression of
thoughts and feelings
A good message must be:
Meaningful
Based on needs
Clear
Understandable
Timely and adequate
CONT….
CHANNELS OF COMMUNICATION:

 It is the media of communication between the

sender and receiver
It means sending and receiving messages
through visual, auditory and tactile senses
CONT…

• FEEDBACK:
 It is the message a receiver receives from the
sender
It evaluates whether the receiver understood
the meaning of the senders message
Interpersonal variables are factors within both
the sender and the receiver that influence the
communication.
CONT…

• ENVIRONMENT:
it is the setting for the sender- receiver
interaction.
Noise, temperature, distraction and even lack
of privacy create confusion and discomfort.
 FORMS OF COMMUNICATION

META COMMUNICATION

FORMS OF
COMMUNIC
ATIONS
VERBAL NON-VERBAL
COMMUNICATION COMMUNICATION
VERBAL COMMUNICATION
It uses spoken or written words
• Vocabulary: communication should be done
with use of simple words
• Denotative: words having more than one
meaning
• Conative: Interpretation of the meaning of word
influenced by the thought, feelings or ideas that
people have about the word.
CONT…

• Pacing: Speak slowly and enunciate clearly

• Intonation: tone of voice affects the meaning
of the message
• Clarity: communication is simple, brief and
direct
 NON-VERBAL COMMUNICATION
It includes the five senses and every thing that does
not involve the spoken or written word
Personal appearance
o Physical character
o Facial expression
Posture
Gait
Eye contact
Gestures
Sounds
FACTORS AFFECTING
COMMUNICATION
• Development: Language, psychosocial &
intellectual development
• Gender: Girls- use more language
• Values and Perception
• Personal Space
• Territoriality
• Roles & Relationships
• Environment
• Congruence
• Interpersonal attitudes: caring, warmth, respect
Methods of effective communication
• Attending Skills : Effective attending tells
patient that you are with them and that they can
share with you. It puts you in a position to listen
carefully to what the patient is saying.
• S - sit facing the patient
• O- observe an open posture
• L- lean towards the patient
• E- establish and maintain intermittent eye
contact
• R- relax
CONT…

• Rapport building skills:

It is all about matching ourselves with another
person. Listen to what the other person is saying
and look for shared experiences or
circumstances. Show empathy.
CONT…

• Empathy Skills: Empathic listening involves

attending, observing in such a way that the
counsellor develops an understanding of the
client
Empathy is not sympathy
EFFECTIVE COMMUNICATION

Complete

Clear

Correctness
CONT…

Concise

Consideration

Courtesy
BARRIERS OF COMMUNICATION

Enviro Commu
Physiol
Psycho
nmenta nication
ogicallogical
l process
barrier
barrier
barrierrelated
s s
s barriers

Social Cultural Semantic organization

barriers barriers barriers al barriers
CONT…
Physiological barriers
• Poor retention due to memory problems
• Lack of attention
• Discomfort due to illness
• Poor sensory perception
• Hearing problems
• Poor listening skills
• Information overload
• Gender physiological differences
CONT….
Environmental barriers
• Loud background noise
• Poor lighting
• Uncomfortable setting
• Unhygienic surrounding and bad odour
• Very hot or cool room
• Distance
…sychological barriers
P
• Misconception and misunderstanding
• Distrust and unhappy emotions
• Emotional disturbances such as anger,
jealousy and suspicion
• Prejudice, resentment and antagonism
• Psychotic or neurotic illness
• Worry and emotional disturbances
• Fear, anxiety and confused thinking
 CONT…
Social barriers
• Diffidence in social norms, values and behavior
• Social taboos
• Different social strata
Cultural barriers
• Ethnic, religious and cultural differences
• Cultural traditions, values and behavior
CONT…
Semantic barriers
• Language barrier
• Language jargons
• Faulty language translations
• Individual differences in expression and perception
• Past experiences of an individual
• Failure to listen
CONT…
Organizational barriers
• Organizational policies, rules and regulations
• Technical failure
• Time pressure
• Complexity of organizational structure due to
hierarchy
• Size of the organization
 CONT…

Communication process related barriers

• Unclear and conflicting messages

• Stereotypical approach

• Inappropriate channels

• Lack or poor feedback

HELPING RELATIONSHIPS
It is the foundation of the clinical nursing practice.
In such relations you assume the role of
professional helper and come to know a patient
as an individual who has unique health needs.
PEPLAU’S THEORY OF
INTERPERSONAL RELATIONSHIP
Factors influencing orientation phase

Nurse
Patient
Value NURSE- Values
Cultural race PATIENT
RELATI
Cultural race
Beliefs
ONSHIP Beliefs
Past experiences
Past experiences
Expectations
Expectations
Preconceived ideas
PREINTERACTION PHASE
Before meeting a patient
• Review available data, including the medical
and nursing history
• Talk to other care givers who have information
about the patient.
• Anticipate health concerns or issues that arise
• Identify the location and setting that fosters
comfortable, private interaction
• Plan enough time for initial interaction
ORIENTATION PHASE
When the nurse and the patient meet and get to
know one another
• Set the tone of the relationship by adopting a
warm, empathetic, caring manner
• Closely observe the patient and expect to be
closely observed by the patient
• Assess patient’s health status
• Clarify patient’s and your role
• Let the patient know when to expect the
relationship to be terminated
WORKING PHASE
When the nurse and patient work together to
solve problems and accomplish goals

• Encourage and help patient express feelings

about his or her health
• Help the patient with self exploration
• Take actions to meet the goals set by the
patient.
• Use appropriate self disclosure and
confrontation
TERMINATION PHASE

During the ending of the relationship

• Remind the patient that termination is near
• Evaluate goal achievement with the patient
• Achieve a smooth transition for the patient to
other caregivers as needed
 EFFECTIVE COMMUNICATION WITH
PATIENT
• The nurse must first develop a interpersonal
relationship with the patient
• The nurse must explain each procedure clearly before
she could proceed
• The nurse must educate the patient regarding the
dietary pattern, follow up and home care.
• The nurse must record & report the significant
restrictions, position or alert to any symptoms to the
patient.
• The nurse must be a good listener to patients needs
& wants
• The nurse must empathize with the patient when in
need
• While communicating she should maintain eye
contact with the patient
• The nurse must show non-verbal cues to patient
complaints.
• The nurse should practically consider the patient.
EFFECTIVE COMMUNICATION WITH
FAMILY MEMBERS
• While communicating with the family members
encourage, appreciate and sothen them
• Do not approach them in a negative way
• While communicating be clear, gentle and
precise
• Use gestures of affection lavishly in the
communication
• Be frequent in communication with the family
members
• Rephrase the content of communication
• Allow the family members to express their
feeling
• Acknowledge the family members request
EFFECTIVE COMMUNICATION WITH
TEAM MEMBERS
• Always provide chance for each fellowmen in
the team to speak
• Validate each members point of view
• Ensure whether your team members have
understood the goal of care for the patient
• Define the role and responsibility of every
member in the organization.
• Ask for feedback and suggestions from your team
members
• Organize regular team meetings to understand the
doubts and queries of every team member and
provide solutions accordingly.
• Speaking and constant interaction with each other
always helps in developing a healthy team spirit.
VULNERABLE GROUPS

• Children
• Women
• Physically challenged
• Mentally challenged
• Elderly
 COMMUNICATION WITH CHILDREN
• Introduce yourself and your role to the
child/young person and their parents.
• Work in such a way as to ensure that children’s
and young people’s rights are protected and
asserted.
• communicate directly with children and young
people; listen and respond appropriately to what
they say themselves.
• Be attentive to the needs of children and young
people and make time for interventions – don’t rush.
Be prepared to be flexible and patient.

• Acknowledge the role of siblings, other family

members and friends in the lives of children and
young people and the effect that illness or disability
may have on them.

• Work positively with siblings and friends for the

benefit of the child/young person.
• Act in ways that recognize and acknowledge the
expressed beliefs or choices of children, young
people and their parents – don’t be judgmental.

• Provide information for parents about how they

can meet their personal needs and what is
expected of them in relation to their child’s care

• Build relationships with children and young

people that are based on trust and respect

contd….
• Share information that is required for safe
practice and to safeguard children and young
people in a sensitive and proportionate manner
• Work in partnership with parents (and others
where appropriate) to enable them to be involved
when they wish to in all aspects of the
child/young person’s care through.
• Respect the rights of children and young people
and of their parents within the legal frameworks.
contd….
COMMUNICATION WITH WOMEN
• Introduce yourself to the women
• Build respect & trust between you and the
women
• Maintain a humanized and individualized care
• Develop the social network talk with the women
• Understand the need of the women and
empathize with her
 COMMUNICATION WITH PHYSICALLY
CHALLENGED
• Introduce yourself to the person.
• Look at the person as a person, the same way you
look at nondisabled people.
• Speech intelligibility of a person with a speech
impairment will often improve after you've spent
some time and grown accustomed to their speech
patterns.
• Allow extra response time from someone who has a
speech impairment
• Don't be offended if a person with speech difficulties
is reluctant to participate in conversation.
• If the person with a disability must be seated, you
should try to sit also to maintain the same eye level
• To help hold the attention of a distractible or hyperactive person when
you're trying to communicate, call the person's name frequently or
touch their arm or shoulder.

• If you notice signs of fatigue, anxiety, irritability, or disinterest, take a

break. Don't press on, change activities.

• Focus on the person's individual and unique abilities rather than their

disabilities
COMMUNICATION WITH MENTALLY
CHALLENGED
• Maintain calm and low volume
• Know your patient mental age
• Do not cover or hide your mouth because
listeners will want to watch you as you
pronounce your words.
• Do not mimic how the mentally challenged
speaker pronounces words
• Avoid running words together.
• When possible, opt for simple words instead of ones
that are complex.
• Avoid speech complexity which is beyond your
mentally challenged listener's comprehension level.
• Look them in the eye
COMMUNICATION WITH ELDERLY

• Allow extra time for older patients.

• Avoid distractions.
• Sit face to face.
• Maintain eye contact.
• Listen.
• Speak slowly, clearly and loudly.
• Use short, simple words and sentences.
• Stick to one topic at a time.
• Simplify and write down your instructions.
• Use charts, models and pictures.
• Frequently summarize the most important points.
• Give patients an opportunity to ask questions and
express themselves.
PATIENT TEACHING

It is the information given to the patient about

their diagnosis, prognoses and available
treatments to help them make intelligent,
informed decisions about their health and life
style
PURPOSES

Maintenance and
promotion of health
and illness
prevention

PURPOSES

Coping with
impaired
Restoration
functions of health
INTEGRATING COMMUNICATION WITH
NURSING PROCESS
ROLE OF NURSE IN TEACHING AND
LEARNING PROCESS
• S- Speak up if you have questions or concerns
• Pa- Pay attention to the care you get
• E- Educate yourself about your illness
• A- Ask a trusted family member or friend to be
your advocate
• K- Know which medicine to take and why you
take them
• P- Participate in all decisions about your
treatment
 CONCLUSION
• Communication is a powerful therapeutic tool and
an essential nursing skill that influences others
and achieves positive health outcomes.

• Nurses use interpersonal, transpersonal, small

group and public interaction to achieve positive
changes and health goals
 REFERENCES

• Craven & Hirnle.(2007),Fundamentals of Nursing

(5th ed),Philadelphia ,Lippincott Williams & Wilkins.
• Carol Tylor.(2009),Fundamentals of Nursing(6 th
ed),Philadelphia, Lippincott Williams &Wilkins.
• Kozier.(2004),Fundamentals of nursing Concepts,
Process and Practice(7th ed),USA :Pearson
education.
• Potter &Perry.(2007),Basic nursing Essentials for
practice(6th ed),New Delhi, Elsevier.
THANK
YOU