Chapter 4 communication

NURSING FOUNDATION
Unit – 4
COMMUNICATION AND NURSE
PATIENT RELATIONSHIP
BSc NURSING1st Year
ASST.PROf.MR.PRAVESH SHUKLA

INTRODUCTION
• Communication is a
dynamic (constant
change) process that
takes place around us all
the time.
• In fact we spend 70% of
our time receiving and
sending messages.

• Communication word derived from
• Latin - commūnicāre,
• meaning "to share"
• It is exchange of ideas, fact, feelings, thoughts,
opinions and information which is vital in
facilitating human interaction through (written
or spoken) words, symbols or actions.

MEANING
• Communication is simply the act of
transferring information from one place to
another/ one person to another person.
• It is imparting or exchanging of information by
speaking, writing, or using some other
medium.

DEFINITION
“Communication is a process in which a
message is transferred from one person to
other person through a suitable media and
the intended message is received and
understood by the receiver.”

Conti..
“A process by which two or more people
exchange ideas, facts, feelings or impressions
in ways that each gains a ‘common
understanding’ of meaning, intent and use of
message” - Paul Leagens.

“Communication is a two way process of sharing
and transmitting ideas, information and
message between two or more individuals.”

PURPOSE OF COMMUNICATION
www.technocratsgroup.edu.in
• To obtain information
• To influence other
• To solve problem
• To inform
• To inquire

PURPOSE OF COMMUNICATION
IN NURSING
• Good communication between nurses and
patients is essential for the successful outcome
of individualized nursing care of each patient.
• To achieve this, however, nurses must
understand and help their patients,
demonstrating courtesy, kindness and sincerity

Conti>>>
• To collect assessment data
• To initiate intervention
• To evaluate outcome of intervention
• To initiate the change which helps in
promoting health
• To improve nurse-patient relationship
• To take measure for preventing legal problems
associated with nursing practice
• To analyze factor affecting health team

IMPORTANT CHARACTERISTICS
OF COMMUNICATION
• It is two way process.
• Communication process happens between or
among two or more parties.
• Communication involves exchange of ideas
,feelings ,information ,thoughts ,and
knowledge.
• Communication involves mutuality of
understanding between sender and receiver
• Communication is a continue process

THE COMMUNICATION PROCESS
• It has the following main components:
1. Sender (source)
2. Message (content)
3. Channel (c) (medium)
4. Receiver (r)(audience)
5. Feedback (effect)

MAJOR DIMENSIONS OF
COMMUNICATION
1. Content (what type of things are
communicated)
2. Source (by whom)
3. Form (in which form)
4. Channel (through which medium)
5. Destination/Receiver (to whom)

1. SENDER
• The sender (communicator) is the originator of
the message.
• Sender formulates, encodes and transmits the
information which he/she wants to
communicate.
• The impact of the message will depend on
sender's communication skill, social status
(authority), knowledge, attitude and prestige in
the community.

2. MESSAGE
• A message is the information/desired
behaviour in physical form which the
communicator transmits to his audience to
receive, understand, accept and act upon.
• The message may be in the form of words,
pictures or signs.
• Components of message are:

CONT>>>>>
• Message code-any group of symbols that can be
structured in a way that is meaningful to same
person,
• eg., language.
• Message content the material in the message
• i.e., selected by the source to express his
purpose.
• Message treatment i.e, decisions which the
communication source makes in selecting,
arranging both codes and contents.

3. CHANNEL
• By channel is implied the “physical bridge” or
the media of communication between sender
and the receiver.
• Channels can be:
• Interpersonal (face to face communication)
may be verbal or nonverbal, or
• Mass media TV, radio, printed media etc.
• Every channel of communication has its
advantages and limitations.

CONT>>>>>
• The proper selection and use of channels
results in successful communication.

4. RECIEVER
• Who receives messages
from the sender,
decoding, interprets the
meaning and giving
feedback.

5. FEEDBACK
• It is the flow of information from receiver to
the sender, the reaction to the message.

TYPES BASED ON
RELATIONSHIP
• FORMAL COMMUNICATION:-
conversation between officials on various
positions.
• ex:nursing superintendent & staff nurse.
• INFORMAL COMMUNICATION:-
conversation between peoples on non official
matter.
• ex:Interaction between two close friends

BASED UPON FLOW
1. Downward
2. Upward
3. Horizontal
4. One way
5. Two way

DOWNWARD COMMUNICATION
• It is the communication
which occur from top to
bottom such as
communication from
superior to subordinate.
• Ex:- from nursing
superintendent to staff
nurses

UPWARD COMMUNICATION
• Communication occurs from bottom to top.It
may be in the form suggestion, complaints,
report etc.
It can be verbal or written form.
1. application for leave.
2. Suggestion from staff nurse to nursing
superintendent for improving the quality care
in hospital.

HORIZONTAL
COMMUNICATION
The communication flows horizontally among
same hierarchical levels.
e.g. Communication among colleague
• Communication among lecturer
• Communication among staff nurses
• Communication among clinical instructors

• ONE WAY COMMUNICATION:-It always
flows in one direction there is no feedback.
• ex: lecturer delivered by teacher in class
room.
• TWO WAY COMMUNICATION:-In
conversation feedback is present.
• ex: group discussion
•

• VISUAL COMMUNICATION:-Message is
conveyed using symbols. ex: displayed posters
or models in the exhibition
• TELECOMMUNICATION
Communicating in distant places with help of
electromagnetic appliances.
Ex: Television,radio,internet etc

• VISUAL COMMUNICATION:-Message is
conveyed using symbols. ex: displayed posters
or models in the exhibition
• TELECOMMUNICATION:-
Communicating in distant places with help of
electromagnetic appliances. Ex:
Television,radio,internet etc
• META COMMUNICATION: This
communication occurs in deeper sense. It
conveys message within a message

MODES OF COMMUNICATION
VERBAL
• Vocabalary
• Pacing
• Dennotative &
cannotative
• Simplicity
• Clarity and brevity
• Timing &relevance
• Adaptability
• Credibility
• Humor
NON-VERBAL
• Physical appearance
• Body language: posture
& gait
• Gasture
• eye contact
• Obseravable autonomic
• Physiology response
• Voice rediated behavior

FACTORS THAT INFLUENCE
COMMUNICATION

Development
It helps in modifying both the message and the
response.
Example: a message to an astronaut requires
modification if sent to either a lay person or a
ten years old child.

Gender
It is male and female develop differently and so
have some difference communicate, even in
adulthood.

Values
The standards (personal, communal and societal)
that influence behavior – therefore, personal
value traits and experiences do influence the
perception of communication and behaviors of
others as well as the response to them.

Perception
Perception is a personal view of any situation,
which in effect, influences the perception and
response to events.

Attitude
Attitude = caring, concern, interest, etc.,
› They are portrayed or betrayed by either good
or bad mood.

Roles
Roles = student/teacher, father-mother/son-
daughter, roles etc.

Relationships
Relationships = this is a similar role as the
teacher/student relationship above.

The environment
The environment = a comfortable surrounding
with controlled temperature, and noise-free, etc.

Congruence
Congruence (agreement or harmony) = this
refers to compatibility of verbal and non-verbal
messages – that they both match and not seen as
giving two or more different messages.

SKILL FOR EFFICTIVE
COMMUNICATION

BARRIERS TO EFFECTIVE
COMMUNICATION
• Abstract Competing demands, lack of privacy,
and background noise are all
potential barriers to effective
communication between nurses and patients.
• Patients' ability to communicate
effectively may also be affected by their
condition, medication, pain and/or anxiety.

1. PHYSICAL BARRIERS
• Physical environment can make a huge
difference in successful communication.
Shouting down a flight of stairs doesn’t exactly
make for great correspondence.
• Similarly, according to Weaver, insufficient
lighting, room size, ambient noise, and lack of
privacy can prevent effective communication
in nursing.

2. PSYCHOLOGICAL BARRIERS
• Obesity, sexuality, disease, and death aren’t
exactly pleasant conversation starters.
• And the anxiety and stress that comes from
addressing sensitive topics can block effective
communication in nursing.

3. SOCIAL BARRIERS
• Gender, education, religion, attitude language
and age all drive human behavior. We can’t
change others’ behavior, let alone the way they
see the world.
Awareness is key. According to “Nurse Perceived
Barriers to Effective Nurse-Client Communication,”
sufficient knowledge of a patient’s culture,
language, and customs can help nurses
communicate clearly and avoid prejudice.

4.ENVIRONMENTAL BARRIERS
The major environmental /
physical barriers are
• Time
• Place
• Space
• Climate and Noise.
• Lake of ventilation
• Lack of light
• Lack of privacy

METHOD OF COMMUNICATION
Definition of Attending Skills › Attending is a
skill that involves the nurse observing client
verbal and nonverbal behaviours as one way of
understanding what clients are experiencing, and
displaying effective nonverbal behaviours to
clients.

Egan (1994) elaborates upon these two major
aspects of attending, which he refers to as
“psychological attending,” and “physical
attending,” respectively.
1. Attending skills
2. Rapport building skills
3. Empathy skills

ATTENDING SKILLS
The attending cluster consist of the following
Skills: ›
• A Posture of Involvement
• Appropriate Body Motion
• Eye Contact
• Creating a Non distracting Environment

Bolton, in his book People Skills (1979),
describes attending as giving all of your physical
attention to another person. ›
• The process of attending, whether you realize
it or not, has a considerable impact on the
quality of communication that goes on
between two people.
For example, by attending you are saying to the
other person "I am interested in what you have
to say", however, a lack of good attending
communicates that "I really don't care about
what you have to say."

The body can be used as a tool to facilitate good
communication.
• This is done through positioning the parts of
the body so that they invite and hold an
interpersonal relation.
• A relaxed alertness expressed by body posture
seems best suited for fostering good
communication

Bolton offers these suggestions to establish a
posture of involvement: ›
• Lean toward the speaker. This will communicate
energy and attentiveness.
• Face the other squarely (i.e., your right shoulder
to the speakers left). This communicates your
involvement.
• It is especially important for you to position
yourself so that you are at eye level with the
speaker if you are seen as a authority figure.
• This will circumnavigate feelings of threat and can
greatly aid in forming an interpersonal
relationship.

• Maintaining an open posture is also important
for fostering interpersonal relatedness. A
closed posture (i.e., crossed arms and or legs)
often communicates coldness and
defensiveness. ›
• You also need to be aware of your proximity to
the speaker. We all have a concept of
"personal space." When those boundaries are
crossed it puts the other on the defensive and
makes them feel uncomfortable. However, to
much distance communicates aloofness and
disconectedness.

Body motion, it's a funny thing!
Have you ever paid attention to what your
hands were doing during the course of a
conversation? Some of us simply shove them in
our pockets or let them hang aimlessly by our
sides.
• Then there are others, like me, who tend to
fling them around as if to place some kind of
emphasis on each word! There is such a thing
as too little and too much.

Body motion is good but it can be over done if
you are not careful.
• The purpose of gesturing when you are
listening is to encourage the speaker to
continue speaking.
• This can most easily be done with a periodic
head nod.
• A good listener moves his or her body in
response to the speaker.

Effective eye contact says that you are visually
attuned to what the speaker is saying.
• Good eye contact involves focusing on the
speakers face and occasionally shifting the focus
to other parts of the body.
• The key is that the other is aware that they have
your attention because your eyes are "on them".
• Good eye contact should seem natural to the
other person. What ever you do, don't "stare
them down." This makes you seem anxious and
sometimes critical of them.

The environment where the communication
takes place is also an important factor in
whether an interpersonal relationship can be
formed.
• It is not always possible to move the
conversation into a private room or office, but
every attempt should be made to reduce the
number of distractions that are present.

In his book, The Skilled Helper (1998), Gerad
Egan offers what he has labelled the Micro Skills
of Attending.
• The are very close to the information presented
above from Bolton's People Skills. ›
• S - face the client squarely
• O- have an open posture
• L- lean into the conversation
• E- eye contact
• R- be relaxed

RAPPORT BUILDING SKILLS
What Is Rapport? ›
1. Rapport forms the basis of meaningful, close
and harmonious relationships between
people.
2. Rapport building relationship

According to researchers when you have a
rapport with someone, you share: ›
• Mutual attentiveness: you're both focused on,
and interested in, what the other person is
saying or doing.
• Positivity: you're both friendly and happy, and
you show care and concern for one another. ›
• Coordination: you feel "in sync" with one
another, so that you share a common
understanding. Your energy levels, tone and
body language are also similar.

How to Build Rapport? ›
• Rapport must be a two-way connection
between people, so it's not something that
you can create by yourself.
• You can, however, learn how to stimulate it by
following these six steps.

1. Check Your Appearance
• First impressions count , and your appearance
should help you to connect with people, not
create a barrier.
• A good rule of thumb is to dress just a little
"better" than the people you're about to meet.
• However, if you arrive and see that you're
overdressed, you can quickly dress down to
suit the situation.

2. Remember the Basics
• Always remember the basics of good
communication
• Be culturally appropriate.
• Smile.
• Relax.
• Remember people's names .
• Hold your head up and maintain a good posture.
• Listen carefully and attentively .
• Don't outstay your welcome.

3. Find Common Ground
• Identifying common ground can help to
establish rapport, so use small talk to find
something that you both share.

4. CREATE SHARED EXPERIENCES
• Rapport can't grow without human interaction,
and a great way to interact is to create new, shared
experiences.
• Shared experiences can be as simple as attending
the same conference session together, or as
complex as cooperating on a new management
process.
• Working collaboratively to define problems,
devise solutions, and design strategies, for
example, can help to bring you and the other
person closer.

5. BE EMPATHIC
• Empathy is about understanding other people by
seeing things from their perspective, and
recognizing their emotions.
• So, to understand and share another person's
perspective, you need to learn what makes him
tick.
• You need to really hear what they say, so that you
can respond intelligently and with curiosity. So,
it's important to be a good listener, and to fine-
tune your emotional intelligence. You can also use
Perceptual Position – a technique for seeing
things from other people's perspectives

6. MIRROR AND MATCH
• Research shows that we prefer people who we
perceive to be just like ourselves.
• Mirroring and matching are techniques for
building rapport by making yourself more like
the other person.

TECHNIQUES TO BUILD
RAPPORT
• Watch the other person's body language ,
including gesture, posture and expression.
• Adopt a similar temperament. If the other
person is introverted or extroverted, shy or
exuberant, you should behave in the same
way.
• Use similar language . If he uses simple, direct
words, then you should, too.

• If he/she speaks in technical language, then
match that style. You can also reiterate key or
favourite words or phrases.
• Match the other person's speech patterns,
such as tone, tempo and volume. For ex, if he
speaks softly and slowly, then lower the
volume and tempo of your voice.

RE-ESTABLISHING RAPPORT
• It takes time to rebuild rapport when it has
been lost. › First, address why you lost rapport
in the first place.
• Be humble and explain honestly and simply
what happened. If you need to apologize , do
so. ›

• Next, focus on ways of repairing any broken
trust. Put in extra work if you need to, and
keep your word.
• Transparency and genuine concern for the
other person's needs will go a long way to
rebuilding trust and re-establishing rapport.

EMPATHY SKILLS
Empathy is the ability to accurately put yourself
"in someone else's shoes"– to understand the
other’s situation, perceptions and feelings from
their point of view – and to be able to
communicate that understanding back to the
other person.

1. Empathy is a critical skill for you to have as a
leader. It contributes to an accurate
understanding of your employees, their
perceptions and concerns.
2. It also enhances your communication skills
because you can sense what others want to
know and if they are getting it from you or
not.

GUIDELINES TO DEVELOP
EMPATHY
1. Experience the major differences among
people.
2. Learn to identify your own feelings – develop
some emotional intelligence.
3. Regularly ask others for their perspectives
and/or feelings regarding a situation.

IMPORTANCE OF
COMMUNICATION IN HEALTH
1. Information
2. Education
3. Motivation
4. Persuasion
5. Counselling
6. Bring peace
7. Reduces stress
8. Health promotion

PATIENT TEACHING
DEFINITION
• Definition of Patient Teaching "The process of
informing a patient about a health matter to
secure informed consent, patient cooperation,
and a high Patient Teaching level of patient
compliance.”

• Patient education is the process by which
health professionals and others, provide
impart information to patients and their
caregivers that will alter their health
behaviours or improve their health status.

• Nurse can perform patient Teaching when it is
required.
• This could be more fruitful if it is planned
properly after the assessment, nurse
understands the clients educational background,
his perception about health , illness, his disease
condition and overall his knowledge.
• Nurse should always be ready for incidental
Health Teaching to the patient depending on the
situation and the need and the incident.

PURPOSES OF PATIENT
TEACHING
The three main purposes of patient education are
1. To maintain and promote health
2. Prevent illness, restore the patient’s health,
3. Teach the patient how to cope with their
condition.

Prerequisites(Preliminary assessment)
of Patient Education
1.Before even starting to educate the patient,
the nurse must always assess the patient to see
what type of environment will be most
beneficial for them and factors that may
interfere.
2. Another component to consider about the
environment is appropriate lighting,
temperature.

3. Along with comfort, it is important to always
asses the patient for any pain before
proceeding.
Pain would interfere with patient’s necessary
level of strength in order to perform learned
skills and distract them from the learning
material.
Also she/he should be well-rested in order to
stay alert and fully engaged in discussions for
maximum learning.

The patient should always be assessed for
coordination and sensory acuity as well in order
for them to perform certain motor skills and
receive and respond to messages being taught.
Lastly, the nurse must take into consideration
their condition and how it may interfere with
the learning process.

IMPORTANCE OF PATIENT TEACHING
• Patient education enables patients to assume
better responsibility for their own health care,
improving patients’ ability to manage acute and
chronic disorders.
• Patient education provides opportunities to
choose healthier lifestyles and practice
preventive medicine.

• • Patient education attracts patients to the
provider and increases patients’ satisfaction
with their care, while at the same time
decreasing the provider’s risk of liability.
• Patient education promotes patient-centered
care and as a result, patients’ active involvement
in their plan of care.
• Patient education increases adherence to
medication and treatment regimens, leading to
a more efficient and cost- effective health care
delivery system.

• Patient education ensures continuity of care
and reduces the complications related to illness
and incidence of disorder/disease.
• • Patient education maximizes the individual’s
independence with home exercise programs and
activities that promote independence in
activities of daily living as well as continuity of
care.

PROCESS OF PATIENT
TEACHING/EDUCATION
• The process of patient teaching refers to the steps
follow to provide teaching and to measure learning.
The steps involved in the teaching-learning process
are:
1. Assessing learning needs
2. Developing learning objectives
3. Planning and implementing patient teaching
4. Evaluating patient learning
5. Documenting patient teaching and learning

1. Assessing the Learning needs:
• Learning needs vary according to the patients
health status every time during his stay in the
hospital and even after the follow up visits.
e.g. • On admission the patient teaching would
include the ??
• Before starting of the treatment patient would
want to know???
• Before the surgery or during any special
treatment or investigation patient must
understand it.

2. Developing learning objectives
• What you want to achieve at the end of the
teaching should reflect in the learning objectives
of the patient.
• Objectives should be achievable and
assessable.
• Mention clearly what is expected form the
patient in relation to his attitude, lifestyle,
understanding etc.

3. Planning and implementing patient teaching
• Always be ready for patient teaching.
• Patient can be more fruitful if it is well planned
and organised.
• Planning is done according to the need of the
patient.
• Environment, Time of the P.T., patients health
status has be taken into consideration.
• Good to take an appointment with the patient and
fix the time of the patient and also tell the
approximate time you are going to require.
•

• Use of charts, flash cards, posters can be
useful.
• Introduce the topic and also don’t forget to tell
the patient and the family that they may stop
you anytime during the patient teaching to
clear their doubt.
• Before ending the patient confirm that client
understood the topic and also whether the
objectives of the patient are achieved.

4. Evaluating the patient teaching
• Check out the P.T. objectives.
• Evaluate the P.T. according to the objectives
met/unmet/needs more time to change the
attitude of the patient.
• Take feed back from the patient, family
members, and other patients if at all they were
attending the P.T.

5. Documenting the Patient
• Document the Patient Teaching, along with the
Topic, Time, patients response and number of
participants who attended the P.T. to avoid the
repetition of the information for the patient and
prevent health care professional from repeated
works.
• It is safe for the nurse because client may admit
some time that he was unaware about the facts
that created harmful situation for him or
others(Oxygenation –safety precautions)

IMPORTANCE OF NON VERBAL
COMMUNICATION IN HEALTH CARE
• The ability to understand and use nonverbal
communication, or body language, is a
powerful tool that can
help healthcare professionals connect with
patients in a positive way and reinforce
mutual understanding and respect.
• Smile and maintain appropriate eye contact,
but do not stare.

NURSE PATIENT RELATIONSHIP
Peplau's theory is of high relevance to the nurse-
client relationship, with one of its major aspects
being that both the nurse and the client become
more knowledgeable and mature over the
course of their relationship.

Hildegard Peplau believed that the relationship
depended on the interaction of the thoughts,
feelings, and actions of each person and that the
patient will experience better health when all
their specific needs are fully considered in the
relationship

DEFINITION
It is interaction process between two persons in
which the nurse offers a series of purposeful
activities and practices that are useful to
particular patient

TYPES OF RELATIONSHIP
1. Social relationship
2. Intimate relationship
3. Therapeutic relationship

SOCIAL RELATIONSHIP
Broadly defined, social relationships refer to the
connections that exist between people who
have recurring interactions that are perceived by
the participants to have personal meaning.

INTIMATE RELATIONSHIP
• An intimate relationship is an
interpersonal relationship that involves
physical or emotional intimacy.
• Although an intimate relationship is
commonly a sexual relationship, it may also
be a non-sexual relationship involving family,
friends, or acquaintances.

THERAPEUTIC RELATIONSHIP
• The therapeutic relationship refers to
the relationship between a healthcare
professional and a client or patient.
• It is the means by which a therapist and a
client hope to engage with each other and
effect beneficial change in the client.

DEVELOPING HELPING
RELATIONSHIP
1. Listen actively
2. Be honest
3. Be genuine
4. Be aware of cultural differences
5. Confidentiality
6. Know yours roles your limitations

PHASES OF HELPING
RELATIONSHIP
1. Preinteraction phase
2. Introductory phase
3. Working phase
4. Termination

THERAPEUTIC COMMUNICATION
• Therapeutic communication is defined as the
face-to-face process of interaction that
focuses on advancing the physical and
emotional well-being of a patient.
• Nurses use therapeutic
communication techniques to provide
education and support to patients, while
maintaining objectivity and professional
distance.

THERAPEUTIC COMMUNICATION
TECHNIQUES
• Offering self
• Broad openings
• Silence
• Open ended comments
• Reflection
• Restating
• exploring
• Recognition
• Focusing
• Directing
• Making observation
• Clarifying

Chapter 4 communication

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