Communication in nursing

Prepared by: Rumysa Yousuf
PG Pediatric Nursing

INTRODUCTION
• The word communication originates from
‘communis’, a Greek word, meaning ‘to make
common’.
• By communication we try to establish a
“commoness” With others that is we try to share
information, an idea or an attitude.
“Communication is the process of passing
information and Understanding from one
person to another” (Keith Davis. )

DEFINITION
According to Paul Leagens
“Communication is 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 a
message.”

ELEMENTS OR COMPONENTS
OF COMMUNICATION
1. Sender (source)
2. Message (content)
3. Channel (s) (medium)
4. Receiver (audience)
5. Feedback (effect)

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.
• To be effective communicator, sender must know:
– His objectives, clearly defined
– His message
– Channels of communication
– His professional abilities and limitations

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:
 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- decisions which the communication source
makes in selecting, arranging both codes and contents.

A GOOD MESSAGE MUST BE:
 In line with the objectives
 Simple
 Meaningful
 Based on felt needs
 Clear and understandable
 Specific
 and accurate
 Timely and adequate
 Fitting the audience
 Interesting
 Culturally and socially appropriate

. CHANNELS OF
COMMUNICATION
 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
non-verbal, or
• Mass media TV, radio, printed media etc.
• Traditional folk or folk media
 Every channel of communication has its advantages and
limitations.
 The proper selection and use of channels results in successful
communication.

RECEIVER
The receiver is also called the decoder.
Decode means to related the message
perceived to the receiver’s storehouse of
knowledge and experience and to sort out
the meaning of the message.
Who receives messages from the sender,
decoding, interprets the meaning and giving
feedback.

FEEDBACK
It is the flow of information from receiver
to the sender, the reaction to the message.
Those responses likely to be perceive as
rewarding ( smiles or nodes of agreement)
are called positive feedback.
Those perceived punishing ( yawns, signs
of inattention) are called negative feedback.

“SMCR” model ‘S’ stands for Source,
‘M’ stands for Message, ‘C’ is channel
and ‘R’ is Receiver
• .Source: it is sender or encoder who initiate the message. The message may be
verbal or non verbal. The sender needs to have similar communication skills,
attitude, knowledge, understanding level, social system and culture as the receiver
or decorder.
• Message: message should have all the elements properly coded. Content should be
clear form the source of the message or sender to receiver.
• Channel: various channels are used by sender to communicate a message i.e.
seeing , hearing, touching, smelling and tasting.
• Receiver: receiver or decoder is the person who is receiving the message and
interpreting it. To interpret the message correctly the receiver needs to have
similar communication skills, attitude, knowledge, social system and culture as

TYPES or MODE OF
COMMUNICATION
• VERBAL COMMUNICATION
• NON VERBAL COMMUNICATION
• ONE WAY COMMUNICATION
• TWO WAY COMMUNICATION
• FORMAL COMMUNICATION
• VISUAL COMMUNICATION
• TELE COMMUNICATION
• DOWN WARD, UPWARD, DIAGNOAL & HORIZONTAL
COMMUNICATION

VERBAL
COMMUNICATION
 The traditional way of communication by mouth.
 Language is the chief vehicle of communication.
 Verbal communication -Speaking, Listening, Writing, Reading.
 "Effective verbal communication techniques" include
– Clarity and brevity
– Vocabulary
– Denotative and connotative meaning
– Pacing
– Timing and relevance
– Humour
– Verbal communication also involves written words.

NON VERBAL
COMMUNICATION
Communication occur other than words.
Non verbal communication- Gestures,
Facial Expressions, Posture and Gait, Tone
of Voice, Touch, Eye Contact, Body
Position, Physical Appearance

ONE WAY
COMMUNICATION
• One-way Communication (didactic) the flow of
communication is “one-way” from the
communicator to the receiver. Eg. Lecture
method.

ADVANTAGES
• Considerable faster than
two-way communication
• Appears neat and efficient
to an outsider observer.
• Sender is more
psychologically
comfortable
• Plan-fullness, order,
systemization are
associated with.
DISADVANTAGES
• knowledge is imposed
• Learning is authoritative
• Little audience
participation
• No feedback
• Little influence on human
behaviour.

TWO-WAY
COMMUNICATION (Socratic)
• both sender and receiver take part.
• The process of learning is active and
democratic.
• It is more likely to influence behaviour than
one-way communication

FORMAL AND NON-FORAMAL
COMMUNICATION
• Formal communication follows lines of
authority and informal communication don’t
follow the lines of authority e.g: Gossips.
The information channel may be more
active if the formal channel don’t cater to
the information need in any orgranisation.

VISUAL COMMUNICATION
• Visual form of communication is charts,
graphs, pictograms, tables, maps, posters
etc.

TELE COMMUNICATION
• Tele communication is the process of
communication over distance using
electromagnetic instrument designed for the
purpose.
• E.g. T.V., Radio, internet etc. are mass
communication media while telephone, and
telegraphs are known as point-to-point
telecommunication system. With the launching of
satellite, a big explosion of electronic
communication has taken place all over the world.

DOWNWARD
COMMUNICATION
• It is that which flows from top to the
bottom. i.e., from a superior to subordinate
or from the manager to the assistant
manager.
• It refers to directiveness, and other
messages that originate with officials at the
top of the organization and are transmitted
down through the hierarchy to reach the
lowest ranking worker in the chain.
• E.g. orders, policies, procedures etc.

DIAGONAL
COMMUNICATION
• Diagonal communication occurs between
individuals or department that is not on the
same levels of hierarchy.

HORIZONTAL OR LATERAL
COMMUNICATION
• It is one, which takes place direct between
two equals or two subordinates of the same
superior.
• This is sideway communication between
people of the same level in managerial
hierarchy.
•

UPWARD
COMMUNICATION
• It is that which passes from the subordinate
to the Superior.
• It stimulates employees to participate in the
operation of the department or unit,
encourages them to defend the decisions
and support the policies co-operatively
developed with management.

PRINCIPLES OF
COMMUNICATION
• Objective and purpose.
• Appropriate to situation.
• Systematic analysis of the message, i.e., the
idea, the thought to be communicated, so that
one is clear about it.
• Selection and determination of appropriate
language and medium of communication
according to its purpose.

• Organizational climate, including appropriate
timing and physical setting to convey the desired
meaning of the communication.
• Consultation with others for planning of
communication; involves special preparation.
• Credibility.
• Communication programme should make use of
existing facilities to the great extent possible and
should avoid challenging them unnecessarily.

EFFECTIVE
COMMUNICATION
 co-operative process involving two people, sender and a receiver
 Effective Message should convey something of value to the
receiver in the light of his needs and interests.
 It involves both information and understanding.
 It includes all means by which meaning is conveyed from one
person to another.
 The end result of communication understands.
 It is the basis for action and co-operation.
 Its primary purpose is to motivate a response.
 A further attribute of communication is its universality in the
organization.
 It is an integral part of the process of exchange.

Environmental
factors
Attitude
Socio-cultural/
ethnic
background
Interpersonal
perception Past experience
Ability to relate
to others
Knowledge of subject
matter

ATTITUDE
• Attitudes can be described as accepting, caring,
prejudiced, judgmental and open or closed
minded.
• An individual with a negative or closed attitude
may respond with” it won’t work” or “it’s no use
trying’’. Conversely, the individual with a
positive or open-minded attitude may state “why
not try it? We have nothing to lose”.

SOCIO-CULTURAL/ ETHNIC
BACKGROUND
• Various cultures and ethnic groups display
different communication patterns.
• For example, people of French or Italian heritage
often are gregarious and talkative, willing to
share thoughts and feelings.
• People from Southeast Asian countries such
Thailand or Laos, who often are quiet and
reserved, may appear stoic and reluctant to
discuss personal feelings with persons outside
their families

PAST EXPERIENCE
• Previous positive or negative experiences influence
one’s ability to communicate.
• For example, teenagers who have been criticized by
parents whenever attempting to express any feelings
may develop a poor self image and feel their opinions
are not worthwhile.
• As a result, they may avoid interacting with others,
become indecisive when asked to give an opinion, or
agree with others to avoid what they perceive to be
criticism or confrontation.

KNOWLEDGE OF SUBJECT
MATTER
• A person who is well educated or knowledgeable about
certain topics may communicate with others at a high
level of understanding.
• The receiver of the message may unable to comprehend
the message, or consider the sender to be a “know-it-all
expert”.
• As a result of this misperception, the receiver, not
wanting to appear ignorant, may neglect to ask questions
and may not receive the correct information.

ABILITITY TO RELATE TO OTHERS
• Some people are “natural-born talkers” who claim to
have “never met a stranger”.
• Others may possess an intuitive trait that enables them
to say the right thing at the right time and relate well to
people.
• “I feel so comfortable talking with her” “she is so easy
to relate to ,” and “ I could talk to him for hours” are just
a few comments made about people who have the ability
relate well with others.
• Such ability can also be a learned process, the result of
practicing effective communicative skill over time

INTERPERSON PERCEPTION
• Interpersonal perceptions are mental processes
by which intellectual, sensory, and emotional
data re organized logically or meaningfully.
• Satir (1995) warns of looking without seeing,
listening without hearing, touching without
feeling, moving without awareness and speaking
without meaning.
• In other words, inattentiveness, disinterest, or
lack of use of one’s senses during
communication can result in distorted
perceptions of others.

ENVIRONMENTAL FACTORS
• Environmental factors such as time, place, number of
people present, and noise level can influence
communication.
• Timing is important during a conversation. Some
people prefer to “buy time” to handle a situation
involving a personal confrontation. They want time to
think things over or “cool off”.
• The place in which communication occurs, as well as
the number of people present and noise level, has a
definite influence of interactions.

BARRIERS OF
COMMUNICATION
1. PHYSICAL BARRIER
2. PERCEPTUAL BARRIER
3. EMOTIONAL BARRIER
4. CULTURAL BARRIER
5. LAGUAGE BARRIER
6. GENDER BARRIER
7. INTERPERSONAL BARRIER
8. STEREOTYPING BARRIER
9. WRONG CHANNEL
10. LACK OF FEEDBAKC

METHODS OF OVERCOMMING
BARRIERS OR FACILITATING
COMMUNICATION
 Organization of information and objective analysis of situation will
help prevent filtering of information. Written mode of
communication reduces filtration because communication is more
directing in manner. By the judicious of relevant information and
organizing information according to relevance and priority ,we can
prevent information overload.
 There should be proper sitting arrangement
 Ensuring adequate audibility and visibility to overcome physical
barrier.
 Reduction of visual and aural distractions and provision of
conductive environment will help overcome physical barriers.
 Age, education and cultural background are the main factors that
influence the language a person users and the definition he or she

Use of simple language, proper explanation with
adequate examples.
Initiating a healthy interpersonal relationship with the
receiver, creation of a non-threatening atmosphere,
encouragement feedback, calling by name and
motivating the receiver.
Clear understanding of the receiver’s background,
explaining the receiver about the significance of
message and explanation about merits of the proper
comprehension of the message.
Have a positive attitude about communication.
Work at improving communication skills. It takes
knowledge and work. The increased awareness of the
potential for improving communication is the first step
to better communication.

 Include communication as a skill to be evaluated along
with all other skill. Help other people to improve their
communication skills by helping them to understand
their communication problems.
 Make communication goal oriented .
 Approach communication as a creative process rather
than simply part of the chore of working with people.
 Accept the reality of miscommunication and work to
minimize its negative impact.
 Communication maintain qualities of warmth and
friendliness.
 An attitude of acceptance, frankness, respect and lack
of prejudice help to improve the communication.

ESSENTIALS FOR
EFFECTIVE
COMMUNICATION
Think before communicating
Know your objective
Know your audience
Consult
Determine your medium
Tone and content.
Help the receiver
Timing and timeliness:

Check the result
Look for tomorrow
Support with action
Listen
Climate of trust and confidence
Continuing process
Feed back

THERAPEUTIC
COMMUNICATION
Therapeutic communication is an
interpersonal interaction between the nurse
and client during which the nurse focuses
on the client’s specific needs to promote an
effective exchange of information.

PRINICIPLE OF THERAPEUTIC
COMMUNICATION
FOCUS ON PATIENT
USE SELF-DISCLOSURE CAUTIOUSLY AND FOR A PURPOSE.
AVOID SOCIAL RELATIONSHIPS.
MAINTAIN CONFIDENTIALITY.
ASSESS LEVEL OF UNDERSTANDING.
MAINTAIN A NONJUDGMENTAL INTERACTION
GUIDE PATIENT TO REINTERPRET EXPERIENCES RATIONALLY

CHARACTERISTICS OF THE
THERAPEUTIC COMMUNCATION
Establishing a contract for the time, place, and
focus of the nurse-client meetings
Planning conditions for termination at the onset
of an throughout the relationship
Roles and responsibilities should be clearly
defined; the nurse is the professional helper and
facilitator, and the client's needs and problems are
the focus of the relationship
Confidentiality is maintained by:
Sharing information only with professional staff
who have a need to know

Informing the client of all information to be
shared beforehand
Advising the client that information which deals
with harming himself or others will be
communicated to the staff as needed
Therapeutic behaviors by the nurse include:
Self-awareness of thoughts, feelings, and
behaviors
Clarification of personal values
Empathic understanding
Effective communication

Realistic goal setting
Collaborative work with clients
Responsible and ethical practice
Therapeutic use of self is the ability to use one's
personality consciously and with full awareness
in an attempt to establish relatedness and to
structure nursing interventions.
The nurse must possess self-awareness, self-
understanding, and a philosophical belief about
life, death, and the overall human condition.
Values clarification is the process by which an
individual may gain self awareness.

Beliefs are ideas that one holds to be true. Beliefs may
be:
Rational--objective evidence exists to substantiate their
truth
Irrational--an individual hold the idea as true despite
the existence of objective, contradictory evidence
Held on faith--ideas that an individual hold as true for
which no objective evidence exists
Sterotypical--the belief describes a concept in an
oversimplified or undifferentiated manner

Attitudes are frames of reference around which an
individual organizes knowledge about his or her
world.
Attitudes have an emotional component and may
be judgmental, selective, and biased. They may be
positive or negative.
Values are abstract standards, positive, or
negative, that represent an individual's ideal mode
of conduct and ideal goals. They differ from
attitudes and beliefs in that they are action
oriented or action producing.
Attitudes and beliefs become values only when
they have been acted upon. Attitudes and beliefs
flow out of one's set of values.

CONDITON ESSENTIALS FOR
THERAPEUTIC
COMMUNICATION
RAPPORT TRUST RESPECT
GENUINE
NESS
EMPATHY

FACTOR INFLUENCING THE
NURSE PATIENT
RELATIONSHIP
Values, attitude, and beliefs.
Culture or religion
Social status.
Gender
Age or developmental level
Environment
Territoriality
Distance

THERAPEUTIC
COMMUNICATION TECHNIQUES
Using silence
Accepting
Giving recognition
Offering self
Giving broad openings
Offering general leads
Placing the event in time or sequence
Making observations
Encouraging description of perceptions
Encouraging comparison

Restating
Reflecting
Focusing
Exploring
Seeking clarification and validation
Presenting reality
Voicing doubt
Verbalizing the implied
Attempting to translate words into feelings
Formulating a plan of action

PHASES OF THERAPEUTIC
COMMUNICATION
PRE INTERACTION PHASE
ORIENTATION PHASE
WORKING PHASE
TERMINATION PHASE

ROLE OF NURSE
Teacher
Caregiver
Advocate
Parent surrogate

IMPORTANCE OF
COMMUNICATION IN NURSING
• A critical component of nursing practice
• Generate trust between nurse and clients.
• Provides professional satisfaction.
• It is a means for bringing about change, i.e. nurse listens, speaks
and acts to negotiate changes that promotes client’s well-being.
• Is the foundation of the relationship between the nurse and other
members of the health team.
• Helps to promote managerial efficiency.
• Provides basis for leadership action.
• Provides means of co-ordination.

PURPOSES OF COMMUNICATION
IN NURSING SYSTEM
To transfer information between all classes of employees to
have a common understanding among them.
To interpret and adopt policies in the organisation.
To include motivation, co-operation and co-ordination in the
employees.
To improve employer-employee relationships.
To recruit, select, train and develop the personnel in the
organization.
To encourage participation in decision making.
To delegate or decentralize authority.

To boost the group morale of the workers.
To ensure job satisfaction.
To help in the grievance procedure and disciplinary
actions.
To informs the community of the services available
in the organization.
To prepare the personnel and the public for a change
process.
To improve public relation with the government and
other agencies.
To get feedback from the personnel and public for
improvement.
To clarify gossips rumors.

CONCLUSION
• Communication is really an important
aspect of our life.
• Every one communicate with others but for
effective, productive and interesting
communication, proper communication skill
has to be developed.

BIBLIOGRPHY
 Lalitha K.(2007) “ Mental Health And Psychiatric Nursing”, V.M.G Book
House publishers, Bangalore; 152-165.
 Aggarwal JC. Essentials of Educational Technology: Teaching Learning.
Delhi:Vikas publisher; 1996.
 Basavanthappa BT. Nursing Administration. New Delhi:JAYPEE;2005
 Neeraja KP. Textbook of Nursing Education. Delhi: Jaypee Brothers; 2005.
 Park K. Preventive and Social Medicine. 18th ed. Jabalpur: Banarsidas
Bhanot; 2005.
 Kumar KL. Educational Technology. New Delhi: New Age International (P)
Limited; 1996.
 Rajinikanth AM. Essential Communication In Nursing.: Publisher by Jaypee
Brothers (P) Ltd New Delhi ; Edition Ist (2006), Pp 1 to 90

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