This document provides an overview of communication and the nurse-patient relationship. It begins with objectives around gaining knowledge of communication purposes, levels, elements, types, and factors influencing effective communication. It then defines communication and discusses its purposes. It outlines various levels of communication including intrapersonal, interpersonal, small group, public, and electronic. It also describes elements, types based on flow and formality, verbal versus nonverbal communication, characteristics, modes, the communication process, and factors influencing communication such as developmental level, gender, sociocultural differences, roles and responsibilities, physical and emotional states, values, and environment.

1. Placement : I Year B.Sc (N)
Subject : Nursing Foundation
Unit : IV
Topic : Communication and Nurse Patient
Relationship
Presented by:
Mr. P. Vethadhas M.Sc (N),
Assistant Professor,
Hindusthan College of Nursing,
Coimbatore.

2. CENTRAL OBJECTIVE
At the end of the class, the students will gain knowledge
regarding the purpose and develop positive attitude and skills
and maintain effective communication with the patient.

3. SPECIFIC OBJECTIVES
The student will be able to,
define communication
enlist the purposes of communication
list down the levels of communication
illustrate about the elements of communication
explain about the types of communication
list out the characteristics of communication
enumerate the modes of communication
explain the process of communication
discuss about the factors influencing and affecting the effective
communication

4. INTRODUCTION
The word communication derived the Latin word
‘communis” which means to share or to participate. It is a two
way process of reaching mutual understanding such as
exchange of information, news, ideas and feelings.
Communication enable us to grow, to learn, to be aware of
ourselves and to adjust to our environment.

5. DEFINITION
“Communication is a process of mutual
exchange of thoughts, feelings, ideas, facts and
emotions”. -Merrihue

6. 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. To recruit, select, train and
develop personnel in the organization
 To encourage participation in decision making
 To delegate authority
 To get the feedback from the personnel
 To ensure job satisfaction
 To improve public relation

7. LEVELS OF COMMUNICATION

8. 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.

9. 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. Meaningful
interpersonal communication results in an exchange of ideas,
problem solving, expression of feeling, decision making,
team building and personal growth .

10. 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.

11. 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

12. 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

13. ELEMENTS OF COMMUNICATION

14. Referent
Motivates one person to communicate with another in heath
care setting:
Sights
Sounds
Sensation
Perception
Ideas

15. 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.

16. Receiver
The person who receives and decodes the
message. The sender puts the message into verbal
and non verbal symbols that the receiver can
understand.

17. 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

18. 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.

19. 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.

20. Environment
It is the setting for the sender- receiver interaction.
Noise, temperature, distraction and even lack of
privacy create confusion and discomfort.

21. TYPES OF COMMUNICATION
1. On the basis of flow of communication:
a. One-way communication:
The flow of communication is one way from the communicator to the
audience. In this type of communication the sender will not get instant return or
feedback from receiver. The familiar example is the lecture method in the
classroom. Drawbacks are:
• Knowledge is imposed
• Learning is authoritative
• Little audience participation
• No feedback
• Does not influence human behavior.

22. cont..,
b. Two-way communication:
In this, both the communicators and the audience take part. The
process of communication is active and democratic. The audience
may raise questions and add their information, ideas and opinions to
the subject. It is more likely to influence behavior than one way
communication.

23. 2. Formal and informal communication
a. Formal communication:
It is officially organized channel of communication and a
delayed communication. It is generally used for all practice
purposes. This type of communication is authoritative, specific and
accurate. The medium of formal communication may be department
meeting, conferences, telephone calls, interviews, circular, etc.

24. cont..,
b. Informal communication:
Gossip circles such as friend’s group and casual groups.
Communication is faster here. The informal channels may be more
active. It follows grape wine route. It does not reach every one,
informal communications are quite fast and spontaneous.

25. 3. Verbal or non verbal communications
a. Verbal communication:
The traditional way of communication is the use of spoken and
written words. Language is the chief vehicle of communication.
Through it, one can interact with other that can be able to pass the
information. The important aspects of verbal communications are as
follows:

26. Vocabulary
Communication is unsuccessful, if sender and receiver cannot
translate each other’s words and phrases and when a nurse cares for
a client who speaks another language, an interpreter may be
necessary.

27. Denotative and connotative
A single word has several meanings. Individuals who use a
common language share the denotative meaning, for example,
baseball has the same meaning for everyone who speaks English.
The connotative meaning is the shade or interpretation of a word’s
meaning influenced by the thoughts, feelings or ideas that people
have about the word.

28. Pacing
Conversation is more successful at an appropriate speed or
pace. A nurse should speak slow enough to enunciate clearly. Pacing
is improved by thinking before speaking.
Adaptability
Spoken messages need to be altered according to the
behavioral cues from the receiver.

29. Clarity and brevity
Effective communication is simple, brief and direct. Clarity is
achieved by speaking slowly, enunciating clearly and repeating
important parts of a message also clarifies communication. Brevity is
achieved by using short sentences and words that expresses an idea
simply and directly.
Credibility
Credibility means worthiness of belief, trustworthiness and
reliability.

30. Timing and relevance
Timing is critical in communication. Even though message is
clear, poor timing can prevents it from being effective. Often the best
time for interaction is when a client expresses an interest in
communication. If messages are relevant to the situation at hand,
they are more effective.

31. b. Non-verbal communication
Communication can occur even without words. Non-verbal
communication is the message transmission through body language
without using words. It includes bodily movements, positive facial
expressions, etc. Silence is also a non-verbal communication. The
aspects of non verbal communication are as follows:

32. Touch and personal space
Touch is important because it provides the person with a sense
of identity, security and control. Holding a crying infant, patting the
crying patient are some examples of touch which the nurses use a
mode of communication.
personal space is the distance maintained by two persons
during interpersonal communication. The space between each other
depends on the culture, ethnicity and nature of the individual. The
nurse must exhibit confidence, respect, privacy and gentle when
involving with this type of communication.

33. Eye contact
Maintaining eye contact during conversation shows respect and
willingness to listen, lack of eye contact may indicate anxiety,
discomfort or lack of confidence in communicating.

34. Facial expressions
The face is the most expressive part of the body. Facial
expressions convey emotions such as surprise, fear, anger, happiness
and sadness. People can be unaware of the messages their
expressions convey during procedure and the client may interpret
them.

35. Posture and gait
Posture and gait are forms of self expressions. The way people
sit, stand and move reflects attitudes, emotions, self concept and
health status.

36. Gestures
Various parts of the body carry numerous messages. Gestures
identifies three functions such as illustrating an idea, expressing an
emotional state and signaling by use of signs, e.g. thumbs up means
victory, where as thumbs down carries a negative connotation.

37. Personal appearance
A nurse learns to develop a general impression of client’s
health and emotional status through appearance and in the same way
clients develop a general expression of the nurse’s professionalism
and care. Personal appearance includes physical characteristics,
facial expressions, manner of dress and grooming. First impressions
are largely based on appreance.

38. Sound
Crying, gasping and moaning are oral but non-verbal forms of
communication. Such sounds can be interpreted in numerous ways,
e.g. a person cries because of sadness or joy.

39. 4. Visual communication
Visual form of communication includes charts, graphs,
pictograms, tables, maps, posters, etc.

40. 5. Telecommunication
It is the process of communication over distance using
electromagnetic instrument designed for the purpose, e.g. TV, radio,
internet, etc. are mass communication media while telephone, telex
or telegraph are known as point-to-point telecommunication system.

41. Characteristics of communication
Purposeful process: It is a purposeful process which involves sources,
message, channels and receiver.
Interactive process: Communication involves interaction. It is imparting or
interchanging thoughts and ideas by speech, writing or signs.
Continuous process: It is a never ending process. It occurs everywhere,
intentionally or unintentionally.
Contextual process: Communication always takes place within a context.
There is an aim or goal of communication.
Based upon punctuation: Nature of relationship depends upon the punctuation
of dialogue between participants. Be precise and exact in communication
approach.

42. MODES OF COMMUNICATION
Face to face communication (direct communication)
Written communication
Non-verbal communication
Electronic communication

43. Face to face communication (direct
communication)
Face to face or oral communication is used between the
sender and receiver to provide information. It is rapid and
clear process of receiving the necessary information. It is
used in both formal and informal meetings.

44. Written communication
In this mode of communication, documentation is used
to send the information to receiver. This is a formal method of
sending the information and mostly used in organizations. It
requires a clear format and clear statements to prevent
misinterpretation of information by the receiver.

45. Non-verbal communication
Facial expression, body movements and gestures are
commonly used under non-verbal communication. It helps to
convey the emotional part of message between sender and
receiver. Subordinates can use gestures to deliver the message
between group.

46. Electronic communication
It is the method of communication by using the
electronic media like telephone, internet, radio and television.
The advantages of electronic communication is that, it covers
a wide area of population. Health education can be given
through mass media and communicated to the public.

47. PROCESS OF COMMUNICATION
“Communication as a process by which
information is exchanged between individual
through a common system of symbols and signs of
behavior’’.
- Webster’s dictionary

48. Cont..,
The process of communication includes SMCR
model,
S – stands for Source
M – Stands for message
C – Stands for channel
R – Stands for receiver

49. SEND
ER
RECEIV
ER
Formulates
Encodes
Transmits
Message Media
Medium Message (feedback)
Transmits
Decodes
Interprets
Via

50. 1. Sender
The sender (encoder) of communication
initiates the message, encodes his thoughts, ideas,
information, etc. into words, pictures, symbols, etc.
and deliver a message to another person. The
message may be verbal or non-verbal.

51. 2. Receiver
The receiver (decoder) decodes the words,
pictures or symbols to understand the thoughts,
ideas, feelings, experiences, etc. of the sender.
Sometimes, messages are misinterpreted, especially
when the receiver is not physically or emotionally
ready to receive the message, e.g. anxiety may cause
an individual to experience an alterations in hearing,
vision or feeling.

52. 3. Channel or medium
Channel or medium is the means used to convey
the message; it may be verbal channels like talks,
lectures, pictures, newspaper, booklets, etc. and non-
verbal channels- like facial expressions, eye
contacts, body postures, gestures, etc. the type of
message, the purposes and the size of the audience
influence the choice of what channel is best suited
for communication.

53. 4. Message
Message should have all the elements properly
coded. It is the stimulus produced by the sender and
responded by the receiver. Effective messages are
complete, concise, organized and expressed in a
manner that the receiver can understand.

54. 5. Feedback
It is the message or answer gives by the receiver in
response to the message sent by the sender correct
feedback ensures that the sender message understood. In
order to known that the communication is effective, the
sender must use clear verbal, non verbal communications
and the receiver must be sensitive and open the message
and clarify the messages so, that it can bring about social
relationship.

55. FACTORS INFLUENCING THE
COMMUNICATION
Many factors influencing the communication. Some of these
are in addition to channels, there are many other variables that
influence communication.

56. Factors Influencing
the
Communication
Developmental
level
Gender
Sociocultural
Differences
Roles and
Responsibilities
Space and
Territoriality
Physical, Mental,
and Emotional
state
Environment
Values

57. Developmental Level
The rate of language development is directly correlated with
the patient’s neurologic competence and cognitive development.
Thus, it is helpful to understand the process of language
development and the stages of intellectual and psychosocial
development. This helps you communicate effectively with
patients and family of all age ranges.

58. Gender
Men and Women have differing communication styles and might
give different interpretations to the same conversation. It is
necessary to be sensitive to the fact that men and
women might communicate differently. As such, when
working with patients of the opposite gender, you’ll need to
validate that both you and your patient are accurately receiv-
ing the message the other is trying to communicate.

59. Sociocultural Differences
Nurses need to develop skills in recognizing the ways in
which culture, economic condition, and overall lifestyle
influence a patient’s preferred mode of communicating. This
helps in understanding what the patient understands.
Culture refers to the common lifestyles, languages, behav-
ior patterns, traditions, and beliefs that are learned and passed
from one generation to the next.

60. Roles and Responsibilities
A person’s occupation might give the nurse a general suppo-
sition of his or her abilities, talents, interests, and economic
status. Stereotyping a person according to occupation, how-
ever, can be misleading and should be avoided. This can be
particularly dangerous when nurses assume that patients who
are healthcare professionals know everything about their con-
dition and need little nursing assistance, teaching, and coun-
seling. The challenge in the provision of care is to respect the
patient’s roles and responsibilities, especially because these
influence their preferred manner of communicating, without
denying the patient needed care.

61. Space and Territoriality
Individuals are most comfortable in areas they consider their
own. We generally feel relief when we come home, take our
shoes and professional’s clothes off, and relax. This urge to
maintain an exclusive right to certain space is termed territo-
riality. You might have already noticed that patients behave
differently when being interviewed in their homes, at a health
fair in the mall, or in an institutional setting.

62. Physical, Mental, and Emotional State
The degree to which people are physically comfortable and
mentally and emotionally free to engage in interactions also
influences communication. A full bladder, a dull headache,
crushing chest pain, anxiety about a pending diagnosis, or
concern about what is happening at home or at work, and fear
can all negatively influence communication. For example, a
patient who thinks that a nurse wants to hurt him or her will be
difficult to interview. It is important to develop sensitivity to the
physical, mental, and emotional barriers to effective
communication.

63. Values
Communication is influenced by the way people value them
selves, one another, and the purpose of any human interaction.
Nurses who believe that teaching is an important aspect of nursing
and who value empowering patients will communicate this to
patients. Conversely, a nurse who believes teaching is an
unimportant chore is unlikely to be an effective teacher. Similarly,
the patient’s motivation (or lack of motivation) to develop new self-
care behaviors cannot help but influence nurse–patient
communication.

64. Environment
Communication happens best when the environment facili-
tates an easy exchange of needed information. The environ-
ment most conducive to communication is one that is calm
and nonthreatening. The goal is to minimize distractions and
ensure privacy. The use of music, art, and interior design
decorations might assist in placing the patient at ease.

65. FACTORS AFFECTING COMMUNICATION
The various factors which affects communication process are:
Attitude
Sociocultural background
Past experience
Knowledge
Interpersonal Perception
Environmental Factors
Physiological Factors
Psychosocial Factors
Medication/ Drugs

66. Factors
Affecting
Communi-
cation
Sociocultural
background
Past experience
Knowledge
Interpersonal
Perception
Environmental
Factors
Physiological
Factors
Psychosocial
Factors
Medication/ Drugs
Attitude

67. Attitude
Attitude refers to the internal predisposition of a
person to act in a certain way towards a situation. The
attitude of person influences the communication. A person
with negative attitude may not response adequately to
question, on the other hand; a person with positive
attitude will help and try to solve the problem.

68. Sociocultural background
Culture plays a significant role in patient’s
psychosocial well being, so for effective therapeutic
relationship, a nurse should seek information
regarding cultural practices and beliefs of the patient.

69. Past experience
Previous experiences influence one’s ability to
communicate, for example, a person who has been
criticized by family or friends whenever attempting to
express feelings may develop a poor self image as a
result may avoid interaction with other people.

70. Knowledge
A person who is well educated or knowledgeable
about certain topics may communicate with others at
a high level of understanding. The receiver who is
relatively less knowledgeable of topic under
discussion may be unable to comprehend the message
or consider the sender to be an expert.

71. Interpersonal perception
Interpersonal perceptions are mental processes
by which intellectual, sensory and emotional data are
reorganized logically and meaningfully, which
determine how we perceive others. Inattentiveness,
disinterest or lack of use of one’s senses during
communication can result in distorted perception of
the other.

72. Environmental factors
Environmental factors such as time, place,
number of people present and noise level can
influence the communication between people in those
particular surroundings.

73. Physiological factors
Physiological factors can interfere with
communication, example, pain is experienced by
patient, so all his energy is focused on coping with
the pain and it is difficult for him to communicate
about anything.

74. Psychosocial factors
The client with anxiety, fear, loss and grief make
client emotionally disturbed, which can alter the
process of communication. Certain mental diseases
like depression, schizophrenia and mania, the client
has flights of ideas and disturbed thought process
which can alter the verbal communication.

75. Medication/ drugs
Certain drugs like alcohol sedatives,
antidepressants, anesthetics, opiates and neuroleptics
can alter the consciousness of patient which can also
cause verbal speech impartment or a heavily sedated
person may not send or respond to the messages.

76. SUMMARY
So far we discussed about the definition , the
purpose, elements , level, and the forms of
communication as well the factors influencing and
factors affecting communication.

77. CONCLUSION
Success in communication means, a skillful
communicator sending useful message through
proper channel, effectively used to an appropriate
audience that responds as desired. Response the task
of communication is to provide powerful incentive
for change.

78. EVALUATION
1. Define communication
2. Enlist the purposes of communication
3. List down the levels of communication
4. Illustrate about the elements of communication
5. Explain about the types of communication
6. List out the characteristics of communication
7. Enumerate the modes of communication
8. Explain the process of communication
9. Discuss about the factors influencing and affecting the
effective communication

79. ASSIGNMENT
ROLE PLAY ON - Factors affecting communication.

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