This document discusses communication in healthcare. It defines communication and its importance in patient care. Effective communication involves all members of the healthcare team sharing patient information. Poor communication can negatively impact patient care. The document outlines different levels, types, elements and factors that influence communication. It discusses the communication process and provides examples of both verbal and non-verbal communication methods. Barriers to effective communication and methods to improve communication are also presented.

1. COMMUNICATION

3. • Betty Botter bought some butter.

4. INTRODUCTION:
• The care of patients involve many different
individuals, all needing to share patient
information and discuss their management.
• Effective communication is the foundation of any
healthcare team. Conversely, poor or nonexistent
communication among health care professionals
can negatively impact patient care

5. Communication
• Meaning: Latin word- commūnicāre, meaning "to
share"
Definition:
• It is the activity of conveying information through
the exchange of ideas, feelings, intentions,
attitudes, as by speech, non-verbal gestures,
writings, behavior and possibly by other means
such as electromagnetic.

6. • It is the meaningful exchange of information
between two or more person
• Communication is defined as the interchange of
thoughts or information conveyed to a person in
such a way that the meaning received is
equivalent to those which the initiator of
message intended.

7. Levels of communication
• Interpersonal Level: Interpersonal level of
communication is an exchange of information between
two or more persons
• Intra-personal Level: Intra-personal communication is
the communication with oneself.
• Emotional Level: The emotional level of communication
is the level, which takes into account the emotions,
feelings, sentiments and reactions of the individuals.
Ex: the individuals express positive emotions such as,
happiness and negative emotions, such as, anger,
sadness, fear

8. • Organizational Level: The level of
communication, which takes place within
organizations( Hospital, College)
• Downward communication is from superiors to
subordinates
• upward communication is from subordinates
to superiors
• horizontal communication takes place among
colleagues

9. Components/Elements of communication
Elements of communication process are:
• Sender
• Encoding
• Communication channel
• Receiver
• Decoding
• Feedback.

12. Communication Process
• Sender: It is a person who wishes to convey a
message to another
• Message: It is a piece of information passed from
one person to another
• Receiver: It is listener who receives the message
• Feedback: It is the message the receiver returns to
the sender

13. Importance of communication
• To understand and to exchange ideas to the clients
and their family members, doctors and other
members of the health team
• To improve interpersonal relationships
• To improve patient care
• Good communication avoids confusion, doubts and
clarifies doubts

14. Types of communication
• Verbal: use of spoken or written words
• Non verbal: facial expression, body posture, eye
contact etc.

17. Factors influencing communication

18. Perception:
• understand the meaning of messages being
communicated.
• it varies from person to person. “Perceptions
are influenced by our culture, socialization,
education, and experience.
Culture: According to difference in culture, style
of communication is become different.
• Space and distance between people

19. Time: The amount of time spent communicating
depends on the client’s needs. Some clients will
require more of the nurse’s time than others.
Example: the same message received at 8:00 AM
will be perceived and responded to differently at
6:00 PM

20. Past experiences: Previous experience with the
sender impacts psychologically on the receiver.
• Example: A patient told a nurse about his
disturbance in life. After some days patient got
to know that everyone in the unit knows about
his disturbance. The nurse loses trust with that
patient and the patient will not further share his
experiences with that nurse. That’s how past
experience affects communication

21. Position:
• The position of an individual plays a major role
in communication.
• When a senior experienced person tells
something to subordinates it becomes more
effective because he has all the experience,
knowledge and position.

22. Group relations:
• Same group employees have better
coordination. For example, Nurses in same shift
help each other in finishing their work and
providing care to the patient.

23. Geographical Difference:
• If the sender and receiver reside in several
geographical areas, will affect the
communication.
Example: an individual from an Uttar Pradesh or
Gujarat or Karnataka or Tamilnadu or Kerala or
Kolkata will obviously have a different values and
attitude and such differences will influence
communication

24. Working environments:
• An individual working in a better environment
will obviously have good communication skills,
while an individual working in a poor
environment will obviously have limitations in
communication.
Example: an individual working in private
hospital and an individual working in a govt.
hospitals going to be different communicators.

25. • Development ( age specific)
• Gender
• Values
• Personal space
– Intimate : touching to 1 .5 feet
– Personal space : 1.5 to 4 feet
– Social: 4 to 12 feet
– Public : 12-15 feet
• Territoriality (privacy / curtains)

26. • Roles and relationship ( first time and continuous
contact)
• Environment ( temperature/noise/privacy)
• Congruence
• Attitudes ( caring/warmth/respect & acceptance

27. Barriers to effective communication
A message may be distorted(disturbed) by the following
factors
• Emotional factors: Fear, jealous, anger, suspicion, lack of
interest, poor attention
• Physical factors: Weakness, disease, pain, deafness
• Intellectual factors: low IQ, lack of knowledge and
confidence
• Social factors: differences in culture, language,
professional status, economic status
• Environmental factors: Noise, distance, physical
obstruction
• Poor facilities for communication in the organization

29. Communication may get blocked by the following
• Stereotyping: offering generalized/ simplified beliefs
• Agreeing / disagreeing: judgemental response
• Being defensive: attempting to protect
• Challenging
• Probing : to collect information out of curiosity
• Testing: to make the client to admit
• Rejecting: refusing to discuss
• Changing topic / subject
• Unwarranted reassurance
• Passing judgement: giving opinion about client’s values
• Giving common advice

30. Methods of Effective communication
• The sender and receiver use the same language and
express the ideas in commonly understood words
• Avoid technical words, abbreviations that are not in
use
• There should be clarity in the expression of ideas:
The sender clearly states what, when, how, where
etc.
• Pay attention to the non verbal messages

31. Cont..
• Nurse should be aware of both relevance
and timing when communicating with
others. (Eg: patient is in severe pain)
• Maintain eye to eye contact
• Maintain relaxed posture
• Getting and giving feedback from others

32. Methods of Effective communication
Methods :
Attending skills
Rapport building skills
Empathy skills

33. Methods of Effective communication
Attending skills
– Face the other person squarely
– Adopt an open posture
– Lean towards the person
– Maintain good eye contact
– Restating / paraphrasing
– Seeking clarification
– Perception checking / seeking consensual validation
– Offering self
– Giving information
– Acknowledging
– Facilitation

34. Methods of Effective communication
Rapport building skills
– Using silence
– Providing general leads
– Being specific and tentative
– Using open ended questions
– Using closed ended questions
– Broad opening ( and after that, you were saying)
– Using touch

35. Methods of Effective communication
Empathy skills
– Empathy is neither sympathy nor compassion
– Reflect understanding
– Show concern and support
– Use statements reflecting empathy
– Use neutral and non judgemental statements
– Clarify-time/sequence
Client: I vomited this morning
Nurse: was that after breakfast?

36. Methods of Effective communication
Empathy skills
– Present reality
– Focusing
– Reflecting
Client: do you think I should tell to my husband?
Nurse: you seem unsure about telling to your husband.
– Summarizing and planning
• End of interview
• Health teaching

37. Methods of Effective communication
Confidence
Critical thinker
Analytical
Open-mindedness
Active listener
Empathetic
Honest
Confidentiality
Knowledge
Systematic
Tactfulness

40. Methods of Effective communication
Verbal communication
Pace and intonation: pause / rhythm, tone
Denotative and connotative meaning
:denotation is the literal meaning of the word,
connotation is a feeling or indirect meaning. For
example: Denotation: blue (color
blue) Connotation: blue (feeling sad)

41. Methods of Effective communication
Verbal communication
Simplicity
Clarity and brevity: expressing in an exact and
concise manner
Timing and relevance
Adaptability ( based on person / situation)
Credibility: dependable and honest

42. Methods of Effective communication
Verbal communication
Humour : promote sense of wellbeing
Verbal communication skills: assignment

43. Methods of Effective communication
Non-Verbal communication
Body language: action speak louder than words
Physical appearance
 Personal appearance: dressing, grooming, hygiene
 Posture and gait: fidgeting, toe tapping, clenched
fists
 Facial expression: smile, fear, anger, disgust, sad
 Gestures : movement of the hand, head

45. Communication channel (message is
conveyed):
• face-to-face conversation,
• Written ( Patient record)
• telephone or
• e-mail

49. Communication video links
https://www.youtube.com/watch?v=UxLBXCjD-
yM
https://www.youtube.com/watch?v=tfxEYnUeH
8g
https://www.youtube.com/watch?v=S4wWClQh
ZaA
https://www.youtube.com/watch?v=_uOS7hfKk
VI delivering bad news

50. Professional communication

51. https://www.youtube.com/watch?v=Wu9LxyVD
FYE
Poor communication
https://www.youtube.com/watch?v=W1RY_72O
_LQ
OET: Discharge from 3.30 seconds
https://www.youtube.com/watch?v=8januN-
oxPY

52. Interpersonal relationship in Nursing(IPR)
Nurse-Patient relationship
• Nurse is an important member of the health care team that
must work in cooperation and harmony with other members
of health care team to provide quality care to the patient
Definition:
• Nurse patient relationship is defined as an Interaction
process in which the nurse use her professional knowledge
and skill to help the patient physically, socially and
emotionally.

53. Interpersonal relationship in Nursing(IPR)
Nurse-Patient relationship
Definition:
• It is an interaction process between two
persons in which the nurse offers a series of
purposeful activities and practices that are
useful to a particular patient

54. Principles of IPR
• Learn every one’s name and never address anyone by nick
name
• Respect everyone’s individuality( Each person is important
as other)
• Keep emotions under control
• Do not give or take personal favor
• Develop habits of listening
• Be impartial and do justice
• Do not do or say anything that will disturb other’s faith

55. • Practice team spirit (We feeling)
• Have smiling face and avoid argument
• Keep up to date with the information that are
going around
• Carry out assigned work promptly
• Praise others for good work
• Have good relationship with each member of the
health team

56. Types of relationship
• Social relationship
– Purpose of socialization / friendship
• Intimate
– Emotional commitment between two person
• Therapeutic
– Nurse and patient- to enhance client health

57. Dimensions of helping relationship
• Geniuness: The individual involved in relationship is
an open, honest and sincere to himself and to the
others.
• Respect
• Empathy
• Concreteness: Use of specific words, avoid vague
words
• Warmth : eye contact, tone of voice

58. Phases of helping relationship
• Pre-interaction Phases
– Socio demographic data and history
• Introductory Phases
– Opening relationship
– Clarifying the problem
– Structuring and formulating the contract
• Working Phases
• Termination Phases

59. Phases of helping relationship
• Working Phases
– Exploring and understanding thoughts and feelings
– Facilitating and taking actions
• Termination Phases
– Started in advance
– Referrals
– Follow up phone calls
– emails

60. Communicating effectively with
patient, family and team members
• Effective communication is critical to the delivery
of high-quality, safe and integrated health care.
• collaborative communication results in increased
patient satisfaction, treatment adherence,
increased practitioner job satisfaction and, most
important, better patient outcomes
• Ineffective communication is also a primary
cause of complaints filed with the Commission

61. Communicating effectively with
patient, family and team members
Guidelines for Communicating with Patients and Family
Members
1. The Opening: A good opening is essential to establishing a
positive relationship with the patient. The opening builds the
foundation of the relationship.
a. Take a deep breath and knock on the door.
b. Use the patient’s preferred name. State your name and role.
c. Say hello to guests. Ask their names.
d. Get to know the patient personally. Consider asking “What is
important that I know about you so I can give you the best
care?”
e. Start with an open-ended question, such as “Tell me what is
happening,” or “How can I help you?”

62. Communicating effectively with
patient, family and team members
2. Interviewing the Patient:
a. Sit down, lean forward and make eye contact. Avoid
crossing your arms.
b. Give the patient your complete attention. Stop talking.
Allow the patient 1-2 minutes to speak.
c. Find out what the patient understands. We encourage
clinicians to not use the word understand—adults often feel
like they are being tested and do not like that. We
encourage “In your own words can you tell me what you
have heard from the doctors about your condition?”

63. Communicating effectively with
patient, family and team members
2. Interviewing the Patient:
d. Ask before you tell. Every patient will want a different
level of detail of information about their condition or
treatment. Ask the patient for the amount of information
desired before providing the information.
• Be empathetic. Acknowledge a patient’s emotions
explicitly. This is essential to the therapeutic relationship.
This may actually shorten the visit by putting the patient
at ease.

64. 2. Interviewing the Patient:
f. Slow down. Provide information slowly and deliberately
to allow time for the patient to comprehend the new
information and to give the patient an opportunity to
formulate questions which can help the physician provide
targeted information.
g. Keep it simple. Use short statements and explanations.
Avoid long monologues. Tailor information to the patient’s
desired level of information. Avoid medical jargon.
h. Tell the truth. Do not minimize the impact of the
information.
i. Avoid “why” questions. Ask “how” questions.
j. Never answer a feeling with a fact.

65. 2. Interviewing the Patient:
k. Watch the patient’s body and face. Most of nurse-patient
communication is a two-way exchange of non-verbal
information. Be attentive to and respond to a patient’s facial
expressions. Face the patient when conversing with the
patient.
l. Be prepared for a reaction. When delivering bad news, it
is important for the practitioner to be prepared, recognize
the response by the patient, allow sufficient time for a
display of emotions, and listen quietly and attentively.

66. 3. The Closing: The last moment of the interaction will
reflect on the entire experience the patient just had.
a. Keep track of personal comments. If the patient
mentions a big event coming up, mention this item in
closing.
b. Use the patient’s name to create a personalized ending
to the visit.
c. Make a positive statement. Show the patient you hope
for the best outcome. For example, “I hope this new
medication will help you feel better.”
d. Make a partnership statement. This is a statement
indicating that you and the patient are working as a team.
For example: “I know this is happening to you, but we’ll face
it together.” Or, “We’ll work on this together.”

67. Communicating with patients
• Be open, respectful and gracious in all your interactions
with the patient and keep his/her
• cultural preferences in mind.
• Answer nurses’ bells promptly.
• Make sure you have the patients’ attention when
communicating.
• Use words that are non-threatening – explain what you
would like to do and do not give orders to the patient.
• Use simple, understandable phrases, not medical terms
as most patients do not understand these terms.

68. Communicating with patients
• Speak clearly and courteously.
• Use a pleasant and normal tone of voice to the hard of
hearing.
• Always stand so that the patient can see the nurse’s face
when communicating, as lip reading is part of all normal
hearing.
• Use body language that is appropriate.
• Explain facts and procedures before donning a mask that
covers the wearer’s mouth and lower face.
• Be alert to the patient’s needs. Allow time for answers to
your requests and to answer patient’s questions

69. https://www.youtube.com/watch?v=tesWRBw0
bHY
Delivery bad news
https://www.youtube.com/watch?v=_uOS7hfKk
VI

70. Handling the Difficult Patient
• Every nurse has to encounters with the difficult patient. If
not handled properly, the interaction can leave both the
nurse and the patient feeling frustrated.
• The best approach is prevention.
• To avoid difficult interactions, first acknowledge and
address underlying mental health issues in your patient
early in the relationship.
• Second, be aware that the greatest source of discontent
for patients is feeling that they don’t matter or that they
are not heard.

71. Handling the Difficult Patient
• Third, consider your body language while you are
interacting with the patient; sit and look at them when
they are providing their history.
• Fourth, be aware of your own emotional state; it is often
the first clue of a potential conflict.
• If a patient encounter becomes tense, there are two
things you can do to de-escalate the situation:
1. Remain professional. If you feel your own emotions
getting the better of you, step outside the room and take a
few deep breaths. While you are cooling down, ask yourself
what the patient is really asking. Put yourself in their shoes.
Anger is most often an outward expression of fear, and
recognizing this can restore your sense of compassion.

72. Handling the Difficult Patient
2. Engage in active listening. Set aside your agenda and give
the patient your full attention. Summarize what the patient
has said and acknowledge the emotion they are expressing.
By taking these steps, you will help maintain a therapeutic
relationship with the patient, as well as greatly reduce the
likelihood the patient will file a complaint
https://www.youtube.com/watch?v=A-aZFhMPoZQ

73. Original Response Suggested Response
I don’t know. I don’t know, but I will find out for you.
I can’t do that. Here is what I can do for you.
That’s too bad. I’m sorry that this is happening to you.
I can’t tell you that
information.
I will find out who can help get that information
for you.
Why don’t you relax?
I understand why you are so upset and I’m
sorry.
I wish there was something
I could do.
What can I do for you? How can I help you?
I’m too busy right now. I will be there to help you in a moment.
No problem. I am glad I could help.
Don’t worry about it.
I understand your concerns; what can I do to
help?
It’s good for you.
This is important because it will help you get

74. Communicating with patient’s family
members
• You are likely often busy with many tasks and may be
looking after multiple patients, but taking the extra
moment to connect can be vital to patient care, or in
some cases, a matter of life and death.
• Loved ones, such as spouses, parents, and children, may
have questions, concerns, or information they need to
share with you. Here are some tips that can help you
navigate those emotionally challenging situations.

75. Communicating with patient’s family
members
• https://www.youtube.com/watch?v=kBuljGaFj
P8

76. Communicating with patient’s family
members
1.Listen
• Half of communicating effectively is listening.
• Be sure that you employ active listening skills.
• Don’t just wait for a family member to finish speaking. Be
present and fully listen to what they are saying.
• Don’t interrupt and take a moment to understand what
your patient’s loved one is saying.

77. Communicating with patient’s family
members
2. Look
• Be mindful of nonverbal cues. Body language and tone of
voice are just as important as words.
• Not only should you look for nonverbal cues in your
patients’ families, but also be aware of the nonverbal cues
you are sending them.
• Convey genuine interest and concern by making direct eye
contact with them as they speak. Making eye contact will
also help you to focus on what they are saying.
• Be sure to use a tone of voice that conveys both empathy
and confidence.
• You want your patients’ families to know that you care, but
that you also are an expert in what you are talking about.

78. Communicating with patient’s family
members
3.Summarize and Ask
• When you have listened to what your patients’ loved ones
have said, repeat it back to them.
• Summarizing what they have said is an effective way to
show that you understand what they are saying.
• It also helps you to solidify that information in your own
memory.
• Be sure to ask follow up questions when needed. This also
shows that you have been listening to what someone has
to say.
• Seeking more information can also help to improve patient
care.

79. 4.Ensure Patient Privacy
• Stay Legal :It is critical to remember that there are privacy
rules when communicating health information.
• You need to make sure that you are familiar with HIPPA
(The Health Insurance Portability and Accountability Act)
laws as violating them may harm patients or lead to a
lawsuit.
• Patients generally must consent for their medical
information to be released.
• You can usually give medical information to family
members involved in treatment or payment for treatment,
providing that the patient does not object. When in doubt,
it’s always best to ask a patient before sharing medical
information.

80. Communicating with patient’s family
members
5. Be Tactful and Honest
• Honesty is always the best policy.
• You never want to lie about a patient’s condition just to
ease the worry of a loved one but always make sure that
you are tactful when doing so.
• You may receive reactions of anger or sadness so be
prepared to stay calm.
• You are there to provide care for the patient as well as
comfort and understanding for their family during a
difficult time.
Effective communication with the loved ones of patients can lead to
better care of your patients as well as build trust with the families.

81. Communicating by phone
• Nurses often communicate over the phone with patients,
family members and colleagues and this can lead to
misunderstandings.
• The way in which the pone is answered and a message is
interpreted needs special skills because the body language
of the person at the other end of the phone line cannot be
seen.
When answering the phone or making a call:
• Always speak clearly into the mouthpiece of the phone.
• Offer a greeting for example, good morning or good
afternoon.
• Identify the unit or place of work.

82. Communicating by phone
• Identify yourself by indicating who you are and where you
are phoning from.
• Identify the person to whom you are speaking.
• Politely listen to the message and make notes if you think
you may not remember all the information.
• If you are asked to call another person, note the date,
time, caller’s name and telephone number together with
the message.
• Date and sign the message

83. Communicating by phone
• https://milnepublishing.geneseo.edu/nursingcare/chapter
/nurse-patient-family-communication/

84. Health Care Team Members
• Nurses routinely report information to other health care
team members, as well as urgently contact health care
providers to report changes in patient status.
• Standardized methods of communication have been
developed to ensure that information is exchanged
between health care team members in a structured,
concise, and accurate manner to ensure safe patient care.
• One common format used by health care team members
to exchange patient information is ISBARR, a mnemonic
for the components
of Introduction, Situation, Background, Assessment, Requ
est/Recommendations, and Repeat back.

85. Health Care Team Members
• Introduction: Introduce your name, role, and the agency
from which you are calling.
• Situation: Provide the patient’s name and location, why
you are calling, recent vital signs, and the status of the
patient.
• Background: Provide pertinent background information
about the patient such as admitting medical diagnoses,
recent relevant lab or diagnostic results, and allergies.

86. Health Care Team Members
• Assessment: Share abnormal assessment findings and
your evaluation of the current patient situation.
• Request/Recommendations: State what you would like
the provider to do, such as reassess the patient, order a
lab/diagnostic test, prescribe/change medication, etc.
• Repeat back: If you are receiving new orders from a
provider, repeat them to confirm accuracy. Be sure to
document communication with the provider in the
patient’s chart.

87. Health Care Team Members
• Sample ISBARR Report From a Nurse to a Health Care
Provider
• I: “Hello Dr. Smith, this is Jane White, RN from the Med
Surg unit.”
• S: “I am calling to tell you about Ms. White in Room 210,
who is experiencing an increase in pain, as well as redness
at her incision site. Her recent vital signs were BP 160/95,
heart rate 90, respiratory rate 22, O2 sat 96%, and
temperature 38 degrees Celsius. She is stable but her pain
is worsening.”

88. Health Care Team Members
• Sample ISBARR Report From a Nurse to a Health Care
Provider
• B: “Ms. White is a 65-year-old female, admitted yesterday
post hip surgical replacement. She has been rating her
pain at 3 or 4 out of 10 since surgery with her scheduled
medication, but now she is rating the pain as a 7, with no
relief from her scheduled medication of Vicodin 5/325 mg
administered an hour ago. She is scheduled for physical
therapy later this morning and is stating she won’t be able
to participate because of the pain this morning.”

89. Health Care Team Members
• Sample ISBARR Report From a Nurse to a Health Care
Provider
• A: “I just assessed the surgical site and her dressing was
clean, dry, and intact, but there is 4 cm redness
surrounding the incision, and it is warm and tender to the
touch. There is moderate serosanguinous drainage.
Otherwise, her lungs are clear and her heart rate is regular.”
• R: “I am calling to request an order for a CBC and increased
dose of pain medication.”
• R: “I am repeating back the order to confirm that you are
ordering a STAT CBC and an increase of her Vicodin to
10/325 mg.”

90. Health Care Team Members
• https://www.youtube.com/watch?v=W0ZbfsBOBUA

92. https://www.youtube.com/watch?v=n29uOcN
5vO0

96. Communicating 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 the instructions
 Use charts, models and pictures
 Frequently summarize the most important points
 Give patients an opportunity to ask questions and
express themselves

97. UNIT IV
COMMUNICATION AND NURSE PATIENT RELATIONSHIP
SHORT ANSWERS (2 marks)
1. Define communication
2. Enlist the levels of communication
3. List down the elements of communication
4. Enlist types of communication
5. Enlist steps of communication process
6. List out the modes of communication
7. List down factors influencing communication
8. Enlist four barriers to effective communication
9. Define empathy
10.List down any four purposes of patient teaching

98. References
• https://myallamericancare.com/blog/2019/03
/16/5-tips-to-communicate-effectively-with-
family-of-patients/
• https://www.medpagetoday.com/nursing/nur
sing/73130