Nursing Foundations · Communication & Nurse-Patient Relationship

Communication & Nurse-Patient Relationship

Communicationdefinition

A dynamic, two-way process involving both sending and receiving messages.

in simple words: A message goes out and a reply comes back.

Essential Elements – SMCR model

Sender – originates the message High yield
Message – content transmitted High yield
Channel – medium/pathway (auditory, visual, tactile) High yield
Receiver – intended recipient High yield
Feedback – receiver's response back High yield

Correct Sequence

Senderencodes idea
Messagethrough channel
Receiverdecodes
Feedbackcompletes loop

Encoding vs Decoding

Encoding = sender converts thoughts into verbal/non-verbal symbols. Decoding = receiver interprets those symbols. Encoding is done by the sender, decoding by the receiver.

Communication & Nurse-Patient Relationship · Nursing Foundations

Types & Levels

Levels of Communication

Classified by number of participants and context: intrapersonal, interpersonal, small-group, and public. 'Private' is not a level — it describes confidentiality.

Levels at a Glance

Level	Meaning	Example
Intrapersonal	Self-talk; internal	Nurse's self-reflection
Interpersonal	Between two people	Nurse–patient talk
Small-group	Within a group	Team conference
Public	Addressing a large group	Health education class
Transpersonal	Spiritual level	Prayer, meditation

Verbal

Spoken or written words
Speaking = commonest oral form
Letters, emails = written channels

Non-verbal

No words: body language, posture, gestures, facial expression, tone
Reflects true emotion better than words
Components: kinesics, proxemics, haptics, paralinguistics

Key Non-verbal Cues

Eye contact – signals interest, willingness or avoidance
Facial expression – most expressive part of body; universal emotions
Gestures – emphasise or replace spoken words
Tone of voice – paralanguage; conveys emotion
Haptic – therapeutic touch — empathy, support, comfort

Communication & Nurse-Patient Relationship · Nursing Foundations

Therapeutic Techniques

Therapeutic Communicationdefinition

A purposeful, goal-directed process aimed at promoting a patient's health and well-being.

in simple words: Talking with a clear health purpose.

Therapeutic Techniques

Active listening – foundation; full attention to verbal + non-verbal High yield
Restating – repeat patient's main idea to show listening High yield
Reflecting – mirror patient's statements to encourage elaboration High yield
Focusing – guide patient to one important point High yield
Paraphrasing – restate in own words to confirm understanding
Exploring – 'Tell me more' to gather detail
Clarifying – used when message is unclear
Summarizing – pull together key points
Silence – allows patient time to think
Validating – acknowledge feelings, build trust

Open-ended Questions

Core therapeutic technique
Encourage expression of concerns and feelings
Patient controls the conversation
Closed-ended = only yes/no; discouraged

Communication & Nurse-Patient Relationship · Nursing Foundations

Non-Therapeutic Responses

Why They Block Communication

Non-therapeutic techniques dismiss the patient's distress, invalidate their experience and block further sharing. They create defensiveness and damage trust.

Non-Therapeutic Techniques

Advising – imposes nurse's opinion; undermines autonomy High yield
Arguing / judgmental – creates hostile environment, puts client on defensive
Belittling – minimises patient's feelings
Challenging – forces patient to defend feelings
Probing – persistent 'why' questions; feels like interrogation
Rejecting – refuses to consider the concern
Passing judgment – labels thoughts as right or wrong
False reassurance – dismisses distress
Stereotyping – assumes traits from group affiliation
Automatic responses – clichéd, stereotyped statements

Empathy

Understand and share another's feelings
Remain objective
Builds trust and rapport

Sympathy

Feeling pity or sorrow
Causes emotional entanglement
Loss of professional objectivity

Communication & Nurse-Patient Relationship · Nursing Foundations

Barriers to Communication

Barrierdefinition

Any factor that disrupts or distorts a message, preventing correct understanding.

in simple words: Anything that blocks the message.

Types of Barriers

Barrier	Cause / Example
Semantic	Misunderstanding meaning of words, jargon, poor pronunciation High yield
Environmental	Background noise, poor lighting, lack of privacy High yield
Physiological	Hearing impairment, poor vision, illness, pain High yield
Personal	Attitudes, prejudices, fear, lack of attention High yield
Emotional	Anger, anxiety, distress
Cultural	Differences in customs, values, beliefs
Mechanical	Bad phone line, faulty microphone, illegible writing
Psychological	Anxiety, fear, anger, impatience
Organisational	Complex hierarchy, rigid rules, lack of time
Social	Differences in status, hierarchy, power

Noise

Any interference that disrupts or distorts a message
Examples: anxiety, pain, hearing impairment, language barriers, distractions
Nurses must assess and minimise noise

Communication & Nurse-Patient Relationship · Nursing Foundations

Overcoming Barriers

Strategies

Use simple clear language, avoid jargon, choose the right channel, and confirm understanding with feedback. Reduce visual and vocal distractions in the environment.

Teach-Back Method

Formal, evidence-based strategy
Patient restates information or demonstrates skill in own words
Confirms comprehension High yield

Choosing the Right Channel

Urgent/critical – direct verbal — phone call or in-person, not email
Multiple channels – speak clearly + printed schedule + pill organizer for hearing loss
Hearing impairment – visual materials with clear illustrations; face patient, speak clearly at normal pace
Adolescent sensitive topics – open-ended questions in private setting; confidentiality explained

Communication & Nurse-Patient Relationship · Nursing Foundations

Nurse-Patient Relationship

Therapeutic Relationshipdefinition

A professional, one-on-one interaction between nurse and patient, not a social friendship.

in simple words: A planned, goal-directed partnership.

Phases of Helping Relationship

Pre-interactionintrapersonal; nurse plans
Orientationform contract, clarify roles, assess High yield
Workingimplement interventions, work toward goals
Terminationprocess loss, review progress

Nurse-Patient

Core Conditions

Empathy – understand and share feelings; core technique High yield
Genuineness – authentic, open, congruent
Trust – foundation; patient feels safe High yield

Communication & Nurse-Patient Relationship · Nursing Foundations

Professional Communication

Formal vs Informal

Formal communication originates from a deliberately structured system established by management, follows a predefined chain of command, and is predominantly written (memos, reports, emails) for a permanent official record. Informal communication flows through unofficial channels and is prone to rumours and distortion.

Comparison

Feature	Formal	Informal
Origin	Structured by management	Unofficial channels
Flow	Chain of command	Grapevine
Form	Mainly written	Mainly oral
Accuracy	Expected accurate/official	Prone to rumours

ISBAR / SBAR

Structured tool for clear, concise, complete handover
Situation, Background, Assessment, Recommendation
In ISBAR, 'R' = Recommendation — propose specific action

Communication & Nurse-Patient Relationship · Nursing Foundations

Models of Care

Communication in Care Delivery

The model of nursing care determines how information flows between team members and how continuous the nurse-patient relationship is.

Nursing Care Models

Model	Key Feature
Patient/total care	One nurse provides all aspects of care for a patient during shift High yield
Team method	Group led by team leader shares responsibility for a group of patients High yield
Functional	Task-oriented; different nurses perform specific tasks for all patients High yield
Primary nursing	One RN assumes 24-hour responsibility from admission to discharge
Case management	Coordinates and links services across all levels of care

Best in General Ward

Team method — collaborative group led by professional RN team leader
Provides comprehensive, continuous care
Effectively utilises diverse skills

Communication & Nurse-Patient Relationship · Nursing Foundations

Special Situations

Adapting Communication

Different patients need different channels and techniques. Match the method to the patient's sensory, cognitive and emotional state.

Key Situations

Hearing disability – Face patient, speak clearly at normal pace; arrange sign language interpreter if needed
Lethargic/drowsy – Voice is most effective — hearing is last sense impaired
Different language – Semantic + cultural barrier; use professional medical interpreter
Adolescent sensitive – Open-ended questions, private setting; confidentiality may be broken if danger to self/others
Hearing impairment – Visual materials with clear illustrations best

Metacommunication

Interpretation of relationship between verbal and non-verbal messages
Uncovers true meaning behind conflicting message
Example: patient says calm but rigid body and sharp voice = anxiety

Communication & Nurse-Patient Relationship · Nursing Foundations

High-Yield Recap

Must-Know Facts

Elements – Sender, message, channel, receiver, feedback High yield
Sequence – Sender → Encoding → Message → Decoding → Receiver → Feedback
Therapeutic techniques – Active listening, restating, reflecting, focusing High yield
Non-therapeutic – Advising, arguing, belittling, challenging, probing High yield
Barriers – Semantic, environmental, physiological, personal High yield
Phases – Orientation, working, termination High yield
Core conditions – Empathy, genuineness, trust High yield

SURETY for Active Listening

SURETY

Sit facing the patient
Uncross arms and legs
Relax
Eye contact
Touch (therapeutic)
Your presence — offer self