Conceptual Framework

• Effective communication is imperative not only personally but also to nursing profession. The very quality of patient care depends on it.
• Communication is critical to the successful operation of the health care system as the health workers must coordinate care to effectively and efficiently treat and manage patient illnesses and diseases.
• Every nurse needs to understand the fundamentals of effective communication.
• Communication


  The act or process of using words, sounds, signs, or behaviors to express or exchange information or to express your ideas, thoughts, feelings, etc., to someone else
• Communication


  A two-way process of reaching mutual understanding, in which participants not only exchange (encode-decode)information, news, ideas and feelings but also create and share meaning. In general, communication is a means of connecting people or places.
• All behavior in the presence of others is communication (e.g. Sleeping in class is a form of communication).
• Essential issues to be aware of in any communication situation

  • Content
  • Process
  • Context
• Content


  The actual words or symbols of the message that are known as language, the spoken and written words combined into phrases that make grammatical sense. Meanings of words are interpreted differently, so even simple messages can be misunderstood. And many words have different meanings to confuse the issue even more.
• Process


  The way the message is delivered. It includes the nonverbal elements in speech that can be detected such as the tone of voice, the look in the sender's eyes, body language, hand gestures and state of emotions (anger, fear, uncertainty, confidence, etc.). The non-verbal messages can be misunderstood as people tend to believe what they see more than what they hear. People often trust the accuracy of nonverbal behaviours more than verbal behaviours. A study found that only around 7% of the meaning of spoken communication came from words alone, 55% came from facial expression and 38% came from the way the words were said.
• Context

  The situation or environment in which your message is delivered. Contextual factors that influence the effectiveness of a message include the physical environment (e.g. a patient's bedside, noisy street), cultural factors (e.g. International & organisational cultures) and developmental factors.
• The communication process


  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.
• Message


  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


  • Message code - any group of symbols that can be structured in a way that is meaningful to same person, e.g., 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
  • Meaningful
  • Based on felt needs
  • Clear and understandable
  • Specific and accurate
  • Timely and adequate
  • Fitting the audience
  • Interesting
  • Culturally and socially appropriate
• Channel


  The "physical bridge" or the media of communication between sender and the receiver. Channels can be interpersonal (face to face communication) which may be verbal or non-verbal, or mass media like TV, radio, printed media etc. Every channel of communication has its advantages and limitations. The proper selection and use of channels results in successful communication.
• Receiver


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


  The flow of information from receiver to the sender, the reaction to the message.
• Types of Communication


  • Verbal communication
  • Non-verbal communication
• Verbal communication


  • The traditional way of communication by mouth. Language is the chief vehicle of communication. It involves written words.
• Effective verbal communication techniques

  • Clarity and brevity
  • Vocabulary
  • Denotative (word's literal meaning) and connotative (word's underlying) meaning
  • Pacing
  • Timing and relevance
  • Humour
• Non-verbal communication


  • Communication occur other than words, such as facial expression, gesture, touch, vocal tone
• Levels of Communication


  • Intra-communication: self-talk or self- verbalization
  • Inter-personal communication: one to one person interactions
  • Transpersonal: interaction within a person's spiritual domain e.g. praying, meditation, religious rituals
  • Small group communication: interaction within a small group
  • Public communication: interaction with an audience
• Group communication


  Usually goal directed and requires an understanding of group dynamics. Group communication are more effective when they are a workable size, have an appropriate meeting place among group members, suitable seating arrangements and cohesiveness and commitment among team members.
• Two key features for effective communication and working relationship

  • Respect people as partners
  • Active listening to others
• Therapeutic Communication


  At the core of the nursing are caring relationships formed between the nurse and the patient. Communication is the means to establish these helping-healing. All behavior communicates and all communication influences behaviour. Communication is essential to the nurse-client relationship for establishing a therapeutic relationship and influencing the client's behaviour to lead to successful nursing intervention.
• The therapeutic nurse-patient relationship

  A helping relationship that's based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with the gratification of the patient's physical, emotional, and spiritual needs through the nurse's knowledge and skill. This caring relationship develops when the nurse and the patient come together in the moment, which results in harmony and healing. Effective verbal and nonverbal communication is an important part of the nurse-patient interaction, as well as providing care in a manner that enables the patient to be an equal partner in achieving wellness.
• The nurse's therapeutic use of communication is the mechanism by which clients can achieve successful outcomes for the problems currently preventing the client from achieving optimal health.
• There is an explicit time frame, goal directed approach and a high expectation of confidentiality in the therapeutic nurse-patient relationship. The nurse establishes, directs and takes responsibility for the interaction and the client needs take priority over the nurse's needs.
• Phases of the helping relationship

  1. Pre-interaction phase: Before meeting the client the nurse reviews available data (medical and nursing history), talks to other care givers with information about the patient, anticipates health concerns, identifies a location and setting that will foster comfortable and private interaction, plans enough time for initial interaction

  2. Orientation phase: When the nurse and client get to know each other. The nurse sets the tone for the relationship by adopting a warm, empathetic, caring manner. Recognizes that the initial relationship may be superficial, uncertain and tentative. Expects client to test the nurse's competence and commitment closely observed by the client and vice versa. Begins to make inferences and form judgments about the client, assesses the client's health status, prioritizes client problems and identifies client goals, clarifies the client and the nurse's roles, forms contracts with the client that specify who will do what, lets the client know when to expect the relationship to be terminated

  3. Working phase: When the nurse and client work together to solve problems and accomplish goals. The nurse encourages and helps the client to express feelings about his or her health, encourages and helps the client in self-exploration, takes action to meet goals using therapeutic communication skills, uses self-disclosure and confrontation

  4. Termination phase: During the ending of the relationship the nurse reminds the client that termination is near, evaluates goals achieved with the client, reminisces about the relationship with the client, separates from the client
• Phases of the helping relationship

  • Orientation phase
  • Working phase
  • Termination phase
• Orientation phase


  1. Begins to make interference and form judgment about the client

  2. Assess the client health status

  3. Priorities client problems and identify client goals

  4. Clarifies the client and the nurse's roles

  5. Forms contracts with the client that specify who will do what

  6. Let the client know when to expect the relationship to be terminated
• Working phase


  1. Encourages and help the client to express feelings about his or her health

  2. Encourages and help the client in self exploration

  3. Takes action to meet goals uses therapeutic communication skills

  4. Uses self-disclosure and confrontation
• Termination phase


  1. Reminds the client that termination is near

  2. Evaluates goal achieved with the client

  3. Reminisces about the relationship with the client

  4. Separates from the client by relinquishing responsibility for his care

  5. Achieves smooth transition from the client to other caregivers as needed
• Therapeutic communication


  • Facilitates client autonomy
  • Creates a nonjudgmental environment
  • Provides the professional with a holistic view of their client
  • Reduces risk of unconscious influence by the professional
• Therapeutic communication


  • Helps the patient achieve harmony in mind, body, and spirit when engaging in a therapeutic relationship based on effective communication that incorporates caring behaviors
  • It's a win-win situation in which the nurse and the client patient can experience growth by sharing "the moment" with each other
• Therapeutic communication techniques


  • Using silence
  • Accepting
  • Giving recognition
  • Offering self
  • Using broad openings
  • Using general leads
  • Placing the event in time or sequence
  • Making observations
  • Encouraging description of perceptions
  • Restating
  • Reflecting
  • Focusing
  • Exploring
  • Giving information
  • Seeking clarification
  • Presenting reality
  • Voicing doubt
  • Seeking consensual validation
  • Verbalizing the implied
  • Encouraging evaluation
  • Attempting to translate into feelings
  • Suggested collaboration
  • Summarizing
  • Encouraging formulation of a plan of action
  • Identifying themes
• Barriers of communication


  • Physical/environmental barriers
  • Personal barriers: Defensiveness, hostility
  • Physiological barriers: physical disabilities, inarticulateness, illness
  • Psychological barriers: emotional blocks, preoccupation, mind wandering
  • Cultural barriers: stereotyping, status, age, gender
  • Background barriers: past experiences, hidden agendas
• Steps toward promoting successful communications

  1. Think before you speak

  2. Know your audience

  3. Have realistic goals for your communication

  4. Ask for feedback if you're not getting any

  5. Follow up on your communications

  6. Be mindful of cultural differences and personal and professional biases which may cause breakdowns in the communication process

  7. Take steps to diffuse any emotions which may interfere with delivery of your message

  8. Remaining calm and making sure you understand the issues at hand is helpful
• Listening


  To give attention with the ear; attend closely for the purpose of hearing; give ear