INTRODUCTION

Communication is a lifelong learning process for the

nurse. Nurses make the intimate journey with clients and
their families from the miracle of birth to the mystery of
death. It is necessary to build therapeutic
communications for this journey. Nurses communicate
with people under stress: clients, families, and
colleagues.
COMMUNICATION

COMMUNICATION
Communication is a process by which information is
exchanged between individuals through a common
system of symbols , signs or data. The word is
derived from the Latin word communicare or
communis which means to share.
There are different modes of communication
available today. These include emails, chats,
WhatsApp, skype (conference calls), etc.
Effective communication makes people’s work
easier and smooth.
 DEFINITIONS
According to Paul Leagens, - Communication is a
process by which two or more people exchange
ideas, facts, feelings impressions in ways that each
gains a common understanding of meaning.
According to Aristotle, - Communication is a means
of persuasion to influence the other so that the
desired effect is achieved
Communication is a two way process of sharing
thoughts, ideas, opinions, messages and feelings.
Basic functions of Communication

1. Information function
2. Command or instructive function
3. Influence or persuasive function
4. Integrative function
COMMUNICATION PROCESS
COMMUNICATION PROCESS
COMMUNICATION PROCESS
1) An idea arises in the mind of the sender,
which he wants to share.
2) The sender encodes the idea in the form of a
‘message’.
3) The sender chooses some medium / channel
to put across the message.
4) The receiver receives the message.
5) The receiver decodes – absorbs, understands,
interprets the message.
6) The receiver sends feedback or his response.
 PROCESS
• Step 1: Idea Formation – The communication process
begins when the sender has an idea to be communicated.
The idea will be influenced by complex factors surrounding the
sender. The sender must begin by clarifying the idea and
purpose.
• Step 2: Message Encoding – The idea must be encoded
into words, symbols, and gestures that will convey meaning.
Because no two people interpret information in the exact
same way, the sender must be careful to choose words,
symbols and gestures that are commonly understood to
reduce the chances of misunderstanding. Therefore, a sender
must be aware of the receiver’s communication skills,
attitudes, skills, experiences, and culture to ensure clear
communication.
Step 3: Message Transmission: Choosing the medium to transmit the
message is the next step in the communication process. Messages can be
transmitted in a verbal, written, or visual manner.
Step 4: Decoding – When the message reaches the receiver, the message
must be decoded into its intended meaning. Therefore, the receiver must
translate the words, symbols, and gestures as the sender intended. Because
no two people interpret information in the exact same way, incorrectly
decoding a message can lead to misunderstanding. Successful decoding is
more likely when the receiver creates a receptive environment and ignores
distractions.
Step 5: Feedback – A vital part of the communication process is feedback.
Feedback occurs the sender and receiver check to ensure the message was
understood as intended. Feedback is a shared responsibility between the
sender and the receiver and can be verbal or non-verbal.
How to achieve effective communication:

•1. Communicate for a purpose

•2. Compose message with care
•3. Study the receiver
•4. Select appropriate medium
•5. Provide feedback
•6. Act promptly on receiving feedback.
TYPES OF COMMUNICATION

1. VERBAL (Verbal communication is one of the

modes where people communicate or transfer
information through words. )
• Oral (This is the communication which
employs the spoken word, either direct or
indirect as a communication channel. )
• Written (This kind of communication
involves any kind of exchange of information in
the written form.)
TYPES OF COMMUNICATION
2. NON-VERBAL (Non-verbal communication is the
use of body language. It includes body gestures,
facial expression, and shaking hands, etc)

3. VISUAL (Visualizing is a form of communication

where one can use photographs, drawing charts
and graphs to convey information through it.)
Mode Of Communication

FORMAL INFORMAL
• Formal Communication refers • Informal communication is
to communication that takes defined as any
place through legal channels communication that occurs
in an organization. That kind outside of the official
of communication takes channels of communication.
place between managers or Informal communication is
employees of the same class often referred to as the
or between high and low and ‘vine’ as it spreads
vice versa. It may be oral or
written but a complete
throughout the organization
record of that communication and on all sides regardless
is kept in the organization. of the level of authority.
 Flow of Communication
 Downward Flow:
In this, communication flows from the higher level to lower
level, i.e. communication carried out by the head of the
organization to the subordinates like providing feedback, giving
job instructions etc.
 Upward Flow:
Communication which flows to the higher level of the
organization is upward communication. Subordinates use upward
flow to transfer their grievances and performances to their
seniors.
Flow of Communication (cont)
Lateral/Horizontal Communication:
It takes place where communication happens between
the same level of the hierarchy that is communication
between colleagues, managers or between any horizontally
equivalent members of the organization
Diagonal Communication:
Communication which takes place between the manager
and employee of other work departments is known as
diagonal communication.
Flow of Communication (cont)
 Grapevine communication
Grapevine communication is a type of informal social
interaction in the workplace. it is characterized by
conversations between employees and superiors that
do not follow any prescribed structure or rule-
based system. This type of information communication
goes up, sideways, down, and diagonally in an
organization, and it spreads the information
LEVELS OF COMMUNICATION

1. INTRAPERSONAL COMMUNICATION
2. INTERPERSONAL COMMUNICATION
3. TRANSPERSONAL COMMUNICATION
4. SMALL GROUP COMMUNICATION
5. PUBLIC COMMUNICATION
• INTRAPERSONAL COMMUNICATION: is a powerful
form of communication that occurs with in a
individual. This level of communication also called
self-talk, self-verbalization, self-Instructions and
inner thought.

• INTERPERSONAL COMMUNICATION: Interpersonal

communication is one-to-one interaction between
the nurse and another person that often occurs
face to face. It is the level most frequently used
in nursing situations and lies at the heart of
nursing practice. It takes place within a social
context and includes all the symbols and cues
used to give and receive meaning.
TRANSPERSONAL COMMUNICATION: Transpersonal
communication is interaction that occurs within a person's
spiritual domain. Many persons use prayer, meditation, guided
reflection, religious rituals, or other means to communicate with
their "higher power." Nurses who value the importance of human
spirituality often use this form of communication with clients and
for themselves. Nurses have a responsibility to assess client's
spiritual needs and intervention to meet those needs.

SMALL-GROUP COMMUNICATION: Small-group communication is

interaction that occurs when a small number of persons meet
together. This type of communication is usually goal directed
and requires an understanding of group dynamics. Small groups
are more effective when they are a workable size, have an
appropriate meeting place, suitable seating arrangements, and
PUBLIC COMMUNICATION: Public communication
is interaction with an audience. Nurses have
opportunities to speak with groups of consumers
about health-related topics, conferences,
classroom discussions with peers and other
students. Public communication requires special
adaptations in eye contact, gestures, voice
inflection, and use of media materials to
communicate messages effectively.
CHARACTERISTICS OF EFFECTIVE
COMMUNICATION

1. Emotion Management 7. Appreciative

2. Ability to focus 8. Polite

9.Respectful
3. Concise
10.Sincere and reliable
4. confident 11.Non-verbal communication
5. Learn to listen 12.Assertiveness
6. Avoid making 13.Empathy.
judgments 14.Mediative and Open-
7. Provide feedback minded
 Factors Affecting Communication
•1) Choice of Medium: The choice of medium can
significantly affect communication, as different
mediums have varying strengths and weaknesses in
terms of their ability to convey information effectively.
For example, face-to-face communication - most
effective medium, as it allows for the use of nonverbal
cues, such as facial expressions and body language,
which can help to reinforce the meaning of the
message.
2). Language Concern: Language concerns are a crucial factor
that affects communication, particularly in cross-cultural
communication, where language barriers can arise due to
differences in language proficiency or understanding.
3). Information Overload/Excess of Information:
Information overload can lead to difficulties in processing and
interpreting information accurately, which can result in
confusion, stress, and reduced productivity.
4) Lack of Feed back : Feed back refers to the information or
response provided by the receiver to the sender, indicating that
the message has been received and understood. Lack of
feedback can affect communication.
5) Time and Distance : Time and distance are two significant
factors that can affect communication, particularly in situations
where the sender and receiver are separated by physical or
temporal barriers. Time and distance can affect communication
in several ways, such as: - Delayed Response,
Misinterpretation, Technical Barriers
6) Selective Perception : Selective perception is a factor
that can affect communication, particularly in situations where
individuals filter information based on their personal beliefs,
values, attitudes, and experiences.
It can lead to misunderstandings and a breakdown in
communication, as individuals may interpret the same
message differently based on their personal biases and
7) Cultural Factor: Culture is a significant factor that
can affect communication, particularly in situations
where individuals from different cultural backgrounds
interact with each other. Culture can affect
communication in several ways, such as: Language,
Nonverbal Communication
8) Clarity of Message: Clarity of the message is a
critical factor that can affect communication. Clarity
refers to the degree to which a message is clear,
concise, and easily understood by the receiver. When
the message is not clear, it can lead to
9) Use of Technical Language: The use of
technical language can be an important factor that
affects communication. Technical language refers to
specialized vocabulary or terminology that is specific
to a particular field, industry, or profession.
10) Emotional Factors : Emotional factors can greatly affect
communication. Emotions can influence how individuals perceive,
interpret, and respond to messages, leading to communication
challenges and misunderstandings. Some emotional factors are:-
 Stress: Stress can cause individuals to become overwhelmed,
leading to a lack of focus and attention.
 Anger: Anger can cause individuals to become defensive,
leading to a breakdown in communication.
 Anxiety: Anxiety can cause individuals to become self-
conscious and hesitant, leading to a lack of confidence in their
ability to communicate effectively.
 Empathy: When individuals are empathetic, they are more
likely to listen actively, show interest, and respond in a positive
Factors Influencing Types of Communication
- Categories
• Factors Affecting Written Communication
• Factors Affecting Verbal Communication
• Factors Affecting Feedback in
Communication
• Factors Affecting Communication in Crisis
Management
• Factors Affecting Media Choice in
Communication
Factors Affecting Written Communication
Some factors that can affect written communication:
1. Language and Grammar: .
2. Audience
3. Tone

Factors Affecting Verbal Communication

Verbal or oral communication flow is influenced by various
factors that can affect the way people communicate with each
other.
1. Language Barriers
2. Cultural Differences
3. Physical barriers
Factors Affecting Feedback in Communication
Several factors can impact the feedback that
individuals receive in communication. This includes:
1. Timing
2. Specific Feedback
3. Power Dynamics: Power dynamics between the
sender and receiver can impact the feedback
received.
Factors Affecting Communication in Crisis
Management
1.Speed : During a crisis, rapid communication is
essential to ensure that everyone is informed about
the situation as quickly as possible.
2.Accuracy: Inaccurate or misleading information can
create confusion, increase panic, and lead to poor
decision-making. It is therefore important to ensure
that the information being communicated is accurate
and up-to-date.
3.Clarity: It is important to use language that is easy
Factors Affecting Media Choice in Communication
Media choice refers to the selection of a specific channel or
method for transmitting information or messages. Some
factors are :
1. Cost: The cost of different communication channels can
impact media choice. For example, video conferencing may be more
cost-effective than for face-to-face meetings.
2. Urgency: The urgency of the message can impact the
choice of media. If the message is time-sensitive or requires an
immediate response, then real-time communication methods
such as phone or video conferencing may be preferred.
3. Audience Preferences: The preferences of the audience
can also influence media choice. For example, younger audiences
Barriers to Communication
Physical Barriers
Linguistic Barriers
Psychological Barriers
Emotional Barriers
Cultural Barriers
Organizational Structure Barriers
Attitude Barriers
Perception Barriers
Physiological Barriers
Technological barriers
Socio-religious barriers
COMMUNICATION TECHNIQUES

THERAPEUTIC
COMMUNICTION TECHNIQUES

NON-THERAPEUTIC
TECHNIQUES

ADAPTING COMMUNICATION
TECHNIQUES
Therapeutic Communication Techniques

• Using Silence • Making Observations

• Encouraging Descriptions
• Accepting of Perception
• Giving Recognition • Encouraging Comparisons
• Offering Self • Summarizing
• Giving Broad • Reflecting
Openings • Focusing
• Offering Hope and Humor
• Active Listening
• Seeking Clarification
 NON-THERAPEUTIC COMMUNICATION
TECHNIQUES
- Ask personal questions
- Giver personal opinions
- Change the subject
- Give automatic responses or false reassurance
- Sympathy- I am sorry
- Ask for explanations: Why?
- Give approval or disapproval
- Provide defensive responses
- Provide passive or aggressive responses
- Argue
ROLE OF NURSE IN GOOD COMMUNICATION
IPR : The interpersonal relationship is
considered the fundamental core of care
nursing. The nurse must utilize their
communication skills, understanding of human
behavior, and personal strengths to enhance the
growth and outcomes of the patient.
Nurse-patient relationship
 Nurse-patient relationship
• In 1952, Peplau introduced the concept of the nurse-
patient relationship in her book Interpersonal Relations
in Nursing, and it has since been widely accepted and
utilized in all areas of nursing practice. According to
Peplau, the relationship “facilitates forward movement”
for both nurse and patient, progressing through a series
of phases that together promote independent problem
solving and decision making for the patient . Trust,
mutual respect, and empathy are essential aspects of
the bond between nurse and patient in any healthcare
setting or context.
•Definition
IPR is any or all behavior which a person undertakes in
the presence of others. These are social associations,
connections or affiliations between two or more people.
TYPES OF RELATIONSHIP
A relationship is an interpersonal process that involves
two or more people. On the basis of the nature of
relationship it can be classified into three types
• 1. Social relationship
• 2. Intimate Relationships
• 3. Therapeutic relationships
SOCIAL RELATIONSHIP
• It is most common type of relationship between
two or more individuals in every day life.
• Individuals are equally involved in this
relationship and meet their needs through
relationship
• There is no predetermined goal or focus in
relationship.
• Continuation of the relationship is not
determined at the onset
• It may last for months or years. Eg: friends, work
 Therapeutic relationships
• Therapeutic relationships: It is established, goal
directed, purposeful, time bounded deliberately
professional relationships between professionals
and clients. Relationships between nurse and
patient, teacher and students, lawyer and client,
doctor and patients or doctor and nurses all are the
examples of therapeutic relationship
NURSE-PATIENT RELATIONSHIP
•Definition
The nurse-patient relationship is the result of series of
interaction between the nurse and the patient over a period
of time with the nurse focusing on needs and problems of
patient and his family while using the scientific knowledge
and scientific skills of nursing profession.
Joyce Travelbee
Stages - IPR
Principles of IPR

• Principles of recognition
• Principles of mutual understanding
• Principles of inculcation of common interests
• Principle of respect for human dignity
• Principle of personality development
• Principle of stimulation, motivation and encouragement
• Principle of incentives/rewards for good accomplishment
• Principle of honesty, punctuality and trustworthiness.
Characteristics - IPR

• Genuineness
• Respect
• Empathetic Understanding
• Concreteness
PHASES OF IPR
• Orientation Phase:
• Identification Phase:
• Exploitation Phase:
• Termination Phase:
Phases of Nurse-Patient Relationship Process
Characteristics of Therapeutic
Relationship
GOALS OF THE THERAPEUTIC NURSE CLIENT
RELATIONSHIP

 The nurse helps the client to cope with the present

problems
 The nurse helps the client to understand his
problem
 The nurse helps the client to find out a new
alternative for his or her problem
 The nurse helps the client to communicate.
 The nurse helps the client to socialize
 The nurse helps the client to find a meaning in his
illness
PURPOSE OF NURSE PATIENT
RRELATIONSHIP
• Improve patient's functioning
• Identify and explore patient's current
needs
• Promote patient's recovery
• Develop adaptive problem-solving
approaches
• Develop adaptive coping skills among
patients
ELEMENTS OF NURSE PTIENT RELATIONSHIP

•Altruism: A professional nurse should be passionate to her services to

the patients, family or to community at large. He /She must be
compassionate and have concern for the welfare of others.
•Ethics and responsibility: Nurse should practice in a professional
manner where her behavior, decisions, activities should reflect
professional ethics and accountability.
• Communication skills: Nurse should be skillful while communicating
with the patients and should have adequate knowledge of verbal as
well as nonverbal communication
 ELEMENTS (CONTIN…)
•Genuineness: Nurse should be sincere and honest in therapeutic
relation. She must have clear and concrete in communications with
patient.
•Respect: It is an unconditional positive regard to the patient and her
behavior toward client should not depend on the patient's behavior. There
are different ways to promote respect and positive regard to the patient.
Ways to promote respect and positive regard to the patient
 Remain unconditional
 Respect patient's autonomy
 Calling the patient by name
 Be open in responding to the patient
 Spend time with the patient
 Actively listening to the patient
ELEMENTS…
• Empathy: It is the ability of a nurse to accurately
understand the person's current feelings and
their the patient. Empathy indicates a central
focus on the meanings, and to communicate this
understanding to patient's feelings. It involves
three steps
 Elements.. (conti..)
• Concreteness: Nurse must communicate
information in a clear language using specific terms,
according to the patient's level of understanding.
Nurse should avoid vagueness while discussing the
patient's feelings, experiences and behavior.
• Confrontation: It is a process of helping the client
become aware of inconsistencies in his/her feelings,
attitudes, beliefs and behaviors. (working phase of
nurse patient relationship is an ideal time for using
confrontation).
Elements
• Immediacy: Immediacy involves sensitivity to
the patient's feelings and a willingness to deal
with these feelings rather than ignore them.
(Focus on here and now).
• Nurse self-disclosure: Nurse intentionally
reveals personal experiences about the self to
the patient for the purpose of emphasizing both
the similarities and the differences of
experiences.
ROLE OF A NURSE IN IMPROVING
INTERPERSONAL RELATIONSHIPS
Willingness to Give and
Take
Acceptance of Others
Self Acceptance
Emotional Maturity
The Nurse and Her Patients
SOCIAL AND HUMAN RELATIONS IN NURSING
Human relation in nursing is a very significant
aspect. The nurse is dealing with the human beings
who have complex needs. They have their identity,
life style, status and background. When they fall sick
and are dependent on others for care, they need to
be considered as unique human being. Nurse and the
hospital team need to use effective communication
skills so that the patient feels that they are being
considered as an individual and not merely another
patient suffering from a particular disease.