The
Art of Communication
in Nursing
Cathy Groggel
Nursing 450
Objectives:
★ To understand the basic components and forms of
communication.
★ To understand the importance of effective
communication in the healthcare environment.
★ Discuss what approaches and techniques are
useful for nurses in communicating with their
patients and families.
★ Understand the barriers in communication and how
improvements can be made in nursing.
Communication
The Who?
What?
Where?
When?
Why?
How?
Communication
“Effective
communication is the
creation of meaning in communication in
which patients and healthcare providers
exchange information so that patients are
able to actively participate in their care.”
Boykins, 2014, p. 40
Root Cause Analysis
Measurement
Patient Satisfaction
NDNQI
Training/Skills
Time
Safety Reports
Errors
Materials
Method
Written
Verbal
Content
Non-Verbal
Medical Jargon
Manner
Brochures
Emotions
Cue-Cards
Feelings
Interpreters
Task Approach
Medication
Respect/Dignity
Communication
Breakdowns
Noise
Nurse
Lighting
Physician
Home
Unlicensed Personnel
Hospital
Patient
Privacy
Family Members
Readiness
Age
Distractions
Socio-economic Status
Environment
Manpower
EMR
Email
Telephone
Texting
Social Media
Web
Machine
“Between 1995 and 2005, ineffective
communication and breakdowns in working
together was the root cause of 66% of
healthcare errors (Hughes, 2008).”
Sherwood & Zomorodi, 2014, p. 17
“…suggest that an estimated ‘70-80% of
healthcare errors are caused by human
factors associated with poor team
communication and understanding.’”
Bleakley& Marshall, 2013, p. 128
“The nurse should be able to build communication
and leadership skills in practice settings, to function
effectively within nursing and other
interprofessional teams, to foster open
communication, to demonstrate mutual respect,
and to engage in shared decision making to
achieve quality care.”
Boykins, 2014, p. 42
Communication
SMR
★ It’s the Right thing to do!
★ The Joint Commission includes PatientCentered communication as a Standard
for Hospitals.
★ ANA Standards of Professional Nursing
Practice.
Assessment
Implementation
Collaboration
Environmental Health
★ Quality and Safety Education for Nursing
(QSEN).
★ AACN
“The nurse caring for the acutely and critically ill
patient uses skilled communication to
collaborate with
the team of patient, family, and healthcare
providers in providing patient care in a safe,
healing, humane,
and caring environment.”
AACN, p.16
Basic Components of Communication
“Human communication is a two-person
process in which both individuals influence
and are influenced by each other.”
Kearney-Nunnery, 2008, p. 124
SMRC Model by David Berlo in 1960
★ Source/Encoder
★ Message
★ Channel
★ Receiver
Kearney-Nunnery, 2008, p. 125
Source-Message-Channel-Receiver Model
Health
Communications
Model
Types of Relationships
Kearney-Nunnery, 2008, p. 125
Professional/Professional
Professional/Client
Professional/Significant other
Client/Significant other
Health Communications Model
Transaction Types
Verbal
Non-verbal
Contexts
Setting
One on one
Group
Kearney-Nunnery, 2008, p. 127
Forms of Communication
★ Metacommunication
★ Verbal
■
■
■
■
■
Vocabulary
Meaning
Intonation
Pacing
Clarity/Timing
“Nurses should also demonstrate credibility,
which is defined as a sense of
trustworthiness, sincerity, reliability, and
integrity. The nurse must be dependable
and believable.”
Kearney-Nunnery, 2008, p.129
★ Non-Verbal Communication
■ Body Language
■ Cultural differences
● Personal space
● Gestures
● Eye contact
● Touch
■ Use of space
■ Appearance
Kearney-Nunnery, 2008, p. 130-132
Approaches in Communication
★ Involvement of Patient
■ Patient-centeredness
★ Sensitivity in Providing Information and
Explanations
■ Quality
■ Readiness
★ Task Approach
★ Manner of Approach
■ Rapport
■ Tone
■ Pleasant
“The words people say are important, but
the way they are said is important too.
When we talk to someone, we choose the
words to use and modify the way they are
used on the basis of an unconscious
appraisal of that person.”
Draper, 2014, p. 276
Communication Techniques
★ Tools
■
Question types
■
■
■
Interest
Attention
Restatement/Reflection
■
■
■
■
Open-ended
Close-ended
Circular
Goal oriented
■
■
Elaboration
Alternatives
★ Active listening
★ Questioning
★ Understanding
★ Non-Verbal
★ Silence
Communication Barriers
★ Distractions
■ Nurse
■ Sensory
★ Knowledge Level
■ Deficits
★ Interpretation
■ Language
■ Cultural
■ Literacy level
Communication Barriers
★ Training
■ Inadequate Nurse Training
■ Poor planning
★ Emotions
■ Regulate
★ Time
Yoder-Wise, 2014, p. 350-351
Communication Pitfalls
“...pitfalls in communication comprise
actions, behaviors, and words that create
distrust, are dishonoring, and decrease the
feelings of self-worth in the receiver and
can lead to poor outcomes for patients.”
Yoder-Wise, 2014, p. 351
Improving Communication
★ Speak-Up
■ https://www.youtube.com/watch?v=rOlCMLbOm6c
Improving Communication
★ Share stories
■
■
Near-misses
Simulated learning
■
■
■
Classes
Scripting
Emotions
Be accountable
★ Change Behavior
■
Improving Communication
★ Use Standard Methods of Communication
■ Bedside Handovers
■ SBAR
■ Read-Backs
■ Briefings/Huddles
■ Huddles
■ Interdisciplinary Rounds
■ Nurse Liaison
★ Research in Nursing
Types of Communication
★ Face to face
Types of Communication
Written
Types of Communication
Email
Types of Communication
Electronic Health/Medical Records
Types of Communication
Telephone
Types of Communication
Text Messaging
Types of Communication
Social Media
Future Communications
Nursing Impact
★
★
★
★
★
★
★
★
Improving patient outcomes
Enhancing patient connection
Improving efficiencies
Decreasing costs
Strengthen communication
Informed decision making
Standardizing report
Engaging patients
References
American Association of Critical-Care Nurses. (n.d.). Standards. In American Association of Critical-Care Nurses.
Retrieved June 22, 2014, from
http://www.aacn.org/WD/Practice/Content/standards.content?menu=Practicetww.aacn.org/WD/Prac
tice/Contenstadards.content?menu=Practice
American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.)
Silver Spring, MD: Nursebooks.org.
Bleakley, A., & Marshall, R. (2013). Can the science of communication inform the art of the medical humanities?.
Medical Education, 47(2), 126-133. doi:10.1111/medu.12056
Boykins, D. (2014). Core Communication Competencies in Patient-Centered Care. ABNF Journal, 25(2), 40-45.
Davies, N. (2014). Empathic nursing: going the extra mile. Practice Nursing, 25(4), 198-202.
Draper, P. (2014). Words, words, words: conversation as a tool to promote wellbeing. Nursing & Residential Care,
16(5), 275-277.
Kearney-Nunnery, R. (2008). Advancing your career: Concepts of professional nursing (4th ed.). Philadelphia,
PA: F. A. Davis Company.
References
Leef, B. L., & Hallas, D. (2013). The Sensitivity Training Clown Workshop: Enhancing Therapeutic
Communication Skills in Nursing Students. Nursing Education Perspectives, 34(4), 260-264.
McGilton, K., Boscart, V., Fox, M., Sidani, S., Rochon, E., & Sorin-Peters, R. (2009). A systematic review of the
effectiveness of communication interventions for health care providers caring for patients in
residential care settings. Worldviews On Evidence-Based Nursing, 6(3), 149-159.
doi:10.1111/j.1741-6787.2009.00155.x
O'Hagan, S., Manias, E., Elder, C., Pill, J., Woodward-Kron, R., McNamara, T., & Webb, G., & McColl, G. (2013,
October). What counts as effective communication in nursing? Evidence from a nurse educators'
view and clinicians' feedback on nurse interactions with simulated patients. Journal of Advanced
Nursing, 70(6), 1344-1356.
Sherwood, G., & Zomorodi, M. (2014). A New Mindset for Quality and Safety: The QSEN Competencies Redefine
Nurses' Roles in Practice. Nephrology Nursing Journal, 41(1), 15-72.
Spruce, L. (2014). Back to Basics: Speak Up. AORN Journal, 99(3), 407-415. doi:10.1016/j.aorn.2013.10.020
Tremayne, P. (2014). Using humour to enhance the nurse-patient relationship. Nursing Standard, 28(30), 37-40.
Yoder-Wise, P. S. (2014). Leading and managing in nursing: Revised reprint (5th ed.). St. Louis,
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