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Communication in Nursing Practice 



DOI: 10.5455/insin. 2014.26.65-67 published online: 20/02/2014 

Received: 11 November 2013; Accepted: 15 February 2014 Published print: 02/2014 

®AVICENA2014 



PROFESSIONAL PAPER Mater Sociomed. 2014 Feb; 26(1): 65-67 



Communication in Nursing Practice 

Lambrini Kourkouta\ loanna V. Papathanasiou^ 

Nursing Department, Technological Eciucational Institute of Thessaloniki, Greece' 
Nursing Department, Technological Eciucational Institute of Larissa, Greece^ 

Corresponding author: loanna V. Papathanasiou, RN, MSc, PhD, Clinical Professor. Nursing Department. Technological Educational Institute of Larissa, 
Greece. Phone: +302410684446. E-mail: papathan^teilar.gr , lopapathanasiou(avahoo.qr 

ABSTRACT 

Good communication between nurses and patients is essential for the successful outcome of individualized nursing care of each patient. To achieve 
this, however, nurses must understand and help their patients, demonstrating courtesy, kindness and sincerity. Also they should devote time to 
the patient to communicate with the necessary confidentiality, and must not forget that this communication includes persons who surround the 
sick person, which is why the language of communication should be understood by all those involved in it. Good communication also is not only 
based on the physical abilities of nurses, but also on education and experience. 

Keywords: Communication, Nursing, Nursing Care, Communicational Skills, Principles of Communication. 



1. INTRODUCTION 

Nursing as a health care science, focuses on serving the needs 
of human as a biopsychosocial and spiritual being. Its practice 
requires not only scientific knowledge, but also interpersonal, 
intellectual and technical abilities and skills. This means a com- 
position of knowledge, clinical work and interpersonal commu- 
nication (I). Communication is a vital element in Nursing in all 
areas of activity and in all its interventions such as prevention, 
treatment, therapy, rehabilitation, education and health promo- 
tion (2). The nursing process moreover as a scientific method of 
exercise and implementation of Nursing, is achieved through 
dialogue, through interpersonal environment and with specific 
skills of verbal communication (3). 

As communication we can define the exchange of informa- 
tion, thoughts and feelings among people using speech or other 
means. Therapeutic practice involves the oral communication 
of public health officials and nurses on the one hand and the 
patient or his relatives on the other. It is a two way process. 
The patient conveys their fears and concerns to their nurse and 
helps them make a correct nursing diagnosis. The nurse takes 
the information and in turn transmits other information to 
the patient with discretion and delicacy as to the nature of the 
disease and advises with treatment and a rehabilitation plan for 
health promotion (4). 

Effective communication requires an understanding of the 
patient and the experiences they express. It requires skills and 
simultaneously the sincere intention of the nurse to understand 
what concerns the patient. To understand the patient only is 
not sufficient but the nurse must also convey the message that 
he/she is understandable and acceptable. It is a reflection of the 
knowledge of the participants, the way they think and feel and 
their capabilities (5). 



In order for the nurses to be successful in their work they 
have to study communication and interpersonal relations in 
their education with special courses and internships. They need 
to learn the various aspects and applications of communication 
in various fields of nursing (6). In this context it is understood 
that emphasis must be placed on the importance of communi- 
cation between nurse and patient and nursing education must 
focus on communication skills of nurses. 

2. PRINCIPLES OF COMMUNICATION 

Communication can be defined as a transaction and mes- 
sage creation. The entire process occurs in a context consisting 
of physical space, cultural and social values and psychological 
conditions (7). Communication assists in the performance 
of accurate, consistent and easy nursing work, ensuring both 
the satisfaction of the patient and the protection of the health 
professional. When health professionals are not trained in com- 
munication skills, they face more difficulties separating work 
from their personal life, tending to transfer problems from one 
side to the other (8). 

Communication is an intrinsic characteristic of human 
nature. Nobody cannot communicate. Communication has 
content and value. The contents regards to what was said, whilst 
the relationship regards as to how it was said. The nature of the 
relationship depends on how the two parties understand the 
communication sequence (9). Communication is never uni- 
directional. It is an interaction in which each sender becomes 
receiver and vice versa. The failure to recognize the two-way 
communication capability, quite often leads to negative conclu- 
sions and attitudes (10). 

Moreover, the message sent is not the same as the message 
received. The decoding of the messages is based on individual 



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Communication in Nursing Practice 



factors and subjective perceptions. This fact, in conjunction with 
the process of feedback makes communication. We interpret 
something that we heard not according to what the sender actu- 
ally said but according to our own code (11). Particular attention 
should be given by the caregivers to use technical terms and 
medical terminology during their contact with the ill, because 
it is often found that the patient ascribes different interpreta- 
tions to what he hears or even more cannot understand what is 
meant exactly, mainly by the therapist, thus increasing mental 
stress, a fact which makes it more difficult to communicate 
with the patient (12). 

Communication happens without words. It is an ongoing 
process. This non-verbal communication is expressed by facial 
expressions, gestures, posture and physical barriers such as dis- 
tance from the interlocutor (13). It is important that there is 
an agreement between verbal and nonverbal communication. 
Particularly under stressful conditions where it is difficult to 
see the changes in the non-verbal messages of the patients with 
whom we mostly communicate (14). Moreover, each patient 
has his own specific characteristics that influence not only be- 
havior in the process of communication, but also if and how to 
cooperate with nursing services and how they will undertake 
self-management of health (15). 

Listening is important in communication. It is responsible 
nursing practice and requires concentration of attention and 
mobilization of all the senses for the perception of verbal and 
non-verbal messages emitted by each patient. By listening, 
nurses assess the situation and the problems of the patient; they 
enhance his/her self-esteem and integrate both the nursing di- 
agnosis and the process of care at all levels (5). 

Good personal relationships are described as the ability of the 
nurse to ask questions with kindness and provide information 
in a way that does not scare, that demonstrates interest, creates 
feelings of acceptance, trust and a harmonious relationship, 
especially in modern multicultural society (16). The therapeu- 
tic relationship is an important prerequisite to effective com- 
munication between health professionals and patients in order 
not only to transmit information, but also to effectively address 
mental processes which are activated by it. The communication 
between health professionals and patients include the ability to 
express sincere concern for the care of the patient and the patient 
becomes a partaker of this interest (9). 

3. SPEAKING WITH THE PATIENT 

Communication between health officials-in this case nurses- 
and patient is a process that begins with the first contact of the 
two and lasts as long as the therapeutic relationship. The nurse, 
who wants to create the right relationship with the patient, must 
win him/her from the first moment. This will happen if the 
conversation is held in appropriate conditions. Even though it 
seems obvious, it should be noted that courtesy and kindness 
on part of the nurse is required (4, 17). 

The patient should feel comfortable with the nurse, but 
the latter should protect his/her prestige and not give rise to 
misunderstandings. A key element is the need for a peaceful 
environment with no external distractions, which will ensure 
appropriate confidentiality of the dialogue. Frequently we see 
the phenomenon of serious discussions taking place in the mid- 
dle of the corridor of the outpatient department or the nursing 
department, clinic, or in some office of the hospital, in which 



third parties unrelated to the care of the individual patient are 
coming in and out (18). In such an environment the patients 
are ashamed to express themselves freely (19). 

Unfortunately, the concept of privacy is pretty much un- 
known to the Greek hospital system. Skilled nursing operations 
for the patients are made in chambers without screens or in hall- 
ways, in front of others. Patients and visitors of hospitals move 
without restriction in all the areas of the nursing and clinical 
departments. However, it is up to us to teach our colleagues and 
especially the new nurses and their patients setting the right 
example, in order for things to slowly change for the better (20). 

Even more than the comfort of space, communication with 
the patient requires ample time. Each patient has his own way 
and pace to reveal his problem, but it takes some time to get to 
know the nurses and feel the confidence necessary to face them. 
The patient should have the feeling that the time-whether it is 
five minutes or an hour-is entirely his. The patient who has the 
undivided attention of the nurse reveals his problem sooner, 
with the satisfaction that the nurse has listened and observed 
him (21). After the nurse has listened to the ill, he/she should 
also talk to him. The language he uses for this purpose is very 
important. Often the patient is bombarded with big words with 
little or no significance for him (22). Once again the nurse may 
be directed to the ill in an incomprehensible way. Patients that 
are ashamed of their ignorance or are hesitant, avoid seeking 
an explanation, and as a result the consultation is inadequate 
and does not lead to the right outcome for the patient. The lan- 
guage of communication should therefore be at the level of the 
listener, who is not able to assess our scientific knowledge, but 
has to understand what we are telling him (23). 

Another important requirement for proper and successful 
communication between nurses and patients is frankness and 
honesty. The discussion with the patient should leave no suspi- 
cions, doubts and misunderstandings. For example, if the patient 
suspects that while chatting with him we are making gestures 
to an escort, he/she will suspect that we are not telling him the 
whole truth (4). Where there is a need for a separate and pri- 
vate discussion with someone from the patient's environment, 
we should be very careful of the place, manner and time of this 
communication, which should be independent of the discussion 
with the patient (24, 25). 

Communication as already stated is bidirectional, but the 
nurse or other health professional is responsibility for its proper 
conduct. The patient comes into the dialogue under stress and 
the emotional events he/she is facing. Moreover, depending on 
the psychosynthesis it can be more or less calm. Reactions such 
as anger, disbelief, moaning, aggression and denial of reality 
are known defence mechanisms, which are recruited to help 
him adjust to the new situation he is facing (8, 26). The angry 
patient usually does not have any previous personal differences 
with health professionals, although they are the direct recipi- 
ents of his anger. The latter should understand and accept these 
mechanisms which serve the underlying anxiety of the patient 
and to respond with information, awareness and readiness to 
provide all possible assistance (27). 

Finally, people differ in their needs for communication. Some 
expect or require patient listening, without caring much about 
the answers. Others want a specific explanation for everything 
that happens to them. These different needs should be treated 
accordingly by the nurses, who should be able to detect what 



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PROFESSIONAL PAPER • l^ater Sociomed. 2014 Feb; 26(1): 65-67 



Communication in Nursing Practice 



each patient wants (28). What of course in any case should 
be avoided by the caregivers is silence and indifference to the 
questions of the patient. In the best cases, the patient will leave 
disappointed and in the worst really indignant with nurses (9). 

4. CONCLUSIONS 

Communication with the patient is an individual part of the 
'long art' of Hippocratic medicine (19). It is not only based on 
an innate ability that varies from person to person, but also on 
the necessary training and experience that one acquires during 
exercise (13). The need also for education in communication 
has been recognized worldwide (6). The results of this will be 
to demonstrate greater understanding among patients with 
greater benefit to patients and personal satisfaction to nurses 
in the performance of nursing (29). 

Good communication also improves the quality of care pro- 
vided to patients, which is observed in the results. Additionally, 
it is considered an inalienable right and a prerequisite for build- 
ing a genuine and meaningful relationship between patients and 
nurses and other health professionals (30). 

So in order for modern Nursing as a service to humans 
to realize the project, there is a need for dialogue and a good 
interpersonal climate that develops personally with each sick 
person, especially in our modern multicultural society. The 
best expertise training and continuing education of nurses in 
matters relating to the proper technique of communication 
will enable them to respond adequately and humanely to the 
expectations of patients. 

CONFLICT OF INTEREST: NONE DECLARED 
REFERENCES 

1. Raya A. Nursing of man as a unique person Nosileftiki. 2006; 
45(1): 19-24. 

2. Fakhr-Movahedi A, Salsali M, Negarandeh R, Rahnavard Z. 
Exploring contextual factors of the nurse-patient relationship: 
A quahtative study. Koomesh. 2011; 13(1): 23-34. 

3. Raya A. Basic Nursing. Ed. 6th. Athens, 2005. 

4. Papagiannis A. Talking with the patient: fundamental principles 
of clinical communication and announcement of bad news. Med- 
ical Time Northwestern Greece, 2010; 6 (Supplement):43-49. 

5. Papadantonaki A. Communication and Nursing. Nosileftiki. 
2006; 45(3): 297-298. 

6. Wikstrom BM, Sviden G. Exploring communication skills train- 
ing in undergraduate nurse education by means of a curriculum. 
Nursing Reports. 2011; 1(1): e7-e7. 

7. Verderber R. The art of communication. Wadsworth Publ Co, 
London, 1998. 

8. Panagopoulou E, Benos A. Communication in medical educa- 
tion. A matter of need or an unnecessary luxury? Archives of 
Hellenic Medicine. 2004; 21(4):385-390. 

9. Moussas GI, Karkanias AP, Papadopoulou AG. Psychological 
dimension of cancer genetics: Doctor-Patient communication. 
Phychiatriki. 2010; 21: 148-157. 



10. Kourkouta L. Nursing Diagnostic. PH. Paschalidis, Athens, 
2011. 

11. Arapakis GK. Clinical findings and diagnostic. Edit. 4v], Ath- 
ens, 2006. 

12. Lee SJ, Back AL, Block SD. Stewart Enhancing Psysician-Patient 
Communication. Hematology, 2002. 

13. Evans RG. Patient centred medicine: reason, emotion, and human 
spirit? Some philosophical reflections on being with patients. 
Med Humanit. 2003 Jun; 29(1): 8-14. doi: 10.1136/mh.29.1.8 

14. Pangaltsos A. Medical thought. M. Barbounaki, Thessaloniki, 
2011. 

15. Joolaee S, Joolaei A, Tschudin V, Bahrani N, Nikbakht Nas- 
rabadi A. Caring relationship: the core component of patients' 
rights practice as experienced by patients and their companions. 
Journal of Medical Ethics and History of Medicine. 2010; 3: 1-7. 

16. Papadantonaki A. Nursing Role. Nosilefiiiki. 2012; 51(1): 7-9. 

17. Fakhr-Movahedi A, Negarandeh R, Salsali M. Exploring Nurse- 
Patient Communication Strategies. Hayat Journal of Faculty of 
Nursing & Midwifery. 2012; 18(4): 28-46. 

18. McCarthy DM, Buckley BA, Engel KG, Forth VE, Adams JG, 
Cameron KA. Understanding patient-provider conversations: 
what are we talking about? Acad EmergMed. 2013 May; 20(5): 
441-8. doi: 10.1111/acem.l2138. 

19. Maguire P. Communication Skills for Doctors. Arnold, Lon- 
don, 2000. 

20. Mountokalakis TD. Behavioral rules of the modern physician. 
Days Pathology. C Medicine University of Athens. Athens, 2009. 
References to: Hippocrates "on efschimosynis", VII, 7. 

21. Teutsch C. Patient-doctor communication. Med Clin North 
Am. 2003; 87: 1115-1145. 

22. Kidd J, Patel V, Peile E, Carter Y. Clinical and communication 
skills. BMJ. 2005; 330: 374-375. 

23. Papagiannis A. Talking with the patient. University Studio Press, 
Thessaloniki, 2003. 

24. Surbone A. Telling the truth to patients with cancer. What is 
the truth? Lane Oncol. 2006; 7: 944-950. 

25. Fry M, Gallagher R, Chenoweth L, Stein-ParburyJ. Nurses' ex- 
periences and expectations of family and carers of older patients 
in the emergency department. Int Emerg Nurs. 2013 May 6. 
doi: pii: S1755-599X (13)00029-3. 10.1016/j.ienj.2013.03.007. 

26. Vukovic M, Gvozdenovic BS. Stamatovic-Gajic B, Ilic M, Gajic 
T. Development and evaluation of the nurse quality of commu- 
nication with patient questionnaire. Srpski Arhiv za Celokupno 
Lekarstvo. 2010; 138(1-2): 79-84. 

27. Kallergis G. Guide of information and communication with 
the patient: Personalization, therapeutic relationship, character, 
family. Medical Graphics, 2000. 

28. Houghton A, Allen J. Doctor-patient communication. BMJ 
Career Focus. 2005; 330: 36-37. 

29. Jason H. Communication skills are vital in all we do as educa- 
tors and clinicians. Education for Health. 2000; 13: 157-160. 

30. Diamantopoulou E. Parents' Needs for Information about the 
Management of their Chronically 111 Children. Nosileftiki. 
2009; 48(3): 317-324. 



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