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