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Effective Communication in Nursing:

Theory and Best Practices

posted May 11th, 2015 by Brian
Effective Communication in Nursing

To be a successful nurse, excellent

communication skills are required. The
ability to communicate and connect
with patients and health care
professionals can help build
relationships, prevent mistakes and
provide a higher level of care.

According to a 2013 study published

in the Journal of Patient Safety, as
many as 440,000 people die each
year from preventable medical errors,
representing the third leading cause of
death in the U.S. on the list from the
Centers for Disease Control and
Prevention (CDC). Of deaths due to
medical errors, The Joint Commission
estimates that 80 percent involve
miscommunication. The Joint
Commissions analysis of 2012, 2013
and first-quarter 2014 data revealed
that in all three time frames,
communication was one of the top
three leading causes of sentinel

events, a patient safety event

unrelated to the patients illness or
condition that results in death,
permanent harm or another qualifying
negative outcome.

Increases in nursing communication

can lessen medical errors and make a
difference in positive patient
outcomes. In a 2014 study published
by the New England Journal of
Medicine, medical error rates in nine
childrens hospitals decreased by 23
percent after a handoff program was
instituted to enhance and standardize
communication. According to Ros
Wright, the body of literature in

nursing communication points to

increased recovery rates, a sense of
safety and protection, improved levels
of patient satisfaction and greater
adherence to treatment options as
well-documented results of effective
Communication Theories in Nursing
Multiple communication theories are
used in nursing to help explain and
guide interactions made between
nurses and patients, as well as nurses
and other health care professionals.
Peplaus Interpersonal Relations

This theory focuses on the nurse-client

relationship and the therapeutic
process that takes place.
Communication that occurs in this
context involves complex factors such
as environment, in addition to
attitudes, practices and beliefs in the
dominant culture. Peplaus
interpersonal relations theory defines
four stages of the relationship that
achieve a common goal:
Peplau's Interpersonal Relations
Orientation Phase: The nurse engages
the patient in treatment, and the

patient is able to ask questions and

receive explanations and information.
This stage helps the patient develop
trust and is where first impressions
about the nurse and health care
system begin to evolve.
Identification Phase: The patient and
nurse begin to work together. These
interactions provide the basis for
understanding, trust and acceptance
as the patient becomes an active
participant in treatment.
Exploitation Phase: The patient takes
advantage of all services offered,
exploiting the nurse-patient
relationship to address treatment
Resolution Phase: As a result of
effective communication, the patients

needs are met, and he or she moves

toward full independence. The patient
no longer needs help, and the
relationship ends.
Dyadic Interpersonal Communication
The dyadic interpersonal
communication model describes the
dynamic interactive process that takes
place between two people. Based on a
sender and recipient the encoder
and decoder and outside influences
such as perception, attitude, content
and the emotional and physical
elements, the model points to the
many factors that can alter the
message or the messages delivery.

As the sender or encoder provides a

message, the recipient, or decoder,
must process the information. The
dyadic interpersonal communication
model highlights the importance of
clarity and awareness for the many
factors that can affect verbal and
nonverbal communication.
Other Theories
A number of other theories in
communication and specifically in
nursing communication have been
used in health care. For instance, Jean
Ann Seago notes that Habermas

critical theory has been used to

identify successful nurse-physician
collaborative strategies, including a
willingness to move beyond basic
information exchange and to
challenge distortions and assumptions
in the relationships. Also, Seago
mentions theories deriving from
Foucault, feminism and the aviation
industry to understand and enhance
communication. In addition to these
types of theories, several others could
be named, such as those in
experiential communication.
Best Practices in Nursing

Best Practices in Nursing


In order to help patients and work

alongside peers, nurses must consider
the skills and tools that are involved in
effective communication. From being
aware of potential barriers blocking
effective communication to utilizing
integral communication skills, nurses
can take steps toward providing better
Barriers to Effective Communication

Nurses who are aware of the common

barriers to effective communication
will be able to anticipate and properly
react to any roadblocks. With this
focus, nurses can help ensure optimal
communication and patient care.

In Effective Communication Skills in

Nursing Practice, Elain Bramhall
highlights common barriers to
effective communication for the
patient and health care providers.
Patient barriers include environmental
items such as noise, lack of privacy
and lack of control over who is
present; fear and anxiety related to
being judged, becoming emotional or

being weak; and other barriers such

as an inability in explaining feelings
and attempting to appear strong for
someone elses benefit. Health care
professional barriers include
environmental items such as lack of
time or support, staff conflict and high
workload; fear and anxiety related to
causing the patient to be distressed
by talking or responding to questions;
and other barriers such as a lack of
skills or strategies for coping with
difficult emotions, reactions or
Effective Communication Skills
In the Journal of the Academy of
Medical Sciences of Bosnia and

Herzegovina, Lambrini Kourkouta and

Ioanna Papathanasiou highlight three
foundational skills in communication:

Nonverbal Communication
An ongoing process characterized
by facial expressions, gestures,
posture and physical barriers such as
distance from the interlocutor,
nonverbal communication must agree
with verbal communication. In
stressful moments, Kourkouta and
Papathanasiou note, changes in these
two communication types can be
difficult to assess.

An important part of communication,
listening is a responsible nursing
practice and requires concentration of
attention and mobilization of all the
senses for the perception of verbal
and nonverbal messages emitted by
the patient. By listening, nurses can
be attentive to the needs of the
patient and integrate care according
to the patients evolving needs.
Personal Relationships
Marked by kindness, compassion and
care, nurses can develop good
personal relationships with the ability
to ask questions with kindness and

provide information that does not

scare, that demonstrates interest,
creates feelings of acceptance, trust
and a harmonious relationship,
especially in modern multicultural
society. This relationship is connected
to not only the transmission of
information, but also the mental and
emotional dynamics found in
Further skills can promote effective
communication practices in nurses.
Bramhall points out that asking open
questions, clarification and screening
questions can help keep the focus on
the patient. For information giving,
providing small amounts of
information at a time, checking what
information the person knows already
and pausing before continuing can

help. And for listening, summarizing,

paraphrasing, empathizing and
making educated guesses can
demonstrate that the nurse is
listening and able to communicate
effectively to patients and other
health care professionals.
Developing Crucial Communication
SEU - Gray Seal
It is no secret that communication
skills for nurses are essential and
difficult to master and they require
proper attention. Promoting effective
communication in health care is

demanding, complex and challenging

because of the nature of the work
environment, which is often stressful
and pressurized, providing little time
for communication, Bramhall writes.
If nurses are to meet these
challenges in the future, they need to
be supported by high-quality,
evidence-based training.

Through education and employmentsponsored training, nurses can

advance communication skills that are
crucial to improving as effective
health care professionals. At
Southeastern University, current
nursing professionals can enhance

their communication skills with an

online RN to BSN degree. The program
expands on knowledge and skills
nurses need to advance into
leadership positions.

For nurses, communication comes into

play in virtually any context. As nurses
cultivate these skills to develop
professional relationships with fellow
health care professionals, connect to
patients and become more wellrounded and effective individuals,
education and on-the-job training can
maximize the impact improved
communication skills will have in the

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