communication barriers in nursing essay

• Work Environment

10 Ways to Overcome Communication Barriers in Nursing

Effective communication plays a vital role in nursing, fostering understanding, collaboration, and ultimately improving patient outcomes. However, various barriers can hinder communication within healthcare settings.

In this article, we will explore ten practical ways to overcome these communication barriers and enhance the delivery of care.

Importance of Effective Communication in Nursing

Effective communication lies at the heart of nursing practice. It forms the foundation for building relationships with patients, their families, and the interprofessional healthcare team.

When communication breaks down, patient safety, satisfaction, and overall quality of care are compromised. By understanding and addressing communication barriers, you, as a nurse, can ensure effective and meaningful interactions, leading to improved patient outcomes.

Common Communication Barriers in Nursing

Language and cultural differences.

Language barriers pose significant challenges in nursing, especially in multicultural healthcare settings. Nurses must communicate with patients who have limited English proficiency or speak a different native language. Additionally, cultural differences can influence communication styles and expectations. These barriers can lead to misunderstandings, inadequate information exchange, and reduced patient satisfaction.

Technological Challenges

With the increasing use of technology in healthcare, nurses face communication barriers related to unfamiliarity with electronic health records (EHRs) and other digital systems. Technical difficulties, such as system crashes or slow response times, can impede timely communication and information sharing among healthcare providers.

Hierarchy and Power Dynamics

In healthcare settings, hierarchical structures and power dynamics can hinder effective communication. Nurses may feel hesitant to express their opinions or concerns to physicians or higher-ranking professionals, resulting in vital information being overlooked. Open communication channels and a culture of collaboration are necessary to overcome these barriers.

Emotional and Psychological Factors

Nursing can be emotionally demanding, and stress, fatigue, and burnout can affect communication skills. These factors may lead to misinterpretation of messages, increased conflicts, and decreased empathy. Addressing the emotional well-being of nurses is essential to maintain effective communication in healthcare environments.

1. Active Listening

Active listening is a fundamental skill for effective communication in nursing. By actively engaging with patients, you can demonstrate empathy, gain valuable insights, and establish trust. Here are some techniques to enhance active listening:

• Maintain eye contact : Show your attentiveness and interest in what the patient is saying.
• Provide verbal and non-verbal cues : Nodding or smiling encourages patients to express themselves more openly.
• Practice reflective listening : Summarize and rephrase what the patient has said to ensure mutual understanding.
• Avoid interruptions : Allow patients to fully express their concerns and thoughts without interruption.

2. Clear and Concise Communication

Clear and concise communication is essential to ensure information is accurately conveyed and understood. When communicating with patients, consider the following strategies:

• Use simple language : Avoid complex medical jargon and explain information in a way that patients can easily comprehend.
• Avoid assumptions : Ensure that patients understand by asking open-ended questions and confirming their understanding.
• Confirm understanding through paraphrasing : Summarize the information shared by the patient to validate comprehension.
• Encourage questions and feedback : Create a safe environment for patients to ask questions and provide feedback, ensuring effective communication.

3. Open and Transparent Communication Channels

Creating open and transparent communication channels within healthcare settings is crucial for overcoming barriers. Here’s how you can achieve this:

• Foster a culture of open communication where all team members feel comfortable sharing their thoughts and concerns.
• Encourage feedback from colleagues and actively listen to their perspectives.
• Utilize regular team huddles or meetings to discuss communication challenges and find solutions collaboratively.
• Implement mechanisms such as suggestion boxes or anonymous feedback systems to provide an avenue for open communication.
• Share relevant information and updates with the healthcare team in a timely manner to ensure everyone is well-informed.

4. Empathy and Understanding

Empathy is the ability to understand and share the feelings of another person. In nursing, empathy promotes trust and patient-centered care. Enhance empathy and understanding by:

• Practice active empathy : Put yourself in the patient’s shoes and consider their emotions and experiences.
• Strive for cultural competence : Be mindful of cultural differences and tailor your communication to respect diverse backgrounds.
• Maintain a non-judgmental attitude : Create a supportive environment where patients feel comfortable expressing themselves without fear of judgment.

5. Non-Verbal Communication

Non-verbal cues, such as body language, facial expressions, and gestures, significantly influence communication in nursing. Utilize effective non-verbal communication to enhance your interactions with patients:

• Be aware of your body language and posture : Maintain an open and welcoming stance to convey approachability.
• Use facial expressions : Show empathy, concern, and reassurance through appropriate facial expressions.
• Utilize gestures and touch : Use gentle gestures and appropriate touch to convey comfort and support, when appropriate.

6. Use of Technology

In the modern healthcare landscape, technology plays a significant role in communication. While it offers numerous advantages, it can also present challenges. Embrace technology and leverage its potential for effective communication:

• Utilize electronic health records : Ensure accurate and timely documentation, promoting continuity of care.
• Explore telemedicine and video conferencing : Facilitate remote consultations and improve access to healthcare services.
• Leverage mobile communication devices : Use secure messaging platforms to communicate efficiently with colleagues and share important patient information.

7. Team Collaboration

Collaboration among healthcare professionals is crucial for providing holistic patient care. Effective team communication ensures that everyone involved is well-informed, contributing to seamless coordination. Foster effective collaboration through:

• Interprofessional communication: Maintain open lines of communication with colleagues from different disciplines.
• Participate in regular team meetings : Discuss patient care plans, exchange information, and address any communication challenges.
• Establish clear role expectations : Define each team member’s responsibilities and ensure everyone understands their role in patient care.

8. Patient Education

Patient education empowers individuals to actively participate in their care. As a nurse, you play a vital role in educating patients and breaking down complex medical information. Enhance patient education through:

• Use visual aids : Utilize diagrams, charts, and models to simplify complex concepts and enhance understanding.
• Provide written materials and handouts : Give patients written instructions and resources they can refer to after their interaction with you.
• Ensure patient comprehension : Use teach-back techniques to confirm that patients understand the information you have shared.

9. Language and Cultural Considerations

Language and cultural barriers can significantly impact communication in healthcare. Address these barriers by:

• Utilizing professional interpreters : When language barriers exist, engage the services of interpreters to facilitate effective communication.
• Understanding cultural norms and beliefs : Be culturally sensitive and adapt your communication style to accommodate diverse cultural backgrounds.
• Providing translated materials : Offer translated written materials and resources to assist patients who may have language limitations.

10. Feedback and Continuous Improvement

Feedback is essential for growth and development in nursing communication. Seek feedback from patients and colleagues to identify areas for improvement. Foster a culture of continuous improvement by:

• Seeking feedback from patients : Encourage patients to share their experiences and suggestions for better communication.
• Reflecting on your communication practices : Take time to evaluate your communication techniques and identify areas where you can improve.
• Participating in training and workshops : Attend professional development opportunities to enhance your communication skills and stay up-to-date with best practices.

Benefits of Overcoming Communication Barriers

By overcoming communication barriers, nursing professionals can experience numerous benefits:

• Improved Patient Outcomes: Effective communication leads to better patient understanding of their condition and treatment plans, reducing the risk of medical errors and improving overall healthcare outcomes.
• Enhanced Collaboration and Teamwork: Clear communication fosters collaboration among healthcare professionals, facilitating coordinated care and shared decision-making, ultimately benefiting patient outcomes.
• Increased Patient Satisfaction: When patients feel heard and understood, their satisfaction with the healthcare experience increases, leading to greater patient engagement and adherence to treatment plans.
• Reduced Errors and Misunderstandings: Overcoming communication barriers minimizes the likelihood of misinterpretations, misunderstandings, and errors that can compromise patient safety.

Training and Education for Effective Communication

To equip nurses with effective communication skills, various training and educational opportunities can be provided:

• Communication Skills Workshops: Organizing workshops that focus on active listening, conflict resolution, and effective communication techniques can enhance nurses’ interpersonal skills.
• Cultural Competency Training: Offering training programs that promote cultural awareness, sensitivity, and understanding helps nurses navigate diverse patient populations and communicate effectively across cultures.
• Technology Integration Training: Providing comprehensive training on using digital systems, EHRs, and other communication tools ensures nurses can leverage technology for efficient and secure communication.

In conclusion, effective communication in nursing is vital for providing safe, quality care. By implementing these ten strategies we mentioned above, you can overcome communication barriers, establish meaningful connections, and optimize patient outcomes. Remember, communication is a skill that can always be honed, and fostering open, empathetic, and clear interactions is key to delivering exceptional nursing care.

Q: How can you overcome communication barriers with patients who have limited English proficiency?

A: To overcome language barriers, you can utilize professional interpreters, use visual aids and gestures, and provide translated written materials. It’s important to create a supportive environment and allow extra time for communication with patients who have limited English proficiency.

Q: What are some effective strategies for communicating with patients from diverse cultural backgrounds?

A: When communicating with patients from diverse cultural backgrounds, it is important to be culturally sensitive, respect cultural norms and beliefs, and use culturally appropriate communication styles. Take the time to learn about different cultures, ask open-ended questions, and actively listen to foster effective communication.

Q: How can you promote effective communication during challenging situations, such as delivering difficult news to patients or their families?

A: When delivering difficult news, you can promote effective communication by demonstrating empathy, providing a calm and supportive environment, and using clear and compassionate language. Allow patients and their families to express their emotions, actively listen to their concerns, and offer appropriate support and resources.

Q: What can you do to improve communication within interdisciplinary healthcare teams?

A: To improve communication within interdisciplinary teams, actively participate in regular team meetings, clarify roles and responsibilities, and maintain open and respectful communication channels. Share information, seek input from team members, and foster a collaborative environment to enhance teamwork and patient outcomes.

Q: How can you ensure effective communication during patient handoffs or transitions of care?

A: To ensure effective communication during patient handoffs, use standardized protocols, document important information accurately, and engage in face-to-face or electronic communication with the receiving healthcare team. Provide a comprehensive and concise summary of the patient’s condition, treatment plan, and any ongoing concerns.

Q: How can you incorporate feedback from patients into your communication practices?

A: Actively seek feedback from patients by encouraging them to share their experiences, concerns, and suggestions. Provide patient satisfaction surveys or feedback forms to facilitate the collection of valuable input. By listening to patient feedback and implementing necessary improvements, you can continuously enhance your communication skills.

Sophia Miller

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• Open access
• Published: 03 September 2021

A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward

• Abukari Kwame 1 &
• Pammla M. Petrucka 2  

BMC Nursing volume  20 , Article number:  158 ( 2021 ) Cite this article

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Providing healthcare services that respect and meet patients’ and caregivers’ needs are essential in promoting positive care outcomes and perceptions of quality of care, thereby fulfilling a significant aspect of patient-centered care requirement. Effective communication between patients and healthcare providers is crucial for the provision of patient care and recovery. Hence, patient-centered communication is fundamental to ensuring optimal health outcomes, reflecting long-held nursing values that care must be individualized and responsive to patient health concerns, beliefs, and contextual variables. Achieving patient-centered care and communication in nurse-patient clinical interactions is complex as there are always institutional, communication, environmental, and personal/behavioural related barriers. To promote patient-centered care, healthcare professionals must identify these barriers and facitators of both patient-centered care and communication, given their interconnections in clinical interactions. A person-centered care and communication continuum (PC4 Model) is thus proposed to orient healthcare professionals to care practices, discourse contexts, and communication contents and forms that can enhance or impede the acheivement of patient-centered care in clinical practice.

Peer Review reports

Providing healthcare services that respect and meet patients’ and their caregivers’ needs are essential in promoting positive care outcomes and perceptions of quality of care, thus constituting patient-centered care. Care is “a feeling of concern for, or an interest in, a person or object which necessitates looking after them/it” [ 1 ]. The Institute of Medicine (IOM) noted that to provide patient-centered care means respecting and responding to individual patient’s care needs, preferences, and values in all clinical decisions [ 2 ]. In nursing care, patient-centered care or person-centered care must acknowledge patients’ experiences, stories, and knowledge and provide care that focuses on and respects patients’ values, preferences, and needs by engaging the patient more in the care process [ 3 ]. Healthcare providers and professionals are thus required to fully engage patients and their families in the care process in meaningful ways. The IOM, in its 2003 report on Health Professions Education , recognized the values of patient-centered care and emphasized that providing patient-centered care is the first core competency that health professionals’ education must focus on [ 4 ]. This emphasis underscored the value of delivering healthcare services according to patients’ needs and preferences.

Research has shown that effective communication between patients and healthcare providers is essential for the provision of patient care and recovery [ 5 , 6 , 7 , 8 ]. Madula et al. [ 6 ], in a study on maternal care in Malawi, noted that patients reported being happy when the nurses and midwives communicated well and treated them with warmth, empathy, and respect. However, other patients said poor communication by nurses and midwives, including verbal abuse, disrespect, or denial from asking questions, affected their perceptions of the services offered [ 6 ]. Similarly, Joolaee et al. [ 9 ] explored patients’ experiences of caring relationships in an Iranian hospital where they found that good communication between nurses and patients was regarded as “more significant than physical care” among patients.

According to Boykins [ 10 ], effective communication is a two-way dialogue between patients and care providers. In that dialogue, both parties speak and are listened to without interrupting; they ask questions for clarity, express their opinions, exchange information, and grasp entirely and understand what the others mean. Also, Henly [ 11 ] argued that effective communication is imperative in clinical interactions. He observed that health and illness affect the quality of life, thereby making health communication critical and that the “intimate and sometimes overwhelming nature of health concerns can make communicating with nurses and other healthcare providers very challenging” [ 11 ]. Furthermore, Henly [ 11 ] added that patient-centered communication is fundamental to ensuring optimal health outcomes, reflecting long-held nursing values that care must be individualized and responsive to patient health concerns. Given the prevalence of face-to-face and device-mediated communications and interactions in healthcare settings, we must explore and clarify who, what, where, when, why, and how interactions with individuals, families, and communities are receiving care and health services [ 11 ].

The value of effective communication in nurse-patient clinical interactions cannot be overemphasized, as “research has shown that communication processes are essential to more accurate patient reporting and disclosure” [ 12 ]. Respectful communication between nurses and patients can reduce uncertainty, enhance greater patient engagement in decision making, improve patient adherence to medication and treatment plans, increase social support, safety, and patient satisfaction in care [ 12 , 13 ]. Thus, effective nurse-patient clinical communication is essential to enhancing patient-centered care and positive care outcomes.

Patient-centered communication, also known as person-centered communication or client-centered communication, is defined as a process that invites and encourages patients and their families to actively participate and negotiate in decision-making about their care needs, as cited in [ 7 ]. Patient-centered communication is crucial in promoting patient-centered care and requires that patients and their caregivers engage in the care process. As McLean [ 14 ] observed, patient-centered care can be enhanced through patient-centered communication by valuing patients’ dignity and rights. Through open communication and collaboration, where information and care plans are shared among care providers, patients, and their families, care provision becomes patient-centered [ 14 ].

Given the interconnected nature of patient-centered care and communication, we must identify the barriers and enablers of patient-centered care and communication and proposed efficient ways to enhance that because patient-centered communication is essential in achieving patient-centered care. Our aim in this paper is to identify the barriers and facilitators of patient-centered care and communication and propose and present a patient-centered care and communication continuum (PC4) Model to explain how patient-centered care can be enhanced in nurse-patient clinical interactions. As Grant and Booth argued, critical reviews are often used to present, analyse, and synthesized research evidence from diverse sources, the outcome of which is a hypothesis or a model as an interpretation of existing data to enhance evidence-based practice [ 15 ]. Thus, this critical literature review study explores the questions: what are the barriers and facilitators of patient-centered care and how can patient-centered care be enhanced through effective clinical communication?

An earlier version of this study was submitted as part of author AK’s doctoral comprehensive exams in February 2021. An interdisciplinary doctoral committee recommended many of the included literature and the questions explored in this study based on the current discourse of patient-centered care advocated for in many healthcare facilities and in recognition of the universal healthcare access objective of the health sustainable development goal. Additional searches for literature were conducted between September and November 2020 using keywords such as barriers and facilitators of nurse-patient interaction, patient-centered care, patient-centered communication , and nurse-patient communication . Databases searched included CINAHL, PubMed, Medline, and Google Scholar. Included studies in this critical review were empirical research on nurse-patient interactions in different care settings published in English and open access. All relevant articles were read, and their main findings relevant to our review questions were identified and organized into themes and subthemes discussed in this paper. Other published studies were read, and together with those that addressed the review question, a model was developed regarding how to enhance patient-centered care through effective communication.

Barriers to Patient-Centered Care and Communication

Nurses constitute a significant workforce of care providers whose practices can severely impact care outcomes (both positive and negative). Nurses spend much time with patients and their caregivers. As a result, positive nurse-patient and caregiver relationships are therapeutic and constitute a core component of care [ 9 , 13 ]. In many instances, nurses serve as translators or patients’ advocates, in addition to performing their primary care duties. Although good nurse-patient relationships positively impact nurse-patient communication and interaction, studies have shown that several factors impede these relationships with significant consequences on care outcomes and quality [ 6 , 16 , 17 ]. Thus, these barriers limit nurses’ and other care providers’ efforts to provide healthcare that meets patients’ and caregivers’ needs. We categorize the barriers to patient-centered care and communication into four kinds: institutional and healthcare system-related, communication-related, environment-related, and personal and behaviour-related barriers. Although these barriers are discussed in separate subheadings, they are interlinked in complex ways during clinical practice.

Institutional and Healthcare System Related Barriers

Many barriers to providing patient-centered care and communication during nurse-patient interactions emanate from healthcare institutional practices or the healthcare system itself. Some of these factors are implicated in healthcare policy or through management styles and strategies.

Shortage of nursing staff, high workload, burnout, and limited-time constituted one complex institutional and healthcare system-level barrier to effective care delivery [ 18 , 19 ]. For instance, Loghmani et al. [ 20 ] found that staffing shortages prevented nurses from having adequate time with patients and their caregivers in an Iranian intensive care unit. Limitations in nursing staff, coupled with a high workload, led to fewer interactions between nurses, patients, and caregivers. Similarly, Anoosheh et al. [ 16 ] found that heavy nursing workload was ranked highest as a limiting factor to therapeutic communication in nurse-patient interactions in Iran.

In a study on communication barriers in two hospitals affiliated with Alborz University of Medical Sciences, Norouzinia et al. [ 21 ] found that shortage of nurses, work overload, and insufficient time to interact with patients were significant barriers to effective nurse-patient interactions. Similar factors are identified as barriers to nurse-patient communication and interactions in other studies [ 13 , 16 , 18 ]. For instance, Amoah et al. [ 16 ] reported that nursing staff shortage and high workload were barriers to patient-centered care and therapeutic communication among Ghanaian nurses and patients. Amoah and colleagues reported a patient’s statement that:

[B]ecause there are few nurses at the ward, sometimes you would want a nurse to attend to you, but he or she might be working on another patient, so in such case, the nurse cannot divide him or herself into two to attend to you both [ 16 ].

Nurses and patients and their caregivers have noted that limited time affects nurse-patient interactions, communication, and care quality. Besides, Yoo et al. [ 22 ] reported that limited visiting hours affected communications between caregivers and nurses in a tertiary hospital in Seoul, Korea. Since the caregivers had limited time to spend with patients, they had little knowledge about the intensive care unit and distrusted the nurses.

Although nursing staff shortage is a significant barrier to patient-centered care and communication that healthcare institutions and managers must know, some healthcare scholars have critique nurses’ complaints of time limitation. For instance, McCabe [ 7 ] argued that the quality of nurse-patient interactions is what matters and not the quantity of time spent with patients and their caregivers. McCabe maintained that “spending long periods with patients does not always result in positive nurse-patient relationships” [ 7 ]. He argued that implementing patient-centered care does not require additional time; hence, nurses’ perceptions of being too busy cannot excuse poor therapeutic communication during clinical interactions. Instead, nurses are encouraged to develop self-awareness, self-reflection, and a commitment to ensuring that patients receive the needed care.

Another institution-related barrier to patient-centered care and communication is the healthcare system’s emphasis on task-centered care. Care providers are more focused on completing care procedures than satisfying patients’ and caregivers’ needs and preferences. This barrier to patient-centered care and communication is acknowledged in several studies [ 7 , 14 , 20 , 22 , 23 ]. For example, McLean [ 14 ] studied dementia care in nursing homes in the United States. She found that patient-centered care and communication in one nursing home (Snow I) were severely affected when nurses, physicians, and care managers focused on completing tasks or observing care and institutional routines to the detriment of satisfying patients’ care needs. However, in the other care home (Snow II), patient-centered care was enhanced as nurses, physicians, and the care home managers focused on addressing patients’ needs and values rather than completing care routines and tasks.

Similarly, Yoo and colleagues [ 22 ] observed that nurse-patient communication was affected when the ICU nurses placed urgency on completing tasks linked directly to patients’ health (e.g., stabilizing vital signs) than communicating to addressed patients’ specific needs. This evidence shows that when nurses are more task-focused, patients and caregivers are treated as bodies and objects, on which medical and care practices must be performed to restore health. Research has shown that when nurses focus on task-oriented care, it becomes hard to provide holistic care to patients or teach and communicate with patients even when nurses are less busy [ 20 ].

Nursing managers and their management styles can affect patient-centered care and communication. Studies have revealed that the management styles that nursing managers implement can either facilitate or impede patient-centered care [ 14 , 22 ]. When nurse managers orient their nursing staff towards task-centered care practices, it affects nurse-patient interaction and communication. Moreover, when nurse managers fail to address their staff’s mental health needs and personal challenges, it influences how nurses attend to patients’ care needs. For example, nurses have indicated that nurse-patient communication is affected when nurse managers are unsupportive or unresponsive to their needs [ 20 ].

In a study exploring nursing and midwifery managers’ perspectives on obstacles to compassion giving and therapeutic care across 17 countries, Papadopoulos et al. [ 24 ] discovered that nurses and midwifery managers’ characteristics and experiences could facilitate or impede compassion and therapeutic interactions in nursing care. Negative personal attitudes, including selfishness, arrogance, self-centeredness, rudeness, lack of leadership skills, the desire for power, and feelings of superiority among nurses and midwifery managers, were obstacles to compassion building. The study further showed that managers who emphasize rules, tasks, and results do not prioritize relationship-building and see their staff as workers rather than team members [ 24 ]. Therefore, nurse managers and care administrators must monitor nurse-patient interaction and communication to address nurses’ concerns and support them, especially in resource-constrained and high patient turnover contexts [ 25 , 26 ].

Communication-Related Barriers

Effective communication is essential to providing patient-centered care. Studies have shown that poor communication between care providers and patients and their caregivers affects care outcomes and perceptions of care quality [ 7 , 16 , 27 , 28 ]. A consistent communication-related barrier in nurse-patient interaction is miscommunication, which often leads to misunderstandings between nurses, patients, and their families [ 20 ]. Other communication-related barriers include language differences between patients and healthcare providers [ 6 , 16 , 27 ], poor communication skills, and patients’ inability to communicate due to their health state, especially in ICU, dementia, or end-of-life care contexts [ 13 , 22 ]. For instance, in their maternity care study, Madula et al. [ 6 ] noted that language barriers significantly affected effective communication between nurses/midwives and expectant mothers. A patient in their study indicated that although many nurses were polite and communicated well, some nurses had challenges communicating with patients in the Chitumbuka language, which affected those nurses’ ability to interact effectively with patients [ 6 ].

Furthermore, Norouzinia et al. [ 21 ] asserted that effective communication could not be established when nurses and patients have a language difference. Moreover, the meanings of certain non-verbal communication acts (e.g., head nodding, eye gaze, touch) can invoke different interpretations across different cultures, which could impede the interactions between patients and nurses. Even in healthcare contexts where nurses and patients speak the same language, “differences in vocabulary, rate of speaking, age, background, familiarity with medical technology, education, physical capability, and experience can create a huge cultural and communication chasm” between nurses and patients [ 12 ]. In ICU and other similar care settings, nurses find it difficult to effectively communicate with patients because the mechanical ventilators made it hard for patients to talk [ 22 ].

To overcome the communication-related barriers, healthcare institutions must make it a responsibility to engage translators and interpreters to facilitate nurse-patient interactions where a language barrier exists. Moreover, nurses working in ICU and other similar settings should learn and employ alternative forms of communication to interact with patients.

Environment-Related Barriers

The environment of the care setting can impact nurse-patient communication and the resulting care. Thus, “good health care experiences start with a welcoming environment” [ 29 ]. Mastors believed that even though good medicine and the hands working to provide care and healing to the sick and wounded are essential, we must not “forget the small things: a warm smile, an ice chip, a warm blanket, a cool washcloth. A pillow flipped to the other side and a boost in bed” [ 29 ]. The environment-related barriers are obstacles within the care setting that inhibit nurse-patient interaction and communication and may include a noisy surrounding, unkept wards, and beds, difficulties in locating places, and navigating care services. Noisy surroundings, lack of privacy, improper ventilation, heating, cooling, and lighting in specific healthcare units can affect nurse-patient communication. These can prevent patients from genuinely expressing their healthcare needs to nurses, which can subsequently affect patient disclosure or make nursing diagnoses less accurate [ 13 , 18 , 21 ]. For instance, Amoah et al. [ 16 ] revealed that an unconducive care environment, including noisy surroundings and poor ward conditions, affected patients’ psychological states, impeding nurse-patient relationships and communication. Moreover, when care services are not well-coordinated, new patients and their caregivers find it hard to navigate the care system (e.g., locating offices for medical tests and consultations), which can constrain patient-centered care and communication.

Reducing the environment-related barriers will require making the care setting tidy/clean, less noisy, and coordinating care services in ways that make it easy for patients and caregivers to access. Coordinating and integrating care services, making care services accessible, and promoting physical comfort are crucial in promoting patient-centered care, according to Picker’s Eight Principles of Patient-Centered Care [ 30 ].

Personal and Behaviour Related Barriers

The kind of nurse-patient relationships established between nurses and patients and their caregivers will affect how they communicate. Since nurses and patients may have different demographic characteristics, cultural and linguistic backgrounds, beliefs, and worldviews about health and illnesses, nurses’, patients’, and caregivers’ attitudes can affect nurse-patient communication and care outcomes. For instance, differences in nurses’ and patients’ cultural backgrounds and belief systems have been identified as barriers to therapeutic communication and care [ 12 , 13 , 21 ]. Research shows that patients’ beliefs and cultural backgrounds affected their communication with nurses in Ghana [ 16 ]. These scholars found that some patients refused a blood transfusion, and Muslim patients refused female nurses to attend to them because of their religious beliefs [ 16 ]. Further, when nurses, patients, or their caregivers have misconceptions about one another due to past experiences, dissatisfaction about the care provided, or patients’ relatives and caregivers unduly interfere in the care process, nurse-patient communication and patient-centered care were affected [ 16 , 21 ].

Similarly, nurse-patient communication was affected when patients or caregivers failed to observe nurses’ recommendations or abuse nurses due to misunderstanding [ 20 ], while patients’ bad attitudes or disrespectful behaviours towards nurses can inhibit nurses’ ability to provide person-centered care [ 31 ]. The above-reviewed studies provided evidence on how patients’ and caregivers’ behaviours can affect nurses’ ability to communicate and deliver patient-centered care.

On the other hand, nurses’ behaviours can also profoundly affect communication and care outcomes in the nurse-patient dyad. When nurses disrespect, verbally abuse (e.g., shouting at or scolding), and discriminate against patients based on their social status, it affects nurse-patient communication, care outcomes, and patient disclosure [ 6 , 32 ]. For instance, Al-Kalaldeh et al. [ 18 ] believe that nurse-patient communication is challenged when nurses become reluctant to hear patients’ feelings and expressions of anxiety. When nurses ignore patients’ rights to share ideas and participate in their care planning, such denials may induce stress, discomfort, lack of trust in nurses, thereby leading to less satisfaction of care [ 18 ].

Furthermore, when nurses fail to listen to patients’ and caregivers’ concerns, coerce patients to obey their rules and instructions [ 16 , 17 , 20 ], or fail to provide patients with the needed information, nurse-patient communication and patient-centered care practices suffer. To illustrate, in Ddumba-Nyanzia et al.‘s study on communication between HIV care providers and patients, a patient remarked that: “I realized no matter how much I talked to the counselor, she was not listening. She was only hearing her point of view and nothing else, [and] I was very upset” [ 17 ]. This quote indicates how care provider attitudes can constrain care outcomes. Due to high workload, limited time, poor remunerations, and shortage of personnel, some nurses can develop feelings of despair, emotional detachment, and apathy towards their job, which can lead to low self-esteem or poor self-image, with negative consequences on nurse-patient interactions [ 13 , 18 ].

Given the significance of effective communication on care, overcoming the above personal and behaviour related barriers to patient-centered care and communication is crucial. Nurses, patients, and caregivers need to reflect on the consequences of their behaviours on the care process. Thus, overcoming these barriers begins with embracing the facilitators of patient-centered care and communication, which we turn to in the next section.

Facilitators of patient-centered care and communication

Patient-centered care and communication can be facilitated in several ways, including building solid nurse-patient relationships.

First, an essential facilitator of patient-centered care and communication is overcoming practical communication barriers in the nurse-patient dyad. Given the importance of communication in healthcare delivery, nurses, patients, caregivers, nursing managers, and healthcare administrators need to ensure that effective therapeutic communication is realized in the care process and becomes part of the care itself. Studies have shown that active listening among care providers is essential to addressing many barriers to patient-centered care and communication [ 7 , 13 ]. Although handling medical tasks promptly in the care process is crucial, the power of active listening is critical, meaningful, and therapeutic [ 22 ]. By listening to patients’ concerns, nurses can identify patients’ care needs and preferences and address their fears and frustrations.

Another facilitator of patient-centered care is by understanding patients and their unique needs [ 25 ], showing empathy and attending attitudes [ 7 , 13 ], expressing warmth and respect [ 22 ], and treating patients and caregivers with dignity and compassion as humans. For instance, McCabe [ 7 ] noted that attending, which obligates nurses to demonstrate that they are accessible and ready to listen to patients, is a patient-centered care process; a fundamental requirement for nurses to show genuineness and empathy, despite the high workload. Showing empathy, active listening, respect, and treating patients with dignity are core to nursing and care, and recognized in the Code of Ethics for Nurses [ 33 ], and further emphasized in the ongoing revision of the Code of Ethics for nurses [ 34 ].

Besides, engaging patients and caregivers in the care process through sharing information, inviting their opinion, and collaborating with them constitutes another facilitator of patient-centered care and communication. When patients and caregivers are engaged in the care process, misunderstandings and misconceptions are minimized. When information is shared, patients and caregivers learn more about their health conditions and the care needed. As McLean [ 14 ] argued, ensuring open communication between care providers and patients and their families is essential to enhancing patient-centered care. Conflicts ensue when patients or their families are denied information or involvement in the care process. As a result, the Harvard Medical School [ 30 ] identified patient engagement, information sharing, and nurse-patient collaboration during care as essential patient-centered care principles.

Finally, health policy must be oriented towards healthcare practices and management to facilitate patient-centered care and communication. These policies, at a minimum, can involve changes in management styles within healthcare institutions, where nurse managers and healthcare administrators reflect on nursing and care practices to ensure that the Code of Ethics of Nurses and patients’ rights are fully implemented. Resource constraints, staff shortages, and ethical dilemmas mainly affect care practices and decision-making. Nonetheless, if patients are placed at the center of care and treated with dignity and respect, most of the challenges and barriers of patient-centered care will diminish. Empowering practicing nurses, equipping them with interpersonal communication skills through regular in-service training, supporting them to overcome their emotional challenges, and setting boundaries during nurse-patient interactions will enhance patient-centered care practices.

In line with the above discussion, Camara et al. [ 25 ] identify three core dimensions that nurses, patients, and caregivers must observe to enhance patient-centered care: treating the patient as a person and seeing the care provider as a person and a confidant. Regarding the first dimension, care providers must welcome patients, listen to them, share information with them, seek their consent, and show them respect when providing care. The second dimension requires that the healthcare provider be seen and respected as a person, and negative perceptions about care providers must be demystified. According to Camara et al. [ 25 ], care providers must not overemphasize their identities as experts but rather establish good relationships with patients to understand patients’ personal needs and problems. Lastly, patients and caregivers must regard care providers as confidants who build and maintain patients’ trust and encourage patients’ participation in care conversations. With this dimension, patients and caregivers must know that nurses and other care providers have the patient at heart and work to meet their care needs and recovery process.

Camara et al.‘s [ 25 ] three dimensions are essential and position patients, their caregivers, and nurses as partners who must engage in dialogic communication to promote patient-centered care. As a result, effective communication, education, and increased health literacy among patients and caregivers will be crucial in that direction.

Enhancing Patient-Centered Care and Communication: A Proposed Model

Nursing care practices that promote patient-centered communication will directly enhance patient-centered care, as patients and their caregivers will actively engage in the care process. To enhance patient-centered communication, we propose person-centered care and communication continuum (PC4) as a guiding model to understand patient-centered communication, its pathways, and what communication and care practices healthcare professionals must implement to achieve person-centered care. In this PC4 Model, we emphasize the person instead of the patient because they are a person before becoming a patient. Moreover, the PC4 Model is supposed to apply to all persons associated with patient care; thus, respect for the dignity of their personhood is crucial.

Although much is written about patient-centered communication in the healthcare literature, there is a gap regarding its trajectory and what communication content enhances patient-centered communication. Also, little is known about how different clinical discourse spaces influence communication and its content during nurse-patient clinical interactions. Using evidence from Johnsson et al. [ 3 ], Murira et al. [ 23 ], and Liu et al. [ 35 ], among other studies, we outline the components of the PC4 Model and how different discourse spaces in the clinical setting and the content of communication impact patient-centered care and communication.

The proposed PC4 Model in this paper has three unbounded components based on the purpose of and how communication is performed among care providers, patients, and their caregivers. Figure  1 illustrates the PC4 Model, its features, and trajectory.

A Person-Centered Care and Communication Continuum (PC4 Model)

Task-Centered Communication

At the lowest end of the PC4 Model is task-centered communication. Here, the care provider’s role is to complete medical tasks as fast as possible with little or no communication with the patient and their caregivers. Patients and caregivers are treated as bodies or objects whose disease symptoms need to be studied, identified, recorded, treated, or cured. As Johnsson et al. [ 3 ] observed, communication content at this stage is mainly biomedically oriented, where nurses and other healthcare professionals focus on the precise medical information (e.g., history taking, medical examination, test results, medication, etc.) about the patient. With a task-centered orientation, nurses make journal entries about their patients’ disease state and ensure that treatment plans, diagnostic tests, and medical prescriptions are completed. Communication at this stage is often impersonal or rigid (see [ 23 ] for details). Care providers may address patients and their caregivers by using informal attributes (e.g., bed 12, the woman in the red shirt, card 8, etc.), thereby ignoring patients’ and caregivers’ personal and unique identities. Patients’ and caregivers’ nonverbal communication signs are mostly overlooked.

Motivations for task-centered communication can be attributed to time limitation, high workload, and staff shortage, thereby pushing nurses and other care providers to reach as many patients as possible. Moreover, the healthcare system’s orientation towards and preference for biomedically-focused care seems to favour task-centered communication [ 7 , 14 ].

Depending on the clinical discourse space under which patient-provider interactions occur, different forms of communication are employed. Clinical discourse spaces can be public (e.g., in the ward, patient bedside), private (e.g., consulting rooms, medical test labs, nurse staff station, etc.), or semi-private (e.g., along the corridor) [ 35 ]. In these clinical discourse spaces, nurse-patient communication can be uninformed (patients or caregivers are not informed about patients’ care conditions or why specific data and routines are performed). It can be non-private (others can hear what the nurse and patient are talking about) or authoritative (care providers demonstrate power and control and position themselves as experts) [ 23 ]. Finally, in task-centered communication, healthcare providers often use medical jargon or terminologies [ 3 ] since the goal of communication is not to engage the patient in the process. Usually, patients or their caregivers are not allowed to ask questions, or their questions get ignored or receive superficial, incomprehensible responses.

Process-Centered Communication

Process-centered communication is an intermediate stage on the continuum, which could slip back into the task-centered or leap forward into person-centered communication. Through process-centered communication, care providers make an effort to know patients and their caregivers as they perform care routines. Care providers ask patients or their caregivers questions to understand the care conditions but may not encourage patients or caregivers to express their thoughts about their care needs. Patients and caregivers are recognized as persons with uniques care needs but may not have the agency to influence the care process. Care providers may chit-chat with patients or their caregivers to pass the time as they record patients’ medical records or provide care. Unlike task-centered communication, there is informative and less authoritative communication between nurses and patients and their caregivers. The goal of process-centered communication could be a mixture of instrumental and relational, with less display of power and control by nurses.

Person-Centered Communication

This is the highest point of the PC4 Model, where patient-centered care is actualized. At this stage of the communication continuum, patients and caregivers are treated as unique persons with specific care needs and are seen as collaborators in the care process. As McLean [ 14 ] observed, caregiving becomes a transactional relationship between the care provider and receiver at the person-centered stage of the continuum. The care itself becomes intersubjective, a mutual relational practice, and an ongoing negotiation for care providers and receivers [ 14 ].

The content of communication at this stage of the continuum is both “personal” and “explanatory” [ 3 ]. Nurses and other healthcare providers create meaningful relationships with patients and their caregivers, understand patients’ concerns, needs, and problems, use open-ended questions to encourage patients or caregivers to express their thoughts and feelings about the care situation. Nurses and other healthcare professionals explain care routines, patients’ health conditions, and management plans in lay language to patients and caregivers through person-centered communication. Accomplishing this level includes employing alternative forms of communication to meet the needs of intensive care unit patients, deaf patients, and ventilated and intubated patients. For instance, it has been shown that “deaf people […] frequently do not have access to clear and efficient communication in the healthcare system, which deprives them of critical health information and qualified health care” [ 36 ]. Empathetic communication practices, including active listening, showing genuine interest in patients’ care, and respect and warmth, become a significant part of nursing care [ 3 , 7 , 14 , 22 ].

Different communication strategies are employed based on the care situation and context. Chit-chatting, as a form of personal communication [ 3 ], use of humor as a communication strategy [ 7 , 8 ], and even maintaining silence [ 28 ] are essential in enhancing person-centered care and communication. Both care providers and patients or their caregivers use relationship-building and -protecting humor (see [ 28 ] for details) to address difficult situations in the care process.

Implications of the PC4 Model for Nursing Practice

Given the values of effective communication in nurse-patient interactions and care outcomes, nurses and other healthcare providers must ensure that they develop therapeutic relationships with patients, their families, and caregivers to promote person-centered care and communication. Achieving that begins with knowing and reflecting on the barriers of therapeutic communication and ways to minimize them. The PC4 Model draws nurses and all healthcare providers’ attention to patient-centered care pathways and how effective communication is necessary. Healthcare professionals, including nurses, must be aware of how their communication orientation–––either oriented toward completing tasks, following care processes or toward addressing patients’ and their caregivers’ needs––can impact patient-centered care. Healthcare providers must observe the care context, patients’ unique situations, their non-verbal language and action, and whether they belong to historically marginalized groups or cultures.

Mastors [ 29 ] has offered healthcare providers some guidance to reflect on as they communicate and interact with patients and caregivers. Thus, (a) instead of asking patients, “What’s the matter?“ care providers must consider asking them, “What’s important to you?“ With this question, the patient is given a voice and empowered to contribute to their own care needs. Care providers should (b) check with patients in the waiting room to update patients whose waiting time has been longer than usual, based on the care context. They should also (c) try to remember their conversations with patients to build on them during subsequent interactions. This continuity can be enhanced by nurse managers reexamining how they deploy care providers to patients. The same nurse can be assigned to the same patients for the duration of the patient’s stay to help patients feel valued and visible [ 29 ].

Knowledge of cultural competence, sensitivity, humility, and interpersonal communication skills will help achieve and implement the PC4 Model. As Cuellar [ 37 ] argues, “[h]umility is about understanding and caring for all people [and] being empathetic.“ Cultural competence is a “dynamic process of acquiring the ability to provide effective, safe, and quality care to the patients through considering their different cultural aspects” [ 38 ]. The concept of cultural competence entails “cultural openness, awareness, desire, knowledge and sensitivity” during care [ 39 ]. It demands that care providers respect and tailor care to align with patients’ and caregivers’ values, needs, practices, and expectations, based on care and moral ethics and understanding [ 39 ]. Active listening and showing compassion as therapeutic relationship-building skills are essential, and continuous education and mentorship will be crucial to developing these skills among healthcare providers.

We invite qualitative and quantitative studies, especially on language use and communication strategies, to explore and evaluate the PC4 Model. Providing in-depth and experiential data on ways to increase its effectiveness as a tool to guide healthcare providers is highly desired. More knowledge can support healthcare providers in offering evidence-based patient-centered care in different healthcare settings and units.

Conclusions

Effective communication is an essential factor in nurse-patient interactions and a core component of nursing care. When communication in the nurse-patient dyad is patient-centered, it becomes therapeutic. It allows for trust and mutual respect in the care process, thereby promoting care practices that address patients’ and caregivers’ needs, concerns, and preferences. We have identified the barriers and facilitators of patient-centered care and communication and proposed a person-centered care and communication continuum (PC4 Model) to demonstrate how patient-centered communication intersects with patient-centered care.

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Abbreviations

Intensive Care Unit

Institution of Medicine

Person-Centered Care and Communication Continuum

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Acknowledgments

We express our gratitude to the first author’s doctoral committee members for their valuable comments, suggestions, and critique of an earlier version of this paper. We are also grateful to the anonymous reviewers for the insightful comments and suggestions that have helped us improve the study’s quality.

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Abukari Kwame is a Ph.D. candidate in Interdisciplinary Studies in the College of Graduate and Postdoctoral Studies, University of Saskatchewan, interested in patients' rights in nurse-patient clinical communications and interactions in the hospital setting. He holds two Master of Philosophy degrees in Indigenous Studies and English Linguistics. Abukari's research interests include language use in social interaction, health communication, First/Second language acquisition, African traditional medical knowledge, and Indigenous and qualitative research methodologies.

Pammla M. Petrucka is a professor in Nursing and has international research experience with many of her graduate students from Africa, Asia, and the Caribbean. Pammla has published extensively in the field of nursing. Her research interests are vast, including child and maternal health, Indigenous peoples' health, global health, and vulnerable populations, with extensive experiences in qualitative research and indigenous research methodologies. Pammla is co-editor of the BMC Nursing journal and a reviewer for many other academic journals.

The authors have not received any funding for the conduct, preparation, and publication of this paper.

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Kwame, A., Petrucka, P.M. A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nurs 20 , 158 (2021). https://doi.org/10.1186/s12912-021-00684-2

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Communication skills 2: overcoming the barriers to effective communication

18 December, 2017 By NT Contributor

This article, the second in a six-part series on communication skills, a discusses the barriers to effective communication and how to overcome them

Competing demands, lack of privacy, and background noise are all potential barriers to effective communication between nurses and patients. Patients’ ability to communicate effectively may also be affected by their condition, medication, pain and/or anxiety. Nurses’ and patients’ cultural values and beliefs can also lead to misinterpretation or reinterpretation of key messages. This article, the second in a six-part series on communication skills , suggests practical ways of overcoming the most common barriers to communication in healthcare.

Citation: Ali M (2017) Communication skills 2: overcoming barriers to effective communication Nursing Times ; 114: 1, 40-42.

Author: Moi Ali is a communications consultant, a board member of the Scottish Ambulance Service and of the Professional Standards Authority for Health and Care, and a former vice-president of the Nursing and Midwifery Council.

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Introduction

It is natural for patients to feel apprehensive about their health and wellbeing, yet a survey in 2016 found that only 38% of adult inpatients who had worries or fears could ‘definitely’ find someone in hospital to talk to about them (Care Quality Commission, 2017). There are numerous barriers to effective communication including:

• Time constraints;
• Environmental issues such as noise and privacy;
• Pain and fatigue;
• Embarrassment and anxiety;
• Use of jargon;
• Values and beliefs;
• Information overload.

Time constraints

Time – or lack of it – creates a significant barrier to communication for nurses (Norouzinia et al, 2016). Hurried communication is never as effective as a leisurely interaction, yet in pressured workplaces, nurses faced with competing demands may neglect the quality of communication. It is important to remember that communication does not need to be time-consuming – a smile, hello, or some ‘small talk’ about the weather may suffice. Even when there is no pressing news to tell individual patients, taking the time to get to know them can prepare the ground for difficult conversations that may need to take place in the future.

In a pressured ward or clinic, conversations between patients and nurses may be delayed or interrupted because of the needs of other patients – for example, they may need to respond to an emergency or pain relief. This can be frustrating for patients who may feel neglected. If interruptions occur it is important to explain to patients that you have to leave and why. Arranging to return within a specified time frame may be enough to reassure them that you are aware that their concerns are important (Box 1).

Box 1. Making time for communication

Nurse Amy Green was allocated a bay of four patients and two side wards for her shift. Halfway through the morning one of her patients in a side ward became very ill and Amy realised that she needed to spend a lot of time with him. She quickly visited her other patients to explain what was happening, and reassured them that she had not forgotten about them. She checked that they were comfortable and not in pain, asked them to ring the call bell if they needed her, and explained that she would return as soon as she could. The patients understood the situation and were reassured that their immediate needs had been assessed and they were not being neglected.

Environmental factors

You may be so familiar with your surroundings that you no longer notice the environmental factors that can create communication difficulties. Background noise in a busy clinic can affect patients’ ability to hear, and some may try to disguise this by nodding and ‘appearing’ to hear. If you think your patient has hearing problems, reduce background noise, find a quiet corner or step into a quiet side room or office. Check whether your patient uses physical aids, such as hearing aids or spectacles and that these are in working order.

Noise and other distractions can impede communication with patients with dementia and other cognitive impairments, who find concentration challenging. If you have to communicate an important message to a patient with poor concentration, it is useful to plan ahead and identify the best place and time to talk. It can be helpful to choose a time when you are less busy, without competing activities such as medicine rounds or meal times to interrupt your discussion.

Patients may be reticent to provide sensitive personal information if they are asked about their clinical history within earshot of other people, such as at a busy reception desk or in a cubicle with just a curtain for privacy. It is important to avoid asking sensitive questions where others may hear patients’ replies. Consider alternative ways of gathering pertinent information, such as asking the patient to complete a written form – but remember that some patients struggle with reading and writing or may need the form to be provided in a different language or have someone translate for them.

Pain and fatigue

We often need to gain important information from patients when they are acutely ill and distressed, and symptoms such as pain can reduce concentration. If you urgently need to gather information, it is important to acknowledge pain and discomfort: “I know that it is painful, but it’s important that we discuss.”

Patients may also be tired from a sleepless night, drowsy after an anaesthetic or experiencing the side-effects of medicines. Communicating with someone who is not fully alert is difficult, so it is important to prioritise the information you need, assess whether it is necessary to speak to the patient and ask yourself:

• Is this the best time for this conversation?
• Can my message wait?
• Can I give part of the message now and the rest later?

When patients cannot give their full attention, consider whether your message could be broken down into smaller pieces so there is less to digest in one go: “I will explain your medication now. I’ll return after lunch to tell you about how physiotherapy may help.” Ask if they would like any of the information repeated.

If you have to impart an important piece of information, acknowledge how the patient is feeling: “I know that you’re tired, but …”. Showing empathy can build rapport and make patients more receptive. It may also be useful to stress the need to pay attention: “It’s important that you listen because …”. Consider repeating the message: “It can be difficult to take everything in when you’re tired, so I just wanted to check that you’re clear about …”. If the communication is important, ask the patient to repeat it back to you to check it has been understood.

Embarrassment and anxiety

Would you feel comfortable undressing in front of a complete stranger, or talking about sex, difficult family circumstances, addictions or bowel problems? Patients’ and health professionals’ embarrassment can result in awkward encounters that may hamper effective communication. However, anticipating potential embarrassment, minimising it, and using straightforward, open communication can ease difficult conversations. For example, in a clinic, a patient may need to remove some clothes for an examination. It is important to be direct and specific. Do not say: “Please undress”, as patients may not know what to remove; give specific instructions: “Please remove your trousers and pants, but keep your shirt on”. Clear directions can ease stress and embarrassment when delivered with matter-of-fact confidence.

Patients may worry about embarrassing you or themselves by using inappropriate terms for anatomical parts or bodily functions. You can ease this embarrassment by introducing words such as “bowel movements” or “penis” into your questions, if you think they are unsure what terminology to use. Ambiguous terms such as “stool”, which have a variety of everyday meanings, should be avoided as they may cause confusion.

Many patients worry about undergoing intimate procedures such as bowel and bladder investigations. Explain in plain English what an examination involves, so that patients know what to expect. Explaining any side-effects of procedures – such as flatulence or vomiting – not only warns patients what to expect but reassures them that staff will not be offended if these occur.

Box 2 provides some useful tips on dealing with embarrassment.

Box 2. Managing embarrassment

• Look out for signs of embarrassment – not just obvious ones like blushing, but also laughter, joking, fidgeting and other behaviours aimed at masking it
• Think about your facial expressions when communicating with patients, and use positive, open body language such as appropriate eye contact or nodding
• Avoid disapproving or judgmental statements by phrasing questions carefully: “You don’t drink more than 10 glasses of wine a week, do you?” suggests that the ‘right’ or desired answer is ‘no’. A neutral, open question will elicit a more honest response: “How many glasses of wine do you drink in a typical week?”

Some patients are reluctant to ask questions, seek clarification or request that information be repeated for fear of wasting nurses’ time. It is important to let them know that their health or welfare is an integral part of your job. They also need to know that there is no such thing as a silly question. Encourage questions by using prompts and open questions such as: “You’re bound to have questions – are there any that I can answer for you now?”; “What else can I tell you about the operation?”. It is also possible to anticipate and address likely anxieties such as “Will it be painful?”; “Will I get better?”; or “Will I die?”.

Jargon can be an important communication aid between professionals in the same field, but it is important to avoid using technical jargon and clinical acronyms with patients. Even though they may not understand, they may not ask you for a plain English translation. It is easy to slip into jargon without realising it, so make a conscious effort to avoid it.

A report on health literacy from the Royal College of General Practitioners (2014) cited the example of a patient who took the description of a “positive cancer diagnosis” to be good news, when the reverse was the case. If you have to use jargon, explain what it means. Wherever possible, keep medical terms as simple as possible – for example, kidney, rather than renal and heart, not cardiac. The Plain English website contains examples of healthcare jargon.

Box 3 gives advice on how to avoid jargon when speaking with patients.

Box 3. Avoiding jargon

• Avoid ambiguity: words with one meaning for a nurse may have another in common parlance – for example, ‘acute’ or ‘stool’
• Use appropriate vocabulary for the audience and age-appropriate terms, avoiding childish or over-familiar expressions with older people
• Avoid complex sentence structures, slang or speaking quickly with patients who are not fluent in English
• Use easy-to-relate-to analogies when explaining things: “Your bowel is a bit like a garden hose”
• Avoid statistics such as “There’s an 80% chance that …” as even simple percentages can be confusing. “Eight in every 10 people” humanises the statistic

Values, beliefs and assumptions

Everyone makes assumptions based on their social or cultural beliefs, values, traditions, biases and prejudices. A patient might genuinely believe that female staff must be junior, or that a man cannot be a midwife. Be alert to patients’ assumptions that could lead to misinterpretation, reinterpretation, or even them ignoring what you are telling them. Think about how you can address such situations; for example explain your role at the outset: “Hello, I am [your name], the nurse practitioner who will be examining you today.”

It is important to be aware of your own assumptions, prejudices and values and reflect on whether they could affect your communication with patients. A nurse might assume that a patient in a same-sex relationship will not have children, that an Asian patient will not speak good English, or that someone with a learning disability or an older person will not be in an active sexual relationship. Incorrect assumptions may cause offence. Enquiries such as asking someone’s “Christian name” may be culturally insensitive for non-Christians.

Information overload

We all struggle to absorb lots of facts in one go and when we are bombarded with statistics, information and options, it is easy to blank them out. This is particularly so for patients who are upset, distressed, anxious, tired, in shock or in pain. If you need to provide a lot of information, assess how the patient is feeling and stick to the pertinent issues. You can flag up critical information by saying: “You need to pay particular attention to this because …”.

Box 4 provides tips on avoiding information overload.

Box 4. Avoiding information overload

• Consider suggesting that your patient involves a relative or friend in complex conversations – two pairs of ears are better than one. However, be aware that some patients may not wish others to know about their health
• Suggest patients take notes if they wish
• With patients’ consent, consider making a recording (or asking whether the patient wishes to record part of the consultation on their mobile phone) so they can replay it later or share it with a partner who could not accompany them
• Give written information to supplement or reinforce the spoken word
• Arrange another meeting if necessary to go over details again or to provide further information

It is vital that all nurses are aware of potential barriers to communication, reflect on their own skills and how their workplace environment affects their ability to communicate effectively with patients. You can use this article and the activity in Box 5 to reflect on these barriers and how to improve and refine your communication with patients.

Box 5. Reflective activity

Think about recent encounters with patients:

• What communication barriers did you encounter?
• Why did they occur?
• How can you amend your communication style to take account of these factors so that your message is not missed, diluted or distorted?
• Do you need support to make these changes?
• Who can you ask for help?
• Nurses need to be aware of the potential barriers to communication and adopt strategies to address them
• Environmental factors such as background noise can affect patients’ ability to hear and understand what is being said to them
• Acute illness, distress and pain can reduce patients’ concentration and their ability to absorb new information
• Anticipating potential embarrassment and taking steps to minimise it can facilitate difficult conversations
• It is important to plan ahead and identify the best place and time to have important conversations

Also in this series

• Communication skills 1: benefits of effective communication for patients
• Communication skills 3: non-verbal communication
• Communication 4: the influence of appearance and environment
• Communication 5: effective listening and observation skills
• Communication skills 6: difficult and challenging conversations

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171220 communication skills 2 overcoming barriers to effective communication.

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Effective communication between nurses and patients: an evolutionary concept analysis

Dorothy Afriyie

Student Nurse, University of West London, Brentford

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Communication can be considered as the basis of the nurse-patient relationship and is an essential element in building trust and comfort in nursing care. Effective communication is a fundamental but complex concept in nursing practice. This concept analysis aims to clarify effective communication and its impact on patient care using Rodgers's (1989) evolutionary framework of concept analysis. Effective communication between nurses and patients is presented along with surrogate terms, attributes, antecedents, consequences, related concepts and a model case. Effective communication was identified to be a multifactorial concept and defines as a mutual agreement between nurses and patients. This influences the nursing process, clinical reasoning and decision-making. Consequently, promotes high-quality nursing care, positive patient outcome and patient's and nurse's satisfaction of care.

Communication is an essential element of building trust and comfort in nursing, and it is the basis of the nurse–patient relationship ( Dithole et al, 2017 ). Communication is a complex phenomenon in nursing and is influenced by multiple factors, such as relationship, mood, time, space, culture, facial expression, gestures, personal understanding and perception ( McCarthy et al, 2013 ; Kourkouta and Papathanasiou, 2014 ). Effective communication has been linked to improved quality of care, patient satisfaction and adherence to care, leading to positive health outcomes ( Burley, 2011 ; Kelton and Davis, 2013 ; Ali, 2017 ; Skär and Söderberg, 2018 ). It is an important part of nursing practice and is associated with health promotion and prevention, health education, therapy and treatment as well as rehabilitation ( Fakhr-Movahedi et al, 2011 ). The Nursing and Midwifery Council (NMC) (2018) emphasised effective communication as one of the most important professional and ethical nursing traits. Nonetheless, communication remains a complicated phenomenon in nursing, and most patient-reported complaints in healthcare are around failed communication ( Reader et al, 2014 ). The aim of the present concept analysis is to explore and clarify the complexity of establishing effective communication between nurses and patients in practice.

Concept analysis

Concept analysis is the foundation and preparatory phase of nursing research ( Walker and Avant, 2011 ). Concept analysis aids in clarifying concepts in nursing by using simpler elements to reduce ambiguity and identify all aspects of a concept ( Nuopponen, 2010 ; Foley and Davis, 2017 ). Draper (2014) criticised concept analysis as being methodologically weak and philosophically dubious, further arguing that there is no evidence of its contribution to patient care. However, concept analysis facilitates the review of literature on a concept of interest, thereby enabling a thorough examination of the concept ( Bergdahl and Berterö, 2016 ). This helps in understanding the concept and, therefore, applying it appropriately. Correspondingly, understanding key concepts in nursing practice enables the nurse to identify strategic interventions that could benefit patients. Although McKenna (1997) argued that there is no definite meaning of a concept because they are experienced and perceived differently by people, Walker and Avant (2011) highlighted that the ability of the nurse to describe concepts in an exploratory way is an important means to demonstrate evidence base in practice. Nursing is an evidence-based practice; hence it is the responsibility of the nurse to keep up-to-date with quality evidence and demonstrate it in practice ( Thompson, 2017 ). Therefore, it is paramount for nurses to understand concept analysis and be able to analyse key concepts in nursing.

This concept analysis aims to clarify the concept of effective communication and address the gap in knowledge using Rodgers's (1989) theoretical framework. The evolutionary method of concept analysis was chosen because it adopts a systematic approach with focused phases ( Tofthagen and Fagerstrøm, 2010 ). Rodgers's (1989) method is perceived as a simultaneous task approach, which does not seek boundaries to restrict a concept and considers its application within multiple contexts ( Gallagher, 2007 ). However, the framework will be used because it facilitates an exploration and deep comprehension of a concept ( McCuster, 2015 ). Additionally, the framework offers an alternative to a positivist approach to concepts, allowing different findings depending on the situation ( Ghafouri et al, 2016 ). Moreover, the framework provides an opportunity to identify attributes and related features in a manner that minimises bias ( McCuster, 2015 ). Effective communication between patients and nurses was analysed using the seven phases of Rodgers's (1989) evolutionary method ( Box 1A ). Further, the following four questions were addressed ( Box 1B ).

Box 1A.Rodgers's method of analysis (1989)

Box 1B.Rationale for the four focused questionsThe focus questions were driven by the Rodgers's (1989) framework of concept analysis; the four questions are aimed at analysing the concept of effective communication using the seven stages of the framework in a systematic manner to engender an understanding of effective communication

• What is effective communication?
• What are the surrogate terms and related use of the concept of effective communication?
• What attributes, antecedents and consequences apply to the concept of effective communication?
• Who benefits from effective communication between nurses and patients?

Identifying the appropriate realm for data collection

As endorsed by Brown (2005) , a comprehensive review of the literature was conducted for this analysis. Explicit inclusion and exclusion criteria were used to select relevant articles, as recommended by Tofthagen and Fagerstrøm (2010) . Two electronic databases-Cumulative Index for Nursing and Allied Health (CINAHL) and MEDLINE (Ovid)-were searched using the keywords ‘effective communication’ and ‘nurses’ and ‘patients’. The inclusion criteria allowed selection of only peer-reviewed academic journals written in the English language. Studies exploring or analysing effective communication among nurses and patients with underlying communication difficulties and cognitive disabilities were excluded, because it is likely that such patients or nurses represent a special challenge in communicating. Only articles exploring effective communication and factors that influence communication between nurses and patients were considered. A total of 2086 articles were retrieved from the databases, and these articles were screened for relevance by reading the abstract. Finally, 30 articles were determined to meet the inclusion criteria for the analysis ( Figure 1 ). The articles selected were published between 1965 and 2019.

Defining effective communication

The Cambridge English dictionary defines ‘effective’ as ‘successful or achieving the results that you want’ ( Cambridge University Press, 2018 ). According to the Oxford English Dictionary, communication is ‘imparting or exchanging information by speaking, writing or using some other medium’ ( Oxford University Press, 2018 ). The Department of Health and Social Care (2010) described communication as the meaningful exchange of facts, needs, opinions, thoughts, feelings or other information between two or more people. Further, communication can be face-to-face, over the phone or by written words. McCabe and Timmins (2013) also described communication as a cyclical and dynamic process, involving transmission, receiving and interpretation of information between people using verbal or non-verbal means. Rani (2016) simply described communication as ‘sharing meaning’.

Interestingly, Hazzard et al (2013) described communication as a primary condition of human consciousness. They further explained that people always identify themselves in a communicative state. This would imply that people are always exchanging information. The authors, however, described communication as the actions taken after speaking to someone; this highlights communication as responsive. This may be the action and reaction people adopt after a communicated request or statement. Nonetheless, Gadamer (1976) , a twentieth-century philosopher, highlighted communication as what we are and not just what we do. Kourkouta and Papathanasiou (2014) defined communication as the use of speech or other means to exchange information, thoughts and feelings among people. Therefore, effective communication may be classified as exchanging information, thoughts and feelings using either verbal or non-verbal expressions to successfully produce a desired or intended result.

Effective communication between nurses and patients may be analysed from both the nurse's and the patient's perspective. McCabe (2004) identified that the patients' perspective of effective communication entails patient-centred interaction. On the other hand, O'Hagan et al (2013) found that nurses' perspective of effective communication revolves around time, task, rapport and patients' agreement on what has been communicated. Although both perspectives appear to differ, they are both driven by the expectations of the patient and nurse. A nurse may ultimately identify effective communication as the ability to engage with patients and to achieve clinical goals. Similarly, patients may be influenced by their expectation regarding their management outcome ( Schirmer et al, 2005 ). Therefore, effective communication between nurses and patients may be defined as mutual agreement and satisfaction with care (provided and received).

Surrogate terms and relevant uses

The terms most commonly serving a manifestation of effective communication include: therapeutic communication, interpersonal relationship, intercommunication, interpersonal communication and concordance. From a literature search, these terms appear frequently, highlighting their close usage with the concept of effective communication ( Fleischer et al, 2009 ; Casey and Wallis, 2011 ; Jones, 2012 ; Bloomfield and Pegram, 2015 ; Daly, 2017 ). For example, through intercommunication or interpersonal communication, a nurse can encourage a patient to participate in their care decision-making. However, a patient's acceptance to engage in shared decision-making regarding care and agree with a negotiated care plan could reflect effective communication. This act of mutual agreement through negotiation and shared decision-making suggests concordance ( Mckinnon, 2013 ; Snowden et al, 2014 ). Abdolrahimi et al (2017) pointed out that therapeutic communication is the basis for effective communication. They highlighted therapeutic communication as an important means for establishing interpersonal relationships. These concepts are different from effective communication; however, these notions express an idea of the concept of effective communication and highlight an understanding of effective communication as emphasised by Rodgers (1989) .

Daly (2017) described communication as dynamic and cyclical, because it involves a process of transmission, receiving and interpretation through verbal or non-verbal means. This reflects the complexity of communication, which involves speaking, being heard, listening, understanding or being accepted, as well as being seen and acknowledged. Hence, assessing factors that could affect communication, such as noise or interference, is always crucial for effective communication ( McCabe and Timmins, 2013 ; Webb, 2018 ). Daly (2017) explained that other skills for effective communication, which are consciousness, compassion, competence, professionalism and person-centredness, are all important concepts in nursing studies and practice. This indicates that communication is intentional in nature, so the purpose and perspective of individuals involved should be valued and respected ( Jones, 2012 ). In the case of the nurse–patient relationship, a nurse must consider a patient's perspective, background and concerns when communicating. It is important for a nurse to be competent, ethical and professional and exhibit an individualised approach in communicating with patients ( Bramhall, 2014 ; Bloomfield and Pegram, 2015 ). For example, when communicating with a patient with no medical background, medical terms should be explained further or avoided. This promotes person-centredness, which is a determinant for effective communication for patients.

A nurse must respect human rights and be professional ( NMC, 2018 ). However, it can be challenging when communicating with a patient who does not want to communicate about their health, which reflects their right to autonomy. Nonetheless, it is paramount for a nurse to identify the purpose of communication and the difficulties, so that they can mitigate them as part of their professional and ethical duties ( Royal College of Nursing, 2015 ; NMC, 2018 ). This can be done by reassuring and encouraging patients. Correspondingly, this act of communication features in Duldt et al's (1983) theory of humanistic nursing communication. This theory is reflected in Bramhall (2014) and Kourkouta and Papathanasiou's (2014) exploration on communication in nursing. The theory explains the need for comprehensive and exclusive communication among nurses and clients as well as colleagues. The focus of the theory is on interpersonal communication and emphasises the need for humanistic approaches to help improve professional communication. These approaches include empathy, deeper respect, encouragement and interpersonal relationship. For example, listening to people, providing privacy when communicating, giving patients ample time, using kind and courteous words such as ‘please’ and ‘thank you’, as well as being frank and honest when communicating. All these approaches may promote effective communication between nurses and patients ( Jevon, 2009 ; Bramhall, 2014 ; Bloomfield and Pegram, 2015 ).

Further, Miller (2002) , Burley (2011) , Casey and Wallis (2011) , Jones (2012) Bloomfield and Pegram (2015) and Daly (2017) demonstrated how effective communication is key in the assessment, planning and implementation of personalised nursing care. Holistic assessment in nursing includes history-taking, general appearance, physical examination, vital signs and documentation ( Toney-Butler and Unison-Pace, 2018 ). Patient assessment aids in identifying the communication needs of a patient in order to promote person-centred care ( Toney-Butler and Unison-Pace, 2018 ). Moreover, non-verbal cues such as general appearance or posture are vital in communication, and understanding them could help in the assessment process. General appearance such as facial expressions, dressing, hair or skin integrity may convey information that may be helpful in the nursing assessment process. Although not ideal, however, appearance can be a powerful transmitter of intentional or unintentional messages ( Ali, 2018 ). For instance, a nurse may sense neglect or abuse when a patient appears physically unkempt, with bruises or sores. This may inform the nurse on appropriate questions to ask during history-taking in order to ascertain the patient's situation and safeguard, signpost or refer them for support if necessary. Nurses' ability to identify these concerns may aid in providing the best necessary care for their patients. This promotes person-centredness, which is perceived as a means of effective communication by patients ( McCabe, 2004 ).

Effective communication promotes comprehensive history-taking. History-taking involves communicating with patients to collect subjective data and using this information to determine management plans ( Jevon, 2009 ). In history-taking, inaccurate information may be collected when communication is not effective ( Burley, 2011 ; Jones, 2012 ; Daly, 2017 ). However, it is important for nurses to establish good personal relationships with patients, so the latter can feel comfortable in sharing their complaints ( Casey and Wallis, 2011 ). It needs to be noted that, since patients are experts in their own lives, the nurse's ability to make patients feel comfortable may encourage patients to share valuable information, as well as their expectations, concerns and fears. Effective communication is important if nurses are to implement their roles effectively with regard to holistic assessment, considering the subjective experience and characteristics of their patient. Further, a well-informed collaborative assessment through effective communication may contribute to positive patient management outcomes ( Kourkouta and Papathanasiou, 2014 ). For instance, a patient may convey all necessary information to a nurse during assessment, and this may inform the nurse and patient of the necessary examination and investigations to aid in evidence-based nursing diagnosis and a collaborative management plan. The ability to establish a mutual agreement for the nursing process suggests effective communication for both parties.

Effective communication aids in planning and implementing personalised care. It helps patients to set realistic goals and choose preferred management for better outcomes. Communication is a bidirectional process in which a sender becomes a receiver and vice versa ( Kourkouta and Papathanasiou, 2014 ). Therefore, there is a need for both patients and nurses to realise that they are partners in communicating care planning and implementation ( Bloomfield and Pegram, 2015 ). This realisation may promote the patient's dignity and may also influence patients' desire to adhere to their plan when they feel involved in decision-making ( Casey and Wallis, 2011 ). Conversely, patients may be reluctant and unhappy if they feel dictated to or patronised. Most importantly, involving patients through effective communication can empower them to have full control over their health and wellbeing. This is reflected in the self-care theory proposed by Orem (1991) and the theory of self-efficacy proposed by Bandura (1977) . These theories focus on the role of the individual in initiating and sustaining change and healthy behaviours. Orem (1991) reinforced the importance of communication, as self-care is learned through communication and interpersonal relationships.

Attributes of effective communication

Certain attributes can be used to develop a definition of effective communication that is more realistically reflective of how patients and nurses use the term in healthcare settings ( Rodgers and Knafi, 2000 ). The most common attributes identified in the literature include: effective communication as ‘a building foundation for interpersonal-relationship’, ‘a determinant of promoting respect and dignity’, ‘a precedent of achieving concordance’, ‘an important tool in empowering self-care in patient’, ‘a significant tool in planning and implementing person-centred care’ and ‘a determinant of clinical reasoning and the nursing process’ ( Casey and Wallis, 2011 ; Jones, 2012 ; McCabe and Timmins, 2013 ; Bramhall, 2014 ; Bloomfield and Pegram, 2015 ; Daly, 2017 ; Webb, 2018 ; Barratt, 2019 ). These attributes make it possible to identify situations that can be categorised under the concept of effective communication.

Antecedents of effective communication

According to the literature, antecedents to effective communication include: personality trait, perceived communication competence and level of education on communication. Personality traits were linked with communication in early research. Carment et al (1965) demonstrated that people who are introverts are less likely to communicate well compared with extroverts. McCroskey and Richmond (1990) also indicated that people with low self-esteem are less willing to communicate. This is because they are more sensitive to environmental cues ( Campbell and Lavallee, 1993 ). Additionally, McCroskey and Richmond (1990) asserted that people who perceived themselves as poor communicators may be less willing to communicate. Nonetheless, people who may be very capable of communicating may not be willing to, due to low self-esteem, anxiety or fear. As a result, such people may have low communication efficacy despite having high actual competence ( McCroskey and Richmond, 1990 ). Therefore, it is important for nurses to consider these factors when communicating with patients in order to identify their communication needs and manage them accordingly ( Daly, 2017 ). Furthermore, Dithole et al (2017) and Norouzinia et al (2016) highlighted that the nurse's level of education on communication may influence the ability to communicate effectively. Thus, incorporation of targeted communication skills education in the training curriculum and on-the-job training will empower nurses to communicate effectively with their patients.

Consequences of effective communication

The consequences of effective communication can be classified into patient–nurse-related and healthcare system-related outcomes. Skär and Söderberg (2018) mentioned that effective communication ensures a good healthcare encounter for patients. In the community settings, effective communication empowers patients to talk about their concerns and expectations ( Griffiths, 2017 ). Further, effective communication promotes a pleasant and comfortable hospital experience for patients as well as their families; this can also be reflected in the community settings, where patients may report pleasant and comfortable nursing care ( Newell and Jordan, 2015 ; Barratt, 2019 ). Kourkouta and Papathanasiou (2014) and Wikström and Svidén (2011) pointed out that the success of a nurse mostly depends on how effectively they can communicate with their patient. Conversely, ineffective communication may lead to unsuccessful outcomes. For example, a patient may convey their fears, signs and symptoms to a nurse and how the nurse decodes and applies the information may influence the intervention given ( Kourkouta and Papathanasiou, 2014 ). Likewise, a nurse may convey a piece of information to a patient, but the patient's understanding of the information will determine their action. Therefore, how the message is understood determines the action taken ( Kourkouta and Papathanasiou, 2014 ). Additionally, through effective communication, a patient may be empowered to have full control over their health and wellbeing ( Newell and Jordan, 2015 ) and may not require extended care. Clearly, effective communication can lead to positive and cost-saving consequences for patients, nurses and the healthcare system.

The final phase of Rodgers's (1989) method of analysis highlights an application of the concept in an exploratory case scenario. A model case for effective communication between a nurse and a patient is given in Box 2 . This case portrays effective communication between a nurse and a patient, revealing some surrogate terms, defining attributes, antecedents and consequences of the concept. The case model highlighted Audrey's positive engagement in her care decision-making when the nurse Dani communicated effectively. Dani visited Audrey in her home, where Audrey had spatial and environmental control, but she was reluctant to engage in her own care. Audrey perceived that other nurses did not involve her in her care decision-making. This indicates ineffective communication and may be attributed to factors such as age difference, generational gap, gender and culture and ethnic differences between Audrey and the other nurses ( Tay et al, 2011 ; Norouzinia et al, 2016 ).

Box 2.Model caseAudrey, a 90-year-old housebound patient with bilateral leg ulcers was visited by Dani, a 45-year-old community staff nurse working in a diverse multicultural district nursing team. On arrival, Dani introduced herself in a suitable tone, maintaining eye contact. Audrey responded in a low tone, without maintaining eye contact. Audrey appeared to be quiet and in a low mood; Dani identified this nonverbal cue and was determined to engage Audrey in conversation. Dani knew from her experience that leg ulcer treatment can affect a person's mental health, causing low self-esteem, fear and anxiety. Dani asked how Audrey felt and if there was something she could help her with. Audrey mentioned she was fine; her carers had visited and supported her with personal care, breakfast and medication, she had been waiting for the nurse's visit. Dani asked Audrey about her ulcers and how she felt about her dressings; Audrey mentioned she was fine, but expressed concerns about the ulcers not healing. Dani reassured Audrey, explained leg ulcers to her and advised Audrey about some effective practice to promote the healing process.Dani asked Audrey ‘How best can I help you, and how do you want your care to be delivered?’. Audrey responded, ‘You are the nurse, you know better’. Dani took ample time to explain to Audrey how she understands her own body better than any other person. Dani also reassured and encouraged Audrey that her opinions mattered, as this helped empower her, promoted her dignity and informed the nurse on how to care for her. Audrey then expressed to Dani that her other nurses, who are much younger than Dani, never ask her opinion regarding the ulcer management; hence, she was not willing to speak. Audrey mentioned that those nurses came in to re-dress her ulcers and they spoke to her about the care plan, but she did not feel involved in decision-making about her care. Audrey then mentioned that she did not mean to create problems or report anyone. Dani reassured Audrey that there would be no trouble, so she should not be afraid to speak up. Audrey thought that having an honest communication about her needs and views could create problems for her or for the nurses if it seemed that she had reported them.Dani then reassured and encouraged Audrey that the situation will be addressed in a professional manner, and none of the other nurses would feel they had been reported; however, they would involve her in her care and decision-making, which is the expectation. Audrey was then comfortable, communicated in a suitable tone and maintained eye contact with Dani. She asked Dani if she could bandage her right leg first, as she tends to be in pain for a long time when the left one is dressed first. Dani gained consent from Audrey, explained the procedure and advised Audrey to stop her whenever she experienced pain. Dani also asked Audrey a bit more about her pain and her analgesia. Dani identified that Audrey's analgesia had not been reviewed for over 3 years. Dani explained to Audrey that she would be making a referral to her GP about this matter. Audrey was very pleased and indicated she was happy with how Dani had communicated with her; she felt she could trust her. Dani was also pleased, because she could provide the best care for Audrey.

Another important factor that can affect effective communication is the environmental factor. Norouzinia et al (2016) revealed that the hospital environment is a barrier to effective communication for patients. Additionally, Tay et al. (2011) indicated the possibility of unilateral communication due to the hierarchical structure of the hospital environment. Conversely, although nurses may feel quite comfortable in the hospital or inpatient setting, they might feel relatively intimidated when visiting a patient's home. Therefore, an awareness of the contextual discomfort and how it may affect communication is important and should be considered when planning for effective two-way communication between the nurse and patient during home visits. Although all these factors are important in communication, a full discussion of these is beyond the scope of this paper and should be the focus of another complete work.

In the model case described in Box 2 , the nurse acknowledged that she was privileged to be a guest in Audrey's home, and she tailored her strategy to gain Audrey's perspective. The nurse's aim was to get Audrey involved in her care decision-making since Audrey knows herself best. Additionally, Audrey's participation in the decision-making made it possible for her to receive her preferred care. This shows that effective communication is bidirectional, and both partners (nurse and patient) must work together to achieve their desired outcomes, in this case, the patient's satisfaction with care and the nurse's ability to provide the best care.

Effective communication in nursing is clearly a complex, multidimensional and multifactorial concept. Factors such as emotions, general appearance, personality trait, mood and level of education on communication may influence the practice and outcome of effective communication. However, effective communication is an ultimate determinant of success for a nurse. Effective communication was defined as a mutual agreement and satisfaction of care for both patients and nurses. It has been linked to precede the achievement of concordance in patients, and in nurses, it influences clinical reasoning and the nursing process. This aids in implementing compassionate person-centred care and, when successful, it promotes positive patient outcomes and satisfaction with nursing care. Thus, effective communication is an important concept to prioritise in nursing education and practice. For this reason, engaging nurses in communication skills and on-the-job training will empower them to communicate effectively with their patients. As endorsed by Rodgers's (1989) , the outcome of this analysis is not the endpoint of the concept but should direct the future exploration of effective communication. Therefore, a systematic study of effective communication between nurses and patients as well as a systematic review considering effective communication among nurses and patients with underlying communication difficulties, cognitive disabilities and intercultural perspectives can ultimately enhance nursing science.

• Effective communication is a key component of nursing practice
• Effective communication is intentional in nature and can be improved through direct actions taken by the nurse
• Communication is a complex phenomenon and is an essential element of building trust and comfort in nursing
• Concept analysis is the basic way of understanding complex concepts and developing different meanings and perceptions

CPD REFLECTIVE QUESTIONS

• How might concept analysis be relevant in nursing studies or practice?
• What does effective communication mean to you?
• What are some challenges nurses face in communicating effectively?
• How can an interpersonal relationship between nurses and patients influence effective communication?

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Effective communication between nurses and patients: an evolutionary concept analysis

Affiliation.

• 1 Student Nurse, University of West London, Brentford.
• PMID: 32881615
• DOI: 10.12968/bjcn.2020.25.9.438

Communication can be considered as the basis of the nurse-patient relationship and is an essential element in building trust and comfort in nursing care. Effective communication is a fundamental but complex concept in nursing practice. This concept analysis aims to clarify effective communication and its impact on patient care using Rodgers's (1989) evolutionary framework of concept analysis. Effective communication between nurses and patients is presented along with surrogate terms, attributes, antecedents, consequences, related concepts and a model case. Effective communication was identified to be a multifactorial concept and defines as a mutual agreement between nurses and patients. This influences the nursing process, clinical reasoning and decision-making. Consequently, promotes high-quality nursing care, positive patient outcome and patient's and nurse's satisfaction of care.

Keywords: Communication; Concept analysis; Nurse-patient relationship; Nursing traits; Trust.

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Home > Books > Nursing

Effective Communication in Nursing

Submitted: 27 October 2017 Reviewed: 06 February 2018 Published: 21 March 2018

DOI: 10.5772/intechopen.74995

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Nurses are critical in the delivery of essential health services and are core in strengthening the health system. They bring people-centred care closer to the communities where they are needed most, thereby helping improve health outcomes and the overall cost-effectiveness of services. Nurses usually act as first responders to complex humanitarian crises and disasters; protectors and advocates for the community and communicators and co-ordinators within teams. Communication is a core component of sound relationships, collaboration and co-operation, which in turn are essential aspects of professional practice. The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. Increases in nursing communication can lessen medical errors and make a difference in positive patient outcomes. This chapter explores how effective communication and interpersonal skills can enhance professional nursing practice and nursing relationships with various stakeholders. It explains principles of communication, communication process, purpose of communication, types of communication, barriers to effective communication, models of communication and strategies of improving communication and guidelines for successful therapeutic interactions.

• communication
• communication skills
• non-verbal communication
• nurse–patient relationship
• nursing verbal communication

Author Information

Maureen nokuthula sibiya *.

• Durban University of Technology, Durban, South Africa

*Address all correspondence to: [email protected]

1. Introduction

Nurses are critical in the delivery of essential health services and are core in strengthening the health system [ 1 , 2 ]. They bring people-centred care closer to the communities where they are needed most, thereby helping improve health outcomes and the overall cost-effectiveness of services [ 3 ]. Nurses usually act as first responders to complex humanitarian crises and disasters; protectors and advocates for the community and communicators and co-ordinators within teams. Communication skills for nurses are essential but may be difficult to master. Communication is the exchange of information between people by sending and receiving it through speaking, writing or by using any other medium. Clear communication means that information is conveyed effectively between people. To be a successful nurse, excellent communication skills are required [ 4 ]. Nurses speak to people of varying educational, cultural and social backgrounds and must do so in an effective, caring and professional manner, especially when communicating with patients and their families [ 5 ]. The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. This influence can play a very important role in areas such as patient health, education and adherence [ 6 ]. Good communication plays an important role in the organization’s effective functioning [ 7 , 8 , 9 ]. A nurse must therefore, continuously try to improve his/her communication skills as poor communication can be dangerous and lead to confusion.

2. Principles of communication

Communication is a process;

Communication is not linear, but circular;

Communication is complex;

Communication is irreversible; and

Communication involves the total personality [ 5 ].

3. Communication process

A clear message; and

A receiver [ 12 ].

4. Purpose of communication

To convey information/opinion, for example, “I have headache” or “I am here to give you medication”.

To request information/opinion/behavior, for example, “Are you allergic to penicillin?” or “Tell me more about the injury”.

To give social acknowledgement, for example, “Hello” or “Good morning”.

These three primary types of messages can be combined in many ways so that they form an interaction (conversation). The goals of the interaction can be comprehensive. Nurses strive to make all their communication with patients therapeutic, that is, their communication is purposefully and consciously planned to promote the patient’s health and wellbeing.

5. Types of communication

Verbal and non-verbal communications are the two main types of communication used by human beings.

5.1. Verbal communication

Verbal communication is associated with spoken words and is vitally important in the healthcare context. Members of the multi-disciplinary healthcare team communicate verbally with one another and with patients as well as family members.

5.2. Verbal communication

Bodily contact

Direction of gaze

Emotive tone in speech

Facial and gestural movements

Physical appearance

Speech errors

Timing of speech [ 5 , 8 , 9 , 10 ].

6. Communication process

The communication process may be explained by means of a linear model of communication, interactive model of communication or transactional model of communication [ 11 ].

6.1. Linear model of communication

Linear model of communication entails a sender, a message, a receiver and noise ( Figure 1 ).

Linear model of communication.

6.2. Interactive model of communication

Interactive model of communication gives a slightly more complex explanation of the communication process. Communication is seen as a process in which the listener gives feedback or responds to a message after a process of interpretation. A communicator creates and interprets a message with a personal field of expertise and/or a frame of reference Figure 2 ).

Interactive model of communication.

6.3. Transactional model of communication

Transactional model of communication acknowledges and gives emphasis to the dynamic nature of interpersonal communication and the multiple roles of the communicators. Features such as time, messages, noise, fields of experience, frames of reference, meanings, shared systems of communicators and personal systems all pay a role in the process of communication. Communicators often participate simultaneously (sending, receiving and interpreting). The unique interpretive and perceptual processes of individuals thus play an essential role in the communication process.

7. Barriers to effective communication

Effective communication skills and strategies are important for nurses. Clear communication means that information is conveyed effectively between the nurse, patients, family members and colleagues. However, it is recognized that such skills are not always evident and nurses do not always communicate well with patients, family members and colleagues. The message sent may not be the message received. The meaning of a message depends on its literal meaning, the non-verbal indicators accompanying it and the context in which it is delivered. It is therefore, easy to misinterpret the message, or to interpret it correctly, but to decide not to pursue its hidden meaning this leads to obstruction to communication. Continuous barriers to effective communication brings about a gradual breakdown in relationships. The barriers to effective communication outlined below will help nurses to understand the challenges [ 8 ].

7.1. Language barrier

Language differences between the patient and the nurse are another preventive factor in effective communication. When the nurse and the patient do not share a common language, interaction between them is strained and very limited [ 9 , 10 , 11 ]. Consequently, a patient may fail to understand the instructions from a nurse regarding the frequency of taking medication at home.

7.2. Cultural differences

Culture is another hindrance. The patient’s culture may block effective nurse–patient interactions because perceptions on health and death are different between patients [ 12 , 13 , 14 ]. The nurse needs to be sensitive when dealing with a patient from a different culture [ 9 , 15 , 16 ]. What is acceptable for one patient may not be acceptable for another. Given the complexity of culture, no one can possibly know the health beliefs and practices of every culture. The nurse needs check with the patient whether he/she prefers to be addressed by first name or surname. The use of eye contact, touching and personal space is different in various cultures and rules about eye contact are usually complex, varying according to race, social status and gender. Physical contact between sexes is strictly forbidden in some cultures and can include handshakes, hugging or placing a hand on the arm or shoulder. A ‘yes’ does not always mean ‘yes’. A smile does not indicate happiness, recognition or agreement. Whenever people communicate, there is a tendency to make value judgements regarding those perceived as being different. Past experiences can change the meaning of the message. Culture, background and bias can be good if they allow one to use past experiences to understand something new; it is when they change meaning of the message that they interfere with the communication process [ 12 ]. It is important for nurses to think about their own experiences when considering cultural differences in communication and how these can challenge health professionals and service users.

7.3. Conflict

Conflict is a common effect of two or more parties not sharing common ground. Conflict can be healthy in that it offers alternative views and values. However, it becomes a barrier to communication when the emotional ‘noise’ detracts from the task or purpose. Nurses aim for collaborative relationships with patients, families and colleagues.

7.4. Setting in which care is provided

The factors in care setting may lead to reduction in quality of nurse–patient communication. Increased workload and time constraints restrict nurses from discussing their patients concerns effectively [ 16 ]. Nurses work in busy environments where they are expected to complete a specific amount of work in a day and work with a variety of other professionals, patients and their families. The roles are hard, challenging and tiring. There is a culture to get the work done. Some nurses may consider colleagues who spend time talking with patients to be avowing the ‘real’ work and lazy. Nurses who might have been confident in spending time with patients in an area where this was valued, when faced with a task-orientated culture have the dilemma of fitting into the group or being outside the group and spending time engaging with patients. Lack of collaboration between the nurses and the doctors in information sharing also hinder effective communication. This leads to inconsistencies in the information given to patients making comprehension difficult for the patient and their families.

7.5. Internal noise, mental/emotional distress

Internal noise has an impact on the communication process. Fear and anxiety can affect the person’s ability to listen to what the nurse is saying. People with feelings of fear and anger can find it difficult to hear. Illness and distress can alter a person’s thought processes. Reducing the cause of anxiety, distress, and anger would be the first step to improving communication.

7.6. Perception

If a healthcare professional feels that the person is talking too fast, not fluently, or does not articulate clearly etc., he/she may dismiss the person. Our preconceived attitudes affect our ability to listen. People tend to listen uncritically to people of high status and dismiss those of low status.

7.7. Difficulty with speech and hearing

People can experience difficulty in speech and hearing following conditions like stroke or brain injury. Stroke or trauma may affect brain areas that normally enable the individual to comprehend and produce speech, or the physiology that produces sound. These will present barriers to effective communication.

7.8. Medication

Medication can have a significant effect on communication for example it may cause dry mouth or excess salivation, nausea and indigestion, all of which influence the person’s ability and motivation to engage in conversation. If patients are embarrassed or concerned that they will not be able to speak properly or control their mouth, they could be reluctant to speak.

Equipment or environmental noise impedes clear communication. The sender and the receiver must both be able to concentrate on the messages they send to each other without any distraction.

8. Improving communication

Listen without interrupting the sender.

Show empathy at all times and try to understand.

Try to stay focused on the conversation. Do not however, force the patient to continue if he/she becomes anxious or seems to wish to change the subject.

Use the body language that indicates your interest and concern. Touch the patient if it seems appropriate. Lean forward, listen intently and maintain eye contact if it culturally acceptable.

Offer factual information. This relieves anxiety. Do not offer your personal opinion. Assure the patient that you have professional discretion.

Try to reflect the feelings and thoughts the patient is expressing by rephrasing questions and comments using their own words.

Avoid unclear or misleading messages.

Avoid giving long explanations.

Give your co-workers your full attention when communicating with them.

Ask questions to clarify unclear messages.

Do not interrupt until the sender has completed the message.

Provide a quiet environment without distractions.

Be convincing wen communicating [ 17 ].

9. Communicating with patients

Be open, respectful and gracious in all your interactions with the patient and keep his/her cultural preferences in mind.

Answer nurses’ bells promptly.

Make sure you have the patients’ attention when communicating.

Use words that are non-threatening – explain what you would like to do and do not give orders to the patient.

Use simple, understandable phrases, not medical terms as most patients do not understand these terms.

Speak clearly and courteously.

Use a pleasant and normal tone of voice to the hard of hearing.

Always stand so that the patient can see the nurse’s face when communicating, as lip reading is part of all normal hearing.

Use body language that is appropriate.

Explain facts and procedures before donning a mask that covers the wearer’s mouth and lower face.

Be alert to the patient’s needs. Allow time for answers to your requests and to answer patient’s questions [ 17 ].

10. Communicating by phone

Always speak clearly into the mouthpiece of the phone.

Offer a greeting for example, good morning or good afternoon.

Identify the unit or place of work.

Identify yourself by indicating who you are and where you are phoning from.

Identify the person to whom you are speaking.

Politely listen to the message and make notes if you think you may not remember all the information.

If you are asked to call another person, note the date, time, caller’s name and telephone number together with the message.

Date and sign the message [ 17 ].

11. Assertive communication

Content – where the rights of the people involved are embedded gently in the statement. This could be done by using an explanation, empathy for the listener, and praise for the listener, an apology for the consequence for the listener or a compromise that is favorable to both people.

Covert elements – where the speaker is able to recognize their rights and the rights of the listener in the communication process. These include respect, expressing feelings, having your own priorities, being able to say ‘no’, being able to make mistakes and choosing to say nothing.

Process – concerned with how people express themselves assertively. Is their body language, intonation and choice of language reflective of a confident assertive person? Are the processes that make up communication congruent, in keeping with what is being said? The process also involves managing the setting so that people are not embarrassed, or the noise levels are kept to a minimum. Increasing the likelihood of assertive communication happening again involves feedback to the listener to show that their accomplishment is appreciated.

Non-verbal cues – gesture, touch, proxemics and posture – also need to reflect confidence, regard and respect for self and others.

12. Therapeutic interactions

Assess a patient : The nurse wants to know more about a patient to identify his/her problems. This type of conversation can be a structured interview using an interview schedule. The purpose of this conversation is always a better understanding of the patient.

Instruct a patient : Patient instruction may vary from an informal conversation during which few facts are conveyed to an elaborate instruction session.

Problem solving : If a patient discuss his/her problems with a nurse, the nurse helps the patient to analyze the problem, consider possible alternative ways of handling it and how to decide which way is the best. Problem solving is done with the patients and not for them.

Give emotional support : The presence of an empathetic nurse, that is, one who can enter into the patient’s shoes and understand the patient’s experience, is immensely supportive of the patient. Emotional support alleviates the loneliness of the patient’s experience of illness and increases his/her dignity [ 17 ].

13. Guidelines for successful therapeutic interactions

After the purpose of the therapeutic interaction has been established, the following guidelines assist in conducting a successful interaction:

13.1. Maintaining a low-authority profile

The nurse must strive to maintain a low-authority profile at the beginning of the conversation. As the conversation progresses, the nurse can use more directive techniques to find out specific information. There are usually differences in age, sex, occupation, cultural background, moral and religious convictions between the nurse and the patient. These differences make it impossible for the nurse to fully understand the patient’s behavior and reactions. It is therefore, important for the nurse to understand and accept differences in patients’ cultures and beliefs. When in doubt, check with the patient. If trust is established, patient will be willing to teach the nurse.

13.2. Use of understandable language

The nurse should determine the patient’s level of understanding and if necessary change the use of language, comments and questions. Using the terminology which the patient does not understand can also frighten the patient and make him/her think that he/she has a more serious problem than he/she originally wanted help for. At the same time, the patient could give incorrect information because due to confusion, he/she may give affirmative answers to questions about symptoms that he/she has not actually experienced [ 18 ]. Nurses should share their aims with patients before expecting them to participate in the interaction. They should understand that there is a mutual understanding of each other’s point of departure. In an assessment interview, the nurse can, for instance, say: “Mr Jones, I would like to give you information on how to lose weight so as to bring down you high blood pressure, but I first need to find out what you already know about the condition”. It is not only important that the patients understand what nurses expect from the conversation; it is also essential that nurses understand the patients and convey this understanding before they participate in the conversation. When providing emotional support, this understanding is often all that is necessary. For nurses to understand patients, they must encourage them to talk – not just about facts, but also about their feelings. The nurse must listen more than speak, both to what the patient is saying verbally and what is being said non-verbally. Having listened carefully, the nurse then concentrates and responds empathetically to the patients’ feelings. Only when the nurse has a reasonably complete understanding of the patient’s situation and has communicated this understanding, can she proceed to interventions, such as giving information or solving a problem.

13.3. Tailor the message to the totality of the person

Saying something does not necessary mean that the message has been received and understood. It is the responsibility of the nurse to ensure that the person with whom he/she is conversing understands the message. To ensure this, the message has to be adapted to the language, culture and socio-economic status of the patient. The emotional or physical condition of patients may also make it difficult for them to receive long of complicated messages or even any message. There may also be other disturbances in the immediate environment for example, noise that can make the patient not to hear or understand the message. The message must also be adapted to the age of the patient [ 10 ].

13.4. Validate the interpretation with the patient

Validation means that you ask the patient whether your interpretation is correct or not. You therefore, ask him/her to confirm your understanding of what he/she said. Many misunderstandings arise because people interpret other people’s words without checking their interpretation. The nurse should try to eliminate misunderstandings in the conversations by checking meaning with the patient.

13.5. Active listening

Is the eye contact maintained with the person who is speaking?

Are the body and face turned towards the speaker?

Are there regular verbal responses, even if these consist only of encouraging sounds?

Does the response indicate understanding, not only of the facts, but also of the feelings and the implications of the facts?

It is much easier to speak than to listen. Nurses are, in general, very active people, who want help b acting quickly. To ‘just listen’ without expressing opinions or offering advice is therefore, often not in their nature. Active listening is a valuable skill to acquire [ 10 , 17 , 18 ].

13.6. Evaluate own communication

Simplicity : Say what you want to say concisely and without using difficult or unfamiliar terms.

Clarity : Say precisely what you want to say without digressing, and support your verbal message with non-verbal indicators.

Relevance : Make sure that your message suits the situation, the time and the person you are speaking to.

Adaptability : Adapt your response to the clues the patient that the patient gives you.

Respect : Always show respect for the individuality and dignity of the person you are speaking to [ 17 ].

14. Therapeutic communication techniques

Table 1 gives an overview of therapeutic communication techniques and provides examples of each technique [ 10 , 13 ].

Therapeutic communication techniques.

15. Counter-productive communication techniques

There are certain counter-productive communication techniques that the nurse should avoid as they do not assist in the recovery of the patient and do not have any therapeutic value. Table 2 shows counter-productive communication techniques, explains why these should be avoided and gives examples [ 10 , 18 ].

Non-therapeutic communication techniques that should be avoided.

16. Conclusion

Promoting effective communication in health care is demanding and challenging because of the nature of the work environment. Nurses who have received training in communication skills communicate effectively and show increased confidence in communicating with patients. Many nurses choose to work in other countries, providing an opportunity to broaden their experience and knowledge. However, it is important that nurses who have the opportunity to work in other countries develop communication skills, cultural awareness and sensitivity before arriving. For example, in China talking about death is taboo [ 19 ]. In South Africa, maintaining eye during communication may be regarded as being disrespectful by Black people [ 11 ]. This article provides a reflective account of the experiences of one of the authors of working overseas. This chapter provides the effective communication and interpersonal skills that enhance professional nursing practice and nursing relationships by explaining principles of communication, communication process, purpose of communication, types of communication, barriers to effective communication, models of communication and strategies of improving communication and guidelines for successful therapeutic interactions.

Acknowledgments

The author wishes to acknowledge the Durban University of Technology for funding this book chapter.

Conflict of interest

The author declares that there is no conflict of interest in this chapter.

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© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Nursing MSN & DNP

| 20 May 2024

The Importance of Effective Communication in Nursing

To be a successful healthcare provider, clinical nurse or nurse leader, you need exceptional communication skills—and you need to be able to use them during high-stress situations.

Why Is Communication Important in Nursing?

Having good communication skills is essential to collaborating on teams with your fellow nurses and colleagues from other disciplines. It’s also important to patient-centered care.

Nurses who take the time to listen and understand the concerns of each of their patients are better prepared to address issues as they arise, resulting in better patient outcomes.

On the other hand, poor communication, or lack of communication in healthcare , can lead to patients misunderstanding directions and failing to follow treatment protocols. It can also lead to workflow breakdowns on the team, resulting in a medical error . A report by the Joint Commission found that poor communication in healthcare during patient transfers contributed to 80% of serious medical errors.

Additionally, patients who have established an open and secure dialogue with a nurse or healthcare provider are more likely to disclose the true extent of their symptoms. According to the book Interpersonal Relationships: Professional Communication for Nurses by Arnold and Boggs , healthcare communication competency offers a primary means for establishing a trusting, collaborative relationship with patients and families. Interpersonal communication skills influence the quality of decisions made, as well as the level of patient motivation to follow treatment protocols and achieve desired clinical outcomes.

10 Effective Communication Skills for Nurses

For nurses, good communication in healthcare means approaching every patient interaction with the intention to understand the patient’s concerns, experiences, and opinions. This includes using verbal and nonverbal communication skills, along with active listening and patient teach-back techniques. Below, we explore 10 communication skills that are important for nurses.

1. Verbal Communication

Excellent verbal communication is key. Aim to always speak with clarity, accuracy, and honesty. It’s also important to know your audience and speak appropriately according to the person’s age, culture, and level of health literacy. If you are feeling stressed out or frustrated, be aware of your tone of voice and don’t let these emotions leak into your patient interaction. You can:

• Encourage patients to communicate by asking open questions like, “Can you tell me a bit more about that?”
• Avoid condescending pet names like “honey” or “sweetie” and instead use the patient’s first name or name of choice.
• Speak in clear, complete sentences and avoid technical jargon.

2. Nonverbal Communication

Using elements of nonverbal communication—such as facial expressions, eye contact, body language, gestures, posture, and tone of voice—is also essential in creating rapport. Simply smiling can go a long way. You can also:

• Show interest in what the patient is saying by maintaining eye contact and nodding your head.
• Smile, but don’t stare.
• Sit down when you can, and lean forward to show you’re engaged.
• Use nonthreatening body language that conveys openness.

3. Active Listening

“Active listening” means listening in order to understand the other person’s experience. The highest and most effective form of listening requires complete attention and engagement. This skill is important not only for clinical nurses but also for nurse executives and other healthcare providers as a tool for building trust and commitment with their staff. Active listening includes both verbal and nonverbal communication skills. For example:

• Nod your head, but never interrupt.
• Lean forward and maintain eye contact to let the person know you’re engaged.
• Include minimal verbal encouragement, such as “I understand,” and “go on.”

4. Written Communication

Written communication skills are also essential for effective nurse-to-nurse communication. As a nurse, you will be responsible for creating and updating the patient ’s medical record . It is critical that the medical record is accurate and current so your patients can receive the best care possible. Also, remember to protect patient confidentiality. Some tips:

• Make notes immediately following patient care so you do not forget anything.
• Write legibly and clearly, using simple language.
• Be sure to note accurate dates and times.

5. Presentation Skills

Effective presentation skills are most applicable during “handover”—when you are transferring patient care to another nurse or other healthcare providers . These skills will also help you demonstrate your knowledge and expertise clearly in a variety of workplace settings, such as presenting at conferences, participating in job interviews, giving case reports to physicians, and more. It’s a good idea to:

• Plan out your presentation and practice.
• Pay attention to both your verbal communication and body language.
• Add visuals to your presentation for a better explanation.
• Understand your audience and know what they want and need from the presentation.

6. Patient Education (Patient Teach-Back)

Nurses are in charge of most of the communication between the healthcare team and patients. This includes informing patients and family members of health conditions, diagnoses, treatment plans, and medication protocols. This skill is especially important for family nurse practitioners who work with patients and families to provide health and education counseling.

Patient teach-back is an effective communication strategy where providers ask patients to repeat the information back to them. This method improves patient understanding and encourages adherence to care instructions. Poor understanding of information can cause patients and their family members to feel anxious or become defensive. For example, you can say:

• “We’ve gone over a lot of information. Now I’d like you to repeat it back to me to make sure you remember everything.”
• “Can you repeat the instructions for taking this medicine back to me?”
• “Let’s review what we just discussed. Can you explain it to me in your own words?”

7. Making Personal Connections

It’s important to get to know the person behind the patient. Patient-centered relationships are critical in helping patients feel safe and comfortable. Creating meaningful connections with patients can improve outcomes and trust. Some ideas:

• Spend a couple of extra minutes every day with each patient getting to know them.
• Find out a fun fact about each patient.
• Show interest in their lives and share stories of your own.

It’s important for healthcare professionals to inspire trust in patients by listening actively and taking every complaint and concern seriously. Building trust takes time. Healthcare settings are scary for some patients. It’s important to make them feel as comfortable as possible.

Trust is something that nurse educators and leaders should also cultivate as they work to develop the next generation of nurses. To inspire trust, nurse leaders and educators should:

• Always tell the truth.
• Share information openly.
• Be willing to admit mistakes.

9. Cultural Awareness

You will likely work with people every day who come from a wide range of social, cultural, and educational backgrounds. Every patient and coworker is unique, and it’s important to be aware and sensitive. For example, gauge the patient’s fluency with English and grade your vocabulary accordingly or bring in a translator if necessary and possible. With trans and gender nonbinary patients, be sure to use their preferred name and pronoun.

10. Compassion

Conveying compassion is an essential communication skill in healthcare. According to the Journal of Compassionate Healthcare , “studies show that compassion can assist in prompting fast recovery from acute illness, enhancing the management of chronic illness, and relieving anxiety.” You can deliver compassionate nursing care by putting yourself in the patient’s shoes and understanding their needs and expectations.

How to Overcome Communication Barriers in Nursing

Sometimes the message sent is not always received the way it was desired. Communication barriers in nursing result in weak patient-nurse interactions and relationships. To overcome these, we must first understand the types of communication barriers that nurses face. In the article “ Communication and Language Needs ,” Dawn Weaver identifies three common communication barriers in nursing: physical, social, and psychological.

Physical Barriers

The environment in which you communicate with a patient can make a huge difference in effective communication. Busy, loud, and distracting settings can increase patient stress. To create a safe and comfortable environment, try closing doors, opening blinds, and mitigating outside noises whenever you can.

Social Barriers

Social barriers include differences in language, religion, culture, age, and customs. Understanding each patient’s cultural background can help nurses avoid prejudice and communicate clearly. It’s a good idea to tailor your communication strategies depending on the patient’s age, as well: A 12-year-old and a 70-year-old will have very different ideas of what health and healthcare mean to them.

Psychological Barriers

For many patients, a trip to the doctor is anxiety-inducing. Anxiety and stress are psychological barriers, as are dementia and other cognitive conditions. To help reduce their influence, it helps to take extra time to listen, empathize, and be supportive. Such psychosocial care has been proven to improve patient health outcomes and quality of life.

Nurses may also need to overcome their own psychological barriers. Speaking to patients and family members about death, disease, and other sensitive topics can be distressing. A study in the Journal of Advanced Nursing explored the fact that many nurses experience feelings of anxiety when discussing patient medical needs and conditions.

Get Started Developing Crucial Communication Skills Today

Learning these and other communication skills should be part of your education, whether you’re enrolled in undergraduate nursing school or a graduate nursing program . They are also easy to practice on the job, as you will get plenty of opportunities for communicating with patients and your colleagues. Put your favorite idea into practice today!

The University of St. Augustine for Health Sciences (USAHS) offers Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), and Post-Graduate Nursing Certificates designed for working nurses. Our degrees are offered online, with optional on-campus immersions* and an annual interprofessional trip abroad. Role specialties include Family Nurse Practitioner (FNP), Nurse Educator (MSN only) , and Nurse Executive . The MSN has several options to accelerate your time to degree completion. Complete coursework when and where you want—and earn your advanced nursing degree while keeping your work and life in balance.

*The FNP track includes two required hands-on clinical intensives as part of the curriculum.

The Joint Commission. “Joint Commission Center for Transforming Healthcare Releases Targeted Solutions Tool for Hand-Off Communications.” Joint Commission Perspectives 32, no. 8 (August 2012): 1, 3. https://pubmed.ncbi.nlm.nih.gov/22928243/. Accessed: January 26, 2022

Agency for Healthcare Research and Quality. “Use the Teach-Back Method: Tool #5.” Last reviewed September 2020. https://www.ahrq.gov/health-literacy/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool5.html. Accessed: January 26, 2022

Chen, Cassandra Siyun, Sally Wai-Chi Chan, Moon Fai Chan, Suk Foon Yap, Wenru Wang, and Yanika Kowitlawakul. “Nurses’ Perceptions of Psychosocial Care and Barriers to Its Provision: A Qualitative Study.” The Journal of Nursing Research 25, no. 6 (2017): 411–418. doi:10.1097/JNR.0000000000000185.

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Caldwell L, Grobbel CC. The importance of reflective practice in nursing. International Journal of Caring Sciences. 2013; 6:(3)319-326

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Reflecting on the communication process in health care. Part 1: clinical practice—breaking bad news

Beverley Anderson

Macmillan Uro-oncology Clinical Nurse Specialist, Epsom and St Helier NHS Trust

View articles · Email Beverley

This is the first of a two-part article on the communication process in health care. The interactive process of effective communication is crucial to enabling healthcare organisations to deliver compassionate, high-quality nursing care to patients, in facilitating interactions between the organisation and its employees and between team members. Poor communication can generate negativity; for instance, misperception and misinterpretation of the messages relayed can result in poor understanding, patient dissatisfaction and lead to complaints. Reflection is a highly beneficial tool. In nursing, it enables nurses to examine their practice, identify problems or concerns, and take appropriate action to initiate improvements. This two-part article examines the role of a uro-oncology clinical nurse specialist (UCNS). Ongoing observations and reflections on the UCNS's practice had identified some pertinent issues in the communication process, specifically those relating to clinical practice and the management of practice-related issues and complaints. Part 1 examines the inherent problems in the communication process, with explanation of their pertinence to delivering optimal health care to patients, as demonstrated in four case studies related to breaking bad news to patients and one scenario related to communicating in teams. Part 2 will focus on the management of complaints.

In health care, effective communication is crucial to enabling the delivery of compassionate, high-quality nursing care to patients ( Bramhall, 2014 ) and in facilitating effective interactions between an organisation and its employees ( Barber, 2016 ; Ali, 2017 ). Poor communication can have serious consequences for patients ( Pincock, 2004 ; Barber, 2016 ; Ali, 2017 ). Misperception or misinterpretation of the messages relayed can result in misunderstanding, increased anxiety, patient dissatisfaction and lead to complaints ( McClain, 2012 ; Ali, 2017 ; Bumb et al, 2017 ; Evans, 2017 ; Doyle, 2019 ), which, as evidence has shown, necessitates efficient management to ensure positive outcomes for all stakeholders—patients, health professionals and the healthcare organisation ( Barber, 2016 ; Ali, 2017 ; Evans, 2017 ; Doyle, 2019 ). Complaints and their management will be discussed in Part 2.

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Strategies for overcoming language barriers in healthcare

Language barriers between nurses and patients increasingly affect nursing practice, regardless of where care is delivered. In the United States, a language other than English is now spoken at home in one of five households, the highest level since just after World War I. 1 Patients with limited English skills are referred to as patients with limited English proficiency (LEP).

This article provides background information about language barriers between nurses and patients, and how these barriers affect patient outcomes. Practice-based strategies are offered to improve outcomes and reduce readmissions. Although this article doesn’t address barriers to communicating with patients with hearing loss, many of the same principles apply to these patients.

Sources of spoken language barriers

Globalization means more people move around the world for work and educational opportunities. 2 When people migrate, they tend to follow immigrant networks and start recreating communities in their new country. 3 People also migrate and become refugees due to wars and civil conflicts. 3 Countries that accept these refugees place them in communities where they can recover from the trauma of their migration experiences while seeking work and learning about their new country. Structured refugee resettlement has been going on in the United States since after World War II. 4 With the exception of Native Americans, just about everyone in this country is descended from immigrants. When patients have a language barrier, it’s often related to when they migrated to the United States.

The largest group of migrants in the last 30 years speaks Spanish. 5 With only 5% of U.S. nurses identifying as Hispanic or Latino, it’s very common for patients in this group to encounter a language barrier. 6 (No publicly available record of language skills of U.S. nurses exists.) Mandarin and Cantonese Chinese speakers are the next largest group. 1 They’re also underrepresented in nursing. 7 The number of Russian-speaking people in the United States is growing quickly. However, for many Russian-speaking patients, Russian is their second or third language. In many countries under Soviet rule in the latter half of the 20th century, people continued to speak their original languages as well as Russian. With the dissolution of the Soviet Union, their preferred language may be the language of their home country. 8

In some parts of the United States, some older immigrants still face a language barrier. For example, many Italians who migrated to the United States in the early 1900s never developed English language skills and may still need interpreter services. 9 Language demographics depend on who’s moved into your organization’s service area. As people age, some may lose skills in their second language due to how the brain changes with aging. 10 Even those who developed strong fluency in English as adults can lose those skills if they have significant age-related neurologic events. Some of these older adults may end up needing interpreter services.

Another trend involves adults who migrated to the United States and then brought their parents over to join the family. 11 Although the adult children who brought their parents to the United States may speak English well, their parents may not speak English well enough to communicate effectively with a healthcare provider.

How migration dynamics affect nurses

Patients with language barriers change how nurses work and organize patient care. These changes are needed not only to meet communication needs for the patient, but also for legal reasons. In 1964, the U.S. Civil Rights Act helped ensure that a lack of English language skills wouldn’t be a source of discrimination. 12 , 13 U.S. law requires that healthcare organizations provide interpreter services to patients with LEP. 14 Regulations implemented as part of the Affordable Care Act place new restrictions on the use of family members and validating language skills of healthcare workers. 15

Much evidence shows how language barriers impact patient outcomes and healthcare delivery. (See Table 1 .) Patients with LEP have longer lengths of stay than English-speaking patients, even if they have a higher socioeconomic status. 16 - 18 They also have a higher risk of 30-day read-mission, by as much as 25%. 18 , 19

Evidence-based impact of language barriers on patient outcomes 27

How nurses and other healthcare providers respond to the communication needs of patients with LEP also has a significant impact on patient satisfaction, with effective use of interpreter services or bilingual healthcare professionals contributing to higher patient satisfaction ratings. 20 - 26

A closer look at medical interpreters

Aside from facilitating communication between patients and healthcare providers, medical interpreters can also serve as cultural brokers. 27 - 30 The medical interpreter helps bridge the cultural divide between patients and clinicians. The translation process ensures that what a nurse says is delivered not only with technical accuracy, but also with culturally specific phrasing. Nurses can assess the quality of medical interpreters’ cultural brokerage by observing how the patient responds to the interpreter through his or her body language.

Medical interpreters have a professional code of ethics that binds them to the same patient confidentiality requirements as every other healthcare team member. 31 Most interpreters hired by healthcare organizations have undergone some kind of medical interpreter training because healthcare has its own language. 32 According to the National Council on Interpreting in Health Care, no minimum number of course hours is required for interpreter training at this time, but it recommends that programs adhere to its curriculum standards, which were developed in 2011. 33 Implementing a course that meets the standards usually requires a minimum of 40 hours of study and successful live demonstration of the ability to interpret a medical encounter. Participants receive a certificate after they’ve completed the course. They can then take a national exam to become a board-certified medical interpreter. 34 Board certification is voluntary at this time.

Improving care quality and outcomes

How can nurses help improve outcomes for patients with LEP? These evidence-based strategies can help nurses better organize their care to improve outcomes and meet The Joint Commission requirements for bridging language barriers.

Use the organization’s interpreter resources.

Interpreter resources typically include in-person interpreters employed by an organization, in-person interpreters contracted through external agencies, and telephone- or technology-based interpreter services. (See Table 2 .)

10 tips for working effectively with an in-person medical interpreter

Some organizations deal with language barriers all of the time and have excellent resources. They may have an interpreter services department to manage the demand for language interpretation services. Some locations have experience with certain language groups and need interpretation for only a few languages. However, many healthcare organizations are seeing more diversity and have a greater need for interpreters. Most organizations begin with interpreter phone services and, if the demand becomes high enough, hire fulltime interpreters.

Telephone interpretation can work if implemented well. A good telephone interpretation session requires minimal waiting time for the phone interpreter, adequate sound quality so that everyone can hear clearly, and an outcome in which both the patient and provider obtain the information needed. 35

Nonetheless, both nurses and patients have reported problems with interpretation quality, expressing dislike for the depersonalization of the patient encounter when using the interpreter phone. 20 , 36 - 39 However, when no other option is available, telephone interpreter services are the best way to bridge the language barrier. New options with live video interpretation are also coming onto the market and may replace telephone interpreters.

Inappropriate interpreter use, including nonvalidated translation apps on a nurse’s smartphone, puts the organization at legal risk. Many apps for interpretation are available for smartphones, but their accuracy can be poor and most aren’t compliant with the Health Insurance Portability and Accountability Act (HIPAA). The quality of translation is rarely evaluated systematically or using rigorous approaches. Many of these apps are also designed for translating only basic sentences, such as how to order dinner when traveling. Most computer programs don’t yet have the sophistication needed to translate the language of healthcare. Use only those apps sanctioned by your employer that have undergone a thorough internal review and are HIPAA-compliant.

As a general rule, family members, especially children younger than age 18, shouldn’t serve as interpreters, except under extenuating circumstances such as an immediate threat to life. 40 , 41 Using a family member to interpret increases the risk that something won’t be translated correctly. For instance, a family member may not feel comfortable conveying some sensitive types of information to the patient, such as about sexual health, substance abuse, or a terminal diagnosis. Using a family member also increases the risk of medical errors. 35 Depending on the situation, it may also violate patient confidentiality protocols. Err on the side of caution: Don’t use family members for interpretation.

Get your professional staff members who speak other languages fluently certified for their skills and help them obtain medical interpreter training.

It’s inevitable that staff members who speak other languages will get pulled in to interpret at the last minute or when an interpreter isn’t available. Help reduce the risk of adverse outcomes related to poor quality translation by getting your staff certified and trained.

Use care when other staff members provide interpretation.

Staff members who speak the same language as the patient are a common resource for interpretation, but this practice has its own set of risks. Use coworkers with language skills appropriately, but only when necessary. The Agency for Healthcare Research and Quality (AHRQ) has developed guidelines for how to better utilize staff members with language skills. 27 According to the evidence, choosing a nurse or other healthcare professional who speaks the patient’s language and who’s had his or her language skills professionally evaluated by a language assessment expert is best. 32

Unlicensed assistive personnel or housekeeping staff members, who are commonly asked to interpret, may not have the medical vocabulary needed to accurately translate for the patient and family. If they become certified as medical interpreters or the organization assesses their language skills, however, they can then be used to translate.

Organizations that are implementing the AHRQ guidelines use name badges that designate the staff member’s language skills. Those employees have had a formal language skills assessment, understand medical terminology in the languages they speak, and speak the language well enough to safely communicate with patients and families. 27

Every time you ask professional staff members to interpret, you take them away from their own patients and add to their overall patient case load. 30 , 39 , 42 , 43 Consider developing an agreement for the patient care unit so that nurses with other-than-English language skills, with their permission, can be assigned to language-matching patients. Even if this means the staff member doesn’t have a “geographically efficient” assignment, it will help to streamline his or her work.

Document the use of medical interpreter services.

Documenting interpreter use is just as important as documenting wound care or any other clinical intervention. Document not only when an interpreter was used, but also the type of interpretation. For example, state whether it was at admission or discharge, or for informed consent or patient teaching. Then document whether the interpretation was done by a medical interpreter on staff by telephone or with a computer, and the interpreter’s name. In some cases, depending on the organization’s policy, the interpreter will be required to document the encounter as well. The interpreter will include information such as the patient’s unique identifier, time and duration of the encounter, and any other information required by the organization.

When a nurse has to rely on a staff member to interpret, either because no interpreters were available or because of technologic difficulties, documenting the decision making behind that choice will also help protect the nurse. Showing that every effort was made to adhere to organizational policy means the nurse has done what’s legally required.

Time interpreter use strategically.

Research shows that the three critical times when nurses should use interpreters are at admission, during patient teaching, and at discharge. Using interpreters at these times decreases the risks of medical errors and hospital readmissions. 18 , 36 , 44 - 46

How will it help? During admission, using an interpreter will provide more accurate baseline information. That, in turn, will help the healthcare team create a more accurate care plan. An interpreter can also help nurses tailor patient teaching to the needs of patients and their educational level. At discharge, having an interpreter present is equally critical, even if it delays discharge by a few hours. A good patient discharge process with an interpreter will decrease the risk that patients will be readmitted because they didn’t understand how to take their medications or other discharge instructions. 18 , 46

An idea for a clinical ladder project is to have discharge instructions and patient education materials translated into languages spoken by many patients. Bilingual discharge instructions also ensure that when patients are referred for home health services, home healthcare nurses who don’t speak their language can also read the discharge instructions. The more resources that can be used for teaching and facilitating discharge for patients with LEP, the less likely they are to be readmitted or visit the ED. 18 , 46

Prioritize patient understanding of medication management.

Medication adherence is complex when patients speak English, but even more so when patients have LEP. 47 , 48 First, medications may have different names in other countries, even in other English-speaking countries, and may require translation. Second, whenever possible, medication instructions should be in the patient’s preferred language. Remember that even when someone speaks some English, he or she may not be able to read it. A review of medications using teach-back techniques helps promote adherence, reduce readmissions related to failure to take new medications or understand changes to the old regimen, and help with care coordination with community-based providers. 27

Prioritize hiring professional staff members who speak the languages of your patients.

If you have professional staff members who speak the language of your LEP patients, you have an excellent chance of improving patient outcomes and satisfaction. You can determine the demand for these nurses by looking at the census of your non-English-speaking patient population. It’s also worth paying them at a higher hourly rate because their language skills will reduce interpreter costs, improve outcomes, and reduce the risk of costly adverse events. 43

Speaking up

These evidence-based tips for bridging language barriers between nurses and patients with LEP help nurses provide optimal patient care. They can apply to nearly every healthcare delivery setting, with some modification. Remember: Nurses have the responsibility to do their best to bridge language barriers with their patients to adhere to practice standards and improve patient outcomes.

Acknowledgments

The author has disclosed that work for this article was funded by the Agency for Healthcare Research and Quality R01HS023593. The author previously completed consulting work for policy analyses with the Migration Policy Institute. The author and planners have disclosed no other potential conflicts of interest, financial or otherwise.

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Overcoming Barriers to Communication, Essay Example

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Problems of communication diminish the success of principles in the performance of their function. If messages are poorly transmitted or misinterpreted and if action is not effected, managers can not plan and monitor activities properly. Managers can do several things to improve communications in organizations. In general, these center around understand the barriers to communication and knowing how to overcome them.

The sender, the receiver, and the medium are the essential elements of the communication process. But unless a message is interpreted as it was meant, one still does not have communication. Misinterpretation is always possible when two individual in the organizational environment interact. The four types of communication barriers are (a) process barriers, (b) physical barriers, (c) semantic barriers, and (d) personal barriers.

Process barriers may arise in many situations. They stem from unwieldy procedural approaches that limit teams’ ability to do their work. Cumbersome approve processes and communication channels that follow the chain of command are incompatible with effective team operation.

Physical barriers are environmental factors which prevent or reduce the sending or receiving of communication. They include distance, walls, distracting background noise, and similar interferences. For example, in a hospital setting, which functions round the clock in three shifts, the senior officers may not see their subordinates for several days at a time. These are usually obvious barriers.

Personal barriers arise from judgments, emotions and the social values of people and are less obvious. These factors cause a psychological distance between people, which can be just as real as a physical barrier.Managers see and hear what they want to see and hear, and they remain selectively “tuned out” to that which they do not wish to see or hear. Psychological distance may entirely prevent communication, filter part of it or cause misinterpretation. For example, three doctors were discussing the serious condition of a patient. The sister-in-charge, who was working in the duty room, thought that they were talking about her incompetence. She rushed to the matron and requested her to transfer the patient to another floor because the doctors felt that she could not give sufficient nursing care to their patient.

Semantic barriers arise from the limitations of language. Language may take any of the three forms: words, picture and actions. Words have several meanings and they become meaningless if not they are put in the proper sense . One of the basic problems in communication is that the sense and meaning which is actually understood by one person may not be what the other intended to imply.

In a case, an employee noticed a banana peel lying on the floor of the office. She instructed the sweeper on duty to remove it immediately as it was a safety hazard. The sweeper, who was busy mopping up the floor, nodded his head to indicate that he would remove the banana peel. Just as the sweeper had finished mopping up the floor, another employee slipped on that same banana peel. The employee was furious at this mishapwhich could be avoided . She decided to report about the sweeper for disobeying her instructions. She was informed by the sweeper that he was going to pick up the peel just after completing the job in hand, i.e. mopping up the floor. By the word “immediate” the employee meant at once, whereas the sweeper understood he could do the job after completing the one in hand. This example clearly shows that even simple words carry different meanings to different people. Employees have to be told what managers want them to do. The speaker and the listener should understand the words in the same sense.

Managers must be clear about what they wish to communicate as wellas the objective of that communication. Before communicating, it is necessary to be clear about the problem and the information sought to be communicated to solve this problem. Therefore, it is necessary to decide what the receiver should know. If the objective is clear, communication is likely to succeed.

It is preferable to speak in the vernacular language of the receiver, because this is more effective. This is often not practicable in organizational setting because most of the employees belong to different regions and speak different languages. Though English is the most common language used in organizations, its use for communication still causes a language barrier because the majority of employees lack fluency and mastery over it.

Managers should use the right medium of communication, such as diagrams, charts, visual aids; according to the requirements because these can help the receiver achieve a better perception of the content of the communication.

In cases of upward communication, it is necessary to remove the organizational and intentional blocks. While communicating, it is desirable for managers to consider a complete physical and human setting. Even the tone of the communication matters. Therefore, the right climate should be created for communication in terms of the subject matter, the medium used, the situation and the persons involved.

The amount of communication must be adequate so that the recipient gets the complete message. The message should neither be unnecessarily lengthy nor too short.

For written communication, clarity, brevity, and style are important to make reading easier and the content is understandable.

One of the biggest assets of any organization is its human resources. Therefore, it is essential for managers to have interaction with them. The manager any organization should make it a point to meet employees occasionally, ask their problems and try to know whether they know the developments that are taking place in the organization.

Managers can control the choice of words; the use of technical terms, acronyms, or trade jargon; and the speed of delivery. They can sometimes control the time and place of the communication. They also can enhance understanding and retention by repeating vital information and showing the same information in some graphic form. All of these techniques will have considerable impact on the listeners.

A successful system of communication must operate not only from the Chief Executive’s office downwards but must consist of four interlocking circuits transmitting information, opinions, etc. downward, upward, horizontal and grapevine. It is manager’s responsibility that the management of an organization should realize the importance of effective communication within the organization. The management should find from their senior managers and lower employees the difficulties involved in communicating. They should know what information the employees would like to know from the management and what they should know from the employees through upward communication so that unnecessary bottlenecks of communication may be eliminated in the interest of the organization and for the free flow of communication.

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Essay on Barriers To Effective Communication

Students are often asked to write an essay on Barriers To Effective Communication in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Barriers To Effective Communication

Introduction.

Communication is a key part of our lives. It’s how we share ideas, feelings, and information. But sometimes, things can get in the way of clear communication. These obstacles are called barriers to effective communication.

Physical Barriers

Physical barriers are things like distance, noise, or poor technology. If you’re trying to talk to someone far away, or in a loud place, it can be hard to hear and understand them. Bad phone or internet connection can also make communication difficult.

Language Barriers

Sometimes, people don’t speak the same language. This can make it hard to communicate. Even if you both speak the same language, different accents or use of slang can create misunderstandings.

Emotional Barriers

Emotions can also be a barrier. If someone is upset, angry, or scared, they might not be able to communicate clearly. They might also misunderstand what others are trying to say.

Cultural Barriers

Recognizing these barriers is the first step to better communication. With understanding and patience, we can work to overcome these obstacles and communicate more effectively.

250 Words Essay on Barriers To Effective Communication

Understanding communication.

Communication is the process of sharing or exchanging information, ideas, or feelings. It plays a key role in our daily lives. But sometimes, we face problems in communicating effectively. These problems are known as barriers to effective communication.

Physical barriers are the first type of barriers. They include distance, noise, or any other physical hindrance that stops the message from being delivered or understood. For instance, a loud noise in the background can make it hard for someone to hear what another person is saying.

Language barriers happen when people speak different languages or use complex words that others cannot understand. If the receiver doesn’t understand the language or words used by the sender, the message will not be understood.

Emotional barriers occur when people’s feelings or emotions stop them from understanding the message. If a person is angry, upset, or stressed, they might not understand or interpret the message correctly.

Overcoming Barriers

To overcome these barriers, we can use simple language, make sure the environment is suitable for communication, try to understand others’ feelings, and respect different cultures. By doing this, we can communicate more effectively.

In conclusion, understanding and overcoming these barriers can make our communication more effective. It helps us to share our ideas and feelings more clearly and makes our daily lives easier.

500 Words Essay on Barriers To Effective Communication

Physical barriers are the first type of problem. These can be anything that stops the message from reaching the other person. For example, if you are trying to talk to someone in a noisy room, they might not hear you. This is a physical barrier. Other examples include distance, poor lighting, or bad signal on your phone.

The second type of barrier is language. If two people don’t speak the same language, they can’t understand each other. Even if they do speak the same language, they might use different words or phrases. This can cause confusion. For example, in English, the word “biscuit” means different things in the UK and the US.

The fourth type of barrier is cultural. Different cultures have different ways of communicating. What is polite in one culture might be rude in another. For example, in some cultures, it’s rude to make eye contact. In others, it’s a sign of respect. These differences can cause misunderstandings.

Personal Barriers

The last type of barrier is personal. These are things like beliefs, attitudes, or prejudices. For example, if someone believes that all teenagers are lazy, they might not listen to a teenager’s ideas. This is a personal barrier.

In conclusion, effective communication can face many barriers. These include physical, language, emotional, cultural, and personal barriers. By understanding these, we can work to overcome them. This will help us to build stronger bridges of communication with others. This is important because good communication helps us to understand each other better. It helps us to solve problems, make decisions, and build relationships. So, let’s all try to break down these barriers and communicate more effectively.

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