COLLGE OF NURSING GIMS ,GREATER NOIDA

SUBJECT : NURSING FOUNDATION-1

UNIT – V

TOPIC: COMMUNICATION AND NURSE PATIENT RELATIONSHIP

Presented By :

Lecture No:01 Ms. Kirti Rathee

Date: 20/09/24 Nursing Tutor

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 COURSE MAPPING
GENERL OBJECTIVE OUTCOME PO, CO, LO EVALUATION
MAPPING

At the end of the Unit, the At the end of the course,

students will be able to : students will be able to
To apply the principles of Students will demonstrate P5,CO3,L1 Essay
effective communication and effective communication Short answers
collaboration with members of skills and use critical thinking Long answers
health care team. and decision making in
communicating effectively
with patients and families and
team members to maintain
effective human relations.

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SPECIFIC OBJECTIVES OF THE SESSION

At the end of the class, the students will be able to:

1. Explain communication: Levels, Elements and Process, Types, Modes, Factors Influencing
Communication.
2. Discuss methods of Effective Communication/Therapeutic Communication Techniques.
3. Enumerate barriers to Effective Communication/Nontherapeutic Communication Techniques.
4. Explain professional Communication.
5. Explain helping Relationships (Nurse–patient Relationship): Purposes and Phases.
6. Discuss communicating effectively with Patient, Families and Team Members.
7. Understand about maintaining Effective Human Relations and Communication with Vulnerable
Groups (Children, Women, Physically and Mentally Challenged and Elderly).

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 TERMINOLOGY
❖Communication: Communication is an activity in which a sender transmits a
message, with/without the aid of media and vehicles, to one or more receivers, and
vice versa.
❖Communication process: A series of actions on the part of the sender and the
receiver of the message; the parts include the sender, message, channel, receiver,
translation, and feedback.
❖Barrier: Anything that prevents clear, effective communication.
❖Body language: The expression of nonverbal messages through gestures, facial
expressions, and other body actions or posture.
❖Communication: The process of sending and receiving messages that convey
information, ideas, feelings, and beliefs.

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 INTRODUCTION

• Communication is a dynamic (constant change) process that takes

place around us all the time.
• In fact we spend 70% of our time receiving and sending messages.
• Communication word derived from
• Latin - commūnicāre,
• meaning "to share"
• It is exchange of ideas, fact, feelings, thoughts, opinions and
information which is vital in facilitating human interaction through
(written or spoken) words, symbols or actions.
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 INTRODUCTION
❖Communication is the basic element of human interactions. It is one of the most
vital components of all nursing practice. A great deal of nursing practice involves
interpersonal communication skills and all the established of relationship essential
for successful functioning.

❖For example, communication between the nurse and other members of health team,
personnel in other healthcare agencies or the public.

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 DEFINITION

Communication is the process of exchanging information, thought,

ideas and feeling from one individual to another.

Fig:1

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 DEFINITION
• Communication is a process in which a message is transferred from
one person to other person through a suitable media and the intended
message is received and understood by the receiver.

• “A process by which two or more people exchange ideas, facts,

feelings or impressions in ways that each gains a ‘common
understanding’ of meaning, intent and use of message” - Paul Leagens.

• “Communication is a two way process of sharing and transmitting

ideas, information and message between two or more individuals.
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 ELEMENTS OF COMMUNICATION
Sender

Feedback Message

Elements of
communicati
on
Channel
of
Receiver
communi
cation

Interference

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 ELEMENTS OF COMMUNICATION
• The Source idea is the process by which one formulates an idea to communicate
to another party.
• This process can be influenced by external stimuli such as books or radio, or it can
come about internally by thinking about a particular subject.
• The source idea is the basis for the communication.
• The Message is what will be communicated to another party.
• It is based on the source idea, but the message is crafted to meet the needs of the
audience.
• For example, if the message is between two friends, the message will take a
different form than if communicating with a superior.
• Encoding is how the message is transmitted to another party.
• The medium of transmission will determine the form of the communication.
• For example, the message will take a different form if the communication will be
spoken or written.
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 ELEMENTS OF COMMUNICATION
• The Channel is the medium of the communication.
• The channel must be able to transmit the message from one party to another without
changing the content of the message.
• The channel can be a piece of paper, a communications medium such as radio, or it can be
an email.
• The channel is the path of the communication from sender to receiver.
• The Receiver is the party receiving the communication.
• A receiver can be a television set, a computer, or a piece of paper depending on the
channel used for the communication.
• Decoding is the process where the message is interpreted for its content.
• It also means the receiver thinks about the message's content and internalizes the message.
• Feedback is the final step in the communications process.
• This step conveys to the transmitter that the message is understood by the receiver.
• The receiver formats an appropriate reply to the first communication based on the channel
and sends it to the transmitter of the original message.

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 PROCESS OF COMMUNICATION

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 LEVEL OF COMMUNICATION
Level of
communication

Interpersonal Intrapersonal
communication communication

Group Public Organizational

Mass communication
communication communication communication

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R1
 LEVEL OF COMMUNICATION
Fig:2
• Interpersonal Communication: • It involves
two parties-a sender and a receiver who use
common language to transit message either
through oral communication or written
communication.

• Intrapersonal Communication:
• Intrapersonal communication is all about talking
to ourselves.

• • Prefix ‘intra’ means ‘within’ hence

intrapersonal communication is ‘self talk’.

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 LEVEL OF COMMUNICATION
Fig:3
• Group communication: it refers to
the communication that occurs
between three or more individuals.

• Public communication: it refers to

the communication that occurs with a
large gathering like a politician
addressing.

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 LEVEL OF COMMUNICATION
Organizational Communication: • In a team-
based business organization, communication
becomes its lifeblood where people communicate
with one another.
• The flow of communication inside an organization
may filter in up, down and horizontal directions.
• Besides internal communication companies
depend on external communication also.
• Companies exchange messages with people
outside the organization through external
communication. Fig:4

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 LEVEL OF COMMUNICATION
Mass Communication: •
Newspapers, magazines and periodicals, the
means of mass communication are
frequently used for oral or written
communication.
• Besides, technologies such as the internet,
e-mail, voicemail, faxes, audiotape,
teleconferencing, videoconferencing and
closed circuit televisions have increased
options for internal and external
communication.
• These fast means help people from all parts
of the world to work together.
Fig:5

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 TYPES AND MODE OF COMMUNICATION
Written
Verbal
Based on
channel Oral
communication
Non-verbal
Types of Face to
face Distance
communication
Formal
Based on style
and response
Informal

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 MODES OF COMMUNICATION
• The two main ways it is used in communication are:
• verbal,
• non-verbal
• Verbal communication:
Both spoken (type words and tone of voice, speed), written (words and
the meaning they convey), timing and clarity of the message.

• Non-verbal communication:
Body language, facial expressions, posture, gait (manner of walk)
gestures, nods, etc.

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BASED ON CHANNEL COMMUNICATION
• Verbal communication means effectively presenting your thoughts in verbal
format i.e., By talking. People always remember a person who speaks clearly,
effectively, confidently, and charismatically.
• It involves words and language to convey thoughts, ideas, and emotions.
• Nonverbal communication, transfer of information from one person to another
without the use of words or spoken language. Nonverbal communication can
occur in a variety of ways, including through facial expressions, gestures, and
body posture or position.
• Electronic communication refers to the use of electronic media such as
computers, email, telephone, video calling, and FAX machines to transmit
information or messages.
• It involves the transfer of signs, signals, writing, images, sounds, data, or
intelligence using various technologies.

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 Types of Verbal communication

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Fig:6 R1
 Written communication

• Written communication refers to the process

of exchanging information or messages
through written words. It can take many
forms, including emails, letters, articles, social
media posts, and even text messages.

• “Written communication is the art of

conveying information or ideas through the
written word. It is a form of expression that
can be used to inform, persuade, entertain, or
inspire.” – William Zinsser Fig;7

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 NONVERBAL COMMUNICATION
• Nonverbal
communication is the
production and
perception of any type
of signal, excluding Fig:8
speech, that is made in
order to convey
information to another
person.

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 ELECTRONIC COMMUNICATION
• Electronic communication refers to the exchange of digital
messages and data over a network or through other electronic
means. It includes communication via devices such as telephones,
mobile phones, and computers.
Fig:9

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R1
 SOCIAL MEDIA COMMUNICATION
Fig:10
• social media, a form of mass
media communications on the
Internet (such as on websites
for social networking and
microblogging) through which
users share information, ideas,
personal messages, and other
content (such as videos).

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 E-mail and texts
• Email (or e-mail) communication can be defined as the exchange of
short informational messages between at least two people over a
computer network. These messages containing plain text, images or
document attachments are delivered through email web-based services
like Gmail, Outlook, or Yahoo.

• Text messaging is the act of sending short, alphanumeric

communications between cellphones, pagers or other hand-held
devices, as implemented by a wireless carrier.

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 Classification according to the style and
purpose of communication

Formal communication Informal communication

• Follows certain rules and • Does not follow authority lines
principles • Used for casual exchange of
• Its an official style to convey message
message • Mostly used during the face-to-
• Used in professional settings face interactions with friends
• Slangs and jargon are and family
prohibited. • Slangs are not restricted.

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 TYPES OF FORMAL COMMUNICATION

Formal
communication

Vertical Horizontal
communication communication

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 CLASSIFICATION BASED ON FLOW OF
INFORMATION
• One-way communication: it is a process where information flows
from sender to a receiver, but there is no response from the receiver.
For e.g., one way communication include- television, radio,
writings, speeches, and performances.

• Two-way communication: it is a process involved share information

and feedback.
For e.g., chatrooms and instant messaging

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 Fig:11

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R1
 FACTORS INFLUENCING COMMUNICATION
Attitude
of nurse Cultural
Develop
mental backgroun
stage d

Factor
influencing
Values Gender
communicati
on
Physical,
mental
and Status/
emotiona Environ
ment Role
l state
/space/
territory

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 METHODS OF EFFECTIVE COMMUNICATION
Active
listening
Broad
Clarifying opening

Focusing Sharing
observation

Using
Accepting
touch

Reflection Offering
Giving self
recognitio
n
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 THERAPEUTIC COMMUNICATION

• “Therapeutic communication is defined as an exchange between the

patient and provider using verbal and non- verbal methods.”

• “Therapeutic communication is defined as the face-to-face process

of interacting that focuses on advancing the physical and emotional
well-being of a patient.”

• The ultimate goal of this communication style was considered to help

the patient overcome some form of emotional or psychological
distress.
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 GOALS OF THERAPEUTIC COMMUNICATION
➢Establish a nurse-patient relationship(NPR).

➢Guide the patient to cope or recover from illness.

➢Teach the patient about self-care and involve family.

➢Help the patient to ventilate thoughts, doubts and anxiety.

➢Identify the patients unmet needs and collect information related to

physical, social, emotional and mental health of the patient.

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 THERAPEUTIC COMMUNICATION
TECHNIQUES
❑Using silence ❑ Offering self
❑Proving general leads ❑ Giving information
❑Being specific tentative ❑ Acknowledging
❑ Presenting reality
❑Using open ended questions
❑ Focusing
❑Using touch ❑ Reflecting
❑Restarting ❑ Summarizing &
❑Seeking clarification planning
❑ challenging

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 BARRIERS OF COMMUNICATIONS

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 NON THERAPEUTIC COMMUNICATION
TECHNIQUES
❑ Asking personal questions ❑Asking for explanation

❑ Giving personal ❑ Approval or disapproval

opinion/advice ❑ Defensive responses

❑ Passive or aggressive response
❑ Changing the subject
❑ Arguing
❑ Automatic response
❑ Sympathy
❑ False reassurance
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 Nurses role in therapeutic relationship
• The nurse must acquire the necessary knowledge to participate effectively in
therapeutic relationship.
• The nurse needs to understand the process of a therapeutic relationship and be able
to recognize the current phase of his/her relationship with the client.
• Agencies will ensure that at minimum 70% of their nurses are working on a
permanent full- time basis.
• Staffing decision must consider client acuity, complexity level, complexity of
work environment, and availability of expert resources.
• Resources must be allocated to support clinical supervision and coaching process
to ensure that all nurse have clinical supervision and coaching on a regular basis.
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 PROFESSIONAL COMMUNICATION
• Every individual has a space around that allows to develop therapeutic
and professional communication.
Public zone
3.5m -
infinity

Social zone
1.0m – 3.5m

Personal
zone
0.5m-1.0 m

Intimate
zone
0-0.5m

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 NURSE PATIENT RELATIONSHIP
• The nurse patient relationship is a result of series of interaction between the nurse
and the patient over a period of time with the nurse focusing on needs and
problems of patient and his family while using scientific knowledge and scientific
skills of nursing profession.
- JOYCE TRAVELBEE

• A nurse-patient relationship is the professional relationship between a nurse

and a patient. It involves everything from communication, emotional, physical,
and spiritual support, medication administration, and performing treatments to
end-of-life care.
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 PURPOSE OF NURSE PATIENT RELATIONSHIP

Identify and explore patients current needs

Improve patients functioning

Develop adaptive problem-solving approaches

Promote patients recovery

Develop adaptive coping skills among patients

Change maladaptive behaviour to adaptive
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 PHASES OF NURSE PATIENT RELATIONSHIP

Pre- interaction
Introductory phase
phase
Termination
phase

Working phase Orientation phase

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 PHASES OF NURSE PATIENT RELATIONSHIP
• PHASES . 1. (Pre-interaction phase)
• Involves preparation for the first encounter with the client. Nurse’s Tasks
Explore own feelings , fantasies and fears. Analyze own professional
strength and limitations. Gather data about patient whenever possible. Plan
for first meeting with the patient.
• PHASES . 2. (Orientation Phase/ Introductory Phase)
• It is during that the nurse and the client meet for the first time. Nurse’s
Tasks
• Creating an environment for the establishment of trust and rapport.
• Gathering assessment information to build a strong client data base.
• Identifying client’s strength and weakness.
• Formulating nursing diagnoses
• Setting goals that are mutually agreeable to the nurse and client.
• Exploring feelings of both nurse and client.

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 PHASES OF NURSE PATIENT RELATIONSHIP
• PHASES . 3. (Working phase)
• The therapeutic work of relationship is accomplished during this
phase. Maintaining the trust and rapport that was established during
the orientation phase. Promote the client’s insight and perception of
reality. Here nurses must continuously evaluate the process towards
goal attainment.
• PHASES . 4. (Termination phase)
• This is the most difficult , but most important phase of the therapeutic
nurse-patient relationship. The goal of this phase is to bring a
therapeutic end to the relationship. The client may be discharged from
the hospital . Termination can be difficult phase for both the client and
nurse.
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 Communicating effectively with patient
• Nurse- patient relationship is a basic requirement of nursing
practice. A nurse who is efficient and skilful uses the holistic approach
in caring for a patient with any type of problem.

• It is an interaction process in which the nurse fulfils the role by using

professional knowledge and skill such a way that the nurse is able to
help the patient physically, socially and emotionally.

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 Communicating effectively with families

• Many situations require the nurse to form helping relationships with

entire families.
To communicate effectively with families
1. Active listening: Pay attention and show genuine interest.
2. Practice empathy: Understand and validate their feelings.
3. Be clear and concise: Avoid misunderstandings.
4. Notice nonverbal cues: Body language matters.
5. Express positive feedback: Appreciate and encourage.
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Communicating effectively with team members
• Nurses are members of a larger healthcare community and often function in
roles they require interaction with multiple health team members.

• Both social and therapeutic interactions are needed between the nurse and
health team members to build morale and strengthen relationship within the
work setting.

• Everyone has interpersonal needs for acceptance inclusion, identity, privacy,

power and control and affection.

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 Maintaining effective human relation with
vulnerable group
Communicating
with older
adults

Clients who Clients who

are visually Communication are angry
impaired
with vulnerable
population

Clients who Clients who

are hearing are confused
impaired

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 REFERENCES
• R1: clement I , Nursing foundation-1 (as per the revised nursing syllabus), 2nd Edition,
Jaypee Publishers, Page no: 121 – 168.
• R 2: Jyoti kathwal , textbook of Nursing foundation (for BSc nursing students), vision
publisher, Page no: 70-86.
• IMAGES REFERENCES:
• Figure1,2,4,5,6,7,8 : Google Images Courtesy
• Solved The interpersonal communication process Many years | Chegg.com
• Communication Skills Chapter Notes - Class 9 PDF Download - Worksheets ...
• Communication Process: The 5 Keys to Effective Communication | Ifioque.com
• What is Oral Communication? Definitions, Importance, Methods, Types, Advantages, and Disadvantages
(getuplearn.com)
• Written Communication | Communication, Business communication, Student ..

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 REFERENCES

• Digital Communication: Definition, Examples and its Types

• What are the 7 principles of communication? or 7 Cs of
Communication (getuplearn.com)

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Assignment

• Assignment on communication process with example.

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Lesson plan

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Question Bank

• Contains:
➢Short questions
➢Very short questions
➢Long questions
➢Multiple Choice questions

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