Effective Communication in Nursing

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Introduction   

Communication in nursing is key, and the ability to communicate effectively can be our lifeline. We depend on ourself and others to be fluent and effective in the art of communication in order to perform our role as nurses successfully. When any link in our communication chain fails, we immediately see poor outcomes, wastage of resources, reductions in patient and staff satisfaction as well as a decline in the quality of patient care (1). 

Types of Communication

In order to master effective communication in nursing, it is important to understand the various types of communication, their definitions and the impact they can make.

Non-Verbal

This form of communication relies solely on body language, including body and facial mannerisms, and lacks spoken words or sounds (2, 3). We perform and identify non-verbal communication in nursing daily without giving it a second thought. We may see a newborn sucking on their hands, providing us a non-verbal cue that they are hungry. When assessing a patient holding their abdomen, we would initially target that area because they have communicated (non-verbally) that this is where they are experiencing discomfort. Smiling when the next shift nurse walks in the door communicates to them that you are happy to see them and that it's about time to go home!

Since we perform non-verbal communication so often, it can become a potent or extremely damaging tool. This form of communication in nursing can be used positively to show our patients and co-workers that we have compassion and are engaged. Negative forms can make patients uncomfortable with sharing their medical history and result in a lower quality of patient care. Additionally, it can lead to dysfunctional teamwork among staff (2).

Verbal

Verbal communication occurs when we use words or sounds to discuss concepts with others (2). This form of communication in nursing has the conception to be a very easy notion, but it can create unfavorable consequences when used ineffectively. In order to produce clear verbal messages, we should always speak concisely and confidently. As healthcare professionals, we have our language and understanding of when to incorporate medical jargon into conversations versus when not, which is crucial in providing care (4). When communicating among co-workers, our medical knowledge can display professionalism, and they can follow along. However, when speaking with patients and their families, this may only sometimes be the case, and we must be able to effectively gauge our audience and ensure that they clearly understand what we are teaching or explaining; this is a precious tool.

Written

This form of communication can be either a formal or informal transcription of words intended to serve as a direct communication form (2). Written communication in nursing is used daily and incorporates one of our most essential duties: documentation. Throughout our nursing practice, we have learned the importance and necessity of our documentation; it can be helpful for legal protection or provide critical data to other healthcare professionals. Written communication can also be accessed through our policies and procedures to perform various tasks. Having sound, written communication and interpretation skills is vital to the overall success of our nursing career.

Receiving Communication 

The most common communication perception is usually directed at producing communication through non-verbal, verbal, or written forms. While the production of communication is essential, the reception of it holds even greater value. In nursing, ensuring our communication is received correctly affects every clinical, orientation, or job experience we have encountered thus far. Think about it...

• I was taking notes in class or during a shift.
• When a preceptor or instructor educates you on a new skill or equipment.
• You teach your patient, family, or student about a new diagnosis.
• You are watching your patient breathe for rate, depth, and effort.

We must successfully provide and receive communication in nursing through verbal, non-verbal, or written forms. If communication fails, we will experience highly adverse effects throughout our nursing system (2).

Hearing & Listening

Hearing describes the process or act of perceiving sounds or spoken words (2). We hear sounds upon auscultation, varying frequencies of alarms, and patient concerns when voiced. Hearing all these sounds is heavily dependent on how they are used. We must also listen to these sounds and words to successfully implement these sounds. To listen, we must hear and then interpret these sounds carefully (2). We interpret these sounds and words by asking additional questions, performing additional assessments, or paraphrasing the information presented.

Active listening is when the listener understands the information discussed and provides feedback (5). Ways to ensure active listening are having the patient repeat the information in their own words and paraphrasing it. Active listening patients may also ask questions relevant to the topic discussed. Some additional tips to ensure active listening and participation are providing the environment is free from distractions or biases, making eye contact, and allowing the speaker to fully respond before interrupting (5).

Communication Transmission Threads

Communication in nursing occurs multiple times a day between a wide range of communication threads. The type of communication through non-verbal, verbal, and written communication produced and received must be effectively performed (4). Success and implementation depend heavily on the communication between the nurse and the communication thread.

Nurse - Nurse

Communication among nurses is continuous throughout a shift while working within a team environment. Whether we pass our documentation on to another nurse for review or vice versa, there is a consistent, communicative flow of all variants (non-verbal, verbal, and written) between the team to provide patient care. Another way to effectively communicate patient information is to use a structured communication framework, such as the situation, background, assessment, and recommendation (SBAR) format.

Nurse - Ancillary Staff

Your team members will vary depending on your nursing career setting, but some items will remain consistently critical wherever you are. We must communicate clearly when delegating or reporting essential information from the nurse to ancillary staff participating in patient, client, or resident care.

Charge Nurse - Team

There will always be unexpected tasks, staff conflicts, or emergent situations when stepping into a charge nurse role. In this position, you will be putting all the communication skills you have acquired into practice at an all-time high. As the charge nurse, you will be viewed as a leader, meaning you are a role model for your team members. Now, in addition to effectively producing and receiving communication, you will identify poor communication and assist with its correction.

Nurse - Patient

The nurse-to-patient communication thread is one of the ultimate and most essential exchanges in the nursing profession (4). Patients need us, so we must maintain consistent and effective communication with them because any assessment, report, or medication administration is contingent upon it. Additionally, bedside patient reports during shift change are valuable to ensure effective nurse-patient communication.

Nurse - Family

The thread between the nurse and the patient’s family can be the foundation for your nurse-to-patient communication and its effectiveness. The family could be the responsible party or guardian for your patient. It could serve as your sole historian for patient information if the patient cannot communicate at the time of data collection. Ensuring that the family is aware of and understands discharge instructions can help them recognize any potential signs or symptoms that could result in calling a physician or visiting the emergency room.

Barriers & Improvements to Communication in Nursing

Barriers to communication in nursing happen frequently and are sometimes out of our control. These barriers include:

Environmental-related barriers

When providing patient education, the surrounding environment can negatively impact effective communication. Alarms, noisy surroundings, lack of privacy, and lighting can all be distractions when fostering a positive learning environment (6). As nurses, we must try to teach patients in an optimal environment conducive to listening and learning as much as possible.

Cultural differences

Identifying cultural differences during admission and cultural awareness will allow effective communication management throughout each culture you are presented with (6). Nurses must acknowledge their personal and cultural beliefs and differences. Additionally, they should respect patients’ cultural differences and refrain from judgment.

Healthcare Institutional BarriersPatient acuity, low staffing levels, and time constraints can contribute to communication barriers (6). Nurses can improve these barriers by utilizing staff huddles and working with the administration to overcome high-acuity patient assignments and some time constraints. Nurses may utilize a patient-centered approach and prioritize patient communication over routine tasks to improve communication.

Emergent situations

Emergent situations during your shift can be relieved through adequate knowledge of the policies and procedures and by performing debriefs after the problem is resolved. Debriefings hold valuable insight into reflections on the emergent situations we face as nurses, especially on communication performance.

In each thread and form of communication in nursing, we must remember the following items to receive information. While producing communication, we must always be clear, concise, and accurate with the correct corresponding tone when expressed to others. When we receive information, we must ensure we understand, investigate, and act according to the communication presented. Utilizing various communication platforms, including emails, boards, and group messaging apps, can help to ensure education is received.

Benefits of Effective Communication in Nursing 

When we achieve effective and therapeutic communication between both our team and patients, it will create opportunities for enhancements throughout our practice. Fostering a unity of teamwork with co-workers will increase satisfaction and reduce burnout rates. Reduced health care costs through reduced readmissions or emergency room visits will be established by successful patient education and understanding. Our quality of patient care will be heavily influenced by the nursing communication threads created through their care.

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