Importance of Communication in Nursing

Communication, in nursing, forms the key to patient safety, as well as their health and well-being. It is vital for a nurse to communicate effectively as it leads to better care for patients. Nurses relay and interpret information between patients, caregivers, physicians and family members of the patient. In this report, documentation related to clinical handover and the elements and skills of communication process have been analyzed.

Nursing
Communication

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
QUESTION 6..................................................................................................................................1
QUESTION 7..................................................................................................................................3
Elements of communication process...........................................................................................4
Skills of communication process by nurses.................................................................................5
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
Communication, in nursing, forms the key to patient safety, as well as their health and
well-being. It is vital for a nurse to communicate effectively as it leads to better care for patients.
Nurses relay and interpret information between patients, caregivers, physicians and family
members of the patient (Mullan and Kothe, 2010). Hence, they act as the hub of communication.
In the present report, documentation related to clinical handover have been analysed. Further,
information has been provided on elements and skills of communication process.
QUESTION 6
Clinical handover refers to temporarily or permanently transferring the professional
responsibility and accountability concerning the various aspects of a patient to another person.
Handovers are considered as a vital practice for effective continuance of care (Giger, 2016). As
this is regarded as a high risk activity between doctors with concern to patient safety, effective
handover is essential for preventing patient harm. Verbal handover is risky as it only relies on the
memory. Therefore, it is important to study the documentation associated with handover.
Documentation of nursing assessment
Pertinent clinical information- ISBAR mnemonic
When a long break handover is to take place, ISBAR mnemonic is used as a tool which
assists in safe transfer of patient information. Therefore, the documentation related to clinical
handover will be based on the ISBAR mnemonic (Nicotera, Mahon and Wright, 2014). ISBAR
handover forms facilitate the information transfer.
I- Introduction
This step comprises of introducing the person who is handing over the information.
Introduction comprises of details about the role of the person and the reason for handover.
S- Situation
This includes documenting the reason for admission of the patient. It also includes details
of any known diagnosis of the patient,. Further, mode of delivery and date is also included
(Kesten, 2011).
B- Background
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Relevant previous history for the patient is documented.
A- Assessment
This is concerned with documenting the latest clinical assessment and investigations. It
includes Pulse, temperature, Hb, patient anxiety, pain score etc. (Riley, 2015).
R- Recommendation
These are the details of the actions that are required to be carried out after handover. This
section also includes details on any risks to the patient.
Hence the documentation containing the ISBAR mnemonic is important for clinical
handover as it assists in ensuring completeness of information. It also reduces the likelihood of
missed data thus aiding in efficient clinical handover (Hemsley, Balandin and Worrall, 2012).
Time and date of handover
The documentation related to handover also contain the time and date of handover. This
is required to communicate appropriate and comprehensive information about the patient. This
information is assistive in determining the date from which new person handles the responsibility
and accountability of the patient (Zavertnik, Huff and Munro, 2010).
Clinical notes
Another required documentation related to handover is the clinical notes. Notes are to be
taken when the person concerned receives a handover. This would comprise of head to toe
assessment of the patient. Clinical notes or progress notes also contain all the details about the
clinical status as well as course of hospitalization.
Test results
Tests undertaken and their results are also documented and handed over to the receiving person
(Gausvik and et.al., 2015).
Medication and fluid charts
Fluid charts are also to be documented as these provide important information about
altered urine output as well as abnormal losses. Similarly, for increasing medication safety, the
medication charts are to be documented during handover. These contain records of the prescribed
as well as administered medications (Button, Harrington and Belan, 2014). These also contain
information on any allergies and adverse reactions.
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Patient information sheets
Patient information sheet is also an important document that is related to handover. It
contains all the information about patients such as his age, person to be contacted in case of
emergency etc.
Transfer document/ discharge summary
When an intra or inter facility handover is to be conducted, it is important that a detailed
transfer document or discharge summary is prepared. Further, this document should be provided
prior to the patient or along with his arrival. Also the information included in the transfer
document should be the same as the discharge summary (McCabe and Timmins, 2013). This
documentation is done to avoid any communication errors and to foster patient safety.
Discharge summary document includes the following information:
 Past medical history- The past medical history of the patient is provided in detail.
 Discharge diagnoses- The most important diagnosis are listed. This also contains
pertinent behavioral, functional, cognitive and effective diagnoses. This provides the
receiving healthcare provider an overview of the issues of patient.
 Summary of hospital course by problems- This describes the course adopted by hospital
on a problem based fashion (Vasse and et.al., 2010).
 Discharge instructions- These are instructions provided regarding diet, oxygen therapy,
wound care etc.
 Discharge medication list- This is one of the most important part of a discharge summary
during handover as it provides information on the medications started during
hospitalization and any tapering schedules.
 Rehabilitation orders and follow- up appointments- This includes information of
rehabilitation orders concerning speech therapy, PT, OT etc.
 Baseline cognitive status- This information will be helpful to the receiving care provider
to know the plan of care for patient (Cherry and Jacob, 2016).
QUESTION 7
Communication is considered as one of the most important tools in healthcare. It is not
restricted to social interaction but extends beyond it to patient care and even their survival. Any
miscommunication about a medication or treatment can be fatal for the service users (O'hagan
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and et.al., 2014). Communication is a two way process and involves health care professionals
and nurses on one hand and service users and their families on the other.
Elements of communication process
Following are the 4 elements of communication process:
Referent
This is the element that performs the work of motivating one person to communicate with
anther. There are various cues in a health care setting which help in initiating communication.
These include sensations, sights, perceptions, ideas and sounds (Baghcheghi, Koohestani and
Rezaei, 2011). When a person is knowledgeable about the stimulus or referent which is
supportive in developing messages then it enables the person to organize the message in a better
way. For example, a different response is cause by a patient request that is prompted by
breathing difficult as compared to the response caused by patient request arising from hunger.
Sender and receiver
This is another element of the communication process. The person who performs the
work of encoding and delivering a message is called the sender. When a message is to be
communicated, it is put into verbal and non- verbal symbols by the sender for the receiver to
understand. This message of the sender acts as a referent for the receiver. In the case of
transactional communication, there is a back and forth switching of the role of sender and
receiver between the patient and the nurse (Mullan and Kothe, 2010). Decoding is the process in
which the receiver interprets the meaning of the symbols communicated by the sender. In order
accurately decode the message, one needs to possess the skills of active listening. Moreover, it
also depends on the relationship between the sender and the receiver. The ore common the
sender and receiver have between themselves, the more accurately the message will be
understood. It can be analyzed that when a rapport is established by the nurse with the patient,
more effective communication can take place.
Message
This is the third element in the communication process. It comprises of the content of the
communication. Verbal as well as non- verbal expressions of feelings and thoughts form the
message. The characteristic of effective messages are clarity, direct and use of language that is
understandable. Those individuals who café communication barriers require assistive devices
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such as hearing aids, pictures and interpreters (Nicotera, Mahon and Wright, 2014). This is
necessary for ensuring that the message which are sent and received are understandable. The way
a receiver interprets a message may also be distorted by the personal perceptions of the receiver.
A nurse is required to communicate in a way which clear, direct and familiar to the patient.
Moreover, the nurse also identifies the need for clarification if she finds the patient listening for
non- verbal cues. However, when the level of education of the participants is different,
communication becomes difficult. Hence, the message can be sent in writing if the patient is able
to read.
Communication channels
These are concerned with the means through which the message is sent and received. The
channels pertain to auditory, visual and tactile senses. Facial expressions serve as a channel for
sending visual messages. Similarly, spoken words are interpreted and received through auditory
channels. Tactile channels are used by Touch. When more channels are used for communicating
a message, the receiver is able to understand the message better (Hemsley, Balandin and Worrall,
2012). Communication channels are characterized by certain attributes such as noise and
capacity. When the messages are exchanged by two parties across a channel at the same time, it
is known as synchronous communication. Synchronous communication may be interruptive and
thus may negatively impact those individuals who have a high cognitive load. For example, a
nurse mat forget to carry out a task if he or she is interrupted when busy (Button, Harrington and
Belan, 2014). Asynchronous channels, on the other hand, are those when the communication
between individuals is separated by time. For example, the notes left by a nurse for another
colleague is a type of asynchronous communication.
Skills of communication process by nurses
Active listening skills:
Active listening is considered as the most effective level of listening. Generally, there is
need of nurses to be an active listener as it is the special part of the effective communication.
Along with this it is also considered to be a great strategy for conducting the effective
communication. Generally active listening is required for nurses in order to listen the needs and
demands of the patients. Through effective communications nurses are able to build a strong
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relationship with patients and their family and thus are able to provide them type of care they
require (Arnold and Boggs, 2015).
Through the process of active listening, nurses encourage patients to build their trust on
nursing staff in the provision of effective care. Active listening generally includes good body
posture along with facial expression, eye contact, showing interest in the talks of patients, verbal
encouragement, good listening attitude and reflecting back with effective answers that help them
in encouraging further communication (Active listening: The key of successful communication in
hospital managers. 2016).
This skill of communication is not only effective while communicating with patients but
is also required while having communication with other staff members and senior doctors. As it
is key feature of communication which is required while the provision of training to nurses.
Along with this, active listening also enable nurses to get information about new skills and trends
that are prevailing in nursing profession. Thus, it helps them in learning various skills regarding
advanced nursing practices which facilitate them with opportunities to provide patients with
advanced care.
Therapeutic communication:
Therapeutic communication is considered as the collection of techniques which helps in
evincing the physical, mental, and emotional well-being of the patients. There is need of nurses
to provide patients with effective care and support along with maintaining the appropriate
professional distance (Eggenberger, Heimerl and Bennett, 2013). Therapeutic communications
skills aid nurses in conducting the open-ended statement and questions and used to get silent in
some cases to encourage patients in order to come up with their own problem.
On the basis of therapeutic communication nurses learn about skill of acceptance. In thus
particular skill they accept the needs and suggestion of the patients regarding their care and
accept their suggestion. This help in providing encouraging the patients and will accelerate their
healing procedure. Therapeutic skill also tends to develop the habit of offering self. In this
procedure nurses provide their time to patients by their own will, by joining them in lunch,
watching TV shows with them and can sit with patients and boost them through their influencing
talks. These skills also includes deep observation and analysis of the patient's behaviour, their
appearance which can help nurses in gaining information regarding important areas that might
pose problems for patients (17 Therapeutic Communication Techniques. 2017).
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Focusing on patients is also an important principle of therapeutic communication. This
principle is generally used by all nurses, social workers and other health care professionals to
focus on the patient’s problems and provide them effective treatment procedures. This skill also
includes provision of knowledge regarding medical condition to patients.
Non- verbal communication
Non- verbal communication skills are characterized by the use of appropriate gestures,
facial expressions, posture etc. it is important for the nurses to be attentive towards the non-
verbal signals sent by them. This is because, more attention may be paid by a patient or co-
worker towards the non- verbal communication, rather than to the words. It is important for the
body language of the nurses to be synchronized with the words (McCabe and Timmins, 2013).
Non-verbal communications skills involve body posture, eye contact, facial expressions and
touch. When the level of face of the patent is equal to that of the nurse, the message is
communicated in a better manner. Therefore, non- verbal communication skills require nurses to
bring their face to the same level as that of the patient when the latter is in bed or chair. An open
stance need to be adopted by the nurses which conveys that they want to be there to listen to the
patients and their concerns.
Maintaining appropriate eye-contact forms an essential part of the non- verbal
communication skills that need to be considered by the nurses. Good eye contact with the patient
makes him feel confident and thus facilitates the communication process (Vasse and et.al.,
2010). It acts as a stimulant due to which the patients are able to disclose the problems properly
to the nurses and leads to effective treatment. However, since some cultures consider making eye
contact as rude, it needs to be taken care by the nurses.
Facial expressions convey a larger part of thought process of a person. Rolling eyes,
grimacing etc. are some of the facial expressions that discourage the patients to talk to the nurses.
Skills for effective non- verbal communication lie in controlling facial expressions and making
the patients feel comfortable and welcoming (Cherry and Jacob, 2016). If nurses be aware of
their facial expressions while communicating with the patient, they are able to establish a
positive patient nurse relationship as well as open communication. Touch is also considered to be
an effective and powerful means of communication. Gentle touch on the patient’s had by the
nurse conveys concern towards them. This makes them feel comfortable and they are able to
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communicate efficiently. However, as certain cultural issues surround touch. Therefore, this
aspect requires care.
Empathizing
This is one of the core communication skills that are required by nurses. It refers to
communicating in a manner which shows appreciation of the way other may be feeling. Though
empathy is a complex concept for the nurses as they have to attend to a number of patients
throughout the day, it is an important driver for patient satisfaction (Baghcheghi, Koohestani and
Rezaei, 2011). Empathetic communication is a skill that requires the nurses to view situations
form the perspective of the patients. It also requires them to demonstrate an understanding of the
feelings of the patient. This is the skills using which nurses are able to act in appropriate
therapeutic ways thereby considering the views of the patients.
Communicating in an empathetic manner improves the caregiving experiences
considerably. It also leads to better cooperation from the patients. It helps in enhancing the nurse
patient relationship (O'hagan and et.al., 2014). Patients view this skill as powerful because it
transforms their experience. This kills assists in considering the needs of the patient as well as
his family members. It further leads to development of authentic connections. Improvement in
mutual understanding and respect makes the patient as well as his family members confident
about the communication of the care that is being provided.
CONCLUSION
From the report, it can be concluded that effective handover is important for patient
safety. It requires communication of all the aspects of the patient to the other authority who
would be responsible and accountable for taking care of the patient. Documentation related to
clinical handover include patient information sheet, fluid chart, medication chart, discharge
summary, Time and date of handover, Clinical notes and Test results. Four elements of
communication process are referent, sender and receiver, message and communication channels.
In addition to this, four communication skills are active listening, therapeutic communication,
empathizing and non- verbal communication skills.
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REFERENCES
Books and journals
Arnold, E. C. and Boggs, K. U., 2015. Interpersonal Relationships-E-Book: Professional
Communication Skills for Nurses. Elsevier Health Sciences.
Baghcheghi, N., Koohestani, H. R. and Rezaei, K., 2011. A comparison of the cooperative
learning and traditional learning methods in theory classes on nursing students'
communication skill with patients at clinical settings. Nurse education today. 31(8).
pp.877-882.
Button, D., Harrington, A. and Belan, I., 2014. E-learning & information communication
technology (ICT) in nursing education: A review of the literature. Nurse Education
Today. 34(10). pp.1311-1323.
Cherry, B. and Jacob, S. R., 2016. Contemporary nursing: Issues, trends, & management.
Elsevier Health Sciences.
Eggenberger, E., Heimerl, K. and Bennett, M. I., 2013. Communication skills training in
dementia care: a systematic review of effectiveness, training content, and didactic
methods in different care settings. International Psychogeriatrics. 25(3). pp.345-358.
Gausvik, C. and et.al., 2015. Structured nursing communication on interdisciplinary acute care
teams improves perceptions of safety, efficiency, understanding of care plan and
teamwork as well as job satisfaction. Journal of multidisciplinary healthcare. 8. p.33.
Giger, J. N., 2016. Transcultural Nursing-E-Book: Assessment and Intervention. Elsevier Health
Sciences.
Hemsley, B., Balandin, S. and Worrall, L., 2012. Nursing the patient with complex
communication needs: time as a barrier and a facilitator to successful communication in
hospital. Journal of advanced nursing. 68(1). pp.116-126.
Kesten, K. S., 2011. Role-play using SBAR technique to improve observed communication skills
in senior nursing students. Journal of Nursing Education. 50(2). pp.79-87.
McCabe, C. and Timmins, F., 2013. Communication skills for nursing practice. Palgrave
Macmillan.
Mullan, B. A. and Kothe, E. J., 2010. Evaluating a nursing communication skills training course:
The relationships between self-rated ability, satisfaction, and actual performance. Nurse
education in practice. 10(6). pp.374-378.
Nicotera, A. M., Mahon, M. M. and Wright, K. B., 2014. Communication that builds teams:
Assessing a nursing conflict intervention. Nursing administration quarterly. 38(3).
pp.248-260.
O'hagan, S. and et.al., 2014. What counts as effective communication in nursing? Evidence from
nurse educators' and clinicians' feedback on nurse interactions with simulated
patients. Journal of advanced nursing. 70(6). pp.1344-1355.
Riley, J.B., 2015. Communication in nursing. Elsevier Health Sciences.
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Vasse, E. and et.al., 2010. A systematic review of communication strategies for people with
dementia in residential and nursing homes. International Psychogeriatrics. 22(2). pp.189-
200.
Zavertnik, J. E., Huff, T. A. and Munro, C. L., 2010. Innovative approach to teaching
communication skills to nursing students. Journal of Nursing Education. 49(2). pp.65-71.
Online
17 Therapeutic Communication Techniques. 2017. [Online]. Available through
<https://online.rivier.edu/therapeutic-communication-techniques/>. [Accessed on 30th
October 2017].
Active listening: The key of successful communication in hospital managers. 2016. [Online].
Available through <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844478/>.
[Accessed on 30th October 2017].
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