Nurses are charged with medically providing care for patients, but they must also develop relationships with patients in order to build trust and an environment where a patient can become informed and make proper decisions about his or her care. The ability to communicate well with patients and their families affects patients’ well-being and the quality and outcomes of nursing care (Loghmani, Borhani & Abbaszadeh, 2014).
There are many types of communication that take place between a nurse and her patient besides language. Facial expressions, eye contact, demeanor, and behavior also play a role in positive or negative communication. These are all internal factors and under the control of the nurse, which is important because the external factor in the patient, and they may not be able to decode communication as well as usual. The mental state of patients, especially in the emergency room, requires special attention to every detail of communication.
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When caring for a patient, nurses are required to listen carefully and respond courteously to patients who may be scared, in pain, or ashamed of their ignorance in regard to medicine. Nurses may discuss diagnoses or proper wound care with patients, and these are things that should be done in a private environment, where there are no outside observers and where a patient can feel free to express himself or herself (Kourkouta & Papathasiou, 2014).
Factors that facilitate positive communication include consultation with patients, emotional support, and the level of cultural or spiritual understanding that nurses had of the patient’s personal circumstance. Making eye contact can instill trust and let the patient know that he or she is being heard. Facial expressions should be friendly and empathetic, and behavior should not suggest flippancy or arrogance. The patient needs to know that the nurse is prioritizing his or her care, and the nurse should be honest with the patient when explaining their condition or treatment (Kourkouta & Papathasiou, 2014).
Barriers to communication include misunderstandings related to the patient’s treatment, job, or difficulties with care (Loghmani, Borhani & Abbaszadeh, 2014). To communicate effectively, nurses may need to adapt their philosophy and the culture in which care is provided to individuals (Zamanzadeh et al., 2014). Other factors that may impact communication may include market forces, which may impact staffing, mental health or substance abuse, physical health, and adherence to treatment among patients (Kelley, Kraft-Todd & Schapira, et al. 2014). Additionally, age and gender can be barriers. Gender can be a difficult cultural barrier in some cases, such as in cultures where women are not allowed to be seen unclothed by members of the opposite sex. Ultimately, ineffective communication can lead to misdiagnoses because patients don’t feel comfortable giving all necessary information. It can also provide poor experiences for patients who value health outcomes based on their perception of the experience rather than whether they are cured or healed effectively.
The nature of illness affects the way that patients receive communication, and the way that some nursing staff and other professionals deliver communication to patients has an impact on healthcare outcomes (Luxford & Sutton, 2014). For example, patients with a staff member treating a patient with a chronic illness may highlight models of self-management of disease in the home as a primary means of empowering the patient. Nursing staff working with a patient with a mental illness may adjust their communication style to ensure that the patient understands treatment protocols and outcomes, and may communicate with family members or other support structures to ensure compliance with treatment protocols if appropriate. Other strategies that health professionals may adopt may include listening to patient stories (which can provide detailed information about patient experiences), providing patients with opportunities for representation in governance or on health boards, and allowing patients to have representation or advocacy through patient committees so that patients can also contribute to the design of processes and even facilities within healthcare facilities (Luxford & Sutton, 2014).
For patients and providers, the perception of care must balance, and it needs to complement the population and community in which health is served. Health care delivery models need to reflect a continuum of care, where the patient’s experience fits into the overall picture of care as factors including population health, management, accountable care, healthcare reform and the efficacy of these efforts depend ultimately on how well providers can integrate the patient experience into care (Luxford & Sutton, 2014). Kelley, Kraft-Todd, Schapira et al. (2014) explore the influence of patient-clinician relationships on healthcare outcomes, to determine whether the patient and the clinician relationship has a helpful and positive effect on objective or perceived health outcomes. The researchers find that the patient-clinician relationship has a small but influential effect on health outcomes but also that more research is needed in this area, as not enough studies are available at present to further link this, thus the researchers call for additional studies on this subject.
Strategies to improve nurse-patient communication include delivering culturally appropriate communication and multiple communication strategies to patients to ensure that information is well-received by patients and their family members (Kelley, Kraft-Todd & Schapira et al., 2014). Luxford & Sutton (2014) note that capturing feedback about the health care provides health professionals with insights into how patient expectations of care have been or have not been achieved. Studies about patient experience show that a gap often exists between what patients want and what doctors and other health providers feel they need. Models for care improvement and communication include partnering with patients, point of care and patients accelerating care, all of which support enhanced patient engagement in healthcare to improve patient outcomes (Luxford & Sutton, 2014). The goal of many of these models also includes facilitating patient-focused care by creating more healing environments through collaborative care offered in the community of healthcare organizations, combined with greater support for patients within their community.
Research demonstrates that improved communication is possible when a partnership is established between health professionals and patients that have experienced care, when health professionals engage patients in a quest to improve healthcare services (Luxford & Sutton, 2014). Consumer engagement has been defined as a key factor that is unfulfilled in many organizations but critical to the safe delivery of care (Luxford & Sutton, 2014). While patient engagement has largely focused on individual patients and self-management for chronic conditions in the past, more recently health professionals have realized the significance of working with family members and the community to enhance delivery of safe care for patients. A partnership with patients requires that patients be engaged on multiple levels and that a shift in mindset be adopted among health providers to consider patients as a member of the care team, rather than being considered as served by the health team alone.
Strategies for communication between nurses and patients should include being polite or courteous but also frank and honest. The patient must trust that they are being informed but also that they are cared for emotionally. Eye contact and body gestures should be appropriate and used to enhance the trusting relationship. Equally important is the environment, which can be controlled by nurses by not delivering confidential or potentially harmful information in areas that can be observed by outsiders. Lastly, active listening will ensure that patients are heard, and this will aid in diagnosis and prevent other healthcare barriers.
Nurses communicate with patients verbally and non-verbally. What they say, how they say it, and what they mean must be understood for a patient to received good healthcare and achieve positive health outcomes.
- Kelley, J.M., Kraft-Todd, G., Schapira, L., Kossowsky, J. & Riess, H. (2014). The influence of the patient-clinician relationship on healthcare outcomes: A systematic review and meta-analysis of randomized controlled trials. PLoS One, 9(4): e94207.
- Kourkouta, L. & Papathanasiou, I.V. (2014). Communication in Nursing Practice. Materia Sociomedica 26(1): 65-67. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990376/
- Loghmani, L., Borhani, F. & Abbaszadeh, A. (2014). Factors affecting the nurse-patients’ family communication in intensive care unit of Kerman: a Qualitative study. Journal of Caring Science, 3(1): 67-82.
- Luxford, K. & Sutton, S. (2014). How does patient experience fit into the overall healthcare picture? Patient Experience Journal, 1(1): 20-27.
- Zamanzadeh, V. et al. (2014). Factors influencing communication between patients with cancer and their nurses in oncology wards, Indian Journal of Palliative Care, 20(1): 12-20.
