Communication

The Latin term "communis," which means to inform, communicate, exhibit, or spread information, is the root of the English word "communication."

Definitions of Communication:

• Communication can be defined as the process by which people share ideas, experience, knowledge and feelings through the transmission of symbolic messages.
• "Communication is the process of passing information and understanding from one person to another."- Keith Davis
• Communication is the sharing of information, ideas, attitudes or emotions from one person or group to another primarily through symbols.

Importance of Communication in Nursing

The importance of communication can be listed as:

• Between the client, family, and nurse, communication promotes rapport and trust.
• Professional happiness, job contentment, work motivation, etc. are all benefits of effective communication.
• Communication enables knowledge, skill, and attitude changes.
• Establishing and maintaining relationships with other members of the medical professional team, such as doctors, paramedics, and other departments' staff, depends on effective communication.
• It fosters coordination and cooperation, which fosters managerial effectiveness.
• It offers a foundation for leadership.
• Put human and other resources in the best possible order.
• The secret to oversight and control is communication.
• The primary method of delivering health education is through this.
• It avoids issues and misunderstandings.

Principles of Communication

There are specific communication rules. It will be better to use them when communicating information and ideas.

• Stay on topic:
  • Be explicit in your own words and stay on the subject of the major idea you want to get across. It eliminates uncertainty.
• Talk rationally:
  • Make sure the message you are delivering is logical and sure. The explanation is required for easy comprehension.
• Pay attention to the audience:
  • For clear communication and comprehension, both the speaker and the listener must pay close attention.
• Respect:
  • Regardless of the audience member's skill level, the communicator and speaker should respect their words and viewpoint. The most crucial factor for effective communication is human dignity.
• Clarity:
  • The message and information must be understandable. There should be no room for doubt. The massage should be delivered in a professional manner, employing clear vocal intonation, music, and other techniques.
• Objective:
  • Prior to communicating, the communicator must be aware of the message's explicit objective. The goal can be to spread knowledge, alter attitudes and behaviors, promote health, or something else entirely. It may be difficult to communicate information properly if the communication's goal is unclear. The mode/channel of communication is also chosen based on the goal.
• Communication according to understanding level of audience/receiver:
  • The communicator must be aware of the audience's comprehension level. In order for the audience to comprehend properly, she must speak in plain language, refrain from using technical terms and jargon, and provide facts in a straightforward and consistent manner. Before communicating, she or he must employ a variety of A/V aids, be cognizant of the social context, culture, values, and traditions, and demonstrate empathy for the audience. If the communicator is unaware of the audience's comprehension level, communication may not be successful.
• Completeness:
  • To be understood by the intended audience, the message must be comprehensive, precise, and short. Confusion and misunderstanding are caused by incomplete and insufficient information.
• Feedback:
  • The primary component of effective communication is feedback. Feedback is useful in determining whether the recipient has received accurate information. This two-way communication gives the recipient the chance to offer and receive suggestions, accept and follow instructions, and respond to the communicator's and the message's contents. Feedback thus completes the entire communication process.
• Time:
  • Both the communicator and the recipient should receive the information at the appropriate time. It should be sent at a time that is suitable and convenient for the recipient. This aids in getting the receiver's attention so that communication can be effective.

Elements of Communication Process

The key elements of communication in the above model are:

Message: That is what has to be said. Any ideas, facts, news, or feelings are acceptable.

The following are possible procedures or processes for message transmission:

• Sender:
  • The process of communication is started by it. The sender initiates communication by encoding thoughts and ideas into a message that can be comprehended by both the sender and the receivers. The sender may be impacted by both internal elements such as values, temperament, feelings, and attitudes as well as stress levels as well as external factors such as organizational atmosphere, timing, weather, status, power, and authority.
• Encoding:
  • It is the process of creating messages in the communicator's head, in which the sender not only converts his intended meaning (ideas, thoughts, or information) into a message but also selects the format, such as written, spoken, signaling, gesturing, etc., for delivery.
• Channel:
  • It is the means of communication between the communicator and the receiver. There are many other ways to communicate, including through written, spoken, nonverbal, and mass media including TV, radio, newspapers, and books. It can be challenging to select the channel that is best for both the message and the recipient. The choice of the appropriate channel determines whether communication is successful or unsuccessful.
• The receiver:
  • It is the message's intended receiver. The receiver won't be able to understand and decode the messages the way the communicator wants him to if he lacks the cognitive abilities of listening, reading, and thinking.
• Decoding:
  • It is how the recipient interprets the message. Actually, the receiver searches for the message's meaning, which is something both the communicator and the receiver do. Effective communication occurs when the recipient's comprehension of the message matches the sender's intended messages.
• Feedback:
  • It is the recipient's reaction or recognition to the communicator's message. Only if the receiver responds is the exchange feasible. The communication is sculpted and reshaped by the communicator and the recipient until the meaning is evident, even by fluttering eyelashes, raising an eyebrow, making a face, arranging a point, and asking for clarification. Both parties to a communication interact and frequently switch roles in this fashion. When communicating face-to-face, the recipient reacts naturally, honestly, and right away. The communicator might use this as an opportunity to get better and communicate more effectively.
• Noise:
  • It is an obtrusive interruption that can enter any part of the conversation and render it useless. Environment is a significant factor that affects message reception. Examples include things like roadside noises, people talking constantly outside of the communication act, blasting loudspeakers, defective transmission, etc. Other types of noise include sloppy handwriting, a loud or soft accent, speaking in a dimly lit environment, etc. In actuality, obstacles stand in the way of clear communication.

Methods/forms of Communication

The most effective communication techniques save time and money while effectively conveying the desired message in a way that is noticed by the target audience. The chosen technique of communication has an impact on how clearly the message is conveyed. The use of direct rather than indirect communication is more effective. The various forms of communication can be categorized in various ways. The following are the typical techniques for message transmission:

Verbal Communication:

Information is conveyed or shared verbally, either face-to-face or over the phone. In meetings, interviews, seminars, conferences, and casual talks, this style is typically employed.

Advantages:

• A straightforward, convenient, and inexpensive mode of communication.
• Direct and less likely to misinterpret the message in a formal setting.
• Permits the emergence of personal information and thoughts.
• Encourages feedback through interpersonal communication.
• By eradicating misunderstanding, promote friendly interpersonal ties.

Disadvantages:

• No official documentation of the interactions.
• This form cannot be used to send long or distant information.
• Because of perception issues and other obstacles, the message's intent may not be clearly comprehended.
• Greater time commitment compared to other forms of communication.

Written Communication:

To send a message, written communication is always done on paper or in writing form. It can appear in the form of a letter, statement, circular, memorandum, guidebook, report, etc.

Advantages:

• The message is certain to be accurate because it is less likely to miss the point.
• Most effective at expressing long messages.
• Able to be preserved as a permanent record and used as proof.
• Messages can be disseminated widely or selectively.
• Saves time because this can be used to reach individuals in many different places.
• When necessary, formal appearances provide a sound foundation for disciplinary proceedings.

Disadvantages:

• Avoid in-person conversations that could cause misunderstandings.
• Time-consuming in terms of message preparation.
• Possibly no rapid response.
• If messages are written improperly, communication may not be successful.

Nonverbal Communication:

It is the communication of a message without the use of words, either in writing or speaking. Body language, or the positions and movements of the body, is a major kind of nonverbal communication. Face expression, eye movement, gestures, bodily postures, vocal cues, outer appearances, etc. are all part of it.

A facial expression that supports the message being delivered is necessary for effective communication. Receivers will feel more at ease if the message sender has a pleasant and friendly demeanor. The way someone dresses and looks outside the body might affect how powerful they are seen to be.

Visual communication:

It is the exchange of concepts via visual cues and information visualization. Such as: typography, photography, and the arts.

Telecommunication and internet:

When technology is used to exchange information between communication partners, this is referred to as telecommunication. It is the transfer of any kind of information via wire, radio, optical, or electromagnetic systems, including signs, signals, messages, letters, words, images, and sounds. Either electrically across physical medium, such cables, or through electromagnetic radiation, it is communicated.

Others:

• One way communication:
  • If the sender provides information to the receivers, the communication only flows in one direction. Learning is passive, and there is no feedback. Receivers, such as those who receive information through radio or posters, are not involved.
• Two way communication:
  • The transmitter and receivers are in constant communication with one another. The receiver is actively involved.
• Formal communication:
  • Those communications that are part of the formal chain of command are referred to as formal communication. Any communication that occurs inside the confines of a predetermined organizational work arrangement is regarded as formal.
• Informal communication:
  • Unstructured organizational hierarchy does not define informal communication, which is a type of organizational communication. It is informal communication when workers converse with one another in the launch room or while walking through a hallway.
• Downward communication:
  • It is the exchange of information between a supervisor and a subordinate at lower management levels. Employees are informed, directed, coordinated, and evaluated using it. The management is employing downward communication when they delegate tasks, give job descriptions, or communicate company policies to their staff.
• Upward communication:
  • Upward communication is the movement of information from employees to managers. It keeps the manager informed on how staff members are performing, as well as how they feel about the organization as a whole, their jobs, and their coworkers. The management also looks to upward communication for suggestions on how to make improvements, such as performance reviews created by staff, suggestion boxes, employee attitudes, and staff reports.
• Lateral communication:
  • In an organizational structure, it refers to the communication that occurs between departments or individuals at comparable levels. Another name for it is horizontal communication. It has a more casual tone. Coordination or cross-departmental issue resolution are typically the purposes.
• Mass communication:
  • Mass communication is the act of disseminating information to a sizable group of people or audience using a variety of media. In the case of radio, television, lectures, exhibitions, etc., there is no face-to-face interaction between the transmitter and the recipient.

Different Barriers of Communication

This could be brought about by a number of things, which are typically summed up as being due to physical barriers, errors in the system design, or new barriers.

• Physiological barriers:
  • Barriers due to physiological factors include difficulties speaking, hearing, seeing, and expressing for some persons. Poor health also has an impact on communication.
• Psychological barriers:
  • Staff members differ from one another on a personal level. Some customers experience emotional upsetness more rapidly than others; this affects how well they communicate, for example, some people become angry quickly. Making individuals realize the situation is more challenging, particularly when they are emotionally disturbed and neurotic.
• Environmental barriers:
  • Additionally, it is very important for communication. Things become easier to understand if the surroundings is favorable. A person will become bored if the surroundings are noisy. Poor hearing impacts a person's ability to communicate.
• Cultural factors:
  • It is also one of the key elements in communication barriers. Depending on one's knowledge and comprehension, customs, beliefs, religion, and attitudes, one can comprehend. Since they vary from one group of people to another, these differences can serve as communication hurdles.
• Others:
  • Language
  • Noise
  • Low attention
  • Unspecific message
  • Low listening habit
  • Education level
  • Lack of communication skills
  • One way communication
  • Interest
  • Time
  • Gender differences
  • Non-verbal communication

Measures of Overcoming Barriers for Effective Communication

• Clarify concepts before communicating:
  • The individual communicating should be quite certain of his or her intentions. He should be aware of the purpose of his communication, and as a result, he should arrange his ideas in a sensible sequence.
• Communicate in a way that meets the recipient's needs:
  • The communication's sender should structure the message in accordance with the receiver's level, comprehension, and environment rather than his or her own level or competence. The message's topic matter need to be beneficial to the recipient. It is especially important to keep in mind the recipient's needs and interests.
• Consult with others before communicating:
  • All parties involved should be asked for their suggestions when the communication is being planned. Its key benefit is that everyone who was consulted when creating the communication plan will be able to contribute to the system's success.
• Watch out for the message's grammar, tone, and content:
  • The sender must ensure that the message is written in a clear, elegant style. The message's tone shouldn't hurt the recipient's feelings. The message's substance should, to the extent possible, be straightforward, concise, and free of overly technical language.
• Be sure to provide accurate feedback:
  • Feedback is used to determine whether the recipient has correctly absorbed the meaning of the information provided. When speaking face-to-face, it is possible to read the recipient's response from their expression. However, while sending a written message or another type of communication, the sender should use appropriate feedback techniques.
• Message coherence:
  • The information conveyed to the recipient shouldn't be conflicting in any way. It must to be in line with the organization's goals, policies, plans, and strategies. When a new message needs to be sent in place of the old one, it should always note the change because failing to do so can raise some questions.
• Follow-up communication:
  • We should routinely strive to determine the effectiveness of the communication system in order to improve communication. Follow up is crucial in this regard.
• Take time to listen:
  • The ability to listen well on both ends is essential to effective communication. Both parties should listen to each other's viewpoints with care, patience, and a positive outlook. By listening carefully, a sender can learn a lot of essential information.
• Ideas should be accurate, systematic, powerful, clear and right word in right place to the right person at the right time with a right manner.
• Massage should be complete.
• Use appropriate channel
• Effective communication also depends upon voice of the speaker, its tone, pitch, body movements. Speak in normal tone.
• Communication should be two-way and it should involve active listening.

Therapeutic Relationship

The therapeutic interaction with the patient is the foundation of professional nursing. It is the professional duty of the nurse to develop and preserve the therapeutic connection within therapeutic boundaries as well as to comprehend its dynamics. In contrast to social and interpersonal relationships, a therapeutic connection between a nurse and a client makes use of the nurse's strengths in communication, understanding of human behavior, and self-awareness in order to promote the client's progress. The client's thoughts, experiences, and feelings are the main emphasis of the interaction. The attention of the nurse on key personal difficulties brought up by the client during the clinical interview is a necessary component of a therapeutic (helping) relationship. Together with the client, the nurse identifies areas that require investigation and periodically assesses the client's level of change. Despite the fact that the nurse may play a number of functions (such as teacher, counselor, socializer, and liaison), the connection is always centered on the client's issue and requirements. The development and maintenance of a therapeutic relationship requires the use of communication skills as well as awareness of the stages and phenomena that take place in that connection.

According to Wanda, K Mohr, 2006, therapeutic relationship is "a meaningful ongoing communication with the clients in an atmosphere of mutual respect and trust where by close helping relationship will be established which allows the nurse and the client to work collaboratively."

According to Bimala Kapoor, 2002, therapeutic relationship is "an interaction process in which the nurse fulfills her role by using professional knowledge and skills in such a way that she will help the client in all the aspects (physically, mentally, emotionally and socially)".

Purposes/goals of therapeutic relationship:

• To foster mutual progress between two people, such as between a nurse and a patient or caregivers.
• To encourage more self-awareness, self-acceptance, sincerity, self-respect, self-identity, and personal integration.
• To determine the best nursing strategies.
• To fulfill developmental objectives.
• Obtaining safety, comfort, rest, and respite from the pressures of the person's typical home and workplace.
• The client's disease to be nourished.
• To teach the client self-control mechanisms and problem-solving skills or new alternative ways, so they may address difficulties or issues,
• To assist the patient in building good coping mechanisms by helping him comprehend his issue and actively engaging in the experience.
• To aid the nurse in helping the client realistically identify current issues and try out new behavioral patterns.
• To help mentally ill people gain understanding and change their behaviors.
• To encourage the client's open communication in order to improve his social skills.
• To establish health care accountability.
• To aid the patient in communicating, interacting with others, and understanding their mental illness.

Phases in Nurse-Patient Relationship/ phase in therapeutic relationship

Relationships in therapeutic settings are centered on the patient's needs, experiences, feelings, and ideas rather than the nurse. There are three stages in a therapeutic relationship: phase before orientation or before contact

Pre-interaction, also known as pre-orientation, refers to the stage that a nurse goes through before engaging with a patient. This stage starts when a patient is allocated to the nurse so that they can build a therapeutic relationship before the nurse visits the patient for contact. Before engaging in any interaction, the nurse considers and feels about the patient in light of her knowledge, fear, and preconceptions. In order to learn more about the client and their family members, she tries to gather information from secondary sources including client records, OPD reports, resource people, and other nurses working in the ward.

The nurse makes preparations for this phase, including how she will interact with the patient, what she hopes to accomplish via it, and how she will assist the patient. She prepares her goals for the interaction phase, yet the nurse might feel some worry. Will the patient talk to me? may be the nurse's main worry. He/she might not accept me, etc., thus the nurse seeks support from the clinical supervisor or other employees to get over her concerns or anxiety.

• Introductory or Orientation Phase:
  • When the nurse approaches the patient, introduces herself and begins to learn more about him or her, the introductory or orientation phase begins. When a patient and nurse who have never met before finally do, they become friends (friends). When the nurse and the patient start to accept one another as a distinct human being, the orientation phase is over. Establishing contact with the patient, coming to an agreement or pact, and speaking with him or her are important activities in this phase.
• Establishment of contact:
  • Contact is established when the nurse finds her patient. She observes the patient's appearance, including personal grooming and how he or she is dressed. She introduces herself to the patient and inquires about a comfortable place for them to chat.
• Pact:
  • The first meeting is called Pact. In order to assist the patient in achieving social recovery, the nurse and patient come to an agreement or pact. She introduces herself by stating her name, her status, and any other relevant information. The nurse explains to the patient why she chose to contact with them and that their relationship is ending. In this stage, the nurse begins to view the patient as a distinct individual in addition to his or her surroundings.
• Talking with patient:
  • The nurse displays confidence in her actions while speaking with a patient. When the nurse inquires, "What is your problem? ", the patient could deliver a prepared "SPIEL" to her. The patient provides a thorough background and addresses the nurse by saying, "I hope you know about me now." The patient experiences this kind of emotion when he learns that everyone in the room is there to question him and gather information rather than to assist him. If a nurse interrupts the patient to provide further explanation and facts, the latter may change their minds and provide the information requested. Establishing an atmosphere of trust, understanding, acceptance, and open communication as well as creating a contract are the tasks at hand during this stage of the relationship.

Give the client the chance to reply to the nurse, and encourage him to speak up when he needs to refocus on his feelings, abilities, and positive attributes. Clients and nurses will communicate effectively. They will talk about their expectations and preconceptions with one another.

The nurse will serve as the client's surrogate parent and a positive role model. The client's underlying thoughts, beliefs, and relationship objectives will be probed by the nurse. The client begins to regard the nurse as a "ego ideal" and begins to obey her instructions. This is the transference that is positive. The client takes longer to enter transference if they are going through traumatic experiences. Give the client new coping mechanisms that will enable them to take care of themselves.

Confidentiality is a crucial topic to bring up with the patient right now. Only those people who have been specifically permitted to see the material are considered to be in violation of confidentiality. The nurse's other duties throughout the relationship's orientation phase include investigating the patient's perspectives, ideas, feelings, and behaviors, locating pertinent patient issues, and establishing mutually specific goals with the patient. Therefore, the following activities must be completed during this phase:

• This phase lasts for 2-10 sessions.
• Establish the contract, follow the contract and keep the appointments correctly.
• Allow the client to be responsible for this contract.
• Discuss the contract, i.e. dates, time, place to meet, duration of the contract, purpose of meeting, role of each person.
• Acquaint with the client.
• Establish boundaries of relationship and trust with client.
• Sincerity in formulation IPR.
• Identify the problems of client.
• Identify the expectations of client.
• Demonstrate sincere caring and understanding.
• Express honesty towards the client to achieve the goal. 
• Set limits when behavior is uncontrollable and not acceptable and not acceptable.
• Observe the content of the thought of the client, e.g. what the client are talking, his moods, inner world processes, and the interaction pattern of the client.
• Nurses have to be familiar with client's condition, environmental situation.
• Working phase / Exploration/ Identification phase:
  • When the nurse and the patient are able to get over the initial or introduction phase barrier, the working phase begins. The working phase is when the majority of therapeutic work is done. Working phase activities include:
• Phase of problem identification:
  • In this stage, the nurse and the patient discuss stressors and encourage the patient's growth in insight by connecting perceptions, thoughts, feelings, and deeds. These realizations ought to be followed by action and a modification of conduct. The patient recognizes the problems or worries that are causing them. The nurse also looks at the patient's emotions and reactions. A client's dependence, independence, and interdependence on the nurse change over time.
• Exploitation phase:
  • The patient responds by clinging to previous barriers and refusing the nurse's attempts to move forward as the relationship between them grows. The client's independence changes as a result of the development of better coping mechanisms, a more positive self-image, and improved conduct. The client improves their ability to interact with others, solve problems, and communicate differently (more open, flexible).

In the working phase, the nurse must be acutely aware of two common elements that can arise:

• Transference: Transference occurs when patients unintentionally project their feelings for important people in their lives onto the nurse.
• Counter transference: Counter transference is when a nurse reacts to a patient in accordance with his or her own underlying desires and conflicts.

The client's behavior is the emphasis of the evaluation and the connection, and the client's feelings are the center of the conversation. Therefore, the nurse should be aware that maintaining consistency at all times helps the client feel secure. In order to shift the client's behavior to one that is adaptive and appropriate, the nurse helps the patient develop coping skills, a positive self-concept, and independence. To assist the client, the nurse takes on several roles and uses communication tactics. The following summarizes the relationship and the development or change that has taken place in both the nurse and the patient at this stage:

• Ensure that the patient has more autonomy while becoming less dependent on the nurse.
• Maintain the objective of having clients address and resolve recognized issues.
• The fundamental goal is to modify the client's behavior for the better.
• Prioritize the needs of the client
• Altering actions that are disrespectful to others, such as being aggressive or unclean
• Encourage the client to make goals, alter his behavior, and set goals in front of him that will help him mature and build self-worth.

Maintenance phase: To maintain social and emotional well-being in chronically ill cases, where termination is not possible up to death, certain nursing interventions were planned and carried out.

Termination phase/ Resolution phase:

Resolution phase and end phase are other names for the termination phase. One of the most challenging but crucial stages of the therapeutic nurse patient interaction is termination. Termination is a moment for emotional and memory exchange as well as a mutual evaluation of the patient's development and achievement of goals. The quality of the connection and the sense of loss felt by both nurse and patient are reflected in the increased levels of trust and intimacy.

When the mutually agreed upon objectives are achieved, the patient is discharged or transferred, or the rotation is complete, the nurse ends the relationship. The nurse assists the patient in becoming independent and responsible in making his own decisions at this stage, which is focused on the client's growth.

The relationship and the growth or change that has occurred in both the nurse and the patient is summarized below:

• Client may experience separation anxiety and exhibit greater reliance, antagonism, and withdrawal in response. These emotions are common and should be explored with the client.
• Up to the conclusion of the partnership, the nurse should be resolute in upholding professionalism.
• She shouldn't assure the client that the connection would last.
• Early in the partnership, the time limitations should be established, and encounters should be spaced widely apart near the end to encourage the patient's independence and help the latter prepare progressively for the separation.
• The patient shouldn't be given the nurse's home or cell phone numbers.
• Referrals for ongoing medical care and support after discharge give the patient and their family access to more services.
• When a patient has achieved emotional stability, can cope well, recognizes sources or reasons of worry, shows ability to manage anxiety and independence, and is able to take care of themselves, the therapy relationship's goal has been achieved.
• When the duration and length of the nurse-client connection were defined during the orientation phase, the termination phase was prepared.
• The client's separation anxiety symptoms, such as restlessness, anorexia, physical symptoms, withdrawal, and hostility, are common.

Factors determining effective nurse-patient relationship

• Self-awareness:
  • It entails one's conception of oneself, as well as one's views, values, and experiences. A self-aware nurse will be able to help the client in a productive way.
• Attitude toward the patient:
  • Acceptance of the patient as she is; treating the patient with dignity and respect; tolerating the patient's sentiments; nurses must be nonjudgmental and maintain boundaries for the patient's conduct.
• Rapport:
  • It must be built via mutual pity, respect, and consideration. Warmth, sincerity, and empathy are necessary.

Problems in therapeutic relationship/ anti therapeutic relationship

• Client shows resistance to talking about who they are and has self-doubt.
• Transference: Patients unintentionally project their feelings towards important people in their lives onto the nurse. Because the client feels as though the nurse is a significant individual and as a result, the nurse needs to make clear their relationship.
• Counter transference: The nurse forms an emotional bond with the patient when he or she reacts to them in accordance with their unconscious needs and conflicts. When a therapeutic nurse-patient interaction is challenging, the nurse can seek assistance from seniors or other knowledgeable individuals.
• A relationship that crosses inappropriate boundaries (becomes social or intimate).
• A sentiment of pity and support for dependence.
• Because of their actions, the patient is not accepted as a person, which can result in avoidance of the client, rude verbal answers, annoyed facial expressions, or turning away from the client.
• Unable to communicate person.
• There is no emotional response that prevents the formation of therapeutic connections.
• Hiding and staying with the group to avoid the nurse.
• Hallucinations and how to react to them.
• Superficiality.
• Individuals engaging in phony communication.
• A person who is extremely irate, has low self-esteem, and is wary.