Communication impacts every single management activity, and cuts all phases of the management process. The nurse-leader communicates with clients, colleagues, subordinates, and superiors. The practice of nursing often becomes group-oriented, necessitating effective interpersonal communication for continuity and productivity.
Models & Theories of Communication
| Model | Principle |
|---|---|
| Transmission Model | By Ellis and McClintock. It describes communication as a linear, one-way process in which a sender intentionally transmits a message to a receiver. There is no on-going process, simply an end point. |
| Interaction Model | By Schramm. It describes communication as an interactive, two-way process in which participants alternate positions as sender and receiver, and generate meaning by sending messages and receiving feedback. |
| Transactional Model | This extends the role of communication from an exchange of messages to a way to create relationships, alliances, self-concepts, and engage with others to create communities. Participants are called “communicators” and are simultaneously senders and receivers. |
| Interpersonal Relations | By Hildegard Peplau. She specifies the nursing communication as an interpersonal, therapeutic process that takes place when professionals engage in therapeutic relationships with people who are in need of health services. |
Peplau’s Theory of Interpersonal Relations outlines four phases of the nurse-patient relationship that the nurse must pass through for success:
- Orientation Phase: the problem is defined via assessment. The patient seeks assistance, expresses their needs, asks questions, and shares their preconceptions and expectations based on past experiences.
- Identification Phase: the patient begins to feel involved, as appropriate assistance is provided by a professional. Confidence in resolving the problem is increased. A nursing care plan is formulated in this phase.
- Exploitation Phase: professional assistance is used to determine problem-solving alternatives. The nurse uses interview techniques to explore, understand, and adequately deal with the underlying problem. This phase is the implementation phase of the nursing care plan.
- Resolution Phase: the termination of the professional relationship once the needs have been met through the nurse-patient collaboration. This phase is the evaluation phase of the nursing process.
Barriers to Communication
According to Schwarts, Lowe, and Sinclair (2010), many challenges impede communication in the healthcare setting:
- Low Health Literacy: lacking competence in acquiring and using healthcare information limits self-care for chronic conditions and medication regimens. These people are frequently dependent on facilities and have higher mortality rates.
- Cultural Diversity: communication is affected by culture— in how the content is conveyed, emphasized, and understood.
- Cultural Competence: healthcare professionals need to recognize and relate how culture is reflected in each other and in the individuals with whom they interfere.
- Interprofessional Communication Education of Healthcare Providers: communicating with other disciplines can be difficult. Jargon is varied, and the understanding or meaning of situations may be altered or incomplete.
Written Communication
Written communication is the most commonly used form of communication due to its easy distribution and nature as a document.
- Memos: used by managers for daily work life. They bring attention to problems, and they solve problems. These are not used for sensitive information, and are sent to small or moderate number of people.
- Business memos contain a header (⅛ of the paper), opening (context, task; ¼ of the paper), summary & discussion (½ of the paper), and a closing segment with necessary attachments (⅛ of the paper).
- Messages should be kept succinct. Use bullet points if possible. Keep it one page in length. The first paragraph expresses purpose— the introduction. The last paragraph is a conclusion, summarizing the memo, clarifying intended results, and main information.
- Meeting Minutes: notes or records (often by the secretary) of meetings. These include issues, motions, and votes taken, among others. These are used for those who could not attend a corporate meeting. In a normally structured meeting, these are basic steps in taking meeting minutes:
- Plan and outline. Meet with the person holding the meeting before it begins to decide on an agenda.
- Record-taking at the meeting involves the following, for each agenda of the meeting: decision made, actions (to be) taken, succeeding steps to take, voting outcomes, rejected motions, items to be held over, new business, date and time of next meeting.
- Writing the detailed notes into meeting minutes: opening (title, location, time, date), present members, absent members, approval of the agenda, approval of the previous minutes, business from previous meetings, new business, additions to the agenda, agenda for the next meeting, and adjournment.
- Submission to and approval by the chairperson.
- Distribution of meeting minutes, often as a responsibility of the secretary.
Reports in Nursing
Nursing reports are oral, taped, or written exchanges of information between nurses and members of the health team, such as in change-of-shift reports (endorsement), telephone orders, and transfer reports.
- Change-of-Shift Reports: the transfer of essential information and holistic care of patients, providing continuity of patient care for 24 hours. This may be done orally, by audio recording, or at the bedside during nursing rounds. Initially, oral reporting is done at the nurse’s station or conference room with nurses from the departing and arriving shifts.
- Oral Report: essential information such as patient name, diagnoses (medical, nursing), related causes, diagnostic measures completed and to be done, observations, effects of nursing and medical measures, priorities, and instructions for procedures to be done are transferred during a pre-conference. Any alarming information should be discussed out of hearing of the family.
- Audio-tape Report: outgoing nurses relay recordings of pertinent information. The lack of immediate feedback on inquiries is a major disadvantage of this method.
- Nursing Rounds: endorsement at bedside, where the care plan is discussed, allowing the patient and family to participate, pose questions, and seek clarifications. Any additional assessments and evaluations can also be made at this time.
- Telephone Reports: physicians or other nurses may be updated about patients via telephone. All information transmitted should be transcribed accurately, especially if medications are involved or if significant variances have occurred. The date, time, name of the physician, and signature of the nurse receiving telephone orders are all documented to be countersigned within 24 hours.
- Transfer Reports: patients being transferred from one unit to another require proper referral and coordination. The receiving unit is usually advised beforehand about the transfer so that the unit or bed including special equipment, if necessary, will be arranged. All pertinent information for the continuity of care is provided to the receiving unit, including a summary of medical progress and current health status. An oral report is also made by the accompanying nurse so that additional information can be made or clarified. A transfer report accompanies the patient.
Meetings
Meetings can become effective if managed properly, with the following steps undertaken (Cherry & Jacobs, 2014):
- Pre-meeting Work: determine the purposes of the meeting. A list of meeting topics is made, and a fact sheet is created in relation to each topic. This is distributed to those in attendance.
- Determine those who will attend the meeting— those affected by decisions made during the meeting and those who may provide valuable insight for the topics.
- Schedule the meeting by date, time, and location, then invite the attendees. Consultation with the attendees will allow for maximized attendance.
- Meeting agendas (containing the aforementioned information) are distributed at least one week before the meeting, with a reminder two days before the meeting.
- During the Meeting: ensure that the participants are comfortable. In the group, there should be a leader (chairperson), timekeeper, and recorder. The leader processes one agenda at a time, allowing the timekeeper to do their job to keep the meeting on track. At the end of the meeting, debriefing is done, asking “what went well?” and “what could have been better?“. This improves subsequent meetings over time.
Patient Satisfaction & Customer Service
Nurses need to provide a comprehensive range of patient needs. In settings where facilities desire for patients to use their services, nurses are expected to keep patient satisfaction and customer service, which includes safety and quality care as the leading motivator of all plans and activities (Cherry & Jacobs, 2014). Customers may be categorized as external or internal:
- External customers: those not employed by the organization (patients, families, referral physicians, payers e.g. insurance companies, managed care plans).
- Internal customers: those employed by the organization (patient care staff members, staff members of departments, administrators, social workers, dietitians, therapists, etc.)