• Communication is derived from the Latin word “Communicare” or “communico” both.
• Communication is a simple form that transfers ideas, thoughts, and information from one person to another person.
• Communication is a process in which a message is transmitted from the sender to the receiver.
• Communication helps in the mutual interchange of ideas, information, and thoughts in an effective way.

Purpose of Communication

• Use for understanding and exchange ideas
• To improve the interpersonal relationship
• To develop the plan for their achievement
• Good communication help to modify her behaviour
• To prevent the disorders in the ward
• Help to interpret the hospital policies and client care
• Use information to learn more things
• Help to solve problem
• To reduce stress, and maintain public contact
• To exchanging regarding health

Process of Communication

1. Sender in Communication

• It is also called communicator or source of communication.
• A sender is a person who send the information, idea, though to another person.

2. Message

• Message is a relevant, interesting, useful and profitable piece that is include the information, feelings, ideas, etc.
• Message passed from one person to another person.

3. Channel

• The channel is a medium that is help in the transporting ideas, information, feeling, etc from one person to another.

4. Receiver

• The receiver has a person who receives the message sent by the sender.
• The receiver is a listener.

5. Feedback

• In feedback process, a return message response give to sender by receiver.

Encoding- Encoding means creation of message by a sender.

Decoding- Decoding means interpreting the meaning of the message by receiver.

Types of Communication

Types of communication based on the communication channel

1. Verbal Communication
2. Non-Verbal Communication

Communication based on the style and purpose

1. Formal Communication
2. Informal Communication

1. Verbal Communication

• Verbal communication is referring to transmitted a message by verbally.
• Verbal communication uses the sounds and words to express yourself.
• A message is transmitted by the spoken and written words.

1. Oral Communication

• Message and information are transmitted from one person to another by spoken words.
• Oral communication influence by speed, volume, pitch, and clarity of speaking.
• Oral communication include face to face communication and distance communication.
• Distance oral communication done by – Telephone, TV, Radio, Video, Audio, etc.
• Advantage
• Time saving
• Easy to convey
• Immediate feedback receive
• Effective for illiterate persons
• Less expensive
• Useful in difficult in situations
• Complete understandable
• More reliable
• Disadvantages
• Speaking problems
• Language problems
• Chance of misunderstanding
• Problem for distance people
• Not helpful to remember
• Distortion of meaning

2. Written Communication

• In written communication, written sign and symbol use for communication.
• Written communication transmitted by mail, text, message, letter, report, etc.
• The doctor gives a written prescription to the nurse to do any kind of work in the hospital.
• Advantage
• Provide legal document and record.
• Provide permanent record.
• Building the image and good will.
• Provide evidence.
• Is a capable of relaying complex ideas.
• Disadvantage
• Expensive
• Lack of flexibility
• Delayed correction
• Wastage of time
• Lack of the direct relation
• Not useful for illiterate persons

2. Non-verbal Communication

• Non-verbal communication is the process in which sending or receiving a message without using words, either spoken and written.
• Non-verbal communication is a technique in which transmission of message or feelings via eye contact, fatal expression, posture, gesture, etc.
• Advantage
• Help to handicapped peoples
• Attractive presentation
• Easy to understand every person
• Clear explanation
• Use to exchange of feelings
• Time saving
• Disadvantage
• Lack of flexibility in message
• Encoding and decoding problem
• Show incomplete communication
• Lack of evidence message

3. Formal Communication

• Formal communication generally done in the professional setting
• Formal communication include the exchanging of information by following the prescribed or official rules
• Flow of communication along the line of management or authority

Types

• Downward Communication transfer from higher group to lower group peoples.
• Upward Communication-Where information are transfer from lower group to higher group of peoples.
• Horizontal Communication-Where information are transfer between same group of peoples.

4. Informal Communication

• Informal communication occurs when peoples are meet and discuss about their problems, working, family, etc.
• E.g- Rumours, gossip, etc.
• Informal communication usually done in the friends and family members.
• Graperies communication is a informal communication

Essential of good Communication

• Sender and receiver will always use the same language
• Always use the only understandable words and proper explained words
• Maintain the clarity in the expression of ideas
• Pay attention to the common verbal message
• Maintain eye to eye contact during communication
• Receiver should always listen carefully to the words of sender
• Participate in the discussion
• Maintain proper body language during discussion
• Maintain proper body language during discussion
• Accumulate proper knowledge about communication
• Give feedback, feedback is essential for the effective communication

Barrier of Communication

• Physical Barrier-are the noise, lack of privacy, information overload, speech defects, fatigue, illness, pain, nature of environment, deafness, uncomfortable accommodations, etc.
•  Psychological Barrier-Economic background, social background, self-image, group identification, filtering, poor communication skill, etc.
• Language Barrier-
  • • • Different pattern of language
      • Speaking tone
      • Unclear voice pattern
      • Unclassified assumptions
      • Pause in speaking
  • Gender Barrier- Some time men and women’s are uncomfortable to communicate with each other.
  • Emotional Barrier- are fear, anger, lack of interest, suspicion, jealousy, anxiety, prejudice, lack of listening, antagonism, etc.
  • Cultural Barrier- Different cultures are interfere in the communication.
  • Interpersonal Barrier-
    • • Lack of motivation
      • Lack of confidence
      • Lack of interest and trust
      • Lack of knowledge about discussion
      • Lack of co-operation

Level of Communication

1.  Intrapersonal Communication

• The communication occurs within yourself.
• Self-concept and self-awareness are formed at this level.

2. Interpersonal Communication

• It is a direct verbal or non-verbal communication between two or more active participants.
• Getting to know someone personally.

3. Small group communication

• Interaction between the small group of peoples are meet together.
• To communicate information that is of common interest.

4. Public Communication

• Communication between on audience
• In public communication, require a special attention in a eye contact, voice inflection, gesture and use of precaution material.

5. Mass Communication

• Mass communication is exchange or share of information on a large scale to a wide range of people.

KEY POINTS of Communication

1. In communication, source of communication is a – Sender

2. Medium is helpful to transporting the ideas from one person to another person – Channel

3. Who is the person, receive the message – Receiver

4. Message delivered to sender by receiver – Feedback

5. Creation of message by a sender – Encoding

6. Formal communication, information transfer from high to low level – Downward Communication

7. In Horizontal Communication, Communication between – Same group of peoples

8. Communication Occur within yourself – Intrapersonal Communication

• Therapeutic nurse patient relationship is a relationship between a healthcare professional and client.
• Therapeutic relationship is an interpersonal between nurse and patient during which the nurse focuses on the patient’s specific care and needs to promote an effective exchange of information.
• Therapeutic relationship is a state of being related or state of affinity between two individuals.

Characteristics of Therapeutic relationship

• The patient should be the primary focus of interaction.
• Therapeutic relationship focused on goals.
• Therapeutic relationship is a planning to help the patient.
• It is a limited duration relationship.
• Therapeutic relationship is a non-judgmental process.
• The relationship promotes the comfort and wellbeing of the client.
• It is a mutual learning experience and a corrective emotional experience for the patient.
• Relationships maintain confidentiality.

Goal of therapeutic relationship

• Relationships help to understand his or her problems.
• Help to identify the emerging problems.
• Also help in cope with present problems.
• Modified the new pattern of behaviours.
• Find out the new alternative to problems.

Types of relationship

1. Social relationship
2. Intimate relationship
3. Therapeutic relationship.

1.  Social relationship  

• The primary purpose of social relationships is friendship, socialization and companionship.
• Social relationships are sharing ideas, feelings and experience and meeting the basic needs of people.
• Social relationships must be limited in therapeutic nurse patient relationships.

2. Intimate relationship

• Intimate relationships involve the 2 people who are emotionally related to each other and both are concerned about having their needs met and helping each other.
• Relationships may include sexual or emotional intimacy as well as sharing mutual goals.

3. Therapeutic relationship

• Therapeutic relationship focuses on the needs, ideas, feelings and experience.
• In these relationships, nurses use communication skills, personal strengths and understanding of human behaviour to interact with the client.

Phases of therapeutic nurse-patient relationship

4 phases –

1. Pre interaction phase
2. Orientation phase
3. Working phase
4. Termination phase.

1. Pre interaction phase  

• Pre interaction phase begins before the nurse’s actual contact with the patient.
• These phases include self-exploration – The nurse explores herself regarding.

• Self-misconception.
• Self-feeling, fear and anxiety.
• Personal value, attitude.

• Planning of objectives of interaction phase.
• Collection of data’s regarding patients.
• Improve communication and promotion solving skills.
• Prepare himself to face aggressive patients.

2. Orientation / introduction phase  

• Orientation is also known as the introduction phase, because these phases start with introduction.
•  In these phases nurses show respect and caring attitude for the patient.
• Orientation phase establishes the balance between verbal and nonverbal communication.
• Nurses determine the level of motivation of patients.
•  Maths paper during face is trusting acceptance and open communication environment.
• Nurses introduce themselves to the patient and classification of role and purpose of meeting.
• Nurses find out the problems of patients and determine the objectives.

3. Working phases

• Working phase starts when the nurse and patient overcome the barriers of orientation phase.
• Working phase work on predetermined goals.
• Patients also help to plan, implement and evaluate actions.
• In these phases, therapeutic blocks are identified and problems should be discussed and resolved.

4. Termination phase  

• Termination phase includes the end of therapeutic relationships between the nurse and patients.
• Termination phase is a gradual process in which goals and objectives achieved should be summarised.
• Adaptive behaviour should be reinforced.
• Nurses and patients share the feeling and experience for both.
• Plan for help in the future.

Techniques of therapeutic communication

1. Listening
2. Broad opening
3. Restating
4. Reflecting
5. Using silence
6. Clarification
7. Linking
8. Focusing
9. Information
10. Theme identification
11. Sharing perception
12. Accepting
13. Encouraging comparison
14. Suggestions
15. Rejecting
16. Asking elevated questions
17. Exploring.

1. Listening  

• Listening is an active process of receiving information.
• Listening creates complete attention towards the patient and shows respect.

2. Broad opening  

• Broad opening encourages the client to define the problems.

3. Restating – Repeating the main thoughts expressed by the patients.

4. Using silence

• Silence utilizes verbal communication.
• Silence prevents the barrier of communication.
• During receiving information silence is most important.

5. Clarification  

• Sometimes the verbalization of the client may not be clear.
• She is confused about the illness and problems show the nurse needs to clarify the feelings and ideas.

6. Reflecting – Directly back to the patient questions, feelings and ideas.

7. Linking – Nurse tries to link the client’s feelings with the activity.

8. Focusing – Concentrating on a particular point and trying to focus on reality.

9. Informing – The skill of information giving.

Eg. – I think you need to know more about your medication.

10. Theme identification – These involved the identification of underlying issues or problems experienced by the client.

11. Sharing perception – Nurse and patient share thoughts, ideas and clarify doubts.

12. Accepting – Giving indication of reception.

13. Encouraging comparison – Asking about similarity and difference.

14. Suggestions – Presentation of alternative ideas for the patient’s consideration relative to problem solving.

15. Rejecting – Refusing to consider patient ideas or behaviour.

16. Exploring – Going deep into an idea or subjects.

Barriers of therapeutic communication

• Use medical terminology without explaining the details to the patients and family members.
• Improper use of communication techniques.
• Rejecting the person not the behaviour.
• Anxiety also creates a barrier in communication.
• Pressuring the client and family members for an explanation.
• Offering unrealistic hope for the future.
• Gift giving also barriers in therapeutic communication.
• Avoidance of being discharged.
• Difficulty in data collections.
• Countertransference.
• Social class of patient and status of patient.

Dynamics of therapeutic nurse patient relationship

1. Therapeutic use of self.
2. Gaining self-awareness.
3. The Johari window.

1. Therapeutic use of self  

• It is defined as the ability to use one personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions.
• Nurses must clearly understand themselves to promote patients growth, change and heal.

2. Self-awareness – It is a process of understanding one’s beliefs, thoughts, motivations, biases and limitations and recognising how they affect others.

• Without self-awareness, nurses will find it impossible to establish and maintain therapeutic relationships with patients.

3. The Johari window – The Johari window is a representation of self-awareness.

• Johari window into four quadrants.
• The goal of increasing self-awareness by using the Johari window.
• Johari window is to increase the size of the quadrant that represents the open or public self.