Copyright EMAP Publishing 2017

This article is not for distribution

Nursing Practice Keywords Communication/Definition/

Effective communication
Discussion
Communication This article has been
double-blind peer reviewed

In this article...
● W
 hy effective communication skills are important
● How to overcome anxiety and improve your communication with patients
● Reflecting on personal and team communication skills

Communication skills 1: benefits of

effective communication for patients
Key points
Author Moi Ali is a communications consultant; board member of the Scottish
It is estimated that Ambulance Service and of the Professional Standards Authority for Health and Care
the effects of poor and former vice president of the Nursing and Midwifery Council.
communication
cost the NHS is Abstract Effective communication protects patients from potential harm arising from
over £1bn a year misunderstandings, and can have a positive effect on staff. This first article in a
six-part series on communication discusses the benefits of effective communication
Effective and offers practical tips on how to reflect on your communication skills.
communication
enhances patient Citation Ali M (2017) Communication skills 1: benefits of effective communication for
experience and patients. Nursing Times [online]; 113: 12, 18-19.
reduces complaints

I
It can boost nurses’ t is estimated that the cost of poor misunderstandings. While communica-
self-confidence, communication to the NHS is over tion failures leading to serious harm - such
job satisfaction and £1bn per year, and can lead to poor as the wrong leg being amputated - are
reduce workplace adherence to medication regimens, rare, even minor shortcomings can have
stress time repeat visits to clinics, disputes and ulti- serious repercussions. For example, com-
mately litigation (McDonald, 2016). Effec- munication errors between colleagues can
It is important to tive communication can: result in nurses giving the wrong medica-
reflect on how you l E nhance the patient experience; tion, or patients taking an incorrect dose of
communicate and l R educe complaints; the right one. Poor communication in an
work at improving l I ncrease nurses’ self-confidence, end-of-shift handover can result in patient
any weak areas professional standing, career prospects harm if important information is not
and job satisfaction and reduce stress. passed from one professional to another.
Jones (2010) suggests that patients are Although no nurse would set out with
less likely to remember technological the intention of communicating poorly,
interventions than the communication not everyone can be a good communicator
Box 1. Seeing the patient
and human interaction from health pro- at all times. The Care Quality Commis-
behind the task
fessionals and judge the quality of their sion’s 2016 Inpatient Survey asked patients
“A hospital nurse told me she care by these markers. They have more whether they received an answer they
needed to take my blood pressure. confidence in health professionals who could understand when asking a nurse an
She duly recorded the results in my communicate effectively, which in turn important question: 70% replied “yes,
notes. Job done? No. She did not tell makes it more likely that treatment regi- always”, an increase of four points since
me the result, whether it was normal, mens are followed or advice taken. the 2006 and 2011 surveys, but a decrease of
or why it was necessary. It didn’t occur one percentage point from 2015 (CQC,
to her that I might be relieved to hear: Effects of poor communication 2017). Almost a third of patients did not
‘Your blood pressure has returned to Communication is defined as imparting or understand nurses’ explanations some or
the normal range’. What the nurse exchanging information, thoughts or all the time. Communication with patients
regarded as a task to be completed ideas using speech, writing, or some other can go wrong for a variety of reasons;
was an opportunity to reassure a medium such as signals or behaviour. Fig 1 illustrates typical factors that can
worried patient.” Effective communication protects patients have a negative effect on communication
from potential harm arising from (see part 2).

Nursing Times [online] December 2017 / Vol 113 Issue 12 18 www.nursingtimes.net
 Copyright EMAP Publishing 2017
This article is not for distribution

Nursing Practice
Discussion

Fig 1. Barriers to effective communication

Nurse’s intended message

Patient ‘decodes’ Patient in pain, Patient cannot hear Nurse’s message is Complex message, Nurse’s body
message (interprets distressed, tired or message properly ambiguous. Patient jargon used or language
it according to own on medication due to background misunderstands patient not contradicts spoken
values, beliefs and that affects their noise proficient in English message
experiences) understanding and so cannot
cannot absorb or hearing understand
message impairment message

Message received by patient is different from intended message

Factors contributing to poor communication
Patient ‘belief’: previous Patient condition: message is Environmental factors: noise Practitioner factors: nurses fail
experiences or personal not absorbed due to patients’ or other external factors to communicate in a way
attitudes cause patients condition (for example, effects interfere with patients’ ability patients can understand, or
to reframe message to fit of medication, dementia or to receive message their body language gives
their beliefs hearing problems) patients an unintended
message

Understanding patients’ needs communication. Do not allow excessive ● Moi Ali is author of How to Communicate
Communication failure, such as failing to nervousness to destroy your confidence in Effectively in Health and Social Care: A
introduce oneself, can occur when staff yourself or patients’ confidence in you. If practical guide for the caring professions,
regard patients as a series of symptoms you are nervous about a conversation with published by Pavilion
and tasks rather than as people with social a patient or relative remember to:
and emotional needs; this can leave l I dentify what you need to tell the References
Care Quality Commission (2017) 2016 Inpatient
patients feeling dehumanised, while patient and the aim of the conversation; Survey: Statistical Release. Bit.ly/CQCSurvey2016
simple positive actions such as an explana- l T ake deep breaths before approaching Jones J (2010) Foreword in Kraszewski S, McEwen
tion can have huge beneficial effects (see the patient; A (eds) (2010) Communication Skills for Adult
Nurses. Maidenhead: Open University Press.
case study in Box 1). l P ay attention to your body language;
McDonald A (2016) A Long and Winding Road:
Patients sometimes selectively process l M entally rehearse your opening words Improving communication with patients in the
information, hear only what they want to – being fluent will put the patient at NHS. Bit.ly/MarieCurieLongWinding
hear, and subconsciously reframe or over- ease from the outset.
simplify a message if they do not like its Reflecting on the conversation after-
content. If your message is not interpreted wards using the communication checklist Box 2. Effective
as planned, understanding where it went in Box 2 is also helpful to improve your communication checklist
wrong and why can help you to rephrase it skills and confidence. Use this checklist to identify areas for
so it is understood. improvement. Do you:
‘Teach-back’ is a useful technique to Reflection l Use appropriate language for your
check patients’ understanding by asking Activity audience?
them to summarise a message they have Think about a recent shift and your inter- l Listen actively and concentrate on
been given in their own words; in doing action with patients and use Box 2 to reflect what is being said?
this you are checking your capacity to on how you communicated with them. l Ask open questions to gain
communicate, not the patient’s ability to Identify scenarios where you communi- information?
understand. It is important to put yourself cate well and those where you need to l Demonstrate you are listening?
in your patient’s shoes and anticipate how improve. Become conscious of your com- l Use appropriate body language?
your message may be received. Try to munication style and analyse your l Respond appropriately to other
imagine how you, or someone close to you, strengths and weaknesses. Discuss these people’s body language?
might react and how the addition of a few with your mentor or manager and identify l Check you have understood and have
reassuring words may prevent needless your learning needs. been understood?
worry for patients. l Seek clarification where necessary?
Conclusion l Correct misunderstandings?
Coping with anxiety By spending a little time reflecting on l Reflect on your performance?
It is natural to be nervous when having dif- how you communicate, and working at
ficult conversations with patients or their improving any weak areas, you can reap the
relatives. However, nervousness can have many personal rewards of being an effec-
an adverse effect on communication, so tive communicator – including a better Communication skills series
Part 1: Benefits of effective communicationDec
you may forget to introduce yourself or patient experience for those in your care.
Part 2: Overcoming barriers Jan
maintain appropriate eye contact; or it The second article of this series will Part 3: Non-verbal communication Feb
may cause you to blush, stutter or frown – explore the barriers to communication in Part 4: Unintentional communication Mar
all of which will interfere with effective more detail. NT

Nursing Times [online] December 2017 / Vol 113 Issue 12 19 www.nursingtimes.net