Effective communication represents a key aspect of patient care, which enhances nurse-patient relationship and has a remarkable effect on the patient’s perceptions of treatment and outcome of health care quality. Major problems affecting effective communication identified in this research work include: language barrier, cultural barrier, inability for nurses to make use of their communication skill, poor income for nurses and increased workload on nurses. The need for improved communication skills for healthcare professionals is recognized. Nurses that have received training in communication skills interact effectively and exhibit increased confidence in communicating with patients. In other words, to establish effective communication, it is imperative that the nurse-patient communication should be well identified and understood. The study seeks to bring to light and harmonize what effective communication with patients is about.

Keywords: effective communication, nurses, patients

Effective communication between patients and nurses is essential for success in individualized nursing care for patients. To succeed in this, nurses must help and understand their patients, showing courtesy, sincerity and kindness. Also, time should be devoted to the patient and communication made with the necessary confidentiality. The language of communication should be understood by everyone involved in the communication. The physical abilities of nurses are not the only basis for good communication, but also experience and education. Communication is an important element in nursing in every area of its activity such as prevention, treatment, therapy, rehabilitation, education and health promotion.¹

However, poor nurse-patient relationships have been reported by most studies.^2–4 Therefore, general nurse-patient communication has not resulted in personal satisfaction.³ This is because of health care quality being strongly affected by nurse-patient relationship and lack of communication skills (or not using them) thus having a negative impact on services provided for the patients. The results of previous studies have shown that nurses have been trained to establish an effective communication; however, they do not use these skills to interact with their patients in clinical environments.⁵

Major problems affecting effective communication identified in this research work include: language barrier, cultural barrier, inability for nurses to make use of their communication skill, poor income for nurses and increased workload on nurses. The need for improved communication skills for healthcare professionals is recognized⁶ and the opinion that courses as such be compulsory for health professionals has been voiced.⁷

What is meant by effective communication?

A key element in providing quality health care services that leads to patient satisfaction and health is communication.⁸ Communication can be defined as the exchange of information, feelings and thoughts among people using speech or any other means.¹ Effective communication represents a key aspect of patient care, which enhances nurse-patient relationship and has a remarkable effect on the patient’s perceptions of treatment and outcome of health care quality.⁹ It represents the key element in providing high-quality nursing care, and leads to patient satisfaction.¹⁰

According to Robinson et al.,¹¹ “Effective communication better helps us understand a person or situation and helps us to resolve differences, develop respect and trust, and create atmosphere where creative ideas, problem resolution, love, and care can flourish”. Health professionals’ skill of effective communication is vital to providing effective health care, and can have positive results such as: decreased anxiety, guilt, pain, and disease symptoms. This skill can also improve patient satisfaction, acceptance and compliance with the medical team, and also improve the patients’ physiological and functional status; it also has a great effect on the training made available for the patient.¹²

Therapeutic practice involves the verbal communication of nurses and public health workers on the one hand and on the other hand the patient or his relatives. It can be said to be a two way thing. The patient relay their concerns and fears to their nurse. This helps them make the right nursing diagnosis. The information is taken by the nurse and the nurse in turn relay other information to the patient with discretion and care as to the kind of the disease and gives advice with treatment and a rehabilitation plan for the purpose of health promotion. Understanding the patients and the experiences they express are required for effective communication. Also the skills and simultaneously the sincere intention of the nurse to understand what concerns the patient is required. Understanding the patient only is still not completely sufficient but the nurse must also relay the message in such a way that is acceptable and understandable. It’s a reflection of the knowledge of the parties involved, the way he/she feel, think and their capabilities.¹

Also involved in effective communication are: teamwork and collaboration, intercultural communication, critical reasoning, using a varieties of communication techniques for expressing one’s thoughts and understanding others.¹³ The need for improved communication skills for healthcare officials is well recognized⁶ and the opinion that courses as such be mandatory for health officials has been voiced.⁷

Barriers to communication with patients

The culture of the patient could block effective nurse–patient interactions because perceptions on health and death differ between patients.^14,15 Nurses having sufficient knowledge with regards to patients’ culture, customs, language, and beliefs can go a long way in helping them communicate with the patients without having any form of pre-judgments or prejudice. Culture can act both as a promoter and a barrier to communication.¹⁶ No person (health practitioner or individual) can know for sure the health beliefs and practices of every culture in the world.^17,18

Also, shortage of nurses causes an increase in workload, thereby creating time constraint towards establishment of good therapeutic relationship. This inturn affects the quality of the relationship between nurses and patients. The lack of will of the nurses to communicate, and poor understanding of patients’ needs are the strongest barriers from the patients’ view.¹⁹ The abilities and characteristics of each nurse can influence the level of care and help them to understand patients, find solution to problems and also provide holistic care, which are the goals of the nursing process.²⁰

Also, low income of nurses has been mentioned as a barrier to nurse-patient communication.²¹ The frequency of interaction of nurses with hospitalized patients with intellectual disability is reportedly lower than when compared to that with a person who is not intellectually disabled.²² In the case of environmental barriers, the presence of critically ill patients in the hospital, the hospital hectic environment, and unsuitable environmental working conditions are considered the main barriers in both patient and nurse end of the relationship. The findings of previous studies confirm the aforementioned results.²³

Also, difference in Language between the patient and the nurse poses another strong barrier to effective communication. Common language not shared by the nurse and the patient causes strain and limitation in the interaction between them.²⁴ Difference in spoken language hampers the establishment of effective communication. Non-verbal communication in different group of people (cultures) may have different interpretations.¹⁶

How does the barrier affect communication with patients?

Nurses have less acceptance by patients with different languages and cultures (culture has an impact on individuals’ attitudes and behaviors). This affects the way they communicate. Previous studies have shown that communicative needs and methods of expressing emotions are different in different religions and cultures.¹⁶ For example, being able to be very expressive and verbal are highly valued in the Euro-American culture. Whereas, other cultures, such as traditional Chinese and Korean cultures, tend to discourage the expressing physical and emotional distress to people not from the family.²⁵ This could make it difficult for patients from cultures as these to disclose their problems to medical professionals.

The presence of patients who are critically ill and the shortage of nurses in the ward causes stress for the patient and nurses and lead to decreased ability and motivation to communicate. Also, medical environment conditions have adverse effects on the quality and quantity of communication.²³ Chan et al.²⁶ found that, depending on their views of the need for the communication, nurses are of the view that availability of time remains a key determinant of the quality communication. Thus, communication seen as rapport or relationship-development has been viewed as time consuming unlike for communication seen as task-oriented.

Nurses have reported difficulty interpreting modes of communication that are non-verbal from people with intellectual disability and are confused regarding terminology, for instance, not knowing how to refer to those with intellectual disability has inhibited their will to communicate about people who are affected.²⁷ Poor explanations and questions delivery affects nurses’ understanding of patients’ problems and situations. Patients also feel concern with regards whether nurses accurately understand their situation.²⁸

How can communication be used to overcome the barrier in order to improve patient care.

The quality of communication in the dealings between healthcare providers and patients has a significant influence on the outcome of the patients. This influence can be key in such areas as patient health, adherence, education and satisfaction with care.²⁹ A properly developed understanding of effective nurse– patient communication will be required to support the development of effective communication skills among nurses.³⁰

The first step towards eradicating the problems related to nurse-patient communication can be said to be a two-sided (the nurse and the patient) awareness of communication barriers. Building an effective communication relationship can be said to be dependent on the understanding of all parties involved in the interaction.¹⁹ Nurses can have effective interactions with patients by developing awareness of each age group’s attitudes towards disease, health, and body function.³¹

Every aspect of care and nursing has high importance in communication with patients because patients consider interaction with nurses essential to their treatment. Also, through communication, nurses get familiar with the needs of their patients. This makes them able to deliver high-quality health care services.¹⁰

Internal communication systems are also important, so managers and supervisors play a vital role in keeping their employees up and doing. To be effective, managers should develop new and sharpen existing communication skills such as listening, managing stress, understanding nonverbal communications and being emotionally aware of others.¹¹

Summary of findings

The use of effective communication skill is an integral part of the nursing profession. It is one of the important ways for nurses to support patients and their family members. Promoting effective communication in health care can be challenging because of the nature of the work environment, income, culture, age difference, language and so on. Nurses that have received training in communication skills interact effectively and exhibit increased confidence in communicating with patients. Inother words, to establish effective communication, it is imperative that the nurse-patient communication should be well identified and understood.

Communication skill involve the ability of a person to accurately understand (via both verbal and non-verbal method) another person, and effectively deliver what is desired by the person.³² Good communication skills are a basic requirement for provision of professional nursing services since they enable a deep understanding of patients, solving of complex problems, and analysis of situations reasonably and logically.^33,34

According to previous studies, the following measures will be significantly helpful in establishment of an effective nurse-patient communication: allocation of medical staff according to the language and culture of the region, by motivating nurses to provide high-quality health care services, upgrading medical facilities and clinics, organizing periodic workshops on communication skills, and most importantly, changing the attitudes of nursing administrators and managers from offering task-based services toward following an approach that is holistic.¹²

Previous studies have shown that nurses communication skills are related structurally to their perception of professionalism. With regards to nurse’s perception of professionalism, Adams et al.³⁵explained that a good perception will lead to higher-level capabilities. The above study reported that, because nurses’ communication skills are related to the nurse’s perception of professionalism, communication skills should be seen as a predictor of success.³⁵

Therefore, communication is one of the most important aspects of nursing care and alot of nursing responsibilities, such as physical care, mental support and information exchange with patients will not be possible without communication. Improper communication with the patients could cause problems such as: lack of access to vital information of the patient, misinterpretation of the patient’s information, and creating an atmosphere of distrust between the healthcare providers and the patient.

Special acknowledgment goes to Lenne Shaw, Senior lecturer and course director Adult Nursing, Peterborough, UK and Tessyfrancis Oby Ofoegbu (PhD in view) Library and Information Science; a writer, poet, disciplinarian and bibliotheca.

The author declares there is no conflict of interest.

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