Communication and Nursing Management


Basic Principals of Communication

– Most People spend about 70% of their working hours communicating speaking, reading or writing. Yet the quality of people’s communication is not effective communication can lead to misunderstanding.

– Poor performance, interpersonal conflict, and many other undesirable outcomes.

– To communication, people must “ construct shared realities-create shared meanings” in other words, they must engage in an exchange that is both understood and meaningful.


Definition of Communication

Communication means transfer meaning and enhance understanding. It provides a two- way flow of information and includes sending and receiving messages.

Functions of Communication

– Provides information

– Enhances decision- making

– Facilitates expression of feeling.

– Promotes closer working


Dimensions of Communication

– Communication is usually described along a major dimensions

1. Content (what type of things are communicated

2. Source/Emisor/Sender/Encoder (by whom

3. Form (in which form)

4. Channel through which medium

5. Destination/Receiver/Target/Decoder (to whom)

6. Purpose/Pragmatic aspect


Elements of the Communication Process


the “who” in communication, i.e., the person who initiates communication


the “what” in communication; consists of verbal and/or nonverbal stimuli that are taken in by the receiver


the person who takes in the message and analyzes it


the new message that is generated by the receiver in response to the original message from the sender



The Communication Process

Thought: First, information exists in the mind of the sender. This can be a concept, idea, information, or feelings.

Encoding: Next, a message is sent to a receiver in words or other symbols.

Decoding: lastly, the receiver translates the words or symbols into a concept or information that he or she can understand.


Principle of communication

– One Can Not Communication

– No matter what happens in any communication interaction, some form of communication is taking, place.

– Activity, inactivity or even silence can convey a message.

– Once a message is sent, it is impossible to retract it.

Each communication has A content and Relationship Aspect

– Communication not only conveys information (content) but it also imposes behavior (relationship).

– How we communication depends not only on what we say, but how we relate to the person we are communicating with.

A series of communications can be viewed as an uninterrupted sequence of exchanges

– Communication is a continuous, circular process.

– It is a dynamic process in which messages are sent and received.

– The content of the channels open and the communication continuous and uninterrupted.


Types of Communication and Communication System

Communication system

– Downward Communication.

– Upward Communication.

– Lateral Communication.

– Diagonal Communication.

– Grapevine Communication.

Downward Communication

Formal communication consists of messages sent from superiors to subordinates.

1. Instructions or directions concerning job-performance.

2. Information about organizational procedures and policies

3. Feedback to the subordinates concerning job performance

4. Information to assist in of work tasks.

– Low employee satisfaction

– Downward communication is limited.

Downward Communication must Accomplish the Following:

– Demonstrate empathy .

– Be accurate

– Be definite.

– Consider selective perception.

– Provide for feedback

– Avoid message overload

Upward Communication

– Upward communication : the flow of messages from the lower levels of the organization to the upper levels.

– It most consists of information such as feedback of lower-level operations (reports of production).

– Upward is important work-related decisions.

– Upward communication involves complaints and suggestions for improvement .

– High employees satisfaction

– Successful upward communication requires the following:

– Frequent face-to-face contact

– Recognition of and rewards for accomplishment

– The ability to listen

– Action.

Lateral Communication

– Lateral communication This is the flow of communication between people who are on the same level in an organization.

– It requires co-workers co-ordination to accomplish a goal.

– Lateral communication can also occur between two or more departments in an organization.

– Lateral communication helps develop interpersonal relationships.

– Lateral communication has three formal functions:

a) Coordination.

b) Problem solving.

c) Conflict resolution

– Lateral communication tends to be faster, more accurate, and less threatening than vertical communication.

Diagonal communication

– It occurs between individual or departments that are not in the same level of the hierarchy.

– informal

The grapevine

– Informal

– Rapid and fast

– Grapevine has three main characteristics.

  1. it is not controlled by management.
  2. it is perceived by most employees as being more believable and reliable than formal channel issued by top management.
  3. it is largely used to serve the self-interests of the people within it.

Barriers to Communication

– Culture, background, and bias

– Noise

– Ourselves

– Perception

– Message

– Environment

– Smothering

– Stress

– Gender differences

Culture, background, and bias – We allow our past experiences to change the meaning of the message. Our culture, background, and bias can be good as they allow us use our past experiences to understand something new, it is when they change the meaning of the message then they interfere with the communication process.

Noise – Equipment or environmental noise impede clear communication. The sender and the receiver must both be able to concentrate on the messages being sent to each other.

Ourselves – Focusing on ourselves, rather than the other person can lead to confusion and conflict. The “Me Generation” is out when it comes to effective communication. Some of the factors that cause this are defensiveness (we feel someone is attacking us), superiority (we feel we know more that the other), and ego (we feel we are the center of the activity).

Perception – If we feel the person is talking too fast, not fluently, does not articulate clearly, etc., we may dismiss the person. Also our preconceived attitudes affect our ability to listen. We listen uncritically to persons of high status and dismiss those of low status.

Message – Distractions happen when we focus on the facts rather than the idea. Our educational institutions reinforce this with tests and questions. Semantic distractions occur when a word is used differently than you prefer. For example, the word chairman instead of chairperson, may cause you to focus on the word and not the message.

Environmental – Bright lights, an attractive person, unusual sights, or any other stimulus provides a potential distraction.

Smothering – We take it for granted that the impulse to send useful information is automatic. Not true! Too often we believe that certain information has no value to others or they are already aware of the facts.

Stress – People do not see things the same way when under stress. What we see and believe at a given moment is influenced by our psychological frames of references – our beliefs, values, knowledge, experiences, and goals.

One- way Communication

– The flow of information is in one direction. (sender controls situation)

– It is quick, uncomplicated.

– Little, if any response is expected from the receiver.

– Very structured.

– It does not allow the sender of communication to know if the message has been accurately understood

– It does not allow the sender of communication to know if the message has been accurately understood.

– It tends to inhibit questions from the recipient until the very end of the communication.

Example One- way Communication

– Public speeches. Memo, and may university lectures.

– She or he can present information in an organized manner and usually can outline his or her talk or communication before it takes place.

– Television and radio are the two most common forms of public one-way communication in our culture.

Two- way Communication

– The “ recipient” becomes actively involved in the communication process, giving responses immediately to the message sender, who in turn can modify the next message based on the other’s response or “feedback”.

– It is slower than one-way communication.

– It requires listening and flexibility on the part of the message sender.

– It is generally more effective than one-way communication.

–  Sender and receiver contribute equally.

– Feedback is expected and respected.

– Unstructured – flexibility allows for dynamic exchange.


Basic Communication skills

Sending Skills

a. Self-Awareness:

The sender should be aware of this feeling if he is anxious angry, tired, impatient …etc.

b. Awareness about the Receiver:

• The message should be aware of the receiver’s needs.

• The message should suit, receiver’s cultural background and level of understanding.

• The message has signification for receiver.

• How is receiver responding, as the health provider sends the message.

C- Message are sent through verbal and nonverbal channels:

–  Nonverbal messages.

– Verbal message.

– Effecting sending..


Receiving skills

Receiving skills involve not only listening to what people say but also observing their behavior:

– They enable people to receive accurate and complete message.

– Effective receiving skills require attention to nonverbal as well as verbal message and seeking feedback to understand their meaning.

Skills needed for effective receiving are:

Active listening (reflective listening).

– The skill of assuming responsibility for and understanding.

– The feelings and thoughts in a sender’s message.

To be an active listener you should demonstrate interest by:

– Sitting forward

– Sustaining eye contact

– Nodding the head

– Asking occasional quest ional for clarification

Active listening includes

1. Reflective questions

2. Communication acceptance and increase trust.

3. Exercise problem-solving skills.


Interpersonal skills

a. Showing respect

showing respect means conveying the attitude that people have importance, dignity, and worth e.g. using the title of “MR” or “Mrs”

b. Empathizing

Empathy is the ability to communicate understanding and experience of feelings and reduces their anxiety and defensiveness.

– It focuses attention on receivers and their feelings and reduces their anxiety and defensiveness.

– It show that the sender shares peoples concerns, and make them feel that their contributions are valued.

c. Developing trust

Trust developed through an open, honest and patient approach with others:

– As trust develops, communication becomes more free flowing and productive.

– Receivers will not express their true feelings if they do not fully trust the sender.

– Health care providers develop trust in communication process by showing that they truly accept others, that they believe in them as people.

– “Trust generates trust” e.g. if you show confidence in people you communicate with, they will respond the same way.

– Treating people as fully participating partners in the communication process, and demonstrating that they are trustworthy and responsible.


Factors influencing communication

Effective communication , both sending and receiving is strongly influenced by three factors:

– Pervious Experience

– Culture

– Relationship

Helpful Tips for therapeutic Communication

– Use broad opening statements to open communication (How have you been feeling?).

– Listen carefully, eagerly, actively, responsively, and seriously to what client.

– A knowledge client without inserting your own values or judgments. (I hear what you are saying).

– Use feedback to relay to client the effect of his or her words. (you did that well?).

– Being congruence , the harmony or verbal messages (A client is crying, health providers says “I want to help” and puts his hand on the client’s shoulders)

– Clarify clients’ message (you said it was hot in here. Would you like to open the widow?)

– Focus or refocus on client’s statement (You were telling me how hard it was to talk to your mother)

– Validate accuracy of client’s message. (Yes it is confusing with so many people around )

– Identify and send back a message acknowledging the feeling expressed ( reflection) (You distrust your doctor).

– Ask client open ended question( what kind of job would you like to do?)

– Give client encouragement through use of nonverbal action (Nods appropriately as someone talks)

– Restate the last few wards the client says.

– Paraphrase or reward what client has said? ( you mean you are unhappy)

– Show interest and involvement without saying anything else. (Yes ….uh hm)

– Use incomplete sentence to encourage client to continue. (Then your life is….).

– Keep your own verbalization minimal and let the client lead feel…..?)

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