interpersonal skills in nursing essay

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• PMC7903201.1 ; 2021 Jan 28
• ➤ PMC7903201.2; 2021 Mar 11

Interpersonal and communication skills development in nursing preceptorship education and training programmes: a scoping review protocol

Philip hardie.

1 UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland

Andrew Darley

2 UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Catherine Redmond

Attracta lafferty, suzi jarvis.

3 UCD Innovation Academy, University College Dublin, Belfield, Dublin 4, Ireland

Associated Data

No data are associated with this article.

Version Changes

Revised. amendments from version 1.

Many thanks to our reviewers for their suggested comments and suggestions. The article has been updated accordingly to reflect some of this feedback. Version 2 of this scoping review protocol includes minor additions including a broader definition of preceptorship and change in the narrative describing the interpersonal relationship between the preceptor and student nurse. The data extraction template has been modified to include additional items as suggested by the reviewers.

Peer Review Summary

The preceptorship model is an education-focused model for teaching and learning within a clinical environment in nursing. It formulates a professional educational relationship between a staff nurse (preceptor) and student nurse and is based on the provision of providing patient care. Preceptorship is widely acknowledged in the literature as a positive pedagogical approach in clinical nursing education in terms of knowledge and skill acquisition, confidence, and professional socialisation of undergraduate nursing students. However, the literature also widely reports negative interpersonal experiences within this professional educational relationship resulting in negative educational experiences and in some cases, negative patient experiences. Therefore, the authors set out to examine what teaching strategies are being implemented by nurse educators to encourage the development of interpersonal and communication skills in facilitating positive interpersonal relationships between the preceptor, nursing student and patient. This paper outlines the protocol for an exploratory scoping review that aims to systematically and comprehensively map out the available published and unpublished literature on the teaching strategies to develop interpersonal and communication skills in preceptorship education and training programmes. To conduct a systematic and comprehensive scoping review, the review will be guided by the Joanna Briggs Institute and Arksey & O’ Malley (2005) six-stage iterative framework, as well as PRISMA-ScR framework guidelines, to ensure the quality of the methodological and reporting approaches to the review. It is anticipated that the results of the scoping review will inform nurse educators on the current educational practices for developing interpersonal and communication skills in preceptorship education and training programmes and identify any educational practices that are worthy of further consideration for future research.

Introduction

The preceptorship model is a teaching and learning strategy frequently employed internationally to educate undergraduate and graduate nursing students in the clinical environment. Some debate exists regarding the definition and function of preceptorship, for example Billay & Myrick’s (2008, pg. 259) defines preceptorship as:

“ an approach to the teaching and learning process within the context of the practice setting which allows students to develop self-confidence while increasing their competence as they become socialised into the profession of nursing ”.

Carlson (2013, pg.457) further defines preceptorship “ as a trusting relationship between preceptor and student.... where the preceptor strives to create a safe and meaningful interactive relationship with the student...... thus supporting the student’s ability to implement generalized theoretical knowledge into patient-centered problems ”. Another key function of a preceptorship not captured in the previous definitions is the preceptor’s role in the assessment of students’ competencies. Vae et al. , (2018, pg.13) states “ the students' learning process is dependent on high-quality assessment processes and feedback from preceptors permitting students to critically reflect on their practice and learn for that experience ”.

Acknowledging that up to 50% of undergraduate nursing curriculums take place in the clinical environment, the preceptorship model plays a pivotal role in the education of student nurses ( McSharry & Lathlean, 2017 ; NMBI, 2016a ; NMC, 2018 ). The preceptorship relationship is a purposeful short-term professional partnership in the practice setting between the preceptor (staff nurse) and a nursing student (preceptee) and is based on the provision of providing patient care. Hence, within the preceptorship model, there are three members: the preceptor, the student nurse, and the patient, forming a triadic professional relationship. This relationship provides opportunities for nursing students’ socialisation into nursing practice and helps to integrate theory into practice, under the guidance of the preceptor ( McSharry & Lathlean, 2017 ; Muir et al ., 2013 ; Ward & McComb, 2017 ). The Nursing and Midwifery Board of Ireland ( NMBI, 2016b ) states that effective interpersonal relationships are not only essential for the foundation of effective patient care but also a successful teaching and learning environment. Therefore, the quality and support within this relationship contribute significantly to nursing student’s socialisation into the nursing profession and their learning ( Ward & McComb, 2017 ) whilst also ensuring quality patient care and their satisfaction in their nursing care ( Suikkala et al ., 2020a ). Thus, the formation of a therapeutic interpersonal relationship between the preceptor/nursing student and patient is essential.

Kornhaber et al . (2016 pg. 537) define a therapeutic interpersonal relationship between the nurse and patient as:

“ a relationship which is perceived by patients to encompass caring, and supportive non-judgmental behaviour, embedded in a safe environment during an often-stressful period ”.

Typically, a positive therapeutic relationship portrays characteristics of good interpersonal competence with meaningful dialogue that displays warmth, friendliness, genuine interest, respect, and empathy, while at the same time responding to patients’ emotions and having a desire to provide support and care ( Dinç & Gastmans, 2013 ; Kornhaber et al ., 2016 ; Prip et al ., 2018 ). It is therefore essential that preceptors are proficient in these skills, which will enable them to provide patient-centered care, while also utilising teaching techniques such as role modelling, coaching and contextual questioning to facilitate the student’s learning ( McSharry, 2013 ). For this reason, there needs to be a strong educational and trustful professional relationship between the preceptor and student nurse, so that positive therapeutic interpersonal relationships can then be developed with patients. In light of the increasing complexity of healthcare delivery, the importance of effective interpersonal relationships between the preceptor, nursing students and patients has grown exponentially. The literature emphasises the benefits of effective interpersonal and communication skills but also highlights the consequences of negative interpersonal interactions. Effective interpersonal relations have been shown to play a pivotal role in building trusting relationships and creating a caring and welcoming environment in nursing ( Arnold & Boggs, 2020 ). This thereby improves communication between the preceptor, nursing student and patient, leading to person-centred care, patient satisfaction, patient empowerment and decreases adverse events among patients ( Suikkala et al ., 2020a ; Suikkala et al ., 2020b ). Effective interpersonal relations also facilitate the development of knowledge, skills acquisition, and theory-practice integrations for nursing students ( Irwin et al ., 2018 ; Ke et al ., 2017 ; Omer & Moola, 2019 ; Ward & McComb, 2017 ; Washington, 2013 ).

However, the literature to date also widely documents negative interpersonal relationships within this professional educational relationship and the clinical environment. Reports from both preceptors and nursing students exist regarding workplace incivilities such as rudeness, humiliation, anger, generational clashes, and inappropriate criticism from experienced preceptors ( Dyess & Sherman, 2009 ; Gardiner & Sheen 2016 ; Omer & Moola, 2019 ). These challenging experiences consequently result in a negative learning experience for the student and, in some cases, interpersonal conflict occurs due to a breakdown in the preceptorship relationship ( Hugo & Botma, 2019 ; McCloughen & Foster, 2018 ). Furthermore, it has been reported that displaying poor interpersonal skills, where there is a lack of emotional intelligence demonstrated by preceptors and student nurses, can result in negative feelings amongst patients, leading to a lack of trust and a possible breakdown in the relationship ( Holst et al ., 2017 ; Mukumbang & Adejumo, 2014 ). As educators, this is concerning to the authors, as fragmented relationships can have not only a negative impact on the student nurses’ learning experience but also on patient care ( Cho et al ., 2017 ; Suikkala et al ., 2018 ; Suikkala & Leino-Kilip, 2005 ).

As with any human skill, interpersonal and communication skills, also referred to as “soft skills” can be improved through conscious effort ( Moss, 2020 ). McConnell (2004, pg. 178) describes soft skills as “ those essential skills involved in dealing with and relating to other people, largely on a one-to-one basis ”. These include the ability to engage with others at a personal and professional level, and display levels of empathy towards the situation that others may be experiencing ( Grant & Goodman, 2019 ). This process stimulates feelings of support, comfort, and recognition in individuals ( Wright, 2007 ). Enhancement of interpersonal skills concerns several key components, including the individuals’ emotional intelligence, learning to recognise the uniqueness of everyone, empathising with the individual, learning to listen, effective communication, empowering others and building trust ( Grant & Goodman, 2019 ).

Teaching effective interpersonal and communication skills requires providing the relevant knowledge, as well as guiding and coaching learning to develop and enhance these skills. It takes time and experience to build effective interpersonal and communication skills, beginning with foundational skills, for example, knowing when to use open-ended and closed-ended questions. More advanced listening skills paired with sensitivity and empathy generate highly effective interpersonal relationships ( Pavord & Donnelly, 2015 ). Investing in developing preceptors’ interpersonal and communication skills is essential in maintaining good interpersonal relationships, an effective teaching environment and exemplary patient care. Preceptors not only have the responsibility of role modelling effective soft skills but also evaluating student nurses’ competencies in these skills as part of their clinical assessment document ( NMBI, 2016a ). Therefore, the inclusion of such skills is paramount in preceptorship education and training programmes. Preceptors bring their own distinctive set of communication skills, cultural influences, learning styles and life experiences that directly affect their ability to engage in effective interpersonal relationships ( Gardiner & Sheen, 2016 ). Nurse educators must build on preceptors’ strengths and experiences to enhance their interpersonal skills. A preceptor short of adequate interpersonal and communication skills may be able to facilitate positive interpersonal relationships with the nursing students and patients ( Martínez-Linares et al ., 2019 ). Interpersonal and communication skills are practical skills. Therefore, nursing educators need to adapt teaching strategies that involve activities which allow opportunities for active participation to develop such skills, e.g., experiential learning opportunities ( Reid-Searl et al ., 2017 ). Pedagogical approaches observed in the literature include simulation practices such as the use of puppets ( Reid-Searl et al ., 2017 ), standardised patients ( Lin et al ., 2013 ; Maclean et al ., 2017 ), real patients ( Perry et al ., 2013 ) and roleplay ( Jackson & Back, 2011 ; Pearson & McLafferty, 2011 ). Other methods observed included clinical placement ( Purdie et al ., 2008 ), group discussions ( Waugh et al ., 2014 ), online discussion ( Deering & Eichelberger, 2002 ), and audiotapes ( Sloan, 2003 ).

The existing evidence outlined provides an overview of the importance of interpersonal and communication skills, particularly in the context of a nursing preceptorship relationship. This literature highlights the need for active development of these skills in preceptorship education and training programmes. However, an initial inspection of the literature demonstrates that the focus of interpersonal and communication skills development centres around nurse-patient relationships and is predominantly completed as part of an undergraduate nursing programme. Given the importance of effective interpersonal and communication skills for preceptors in not only facilitating and guiding such skills among nursing students and the patients, the authors feel it is therefore worthwhile to systematically examine the literature to identify what teaching strategies are being implemented to develop interpersonal and communications skills among trainee preceptors (qualified nurses). It is also important to determine if trainee preceptors are being afforded the opportunity to specifically develop interpersonal and communication skills required to facilitate and guide the triadic preceptorship relationship between the nurse, student nurse and patient.

A scoping review protocol will outline the approach that will be adopted to determine the available literature on the pedagogical approaches to developing interpersonal and communication skills among nursing preceptors as part of their preceptorship education and training programme.

An exploratory scoping review approach will be employed to establish the nature and extent of knowledge relating to pedagogical approaches in preceptorship education and training programmes for the development of interpersonal and communications skills among trainee preceptors. Scoping reviews are used to map the concepts underpinning a research area and the primary sources and types of evidence available ( Arksey & O’Malley, 2005 ). Scoping reviews present a broad overview of the evidence concerning a topic and are beneficial when investigating areas that are emerging to clarify key concepts, definitions and identify gaps ( Lockwood et al ., 2019 ; Page & Moher, 2017 ). Scoping reviews are also implemented to examine the breadth of the literature, as well as the conduct of research on a specific topic to inform the design of future research studies ( Lockwood et al ., 2019 ).

To the best of the authors’ knowledge, there are currently no scoping reviews examining the educational practices of nurse educators in developing interpersonal and communication skills among trainee preceptors. Therefore, the findings of this exploratory review will contribute to existing literature regarding current pedagogy for interpersonal and communications skills development in preceptorship education and training programmes. The findings of this review may benefit the wider society, considering that interpersonal relationships of a preceptorship not only play an essential role in providing effective patient care, but also in facilitating nursing education in the clinical environment. It will also contribute a theoretical and empirical basis for the future development of pedagogical approaches that aim to enhance interpersonal and communication skills in preceptorship education and training programmes. The scoping review protocol introduced by Arksey & O’Malley (2005) that encompasses a six-stage iterative framework, as well as Peters et al . (2020) updated approach to conducting scoping reviews, will guide this review protocol and subsequent scoping review.

Aim and objectives

The overall aim of the scoping review is to identify, explore and map the literature regarding the development of interpersonal and communication skills for preceptors as part of their preceptorship education and training programme.

This will be achieved by addressing the following objectives:

• 1. Determine the extent and nature of existing literature on the development of interpersonal and communication skills in preceptorship education and training programmes, so that the literature can be examined and mapped out, to identify any gaps.
• 2. Examine current educational practices for the development of interpersonal and communication skills in preceptorship education and training programmes, to identify any educational practices that are worthy of further consideration for future research.

Stage 1: Identification of the scoping review research question

Peters et al . (2020) state that a clear scoping review question should incorporate elements of the PCC mnemonic (population, concept, and context). In this instance, qualified nursing staff (trainee preceptors/preceptors) are the relevant population, the concept is educational practices for interpersonal and communication skills development for supporting newly qualified nurses taking part in preceptorship programmes as well as undergraduate nursing students, and the context is preceptorship education and training programmes in acute/residential clinical settings. The research question that will therefore guide this scoping review is:

“ What is known about the development of interpersonal and communication skills amongst trainee nursing preceptors in preceptorship education and training programmes? ”

Stage 2: Identifying relevant studies

The Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) Checklist framework guidelines introduced by Tricco et al . (2018) will also guide the systematic scoping review. These guidelines are recommended to enhance transparency and quality of the completed scoping review ( McGowan et al ., 2020 ), and will help the researchers and the readers develop a greater understanding of the evidence. The research team will undertake a comprehensive search of the literature within the following databases:

• CINAHL Nursing and Allied Health (CINAHL Plus)
• SCOPUS (Elsevier Publications)
• Academic Search Complete (EBSCOhost)
• APA PsycINFO (American Psychological Association)
• Education (ERIC)

Joanna Briggs Institute (JBI) three-step process for applying a search strategy will be implemented ( Peters et al ., 2020 ). Firstly, an initial search was deployed on CINAHL Plus, the identification of search terms was conceptually based on an oriented search to identify key text words used to address the major concepts which include population (preceptors), concept (interpersonal and communication skills development), and context (nursing preceptorship education and training programme). Synonyms for each of the concepts will also be included. Each search strategy will be adapted to the functionality of each database using specific Boolean operators, truncation markers, and MeSH headings where necessary to broaden the search and capture all literature that may use such terms. McGowan et al . (2020) state the input of a research librarian is invaluable when carrying out a scoping review; the authors worked with an expert university librarian (D.S.) in designing and refining the search strategy. Table 1 outlines the keywords for each search string.

As per the second stage of the JBI search strategy protocol, the same keywords from Table 1 will be searched in the remaining aforementioned databases. During this stage, the research team will review and ‘hand search’ the reference list to identify any additional relevant studies. Given that this is an exploratory scoping review, the authors are interested in identifying all literature including RCTs, exploratory studies and discussion papers. Therefore a “web search” of the grey literature will also be conducted using “OpenGrey” and “Google Scholar”. Specific educational policy publications by regulatory and professional bodies for preceptorship education and training programmes will also be searched to examine the focus of interpersonal and communication skills required for a preceptorship role. Table 2 outlines the search terms for grey literature and regulatory and professional bodies for preceptorship education and training programmes.

Stage 3: Study selection

Each search conducted will be systematically documented (date, search terms, results per string) and saved by two independent authors (PH, AD), with the findings of the searches compared and then imported into Mendeley (1.19.6 / 2020), a bibliographic reference manager, where any duplicates of literature will be removed before the initial screening of title and extract is divided out and screened by all of the authors. Covidence screening and data extraction software tool ( www.covidence.org ) will be utilised by the authors for screening. Each article will be required to be approved by two independent screeners before either being included or excluded in the review. A pilot testing of articles (n=50) using Covidence software package and inclusion and exclusion criteria will be undertaken by the authors to ensure consistency of the methodology adopted in the selection process ( Peters et al ., 2020 ). Full text screening will then be carried out on all articles that meet the inclusion criteria during the initial screening round by two independent authors (PH, CR). For any articles in which a disagreement may arise a third independent author (AL) known as the “tie-breaker” will further review the article against the inclusion criteria to settle the difference of opinion. The number of articles identified, screened, assessed for eligibility, and included in the review will be captured using the Covidence software package. A PRISMA flow diagram will be created to ensure transparency of reporting, decisions for the exclusion of studies permitting replication and comparison of any further studies.

The inclusion and exclusion criteria, highlighted in Table 3 , will be developed through an iterative process based on the PCC elements of the review question, plus a specification of the types of studies that have addressed the scoping review question and discussions amongst the authors ( McKenzie et al ., 2020 ). The primary author will record any changes. All authors will utilise and adhere to its criteria during the screening process to ensure consistency.

Stage 4: Data charting

In this stage, a data extraction form will be created by the lead author (PH) ( Table 4 ) based on JBI (2020) data charting form, mapping it with the objectives and research question of the scoping review ( Peters et al ., 2020 ) and piloted on two articles by all authors. Any changes to the chart will be documented and reported in the final scoping review for transparency in the reporting.

Stage 5: Collating, summarising and reporting the results

Each data charting form will be logged electronically using Microsoft Excel to capture relevant information for each study and will be available for all members of the research team via a shared drive. All authors will discuss the data before a descriptive analysis commences. As recommended by Peters et al . (2020) , the analysis of data extracted should not involve any more than descriptive analysis to achieve the desired outcomes of a scoping review. Therefore, a narrative report will be produced, using a deductive thematic analysis approach summarising the extracted data concerning the objectives and scoping review question, for example, the pedagogy adopted for interpersonal and communication skills development and the impact of such training on trainee preceptors. Identification of areas in which a gap in the literature exists will also be reported. Quality appraisal of studies will not be conducted, as this review aims to explore the general scope of research conducted in the field of interpersonal and communication skills development in preceptorship education and training programmes and identify current pedagogical practices implemented to contribute a theoretical and empirical basis for the future development of preceptorship education and training programmes.

Stage 6: Consultation and dissemination

Initial findings from the scoping review will be presented to several stakeholders. The primary author (PH) will disseminate the results of the review with local academic networks within the authors’ place of work (third level institution) and associated clinical settings. The author will specifically report the findings to Clinical Placement Coordinators (CPC), who typically develop and facilitate preceptorship education and training days in the clinical settings in Ireland. The primary author will also share the results at the Clinical Skills Network of Ireland in which he is a stakeholder to reach a national targeted audience. The authors will engage with these groups to share and discuss our findings and interpretations to capture their perspective on the evidence identified. The primary author also aims to deliver an oral or poster presentation at National and International conferences such as the International Nursing & Midwifery Research and Education Conference, scheduled for March 2022. Finally, the authors aim to publish the scoping review findings in a peer-reviewed journal for a wider communication of the results. All data generated and analysed during the scoping review will be included in the published scoping review article; including search results, list of included studies, data extraction spreadsheets and final results, to ensure transparency and reproducibility of the review.

Study status

This study is at Stage 2 – a preliminary search of the literature has been conducted and the software packages Mendeley and Covidence have been trialled.

Conclusions

This scoping review protocol has been designed in line with the latest literature and evidence ( Arksey & O’Malley’s, 2005 ; Peters et al ., 2020 ; Tricco et al ., 2018 ) to create and perform a systematic scoping review. The distinguishing features of a scoping review will permit the authors to answer the specified research question, applying a systematic and evidence-based approach to identify the current knowledge on educational practices for the development of interpersonal and communication skills as part of preceptorship education and training programmes. It will also enable the authors to identify gaps in our knowledge base in this field which could justify new research and also inform the design, conduct and reporting of future research.

While this scoping review will not formally evaluate the quality of evidence available, it will provide a comprehensive overview of the available literature that will inform the researcher on current educational practices for the development of interpersonal and communication skills as part of preceptorship education and training programmes. This knowledge may identify the gaps in training that are contributing to interpersonal conflicts in preceptorship relationships that are widely reported throughout the literature. Only articles in English will be utilised; however, there will be no restrictions on the country of origin where the publications were produced, which should therefore provide a diverse range of opinions, experiences and cultural contexts. Following the open peer-review process and achieved approval, the authors will commence the systematic scoping review.

Data availability

Acknowledgements.

Diarmuid Stokes, UCD Librarian

[version 2; peer review: 3 approved]

Funding Statement

The author(s) declared that no grants were involved in supporting this work.

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Reviewer response for version 1

Karen poole.

1 Faculty of Health and Medical Sciences, School of Health Sciences, University Of Surrey, Guildford, UK

Thank you for inviting me to review this protocol. The authors make a compelling case for conducting a scoping review on the pedagogic practices used to develop communication and interpersonal skills in nurse preceptors. This protocol draws upon the most recent guidance for the conduct of scoping reviews, with a clear and well written account of the planned search strategies, data extraction and dissemination plans. 

In terms of "context" scope, it may be helpful to clarify if you are including the educational preparation of preceptors for supporting Newly Qualified Nurses taking part in preceptorship programmes as well as undergraduate nursing programmes.

I agree with Elisabeth Carlson (first reviewer) regarding the difficulty of applying the concept of the therapeutic relationship to the preceptor and nursing student. There are characteristics that are relevant, but I am not sure whether it is a faithful representation of this concept. You may wish to consider a minor revision to this paragraph? Preceptors have a critical role in shaping students' clinical experiences, but are also responsible for assessing their developmental progress both formatively and summatively (often in a placement of short duration). As such, there is a complex relationship between preceptors and nursing students and the use of effective communication and interpersonal skills (in both parties) is essential in negotiating learning opportunities and navigating safe honest formative feedback/feed-forward that enables students to optimise learning in practice placements through their programmes.

Here are a couple of minor suggestions for inclusion in your plans for data extraction:

• capture of "nursing field" (learning disability, mental health, child, adult).
• capture of whether the educational strategies include both preceptors and students or preceptors alone.

This scoping review has the potential to make an important contribution in shaping how preceptors are prepared and support the future nursing workforce.

Is the study design appropriate for the research question?

Is the rationale for, and objectives of, the study clearly described?

Are sufficient details of the methods provided to allow replication by others?

Are the datasets clearly presented in a useable and accessible format?

Not applicable

Reviewer Expertise:

Education of Healthcare Professionals, Integrated Programmatic Assessment, Self-regulated Learning, Teaching Evidence-based Practice, Cancer Care.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

The authors would like to thank you for your comments on our scoping review protocol and for your suggestions.

We have responded to your comments below:

• A broader definition of preceptorship will be provided which will be more aligned to the diverse range of roles and responsibilities associated with a nursing preceptorship.
• We acknowledge the therapeutic relationship better describes the relationship between the nurse and patient and have amended the text accordingly.
• The “context” of the scope has been updated to include the educational preparation of preceptors for supporting Newly Qualified Nurses taking part in preceptorship programmes as well as undergraduate nursing programmes

Edel McSharry

1 Department of Nursing, Health Science and Disability Studies, National University of Ireland Galway, Galway, Ireland

2 St. Angela's College Lough Gill Sligo, Lough Gill, Ireland

The preceptor holds a dual role of practitioner and teacher. The preceptor must utilise complex teaching strategies to the foster the student’s ability to practise nursing competently and compassionately. One of the core competencies inherent in all nursing programmes is the student's ability to communicate effectively and develop positive professional interpersonal relationship with both patients and other health care professionals. It is essential that the preceptor trainee is proficient in these skills in order to be able to provide patient centered care and utilise the teaching techniques of role modelling, coaching and contextual questioning to facilitate the student’s learning. Students often find these skills a challenge to learn and preceptors often undervalue their own professional interpersonal communication skills ( Mallik et al 2009 1 , Mc Sharry 2013 2 ).

Preceptorship preparation varies in length and content and some studies have reported that preceptors do not feel adequately prepared for their teaching and assessment role. This scoping review focusing on interpersonal and communication skill development of preceptor trainees will contribute to existing literature that can inform the development of preparation programmes both nationally and internationally. It has the potential to contribute to pedological approaches that enhance both preceptor trainee skills and student’s interpersonal and communication skills. Any enhancement in these skills are can only positively contribute to the provision of quality person- centered care. The protocol is clearly written with well-defined aim and objectives, inclusion and exclusion criteria and appropriate search terms. It aligns wells to recent writings on methodological guidance for the conduct of scoping reviews.

I have 3 suggestions that the authors may find useful in refining this protocol:

• Page 3 The definition of preceptorship offered is valuable and constitutes many of the attributes of the preceptorship model. Carlson (2013) definition develops on this definition and may be more appropriate. The preceptorship model in the Irish context further involves an assessment role which is not specified or encapsulated within these definitions as they are presented.
• Page 3 I would not entirely agree the preceptor- preceptee relationship is a therapeutic interpersonal relationship. This type of relationship is associated with a long term mentor- student relationship. The preceptor has to ensure the student gains the competencies required to pass the placement and therefore its focus is educational. The paper already sets out that the preceptor relationship is purposeful and short-term therefore I would suggest preceptorship involves a reciprocal student -preceptor relationship based on equality and mutual respect where the student’s confidence is fostered( Mc Sharry & Lathlean 2017 3 ).
•  Page 3 and Page 4 there is a sentence that is repeated at the beginning of the paragraph at the bottom of page 3 and at the beginning of the paragraph on page 4. This repetition is not required and just requires some editing.

clinical education, digital learning, internationalisation

Elisabeth Carlson

1 Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden

The training and preparation of preceptors vary over the world. Some programs or rather initiatives are merely a couple of days or even hours long while others are full academic credit bearing courses at universities. This implies that studies on preceptor preparation is a subject always worthy of investigation. The protocol is well written, easy to follow and uses current methodological references. I applaud the authors that despite their educational context being Ireland, the protocol is written in such a way that it is easily transferable to an international context. I have three minor  comments or rather thoughts that might be useful.  

Keywords: Alphabetical order

Page 3 Definition (the quote): While this is very true and a frequently used definition, I would also recommend the more elaborated definition to be found in CARLSON E. (2013) Precepting and symbolic interactionism – a theoretical look

at preceptorship during clinical practice. Journal of Advanced Nursing 69(2), 457– 464. doi: 10.1111/j.1365-2648.2012.06047.x 1

Page 3: I am not quite sure if I agree that there is a therapeutic relationship between preceptor an nursing student. I would say there should be a strong educational and trustful professional relationship which in turn enables therapeutic interpersonal relationships with patients.

Higher Health Care Education, Learning theories, Preceptorship, Clinical Training, Methodology, Interprofessional Collaboration and learning, Educational models.

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Home > Books > Nursing

Effective Communication in Nursing

Submitted: 27 October 2017 Reviewed: 06 February 2018 Published: 21 March 2018

DOI: 10.5772/intechopen.74995

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Nurses are critical in the delivery of essential health services and are core in strengthening the health system. They bring people-centred care closer to the communities where they are needed most, thereby helping improve health outcomes and the overall cost-effectiveness of services. Nurses usually act as first responders to complex humanitarian crises and disasters; protectors and advocates for the community and communicators and co-ordinators within teams. Communication is a core component of sound relationships, collaboration and co-operation, which in turn are essential aspects of professional practice. The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. Increases in nursing communication can lessen medical errors and make a difference in positive patient outcomes. This chapter explores how effective communication and interpersonal skills can enhance professional nursing practice and nursing relationships with various stakeholders. It explains principles of communication, communication process, purpose of communication, types of communication, barriers to effective communication, models of communication and strategies of improving communication and guidelines for successful therapeutic interactions.

• communication
• communication skills
• non-verbal communication
• nurse–patient relationship
• nursing verbal communication

Author Information

Maureen nokuthula sibiya *.

• Durban University of Technology, Durban, South Africa

*Address all correspondence to: [email protected]

1. Introduction

Nurses are critical in the delivery of essential health services and are core in strengthening the health system [ 1 , 2 ]. They bring people-centred care closer to the communities where they are needed most, thereby helping improve health outcomes and the overall cost-effectiveness of services [ 3 ]. Nurses usually act as first responders to complex humanitarian crises and disasters; protectors and advocates for the community and communicators and co-ordinators within teams. Communication skills for nurses are essential but may be difficult to master. Communication is the exchange of information between people by sending and receiving it through speaking, writing or by using any other medium. Clear communication means that information is conveyed effectively between people. To be a successful nurse, excellent communication skills are required [ 4 ]. Nurses speak to people of varying educational, cultural and social backgrounds and must do so in an effective, caring and professional manner, especially when communicating with patients and their families [ 5 ]. The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. This influence can play a very important role in areas such as patient health, education and adherence [ 6 ]. Good communication plays an important role in the organization’s effective functioning [ 7 , 8 , 9 ]. A nurse must therefore, continuously try to improve his/her communication skills as poor communication can be dangerous and lead to confusion.

2. Principles of communication

Communication is a process;

Communication is not linear, but circular;

Communication is complex;

Communication is irreversible; and

Communication involves the total personality [ 5 ].

3. Communication process

A clear message; and

A receiver [ 12 ].

4. Purpose of communication

To convey information/opinion, for example, “I have headache” or “I am here to give you medication”.

To request information/opinion/behavior, for example, “Are you allergic to penicillin?” or “Tell me more about the injury”.

To give social acknowledgement, for example, “Hello” or “Good morning”.

These three primary types of messages can be combined in many ways so that they form an interaction (conversation). The goals of the interaction can be comprehensive. Nurses strive to make all their communication with patients therapeutic, that is, their communication is purposefully and consciously planned to promote the patient’s health and wellbeing.

5. Types of communication

Verbal and non-verbal communications are the two main types of communication used by human beings.

5.1. Verbal communication

Verbal communication is associated with spoken words and is vitally important in the healthcare context. Members of the multi-disciplinary healthcare team communicate verbally with one another and with patients as well as family members.

5.2. Verbal communication

Bodily contact

Direction of gaze

Emotive tone in speech

Facial and gestural movements

Physical appearance

Speech errors

Timing of speech [ 5 , 8 , 9 , 10 ].

6. Communication process

The communication process may be explained by means of a linear model of communication, interactive model of communication or transactional model of communication [ 11 ].

6.1. Linear model of communication

Linear model of communication entails a sender, a message, a receiver and noise ( Figure 1 ).

Linear model of communication.

6.2. Interactive model of communication

Interactive model of communication gives a slightly more complex explanation of the communication process. Communication is seen as a process in which the listener gives feedback or responds to a message after a process of interpretation. A communicator creates and interprets a message with a personal field of expertise and/or a frame of reference Figure 2 ).

Interactive model of communication.

6.3. Transactional model of communication

Transactional model of communication acknowledges and gives emphasis to the dynamic nature of interpersonal communication and the multiple roles of the communicators. Features such as time, messages, noise, fields of experience, frames of reference, meanings, shared systems of communicators and personal systems all pay a role in the process of communication. Communicators often participate simultaneously (sending, receiving and interpreting). The unique interpretive and perceptual processes of individuals thus play an essential role in the communication process.

7. Barriers to effective communication

Effective communication skills and strategies are important for nurses. Clear communication means that information is conveyed effectively between the nurse, patients, family members and colleagues. However, it is recognized that such skills are not always evident and nurses do not always communicate well with patients, family members and colleagues. The message sent may not be the message received. The meaning of a message depends on its literal meaning, the non-verbal indicators accompanying it and the context in which it is delivered. It is therefore, easy to misinterpret the message, or to interpret it correctly, but to decide not to pursue its hidden meaning this leads to obstruction to communication. Continuous barriers to effective communication brings about a gradual breakdown in relationships. The barriers to effective communication outlined below will help nurses to understand the challenges [ 8 ].

7.1. Language barrier

Language differences between the patient and the nurse are another preventive factor in effective communication. When the nurse and the patient do not share a common language, interaction between them is strained and very limited [ 9 , 10 , 11 ]. Consequently, a patient may fail to understand the instructions from a nurse regarding the frequency of taking medication at home.

7.2. Cultural differences

Culture is another hindrance. The patient’s culture may block effective nurse–patient interactions because perceptions on health and death are different between patients [ 12 , 13 , 14 ]. The nurse needs to be sensitive when dealing with a patient from a different culture [ 9 , 15 , 16 ]. What is acceptable for one patient may not be acceptable for another. Given the complexity of culture, no one can possibly know the health beliefs and practices of every culture. The nurse needs check with the patient whether he/she prefers to be addressed by first name or surname. The use of eye contact, touching and personal space is different in various cultures and rules about eye contact are usually complex, varying according to race, social status and gender. Physical contact between sexes is strictly forbidden in some cultures and can include handshakes, hugging or placing a hand on the arm or shoulder. A ‘yes’ does not always mean ‘yes’. A smile does not indicate happiness, recognition or agreement. Whenever people communicate, there is a tendency to make value judgements regarding those perceived as being different. Past experiences can change the meaning of the message. Culture, background and bias can be good if they allow one to use past experiences to understand something new; it is when they change meaning of the message that they interfere with the communication process [ 12 ]. It is important for nurses to think about their own experiences when considering cultural differences in communication and how these can challenge health professionals and service users.

7.3. Conflict

Conflict is a common effect of two or more parties not sharing common ground. Conflict can be healthy in that it offers alternative views and values. However, it becomes a barrier to communication when the emotional ‘noise’ detracts from the task or purpose. Nurses aim for collaborative relationships with patients, families and colleagues.

7.4. Setting in which care is provided

The factors in care setting may lead to reduction in quality of nurse–patient communication. Increased workload and time constraints restrict nurses from discussing their patients concerns effectively [ 16 ]. Nurses work in busy environments where they are expected to complete a specific amount of work in a day and work with a variety of other professionals, patients and their families. The roles are hard, challenging and tiring. There is a culture to get the work done. Some nurses may consider colleagues who spend time talking with patients to be avowing the ‘real’ work and lazy. Nurses who might have been confident in spending time with patients in an area where this was valued, when faced with a task-orientated culture have the dilemma of fitting into the group or being outside the group and spending time engaging with patients. Lack of collaboration between the nurses and the doctors in information sharing also hinder effective communication. This leads to inconsistencies in the information given to patients making comprehension difficult for the patient and their families.

7.5. Internal noise, mental/emotional distress

Internal noise has an impact on the communication process. Fear and anxiety can affect the person’s ability to listen to what the nurse is saying. People with feelings of fear and anger can find it difficult to hear. Illness and distress can alter a person’s thought processes. Reducing the cause of anxiety, distress, and anger would be the first step to improving communication.

7.6. Perception

If a healthcare professional feels that the person is talking too fast, not fluently, or does not articulate clearly etc., he/she may dismiss the person. Our preconceived attitudes affect our ability to listen. People tend to listen uncritically to people of high status and dismiss those of low status.

7.7. Difficulty with speech and hearing

People can experience difficulty in speech and hearing following conditions like stroke or brain injury. Stroke or trauma may affect brain areas that normally enable the individual to comprehend and produce speech, or the physiology that produces sound. These will present barriers to effective communication.

7.8. Medication

Medication can have a significant effect on communication for example it may cause dry mouth or excess salivation, nausea and indigestion, all of which influence the person’s ability and motivation to engage in conversation. If patients are embarrassed or concerned that they will not be able to speak properly or control their mouth, they could be reluctant to speak.

Equipment or environmental noise impedes clear communication. The sender and the receiver must both be able to concentrate on the messages they send to each other without any distraction.

8. Improving communication

Listen without interrupting the sender.

Show empathy at all times and try to understand.

Try to stay focused on the conversation. Do not however, force the patient to continue if he/she becomes anxious or seems to wish to change the subject.

Use the body language that indicates your interest and concern. Touch the patient if it seems appropriate. Lean forward, listen intently and maintain eye contact if it culturally acceptable.

Offer factual information. This relieves anxiety. Do not offer your personal opinion. Assure the patient that you have professional discretion.

Try to reflect the feelings and thoughts the patient is expressing by rephrasing questions and comments using their own words.

Avoid unclear or misleading messages.

Avoid giving long explanations.

Give your co-workers your full attention when communicating with them.

Ask questions to clarify unclear messages.

Do not interrupt until the sender has completed the message.

Provide a quiet environment without distractions.

Be convincing wen communicating [ 17 ].

9. Communicating with patients

Be open, respectful and gracious in all your interactions with the patient and keep his/her cultural preferences in mind.

Answer nurses’ bells promptly.

Make sure you have the patients’ attention when communicating.

Use words that are non-threatening – explain what you would like to do and do not give orders to the patient.

Use simple, understandable phrases, not medical terms as most patients do not understand these terms.

Speak clearly and courteously.

Use a pleasant and normal tone of voice to the hard of hearing.

Always stand so that the patient can see the nurse’s face when communicating, as lip reading is part of all normal hearing.

Use body language that is appropriate.

Explain facts and procedures before donning a mask that covers the wearer’s mouth and lower face.

Be alert to the patient’s needs. Allow time for answers to your requests and to answer patient’s questions [ 17 ].

10. Communicating by phone

Always speak clearly into the mouthpiece of the phone.

Offer a greeting for example, good morning or good afternoon.

Identify the unit or place of work.

Identify yourself by indicating who you are and where you are phoning from.

Identify the person to whom you are speaking.

Politely listen to the message and make notes if you think you may not remember all the information.

If you are asked to call another person, note the date, time, caller’s name and telephone number together with the message.

Date and sign the message [ 17 ].

11. Assertive communication

Content – where the rights of the people involved are embedded gently in the statement. This could be done by using an explanation, empathy for the listener, and praise for the listener, an apology for the consequence for the listener or a compromise that is favorable to both people.

Covert elements – where the speaker is able to recognize their rights and the rights of the listener in the communication process. These include respect, expressing feelings, having your own priorities, being able to say ‘no’, being able to make mistakes and choosing to say nothing.

Process – concerned with how people express themselves assertively. Is their body language, intonation and choice of language reflective of a confident assertive person? Are the processes that make up communication congruent, in keeping with what is being said? The process also involves managing the setting so that people are not embarrassed, or the noise levels are kept to a minimum. Increasing the likelihood of assertive communication happening again involves feedback to the listener to show that their accomplishment is appreciated.

Non-verbal cues – gesture, touch, proxemics and posture – also need to reflect confidence, regard and respect for self and others.

12. Therapeutic interactions

Assess a patient : The nurse wants to know more about a patient to identify his/her problems. This type of conversation can be a structured interview using an interview schedule. The purpose of this conversation is always a better understanding of the patient.

Instruct a patient : Patient instruction may vary from an informal conversation during which few facts are conveyed to an elaborate instruction session.

Problem solving : If a patient discuss his/her problems with a nurse, the nurse helps the patient to analyze the problem, consider possible alternative ways of handling it and how to decide which way is the best. Problem solving is done with the patients and not for them.

Give emotional support : The presence of an empathetic nurse, that is, one who can enter into the patient’s shoes and understand the patient’s experience, is immensely supportive of the patient. Emotional support alleviates the loneliness of the patient’s experience of illness and increases his/her dignity [ 17 ].

13. Guidelines for successful therapeutic interactions

After the purpose of the therapeutic interaction has been established, the following guidelines assist in conducting a successful interaction:

13.1. Maintaining a low-authority profile

The nurse must strive to maintain a low-authority profile at the beginning of the conversation. As the conversation progresses, the nurse can use more directive techniques to find out specific information. There are usually differences in age, sex, occupation, cultural background, moral and religious convictions between the nurse and the patient. These differences make it impossible for the nurse to fully understand the patient’s behavior and reactions. It is therefore, important for the nurse to understand and accept differences in patients’ cultures and beliefs. When in doubt, check with the patient. If trust is established, patient will be willing to teach the nurse.

13.2. Use of understandable language

The nurse should determine the patient’s level of understanding and if necessary change the use of language, comments and questions. Using the terminology which the patient does not understand can also frighten the patient and make him/her think that he/she has a more serious problem than he/she originally wanted help for. At the same time, the patient could give incorrect information because due to confusion, he/she may give affirmative answers to questions about symptoms that he/she has not actually experienced [ 18 ]. Nurses should share their aims with patients before expecting them to participate in the interaction. They should understand that there is a mutual understanding of each other’s point of departure. In an assessment interview, the nurse can, for instance, say: “Mr Jones, I would like to give you information on how to lose weight so as to bring down you high blood pressure, but I first need to find out what you already know about the condition”. It is not only important that the patients understand what nurses expect from the conversation; it is also essential that nurses understand the patients and convey this understanding before they participate in the conversation. When providing emotional support, this understanding is often all that is necessary. For nurses to understand patients, they must encourage them to talk – not just about facts, but also about their feelings. The nurse must listen more than speak, both to what the patient is saying verbally and what is being said non-verbally. Having listened carefully, the nurse then concentrates and responds empathetically to the patients’ feelings. Only when the nurse has a reasonably complete understanding of the patient’s situation and has communicated this understanding, can she proceed to interventions, such as giving information or solving a problem.

13.3. Tailor the message to the totality of the person

Saying something does not necessary mean that the message has been received and understood. It is the responsibility of the nurse to ensure that the person with whom he/she is conversing understands the message. To ensure this, the message has to be adapted to the language, culture and socio-economic status of the patient. The emotional or physical condition of patients may also make it difficult for them to receive long of complicated messages or even any message. There may also be other disturbances in the immediate environment for example, noise that can make the patient not to hear or understand the message. The message must also be adapted to the age of the patient [ 10 ].

13.4. Validate the interpretation with the patient

Validation means that you ask the patient whether your interpretation is correct or not. You therefore, ask him/her to confirm your understanding of what he/she said. Many misunderstandings arise because people interpret other people’s words without checking their interpretation. The nurse should try to eliminate misunderstandings in the conversations by checking meaning with the patient.

13.5. Active listening

Is the eye contact maintained with the person who is speaking?

Are the body and face turned towards the speaker?

Are there regular verbal responses, even if these consist only of encouraging sounds?

Does the response indicate understanding, not only of the facts, but also of the feelings and the implications of the facts?

It is much easier to speak than to listen. Nurses are, in general, very active people, who want help b acting quickly. To ‘just listen’ without expressing opinions or offering advice is therefore, often not in their nature. Active listening is a valuable skill to acquire [ 10 , 17 , 18 ].

13.6. Evaluate own communication

Simplicity : Say what you want to say concisely and without using difficult or unfamiliar terms.

Clarity : Say precisely what you want to say without digressing, and support your verbal message with non-verbal indicators.

Relevance : Make sure that your message suits the situation, the time and the person you are speaking to.

Adaptability : Adapt your response to the clues the patient that the patient gives you.

Respect : Always show respect for the individuality and dignity of the person you are speaking to [ 17 ].

14. Therapeutic communication techniques

Table 1 gives an overview of therapeutic communication techniques and provides examples of each technique [ 10 , 13 ].

Therapeutic communication techniques.

15. Counter-productive communication techniques

There are certain counter-productive communication techniques that the nurse should avoid as they do not assist in the recovery of the patient and do not have any therapeutic value. Table 2 shows counter-productive communication techniques, explains why these should be avoided and gives examples [ 10 , 18 ].

Non-therapeutic communication techniques that should be avoided.

16. Conclusion

Promoting effective communication in health care is demanding and challenging because of the nature of the work environment. Nurses who have received training in communication skills communicate effectively and show increased confidence in communicating with patients. Many nurses choose to work in other countries, providing an opportunity to broaden their experience and knowledge. However, it is important that nurses who have the opportunity to work in other countries develop communication skills, cultural awareness and sensitivity before arriving. For example, in China talking about death is taboo [ 19 ]. In South Africa, maintaining eye during communication may be regarded as being disrespectful by Black people [ 11 ]. This article provides a reflective account of the experiences of one of the authors of working overseas. This chapter provides the effective communication and interpersonal skills that enhance professional nursing practice and nursing relationships by explaining principles of communication, communication process, purpose of communication, types of communication, barriers to effective communication, models of communication and strategies of improving communication and guidelines for successful therapeutic interactions.

Acknowledgments

The author wishes to acknowledge the Durban University of Technology for funding this book chapter.

Conflict of interest

The author declares that there is no conflict of interest in this chapter.

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• OJIN Homepage
• Table of Contents
• Volume 19 - 2014
• Number 3: September 2014
• Effective Interpersonal Communication

Effective Interpersonal Communication: A Practical Guide to Improve Your Life

Dr. Vertino received her DNP and MS degrees from the University at Buffalo. She holds dual national board certification as a PMHNP and CARN-AP. In addition to her role as a Nurse Practitioner in the Behavioral Health Clinic at the VA Western New York Healthcare System, she is involved in a number of scholarly, academic, and community service activities which include publishing and presenting. Due to her clinical expertise, leadership qualities, compassion for and understanding of patient care, and business acumen she has is sought by peers, colleagues and superiors for participation in numerous diverse task forces, academic and professional development programs, strategic planning initiatives and operations issues both within and outside the Veterans Healthcare Administration (VHA). She is a VHA Certified Mentor at the Fellowship level and has mentored staff with special projects. She is an active voice at the National level for Advanced Practice Nursing.

Use of effective interpersonal communication strategies by nurses in both personal and professional settings, may reduce stress, promote wellness, and therefore, improve overall quality of life. This article briefly explores the concept of interpersonal communication as it relates to Maslow’s hierarchy of human needs ; describes personal variables and the interaction of internal and external variables that can impact communication; and discusses possible causes and consequences of ineffective communication . Drawing on both the literature and experiences as a longtime provider of care in the mental health field, the author offers multiple practical strategies, with specific examples of possible responses for effective communication. Recommendations in this article are intended for nurses to consider as they seek healthy communication strategies that may be useful in both their personal and professional lives.

Key words: Interpersonal communication, Maslow’s hierarchy of human needs, communication variables, ineffective communication

Communication is an integral part of life; without it, we would not survive. Verbal and non-verbal communication begins at birth and ends at death. We need communication not only to transmit information and knowledge to one another, but more importantly, to relate to one another as human beings around the world in the context of relationships, families, organizations, and nations.

The how, what, why, and wherefore of communication can either edify or harm us, as individuals, cultures, religions, and governments of countries, as we attempt to coexist. What we say, how we say it, and what we mean by it are extremely important, and can be life-changing. I recollect two teachers in elementary school. To me, one was a kind, caring person; the other was mean and sarcastic. Students, especially children, are particularly vulnerable during their formative years.  Adults, teachers, and other children have the power to either help us blossom as an individuals or to destroy our self-esteem, and thus impact our potential for life. How? A kind (or cruel) word, or facial expression, can mean the world to a child. These two teachers in my past were polar opposites, but both affected me deeply.

In our professional roles as nurses, we are responsible to care for persons who are ill. When ill, patients may be unable to speak or advocate for themselves. Vulnerable patients need our voices to speak for them. Due to our constant exposure to other human beings who are suffering, nurses are perfectly positioned to utilize effective interpersonal communication, and in doing so, support our own emotional, psychological, and spiritual development.

There is a well-established link between team communication, worker morale, and patient safety. Poor team communication has been directly linked to preventable medical errors, high nurse turnover rates, and low morale ( Brinkert, 2010 ; Institute of Medicine, 1999 ; Vessey, DeMarco, & DeFazio, 2010 ). Low morale contributes to high levels of stress, burnout, poor job satisfaction, and an overall poor quality of life. Controlling stress and burnout is an essential component of a healthy lifestyle.

Use of effective interpersonal communication strategies by nurses... may reduce stress, promote wellness, and therefore, improve overall quality of life.  Use of effective interpersonal communication strategies by nurses in both personal and professional settings, may reduce stress, promote wellness, and therefore, improve overall quality of life. This article briefly explores the concept of interpersonal communication as it relates to Maslow’s hierarchy of human needs; describes personal variables and the interaction of internal and external variables that can impact communication; and discusses possible causes and consequences of ineffective communication. Drawing on both the literature and my experiences as a longtime provider of care in the mental healthcare field, I offer multiple strategies, with specific examples of possible responses for effective communication. Recommendations in this article are intended for nurses to consider as they seek healthy communication strategies that may be useful in both their personal and professional lives.

Interpersonal Communication and Maslow’s Hierarchy of Human Needs

In 1943, Abraham Maslow developed a hierarchy of human needs wherein he described the basis of human behavior in terms of the priorities of survival ( Figure 1 ). Oxygen, food, water, and shelter, our most basic needs, must be met first. Once these basic needs are met we can progress upward in the hierarchy toward fulfillment of needs for safety/security, love/belonging, and esteem. Finally, according to Maslow, the highest human needs revolve around finding one’s purpose and realizing one’s full potential, which culminate at the pinnacle of the hierarchy in self-actualization.

Figure 1: Source: Maslow’s hierarchy of needs, n.d.

Maslow’s hierachry of human needs can be applied to interpersonal communication. The concept of communication can be most appropriately considered in the context of three levels of the hierarchy: safety, love/belonging, and esteem. Of these, safety has the most intimate involvement with basic, “primitive” needs. For example, it feels very personal when one’s safety is threatened by loss of any kind, whether it is a perceived or actual loss.  A loss can invoke anger, grief, or fear in response to feeling helpless, powerless, unsafe, and vulnerable. Likewise, effective or ineffective communication may impact our ability to satisfy the needs of love and belonging, and also esteem.

... little has addressed how effective interpersonal communication can contribute to a healthy lifestyle in both the personal and professional life of the individual nurse.  Many would agree that interpersonal communication is an intimate, human activity that can weigh heavily on our overall psychological health and wellness, and therefore, warrants much discussion and attention. Despite this realization, the literature, especially in nursing, has not addressed this topic adequately. Although much has been written on workplace safety, lateral violence, and bullying to address issues that we face as professionals in the workplace, little has addressed how effective interpersonal communication can contribute to a healthy lifestyle in both the personal and professional life of the individual nurse. As each person seeks to meet his or her human needs, a number of variables, both internal (or personal factors) and external (or behavior of others) can combine to support effective or ineffective interpersonal communication. The next section will offer professional insight that I have gained in my nursing practice related to how multiple variables may impact communication. I offer this not as an exhaustive list of variables, but in the hope that it will provide some context for readers to reflect on their own unique mix of variables as they go on to read and consider the recommendations for effective communication.

Personal Variables: Internal Predisposing Factors

Human beings are complex creatures. We are composed of a plethora of variables that are continuously interacting with one another. Some of these personal variables are internal in nature; they are part of our makeup. Figure 2 , developed by the author, is a simple representation of how variables might interact to produce a unique individual. In addition to our genetic makeup and gender, the variables (termed internal predisposing factors) consist of thoughts, feelings, and perceptions that are often learned early in life and shaped by childhood upbringing and experiences. In my clinical experience with patients, I have observed that early experiences can affect persons deeply, and perceptions of these experiences are not easily changed. Indeed, the impact of these experiences can cause a person to be rigid and inflexible. For example, a person who has been abused physically, verbally, or sexually by the opposite sex, and unhealed from this, can become unyielding in any future interactions with persons of that gender regardless of the situation or circumstances. However, all is not lost. In addition to factors that CAN be controlled and factors that CANNOT be controlled, there are factors that may change over time. Consider the variables listed in Figure 2 . Which can be changed or controlled? Which cannot? Which are subject to change? These are important distinctions that will become clearer in the discussion of the following sections, as applied to interpersonal communication.

Figure 2: Personal variables: Internal predisposing factors (Source: Author)

Interaction of Internal and External Variables

Figure 3 , developed by the author, represents how internal personal variables demonstrated in Figure 2 and external variables (behavior of others and situations) might interact.  Further, consider how the interactions depicted in Figure 3 could influence the outcome and effectiveness of (our) interpersonal communication. Understanding and acceptance that one cannot control others and/or situations can create the psychological freedom necessary to develop insight into one’s own behavior. That insight can be the first step toward positive change and improve communication. The next section will consider some causes and consequences of ineffective interpersonal communication, along with strategies and selected examples to support alternatives.

Figure 3: Interaction of Internal and External Variables (Source: Author)

Causes and Consequences of Ineffective Interpersonal Communication

Some consequences of ineffective interpersonal communication can be chaos, confusion, disorder, fear, conflict, inefficient systems, and wasted resources.  Some consequences of ineffective interpersonal communication can be chaos, confusion, disorder, fear, conflict, inefficient systems, and wasted resources. Poor team communication has been cited as the number one cause of unnecessary patient deaths related to medical error since the 1990s ( Institute of Medicine, 1999 ). Further, criticism has been directed at healthcare providers, including physicians, for their lack of study of interpersonal communication ( Hull, 2007 ; Shapiro, 2011 ). Although numerous interpersonal communication theories exist, few have been applied to healthcare communication or utilized in any relevant manner by providers ( Bylund, Peterson, & Cameron, 2012 ). Thus, a knowledge gap exists necessitating a frank discussion and pragmatic strategies for change. This section will offer selected strategies for effective communication for consideration, drawn from both literature and practice experience.

Personal life versus professional role calls us to develop and apply competent skills based on the specific situation, and adopt an appropriate demeanor and response. However, behavior based solely on role expectations may not always be appropriate. Here are some suggestions to begin to think differently. When applying what is discussed in this article to your personal and professional lives, think of yourself holistically.  In other words, you cannot compartmentalize basic personality structure, or your personal way of relating to the world; you are who you are. Divorce yourself from antiquated acculturated role expectations of how women or men and nurses are supposed to behave. Strive to develop new ways of relating to support more rewarding interpersonal communication experiences.

One way to do this is to think in terms of the use of “self” versus “skills.” Effective interpersonal communication is much more than techniques, skills, or procedures to be mimicked or parroted. Parroting or mimicking is generally viewed as insincere; if one behaves as a robot, most people will sense this. To say one must perform a certain skill or competency, in my opinion, diminishes our ability to have spontaneous human interactions that are meaningful. Techniques and skills can become too automatic and thus may limit your options.

Genuine human rapport requires creativity and flexibility.  Genuine human rapport requires creativity and flexibility. Best practice would dictate relating genuinely, human to human, and disregard of communication “scripts.” Since new behavior can be risky and frightening, pragmatic strategies aimed at prevention of ineffective interpersonal communication are needed.  With this goal in mind, Table 1 , developed by the author, provides a brief overview of possible causes, consequences and cures for ineffective interpersonal communication, as well as possible strategies and/or examples for application.  The section that follows elaborates on the information in Table 1 and offers additional discussion and/or practical guidance.

Table 1: Ineffective Interpersonal Communication: 12 Possible Causes, Consequences, Cures, and Examples for Effective Communication (Source: Author

Additional Insight about Barriers to Effective Communication: Thoughts from the Trenches

The above table offers many “possibilities” to explain and address some common areas that may contribute to ineffective interpersonal communication. Below is some additional discussion and implications for practice to provide further insight into these concerns.

Cultural and Organizational Taboos/NO TALK Rules

It may be helpful to question “NO TALK” rules and communication taboos, such as the expression, “Children should be seen and not heard.” In much of today’s society, this may seem an absurd statement, but likely it was an accepted societal norm at some time in the past. But times have changed. In 2014, do not accept statements or situations at face value that do not make sense. You are entitled to an explanation and rationale when it is spoken or inferred that you should “not talk about” something. Find out why. If you are afraid to speak up, ask yourself why.  If you are afraid or uncomfortable with conflict, then you must understand that fear of conflict can lead to poor conflict management and poor negotiation/problem solving skills (numbers 2 and 3 in the above table). NO TALK rules are often unspoken; in fact they are generally inferred, creating a more confusing situation.  This can add to frustration, helplessness, lack of trust, and avoiding discussion about and problem solving of important issues. The only way around this frustrating barrier is to bring NO TALK issues forward and discuss them openly and honestly.

In the workplace, most nurses know that not reporting (i.e., not talking about) something that they know is wrong or against policy (or could bring harm to a patient) because “you don’t want to get someone in trouble” is unethical behavior. A striking example of this is failure to report an impaired colleague. How might you talk about this NO TALK issue? Here are some suggestions that I have found helpful. Stick with the facts. Do not make judgments, or offer moralizing and/or solutions for fixing the problem. Go to the person’s supervisor and ask if you can speak privately. If you are uncomfortable, say so. You might try saying, “I am not comfortable discussing this, but I feel it is my duty to report that I smelled alcohol on Fred when he gave me report this morning.” Keep a record of the date, time, and name of the person with whom you had this conversation. If the behavior is not addressed and occurs again, your next step is to go up the chain of command.

Poor Conflict Management

... it is ok to disagree, and not all problems will be or can be solved.  If you are not comfortable with conflict, chances are somewhere along the line you may have learned that conflict is “bad.” Maybe you witnessed conflict that escalated into inappropriate aggression or violence, or you were not allowed to express negative feelings in order to solve conflict.  The term “conflict management” that was coined years ago by the business world suggests that conflict must be managed or kept under control. This is not always true. Conflict often can provide the friction we need to discuss issues, consider alternative strategies and solve problems. Conflict in and of itself is not bad, but necessary. Opinions that differ from our own help us to learn and grow (Peck, 1978).  Keep an open mind and discuss solutions respectfully when conflict arises. Remember, too, it is ok to disagree, and not all problems will be or can be solved. You do not have to fix everything.

Poor Negotiation/Problem-Solving Skills

...poor negotiation and/or problem-solving skills often happen when people are in a hurry to fix a problem... In my experience, poor negotiation and/or problem-solving skills often happen when people are in a hurry to fix a problem, whether at home or in the workplace. A person may not take time to thoroughly think about the problem and possible solutions because we live in what I have heard described as a hurry-up, fix it now, instant mashed potatoes, just put out the fire culture. This “hurry up and fix it/get it away from me” ideology is sometimes due to discomfort with problems. Why? Because problems can evoke negative feelings within us, and we do not want to feel negative feelings. In my opinion, this is a real shame because “problems call forth our courage and wisdom; indeed they create our courage and wisdom” ( Peck, 1978, p.16 ).

It is common knowledge in present day healthcare that the population requiring care is growing and resources are shrinking. A hurry up, problem-avoidance mentality (one that I have often heard described in my years as a provider, especially recently) may deprive people of the opportunity to learn: 1) toleration for unfinished business; 2) creative problem solving; 3) flexible thinking; 4) coping; 5) spontaneity; 6) testing of boundaries; and most importantly 7) to sit with uncomfortable feelings. Emotional maturity is born of the foregoing experiences, and maturity is necessary to become skilled at negotiation and problem solving. Work to both develop negotiation and problem solving skills and also to ensure adequate time to allow for appropriate consideration of the problem at hand.

Lack of Empathy

...emotional detachment, a technique adopted by some providers, does not protect one from future or worsening burnout.  If you live in a family or work on a team, empathy is a must; however, empathy requires a complex balance of well-developed boundaries, emotional stability, experience, and indeed, effective interpersonal communication. Helping professionals may find themselves on one end or the other of the emotional caring spectrum and err by being overinvested in or, conversely, detached from patients. Unfortunately, emotional detachment, a technique adopted by some providers, does not protect one from future or worsening burnout. For example, physicians have been criticized for their lack of empathy, whereas nurses have been hailed as owning the concept of caring ( Spiro, Curren, Peschel, & St. James, 1996 ). If you lack empathy, you may have become hardened to the world for some reason. Perhaps you have been hurt or are burned out.  Compassion fatigue, a term coined in the mid 1990s, describes a phenomenon wherein professionals working with traumatized clients were actually at risk for secondary traumatization due to over-identification with their clients’ experiences ( Sabo, 2006 ). This phenomenon occurs in all types of healthcare providers. Therefore, to maintain both physical and emotional health, it is important to strive to maintain the delicate balance between over and under caring.

Unresolved Emotional Issues

To support your own health, make the time and effort to get this [professional help] if you need it.  While an extensive discussion of this complex topic is beyond the scope of this article, some basic outcomes of unresolved emotional issues are commonly known by all. A disruptive or abusive childhood, adult victimization or trauma of any kind can leave emotional and psychological scars that can be difficult to heal. Survivors of abuse have trouble trusting, and as a result, can misperceive and misinterpret the motives of others. Mistrust of others can create distorted perceptions of the world, distorted communication patterns and general difficulty in personal and professional relationships. If you need professional help to resolve your own emotional issues, you owe it to yourself to do this. To support your own health, make the time and effort to get this help if you need it.

Poor Self–Image/Negative Self-Talk

If you want respect, you must demonstrate this by respecting yourself.  A poor self-image, possibly combined with negative self-talk, can set the stage for ineffective interpersonal communication. Never degrade yourself or allow others to denigrate or be disrespectful to you. Never refer to yourself or your personal characteristics in pejorative terms. Make a decision to view these behaviors as unacceptable. If you want respect, you must demonstrate this by respecting yourself.

Sometimes we have to teach people how to treat us. For example, if you are spoken to in a disrespectful or condescending manner, by anyone, especially a co-worker, first know that this is unacceptable. You do not have to take verbal abuse from anyone, especially in the workplace. The expectation is for nurses, physicians, and all members of the healthcare team to behave professionally at all times. Should inappropriate behavior occur, you must make the decision to stand up for yourself. Even if it is hard, try calmly stating words such as, “Excuse me, but I would like to be addressed with courtesy and respect at all times” or “Please refrain from making pejorative remarks and focus on a solution to this problem.”

All of us are a mix of positive and not-so-positive characteristics. Learn to appreciate the good qualities in yourself and others. It can be difficult to avoid judging yourself or others. You may find it helpful to pick one quality or character trait you would like to improve. Then, seek the wisdom of a trusted friend, counselor, or sage and ask for support and advice in order to accomplish your goal.

Lack of Boundaries/Inability to Set Limits

Assertiveness, or saying NO and setting limits appropriately is an  ART  that must be learned.  The inability to set limits is generally related to fear of rejection, people pleasing, or emotional insecurity. You may think, “They won’t like me.” Accept that you will not like everyone, and everyone will not like you, and that is okay. Assertiveness, or saying NO and setting limits appropriately is an ART that must be learned. Setting limits requires one to make simple, short statements in a calm, respectful manner. Focus on the positive and describe the desired behavior, as opposed to one that is undesired. Following this, describe the consequences for continuation of the undesired behavior. Do not argue, threaten, and attempt to intimidate, or show fear. State only the consequences that you have power to enforce, and that you will follow through upon. Do not promise what you cannot deliver. In your role as a nurse, you will deal with upset patients at times; however, you have the right and responsibility to set limits on inappropriate behavior. This is true both in your professional and your personal life. Table 1 provides selected examples of suggested verbal interventions that you might utilize to set limits.

Importance of Self Analysis and Insight

Simply taking the time to engage in self-analysis... can support the effective interpersonal communication necessary to maintain your health.  Since we do not live in a vacuum or in isolation, understanding yourself and developing insight into YOU is paramount to effective communication. Refer back to the personal variables in Figure 2. Consider how your upbringing may have influenced you. What was your home like? How were you treated and addressed by your parents and teachers? Was your family patriarchal (led by father) or matriarchal (led by mother)? Who delivered the discipline to children in your home? Who were the other significant adults in your life? How has your race, culture, and/or religion possibly influenced you? As an adult, how has your education and real world experience impacted you? Have you travelled to other countries? How have adult relationships such as spouse, children, and significant other influenced you? Have you been ill or lost someone close to you? It is important to understand how these factors have shaped and influenced you, and to what extent. These variables influence how you present, behave, and communicate in the world. Simply taking the time to engage in self-analysis to develop this type of personal insight can support the effective interpersonal communication necessary to maintain your health.

Physical or Mental Illness

Depression, anxiety, and alcoholism appear more likely to be high in professions with high stress, but there remain gaps in the research literature. Ross and Goldner ( 2009 ) conducted a review of the literature to examine stigma, negative attitudes and discrimination toward mental illness from a nursing perspective. They determined that although substance abuse among nurses has been studied, no such parallel examining nurses with mental illness could be found. The paucity of literature on the subject of nurses with mental illness is of concern. However, Ross and Goldner ( 2009 ) did find that nurses with mental illness are both stigmatized and stigmatizers; they judge themselves and others. In regard to ineffective interpersonal communication, Farrell ( 2001 ) reported that nurses who have mental illness often felt as though they were targets of bullying and lateral violence in the workplace.

Research supports that mental illnesses are biochemical brain disorders that are strongly genetically linked ( Perese, 2012 ). Mental illness is not caused by weakness or lack of moral character. Ghaemi ( 2011 ) noted that some of the greatest leaders in history suffered from mental illness. Moreover, he purported that it was because of their suffering that these men (e.g., Lincoln, Churchill, Sherman) developed the personal characteristics necessary to become exceptional leaders during times of crisis.

Mental illness can be treated and should not be ignored. There is no shame in seeking the help of a mental health provider. Nurses seeking treatment for mental health disorders not only have the ability to improve their own health, but also by their actions may help to address perceived stigma associated with mental illness.

Hidden Agendas, Politics, Games, and Tests

Over a decade ago Horsfall ( 1998 ) addressed several important “personal” variables with respect to effective communication.  Two of her foci addressed how power inequalities and personal prejudices affect communication. Even chosen seating in a meeting (i.e., who sits where) can be the subject of interpretation. Unfortunately much of what Horsfall discussed in 1998 has not changed in the present day. Unequal power structures, abuse of power, and feelings of powerlessness (including certain unspoken practices both within nursing, medicine and the world) prohibit equalization of power structures. For example, persistent use of patriarchal (or exclusively male led) systems still exist and contribute to the “inadequacy of mainstream nursing [and other] concepts of communication” ( Horsfall, 1998, p. 78 ). Women, in particular, who communicate in a firm, assertive manner, may be subject to pejorative remarks in a male dominated environment. If there appears to be a gender barrier to effective communication, be firm anyway. Again, table 1 above offers information about how to address communication barriers due to these concerns, using neutral, nonthreatening, wording and actions.

Lack of Clear Plain Speech/Writing

Lack of clarity in speech and/or writing often contributes to ineffective communication. Avoid jargon, any kind of “isms,” clichés, slogans and boring overused stories. If you have heard something before, it is likely that others have, too.  Use others’ work discriminately and give credit as appropriate. Be original. Shorthand, texting, hashtags, and social networking lingo should never be used in professional communication. Say what you mean and mean what you say. Use plain, straight-forward talk that addresses the issue at hand.

...if a matter has escalated, make the time to talk in person to clarify concerns.  Do not always resort to email to communicate important messages; you can sometimes improve communication by asking for a face to face meeting. Email communication is indeed inappropriate in certain situations.  According to a Forbes magazine article, Do You Hide Behind Email?, there are four times you should never use email: when you are mad, criticizing or rebuking; when there is a chance you could be misunderstood; when you are cancelling; or when apologizing ( Warrell, 2012 ). Furthermore, when issues are delicate, sensitive, awkward, or negotiation is needed, they should always be discussed in person.  Personal discussions facilitate trust and add to the richness of the experience by facial expression and body language ( Warrell, 2012 ). Confident, mature individuals will speak with you face to face and will not hide behind email to communicate important information. Especially if a matter has escalated, make the time to talk in person to clarify concerns.

Effective interpersonal communication is necessary to negotiate the challenges of everyday living, whether in your personal or professional life. Because human beings are complex and each individual brings his or her own set of internal variables to every situation, the possibilities of interactional outcomes of any given communication can be exponential.

Although much has been written regarding workplace violence (e.g., bullying), practical strategies for addressing the mechanics of effective interpersonal communication are lacking. In order to address this, we need frank, open conversations regarding how our personal internal variables affect our interpretation of the world as we see it. This article has hopefully provided an opening dialogue in that direction with pragmatic discussion of common areas of concern. These recommendations are often ones that we, as nurses, offer to patients every day. Taking the time to consider them as they may apply in our professional and personal lives may go a long way to encourage healthy communication, and thus healthy nurses!

Kathleen A. Vertino, DNP, PMHNP-BC, CARN-AP Email: [email protected]

© 2014 OJIN: The Online Journal of Issues in Nursing Article published September 30, 2014

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Vessey, J. A., DeMarco, R., & DeFazio, R. (2010). Bullying, harassment, and horizontal violence in the nursing workforce.   Annual Review of Nursing Research, 28(1), 133-157. doi: 10.1891/0739-6686.28.133.

Warrell, Margie. (2012, August). Hiding behind email? Four times you should never use email. Forbes. Retrieved from: www.forbes.com/sites/margiewarrell/2012/08/27/do-you-hide-behind-email/

September 30, 2014

DOI : 10.3912/OJIN.Vol19No03Man01

https://doi.org/10.3912/OJIN.Vol19No03Man01

Citation: Vertino, K., (September 30, 2014) "Effective Interpersonal Communication: A Practical Guide to Improve Your Life" OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 3, Manuscript 1.

• Article September 30, 2014 Social Media and Nurses: Insights for Promoting Health for Individual and Professional Use Jennifer Jackson, BScN Hon, RN ; Robert Fraser, MN, RN ; Peter Ash, B.Mgmt
• Article September 30, 2014 Practicing Self-Care for Nurses: A Nursing Program Initiative Cynthia A. Blum PhD, RN, CNE
• Article September 30, 2014 Implementation of a Participant-Centered Weight Management Program for Older Nurses: A Feasibility Study Eun-Shim Nahm, PhD, RN, FAAN; Joan Warren, PhD, RN-BC, NEA-BC; Erika Friedmann, PhD; Jeanine Brown, MS, RN; Debbie Rouse, RN-BC, VA-BC; Bu Kyung Park, MS, RN; Kyle W. Quigley, MBA, BS
• Article August 14, 2020 Developing a Course to Promote Self-Care for Nurses to Address Burnout Greg Couser, MD, MPH; Sherry Chesak, PhD, RN ; Susanne Cutshall, DNP, APRN, CNS, APHN-BC, HWNC-BC
• Article August 01, 2023 The Impact of Transcendental Meditation: Reducing Burnout and Enhancing Well-Being in Frontline Healthcare Clinicians During the COVID-19 Pandemic Margaret M. Calarco, PhD, RN, NEA-BC; Kelcey J. Stratton, PhD
• Article September 30, 2014 Factors Related to Healthy Diet and Physical Activity in Hospital-Based Clinical Nurses Nancy M. Albert, PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM ; Robert Butler, MS ; Jeanne Sorrell, PhD, RN
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Communication in Nursing: Why Strong Interpersonal Skills Matter

Each blog post is dated and contains accurate information as of that date. Certain information may have changed since the blog post publication date. If you would like to confirm the current accuracy of blog information, please visit our ABSN overview page or contact admissions at (844) 319-2107.

What is the importance of communication in nursing? Using active listening, interpersonal connection, cultural awareness, and compassion, nurses can overcome physical, social, and psychological barriers to connect with patients, patients’ families, and colleagues. These skills improve patient outcomes by providing efficient care and ensuring patients understand treatment and recovery plans.

Nurses are on the front line of healthcare, constantly communicating with patients, families, and colleagues in high-stress situations. They must have impeccable nursing communication skills to keep composure and convey critical information.

At Madonna University, our Accelerated Bachelor of Science in Nursing (ABSN) program prepares students to strive for excellence and become nursing leaders. If you have a prior non-nursing degree from a regionally accredited college or university, you may be eligible to enroll in Madonna’s hybrid ABSN program. In as few as 16 months, you could graduate ready to take the NCLEX exam and start making a difference.

The Importance of Communication in Nursing

Effective communication in nursing is one of the basic tenets essential to collaborating with fellow nurses and colleagues in other disciplines. It also plays a significant role in patient-centered care.

Taking the time to listen and factor patients’ contributions into care allows nurses to address issues more effectively, leading to better clinical outcomes. Building a mutual understanding and rapport also provides a positive patient experience and increases patient safety.

Nurses must also be competent in communicating information regarding patients’ health and treatment plans and ensuring patients understand how to follow their recovery plans after discharge. Some patients rely on family members to fulfill their care plans, so nurses must explain the patient’s condition and other complex information in more straightforward terms that a layperson can understand.

Nurses need to communicate with each other to ensure patients receive quality care. A 2023 study published by the National Library of Medicine found that fostering quality communication and trust between nurses improves the standard of care and patient safety.

So, the entire profession grows stronger when nurses understand how to communicate.

Vital Skills for Effective Communication in Nursing

How does one effectively communicate? No one is born knowing how to communicate constructively; everybody needs to practice. Nurses can cultivate specific skills, such as active listening or cultural awareness, that will eventually become second nature to their practice and enhance their quality of care.

Let’s examine some essential communication skills nurses should master in their care practice.

Communication is just one of many crucial skills for nurses to have in their repertoire. Explore 11 qualities of a good nurse and discover if you have what it takes.

Active Listening

Active listening is not just about hearing what the patient is saying but taking it in, understanding, and showing you understand. This skill requires complete attention and engagement. Interviewers are taught that silence is the best tool, which applies to active listening. People will fill the silence when given a chance to speak without interruption. That’s why active listening requires both verbal and nonverbal communication skills. When using active listening, make sure to:

• Show continued interest by maintaining eye contact and nodding your head without interrupting.
• Sit down when you can to bring yourself to their level and lean forward to show engagement.
• Maintain non-threatening and open body language while using verbal encouragements, such as “I understand” or “go on.”

Interpersonal Connection

Connecting with your patients beyond the reasons they are in your care is essential. It is easy to get caught up in the flow of your work and focus only on the tasks you need to complete. By building patient-centered relationships, you can help patients feel safer and more comfortable and improve patient outcomes.

To form a meaningful connection with your patients, try to:

• Show an interest in their lives and share details of your own.
• Spend a few minutes each day getting to know them.
• Learn at least one unique fact from every patient.

Cultural Awareness

When working in healthcare, you’ll interact with people from all different social, cultural, and educational backgrounds. It’s essential to absorb verbal and nonverbal cues and be sensitive to the patient’s cultural traits. For instance, listen to patients to assess their English fluency and either adjust your speech or request a translator if available. When working with transgender patients or those who identify outside of the traditional gender binary, make sure to confirm their preferred names and pronouns and only refer to them as such.

Compassion is a necessary skill in every aspect of healthcare. In a 2022 study published in the National Library of Medicine journal, researchers found that patients recognized compassion as listening and paying attention, following up and running tests, continuity and holistic care, respecting preferences, genuine understanding, body language and empathy, and counseling and advocacy. This shows that compassion is conveyed not only in language and emotion but also in physical actions. Putting your total effort and empathy into your care is essential, and your patients will see more positive outcomes.

Nurses leave a positive mark on their community by providing the best care possible. Don’t believe us? Discover six ways that nurses change lives .

Common Barriers to Effective Communication in Nursing

Not every patient will be open and willing to communicate, or they may misunderstand your communication attempts. To overcome these obstacles and build a healthy nurse-patient relationship, we must first comprehend the types of communication barriers that nurses face. There are three common barriers to communication in nursing:

Social Barriers

As a nurse, you will encounter patients with different languages, customs, cultures, religions, and ages, impacting how you communicate. Understanding the nuances associated with these attributes will help you avoid prejudice or insults. For instance, a teenager will have a different conception of health and wellness than an older adult. By acknowledging these distinctions and adjusting your language, you can tailor your communication to the individual.

Physical Barriers

The environment in which the communication occurs can impact a patient’s willingness to cooperate. A trip to the doctor or a stay in the hospital can be anxiety-inducing; adding loud noises or a gloomy atmosphere can heighten those symptoms. Actions as simple as opening the blinds or closing a door are easy ways to reduce patient stress and offer privacy to your conversation.

Psychological Barriers

Unfortunately, some patients have had negative experiences with healthcare, leading to anxiety around receiving medical treatment. Other patients have cognitive deficits from conditions like dementia or Alzheimer’s. By taking care to listen, empathize, and show support, you can help reduce any stress from the situation.

Start Making a Difference Today

In Madonna University’s ABSN program, students can use their nursing communication skills from the start. Students work with our partner, Ascension Michigan, to gain practical experience during clinical rotations . With a values-based nursing curriculum, we encourage our students to provide the highest standard of care.

Contact an admission representative to start your future today.

Published 08/15/24

Published 08/14/24

• Our Process

Interpersonal Skills in a Nursing Essay

Published by Alvin Nicolas at November 24th, 2022 , Revised On January 31, 2024

The importance of interpersonal skills in the nursing profession cannot be understated. Nurses are required to have the ability to communicate and interact well with their patients and other people to provide the most effective care and treatment.

But how do you demonstrate your interpersonal skills in a nursing essay? What is the significance of interpersonal skills in a nursing essay? Do I need to present my interpersonal skills in a nursing essay? 

Suppose these are the questions looming over your head. In that case, there is no need to panic because every year, hundreds and thousands of students in the UK and worldwide learn to showcase their interpersonal skills in nursing writing correctly. 

When do you Need Interpersonal Skills in Writing?

You must demonstrate your interpersonal skills every time you write a reflective nursing essay. A reflective essay is where you will look back on, or reflects upon, your experiences and how they caused personal change or improvement. 

Reflective essays allow you to describe experiences or moments from your life where you had to rely on your interpersonal and communication skills with individuals and organisations to ensure the best possible outcome. 

8 Key Interpersonal Skills for your Nursing Essay

Below we will briefly look at the 8 most critical interpersonal skills that nursing students can showcase in their essays for the best results. 

1. Communication

Communication is an essential skill in the field of nursing. As a nurse, it is vitally important for you to communicate well to deal with situations where information needs to be exchanged or passed on promptly. 

2. Teamwork

Teamwork makes the dream work. As a nursing student, you must shed light on your teamwork expertise to demonstrate your ability to handle jobs that require the entire nursing unit to work together. 

3. Upbeat Attitude

If you are unhappy at work, your patients will likely notice it. Many of the patients are already depressed about their situations. Your upbeat attitude can go a long way towards improving their morale. 

4. Negotiation 

Negotiation in nursing is a two process that requires two conditions: a degree of disagreement from one party or both parties and an agreement to exchange services, goods, information or time for money. Professional nurses learn to hone their negotiation skills to maximise their value in everyday dealings.  

5. Listening 

A good nurse is a good listener. When writing a reflective essay, you must aim to talk about your listening skills. As a successful nurse, you must demonstrate the ability to pay attention to what your patients say. That is critical for successful patient-centred care, particularly for acquiring valuable medical data. 

6. Leadership 

Leadership and decision-making are the two essential qualities of a nurse. Every nurse who wants to excel in her career must be a good leader and decision-maker. A good nurse leader is compassionate and empathetic and possesses emotional intelligence skills characteristics.

7. Empathy 

Write about your compassion, empathetic nature, and ability to understand and assist others. A nurse needs to understand what their patients are going through to correctly identify their needs, especially if they have no friends or family. 

8. Conflict management

When managing conflicts at the workplace, as a nurse, you will need to be able to recognise the early signs of a dispute. Make sure you highlight your capabilities to be proactive, actively listen, remain calm, identify the issue and propose an effective solution. 

Also Read: 6cs of a nursing essay

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Interpersonal skills in a nursing essay demonstrate your ability to deal with different situations at the workplace when interacting with your patients and other people. It would be best if you referred to your interpersonal in the traditional reflective essay. 

The most common interpersonal skills you could base your essay on include but are not limited to communication, positive attitude, listening, leadership, compassion, conflict resolution and teamwork. 

If you are looking for an expert to write a flawless nursing argumentative or reflective nursing essay, look at our services without losing any more time.  

How to showcase interpersonal skills in a nursing essay?

• Highlight the importance of interpersonal skills in nursing practice.
• Describe specific instances where you demonstrated excellent interpersonal skills with patients, families, and colleagues.
• Provide examples of how you established rapport with patients and made them feel comfortable and heard.
• Discuss how you communicated effectively and empathetically with patients and families, especially during difficult situations.
• Explain how you collaborated with healthcare professionals from different disciplines to ensure the best patient outcomes.
• Describe how you actively listened to patients and families and responded to their needs and concerns.
• Discuss how you maintained professional boundaries while building trusting relationships with patients.
• Highlight any training or continuing education you have completed improving your interpersonal skills.
• Emphasise the impact your interpersonal skills had on patient care and outcomes.
• Conclude by reiterating the importance of interpersonal skills in nursing practice and how you will continue to develop and utilise them in the future.

What interpersonal skills are required in a nursing essay?

You should have the following interpersonal skills in a nursing essay:

• Good Communication 
• Teamwork Expertise 
• Upbeat Attitude 
• Negotiation 
• Leadership 
• Conflict Management 

How to improve your interpersonal skills as a nursing student?

You can follow the given tips to improve your interpersonal skills, which are required in dealings with patients and co-workers, and also while writing your reflective essay. 

• Practice Active Listening
• Develop Empathy
• Improve Your Communication Skills
• Be Open-Minded
• Develop Your Teamwork Skills
• Learn Conflict Resolution Skills
• Develop Your Leadership Skills
• Attend Workshops And Training Sessions
• Seek Feedback

Why are interpersonal skills important for nurses?

• Patients feel more comfortable and trust nurses who exhibit strong interpersonal skills.
• Interpersonal skills help nurses build rapport with patients, leading to better communication and improved patient outcomes.
• Effective communication skills help nurses collaborate with other healthcare professionals, leading to better teamwork and coordinated care.
• Interpersonal skills are essential for conflict resolution, which is crucial in high-pressure situations.
• Good interpersonal skills help nurses provide emotional support to patients and their families during difficult times.
• Nurses with strong interpersonal skills are more likely to succeed in leadership roles and advance their careers.

You have to show these interpersonal skills in your nursing essay to demonstrate that you can deal with different people and situations successfully.

You May Also Like

Before we describe a narrative essay, it will make sense to understand what is an essay and what are the different types of essay.

A student of the school, college, or university is assigned to write academic essays throughout the academic career. An essay can be described as a brief composition of informative writing.

Besides reading, listening, and writing skills, good handwriting also plays a major role in improving the language, writing speed, memory, and ability to concentrate. Cursive handwriting is a type of flowy writing in which letters are joined together beautifully, creating an artistic effect on writing.

Essays compose a considerable part of academic curricula. The importance of essays kept increasing with the increasing level of study. A student is writing essays starting from kindergarten up until graduation, on several topics to showcase their knowledge on the subject.

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4 Interpersonal Communication

• Published: January 2012
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Nursing is an interpersonal profession (Ellis and Whittington 1981) which is to say that the majority of the goals of the profession are met through the quality and nature of relationships the nurse is able to form. Effective interpersonal communication which underpins the therapeutic relationship is a complex set of skills which require the nurse to understand the context and purpose of the interactions, in addition to being aware of their own agendas and factors which might form a barrier to effective working relationships. Historically, interpersonal communication was implicit within nursing care and by the 1980s writers such as Morrison and Burnard (1991) and Porritt (1990) had identified and explored the nature of the therapeutic relationship and interpersonal skills within nursing care. Now authors such as Stein-Parbury (2009), Burnard and Gill (2008), Maben and Griffiths (2008), Freshwater (2005) and Greenhalgh and Heath (2005) have studied and written about this area in great depth. Both the Department of Health (DOH) (2010) and the Nursing and Midwifery Council (2008) have identified the centrality of patient-led care and the nurses’ ability to develop effective working relationships that enhance dignity and treat the person with compassion and care. A therapeutic relationship is significantly different from relationships that are formed socially amongst colleagues and friends. In order to establish a relationship which is helpful it is necessary to be aware of the assumptions, expectations and feelings you carry into each new professional relationship. Without this awareness there is a real danger that your own ‘noise’ will make it difficult for you to be present and experience the other person as they are. In order to understand the emotional needs and concerns of the person it is necessary for you to try to understand the world of the person that you are caring for—from that person’s own perspective. The nearer you can come to this the more effective will be the relationship, and the assessed needs of the patient will be more accurate and relevant. Learning about interpersonal communication within the context of nursing and the therapeutic relationship means that you will have the opportunity to develop your skills and adapt them for the purpose of caring for others.

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Communication and Interpersonal Skills in Nursing

• Alec Grant - Independent Scholar, University of Brighton, UK
• Benny Goodman - University of Plymouth, UK
• Description

The new edition of this well regarded book introduces the underpinning theory and concepts required for the development of first class communication and interpersonal skills in nursing. By providing a simple to read overview of the central topics, students are able to quickly gain a solid, evidence-based grounding in the subject. Topics covered include: empathy; building therapeutic relationships; using a variety of communication methods; compassion and dignity; communicating in different environments; and culture and diversity issues. Three new chapters have been added that point readers towards further ways of approaching their communication skills that are less model and technique driven and focusing more on therapeutic considerations, as well as looking at the politics of communication.

‘This is one text that I will definitely be recommending to my students. An excellent starting guide to communication and interpersonal skills, further supported by the NMC standards, which gives this text kudos and rigor.’ 

The book provides an excellent grounding in CIPS and relates this explicitly to nursing practice in an engaging and easy-to-read way. Content is linked to the 'Future Nurse' standards (2018) and is punctuated with useful activities for readers to help embed understanding.

This is a really practical guide to communication and interpersonal skills for those working in healthcare, with clear and appropriate examples of ways that barriers to communication can be overcome. The activities and opportunities for reflection are relevant and helpful. I would thoroughly recommend this to student nurses.

Very beneficial to learning and teaching.

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