Nursing and Communication, Coursework Example

The academic literature addressing nursing and communication generally emphasizes the ubiquity of communication in our lives, and thus the importance of communication to nursing. Such communication, however, becomes even more crucial for the nurse, insofar as the nurse is part of a therapeutic relationship: communication is central to the success of the therapeutic relationship itself. Communication is especially pertinent in the various relations between nurse and patient, nurse and doctor, and nurse management/leadership and other nurses. In the following essay, we shall provide an overview of some of the key conceptual approaches to communication and nursing, while also offering our own thoughts as to some theories of communication that should be put into practice.

Authors such as Sully and Dallas confer a centrality to communication within nursing. They identify six levels of communication: social, professional, personal, conscious and unconscious. (Sully and Dallas, 2005, p. 1) All these types of communication are active in daily life and are essentially interrelated. In the paradigm of the hospital, such levels become radically entangled. For example, the hospital is a public, social space in which intensely personal events occur. Patients are faced with profoundly intimate decisions and obstacles, whereas the hospital itself is a professional working space for personnel such as nurses and doctors. Communication thus becomes complicated by the dynamism of the hospital environment, as “the ability to communicate may require special adaptation. This adaptation can be frustrating and anxiety provoking.” (Mauk, 2009, p. 77) In this regard, Sully and Dallas (2005) stress that theories of communication are pertinent insofar as they “provide us with an understanding of those factors that enhance and detract from our personal and psychological development.” (p. 6) In other words, an understanding of how communication functions in the context of the therapeutic relationship can help improve the quality of this relationship.

In the academic literature, the basic act of communication tends to be delineated in terms of three constitutive elements: sender, message, and receiver. (Ellis et al., 2003, p. 4) The difficulty in communication lies in the transmission of the message between the sender and the receiver. As Ellis et al., (2003) note, “the sender intends to convey a particular message but may send out much that is beyond direct awareness.” (p. 4) For example, a nurse may wish to communicate a specific message to a patient, however, the nurse may unconsciously convey something alongside the message, i.e., a sentiment such as distress or concern, through a physical gesture or the tone of his/her voice. Hence, the basic intent of the message becomes supplemented by the unconscious of the nurse. This unconscious effect can also be present in the sender. The sender may interpret a message in a different manner than it is intended, according to factors such as the “individual’s personal history.” (Ellis et al, 2003, p. 14) The already difficult communicative relationship can thus become complicated by unconscious elements of which the participants in communication are not even aware.

According to such difficulties, communication theories in nursing essentially act as a strategy that endeavors to most effectively carry out the therapeutic relationship. Such strategies can take various forms, such as humanist, systems and psychodynamic perspectives (Sully and Dallas, 2005, p. 3) Systems theory interprets communication by offering a thesis that “the whole is greater than the sum of the parts.” (Sully and Dallas, 2005, p. 13) The communication relationship therefore cannot be posited in terms of merely considering the actions of the sender or the receiver of the message. Rather, the greater communicative system must be emphasized. Systems theory as applied to nursing therefore underscores not only the role of the nurse, but also the understanding of the entire group concept.  Communication is to be thought in a more comprehensive manner with the understanding that there will always be a certain surplus of meaning that is inherent to every act of sending and receiving a message. With knowledge of this surplus, one can therefore anticipate possible misunderstandings in the communicative act.

The psychodynamic theory highlights the unconscious relationship between participants in communication. As Ellis et al. note (2003), this theory “address[es] the intrapsychic world of the person”, (p. 10) The psychodynamic account of communication identifies that notions such as personal histories may be at work in every instance of communication, and therefore complicate the process. Accordingly, in the context of nursing what is required is a sensitivity to the personal history and unconscious of a patient, and not merely a sensitivity to their conscious behavior.

The humanist perspective of communication strives to create “a rapport and becom[e] emotionally attuned to patients and their family members.” (Bastable, 2008, p. 76) In this regard, the primary aim of communication is to emphasize the patient or the receiver of message. By making clear to the patient that he or she is the centre of the relationship, this can potentially minimize any misunderstandings. Moreover, the humanist perspective essentially underscores the notion that each patient is an individual: the sender must deliberately use strategies of communication in a context dependent manner.

With the healthcare system redefining some of its fundamental concepts, increasing views on the centrality of the therapeutic relationship to healthcare theory has made communication paramount. Accordingly, the diverse number of theories concerning communication provides a plethora of ways in which to understand this phenomenon. However, according to the heterogeneous types of relationships that constitute nursing and nursing management, strategies in communication must also remain malleable. In other words, different types of relationships require different approaches. For example, the humanist perspective may be considered exemplary in the nurse-patient relationship, as the complexity of communication is in one sense simplified by emphasizing the importance of the receiver of the message. When considering other communication relationships, such as nursing management and leadership, according to the notion of the nursing staff as a team, a systems theory of communication may be the best option, insofar as it accents the idea that the whole is greater than the sum of the parts. This approach confers importance within the communication relationship to the entire nursing staff, as opposed to individual members of this staff. In essence, individual desires become subjugated to a greater principle that is the shared common goal of nursing and the therapeutic relation.

Thus, when considering the dynamism of the environment in which the nurse works, what is required is a reciprocally dynamic approach to communication. In this regard, context becomes crucial, as modes of communication must be taken into account considering the participants in the communicative act. Communication must above all take into account the type of relationship at stake in the communicative act, in order to maximize the quality of this relationship.

Works Cited

Bastable, Susan Bacorn. (2008). Nurse as Educator: Principles of Teaching and Learning for Nursing Practice. Sudbury, MA: Jones & Bartlett Learning.

Ellis, Roger B., Gates, Bob and Kenworthy, Neil. (2003) Interpersonal Communication in Nursing: Theory and Practice. Philadelphia, PA: Elsevier Health Sciences.

Mauk, Kristen L. (2009). Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones & Barlett Learning.

Sully, Philippa and Dallas Joan. (2005). Essential Communication Skills for Nursing. Philadelphia, PA: Elsevier Health Sciences.