2.2: Models of Communication

Learning Objectives

By the end of this section, you will be able to:

• Describe the process of the transmission model of communication
• Discuss the interactional model of communication
• Summarize the transactional model of communication

Communication can be conveyed in a variety of ways. Transmission, interactional, and transactional models are three of the models that can be used for communication. Communication in health care relies on all three of these models to ensure safe and effective care of patients. Nurses may use the transmission model to speak with patients directly, the interactional model for communication with the healthcare team, and the transactional model for communicating with other providers within a healthcare system. The nurse interchangeably uses the three models of communication depending on the situation with the patient (Table 2.2).

Communication Models	Message	Channel
Transmission	Burden on sender to make sure message was received and understood	Used mostly with verbal communication
Interactional	Allows for feedback between sender and receiver	Can be verbal, nonverbal, written, visual, or electronic
Transactional	Sender and receiver can be sending and receiving simultaneously	Can be verbal, nonverbal, written, visual, and electronic

Table 2.2 Communication Models

Transmission Model

In the 1940s, the transmission model of communication was created as a linear model that describes how communication happens between sender and receiver. Also known as the action model, the transmission model is a one-way process of communication, with up to five elements including the sender, the message, the transmitter or message channel, the receiver, and noise (Figure 2.3).

Figure 2.3 In the transmission model of communication, the sender, the channel, the message, the receiver, and noise are in a linear format. (CC BY 4.0; Rice University & OpenStax)

Sender

In the transmission model, the sender is the person who initiates a message. The sender can use verbal, nonverbal, written, visual, or electronic communication. Verbal communication is used most often (Vermeir et al., 2015). The sender should strive to be clear and concise in their message. The sender should convey credibility and honesty with their message as it may help with the tone, while pitch and content are also important. For example, a sender could be a nurse manager who emails an employee about an important department meeting.

Receiver

The receiver is the person who receives the message and interprets it. The receiver can also be called the listener, reader, or observer depending on how the communication is sent. The receiver is the responsible audience who decodes the message from the sender (Nordquist, 2019). The receiver in the previous example would be the employee who received the email about the important department meeting from the nurse manager.

Message Channel

The message channel can be broken into two parts: the message and the channel. The message is the information to be conveyed or communicated. The channel is the mode in which the communication is sent. In the transmission model, the message channel most commonly used is verbal communication. The burden is placed on the sender to make sure the message sent was received and understood. Either environmental or semantic noise can make the interpretation of the message difficult. Semantic noise refers to a type of communication barrier that occurs when the sender and receiver of a message have different understandings of the meanings of words, phrases, symbols, or language in general (Vrana et al., 2018). For example, medical jargon used by healthcare providers is semantic noise that is difficult for patients to interpret.

Real RN Stories

Interpreting Information

Nurse: Sudita, RN
Clinical setting: Telemetry unit
Years in practice: 15
Facility location: Philadelphia, Pennsylvania

I was working an eight-hour shift caring for a patient who was admitted with a myocardial infarction and was preparing to be discharged. I was assigned to give discharge instructions to the patient including the heart-healthy diet instructions. I started by asking the patient about their current diet and discussing how to modify their current diet to include healthier eating habits. The patient, however, told me that they ate snowballs and drank whole milk as their daily snack. I was the receiver of the patient’s message. Living in the Northeast, I understood a snowball to be a “snow cone,” the sugary, fruit-flavored ice ball often served from roadside vendor trucks. And was I ever confused! I understood how to deal with the whole milk issue, but I could only think that a snowball was not the worst thing this heart patient could snack on. I was further confused because I wondered how the patient made these at home. The semantic noise in the message made it hard for me to interpret. Was I to understand from the message that the patient ate snowballs and drank whole milk as a snack during the day, which although did not meet healthy-heart standards could be modified to include skim milk? In the transmission model of communication, I needed to interpret the information received in the best way I could, which did not allow for me to make the best decision about safe and effective care for the patient. After asking the patient several additional questions, I found they were actually referring to the gooey, marshmallow, coconut, and chocolate rounded cakes that are called snowballs and that they ate them several times a day, washed down with whole milk. Based on the information gathered from the patient, I changed the plan of care and the teaching information.

Interactional Model

The interactional model of communication describes communication as a process in which a person alternates as both sender and receiver. Instead of the transmission model (linear, one-way), the interactional communication model allows for feedback, or a two-way process (Figure 2.4). The main difference between the interactional and transmission models is that the interactional model includes feedback in the communication process to allow for better understanding of the messages being sent and received.

Figure 2.4 The interactional model of communication shows feedback and changing roles. (CC BY 4.0; Rice University & OpenStax)

Sender/Receiver

The sender in the interactional model is also the receiver. The model permits the sender to change roles and become the receiver. The sender and receiver interchange the roles, sending messages rapidly during the communication process. The quick pace and interchanging roles can sometimes lead to miscommunication.

Message Channel

The message channel in the interactional model is similar to the transmission model. The form of communication for the interactional model can be verbal, nonverbal, written, visual, or electronic. Communication in the interactional model can be complex; sometimes messages can be sent and not received. The messages can be affected by the physical and psychological context of the communication. For instance, if the message is sent in a room that is noisy and busy, the intended message may not be completely received, and because the interactional model relies on feedback, when feedback is not present because of noise, the message is lost.

Feedback Channel

The feedback channel distinguishes the interactional model from other communication models. The response given by a receiver to a sender is the feedback. Feedback permits clarification of the message sent so that the receiver can better interpret it. The feedback loop allows for senders/receivers to exchange messages simultaneously. This feedback loop can help with clarification of the message sent.

Transactional Model

The transactional model of communication is a two-way model of creating communication to develop social relationships and engage with others. The transactional model differs from the interactional model because the sending and receiving of messages happen simultaneously (Figure 2.5). Healthcare providers rely on the transactional model to develop relationships with patients, allowing safe and effective care to occur (Kwame & Petrucka, 2021). The transactional model is the preferred model of communication between healthcare providers and patients because it allows for the sender and receiver to share information.

Figure 2.5 The transactional model of communication shows simultaneous communication. (CC BY 4.0; Rice University & OpenStax)

Sender/Receiver

Like in the interactional model, the sender is also the receiver in the transactional model. The senders/receivers are also called communicators, which allows senders to simultaneously be receivers. The transactional model allows for adaptation of communication within the encounter, changing modes while sending and receiving messages.

Message Channel

The message channel within the transactional model allows for all forms of communication including verbal, nonverbal, written, visual, and electronic. The nurse could be using verbal communication with a patient while observing the patient’s nonverbal communication. The nurse might observe the patient’s nonverbal communication while listening to the patient’s verbal communication, observing for congruence between the modes of communication. The healthcare provider who asks the patient to use a pain rating scale would monitor for visible signs of pain while observing the patient use the pain rating scale.

Feedback Channel

Feedback is present in the transactional model and is influenced by the social, relational, and cultural context of the communication. With feedback, the sender and receiver are influenced by their culture, literacy, social context, and native language when interpreting the message, and possibly shifting the context of the message. Because the transactional model is designed to develop social relationships, nurses should respect the context of the feedback and the message.

Patient Conversations

Using the Transactional Model of Communication with Patients

Scenario: A nurse is caring for a mother and partner in an obstetric unit of a local hospital. The mother recently delivered a healthy baby who is in the nursery being assessed.

Nurse: [walking into the room] Hello, my name is Tallulah, and I will be your nurse today. Wow, it is really hot in here isn’t it? [Nurse walks over to the thermostat in the room.] It is set at 80° in here, I am going to lower it. [Nurse lowers the thermostat to 68°F (20°C).]

Partner: It is nice to meet you [slightly bows]. We are Mr. and Mrs. Chow; we thank you for caring for us today.

Nurse: I need to check your name band, what is your name and date of birth?

Patient: Emily Chow, September 27, 1986.

Nurse: I will do a quick assessment of you and then check on your baby, is that okay?

Patient: Thank you [slightly bows].

[Nurse completes assessment while complaining about the temperature of the room.]

Nurse: I am done, is there anything else I can do for you at this time?

Patient: No, thank you.

Scenario follow-up: Nurse leaves the room, and patient asks partner to return thermostat to 80°F. Patient and partner are of East Asian descent and practice Taoism and toa (tos), with the emphasis on returning heat to the postpartum body to prevent future illness from occurring. Nurse returns to the room after thirty minutes.

Nurse: Oh, my goodness, it is still so hot in here, is the thermostat broken? [Nurse checks the thermostat to see it has been returned to 80°F.] Did either of you touch the thermostat? I cannot give care in this hot room.

Partner: Yes, we returned the thermostat to 80°F once you left, because my wife is practicing the maternal medicine of our culture and would like the room to remain warm.

Nurse: I am sorry, I did not realize it was a part of your culture to have a warm room after delivery. I will be sure to respect your wishes and tell all future caregivers your preferences. Is there anything else I should know about your cultural practices after giving birth? I am so glad you shared this information with me.

Source: Bazzanoe et al., 2020.

Context

When attempting to communicate with a patient through their culture and engage in a social relationship, the use of multiple forms of communication is necessary. The use of faces and objects in the place of words during communication encounters is called referent communication. In electronic communication or text messages, the use of referent is seen in the form of emojis or pictures used to describe words like smiley faces or a picture of a chair. Referent communication can be used during texting but may not always be appropriate when speaking with patients. Nurses can use referent communication when checking for pain with a patient who is unable to speak. In this instance, referent communication is helpful in assessing a patient’s pain scale as is done when using the Wong-Baker FACES Pain Rating Scale.

Unfolding Case Study

Unfolding Case Study #1: Part 2

Refer back to Unfolding Case Study #1: Part 1 for a review of the patient data.

Nursing Notes

1700: Intervention Patient appears to be in distress from frequent coughing episodes with expectoration of yellow sputum. Patient is tearful and begins to cry. Son attempts to console patient. Interpreter has been called and will arrive when their current patient encounter is complete. Nurse utilizes a picture board to assist with communication with patient. Oxygen at 2 L per nasal cannula applied per orders and warm cloth given to wipe her face. Patient is instructed by nurse to take slow, deep breaths and to sit in an upright position to improve breathing.

Provider’s Orders

1710: New orders Chest x-ray Close observation

3.

Prioritize hypotheses: What factors are present that may make communication with this patient difficult? What are some other ways the nurse could communicate with the patient despite these factors?

4.

Generate solutions: How could the nurse use the transactional model as a basis for communicating with this patient?