2.3: Effective Communication

Learning Objectives

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

• Explain the importance of effective communication
• Discuss the fundamentals of professional communication
• Identify uses of motivational interviewing

Healthcare providers should be skilled in effective communication in order to provide safe and effective care for patients. Professional communication with other healthcare providers and with patients is a priority for healthcare providers which leads to better, collaborative, high-quality, and safe patient care. Nurses and other healthcare providers use motivational interviewing to elicit information from patients.

Importance of Communication

Nurses need to communicate effectively with patients and other members of the healthcare team. Effective communicators build empathy and trust among patients and the healthcare team. When patients and healthcare providers feel understood and heard, better healthcare outcomes occur, and job satisfaction among healthcare providers improves. Nurses who are good communicators are also self-aware and strive to create better relationships among patients and the healthcare team. Good communication among healthcare providers also promotes better handling of conflicts.

Elements of Effective Communication

Effective communication is paramount in health care. Healthcare providers need to provide factual, practical, clear, concise, and persuasive communication to patients to deliver safe and effective health care (Table 2.3).

Element	Factual	Practical	Clear and Concise	Persuasive
Example	Your heart has three arteries on the outside of your heart that oxygenate the muscle. These are the arteries that are bypassed during open-heart surgery.	The measles, mumps, and rubella virus vaccine is recommended at 18 months of age following the Centers for Disease Control and Prevention (CDC) schedule. You will want to make sure to schedule a healthcare provider visit for the vaccine if desired.	You will need to take this antibiotic with meals. Take one pill with breakfast, lunch, and dinner.	After surgery, you will need to get out of bed and walk every day so that you recover more quickly. Do you prefer to walk with your cane or a walker when ambulating this evening?

Table 2.3 Examples of the Elements of Effective Communication

Factual

Healthcare communication must be factual. Health care is based on science, and nursing is an evidence-based practice. Providing patients with communication that is anything other than factual erodes the patient-provider relationship and deems the provider as untrustworthy. Patients deserve factual communication about their bodies. Nurses should refrain from speaking about their own feelings or hopes when interacting with patients as this can lead to confusion and miscommunication. For instance, when a nurse uses factual communication to speak with a post-op patient, the nurse could say that research has proven that patients who attempt to ambulate within twenty-four hours after a surgical procedure are less likely have postoperative complications. The nurse can explain to the patient that they might be in some pain afterward, but the nurse can provide pain medications as needed. If the nurse was to provide nonfactual communication to the same patient, the nurse would tell the patient it is time to get up and ambulate and that ambulating will not hurt.

Practical

Healthcare communication must be practical. A nurse who communicates and does not give practical information can seem untrustworthy. For instance, a post-op surgical patient might be asked if they are ready to ambulate into the hallway when medically appropriate. The patient would be hesitant to trust the nurse, as that is not a practical goal. Instead, the nurse should ask if the patient is ready to try and ambulate around the room. This sharing of practical information builds trust—the patient recognizes the nurse understands their limitations.

Clear and Concise

The nurse should communicate in a clear, concise manner. Effective communication occurs when the nurse clearly thinks through the purpose of the message. The message should be clear so that feedback can be elicited. An example of unclear communication is when the nurse informs the patient that ambulating after surgery is necessary for healing but adds words such as “if you can” or offers other options such as waiting. The nurse could add that they think waiting might be good, as the patient can rest and have a snack, or maybe take a shower. This communication is unclear because the nurse has stated that ambulation after surgery is important but then is allowing the patient the option to not ambulate. If the nurse used clear and concise communication, they would tell the patient that they should try and ambulate today to help reduce post-op complications, right now or in an hour after the pain level has decreased.

Persuasive

Nurses need to know how to be persuasive in their communication. Many times, nurses are required to persuade patients to change their behaviors. With a postoperative patient who is required to ambulate after surgery, the nurse could give the statistics of reduced postoperative complications if early ambulation is performed, or the nurse might reiterate that they will stay with the patient throughout the process and have pain medications available if they are needed. Nurses should present facts and make recommendations but also listen to the wishes of the patient. If the patient is unsure about taking pain medication, the nurse should explore this ambivalence and use another tool like motivational interviewing (MI).

Essentials of Professional Communication

Professional communication is essential in health care. Communication is part of any successful working relationship, and collaborative, working relationships are integral in health care. Nurses work with people from different professions, class, status, careers, and vocations. To communicate respectfully with different types of people, the nurse should use professional communication (Table 2.4).

Element	Example
Courtesy	Hello, Mr. Lee, I am so glad to meet you. What can I help you with today?
Understanding	Yes, Ms. Awolowo, thank you for sharing your reason for being late to your appointment, we are happy to accommodate you. We will be able to see you soon.
Use of names and titles	Hello, I am your nurse today. Would you please tell me your preferred name, title, and pronoun so that I may refer to you correctly?
Trustworthiness	I will be back in thirty minutes to check on you and your pain level, Mrs. Kuznetsova. Is that okay with you?
Empathy	This must be a hard time for you, Mx. Takahashi. How are you coping?
Assertiveness	I hear what you are saying, Mr. Diaz-Gomez. Would you like me to be present when you speak to your doctor so we can make sure they are addressing your concerns?
Resolution	You were given the wrong medication this morning. I have notified your healthcare provider, and I will be monitoring you closely for the next four hours.

Table 2.4 Elements of Professional Communication

Courtesy

Using courtesy in healthcare communication is important. Courtesy refers to the practice of being polite, respectful, and considerate when interacting with patients, their families, and colleagues. It involves using polite language and maintaining a friendly and professional demeanor. A nurse should try to always acknowledge their audience, speaking politely. Nurses experience many patients who are not courteous to them; however, the nurse should always be courteous to the patient. Nurses who are courteous in all communication encounters are more likely to deliver safe, effective care for their patients (Sibiya, 2018). Initiation of the nurse-patient relationship depends on the nurse’s ability to begin with a pleasant greeting and friendly smile. These actions can build trust and place the patient at ease. By maintaining qualities of politeness and friendliness, the nurse conveys continuous acceptance of the patient and interest in discussing the patient’s feelings and concerns.

Understanding

Communication is most effective if all messages received are understood. Patients are more likely to follow directions provided during an educational session if the information is supplied in a way the patient readily understands. If the patient receives the communication in several forms, like verbal, written, and electronic, the patient will likely better understand the message. A patient who does not understand the directions given to them is less likely to obtain positive health outcomes.

Use of Names and Titles

Nurses should respect the professionals that they work with on the healthcare team and use their correct name and title. Nurses should ask patients and healthcare team members to respect their titles and ask that they be used. Nurses should ask patients what they prefer to be called—their name, title, and pronouns; doing so helps establish a positive patient-provider relationship.

Trustworthiness

Nursing is considered the most trusted profession since the 1990s when the Gallup poll of most trusted professions was first conducted (Gaines, 2023). Nurses are considered honest in their words and actions. They are trusted to deliver honest care with compassion, providing education and answering questions with patience.

Link to Learning

Results of a 2022 Gallup poll about the trustworthiness of the nursing profession are presented and discussed at the Gallup website.

Empathy

Empathy is a key element of nursing communication, embodying the ability to understand and share the feelings of patients. The term empathy can be defined as the ability for one person to understand and share the feelings of another person. A nurse not only reacts in a caring manner, which is considered sympathy, but fully understands the patient, placing value on the patient as a unique individual capable of making decisions. Empathy involves showing genuine concern, using active listening, and responding in a way that acknowledges and validates the patient’s emotions. Nursing empathy helps create a trusting and therapeutic nurse-patient relationship, leading to improved patient outcomes and overall satisfaction (Babaii et al., 2021). Empathy goes beyond mere sympathy or a caring demeanor; it is about deeply comprehending the patient’s emotional and psychological state. When nurses exhibit empathy, they foster an environment where patients feel heard, valued, and supported, which is vital for delivering safe and effective care. Empathetic care often leads to better adherence to treatment plans and a more positive attitude toward recovery. Patients who feel supported and understood are more likely to actively engage in their care (Bas-Sarmiento et al., 2019).

Assertiveness

Showing confidence in oneself is assertiveness. Nurses who are assertive are more likely to build effective communication among healthcare team members. Some facilities provide assertiveness training for nurses, recognizing that nurses who are positively assertive improve patient care (Nakamura et al., 2017). An assertive nurse advocates for patients until their concern is addressed. Assertive nurses are a necessity for patients who are unconscious, nonverbal, or have no advocate at their side as they must speak up as the voice of the patient.

Resolution

Determination of an act is the resolution. In health care, resolution often refers to the communication used when addressing adverse events or risk management concerns. Resolution also involves reaching a point where both parties involved in the communication feel satisfied and understood and that their objectives have been achieved. Effective resolution contributes to clear understanding, improved relationships, and the achievement of desired goals. Adverse events and risk management concerns occur when something has gone wrong. An adverse event could be a medication error or the unintentional death of a patient. Resolution includes healthcare providers discussing through clear and structured communication what went wrong and how to prevent adverse events from occurring again. Resolution depends on both parties agreeing on an outcome. When an outcome is agreed upon, effective resolution has usually been obtained.

Motivational Interviewing

Nurses may use motivational interviewing (MI), an evidence-based counseling approach that involves discussing feelings and incentives with the patient. Motivational interviewing can be used as a clinical communication tool to better understand the motivation behind a patient’s desire to change their behavior (Droppa & Lee, 2014). Nurses can use MI by expressing empathy about the patient’s current point of view. A nurse should help a patient better understand their current practice by highlighting discrepancies between their current behavior and their goal behavior. The nurse uses MI to understand patient ambivalence, which is part of the change process, but they should encourage patients to reach their goals, supporting self-efficacy. For instance, a patient may understand the importance of postoperative pain medication but be ambivalent about receiving it. Motivational interviewing can help the nurse empathize about the patient’s concern while highlighting the importance of pain relief after surgery to help meet postsurgical goals like ambulating.

Patient Conversations

Using Focusing with Motivational Interviewing

Scenario: The nurse, Robin, walks into the patient’s room to complete an assessment, and the patient starts complaining about pain.

Nurse: Hi, my name is Robin, and I am going to be your nurse today. Do you mind verifying your name and date of birth for me?

Patient: Yes, Diane Bock, date of birth 10/12/1940. I am having a lot of pain, like I did last time I was here, and the last time I had a lot of pain, things went wrong, and I had to stay at the hospital longer than I wanted to, and I missed my friends’ eightieth birthday party, and she ended up falling after her party and breaking her hip. I don’t want that to happen to me, but my knee hurts so bad I feel like I could fall. The doctor said I should start physical therapy to help with my knee pain, but I don’t want to, what do you think?

Nurse: You have given me a lot of information, what would be most helpful to discuss first?

Patient: Can we talk about the pain in my knee first?

Nurse: Yes, let me ask some follow-up questions about your pain. Where are you having pain? What is the level of your pain on a scale of 1 to 10 with 10 being the most intense and 1 being the least intense. When did your pain start?

Patient: My knee hurts, it’s an 8 on a scale of 1 to 10, and it started about one hour ago, I just did not want to bother you.

Nurse: You are not bothering me, and I am sorry you are in pain. I can check to see when your next pain medication is due and get that for you. Is it okay if I leave and come back with your pain medication and then we can discuss what you think is most important next?

Patient: Yes, please check on my pain medication. I think I had some last night.

Scenario follow-up: The nurse returns to the room with pain medication for the patient.

Nurse: You can have the pain medication now. Here it is.

Patient: Thank you for the pain medication. I hope it works soon. I do not want to be in the hospital again and go home and have no answers about my knee pain.

Nurse: Would you like to talk to me more about the comment you made earlier about your friend? It seems like you are worried about being in the hospital.

Patient: Yes, I am worried about having to stay in the hospital again, I really don’t like the hospital.

Nurse: I can understand why you do not like the hospital, but it is a good place for you to be in to figure out what is wrong with your knee. Do you think you will be okay to stay until the healthcare providers have run all the necessary tests?

Patient: Yes, I will try to stay until I have an answer about why my knee hurts.

When assessing a motivational problem, always consider the patient’s cultural values, their general and health literacy, and their psychosocial needs. Motivational interviewing should support the patient’s sense of self-confidence. It includes using engaging communication and open-ended questions, helping the patient focus, while evoking the patient to think about change and planning how the patient will accomplish the change. An example of MI is a nurse equating the patient’s love of caring for their grandchild as a reason to slowly add healthy food and exercise to their daily life to improve their health.

Effective MI should include the following processes:

• Engaging: By engaging in communication with a patient, the healthcare provider establishes a relationship with the patient. To engage in communication, the healthcare provider should use active listening, use nonverbal communication, and ask for feedback when necessary.
• Focusing: Focusing is finding a clear direction and a goal. Nurses need to help provide focus with communication and MI. Nurses need to help the patient choose goals for change. Nurses use focusing techniques to help the patient define and refine those goals.
• Evoking: Evoking is the part of the MI process that helps the patient make the change. The nurse encourages the patient to speak in terms of change but understands the patient may be ambivalent for that change. The nurse should use the patient’s natural motivation to invoke the change.
• Planning: The patient needs to plan for the future with their new goal for change. During the planning phase of MI, the goals should be small and achievable. Small victories increase patients’ motivation. The nurse should discuss with the patient the development of SMART goal, an acronym for goals that are specific, measurable, attainable, relevant, and timely (Figure 2.6). Developing goals with the patient during MI increases the probability that the patient will change the behavior.

Figure 2.6 SMART goals can be used with patients during MI. (credit: modification of work by Joint Base Charleston, Public Domain)

Clinical Judgment Measurement Model

Take Action: Using Motivational Interviewing to Counsel Patients to Increase Self-Care

When taking actions, nurses can use MI to counsel patients to increase self-care. For example, if a patient has experienced a myocardial infarction or heart attack, the nurse recognizes that they should teach the patient about decreasing saturated fat in their diet. Telling the patient how to decrease saturated fat in their diet is not the best way to motivate the patient. The nurse may ask questions like, “You want to decrease saturated fat in your diet, what is your understanding of the complications of eating a high-fat diet?” Or “What will it look like in five years for you if you do not lower your saturated fat intake?” Or “What would you gain by cutting back on your saturated fat intake?” The patient’s responses provide detailed information that helps the nurse set goals with the patient to lower the patient’s intake of saturated fat. Nurses can use the acronym OARS to help patients develop goals to increase self-care (Figure 2.7) (Schultz, 2021).

Figure 2.7 The acronym OARS can help nurses to remember steps to take when employing MI with patients. (CC BY 4.0; Rice University & OpenStax)