Communication Skills

What is Communication

Communication is a "two-way process of reaching mutual understanding, in which participants not only exchange (encode-decode) information, news, ideas and feelings but also create and share meaning. In general, communication is a means of connecting people or places." [1]

The Communication Cycle

Communication cycle.png

In the communication cycle, messages are transmitted from a sender to a receiver. The receiver interprets the message and then provides feedback to the sender. This then becomes a message that the sender needs to decode. These messages can be transmitted in several ways; verbal, non-verbal, written, visual or even tactile.

Various factors can influence the communication cycle, such as the communication channel, the environment in which the communication occurs as well as the context of the communication exchange.

Effective Communication Cycle.jpg

Skills to Enhance Communication

Communication skills can be learnt. Displaying openness, empathy, supportiveness, positivity and equality will strengthen the communication process.[2] In a healthcare setting, there are a variety of different communication skills and techniques such as motivational interviewing and using the Calgary-Cambridge guide to medical interviewing. Asking open questions, exploring cues and clarifying can assist in a patient-centred communication style. Developing listening skills by reflecting, acknowledging, summarising, empathising, making educated guesses, paraphrasing and checking will help patients feel heard and enrich the communication cycle.[3] Lastly providing information to a patient is a skill that needs to be developed. Using skills such as jargon-free communication, checking to understand, giving small chunks of information and pausing can also be useful tools.[3]

Benefits of Effective Communication Table.jpg

Barriers to Communication

Communication can be impeded in a variety of ways. Language barriers, physical disabilities such as hearing loss or mental illness, the physical environment and even a person's emotional state can all affect the communication cycle. In healthcare specifically, there can be barriers for the patients as well as communication barriers for the healthcare professional. A noisy environment or lack of privacy may result in a patient not communicating precisely what they need to.[3] They may themselves have specific fears or anxieties or concerns over being judges that may result in them, not communicate effectively. For healthcare professionals, high patient loads, stress and anxiety can play a role. A healthcare professional may also not be able to communicate effectively if they are not confident in their clinical diagnosis or their treatment plan.[3]



One of the biggest patient complaints is that healthcare practitioners did not listen to them. Listening is a skill that needs to be practised to develop it. Listening can be discriminative where the pitch, tone and emotions are analysed. It is also comprehensive where the actual meaning of what is being said is interpreted. Non-verbal communication, such as body language can enhance this process.[2]

Active Listening is a helpful skill to develop in the healthcare setting. It is also known as reflective or empathetic listening. It has been shown to improve interpretation of the sender's message, which, when dealing with patients, is a critical skill.[4] Poor listening has been attributed to inaccurate diagnosis and incorrect treatment.[4]

Guidelines for Active Listening[4]

  • Pay attention
  • Show interest
  • Minimise distractions
  • Create a positive atmosphere
  • Listen without judgement
  • Don't interrupt
  • Use reflections
  • Don't get emotionally involved
  • Use non-verbals to show you are listening, such as nodding or say "I see."
  • Invite further disclosure with phrases such as "tell me more."
  • Clarify with open-ended questions

Interpersonal Gap[5]

John Wallen developed the interpersonal gap theory. It refers to the "degree of congruence between one person's intentions and the effect produced in the other. If the effect is what was intended, the gap has been bridged. If the effect is the opposite of what was intended, the gap has become greater." The terms "intentions"," actions" and "effect" are important in understanding the interpersonal gap. The intention is what someone wishes to covey, and the effect is the person's response to a situation. These are both personal and experienced internally. An action is an outward response which may be conveyed in verbal or non-verbal means.[5]

In the communication cycle, person A has an intention, and this will have an effect on person B, which may then produce an action. If the effect and action are not what person A intended, there is a wide interpersonal gap. It is important to practice recognising whether there is an interpersonal gap and try to rectify it as soon as possible. In healthcare, this is where misunderstandings between patient and healthcare practitioner can happen. Using communication skills to reflect and clarify can help to bridge this gap.

The Ladder of Inference

Ladder on Inference

People often jump to conclusions. The ladder on inference offers a tool to help someone move systematically through logical steps to come to a reasonable conclusion. The bottom rung of the ladder is the starting point of "Observations" and the top of the ladder and endpoint "actions." These are what can be seen on the outside. The processed between of Select data, Meaning, Assumptions, Conclusion and Beliefs are internal processes that guide actions. By using the ladder to explain the process, you have followed in formulating a conclusion it can help others see your reasoning.[6]


  1. Business Dictionary. Definition of communication. Accessed from 13 August 2019
  2. 2.0 2.1 Giesbrecht J. Effective Communication Course Slides. Physioplus 2019
  3. 3.0 3.1 3.2 3.3 Bramhall E. Effective communication skills in nursing practice. Nursing Standard (2014+). 2014 Dec 3;29(14):53.
  4. 4.0 4.1 4.2 Doas M. Are we losing the art of actively listening to our patients? Connecting the art of active listening with emotionally competent behaviors. Open Journal of Nursing. 2015 Jun 12;5(06):566.
  5. 5.0 5.1 North Seattle Community College. The interpersonal gap. BUS236, Interpersonal Communication for the Workplace 2009
  6. Ross R. The ladder of inference. The fifth discipline fieldbook: Strategies and tools for building a learning organization. 1994:242-6.