Communication Skills

What is Communication[edit | edit source]

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]

Effective clinical communication skills can improve health outcomes and are considered an important aspect of high-quality healthcare.[2]

The Communication Cycle[edit | edit source]

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[edit | edit source]

Communication skills can be learnt. Displaying openness, empathy, supportiveness, positivity and equality will strengthen the communication process.[3] In a healthcare setting, clinical communication skills are an essential aspect of high-quality healthcare and can improve health outcomes.[2] Inadequate communication can result in negative outcomes for the patient.[4] 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.[5] 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.[5]

Benefits of Effective Communication Table.jpg

Barriers to Communication[edit | edit source]

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. Environmental factors have been identified as being a key barrier to nurse-patient communication[6] - i.e. a noisy environment or lack of privacy may result in a patient not communicating precisely what they need to.[5] Patient barriers may include anxiety, pain and physical discomfort.[7] The patient may have specific fears or be concerned that they will be judged - this may mean they do not communicate effectively. For healthcare professionals, other identified communication barriers include time management and an inability to build rapport with patients,[8] as well as high patient loads, stress and anxiety. Similarly. healthcare professionals may not be able to communicate effectively if they do not feel confident in their clinical diagnosis or their treatment plan.[5]


Listening[edit | edit source]

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.[3]

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.[9] Poor listening has been attributed to inaccurate diagnosis and incorrect treatment.[9]

Guidelines for Active Listening[9][edit | edit source]

  • 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[10][edit | edit source]

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.[10]

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[edit | edit source]

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.[11]

References[edit | edit source]

  1. Business Dictionary. Definition of communication. Accessed from 13 August 2019
  2. 2.0 2.1 Iversen ED, Wolderslund MO, Kofoed PE, Gulbrandsen P, Poulsen H, Cold S et al. Codebook for rating clinical communication skills based on the Calgary-Cambridge Guide. BMC Med Educ. 2020;20(1):140.
  3. 3.0 3.1 Giesbrecht J. Effective Communication Course Slides. Physioplus 2019
  4. Guttman OT, Lazzara EH, Keebler JR, Webster KLW, Gisick LM, Baker AL. Dissecting Communication Barriers in Healthcare: A Path to Enhancing Communication Resiliency, Reliability, and Patient Safety. J Patient Saf. 2018 Nov 9. Epub ahead of print.
  5. 5.0 5.1 5.2 5.3 Bramhall E. Effective communication skills in nursing practice. Nursing Standard (2014+). 2014 Dec 3;29(14):53.
  6. Al-Kalaldeh M, Amro N, Qtait M, Alwawi A. Barriers to effective nurse-patient communication in the emergency department. Emerg Nurse. 2020;28(3):29-35.
  7. Amoah VMK, Anokye R, Boakye DS, Gyamfi N, Lee A (Reviewing Editor). Perceived barriers to effective therapeutic communication among nurses and patients at Kumasi South Hospital, Cogent Medicine. 2018;5:1.
  8. Albahri AH, Abushibs AS, Abushibs NS. Barriers to effective communication between family physicians and patients in walk-in centre setting in Dubai: a cross-sectional survey. BMC Health Serv Res. 2018;18(1):637.
  9. 9.0 9.1 9.2 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.
  10. 10.0 10.1 North Seattle Community College. The interpersonal gap. BUS236, Interpersonal Communication for the Workplace 2009
  11. Ross R. The ladder of inference. The fifth discipline fieldbook: Strategies and tools for building a learning organization. 1994:242-6.