Nurse Patient Interpersonal Communication
Interpersonal Communication
It is central to the work of a profession that depends on interpersonal expertise as much as clinical expertise. Effective delivery of health care frequently depends to a great extent on the quality of communication between health care providers and their patients.
Communication can encompass the verbal, nonverbal, vocal, content, and process aspects of the interaction as well as the social, cultural, relational, behavioral, and interactional characteristics of participants.
The majority of health related research has been on the verbal communication styles of providers during patient interactions.
Importance For Nursing
Interpersonal communication is the primary means by which patients learn about their particular health problems, appropriate prevention and treatment strategies, and the roles both nurses and patients play in achieving health outcomes.
Such communication is likely to influence patients' willingness to share information, adhere to treatment plans, and participate in followup. Interpersonal communication in health care is often complex influenced by personal characteristics and interaction styles of nurses, patients, or patient companions as well as contextual factors.
Despite the complexity and importance
of such interactions, studies of nurses' communication and its impact on the
processes and outcomes of care are few.
What are the Purposes of Interpersonal Communication
The majority of research on provider patient communication has occurred over the past 30 years. The focus of this research has been on communication styles and strategies that occur within the provider patient relationship.
Physicians' verbal communication has been studied far longer and more frequently than that of any other type of health care provider. Medical researchers have largely ignored the role of non physician providers and have excluded them from communication analysis.
Much of what is known from this research is limited to what is said by white male primary care physicians during initial acute care visits (Roter, 2003).
Style and Type of Communication
Nurse patient communication has also been examined during this time period and has provided a basis upon which to describe the types of communication styles used by nurses in practice.
Important issues have been raised regarding the communication styles nurses most frequently employ and their effect on patient responses and health outcomes (Courtney & Rice, 1997; Jarrett & Payne, 1995; Lawson, MT, 2002). The communication patterns studied have been mainly those of white female advanced practice nurses in primary-care settings or basic clinical nurses in acute-care settings.
Until recently, little attempt has been made to disentangle the independent effects on communication of key provider, patient, and contextual characteristics. This has resulted in diminished attention to the important role these characteristics may play in shaping the nature and dynamics of communication.
Critical methodological issues are also raised about limitations in the ways
provider-patient communication research has been studied.
Characteristics of Communication
Effective communication does not just depend on the acquisition of the right skills. A variety of characteristics have been identified that affect the quality and quantity of provider-patient communication (Wilkinson, S., Roberts, & Aldridge, 1998; Roter, 2003).Provider characteristics.
Provider communication has been studied more than patient communication; however, provider characteristics were studied less than patient characteristics. Provider characteristics include role, gender, race, specialty training, level of education, practice experience, and communication styles.
Most communication studies listed small numbers of providers and meaningful individual differences in providers were difficult to find.There may also be assumptions that only patients' attitudes, emotions, and characteristics influence the interpersonal communication.
Since nurses are human beings, it is important to discern how their specific characteristics are reflected in the care provided and the outcomes of that care. It would be important to discover if there are behavioral differences in the communication styles of male and female nurses and if they produce corresponding gender differences in patients' behavior directed back to them.
Discerning whether relationships exist between specific provider characteristics and their ability to pay attention, give comfort, use feedback behaviors, and adjust communication styles to various individual patients would be important. A better understanding of the effects of nurse characteristics on communication behaviors and clinical judgment is needed.
Patient characteristics, Researchers have been mostly concerned with one direction of causality how providers influence patients. Little work has been done to determine if patient characteristics impact a nurse's communication style.
Patient characteristics include race, gender, age, health status, diagnosis, communications styles, role of patient companion, and values.
What research has been done frequently showed no significant correlations or unexpected relationships (Caris-Verhallen, de Gruijter, Kerkstra, & Bensing, 1999), Because the relationship is both reciprocal and dynamic there is a pressing need to capture the contribution of both participants.
Not only can a nurse be
influenced by his or her own attributes and attitudes, but by those of the
patient.
Contextual characteristics. Interpersonal exchange does not occur out of context. Most communication research has been focused almost exclusively on the verbal interchange between nurse and patient without taking into consideration the setting and context in which it occurred.
Contextual characteristics comprise environmental and situational factors such as site of interaction, initial or established relationship, type of care provided, time constraints, stressors for participants, and role of participants.
Research on nurse practitioner patient communication occurs mainly in the context of initial or episodic encounters, although in practice the majority of dialogue occurs in the context of established relationships (Lawson, 2002). Most research between basic clinical nurses and patients occurs during the provision of physical care with the focus on providing instructions and explanations (Jarrett & Payne, 1995).
This
restricted view has limited the discovery of relevant factors and their
implications for clinical practice. To obtain a more reflective view of the
real contributions of nurse-patient communication to health outcomes, the
context in which the interpersonal exchange is studied must be broadened.
Model Of Communication
Nurse leaders developed conceptual models that focused on describing aspects of nurse patient communication and the intricacies of the nurse-patient relationship; These leaders are known as "interactionist" theorists (Orlando, 1990; Peplau, HT, 1952; Travel Bee, 1971).
Most communication research remains atheoretical, exploratory, and descriptive and appears to be driven by available methodology rather than application of dedicated theories. Discoveries in knowledge about the presumed mechanisms behind the effects of communication will occur when theory driven questions and hypotheses are systematically asked and tested.
Other issues to consider are the realistic selection of subjects (patients or providers), studying subjects in various contexts, and use of simulated patients and contexts; the use of multiple research methods (experimental, observational, survey, ethnographic).
The development of valid and reliable instruments; data collection methods; and the inclusion of other research designs to track the patterns and possible changes in nurse and patient communication over time.
In addition to being studied as a process, communication may serve as an outcome, a predictor, a mediator of process, or a moderator of relationships among other variables.
When these issues begin to be addressed the profession will be better able to determine how the findings on nurse-patient communication research can be used to impact the clinical and educational aspects of nursing.
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