ISSUES IN CLINICAL NURSING

Nursepatient communication: an exploration of patients experiences

Catherine McCabe MSc, RGN, BNS, RNT
Lecturer in Nursing, Trinity Centre for Health Sciences, St Jamess Hospital, Dublin, Ireland

Submitted for publication: 20 November 2002

Accepted for publication: 13 May 2003

Correspondence: McCABE C. (2004) Journal of Clinical Nursing 13, 4149

Catherine McCabe Nursepatient communication: an exploration of patients experiences
Lecturer in Nursing Background. Patient-centred communication is a basic component of nursing and
Trinity Centre for Health Sciences
facilitates the development of a positive nurse-patient relationship which, along with
St Jamess Hospital
other organizational factors, results in the delivery of quality nursing care. Nurses
Dublin 8
Ireland
are frequently described in the literature as poor communicators, however, very few
E-mail: camccabe@tcd.ie studies have examined patients experiences of how nurses communicate.
Aims and objectives. The aim of the study was to explore and produce statements
relating to patients experiences of how nurses communicate.
Design. A qualitative perspective using an hermeneutic phenomenological approach
was considered to be the most appropriate methodology for this study.
Methods. Using purposeful sampling, eight patients in a general teaching hospital in
the Republic of Ireland were interviewed. Data were collected using unstructured
interviews. Data analysis was a reflective process and the findings were presented
through the description and interpretation of themes and sub-themes.
Results. Following data analysis four themes emerged. These were, lack of com-
munication, attending, empathy and friendly nurses.
Conclusions. The findings of this study indicate that, in contrast to the literature
that suggests that nurses are not good at communicating with patients, nurses can
communicate well with patients when they use a patient-centred approach. How-
ever, health care organizations do not appear to value or recognize the importance
of nurses using a patient-centred approach when communicating with patients to
ensure the delivery of quality patient care.
Relevance to clinical practice. The implication of these findings for clinical practice
is that the task-centred approach to patient care that is associated with nursing in
the past, appears to be alive and well. If health care management want to ensure that
patients receive quality nursing care, they will need to consider patient-centred
communication to be essential to encourage and support nurses to communicate in
this manner.

Key words: communication, empathy, nursepatient communication, patient satis-

faction, phenomenology, socialization

cation involves more than the transmission of information;

Introduction
According to Arnold & Boggs (1995) and Balzer-Riley
(1996), communication is a reciprocal process of sending
and receiving messages using a mixture of verbal and non-
verbal communication skills. However, Sheppard (1993)
suggests that, in the nursepatient relationship, communi-
it also involves transmitting feelings, recognizing these
feelings and letting the patient know that their feelings
have been recognized. Peplau (1988), Severston (1990),
Fosbinder (1994), Wilkinson (1999), Attree (2001) and
Thorsteinsson (2002) support this view and indicate that
communication is a fundamental part of nursing and that

2004 Blackwell Publishing Ltd 41

C. McCabe
the development of a positive nursepatient relationship is
essential for the delivery of quality nursing care. However,
Crotty (1985), Reid (1985) and Hodges et al. (1986) also
highlight that nurses do not communicate well with patients
and approach patients only to deal with administrative or
functional activities. Morse (1991), Bergen (1992), Haggman-
Laitila & Astedt-Kurki (1994), Jarman (1995), Hostutler
et al. (1999) and Jarrett & Payne (2000) suggest that this is
because nurses are not aware of the meaning and significance
of the nursepatient relationship for patients. This lack of
awareness by nurses results in them making assumptions
about what nursing care a patient needs or wants because they
do not ask patients (Bergen, 1992; Booth et al., 1996). This
type of communication is not patient-centered and can
adversely affect the development of a positive nursepatient
relationship that is essential for the provision of quality
patient care. Patient-centred communication is defined by
Langewitz et al. (1998, p. 230) as communication that invites
and encourages the patient to participate and negotiate in
decision-making regarding their own care.
Literature review
In order to investigate trained nurses self-perception of
their communication skills, Burnard & Morrison (1988,
1989, 1991) conducted studies using Herons six-category
intervention analysis. The findings of these studies were
consistent, in that the participants generally perceived
themselves to be more skilful in the authoritative than
facilitative categories. The authoritative interventions at-
tempt to direct or control patient behaviour while the
facilitative interventions attempt to empower the patient.
Burnard & Morrison (1988, 1989, 1991) propose that the
findings of their studies be used as a basis for planning and
developing education programmes for training and research
into nurses interpersonal communication skills. However,
the findings of these studies are limited by the use of
Herons framework because it does not take account of
how contextual differences influence which intervention is
used by nurses and it is impossible to know to what degree
nurses focused on their intentions or actual behaviour in
nursepatient interactions. Therefore, the relevance of the
findings for changing or developing nurses interpersonal
communication skills can only be viewed tentatively.
Ashmore & Banks (1997) concur with this view and
recommend that further exploration of patients perceptions
of nurses communication skills be conducted. If, as Briggs
(1982), Macleod Clark (1985), Severston (1990), Fosbinder
(1994) and Oermann et al. (2000) suggest, good commu-
nication is essential for quality nursing care, then it is
42
2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 4149
imperative that nursing research elicits patients experiences
of nursepatient communication and identifies what they
value most in their interactions with nurses (Haggman-
Laitila & Astedt-Kurki, 1994). Such information can inform
nursing theory and education and, therefore, allow nurses
to develop patient-centred communication skills that are
fundamental to the delivery of quality nursing care.
Another view presented by Menzies (1960, 1970), Burton
(1985), McMahon (1990), Telford (1992) and Chant et al.
(2002) suggests that nurses do not communicate well because
of the organizational culture. Traditionally nurses were not
encouraged or supported by ward or hospital management to
establish therapeutic relationships with patients. According
to Menzies (1960, 1970) the reason for this is to protect
nurses from difficult emotional situations, thereby preventing
stress. Studies by Wilkinson (1991) and McColl et al. (1996)
conducted 25 years later concur with this. They found that
nurses have the necessary skills to communicate well with
patients but choose not to because of the lack of organiza-
tional support and encouragement. It appears that, over the
last 40 years, this organizational strategy to prevent stress has
resulted in a socialization process that has perpetuated the
notion in nursing that patient-centred communication should
be discouraged and is unsupported by management (Wilkin-
son, 1991; Graham, 1994; Cody, 1998; Williams, 1998).
Bowles et al. (2001) supports this view and adds that
criticism of nurses communication may be unrealistic as no
benchmark for effective nursepatient communication cur-
rently exists. However, in order to establish a benchmark for
effective nursepatient communication it is essential to
discover patients experiences and views.
Design and method
The purpose of this study was to explore and produce
statements relating to patients experiences of how nurses
communicate with them. A qualitative perspective using a
Heideggarian/Gadamarian hermeneutic phenomenological
approach was chosen for this study because it is concerned
with reaching a new understanding of the meaning of the
phenomenon (nursepatient communication) being studied as
experienced by the participants (LoBiondo-Wood & Haber,
1998). The site chosen for this study was a general hospital in
the Republic of Ireland and ethical approval was granted by
the Hospitals ethics committee.
Sampling
Using purposeful sampling, eight patients agreed to partici-
pate in the study. Purposeful sampling is where the
Issues in clinical nursing
participants are selected prior to the study on the basis that
they have experience of the phenomenon being studied and
can articulate this experience (Holloway & Wheeler, 1996;
Mays & Pope, 1996). Each participant provided written
consent and chose a pseudonym that was the only identifica-
tion used on any documentation related to the study, thus
ensuring their anonymity. The participants included three
males and five females whose ages ranged from the mid-20s
to early 70s and who had been inpatients for a minimum of
4 days. This meant that each participant would have com-
municated regularly with nurses during their stay.
Data collection
Data were collected using unstructured interviews that were
tape recorded and lasted 30 minutes on average. Each
interview began with me asking the participant to tell me
about his/her experiences of how nurses communicated
with her/him during their time as an inpatient. The
participants were asked to clarify and elaborate on certain
issues as this helped the researcher to understand the
meaning of the experience of how nurses communicated for
individual patients. At some stage during most of the
interviews the participants talked about issues unrelated to
nursepatient communication. Holloway & Wheeler (1996)
refer to this as dross and say that unstructured interviews
will always contain a certain amount of irrelevant material.
In order to re-focus the participants during interviews I
asked the same question If you had to describe the
qualities required to be a good communicator, what would
you say they were? This was sufficient to re-focus the
direction of the interview.
Data analysis
The aim of data analysis in phenomenological research is to
reveal the meaning of the lived experience of the phenomenon
being studied for the participants. According to Bergum
(1991) and Ray (1994) data analysis in hermeneutic phe-
nomenological research is a reflective process. Data analysis
in this study was a reflective process using the metaphor of
the hermeneutic circle to explain the dynamic nature of
gaining an understanding of a phenomenon (Annells, 1996)
and reference to Gadamers fusion of horizons to explain
how the researcher came to a new understanding of the
meaning for patients of nursepatient communication. This is
presented through the description and interpretation of
themes and sub-themes. In order to demonstrate trustwor-
thiness in this study Sandelowskis (1986) framework was
used. This framework comprises four factors that are

2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 4149
Nursepatient communication
essential for demonstrating trustworthiness. These factors
are: credibility, fittingness, auditability and confirmability.
The credibility of this study was achieved by including an
interview transcript and a thick description of one of the
themes in the final report. As no personal information was
recorded during the interviews, all audiotapes used to record
the interviews have been retained by the researcher as a
record of data authenticity. Fittingness occurs when the
findings of a study fit into similar contexts outside the study.
The literature used to discuss the findings demonstrates its
fittingness. Auditability of this study was achieved by
recording details explaining and justifying any decisions
made regarding the study in a reflective journal and incor-
porating this information into the final report as a decision
trail. The confirmability of this study arises from its
credibility, fittingness and auditability (Sandelowski, 1986).
Findings
Four main themes relating to aspects of nurses communica-
tion emerged from the data analysis.
Theme 1 lack of communication
The participants in this study frequently referred to how
nurses did not provide enough information and many
commented on how nurses were more concerned with tasks
than with talking to them. However, all the participants said
that it was not the nurses fault as they were too busy. This
theme will be discussed under two sub-themes, patient-
centred communication and task-centred communication.
Patient-centred communication
Patients in this study were reassured when the nurses used a
personal approach when communicating with them:
shed say how are you today John?its things like that that help
to cheer you up, particularly when youre in hospital. (Mr Clinton)
Some of the participants felt that nurses did not commu-
nicate in a patient-centred way because they made assump-
tions about their concerns and needs. This view is supported
by the literature (Bergen, 1992; Booth et al., 1996; Nordgren
& Fridlund, 2001):
Yea they (the nurses) were all nice it was just one nurse taking it
into her own hand like changing your medicationnot changing it
like but giving it when she thought I think she thought she was able
to tell me me body . (Jane)
This participant goes on to describe how important it is for
nurses to talk to them as individuals:
43
C. McCabe
Yea, like if shed had have said to me do you feel that you need them
now? It doesnt matter how you lookyou could say either yea or
no. (Jane)
Task-centred communication
Many of the participants identified how nurses were more
concerned with doing their work than communicating with
them personally:
especially after nine in the morning and theyre coming around,
em, after your breakfast and theyre rushing the beds. You know I
heard one woman saying, Oh you might have let me drink me cup of
tea. (Mrs Brown)
Patients did not blame nurses for having a task-centred
approach. However, this approach resulted in patients feeling
that the tasks were more important than they were. Conse-
quently, they did not like to bother the busy nurse:
Every few minutes theyd come in the only time theyd sit down was
when they were taking your blood pressuretheyd sit there for a few
minutes and then move on to the next patient. (Charlie)
When asked if the nurses spoke to him when they sat
down, Charlie said, very little and then added:
I think thats the slackest part but as I said, they cant be sitting down
talking with patients Id say theyd be neglecting their own work
then (Charlie)
A possible impact of nurses using a task-centred approach
when communicating with patients is that patients view
nurses as workers not professionals. When asked if he
received information about his condition from nurses, Char-
lie replied:
Oh well theyd never tell you that, I suppose bar you ask them, but Id
always wait until the Doctors came around. (Charlie)
Another participant excused nurses lack of communication
by implying that it was out of their control:
you cannot expect nurses to hold a conversation with you when
they see consultants coming along. (Sophie)
Nurses were seen by these two participants as a disem-
powered and subservient group of people who carried out the
orders of consultants. Crowe (2000) supports this and
suggests that a task-centred approach to care ensures the
standardization and predictability of the nurses performance
in the nursepatient relationship and is another possible
reason why it is supported by organizational management.
The result is that the nursepatient relationship is devalued
by nurses in favour of a task-centred approach to patient
care.
44
Theme 2 attending
Attending behaviour is described as the physical demon-
stration of nurses accessibility and readiness to listen to
patients through the use of non-verbal communication
(Stein-Parbury, 1993). Attending is a patient-centred process
and the basic conditions required on the part of the nurse
for attending to occur are genuineness, warmth and
empathy (Burnard, 1990; Stein-Parbury, 1993). Although
considered an attending behaviour, empathy emerged from
this study as a main theme, therefore, is not discussed in
relation to attending. Although the participants of this study
did not refer directly to the term attending, they described
nursing behaviours they valued which are specific to
attending. These behaviours will be discussed as the sub-
themes, giving time and being there, open/honest commu-
nication and genuineness.
Giving time and being there
According to Pontin & Webb (1996) this incorporates giving
attention and showing concern for patients:
They (the nurses) always found some time to talk with you and you
felt happy when they were gone and theyd come back again, even on
their busiest days (Sophie)
This results in patients feeling that nurses are regularly
monitoring their physical condition and also their psycholo-
gical and emotional well being (Pontin & Webb, 1996):
theyd (nurses) call you by your name theyd comment, theyd
talk to you even if the ward was busy. (Claire)
Benner (1984) suggests that expert or senior nurses have
the self-esteem and confidence to recognize the value of their
time and presence for their patients. However, participants
in this study suggest that senior nurses did not demonstrate
this because although they had the skills, they were too
busy:
the more senior nurse would come and shed be good but she had a
lot of responsibilityit wouldnt be as easy for her as the others
she had the ward round consultants coming and going (Sophie):
the students, they were very understanding and you could actually
talk to them which was lovely. If there was something worrying you,
you could actually say it (Jane)
A possible reason why student nurses give patients more
time and allow them to talk to them is that they have not yet
been fully socialized into communicating in a task-centred
way or because of their lack of expertise there are not as
many demands made on their time.

2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 4149
Issues in clinical nursing Nursepatient communication

Open/honest communication There was one particular girl, she was lovely every morning shed
According to McCann & Baker (2001), open and honest come in and ask how you were or if she was going by shed wave in to
communication helps patients to deal positively with their you. (Jane)
illness. The participants of this study valued open/honest
Participants were able to differentiate quite precisely what
communication from nurses and relied on nurses to use lan-
aspect of a nurses non-verbal behaviour was unhelpful:
guage that they could understand:
I wouldnt say it was their body language but their tone was like, em,
I think no matter how small or how big a persons diagnosis is, it
I like to be the boss the little authority (Jane)
should be explained from day oneI think from when doctors come
around they dont actually convey a lot of information and it is left
probably to the nursesId prefer if someone calm said would you Theme 3 empathy
like to know? and to be honest and frank (Claire)
Although the participants in this study did not refer directly
One participant described the reaction from the nurse to the term empathy they referred frequently to many of the
when she requested analgesia: behaviours that according to Morse et al. (1992) form the
basis of empathetic communication. Empathetic communi-
then one of them (staff nurses) would mutter to the other like they
cation is described as communication that emphasies the
cant understand how Im getting two drugs together They actually
process of emotional engagement of the nurse with the
told me they were too strong. I dont care I said, theyre making my
patient (Morse et al., 1992).
pain go away and they were doing nothing to me like making me
dizzy or anything. (Jane) I liked them all, but there was one little girl, she was slightly different
sympathetic I would say. I think the patient deserves sympathy
When asked how she felt when the nurses communicated
when they are hospitalised, their complaint may not warrant
like this, Jane replied:
sympathy but theyre away from their own environment (Sophie)
I felt I could trust her all rightit was in my interest that she was
According to Morse et al. (1992) sympathy is a first-level
looking at itbut she had no kind of experience with meI was
empathetic response and is a verbal and non-verbal expres-
kinda getting a bit frightened (Jane)
sion of the nurses own sorrow or dismay at the patients
This comment suggests that when nurses use this non- situation. When nurses were sympathetic, the participants in
patient-centred type of communication, it can have a negative this study felt that their feelings were justified and made them
effect on a patients sense of well-being and security. feel like the nurses understood their situation and cared about
them as a person. It seemed important to the participants that
Genuineness nurses communicate their recognition and understanding of
Egan (1994), p. 55) says that genuineness is beyond profes- the patients situation. They did not expect the nurse to be
sionalism and phoniness. It is an attitude and behaviour that able to fix everything, but it alleviated their anxiety and
can only be expressed if the nurse is self-aware (Burnard, uncertain feelings when they knew that someone understood
1990; Stein-Parbury, 1993). Participants in this study referred how they were feeling:
to both the nurses verbal and non-verbal communication
During the night when I couldnt sleep, one (nurse) came over
when identifying genuine behaviours although non-verbal
because she noticed that I was still awake, to see if I was OK that
behaviours predominantly influenced when patients per-
stuck in my mind She knew that I was tired and that I wanted to try
ceived a nurse as genuine or not:
and sleep but just couldnt so she came over (Mary Ann)
she just had a way about herits hard to put your finger on it but
The participants trusted nurses who empathized with them
she was jolly and I wont say devil may care but once you were all
and were able to identify specific nursing behaviours that
right, that was everything (Mr Clinton)
demonstrated empathetic communication:
The participants valued non-verbal communication as an
I think the reassurance from the nurse with me at the time of my
indicator of genuineness because it demonstrated emotional
diagnosis she made me feel at ease straight awayShe just
support, understanding and respect for them as individuals
organised everything and was really relaxed and wasnt watching her
(Bottorff et al., 1995).
watch to see was she running late she was just awfully concerned
Many of the participants in this study formed special
and at the same time, very professional. She added the human touch,
relationships with the nurses that they perceived to be most
like as if she knew what it was like in my shoes (Claire)
genuine:

2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 4149 45

C. McCabe
Morse et al. (1992) describe this communication as second
level empathetic communication response. The nurse has
communicated her understanding of Claires predicament
and is reassuring Claire by sharing her self. This type of
empathy is considered to be patient-focused and results in
patients feeling secure and reassured (Morse et al., 1992).
This participant also described her experience of non-
empathetic communication from nurses which made her feel
frustrated and uncared for:
I didnt have a shower for the first two days at allit just would have
taken somebody sensitive enough to understandI mean you can
imagine what you feel like when you cant even wash yourself.
(Claire)
Theme 4 friendly nurses and humour
All the participants in this study commented on how friendly
and happy the nurses were:
I found them absolutely wonderfulthey were good crack and very
friendly, made you feel at home (Mrs Brown)
Many of the participants in this study also expressed an
appreciation of humour in nursepatient interaction:
when theyre coming around with the medicines, they are laughing
and joking with everyone on the wardId have a great joke with
them (Mrs Brown)
In this study, humour appeared to improve the partici-
pants self-esteem when they could make others laugh and
when they could laugh with the nurses. It seemed that the
nurses who used humour appeared more approachable to the
participants:
Theyd (staff nurses) have a laugh and a joke with youthats what
impressed me an awful lot about them. They were very friendly, very
nice, you could have a good talk, you could even have a joke on
themtheyd know when youd be doing a bit of slagging. (Mr Kelly)
Discussion
Lack of communication was the theme referred to most
frequently by the participants in this study. They commented
on how nurses were more concerned with completing their
tasks than talking to them. Some of the participants were
frustrated by this and felt that the nurses did not care about
them as individuals. Other participants acknowledged that
nurses were more concerned with their work and accepted
this as being normal, although they did indicate that they
would have liked to be treated as an individual. However,
regardless of how the participants felt about how nurses
46
communicated, they did not blame them. They all attributed
the nurses poor communication skills to them being too
busy. Pontin & Webb (1995) and Attree (2001) suggest that
patients are reluctant openly to criticize nurses because of a
fear of retribution or the passive nature of the patient role or
acceptance of the national health care delivery. They propose
that instead patients wrap up their criticisms in socially
acceptable responses (Pontin & Webb, 1995). This type of
communication is particularly evident in the responses from
the participants in this study. However, it remains very clear
from the participants responses that nurses do not always
communicate in a patient-centred way. According to Sines
(1995) patients become empowered by a patient-centred
approach to communication. It allows them to be a partner in
making decisions about their own needs rather than the
nurses making assumptions about what their needs are (Sines,
1995). Patient-centred communication does not take up more
of the nurses time or require extra resources (Astedt-Kurki &
Haggman-Laitila, 1992; Williams, 1998), it is initiated by
nurses in the words and body language that they choose to
use when approaching patients.
A possible reason why nurses do not always communicate
in a patient-centred way is that although they have the
necessary communication skills, they choose to use task-
centred communication as a protection mechanism against
emotional or advocacy aspects of their work (Sines, 1995;
Kruijver et al., 2001). This could be because they feel
unsupported or even discouraged from communicating in a
patient-centred way by management (McMahon, 1990;
Wilkinson, 1991; Telford, 1992).
The second theme that emerged from the data was
attending. When the participants experienced some or all
of these behaviours they felt reassured, safe and cared for as
an individual. Attending behaviours as experienced or valued
by the participants in this study do not require extra time or
resources. Knowing that they can trust the nurses to be open/
honest, understanding and be available if they needed them
was the level of commitment required by the participants.
However, the effective use of attending behaviours by nurses
requires that they value patient-centred communication
(Arnold & Boggs, 1995) and have a strong sense of self-
awareness (Burnard, 1990).
The third theme that emerged from the data is empathy.
Empathy is defined by Reynolds & Scott (2000), p. 226) as:
the ability to perceive and reason as well as the ability to
communicate understanding of the other persons feelings and their
attached meanings
Reynolds & Scott (2000) describe empathy as an essential
prerequisite for good nursing practice. If nurses fail to

2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 4149
Issues in clinical nursing
empathize with their patients, then they cannot help them to
understand or cope effectively as individuals with their illness
(Morse et al., 1992; Peplau, 1997; Reynolds & Scott, 2000).
Most of the participants had positive experiences of empa-
thetic communication by nurses. However, one participant
also experienced non-empathetic communication. This made
her feel unhappy, uncomfortable and uncared for. Although
the issues that she refers to are physical needs, it is important
to note that, by not meeting the participants physical needs,
the nurses were failing to communicate to her that they
understood her predicament or needs. This supports the view
that empathetic communication is an essential prerequisite
for the delivery of quality nursing care. Because of the
positive influence that empathetic communication and the
negative influence non-empathetic communication has on
patients, it is essential that nurses are aware of the impact of
the way they choose to communicate has on their patients.
The implications are that nurses who chose to use non-
empathetic communication favour task-centred rather than
patient-centred communication. According to Gould (1990)
the professional socialization of nurses encourages them to
lose their individuality and lose the natural ability to
empathize. This concurs with the literature (Menzies, 1960,
1970; Burton, 1985; McMahon, 1990; Telford, 1992;
Graham, 1994; McColl et al., 1996) which suggests that
the professional socialization of nurses results in task-centred
communication rather than patient-centred communication.
The fourth theme that emerged from the data referred to
friendly nurses. All of the participants in the study praised
the nurses for being friendly, chatty and humorous. This
fulfilled an important social function by relaxing the partic-
ipants, passing the time and helping them to forget their
troubles. A possible reason why all the nurses used humour
and were friendly and chatty was that they perceived it as a
superficial level of communication that creates an atmosphere
that although relaxed and sociable, is unsuitable for dealing
with emotional or difficult issues. The nurses, therefore, felt
relatively safe communicating this way with all the partici-
pants. In contrast, although they can be superficial, social
interactions give patients the opportunity to step out of their
sick role and according to Sumners (1990) and Astedt-Kurki
(2001) humour in the nursepatient relationship helps to
establish rapport and trust, relieves anxiety and tension and
conveys unspoken emotional messages. This is evident from
the findings of this study. The participants appeared to value
highly the informal humorous exchanges with the nurses.
This type of communication can help to pass the time and
deflect from mundane, routine hospital life and patients are
frequently instrumental in creating such interactions (Hollo-
way et al., 1998; Jarrett & Payne, 2000).

2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 4149
Nursepatient communication
Implications
The participants in this study indicate that nurses do not always
communicate in a patient-centred way even when they have the
ability to do so and that nursepatient interaction is heavily
influenced by the work and culture of the organization (Jarrett
& Payne, 2000). However, the literature (Peplau, 1988;
Severston, 1990; Fosbinder, 1994; Redfern & Norman,
1999; Thorsteinsson, 2002) suggests that a positive nurse
patient relationship is essential for quality nursing care and
that this can only be achieved through patient-centred
communication. The implications of this are that, if health
care management want to ensure that patients receive quality
nursing care, they will need to consider positive nursepatient
communication as essential and not an optional extra (Attree,
2001; Chant et al., 2002). Spending long periods of time with
patients does not always result in a positive nursepatient
relationship. Astedt-Kurki & Haggman-Laitila (1992) sug-
gest that patient-centred communication does not require
additional resources. This implies that staff shortages or
being too busy cannot be used as an excuse for poor nurse
patient communication. It is the quality of the interaction
that determines whether the relationship is a positive one or
not and it is the nurse who has the greatest influence on
whether this happens (Milne & McWilliam, 1996). Com-
mitment to providing patient-centred care and a change in
individual, professional and organizational values is sufficient
(Attree, 2001) in order to result in the delivery of high quality
nursing care.
At an undergraduate and postgraduate level, education
relating to patient-centred communication should focus on
illustrating that this type of communication does not require
a great deal of time. Role-play and the use of critical
incidences is an ideal way of helping students and staff nurses
to critically reflect on how they communicate with patients
(Quinn, 1995). This would also help to develop their sense of
self-awareness and subsequently increase their ability to
communicate using attending and empathetic communication
behaviours. The consequence of this in conjunction with
other organizational factors is the delivery of high quality
nursing care. This type of teaching strategy would require
small group teaching and this has implications for how large
undergraduate groups of students are organized for the
effective use of such strategies. The findings of this study and
similar patient-focused studies could, however, be used to
inform even large groups of nursing students about what
patients value about nursepatient communication.
There is a need to conduct further research that explores
patients experiences of how nurses communicate rather than
conducting studies that examine nurses views of what they
47
C. McCabe
perceive good nursepatient communication to be. Patient
focused studies may identify specific nursing behaviours that
patients value highly in terms of patient-centred communi-
cation. This kind of information would allow nurses to
demonstrate and develop specific interpersonal skills that are
patient-centred.
A possible limitation to this study is that the small number
of participants means that the findings cannot be generalized
to a wider context or population, however, the findings are
useful in that they can be used to inform undergraduate and
postgraduate nursing students about the possible impact of
their communication behaviour on the delivery of quality
nursing care.
Conclusion
The findings of this study indicate that in contrast to the
literature that suggests that nurses are not good at commu-
nicating with patients, nurses can communicate well with
patients when they use a patient-centred approach. However,
health care organizations do not appear to value or recognize
the importance of nurses using a patient-centred approach
when communicating with patients to ensure the delivery of
quality patient care. Another reason why nurses may not
communicate in a patient-centred way is that they do not
know what patients value about nursepatient interactions.
This lack of evidence also limits the way in which nurses are
educated in relation to how to communicate in a patient-
centred way. Unless health care organizations and nurses
recognize the importance of communicating in a patient-
centred way in order to deliver good quality care, the task-
centred approach to patient care as experienced by the
participants in this study will continue.
Contributions
Study design: CM; data analysis: CM; manuscript prepara-
tion: CM.
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