The purpose of communication in the health care arena is to improve client outcomes through the exchange of thoughts, feelings, and other information. The components of communication are the sender, the message, the channel, the receiver, and feedback. The sender is the person who is transmitting a message. The message is delivered through an auditory, visual, or kinesthetic channel to the person who is the receiver. The receiver interprets the message. The process of communication is cyclical, in that the receiver provides feedback—information that influences further communication—to the sender.

Several factors influence communication, including perception, one’s subjective sense of the world; the cultural context of the interaction; space and distance, particularly one’s perception of personal space; and the amount of time available for the interaction. The levels of communication are intrapersonal, known as “self-talk”; interpersonal, occurring between two people; group, occurring between three or more people; and interdisciplinary, occurring among professionals. Possible purposes of group communication are to accomplish a task, to improve members’ coping skills, to help each other change behavior, or to provide self-help skills for particular problems, such as alcoholism.

The modes of communication are verbal, nonverbal, written, or artistic expression. Verbal communication is the use of words or language to transmit an idea. Verbal communication can be written or oral. People sending nonverbal messages use body language, such as facial expression, eye contact, posture, physical appearance, artifacts (objects), or gestures.

Therapeutic communication is a purposeful, non-judgmental, and client-centered form of interaction, intended to produce a positive client outcome. The elements of therapeutic communication are empathy, trust, honesty, validation, caring, and active listening. The techniques used in therapeutic communication are helping the client set the pace, encouraging spontaneity in the client, responding to client cues, encouraging the client to express feelings, and encouraging the client to make behavioral changes. Therapeutic communication should remain confidential at all times.

The barriers to therapeutic communication are language, culture, gender, health status, developmental level, emotional maturity, the use of health care jargon, and communication blocks. Communication blocks are numerous. Examples include judging, disapproving, advising, or blaming. Vulnerable clients provide greater communication challenges. Examples of vulnerable clients are those who are hearing or visually impaired, aphasic, unconscious, confused, or angry.

Communication is an inherent part of the nursing process. Eliciting a client history requires understanding between the nurse and the client. Nurses need to use open-ended questions to obtain information; consider the age, developmental level, cultural background and health status of the client; consider the client’s knowledge base and literacy level; and remain calm and caring during assessment.

The basic nursing diagnosis appropriate for clients who cannot send, process, or receive a message is Impaired Verbal Communication. Other possible nursing diagnoses are Social Isolation, Anxiety, and Low Self-Esteem, all of which are related to Impaired Verbal Communication. Impaired verbal communication is seen in people who are disoriented, have difficulty speaking, who are unwilling to speak, or who are unable to speak the language.

Nurses can use a variety of approaches to communicate with clients, including using pictures and diagrams, avoiding medical jargon, using written material, and using an interpreter when there is a language barrier. Accurate communication is an essential part of evaluating the outcome of nursing care.