Use of effective interpersonal communication strategies by nurses in both personal and professional settings, may reduce stress, promote wellness, and therefore, improve overall quality of life. This article briefly explores the concept of interpersonal communication as it relates to Maslow’s hierarchy of human needs; describes personal variables and the interaction of internal and external variables that can impact communication; and discusses possible causes and consequences of ineffective communication. Drawing on both the literature and experiences as a longtime provider of care in the mental health field, the author offers multiple practical strategies, with specific examples of possible responses for effective communication. Recommendations in this article are intended for nurses to consider as they seek healthy communication strategies that may be useful in both their personal and professional lives.
Communication is an integral part of life; without it, we would not survive. Verbal and non-verbal communication begins at birth and ends at death. We need communication not only to transmit information and knowledge to one another, but more importantly, to relate to one another as human beings around the world in the context of relationships, families, organizations, and nations.
The how, what, why, and wherefore of communication can either edify or harm us, as individuals, cultures, religions, and governments of countries, as we attempt to coexist. What we say, how we say it, and what we mean by it are extremely important, and can be life-changing. I recollect two teachers in elementary school. To me, one was a kind, caring person; the other was mean and sarcastic. Students, especially children, are particularly vulnerable during their formative years. Adults, teachers, and other children have the power to either help us blossom as an individuals or to destroy our self-esteem, and thus impact our potential for life. How? A kind (or cruel) word, or facial expression, can mean the world to a child. These two teachers in my past were polar opposites, but both affected me deeply.
In our professional roles as nurses, we are responsible to care for persons who are ill. When ill, patients may be unable to speak or advocate for themselves. Vulnerable patients need our voices to speak for them. Due to our constant exposure to other human beings who are suffering, nurses are perfectly positioned to utilize effective interpersonal communication, and in doing so, support our own emotional, psychological, and spiritual development.
There is a well-established link between team communication, worker morale, and patient safety. Poor team communication has been directly linked to preventable medical errors, high nurse turnover rates, and low morale (Brinkert, 2010; Institute of Medicine, 1999; Vessey, DeMarco, & DeFazio, 2010). Low morale contributes to high levels of stress, burnout, poor job satisfaction, and an overall poor quality of life. Controlling stress and burnout is an essential component of a healthy lifestyle.
Use of effective interpersonal communication strategies by nurses… may reduce stress, promote wellness, and therefore, improve overall quality of life. Use of effective interpersonal communication strategies by nurses in both personal and professional settings, may reduce stress, promote wellness, and therefore, improve overall quality of life. This article briefly explores the concept of interpersonal communication as it relates to Maslow’s hierarchy of human needs; describes personal variables and the interaction of internal and external variables that can impact communication; and discusses possible causes and consequences of ineffective communication. Drawing on both the literature and my experiences as a longtime provider of care in the mental healthcare field, I offer multiple strategies, with specific examples of possible responses for effective communication. Recommendations in this article are intended for nurses to consider as they seek healthy communication strategies that may be useful in both their personal and professional lives.
Interpersonal Communication and Maslow’s Hierarchy of Human Needs
In 1943, Abraham Maslow developed a hierarchy of human needs wherein he described the basis of human behavior in terms of the priorities of survival (Figure 1). Oxygen, food, water, and shelter, our most basic needs, must be met first. Once these basic needs are met we can progress upward in the hierarchy toward fulfillment of needs for safety/security, love/belonging, and esteem. Finally, according to Maslow, the highest human needs revolve around finding one’s purpose and realizing one’s full potential, which culminate at the pinnacle of the hierarchy in self-actualization.
Maslow’s hierachry of human needs can be applied to interpersonal communication. The concept of communication can be most appropriately considered in the context of three levels of the hierarchy: safety, love/belonging, and esteem. Of these, safety has the most intimate involvement with basic, “primitive” needs. For example, it feels very personal when one’s safety is threatened by loss of any kind, whether it is a perceived or actual loss. A loss can invoke anger, grief, or fear in response to feeling helpless, powerless, unsafe, and vulnerable. Likewise, effective or ineffective communication may impact our ability to satisfy the needs of love and belonging, and also esteem.
… little has addressed how effective interpersonal communication can contribute to a healthy lifestyle in both the personal and professional life of the individual nurse. Many would agree that interpersonal communication is an intimate, human activity that can weigh heavily on our overall psychological health and wellness, and therefore, warrants much discussion and attention. Despite this realization, the literature, especially in nursing, has not addressed this topic adequately. Although much has been written on workplace safety, lateral violence, and bullying to address issues that we face as professionals in the workplace, little has addressed how effective interpersonal communication can contribute to a healthy lifestyle in both the personal and professional life of the individual nurse. As each person seeks to meet his or her human needs, a number of variables, both internal (or personal factors) and external (or behavior of others) can combine to support effective or ineffective interpersonal communication. The next section will offer professional insight that I have gained in my nursing practice related to how multiple variables may impact communication. I offer this not as an exhaustive list of variables, but in the hope that it will provide some context for readers to reflect on their own unique mix of variables as they go on to read and consider the recommendations for effective communication.
Personal Variables: Internal Predisposing Factors
Human beings are complex creatures. We are composed of a plethora of variables that are continuously interacting with one another. Some of these personal variables are internal in nature; they are part of our makeup. Figure 2, developed by the author, is a simple representation of how variables might interact to produce a unique individual. In addition to our genetic makeup and gender, the variables (termed internal predisposing factors) consist of thoughts, feelings, and perceptions that are often learned early in life and shaped by childhood upbringing and experiences. In my clinical experience with patients, I have observed that early experiences can affect persons deeply, and perceptions of these experiences are not easily changed. Indeed, the impact of these experiences can cause a person to be rigid and inflexible. For example, a person who has been abused physically, verbally, or sexually by the opposite sex, and unhealed from this, can become unyielding in any future interactions with persons of that gender regardless of the situation or circumstances. However, all is not lost. In addition to factors that CAN be controlled and factors that CANNOT be controlled, there are factors that may change over time. Consider the variables listed in Figure 2. Which can be changed or controlled? Which cannot? Which are subject to change? These are important distinctions that will become clearer in the discussion of the following sections, as applied to interpersonal communication.
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Figure 2: Personal variables: Internal predisposing factors (Source: Author)
Interaction of Internal and External Variables
Figure 3, developed by the author, represents how internal personal variables demonstrated in Figure 2 and external variables (behavior of others and situations) might interact. Further, consider how the interactions depicted in Figure 3 could influence the outcome and effectiveness of (our) interpersonal communication. Understanding and acceptance that one cannot control others and/or situations can create the psychological freedom necessary to develop insight into one’s own behavior. That insight can be the first step toward positive change and improve communication. The next section will consider some causes and consequences of ineffective interpersonal communication, along with strategies and selected examples to support alternatives.
Figure 3: Interaction of Internal and External Variables (Source: Author)
Causes and Consequences of Ineffective Interpersonal Communication
Some consequences of ineffective interpersonal communication can be chaos, confusion, disorder, fear, conflict, inefficient systems, and wasted resources. Some consequences of ineffective interpersonal communication can be chaos, confusion, disorder, fear, conflict, inefficient systems, and wasted resources. Poor team communication has been cited as the number one cause of unnecessary patient deaths related to medical error since the 1990s (Institute of Medicine, 1999). Further, criticism has been directed at healthcare providers, including physicians, for their lack of study of interpersonal communication (Hull, 2007; Shapiro, 2011). Although numerous interpersonal communication theories exist, few have been applied to healthcare communication or utilized in any relevant manner by providers (Bylund, Peterson, & Cameron, 2012). Thus, a knowledge gap exists necessitating a frank discussion and pragmatic strategies for change. This section will offer selected strategies for effective communication for consideration, drawn from both literature and practice experience.
Personal life versus professional role calls us to develop and apply competent skills based on the specific situation, and adopt an appropriate demeanor and response. However, behavior based solely on role expectations may not always be appropriate. Here are some suggestions to begin to think differently. When applying what is discussed in this article to your personal and professional lives, think of yourself holistically. In other words, you cannot compartmentalize basic personality structure, or your personal way of relating to the world; you are who you are. Divorce yourself from antiquated acculturated role expectations of how women or men and nurses are supposed to behave. Strive to develop new ways of relating to support more rewarding interpersonal communication experiences.
One way to do this is to think in terms of the use of “self” versus “skills.” Effective interpersonal communication is much more than techniques, skills, or procedures to be mimicked or parroted. Parroting or mimicking is generally viewed as insincere; if one behaves as a robot, most people will sense this. To say one must perform a certain skill or competency, in my opinion, diminishes our ability to have spontaneous human interactions that are meaningful. Techniques and skills can become too automatic and thus may limit your options.
Genuine human rapport requires creativity and flexibility. Genuine human rapport requires creativity and flexibility. Best practice would dictate relating genuinely, human to human, and disregard of communication “scripts.” Since new behavior can be risky and frightening, pragmatic strategies aimed at prevention of ineffective interpersonal communication are needed. With this goal in mind, Table 1, developed by the author, provides a brief overview of possible causes, consequences and cures for ineffective interpersonal communication, as well as possible strategies and/or examples for application. The section that follows elaborates on the information in Table 1 and offers additional discussion and/or practical guidance.
Table 1: Ineffective Interpersonal Communication: 12 Possible Causes, Consequences, Cures, and Examples for Effective Communication (Source: Author
| Possible Causes | Possible Consequences or Interpretations | Possible Cures/Strategies | Examples of Possible Wording for Effective Communication |
| 1. Social/Familial/ Organizational/Cultural Taboos regarding “No Talk” Issues. | FrustrationHelplessnessLack of TrustSubstantive Issues are ignored | Talk openly about the cultural taboos and how they may have contributed to a climate wherein people are reluctant to share or tackle difficult issues. | “I am not really comfortable bringing this up, but I feel we need to address it.”“I am concerned about a patient safety issue that I want to bring to the attention of the team.”“There is an issue that is bothering me, and I feel we need to discuss it.” |
| 2. Poor Conflict Management Skills | Inappropriate and misdirected angerFinger pointingBlaming | Learn how to respectfully disagree.Become comfortable with affect (yours and others).Remain calm and professional in all situations. | “I can see that you are upset. I would like to discuss this calmly and rationally.”“Perhaps we can negotiate a compromise, middle ground?”“It looks like we may not agree on this, so let’s table it for now and discuss again.” |
| 3. Poor Negotiation/Problem-Solving Skills | Knee jerk responsesTemporary or short-term fixes (sometimes referred to as “Band-Aids”)Focus is on “putting out fires” rather than vision | Learn skills for collaboration.Become comfortable with unfinished (long term) solutions.Discover your strengths and those of others.Assign or negotiate tasks/workgroups/projects based on individual strengths and interests, versus a “we just need a warm body to complete this” approach. | “If you could do what you enjoy most, what would that be?” |
| 4. Lack of Empathy/Understanding of Others | Poor team work/spiritLack of cooperationWasted time and resources | Widen your perceptions and awareness of those around you and the environment.Endeavor to be a team player. Large organizations, hospital units, work groups and families run best with a cooperative spirit among individuals.Conversations and regularly scheduled FACE to FACE meetings are a must for development of rapport, negotiating and problem solving.If your group prefers email for all communication, ask for a scheduled face to face, prepare an agenda and send it out in advance. | It is very important to make eye contact and give undivided attention while the other person is talking.Do not take your phone to meetings unless you are expecting an urgent call.Acknowledge the other person’s feelings. “I can see how tough this must be for you.”“Based on looking around this room at all your faces, I can see the angst you are all feeling about this (patient, situation, issue).”“I know it has been hard on you to worry about scheduling issues all the time.” |
| 5. Unresolved Emotional Issues (e.g., history of physical or emotional abuse) | Distorted perceptions of the worldMisinterpretation of the motives and messages of othersDistorted responses to communication of others | Resolve your issues and do not focus on other peoples’ issues; to do so takes time from looking at your own issues.Seek to clarify and resolve the issue, if you feel the other person misinterpreted what you said or meant and as a result there is conflict or bad feelings.Always own your own words and actions. | “I think there has been a misunderstanding here, I would like to discuss/clarify/clear this up.”“I apologize if I was not clear; let me explain what I meant.” |
| 6. Poor Self-Image/Self-Esteem | Perceived attacksPerceived threatsPerceived lossesFear of others or situations | As above, in number 5.If you feel threatened or attacked, step back, remain calm, and provide feedback to the other person(s). Allow yourself to be honest with your feelings. | “I am feeling like there is quite a bit of emotion in the room right now.”“Sounds like this issue gets people fired up.” |
| 7. Poor Self-Image/Negative Self-Talk | Contributes to low self-image and lack of respect from others. | As above, in number 6.Do not refer to yourself in negative terms, such as, “I’m a mess.”Listen first, then respond.Ask for a specific example. | When receiving feedback that may be helpful for your development – you can listen first, then respond with, “What I hear you saying is that I can become impatient at times….”It may be helpful to ask for a specific example or incident of the behavior to enable you to have a fuller understanding of what may need to be changed. Try, “Can you provide an example of what you are referring to?” |
| 8. Lack of Boundaries/ Inability to Set Limits | Can be caused by history of abuse | As above, in number 6.Learn the difference between being a team player and being taken advantage of.Do not agree to fulfil obligations, tasks, assignments that you are not fully competent to perform; or clearly qualified to do.Do not agree to do anything outside your scope of practice or clinical privileges.Know that it is ok to say NO.Know that it is ok to say YES and ask how to do it. | “I have not been trained to perform that task, I would be happy to observe you at this time and learn.”“Please walk me through this policy, process, procedure….”“I will check with my supervisor and inform you what I find out.” |
| 9. Lack of Insight | Blindness to your faults and flaws robs you of opportunity for personal growth | Be open to input from others.Ask for honest feedback.Be willing to take constructive criticism.Work to develop the insight of a mature adult. Own your mistakes, apologize when you are wrong, and take action to correct any damage that has been done.Resolve to learn from your mistakes and flaws and not to repeat the same behavior in the future.Request feedback from trusted individuals. | “I have been told I am impatient, do you agree with that observation?” |
| 10. Physical or Mental Illness | Pain, depression, or anxiety can affect one’s ability to focus, listen, and respond. | Take care of your health, no one else will do this or should do this for you.Request in simple terms the time you need to take care of yourself at work and at home. | “I am taking a nap/bath/break do not disturb me for one hour.”“I need to take Friday morning off for a medical appointment.” |
| 11. Hidden Agendas, Politics, Games and Tests | Disdain and lack of trust for authority figuresSecrets create disempowerment and dependency which can lead to increased stress, burnout, lack of creativity and motivation | Do not participate in gossip, rumors or back-stabbing.Demonstrate integrity in all that you do.Be honest.Own your own mistakes.Excuse yourself from or try to redirect the conversation if the discussion has turned from facts/problem solving to gossip or complaining. | “It seems we have strayed a bit from the original topic of the meeting…..can we get back to the agenda/problem at hand?”“I believe the item we were discussing was ….and …the following solution(s) have been offered…” |
| 12. Lack of Clear, Plain Speech or Writing (e.g., acronyms, codes, slang, hashtags, accents, culture, apps, jargon) | Distancing strategyPower moveYou can appear uneducated | Speak and present yourself in a professional manner at all times.Never use slang or improper English in professional situations.If you lack communication skills for appropriate speech and/or writing, learn them.Use available software and computer technology to review/correct anything submitted in writing.Ask a colleague to proofread for you. Find the person on your team or work unit who enjoys details, and has the skill to find a misplaced semicolon.Do not use acronyms, abbreviations, or other short-hand language unless everyone on the receiving end knows what they mean. If you do not know, ask for an explanation. |
Additional Insight about Barriers to Effective Communication: Thoughts from the Trenches
The above table offers many “possibilities” to explain and address some common areas that may contribute to ineffective interpersonal communication. Below is some additional discussion and implications for practice to provide further insight into these concerns.