Communication Barrier between Nurse and Patient

ABSTRACT:- CookMyProject Background: Communication is a multi-dimensional, multi-factorial phenomenon and a dynamic, complex process, closely related to the environment in hospital or related places. Nurses…


CookMyProject Background: Communication is a multi-dimensional, multi-factorial phenomenon and a dynamic, complex process, closely related to the environment in hospital or related places. Nurses in hospital need to enhance their skill in communication to improve patient satisfaction. This study conducted a systematic review to describe the communication barrier between nurse and patient at the hospital.

Subjects and Method: This was a systematic review conducted by searching databases from EBSCO e-journals, Elsevier Science Direct, CINAHL Complete, and Google Scholar, published from 2012 to 2017. The literature was analyzed using critical appraisal tool.

Results: Communication barriers included job dissatisfaction due to workload, uncontrolled patient family presence, distrust of nurse competency, gender incompatibility, nurse lack of attention, delay and carelessness in providing information, lack of nurse responsibility, difference in language, over workload, patient family disorder, nurse reluctance to communicate, patient physical discomfort, physical and psychological complaint, language difficulty, limited nurse communication skill, insufficient time, busy environment, and noise. Communication barriers between nurse and patient affected the quality of health service.

Conclusion: Communication barriers between nurse and patient affect the quality of health service.

Keywords: communication barriers, nurses-patients, hospitalCorrespondence:


Masters Program in Communication Sciences, Universitas Diponegoro. Jl. Prof.H. Soedarto, Tembalang, Semarang 50275, Central Java. Email: [email protected]

BACKGROUND:-Effective communication is an important element in the quality of nursing care (Fleischer et al., 2009). This has also been mandated in the National Standards forHospital Accreditation, that nurses have tasks related to management of communication and education, therefore nurses are able to create effective communication skills as a valuable tool allowing to assess patient needs and provide appropriate physical care, emotional support, knowledge transfer and information exchange (Caris-Verhallen et al., 2004). Communication is also a multidimensional, complex and dynamic process (Sheldon et al., 2006). Building effective communication takes into account the needs of patients, because through effective communication capable of improving nurse-patient relationships even has a profound effect on patients’ perceptions of the quality of care and treatment outcomes (Li et al., 2012).Effective communication as the beginning of the creation of a relationshipbetween nurses and patients the ability and ability to communicate effectively willgreatly facilitate nurses to establish relationships with patients and families (Liljerooset al., 2011) According to Epstein et al. (2010), through nurse interaction and communication patients are very useful when responding to their needs, beliefs,hopes, values and preferences. Effective and flexible communication skills of nursesare able to alleviate fears and anxieties related to the illness of patients and theirfamilies (Fakhr-Movahedi et al., 2011). Hospital Accreditation Standard states that each element in it can create a hospital organization that is safe, effective and well-managed. Where the nursing team and management order strengthen so thateffective communication can encourage health care providers to strive to improve service quality, especially the quality of nursing staff in supporting increasinglyprofessional nursing management services. Effective communication is a competencythat is indispensable in nursing services that is able to bridge every action that willbe taken to the patient so as to reduce the adverse effects of medical services andnursing on patients who have communication barriers to communication. Effectivecommunication, information service and effective education in hospitals is one of thenational standards for hospital accreditation, KARS, 2018 sees that the importanceof effective communication must be carried out within the framework of improving the quality of services and patient safety in the hospital.

Communication barriers are ineffective communication activities of patientswith health personnel in the communication process that are carried out so as not todeliver the message as desired (Ganiem, 2018), this greatly affects the communicationprocess between providers of health personnel, especially nurses as a main partin nursing services to patients. Communication barriers that often occur in nursingservices include relationships that are closely related to cultural factors, nurseattitudes and competencies, gender factors, environmental factors, nurse workloadfactors. This article aims to describe and identify the obstacles to nurse patient communication at the hospital.


A systematic review through review of patient nurse communication articles toidentify the occurrence of communication barriers in hospitals. The inclusion criteriawere all types of research that were reviewed, namely research that describesand identifies various barriers to nurse patient communication in the hospital.Literature search articles that have been published with a population of nurses in several hospitals which have experienced various communication barriers. Thesearch was carried out using Elsevier Science Direct, EBSCO E-Journal: CINAHLComplete, and Google Scholar with keywords variable communication barriers,nurses-patients, hospital. Articles found from each search based on the 2012-2017publication date. Articles that meet the inclusion criteria were collected and examinedsystematically. Extraction of study data was carried out by reading the resultsof the study and then taking the essence which included the research title, the nameof the researcher and the year of the study, the journal of the publisher, the studyobjectives, and methods. All parts are included in a table so that it is easier to readthe extraction results. The search process gets 4 articles that meet the criteria forinclusion criteria.


Based on the search results, 11 articles that are considered to be in accordance with the objectives of the study were obtained then they were put together and then a screening whether the title of the article is the same or not was done. After screening, there were 8 articles with the same title, from 13 of these articles then screening based on eligibility according to the inclusion criteria obtained 4 articles for further review. The literature search strategy can be seen in table 1.

Decent study consists of several studies conducted in various countries. The analysis of the 5 articles shows that 1 journal with qualitative analysis of content design, 2 journals with quantitative design with cross sectional, analytic descriptive study, and 1 journal with quantitative descriptive survey design. After a study of the quality study, 4articles can be categorized as good, then the data extraction is carried out. The dataextraction was done by analyzing data based on the name of the author, title,purpose, research method and results, namely grouping important data in thearticle. The results of data extraction can be seen in table 2.

DISCUSSIONS:-Based on the analysis of the article, several barriers to communication between nursepatients in hospitals were found. Vida Shafipour et al. (2014) in his study showedthat there were findings of various communication barriers namely job dissatisfactiondue to workload. High workload caused nurses have not enough time to communicatewith patients, causing negative interactions between nurses and patients.In addition, the presence of the patient’s family was not controlled and interferedwith the nurse’s duties. Distrust of nurse competencies caused by some patients notreceiving the necessary information from nurses. So that they were considered incompetent and experienced. Gender incompatibility from service providers and recipients of care were obstacles to communication communication. For example,male patients were reluctant to interact with female nurses, which was caused bythe incompatibility. Therefore, male patients ignoring advice from female nursesand communication did not work effectively.

A study by Deepak Sethi et al. (2017) stated that barriers to nurse patient communication that were not effective, which was more than 20% in hospitals that have an impact on the communication gap. There were several communication barriersfound between nurses and patients including language barriers, environmentalbarriers, cultural barriers, and overloaded nurse work schedules that affect careservices. Cultural and language diversity was an obstacle for someone to communicate. This was because each region has cultural and language differences that would affect communication between individuals. In addition, the causes of environmental barriers occurred when patients feel strange to the hospital they occupy. Busy ward environment and inappropriate room conditions (ventilation, heating, cooling and lighting). A study by Norouzinia et al. (2016) showed that communication barriers that were often felt by nurses and patients fromthe nurses’ point of view were differences in the everyday language of nurses and patients, nurses who were overworked, nurses who were less attentive, patient familydisorders, emergency patient attendance on the ward, while from the patient’s perspective were gender differences between nurses and patients, nurses’ reluctance to communicate because of the heavy workload, busy environment on the ward,anxiety pain and patient’s physical discomfort were the most important obstaclesin communication. Mann Whitney analysis showed that Patient-related factors 0.001and Nurse-related factors 0.012 have significant differences between the averagevalue of nurses and patients. Ayed (2016) stated that barriers on the patient’s side including; disease processes, language difficulties and physical and psychological complaints such as pain,fever, anxiety, and graving. The obstacle on the side of the nurses involved was limited communication skills due to lack of communication skills training. In addition, other obstacle factors such as insufficient time, because nurses must serve other patients.

Obstacles to the care environment; busy work, the noise of the hospital environment by a large number of patient families. Another obstacle was caused by an irregular and cooperative communication management system. Molazem et al. (2011) reported that the nurse’s main focus was on conducting routine clinical tasks. Llenore and Ogle (1999), showed that nurses on wards were very focused on doing clinical assignments which were only 5% of their time of concern aimed at communicating with patients.Based on the description of the article above, it can be concluded that there wereseveral barriers to communication that occur between nurses and cause dissatisfaction in health services. The aim of the health care system was to provide quality services and the best way to get patient satisfaction was to communicate. Therefore, it was expected to health providers to improve effective communication. In order to reduce barriers to communication in health services in hospitals. Through theefforts of communication and seminar (workshop) skills training. In addition, toreduce the barriers of cultural factors can be done by allocating nurses to hospitalsthat were in accordance with the nurse’s culture and language.


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