COMMUNICATION

INTRODUCTION
Communication is creative like an art. Communication is the exchange of ides, facts,
feelings, thoughts, opinions and information which is vital in facilitating human interaction
through words, symbols or actions. Communication is essential for progress of any
individual and it is the back bone in establishing good interpersonal relationships.
Communication is the life source of any organisation. All the functions of management can
only be performed with effective communication. It is vital for directing an controlling in the
organisation.
DEFINITION OF COMMUNICATION
Communication is the exchange of ideas facts opinion or emotions by two or more persons
Newmn, summer and warren
Communication is the verbal interchange of thoughts or ideas
Hoben
Communication is the transmission and interchange of facts, ideas, feelings or course of
action
Leland brown
Communication is sharing of ideas and feelings in a mood of mutuality
Edgar dale
Communication is a mean of persuasion to influence other so that desired effect is achieved
Aristotle
PURPOSE OF COMMUNICATION
Human relations: Communication promotes human relations. There can be no mutual
understanding without communication and it is possible only through communication.
Empathy: It is the feeling with other person that is expressed by speech.
Persuasion: It is the process of convincing and motivating to get things done. Speech is one
of the methods to persuade the person.
Understanding: The problems of communication are resultant of problem in understanding.
The most important managerial function is to bridge the gap which is possible by
communication.
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Dialogue: It is the process of conversation with purpose. It is democratic, civilized and

constructive weapon. It takes the form of discussion, criticism and deliberation.
Information: In the new information order of the world, information transmission is the
process of getting things done.
Discourage misinformation: Communication is not only used to exchange ideas but also
discourages the spread of misinformation, rumours, gossip and release of emotional tensions.
To influence: The objective of transmitting information is to change the behavior of the
receiver. Communication is aimed at influencing, persuading, motivating or activating
towards desired goals.
Fostering attitude: The purpose of communication is to foster an attitude which is necessary
for motivation, co-operation and job satisfaction.
Suggestions and complaints: It helps to obtain suggestion and encourage ideas to
accomplish goals of an institution.
Free exchange: The two-way communication model ensures free exchange of information
and ideas which gives an opportunity to entire health team in understanding and accepting
the messages, acting and feed back.
IMPORTANCE OF COMMUNICATION
Promotes motivation: Communication promotes motivation by informing and clarifying the
employees about the task to be done, the manner they are performing the task, and how to
improve their performance if it is not up to the mark.
Source of information: Communication is a source of information to the organizational
members for decision-making process as it helps identifying and assessing alternative course
of actions.
Altering individual's attitudes: Communication also plays a crucial role in altering
individual's attitudes, i.e., a well informed individual will have better attitude than a lessinformed individual. Organizational magazines, journals, meetings and other forms of oral
and written communication helps in moulding employee's attitude.
Helps in socializing: Communication also helps in socializing, the only presence of another
individnal communication. It is also said that one 11-i without communication. canny
Controlling process :Communication also assists in controlling pr controlling organizational
member's behavior in ways. There are various levels of hierarchy ar:11:1 mustfolj.i
organization. They must comply with organ; principles and guidelines that employees

perform their job role efficiently and communicate ap, problem and grievance tot heir
superiors T-1. communication helps in controlling function of manag,
ELEMENTS OF COMMUNICATION PROCESS
Interperso
nal
Channel
Visual
Auditory
kinesthetic
message
Referent

Referent
Verbal ,non verbal
feedback receiver

sender

Referent: The referent motivates one person to communicate with another. In health care
setting, sight, sound odour or any other cues initiate communication.
Sender: The sender of message or communicator is a person who transmits the message.
He/she conceive and initiate the message. He/she is the driving force to change the behaviour
of the receiver.
Message: A piece of information, spoken or written, to be passed from one person to another.
It is the subject matter of communication. It may involve any fact, idea, opinion, figure,
attitude or course of action, including information. It exists in the mind of the communicator.
Encoding (Communication symbol): The process of conversion of subject matter into
symbols is called encoding. The message or subject matter of any communication is always
abstract and intangible. Transmission of message requires use of certain symbols. The
communicator plans and organizes his/her ideas into a set of symbols, signs, etc. Encoding
process translates ideas, facts, opinions into symbols, words, actions, pictures, etc. It is left to
the sender in the selection of medium he/she feels suitable to communicate effectively to the
intended receiver.
Communication channel: Transmitter has to select the channel for sending information.
Communication channel means the medium or media through which the message is sent.

Media may be auditory (hearing, listening etc), visual (sight, observation, perception and so
on), kinaesthetic (procedural touch, caring touch and so on).
Receiver: It is the person who receives the message. Effective communication process is not
complete without the existence of a receiver of the message. It is the receiver who receives
and attempts to interpret, perceive, understand and act upon the message.
Decoding: It is the process of translation of an encoded message into ordinary
understandable language. Receiver converts the symbols, words or signs received from the
sender to get the meaning of the message.
Feedback: It has been explained that communication is an exchange process. For the
exchange to be complete the information must go back to the communicator. The sending
back of the knowledge about the message to the transmitter is known as feedback. It ensures
that the receiver has received the message and understood in the same sense as the sender
meant. Feedback enables the communicator to execute corrections or change the message to
be effective.
Interpersonal variables: They are factors within both the sender and receiver that influence
communication. They may be perceptions, sociocultural background, developmental levels
and illness and so on.
Environment: It is the setting for sender-receiver interaction. The environment should meet
the participant needs for physical and emotional comfort and safety.

PROCESS OF COMMUNICATION:
All of the managers functions involve communication. The communication process
involves six steps.
Ideation

Response

encoding

decoding

transmission

receiving

receiving

transmission

decoding

response

encoding

Ideation:
The first step, ideation, begins when the sender decides to share the content of her
message with someone, senses a need to communicate, develops an idea or selects
information to share. The purpose of communication may be inform, persuade, command,
inquire or entertain.

Encoding:
Encoding is the second step, involves putting meaning into symbolic forms. Speaking,
writing or non verbal behavior. Ones personal, cultural and professional biases affect the
goals and encoding process. Use of clearly understood symbols and communication of all the
receiver needs to know are important.
Transmission:
The third step, transmission of the message, must overcome interference such as garbled
speech, unintelligible use of words, long complex sentences, distortion from recording
devices, noise and illegible handwriting.
Receiving:
The receivers senses of seeing and hearing are activated as the transmitted message is
received. People tend to have selective attention (hear the message of interest to them but not
others) and selective perception (hear the parts of the message that conform with what they
want to hear) that cause incomplete and distorted interpretation of the communication.
Sometimes people tune out the message because they anticipate the content and think they
know what is going to be said. The receiver may preoccupied with other activities and
consequently not be ready to listen.
Decoding:
Decoding of the message by the receiver is the critical fifth step. Written messages
allow more time for decoding, as the receiver assesses the explicit meaning and implications
of the message based on what the symbols mean to her. The communication process is
depend on the receivers understanding of the information.
Response or feedback:
It is the final step. It is important for the manager or sender to know that the message
has been received and accurately interpreted.

TYPES OF COMMUNICATION:

Communication

On the basis of relationship

Formal
verbal

informal

on the basis of flow

vertical

Downward

on the basis of expression

horizontal

upward

oral

verbal

non

written.

TYPES OF COMMUNICATION ACCORDING TO CHANNEL OR RELATIONSHIP

Formal Communication
Formal communication is defined as communication which occurs through the official
organizational channels or is undertaken by nurses to do their job. It follows the chain of
command and determined by hierarchy or scalar chain of nursing organization.
Informal Communication or Grapevine
Informal communication is that which occurs outside the official communication networks
such as talking in the lunchroom between employees. This type of communication represents
communication among nurses through informal contacts. Informal communication co-exists
with the formal communication system in the organization. The network of informal
communication is also known as `grapevine'. It is neither pre-planned nor deliberately
motivated by the management. It is neither written nor documented or recorded. It is not set
with the lines of organizational hierarchy. As it has no set rules and regulations, it is not
confined to a particular direction. It just spreads like a grapevine. It can be productive or
negative. It has the potential to build teams, improve working relationships and generate
ideas as nurses are in a relaxed environment.

TYPES OF COMMUNICATION ACCORDING TO DIRECTION OR FLOW

Downward Communication
Communication that flows from a higher level to a lower level in an organization i.e. from
superiors to subordinates in a chain of command is a downward communication. In nursing
organization, it flows from chief nursing officer to staff nurses' i.e. operational level. This
communication flow is used by them to transmit work-related information to the nurses at
operational levels. Nurses require this information for performing their jobs and for meeting
the expectations of their nurse managers. Downward communication is used by the top level
nurse managers to communicate about nursing organization mission, objectives, and policies;
for controlling, influencing and initiating Purposes. At the middle level, the purpose of
communication is passing on the instructions, directives, orders etc. and to get the work done
from operational level nurses. It takes in the form of written and oral instructions, memos,
letters, nursing policies and procedures, feedback of nurses' performance.
Upward Communication
Upward communication flows from bottom to the top, i.e. from subordinates to superiors
positions, from operational level to chief nursing officer level. It provides feedback on how
well the nursing organization is functioning.
The operational level nurses use upward communication for the following reasons:

To convey the problems and performances to nurse supervisors and managers

To tell how well they have understood the downward communication
To share views and ideas
To participate in the decision-making process
To raise and speak dissatisfaction issues to the higher levels
The nurse managers get to know about nurses feelings towards their jobs, supervisor and
organization in general.

Upward communication takes the form of reports giving details of subordinates performance,
suggestions, complaints, enquiries, etc. This can be oral or written. This may include:
problems related to work, confidential reports, feedback of the orders, instructions, opinions,
attitude and feeling of nurses of operational level, etc.
Lateral/ Horizontal Communication
Communication that takes place at same levels of hierarchy in an organization is called
lateral communication or it refers to the exchange of information among nurses of the same
level and status, i.e. communication between staff nurses, between nurse t supervisors and
between nurse managers at same levels or between any horizontally equivalent
organizational members.
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Diagonal Communication
Communication that takes place between a nurse manager and employees of other
workgroups is called diagonal communication. It generally does not appear on organizational
chart.
External Communication
Communication that takes place between a nurse manager and external groups such as nurse
managers of other hospitals is the external communication.
TYPES OF COMMUNICATION ACCORDING TO METHOD OF EXPRESSION
Organization communication is goal oriented. Nurse Managers have to communicate within
or outside the organization. In early times, communication was limited to paper-work,
telephone calls etc. But now with advent of technology, we have cell phones, video
conferencing, emails, and satellite communication. Thus communication according to way of
expression can be classified into verbal and non verbal communication.
VERBAL COMMUNICATION
Verbal communication involves the use of spoken words/oral or written words and depend
upon language.
Oral Communication
Oral communication involves exchange of information with the help of spoken words. These
may be in the form of face to face conversation or through mechanical or electronic devices
Speeches, presentations, discussions are all forms of oral communication. Oral
communication is generally recommended when the communication matter is of temporary
kind or where a direct interaction is required. Face to face communication in the form of
meetings, lectures, conferences, interviews, etc. is significant so as to build a rapport and
trust. Thus it holds an important place in the nursing organization and serves a number of
purposes:
Written Communication
Written communication is the oldest known form of communication. Any form of
communication which is written and documented from the sender to the receiver is known as
written communication. Examples of written communication include letters, memos, research
papers, reports, orders, instructions, statements, posters, handbooks, bulletins, notice boards,
etc.

NON-VERBAL COMMUNICATION
Non-verbal communication is also very important in the organizational set up. It is the
communication of feelings, motions, attitudes, and thoughts through body movements /
gestures / eye contact, etc. The non verbal communication involves the unspoken events and
circumstances that accompany and affects the communication. It is the single most powerful
form of communication. The best communicators are sensitive to the power of the emotions
and thoughts communicated nonverbally. Nonverbal communication involves those
nonverbal stimuli in a communication setting that are generated by both the source and his or
her use of the environment and that have potential message value for the source or receiver.
Basically it is sending and receiving messages in a variety of ways without the use of verbal
codes (words). It is both intentional and unintentional.
Facial Expression: It is an important means of communication. One can simply judge a
person by looking at his/her face. But at time it will be very difficult to read a face.
Blinking of Eyes: Studies have shown that the rate of blinking of eyes are higher when
someone angry or anxious.
Gestures: Gestures too are expressive. Expression of joy could be manifested in simple
exchange of gestures like shaking of hands and hugging. Gestures convey shades of meaning
and their psychological undertones and overtones. Therefore, gesture s should be observed
carefully and continuously to gain clu one's thinking. e to
Coughing: In some instances, it has been proved to be the form of nervousness. Sometimes it
is used to cover up a lie or it serves to express doubts or surprise.
Body Position: A person sitting on a chair in upright position indicates that sh is attentive
about what is going on. While a person sitting with h leaned back on the chair indicates
doubts or surprise.
Silence: It is sometimes said that silence is more vocal than communication. Sometimes, by
remaining silence on a particular issue we register our strong approval. The nurse manager
can also use her nonverbal skills to with doctors, patients and staff members. Looking patient
in the eye work the eye can be a sign that the nurse is listening or nodding her to let them
know she is listening to them.
STRATEGIES OF COMMUNICATION:
Think before you speak:
Think about the purpose of your communication. What do you hope to accomplish
with your words or actions? Are your comments about something you are responsible for
doing, such as parenting or managing someone or about an activity you are doing together

with the other person? Or, is it an opinion about something that is not your business, maybe
even something that the other person has already asked you to stop discussing?
"Before you speak, ask yourself: Is it kind? Is it necessary? Is it true? Does it improve on
the silence?" . Also, think about the structure of your communication.
Listening:
The most effective leaders know when to stop talking and start listening. This is especially
important in three particular situations: when emotions are high, in team situations and when
employees are sharing ideas.
First, listening is crucial when emotions are high. Extreme emotions, such as anger,
resentment and excitement, warrant attention from a personal and a business standpoint. On a
personal level, people feel acknowledged when others validate their feelings. Managers who
ignore feelings can create distance between themselves and their employees, eroding the
relationship and ultimately affecting the working environment.
Questioning:
Many leaders need information but aren't sure how to get it. Similarly, their employees may
have information but don't know how to impart it. Managers can open the lines of
communication by asking good questions. Note that different kinds of questions yield
different kinds of results. Here is a short primer on questioning:
* Closed questions are those that elicit yes/no answers. These are beneficial when a manager
simply needs to check the status of an issue. Has the report been completed? Do you know
what to do? Can you get that to me by Friday? These are examples of closed questions that
are perfectly appropriate in the right situations.
* Open questions are those that elicit longer responses. They are useful almost anytime a
manager wants more than a yes/no answer--for instance, when seeking input from others,
looking for information about a particular topic or exploring a problem. What do you think
would be the best way to go about this? How are you doing on that project? What went
wrong? These kinds of questions give others the chance to give all of the information they
have and to avoid the innumerable consequences that can come when leaders make
assumptions without becoming well-informed.
* Personal questions have a special role in leadership. Inappropriate personal questions can
alienate employees. Asking direct reports if they are dating anyone or why they haven't
bought a house can be perceived as prying, even if the questions are well intended.
Appropriate personal questions, however, can create a sense of camaraderie between
employee and boss.
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Asking whether employees had a nice weekend, inquiring about their families or following
up on common interests all help people connect on a personal level. That relationship leads to
a greater commitment as well as a more pleasant environment.
Using Discretion:
Knowing when not to speak as a leader is just as important as speaking. Managers must
understand that the moment they don a new title, they become a leader--one whom others
look to for guidance, direction and even protection. Good leaders adopt a policy of
discretion, if not confidentiality, with their employees. Only then can they develop the trust
that is so vital to productivity.
Confidential situations may arise in a number of areas, personal and professional. Here are
some topics that may warrant discretion:
* An employee is having a direct conflict with another employee.
* An employee is concerned about another employee's conduct.
* An employee's performance has dropped substantially.
* An employee has a health issue or personal problem.
* An employee wants genuine advice on how to excel but doesn't want to be seen as cozying
up to the boss.
Directing
Notice that directing comes last on the list of communication strategies. It may not be the
least important, but it is definitely one to use less often. Many managers direct their
employees because they believe it's the only way to get things done. It is not.
But directing has its place. Directing means giving directions clearly and unequivocally, such
that people know exactly what to do and when. It is best used in times of confusion, or when
efficiency is the most important goal. Although it can be effective, directing also can lead to
complacency on the part of employees who may adopt an "I just do what they tell me"
attitude. Use it sparingly
CHANNELS OF MANAGERIAL COMMUNICATION:
There are four levels of managerial communication:
Downward communication.
Upward communication.
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Lateral communication.
Diagonal communication.
Downward communication:
This is the traditional and most used communication, where the management gives
orders to the subordinates at the bottom level to carry out the orders as per the organizational
hierarchy.
Management

Subordinates

Subordinates

All the written and oral communication which are carried out from the top
management to the employees by various means in order that the employees carry out their
duties in the organization in achieving its goals.
Upward communication:
Upward communication in the management levels from staff, lower and middle
management personnel and continuous up to the organizational hierarchy. It provides a
means for motivating satisfying personnel by encouraging employees input.

Management

Subordinates

Subordinates

Lateral communication:
Lateral or horizontal communication is referred to the communication which takes
place between the departments or personnel on the same level of the hierarchy.
Management

Subordinates

Subordinates

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Diagonal communication:
Diagonal communication occurs between two individuals or departments that are
not on the same level of the hierarchy.

Management
Medical
department

Medical
unit

Laboratory
CSSD

Nursing
department

Surgical
unit

Patholog
y

x-ray

Medica
l

Surgica
l

Pediatric
s

laundry

Common means are: unit in-charge ordering diet for the patient, X-ray department informs
appointments given to patients in a particular unit, etc.
BARRIERS OF COMMUUNICATION AND MEASURES TO OVERCOME THE
BARRIERS
Any difficulty/obstacles/hindrances/hurdles/Problems/breakdowns, which partly or fully
affect/blocks the meaning or the transmission or free flowing of message from the sender to
receiver in communication process is called as " barriers in communication". It hampers the
ways in achieving communication goals. A good commuicator should be aware of the
Communication barriers and should try to overcome them to avoid problems. Barriers in
Communication Process may arrive at any level
Sender's Level
For Example Less or more knowledge in related fields, using excess of words, unnecessary
repetitions, incomplete sentences, no clarifications, preoccupied with thoughts, poor
vocabulary. usage of jargons, slanting, inadequate explanation, rushing, abstract or brief,
Poor planning attitude and practices of community, failure to understand cultural differences,
poor communication skills of communicator, you presentation, selection of inappropriate
channels and medium, selection of messages contradicting existing beliefs and practices,
Inadequate communication material and Inappropriate language.
Receiver's Level
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e.g. Interrupting Speaker, asking too many questions, for the sake of Probing,inaccessibility
of relevant literature and emotional factors etc.
Tansmission's Level,
e.g. Vague and unclear messages, Irrelevant matter in the expression, Inaccurate translations
feedback Level,
e.g. Negative returns, unable to comprehend due to low intellectual levels, personality
complexes, filtering, Various forms of external noise, insufficient feedback, Technical errors.
Classification of Barriers
1. Semantic barriers
The study of word choice is called "Semantics" and the block that arise from word choice,
it's symbols or signs are called "Semantic blocks or Semantic bathers"
For example;

The difference between inexpensive and cheap. Cheap has a more negative impression or
aura associated with it
Confusion between the symbol and content
Poor Pronunciation
Over use of abstractions.

Words cannot have precisely the same meaning for everyone. Since the same word can mean
different things in different languages and may block communication
Remedies/Methods to overcome the semantic barrier

Educator has to be cautious in selecting the wordsUse direct, simple, easy language
appropriate to the receiver at specific level. He/she has to make sure to speak in the
language that is understood/conveyed the same meaning to the words and going to use by
the receiver, proper care has to be taken in selection of medium and communication
channel, encoding and decoding of message and feed back
Be sensitive to receiver's point of view.

2. physical barriers
Distance: Physical distance like near or far away from the source or sender
Time: More information has to be dealt in Limited time or If message gets delayed, it
becomes useless and creates confusion or Insufficient time to implement new ideas
Environmental factors: strange surroundings, loud noise-Disturbance with music and
public announcements makes difficult to have concentration for both(learner and
sender), Invisibility, congestion
Effects of natural calamities: Floods, Tornado etc. Man made disasters/acquired
problems: Stress due to strikes, public processions, political parties influence
Defects in Channel
Large working areas making physically separated from others
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Defects in material: Unclear photocopies, unreadable print out or messy corrections.

Remedies/Methods to overcome the Physical barrier

3.

Adequate distance has to be maintained between teacher and learner, comfortable seating
arrangements with adequate facilities is needed
Session has to be arranged only for 45 to 50 minutes, give a break of 10 to 15 minutes, if
it has to be continued, in order to maintain attention span of learners and teacher also
may need rest to their vocal cord and to refresh the minds of both teacher and students
Provide the information/message content at right time in a right way, whereby the learner
can understand the subject effectively
Conduct the teaching sessions in a conducive physical environment with adequate
ventilation and silent i.e., free from noise, music or annoyed sound disturbances
Adequate protective facilities against Calamities has to be considered while constructing
class rooms for teaching sessions.
Physiological Barrier
Physical ill health of the encoder or decoder: sender may have inability to transfer the
message or decoder may not be able to receive the message properly, poor listening and
poor retention may occur, when he/she is not feeling well
Defects in the medium: Defects in the devices which are being used, e.g. Poor hearing
power, vision defects, Expression difficulties.

Remedies/Methods to overcome Physiological barrier

Teacher and learner has to be healthy, as sickness affects all aspects of an individual, either to
deliver the lecture competently and understand the session effectively
The needed functional aids, e.g. eye glasses, hearing aids etc. has to be used either by the
learners or the teachers in class room interactions to transfer or to understand the content.
4. Mechanical Barriers
For example: Audio-visual aids-Functional defects in the machines, Projected aids,
electricity failure. interruptions while projecting, inadequate facilities to arrange the
Instructional media. Remedies/Methods to overcome mechanical barrier

Teacher has to select suitable and appropriate, good functioning audio-visual aids,
specific to the lesson/topic, e.g. To teach Anatomy and Physiologybased on topic,
models, specimens, charts, posters, slides, projectors etc has to be selected
Assess
the
working/functioning
condition
of
equipment
prior
to
class/presentation/educational session and if any defects noticed, correct it, to avoid
unnecessary interruptions/barrier in the flow of teaching
The information related to power failure timings has to be gathered, arranEe for
alternative facilities like generator. Check the plug points, if needed, repair it.
Check the plug point, it needed, repair it.

5. Psychological Barriers
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Barriers related to mind are known as "psychological barriers". Ninty percent of the total
barriers in communication are psychological barriers.
a) Emotional barriers
If receiver is engrossed in emotions for some reason tend to have trouble listening to
others or understanding the message conveyed, e.g. Emotional disturbances
If the receiver has low level of intelligence, comprehension difficulties, language
understanding difficulties also unable to understand the message in a correct manner
If the sender is excited, worried, tense or nervous, his thinking will be confused and
he/she will not be able to organize and transmit his message adequately.
b) Perceptual barriers
Each stimuli will have varied responses, people perceives things differently based on
varied factors like their previous experiences and observing others or surroundings,
precisely the same data, people see, interpret or respond to them differently. When
people fill-in information without checking its accuracy or lack of knowledge
c) Selectivity barrier
We cannot absorb all the information which is flowing in our way, hence we will
screen it selectively. One factor in the way people select and react to stimuli is timing
and attention. Some messages that may be effective at one time might be blocked or
even detrimental at another time, e.g. a letter of condolence sent out immediately after
the event is more effective than one sent later.
d) Inattention or lack of concentration: The receiver is distracted and not paying attention to
the sender or the messages conveyed
e) Distrust: Distrust on the part of the sender for the receiver or the receiver towards the
sender can give rise to misunderstanding the content
f) Premature evaluation: Immediately framing judgment and replies, even before the
message is completed
g) Lack of creativity, goal conflicts, offensive style or confused thinking , negative attitudes,
bias and prejudice' impatience, lack of hope and inhibition, non-acceptance, judgmental,
closed mind, effect of fear. Misunderstandings, halo Effect, Inattentiveness, negative
opinions.
Remedies against Psychological barrier
Develop good listening skills Rules for Good Listening skill
Stop talking You cannot listen if you are talking .
Put the person at ease Help a person feel free to talk; create a permissive
environment. Listen to understand
Show the person you Look and act interested -show the interest when listening,
understand, not to oppose
Remove distractions -Do not doodle, tap, or shuffle papers; shut the door, if necessary
to achieve quiet
Empathize -Try to see the other person's point of view
Be patient -Allow plenty of time; do not interrupt; do not start for the door or walk
away, listen completely and patiently

16

 Hold your temper An angry person takes the wrong meaning from words.Go easy
on argument, Don't put people on the defensive and criticism and cause them to "clam
up" or become angry
Do not argue even if you win or you lose
Ask questionsThis encourages a person and shows that you are listening; it helps to
develop points further
Stop talking This is first and last, because all other guides depend on it; you cannot
listen effectively while you are talking.
Other Measures
Develop trust and confidence between the persons who are under interaction
Learn to use feedback well
Feel a sense of responsibility
Provide to use supportive communication not defensive communication
provide conducive environment for listening with adequate facilities
Try to concentrate and understand the situation
Minimise/avoid distractions, stay calm
Have Open Mind and develop which you have to do compulsorily
Eliminate/avoid fear, tension, nervous, have balanced mind, maturity in thinking and
analyze the situation effectively, try to understand cues, signs, subject in
comprehension
Use positive Reinforcement techniques.
6. socio-Psychological Barrier
social status and social consciousness, social differences, strained or discomfort in
interpersonal relationships, rumors, educational difference/illiteracy.

Remedies/Protective measures
Have the goals in reachable terms and means
Utilize the opportunities and improve educational status
Maintain harmonious interpersonal relationships both in family or in working/living
environments Steps has to be taken to raise the status of individuals in society
Improve morale, work right to the conscious.
7. Cultural barriers
Racism,influence of ethnic, religion, caste, traditions, customs, beliefs, language
variations, social distance kvY from culture to culture like intimate, personal public) etc.
Remedies/Protective measures
Maintain the standards of communities and good interpersonal relationship through
eeffective interaction
Steps to raise the concept of equity, commonness, fellow being nature, Humanitarian
approach
17

 Develop healthy habits, good beliefs

measures to learn the local languages, conduct training programs, group cohesiveness,
group dynamics.
8. Organizational Barriers
Hierarchical barriers, Specialization of
Communication load, Organization Policy.

Workforce,

Wrong

choice

of

medium,

Remedies/Protective Measures
Develop Organizational Policies
Advancement of Communication pattern among all categories in the organization
Provide opportunities to specialize work forces like in service education, Continuing
Education programmes, on duty facilities, extra privileges like leaves,
scholarships/stipend/fellowships for the personal and professional development
As per the abilities and intellectual capacities of the individual, select the choice of
Instructional medium
Select suitable Educational Technology and communication techniques to enrich the
knowledge of learners, information should neither overload or under load"
Tougher test-based accountability Schools have been boosted by educational
accountability movement by holding schools and teachers accountable for student's
learning like testing and measuring the performance of individuals (both students and
teachers).

INTERPERSONAL COMMUNICATION
Interpersonal Communication is the interaction between two persons, e.g. in counselling the
transaction involves between the counsellor and counselee. It takes place within a social
context includes all the symbols and cues used to give and receive meaning, as meaning
resides in persons and not in words. Meaningful interpersonal communication results in
exchange of ideas, problem solving, and expression of feelings, decision-making, goal
accomplishment, team building and personal growth. Communication is an ongoing,
dynamic and multidimensional process.
DEFINITION
Interpersonal communication, is a dynamic process involving continual adaptation and
adjustments between two or more human beings engaged in face-to-face interactions during
which each person is continually aware of the other(s)".
BASIC ELEMENTS IN THE PROCESS OF INTERPERSONAL COMMUNICATION
PROCESS
Referent
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It motivates the person to communicate with another person. In health care setting, e.g.
sights, sounds, odours, time schedules, objects, emotions, sensations, perceptions, ideas and
other cues initiate communication. The health professional who knows what stimuli initiated
communication can develop and organize messages more efficiently and better perceive
meaning in another's message.
Sender
The person who encodes and delivers the message, he/she puts ideas or feelings into a form
that can be transmitted and is responsible for the accuracy of its content and emotional tone.
Receiver
The sender's message acts as a referent for the receiver, who is responsible for attending to,
translating and responding to the sender's message. Sender and receiver role are fluid and
change back and forth as two persons interact, sending and receiving may occur
simultaneously. The more they have common and the closer the relationship. The more likely,
they will accurately perceive one another's meaning and respond accordingly.
Messages
It is the content of communication. It may contain verbal, non verbal and symbolic language.
Messages are interpreted by those who receive them through personal perceptions that may
or may not distort the meaning intended by sender. Sender has to communicate clearly,
directly and in a familiar way, whereby the receiver will understand the message clearly.
Communication can be difficult when participants have varied levels of education and
experience.
Channels
These are means of conveying and receiving messages through visual, auditory and tactile
senses. Facial expressions send visual messages, spoken words travel through auditory
channels and touch uses tactile channels. The more channels the sender uses, the more clearly
he/she will understand. Eg: When teaching relaxation technique, the counsellor demonstrates
the technique, gives pamphlet i.e., written procedure to follow and assists the client to
practice.
Feed Back
It is the message returned by the receiver., the sender and receiver both has to be sensitive
and open to each other's messages. They have to clarify the messages and modify the
behaviour accordingly,
Interpersonal variables

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These are the factors within both (Receiver & Sender) that influence communication, eg:
Perception, educational level, developmental level, socio-cultural backgrounds, values,
beliefs, emotions. Gender, physical health, roles and responsibilities etc.
Environment
It is the setting for the sender-receiver interaction. For effective communication conducive
environment should meet the participant needs for physical and emotional comfort and
safety. The factors like noise, temperature variations, distractions, lack of privacy etc., will
distract and interfere the communication process and messages may not be communicated
effectively.
PHASES OF INTERPERSONAL RELATIONSHIP
The nurse and patient relate to each other as they progress through the phases that eventually
lead to therapeutic rapport. The nurse is responsible for directing the patient through the
phases of a helping relationship to ensure the patient's needs are met. Though the phases of
an interview and helping relationship are similar, the communication patterns are different.
The phases of helping/therapeutic/ interpersonal relationship.
Pre-interaction Phase
An ideal nurse reviews the information about the patient in the medical record and gathers
data from other care givers before meeting the patient so that she can bet prepared to face
about concerns or issues that may arise during the nurse-patient interaction. The nurse also
chooses the location and setting for the first meeting such as quiet, private and attractive that
facilitates interaction process.
Introductory/Orientation Phase
This phase begins when the nurse and patient first meet. At the beginning of the relationship,
neither person is able to perceive the other's uniqueness. The nurse perceives a patient who
has come to the health care agency or institution as a person with a health problem and the
patient perceives the nurse as one of many health professionals who can help. Engaging in
social interaction helps the nurse and patient to become relaxed in conversing.
Testing: The patient often tests the nurse during the orientation phase of a relationship and
the nurse who is aware of the patient's doubts and concerns attempts to display confidence
and competence. The nurse should be open and genuine in patient's concern rather being
defensive.
Building trust: Confidence, dependability and credibility are required to build trust. Genuine
caring is a powerful method for acquiring the patient's trust and expressing concern is one
another way to establish trust. A patient often trusts the nurse but is incapable of asking for
20

assistance. Trust allows for effective communication as individuals become more open in
expressing feelings and thoughts.
Identifying problems and goals: Nurse begins to assess patient's health status from the first
encounter and she makes conclusions through interactions and observation. The relationship
with the patient can be strengthened if the nurse discovers what problems are important to the
patient. During this phase, nurse directs the patient toward an awareness of problems, nature
of problems and exploring potential solutions and as problems are identified, the nurse and
patient mutually set goals.
Clarifying roles: The roles of a nurse and patient must be clarified after a helping is
initiated. Clarification occurs through sharing information. This encompasses nurse's
assessment of the patient's immediate needs, the patient's perception of those needs and ways
that patient can participate in his/her care.
Forming contracts: The nurse establishes a contract with the patient after the goals and roles
are defined. It involves a brief verbal interchange, including location, frequency, and length
of contacts and duration of the relationship. The nurse also keeps the patient informed of
when the relationship will be terminated because the more closer the relationship gets on in
the working phase, patients reaction to separate may vary, therefore it will remain less
stressful if the patient in the termination phase.
Working phase
Working phase is a dynamic at verbal and nonverbal levels in therapeutic relationship where
the patients express their problems with nurses who is an expertise to solve their problems.
During the working phase of therapeutic relationship, the nurse takes actions to meet goals
set with the patient. The nurse uses therapeutic communication skills aimed at promoting
successful interaction. The nurse and patient work together.
Sundeen et al, describe three communication skills that help patients to gain better selfunderstanding. They are:
Confrontation: The nurse makes the patient aware of inconsistencies in behaviour or
thoughts that interfere with self-understanding. The technique helps patients to recognize
growth or deal with important issues.
Immediacy: The nurse focuses interaction on the present situation between nurse and
patient. The patient learns to understand how interactions affect others. This involves
drawing attention to the patient's behaviors or statements.
Self-disclosure: The nurse reveals persona feelings in test of relation to experiences,
thoughts, ideas, values or feelings in test relation. The patient can act on idea and feelings
when the working phase is successful. Any attempt at change should be within the patient's
21

abilities because changes become less threatening when patient's express feelings about it
and accept temporary setbacks and the nurse should encourage even the slightest progress.
Integrating communication with nursing actions: Nursing actions can generally be
divided into physiological, psychological and socio-economic groups. Physiological actions
that attend to physical needs of a patient such as nutrition ,elimination and so on.
Psychological acions such as meeting emotional needs and socio-economic nursing actions
such as referring a patient to community health setting.
Termination
The primary objectives at the end of therapeutic relationship is a mutually planned and
satisfying termination
Evaluationof goal achievement: the nurse encourages assessment of the appropriateness
and outcome of goal established. Evaluating goals is viatal to determine a relationship
Separation:Ideally the patient expresses feelings regarding termination. The nurse plans
time to allow the patients to share these concerns and fear.
INTERPERSONAL COMMUNICATION SKILLS
When evaluating own communication skills, it is important to perform three exercises. These can
be taught to nursing students which would enable them to self evaluate their interpersonal
communication skills and nurses as well.
First, take time to consider your cultural background, learned patterns of gender behavior and
cultural behavior, knowledge of others' cultural patterns, openness to and level of comfort
with others different than yourself, beliefs and attitudes, level of self-confidence when
interacting with others, and personality and style of interacting.
Second, consider how these factors affect your ability to interact effectively in a variety of
communication that occur every day. Identify the factors that support effective interaction
and those that do not.
Third, use this information to enhance future interactions.
ADVANTAGES OF INTERPERSONEL COMMUNICATION
There is an opportunity to ask questions, exchange ideas aand clarify meaning
It can develope a friendly and co-operative spirit
It is easy and quik
It is flexible and hence effective
Hels to understand each other
Avoid duplication of work
Share idea knowledge and views on various prospectus

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CONFIDENTIALITY
INTRODUCTION
Confidentiality is mainly about privacy, meaning that any information you write down or tell
someone about will be kept between you and that person. It is common in friends because you
trust them. Keeping certain things confidential is kind of an 'unspoken rule in friendship.
Confidentiality is practiced in many professions. it is utmost importance for the lawyers and the
health care professionals. It is both a legal duty as well as an ethical duty.
INTERNATIONAL CODE OF ETHICS
Except when obligated by the law of the country a doctor shall not disclose, without the consent
of the patient, information which he has obtained in the the course of his professional relationship
with the patient"
PURPOSE OF CONFIDENTIALITY
Confidentiality allows the patient to feel free to make a full and frank disclosure of
information to the physician.
Full disclosure enables the physician to diagnose conditions properly and to treat the
patient appropriately.
In return for the patient's honesty, the physician: generally should not reveal
confidential communications or information without the patient's express consent
unless required to disclose the information by law.
Confidentiality cannot be absolute and there are exceptions to the rule.
IMPORTANANCE OF CONFIDENTIALITY
Natural human desire for privacy.
Fear of social embarrassment or disapproval.
Fear of discrimination, stigmatization.
Information misused against patient.
Builds confidence and open communication.
Demonstrates doctor's fidelity to the patient.
Respects patient's privacy, dignity and individuality.
Encourages free exchange of information which is critical for effective medical
intervention public health effort preventing harm to others
23

 Medical confidentiality respects patient autonomy.

Right to determine with whom, when and how much of personal medical information
is shared.
DISCLOSURE OF INFORMATION
Medical confidentiality is not absolute. Disclosure of the information should be done
with patient's consent
for benefit of patient
Prevent harm to others
When required by law
Medical research or audit
PRINCIPLES FOR DISCLOSURE: The disclosure of information should be done to proper authorities
Information disclosed should not be beyond what is required or relevant
Reason for disclosure documented in the medical records
PATIENT CONFIDENTIALITY FOR HEALTH CARE PROFESSIONALS
Patient Confidentiality is the right of an individual to have personal, identifiable medical
information kept private. Such information should be available only to the physician of record and
other health care and insurance personnel as necessary.
As healthcare providers, we all have the responsibility to uphold confidentiality for patients. In a
busy hospital setting it could be difficult and the increasing workloads for the doctors could lead
to elevator or cafeteria discussion of the cases which is not acceptable. The person next to you in
line could be the patient's relative, friend or media member that is not entitled to this privileged
information. Permission must be received from the patient prior to ANY DISCLOSURE.
MEDICAL CONFIDENTIALITY
It is defined in many ways. In simple it could be said as,
Foundation of trust in doctor patient relationship.
Privileged communication intended only for the knowledge of a particular person.
The act to keep private information secret or undisclosed.
It is both an ethical duty and legal duty.
MEDICAL CONFIDENTIALITY BECOMES CRITICAL IN CONDITIONS like
Sexual history & STD
Adolescent sexuality
Alcohol & drug dependence
Psychiatric Conditions
EXCEPTIONS
Confidentiality is the basis for patient-physician relationship. If the patient is uneasy about
disclosing pertinent or relevant information then the ability of the physician to provide adequate
24

care is severely compromised. It should be made clear to the patient that his information will not
be disclosed unless required by the law. The medical records are to be kept secret except in certain
conditions like,
Treatment of minors
HIV + patients
Abuse of a child or adult
Transportation safety
Duty to report harm/injury.
Treatment of minors :Treatment of the minors involves different variables in terms of
confidentiality. The AMA states "physicians who treat the minors have an official duty to promote
the autonomy of minor patients by involving them in medical decision making process to a degree
to commensurate with their abilities". Minors are categorized as either mature or immature.
Maturity is most concretely defined as a patient able to undergo a medical examination without
their parent or guardians presence. Whether a minor can accept to medical treatment without
parental consent is generally determined by the state law.
HIV + patients: Many States have adopted special statuses to deal with the issue of HIV and
disclosure. Maintaining confidentially is of utmost importance in such cases in order to prevent
discrimination. However there are certain scenarios involving HIVpositivity in which it is
generally legally to disclose HIV positivity to certain third party. For example some states laws
allow the disclosure of HIV patient's spouse. And according to some state laws it is the duty of all
the physicians to bring to the public Health Authorities. notice .
HIV Confidentiality in healthcare workers-One of the most controversial situation involves an
HIV positive healthcare worker and whether there is substantial risk to the patient to allow
disclosure, i.e., is there a significant risk of virus transmission that the patient needs to know. This
is often dealt with on a case by case basis taking into account the relative risk of the practitioner
transmitting the disease. For example a surgeon has a greater risk of transmitting the virus as
compared to the radiology technologist.
Abuse of a child or adult: Any healthcare practioners who has reason to suspect that a child has
been abused or neglected must report this immediately to the local Department of Social Services.
The reporting individual is protected from liability unless it is shown that the person making the
report acted in bad faith or with malicious intent.
Transportation safety: Any physician may, in good faith, report the existence or probable
existence of mental or physical impairment of a patient licensed to drive or fly if it is felt that
impairment could affect the patient's ability to safely operate a motor vehicle or aircraft. The
reporting physician is protected from litigation
example: According to the Epilepsy Foundation of America, epileptics are required to submit a
letter of approval from their attending physician to the local Department of Motor vehicles before
they are allowed to obtain their license.

25

Reporting of wounds and threats:It is the duty of all healthcare providers to report any wound
inflicted by a weapon to the police. The practitioner also has the duty to disclose a patient's threat
of imminent physical harm against another identifiable person. In situations where there is a clear
evidence of danger to other persons , the practioner should determine the degree of seriousness of
threat and warn the victim, warn the police or counsel the patient until the patient is no longer felt
to be a threat.

PUBLIC RELATIONS
INTRODUCTION:
Public relation is an essential and integrated component of public policy or service.
The professional public relation activity will ensure the benefit to the citizens, for whom the
policies or services are meant for. An effective public relations can create and build up the
image of an individual or an organization or a nation. At the time of adverse publicity or
when the organization is under crisis an effective public relations can remove the
"misunderstanding" and can create mutual understanding between the organization and the
public.
DEFINITION OF PUBLIC RELATION:
According to John Millet,
Public relation are knowing what the public expects and explaining how
administration is meeting these desires..
According to J.L MeCamy,
Public relation in Government is the composit of all the primary and secondary
contacts between the bureaucracy and citizens and all the interactions of influences and
attitudes established in these contracts.
According to W.T. Parry
Public relation means the development of cordial, equitable and therefore mutually
profitable relations between a business industry organization and the public it serves.
According to Rex Harlow,
Public relations are the process whereby an organization analyses the needs and
desires of all interested parties in order to conduct itself more responsively towards them.
NEED OF PUBLIC RELATION:
Not many years ago, management decisions took no consideration of public attitudes
but today management cannot ignore the views of employees, and the community in making
policy decisions. It has been estimated that eighty per cent of the problems confronting
management have public relations implications. Management has to foresee the impact of
policy decisions on the opinion of the public.
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There is normally four distinct reasons for ever increasing necessity of public relations:
(1) Increased governmental activities.
(2) Population explosion creating communication problems.
(3) Increased educational standards resulting in rise in expectations.
(4) Progress in communication techniques.
Well-executed public relations will
Increase visibility for the hospital, employees, programs and services.
Position the hospital as a health care leader and authority within the community or
region.
Expand awareness of the hospitals entire range of programs and services.
Enhance the hospitals image.
Aid in recruitment and retention of employees.
Support efforts to raise funds for new programs and services or assist with the passage
of levies and bonds.
Act as a foundation when negative news about the hospital occurs.
Boost employee morale.
ELEMENTS OF PUBLIC RELATIONS:
A planned effort or management function.
The relationship between an organization and its publics.
Evaluation of public attitudes and opinions.
An organizations policies, procedures and actions as they relate to said
organizations publics.
Steps taken to ensure that said policies, procedures and actions are in the public
interest and socially responsible.
Execution of an action and or communication programme.
Development of rapport, goodwill, understanding and acceptance as the chief end
result sought by public relations activities.
FORMS OF PUBLIC RELATION:
Public relation is a general term that may include many other relations with different
audiences, strategies and tactics. For example:
Employee relations:
It is a function of public relations that includes responding to employee concerns and
informing and motivating staff. Some tactics used for employee relations may include new
employee education, employee award programs and recognitions, new-hire press releases and
newsletters to name a few.
Community relations:
It is the function of actively planning and participating with and within a community
for the benefit of the community and the hospital. Tactics within this category include
community events, volunteer activities and co-sponsorship opportunities with other
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community organizations. Community relations may also include fundraising and

development activities.
Government relations:
It is a function of relating to government officials and agencies about issues that
impact the hospital and its audiences. Hill climb events in Olympia, letter writing campaigns,
and op-ed placements in the newspaper are often part of government relations.
Media relations:
It is often considered synonymous with public relations, is the function of working
with the media to communicate news. Media relations can be active seeking positive
publicity for a newsworthy topic at the hospital or reactive responding to a news inquiry
about a positive or negative story of interest to the media and its readers or viewers.
PUBLIC RELATION PLAN FOR A HOSPITAL:
Every hospital should have a current public relations plan that outlines goals and
desired outcomes for a period of three to five years. Once a general PR plan is in place,
periodic planning and updating is critical. The plan and its updates will not only help guide
employees responsible for public relations work, but will result in an effective tool to
communicate with the board and other staff. Following are the key elements of an effective
PR plan:
Goals:
Public relations goals help direct the strategies and tactics in future public relations
endeavors. The goals should clearly support hospital mission statement. While a mission
statement may include what the hospital wants to accomplish, a public relations goal should
be focused on what you want the public to think and know about the hospital
Examples:
General Washington Hospital is a community leader committed to providing high
quality health care for the people of Carter, Key and Kangley counties.

Highland Valley Medical Center provides superior primary care services in a

comfortable, safe environment for people in the Highland Valley region.
Ivy River Hospital, with its friendly, helpful physicians and nurses, is the most
dependable health care service provider in the state.
Objectives:
Objectives help determine specific outcomes from your public relations efforts. Objectives
should be clear and concise, and include timing.
Examples:
Increase awareness of the technology and medical advances used at the hospital within
Evergreen County over the next six months.
Build the reputation of the hospital in the next three to four years as a cornerstone of
the community that provides health care services, jobs and community leadership.
Encourage renewed interest in specialty hospital services such as childbirth classes
over the next two years.
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Target audience
Detail the groups of people that are important to inform or influence, and why.
Examples:
Patients: They purchase health care services and generate revenue for the hospital.
Physicians: They use hospital facilities and generate revenue for the hospital. They
control where patients go for care in the hospital or outside of the community.
Media: They write both positive and negative stories about the hospital, its staff and
services. They have considerable influence and access to all of the hospital s target
audiences.
Other audiences to consider may include employees, board members, community leaders,
local government officials, state legislators, vendors and suppliers.
Tactics:
Its easy for busy hospital professionals to think about tactics first, but it is critical to have a
solid strategy in place. Only pursue the tactics that will help achieve the goals. Here are some
best uses for specific tactics.
Brochure/Collateral To inform patients and community members about programs
and services provided at the hospital for promotional use only. It may be provided to
media for background, but not to be used instead of effective media tools, such as
press releases or fact sheets.
Direct mail To help create awareness for programs or services with target
audiences. Message is controlled.
Letters Good for personal or business communication. Adjustable length (1-2
pages).
Postcards Good for event invitations or welcome cards. Inexpensive postage.
Direct mail packages Good for inclusion in new neighbor welcome packages or
community coupon envelopes. Consider including brochures or inserts. Costs are
typically part of an advertising or sponsorship package. Production of materials likely
not included.
Specialty mailings Good for awareness efforts, such as a child safety campaign
sponsored by the hospital. Mailing may include a magnet with safety tips and local
emergency contact information.
Distribution Methods:
How you distribute materials is often as important as what the organization send. It is
a good idea to know which methods the target audiences, especially reporters, prefer.
Mail Good to use when timing is less sensitive (one to three days). Good for
newsletter mailings, new neighbor welcome packets, media kits, and other materials
that are difficult to fax or e-mail. Mail can also be certified to verify receipt or insured
to avoid loss.
Fax Good for timely communication (faster than mail). Good for press releases,
event reminders, and some forms of newsletters (such as weekly news notices). Less
effective for documents with images or graphics.

29

 E-mail Good for timely and direct communication with an individual. Good for
press releases, media reminders, media personnel questions, and pitch letters. Access
to e-mail and electronic document size can be limitations.
Face-to-face meetings Best way to make a personal connection. It allows for
detailed explanation of a point-of view or complicated subject. Best way to
demonstrate excitement, concern, tolerance, empathy, etc.
Phone conference call Allows for personal contact when face-to-face is not
possible. Good for back-and-forth communication. Inexpensive method for
communicating with large groups in different locations (cities/states).
Web site Web pages allow interested parties to pull information thereby facilitating
distribution. Directing people to a web site may be done through mailings, publicity or
other notices.
Newsletter To regularly update a variety of target audiences about the happenings at
the hospital. Good way to establish and maintain community support for the hospital
and services.
Public service announcement (PSA) To create awareness of a problem or issue
through radio or television.
Press release To distribute straightforward news to the media.
Press kit To provide extensive information about a topic. It may precede an event or
new program launch.
Press conference To disseminate time sensitive and critical news to multiple media
contacts at once. It should be rarely used.
Special event To make a personal connection with target audiences in a positive
environment. It is good way to recognize people for good work or launch new
programs of facilities.
Speaking engagement To reach a target audience, establish the speaker as an expert
and build credibility for the speaker and the hospital.
Video To communicate messages with emotion through visuals. It is good for town
meetings, new employee education, fundraising projects, special events, etc.
Web site To provide 24-hour access to information about the hospital. It may
include health information or links to health information depending on site design. It
is good for general information about the hospital, its services and staff.
Budgets:
Public relations budgets may come in a variety of ways. It may be pre-determined and
passed down from the overall hospital budget. It may include general guidelines but is open
to the tactics decided upon. It may be non-existent, in which case the tactics will need to rely
on investments in staff time, instead of materials. All of these factors will determine where
budgeting fits into the overall public relations planning. Regardless of where budgeting fits
into the plan, consider the following:
Nothing is free------- Consider all of the direct and indirect costs. Even a press release, one of
the least expensive tactics, has a price tag, the time spent writing and editing the release, the
paper it is printed on and the postage its mailed with at a minimum.

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Dont underestimate time investments-------- Every public relations activity has time
investments and opportunity costs and dont just consider the time investments for the PR
staff. Administrative oversight and involvement, interview source preparation and even
volunteer efforts all play into the opportunity costs of public relations. When planning and
prioritizing projects, consider all necessary staff time and what else they would be doing with
their time if not promoting the hospital.
Shop around--------- When producing brochures or printed materials; be sure to get more than
one estimate. Printing shops with more capacity at certain times may discount their rates.
Evaluate options--------- Another way to save money when producing materials is to consider
design options. For example, two-color brochures are far less expensive than their four color
counterparts. Specialty work, such as die-cuts for holding business cards or layered stairsteps for handouts, are nice features, but may carry a hefty price tag. Designers and printers
can be allies in determining options. Just be sure to have your budget in mind.
Be prepared for the unexpected opportunities-------- Reserve 10 to 15 percent of the overall
public relations budget for unexpected activities. There may be some great opportunities to
do events, community outreach activities or other projects that you didnt anticipate.
METHOD OF IMPROVING PUBLIC RELATION IN HOSPITAL:
There are certain other aspects which need careful consideration which are described
in brief as under.
General:
High quality patient care by the hospital is the theme of any public relation
programme. No amount of smile, cheers and propaganda will compensate for bad
administration and poor professional care in the hospital.
Physical facilities:
Well planned hospital with sufficient waiting area for the patient and its relation in the
hospital, optimum floor space for each department of t e hospital, logical layout of the
department and work areas, provision of adequate facilities like toilets, public utility services
like canteen, drinking water facility and so on go a long way in improving the image of the
hospital.
Staff:
In a hospital the staff consists of variety individuals drawn from different status of the society
with different levels of education and background. Imbibing a team spirit in all these groups
of people for the patient care will lead to a general satisfaction foe the patients in the hospital.
Name Labels and Uniform:
All functionaries should wear uniforms and name labels. This creates initial good
impression on patients and reflects good administration. It also infuses among the employees
a pride and sense of belonging to the institutions. These also help in identifying the staff by
name and their status. These are particularly useful in OPD and ancillary departments.

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Importance of Color:
Color affects many of our moods and emotions. Proper choice of color can transform
depressing and monotonous atmosphere into pleasing and exciting one. It stimulates
employees productivity. Hospital is one area where color can be used with measured success
not only in appearance but for the psychological uplifting which it brings to patients.
Operating facility:
The operating efficiency in an organization like, hospital is the outcome of its
soundness of objectives, policies, procedures, programmes and standing orders. The clear cut
policy and procedure in writing and their periodic promulgation to the staff specially, clear
order regarding organizational structure, defining their duties, authorities and accountability
of the staff.

Waiting time
The waiting time in the OPD is invariably the sore point of public grievances. Introduction of
appointment system, staggering of OPD timings for the registration, punctual attendance by
doctors are some of the remedies which can be introduced to reduce waiting time and have
successfully been implemented in many hospitals.
Delay in Admission:
Anxiety and distress is the result of delays in admission due to long waiting list. In allotting
priorities for admission, hospitals consider the physical state of the patients but forget the
social background and as a result, social emergencies have to wait. Adequate facilities in
efficient use of present resources can resolve this problem to some extent.
Ward Reception:
Patients are generally vulnerable to anxiety and fear on arrival in the ward. The reception
they get tends to leave a deep impression. Prompt reception improves the morale of the
patients.
Privacy:
It is normally observed that majority of the patients are dissatisfied with the type of privacy
provided in the ward. Provision of screens around each bed would afford greater privacy. To
have the privacy and at the same time provide the advantage of companionship of other
patients in the ward would go a long way in creating a feeling of warmth and understanding.
Food:
Good food, well prepared and attractively served to patients, makes a very favorable
impression. Presence of dietician or a nurse at the time of service creates good impact on the
patients.
Cleanliness:

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Cleanliness is much a desired thing in a hospital. It not only enhances the image of the
hospital but also helps in controlling hospital infection. Frequent cleaning and liberal use of
detergents and deodorants eliminates the stink which is most dissatisfying.
Information about Illness:
The most important thing to a patient is to know as to what is wrong with him and how long
will it take to recover. Information in this respect will always be associated with fear, anxiety
and thus, will help in building patients confidence. A doctor or a nurse should be available in
the ward during visiting hours to furnish information regarding illness of the patients to their
relatives.
Visitors:
Relatives and friends come rushing to the hospital the moment they learn about the illness of
their near and dear one. This is to show their loyalty, affection and strength of ties. It also
satisfies emotional needs of the patient. The relatives etc. are allowed to visit their patients
for a short while. The visiting hour policy should be more liberal for the visitors to the
serious patients and relatives coming from distant places. Too rigid visiting policy makes the
public critical of the hospital.
Mortuary and Chaplain Facility:
The disposal of the dead is influenced by religion, social and cultural beliefs and practices. It
is necessary to provide within the hospital or its premises a place to which a dead body can
be moved quietly so that other patients do not get upset. Disposal of dead has a great bearing
on public relations of the hospital. This is a sensitive area for the relatives and friends. Even
unintentional neglect or delay may carry unpleasant impression about the hospital. Utmost
care is needed by all members of the staff to ensure that prompt and proper disposal of the
dead is arranged.
NEED FOR PUBLIC RELATION IN THE COMMUNITY:
The main goal is to raise the standard of care to the highest level.
To improve the existing channels of communication and to establish new ways of
setting-up of two-way communication.
To provide the community with the concept of what a hospital and a health centre are.
To ensure financial support.
To create mutual understanding and goodwill through proper communication.
To provide extra services of volunteers.
To keep in touch with the community to assess their needs.
To interpret the expectation of the community, their opinion and impression of the
hospital to the top level management.
In large hospitals relationships can become very impersonal. Project a good image of
the hospital through effective staff performance.
Public relationship is all about relationships efforts, commitment and activities, which
go into building. The right sort of relationships where there is good public relations,
the hospital and health care are functioning at its best and contribute maximum to
which it serves.

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METHODS OF MAINTAINING PUBLIC RELATION IN THE COMMUNITY:

There are mainly two methods:
Operative methods
Communicative methods
Operative methods:
These methods are essentially connected with every aspect of community operation including
those are carried out by such workmen as health personnel, office personnel, enquiry, media
personnel etc.
The fundamental ingredients of community operation are:
i. Cheerful and courteous behavior.
ii. Prompt and efficient treatment.
iii. Clear surroundings and well appearance of the workers.
Some operations of improving operation of primary health care in the community level are:
i. A high quality patient care is the key of good public relation
ii. Adequate physical facility with good functional layout. Waiting room with benches or
chairs, water, refreshment facility in the outpatient department.
iii. To make others happy one must be happy himself. Good morale of workers not only
increases efficiency, but workers with high morale interact in a positive manner with one
another and also with the patients in the community.
iv. Operating efficiency with effective coordination among all clinical departments and other
supportive services stem from good administration, organization structure, policies,
procedures and authority and accountability should be clearly understood by each staff.
Communicative methods:
These methods employ means of communication in all possible forms to enable the
primary health centre to convey its message to the public. Some of these are also intermixed
in a way with intra-mutual functions of the hospital or health centers and the operative
methods may be used in the following ways:
a. Making the available appropriate information to the patients, their relatives and visitors.
b. A provision to listen to verbal complains instead of insisting on written one.
c. Prompt reply to questions.
d. Provision of suggestion box at appropriate place.
e. Visual communication, film shows, exhibitions and hospital Boucher are to be displayed.
f. Hospital tours can be conducted by the school teachers, students, housewives and members
of womens organization and religious leaders.
g. Holding an annual hospital day or open day house where public can be shown every aspect
of the hospital operation including some of the highly technical functions.
h. Using mass media would be helpful to improve public relation.
Qualities of public relation staff:
Warm and friendly with good common sense.
Good organizing ability.
Good judgement, creativity and then critical ability.
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Imagination and appreciate others.

Calm and not excitable person.
Ability to take pains.
Lively and inquisitive minds.
Willingness to work long and in constraint atmosphere, whenever necessary especially
in pulse polio campaigns.
Resilient and a sense of humour.
Flexibility and ability to deal with many problems.
Ability to communicate in any languages.
Capable of correcting and subediting others communication.
Loyalty to the organization.

Indicators for assessing public relation in the community:

Patient-satisfaction surveys.
General opinion pool.
Quality of care using checklist.
Number of complain received.
Extent of voluntary efforts by the community.
Turnover of the health staffs.
Consistency of the attendance of the patients in clinics and health centers.
Donations.
Inpatients leaving against medical advice.
Good recovery: achievement of the health activities.
Poor recovery and high death rate.
Vital rates such as IMR, MMR, BR and DR in the area.
Incidence and prevalence rate of the communicable diseases in the community.
PUBLIC RELATION IN AN EDUCATIONAL INSTITUTION PUBLIC IMAGE:
An idea or mental picture about the organization by the public.
STEPS FOLLOWED IN PUBLIC RELATION IN EDUCATIONAL INSTITUTION:
The followings are the steps followed in public relation campaign in an educational
institution.
i. Listing and prioritizing of information is to be disseminated:
May wish to inform the public:
a) The new policy of the Government or organization.
b) The change in the existing policy.
c) The new scheme promoted.
d) The change in the existing scheme.
Public Relations activity starts with identifying the message to be disseminated and
prioritized.

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ii. Ascertaining the existing knowledge level or understanding the perceptions of the
public:
The organization can check a quick survey among the target group of the public to ascertain
the knowledge level of the issue for which the organization is planning to initiate Public
Relations process and in case of the image it is essential to know whether the image is
positive, neutral or negative in terms of the assessment or in terms of the organization or
both.
iii. Communication objectives and prioritize:
Based on the knowledge level or image factor, a communication objective is to be established
which is possible to evaluate and the top management approval is required. For example,
communication objective instead of using the term increasing awareness level about the
scheme, it should be specific "By 2005, in the number of families where of the scheme be at
least one lakh" so that we can evaluate the impact.
iv. Message and Media:
After choosing the objective, the content of the message need to be developed. While
developing the message we should keep in mind the media in which we are going to use for
disseminating that message. TV/Visual media may be effective for showing the
demonstrating awareness. Training media may be effective whether the recipient may wish to
keep the gap or further reference.
v. Implementation of message and media:
Based on the expected reaching level and target group, the budget is to be prepared and
message is transmitted. through the appropriate media.
vi. Impact assessment:
After release of the message, it is essential to study the impact at interval by interacting with
the target group.
vii. message re designed
In case, the interaction of the target group reveals the message did not reach as expected the
modification in message or media need to be done and the revised message should be
disseminated.
TYPES OF PUBLIC RELATION:
Advertising:
The main forms of advertising are----- Brochures or flyers
Direct mail
E-mail messages
Magazines
Newsletters
Newspaper(major)
Online discussion and chat groups
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 Posters and bulletin boards

Radio and television announcements

Publicity:
Publicity is the spreading of information to gain public awareness for a product, person,
service, cause or organization, and can be seen as a result of effective PR planning.
Propaganda:
Propaganda is a form of communication that is aimed at influencing the attitude of a
community toward some cause or position. Propaganda, in its most basic sense, presents
information primarily to influence an audience and change in their attitude.
Public diplomacy:
Public diplomacy, broadly speaking, is the communication with foreign publics to establish a
dialogue designed to inform and influence. It is practiced through a variety of instruments
and methods ranging from personal contact and media interviews to the Internet and
educational exchanges.
Campaign:
Effective public relations require a knowledge, based on analysis and understanding, of all
the factors that influence public attitudes toward the organization. While a specific public
relations project or campaign may be undertaken proactively or reactively to manage some
sort of image crisis.
Promotion:
Commercialization of publicity.
Annual reports:
They are ripe with information if they include an overview of your year's activities,
accomplishments, challenges and financial status.
Collaboration or strategic restructuring:
If you're organization is undertaking these activities, celebrate it publicly.
QUALITIES OF A PUBLIC RELATION OFFICER IN THE EDUCATIONAL
INSTITUTION:
Abundant common sense.
First class organizing capacity.
Good judgement and objectivity.
Imagination ability and ability to appreciate.
Infinite capacity for taking pain.
Willingness to work long.
Be realistic and sense of humor.
Ability to write and speak English correctly.
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Pleasant voice and ability to speak in public.

Innovative in ideas.
Basic understanding about the profession.
Image building abilities.
Intelligence, foresight, result oriented approach.
Media specialization.
Editorial expertise.
Insight in research.

Public relation with parents:

Maintain healthy public relations with parents in the interest of the organization.
Keep in touch with parents of students already studying in your zone.
Make efforts to identify merit students at the earliest and extend academic support to
them.
Take a feedback from students on the performance of the staff attached to the
campuses in your zone.
Ask parents of exceptional students for feedback on the performance of respective
campuses in academic and administrative areas.
Communicate any significant information about campus performance to management
and staff for improvement.
Sick room:
The health of a student is important since it also reflects on the academic performance. A
student in good health can perform up to potential, whereas a student who is ill cannot.
Besides, the welfare of a student studying on residential campus is of primary concern to the
organization. It is for this reason that every residential campus has a Doctor attending to sick
students with special rooms to keep them in, and under the care of Sick-in-charges.
Monitor the healthcare of students enrolled in the campuses of your zone.
Ensure that hygiene and sanitation is maintained in the sick room so that the recovery
is faster.
Keep in touch with the Campus Doctor in order to take precautionary measures
against common ailments.
Ascertain that the parents of students who are sick are informed about the health status
of their wards.
FACTORS
RESPONSIBLE
FOR
SUCCESSFUL
PUBLIC
RELATION
PROGRAMME
The following are the factors for having successful programme under public relation
Identification of needs: identify the need of public to organise any programme. It
should be need based
Careful planning: determine what community wants, plan various methods, the
time and who all will be involved
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 Get co-operation from all concerned departments administration public and other
agencies
Observe ethical standard
Implement the programme
Evaluate the public reaction
Revamp if required
NURSES ROLE IN IMPROVING HOSPITAL PUBLIC RELATION
Delivering and ensuring high quality patient care
Attending the client admission
Providing orientation to client and relations
Informing about rules and regulation
Educating and guiding them about care and other health matter
Maintaining privacy
Ensuring the client in getting all hospital services in proper way. Eg dietary services
etc
Ensuring environmental sanitation and cleanliness
Attending complaints and suggestions from them
CONCLUSION
Nurse Managers are required to be aware of the techniques that can help them ensure effective
management of educational/service unit. Communication is one of the most important activities in
the nursing management. It is the foundation upon which the manager achieves organizational
objectives. Every hospital should have a current public relations plan that outlines goals and desired
outcomes for a period of three to five years. Once a general PR plan is in place, periodic planning
and updating is critical.

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BIBLIOGRAPHY
Textbooks
1) Jogindra Vati.Principle and practice of nursing management and administration.1 st
edition. 2013. jaypee publishers. Page no.451-463.
2) Pramila R. Nursing Communication and education technology. 1st edition.2010. jaypee
publishers. Page no 2- 38.
3) K P neeraja. Textbook of Communication and Educational Tecnology for nurses. First
edition.2011. Jaypee Publishers. Page no.489-510.
4) B T Basvanthappa. Nursing Administration.1st edition. 2002. Jaypee Publishers.Page no 143152.
5) B T Basvanthappa. Nursing Education. 1st edition.2002. Jaypee Publishers. Page no . 167-170
6) B Shnkaranarayanan. Nursing Education. 1st edition. Jaypee Publishers. Page no 220.
Journals
7) International journal of communication.sep 2012. Volume 3.issue 4. Page no.12
Internet
8) www.pubmed.com/education -process
9) www.scribd.com
10) www.googlebooks.com/nursing_educaion

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