Interpersonal communications in nursing practice-Key to Quality Health care

Communication helps ion fl ow of knowledge from person to person and devlop better interpersonal relationships [1]. Communication and interpersonal skills are the most important factors for improving patient satisfaction, compliance and overall health outcome [2]. Interpersonal communication in recent years has played a pivotal role in successful job performance in any organization, health care been no exception. Nursing staff is the backbone of health care in any country. They are entrusted with the responsibility of delivering quality health services to patient and are not only the primary level of contact with patient but also spend maximum time with patients. The manner in which nursing staff communicates and takes care of patients infl uence the satisfaction level of patients and notably impact the health care outcome [3]. Nursing staff can make patients understand their illness and treatment and being the fi rst level of contact gain confi dence of patients making patients feel like second home. This eventually brings mental peace and creates harmonious environment. It therefore brings good healthphysical, social and mental well being to patient’s i.e. holistic approach to patient care [4].

take control of his/ her day to day activities due to debilitating disease or infi rmity [9]. "Caring is nursing, and nursing is caring" as stated by Kallergis [10]. Watson defi ned nursing as a Relationship between two human beings in mutual agreement, one of them as 'provider' and the second one as 'receiver' [11].
Casey and Wallis [12], stressed on the importance of developing a mutually agreed relationship and inculcating patient centric nursing skills to bring out the best in terms of patient care. The hallmark of nursing training and practice was patient centric care. This is the most vital interpersonal relationship in health care and it is a therapeutic interaction that ensures that patient needs are always on top priority irrespective of patient's attitude thereby putting the entire onus on nursing [13].
There is no iota of doubt that the nursing staff is the backbone of individualized patient care. They are entrusted with the responsibility of delivering tailored patient specifi c treatment, providing necessary information to patientsattendants and by providing as well as creating an environment that is best conducive for patient [14]. They also have to mediate between doctor and patient and create a communication bridge so that optimum results of treatment are achieved [15]. One can say that care and communication are just the two sides of the same coin they are inseparable and are complimentary to each other [14][15][16].
Peplau's theory [17,18], is one of the greatest works in the fi eld of nursing relationships and interpersonal communications and it emphasize on reciprocity between nurses and patients.
The theory is based on following assumption: 1) Both nurse and patient can interact, 2) This interaction helps them to evolve and mature.
3) The two fundamental tools in nursing are-communication and interpersonal skills.

4) Nurses must clearly understand themselves in order
to promote their patient's growth and to prevent the limitation of patient's choices to those that nurse's value.
The theory involves interactions between nursing, society or environment, health and man. It describes the relationship into fi ve different phases.

Phase 1: Orientation Phase
The fi rst and foremost formal phase for building therapeutic relationship coordinated by the nurse involving patients in their treatment addressing to their queries and information pertaining to treatment. The manner in which the nurse introduces herself / himself to the patient showing warmth, empathy and care in this introductory phase is the key factor that promotes interpersonal relationship between nurse and patient. It may start by introduction of nurse to the patient and addressing patients by their formal name initially and then can be inquired whether they prefer it or any not.
One of the important ingredient of effective communication is two way communication, allowing patients to speak and listen carefully as it is in this phase that maximum data is collected.
The nursing assessment requires accurate data gathered from patients and calls for effective two way communication between nurses and patients. Once the patient has been greeted, their anxiety decreased the patient is primed for participation in relationship. The nurse describes their role to patients and other information relevant to patient. As no two individuals are alike so is their working style, the same holds true for nursing professionals. The information gathered by them may vary and it is imperative not to overlook this part of the relationship as the exterior part of the real work.
There is need for nurse to have open mind so that they are able understand patients' problem and the need for the treatment, and respond appropriately. The orientation phase commences with the decision to treat.

Phase 2: Identifi cation Phase
The patient and nurse work together to clarify problems and set specifi c goal and in fact this phase is the working one. In this phase, nurses can help patients in exploring their hidden fears and apprehensions as well as identify their personal strengths and resources. In this way they can direct their energy towards helpful actions. These actions have benefi cial effect on patient care , recovery and treatment effectiveness.

Phase 3: Exploitation Phase
The practical work of nurse-patient relationship happens during exploitation, the nurse guides patient in optimum health facility utilization and attainment of mutually decided goals of therapeutic interventions.

Phase 4: Resolution Phase
This phase culminates in ending a therapeutic relationship [19]. The earlier targets achieved and new targets for treatment and care come up. The relationship was originally established with purpose and deep and meaningful sharing occurred between the nurse and patient. Whether it's a short term or long term interaction both demand an end or resolution.
Operating theater nurse may have a short term relationship with patient, where as a nurse in oncology unit may have a longer duration of relationship.

Phase 5: Termination Phase
The termination phase is marked by ending of professional The patients may respond differently at this phase, they might show regression, anxiety, and act strangely superfi cial to the nurse or even become more dependent. The nurse has to prepare the patient for the termination of therapeutic relationship. The therapeutic nurse-patient relationship between the nurse and patient will end with a completeness and satisfaction that is rewarding for both the nurse and the patient.

Barriers to communication [20,21]
The barriers to effective communication can be broadly can be from a culture where making a long direct eye contact may be insolent to a different cultural background where it is considered reliable [22]. It is imperative that designing a training for communication skill learning, the coordinators emphasize on various domains .

Role and responsibility of organizations
The organization cannot shred away from their responsibility towards the behavior of their staff. They need to develop strategy, align and engage employee's workforce by putting key elements in place including motivation, 'fi t for objective' structure, talented leadership and operative people system.
The organization should evolve process like communication to all key stakeholders including nurses stating clearly what, why, when and how the goals can be achieved. They should develop process to ensure that leaders who have knowledge and skills to take action, aligning energy and resources towards fulfi llment of strategy. Essentially, the organization should also develop fair, transparent process to measure success, maintain respect of nurses, satisfy their needs and defend their rights without manipulation, dominating or abusing them.

Conclusion
Good communicate on between nurses and a patient is of vital signifi cance as it provides patients with individualized care. Nurses who take the time to understand the unique challenges and concerns of their patients will be better prepared to advocate on their behalf and properly address issues as they arise. The attention given to the patient makes patients more compliant with treatment and imparts feeling of safety, affection and confi dence, all of which are important during a patient's treatment and recovery. Therefore, this aspect in healthcare should never be neglected and reinforced with training, learning and practice of soft skills.