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Medical institutions compose one of the most important sectors of the service industry in a country. The main reason for the importance placed on these institutions is the influence they have on the economy of a country. Studies have shown  a country's economy is directly related to the level of health of citizens of that country. There is a variety of available written materials on the medical sector. Most of these materials focus on the cost of medical care with the focus on insurance cover. Matters pertaining to the needs of patients as well as challenges faced by medical practitioners are rarely addressed in these materials. This paper addresses the inadequate communication between nurses and patients that results in poor services to the latter. The paper also addresses challenges that understaffed nurses undergo when dispatching off their services.

Events Leading to the Study

A close examination reveals a very strong dissatisfaction of patients with the quality of medical care delivered by nurses in health centers. Most of the patients are especially complaining about the poor level of communication that exists between them and nurses. Nurses are observed to engage patients in very basic communication which majorly focuses on basic questions and answers about patients’ condition. According to a study conducted by Angus, this results to very limited communication between patients and nurses (Angus 2009).

The problem all patients seam to complain about is the attitude of nurses towards them. Nurses take a very limited time with a single patient. This time is observed to be about five minutes. As a result, the diagnosis of patients’ conditions may be inaccurate. Nurses also show a lack of initiative to address patients’ needs. This shows up during their free time when they prefer to focus on the book rather than establish a connection with patients through communication (Angus 2009).

The problem of communication, however, cannot be blamed entirely on nurses. It starts from top management of health institutions. The major challenge that nurses face is the issue of understaffing. This results in high workload as the nurse-patient ratio is too big (Grieves 2000). This creates a need to review the condition of nurses according to major principles of management of these institutions. Due to the heavy workload, nurses cannot spend as much time as required by patients. They are always in a rush to complete patients’ check up and, therefore, miss a lot of what patients have to say. For example, the morning shift is characterized by a ratio of about 12:1 patients per nurse. This puts nurses under pressure to attend a very large number of patients in a limited time and is the major contributor to the poor communication between patients and nurses (Rea 2003). The quality of medical care involves both services that patients receive as well as their reaction to these services. The quality does not only depend on the attendance to a patient and speedy completion of the checkups of patients. On the contrary, patients’ mental, psychological as well as physical needs need close attention during treatment. Many studies relate the speed of recovery of patients to their psychological wellbeing. The happier a patient is with the service delivery, the faster the patient is likely to recover (Rea 2003).

The widespread concern among patients is the little time taken by nurses to examine them. Nurses only ask patients about critical conditions and major symptoms. As a result, patients complain that nurses may come to a wrong conclusion in their diagnosis of the patient’s condition. This can be catastrophic in the case where the patient receives the wrong prescription for the disease (Oatman 2008).

In this reflection the following question has to be critically analyzed: How is interactional communication important for establishing relationships between nurse and patient for achieving qualified patient-centered care?

Effect of the Heavy Workload on the Nurse-Patient Relationship

While devising strategies in a quest to improve the patient-centered care, nurses have also to be taken into account. Nurses are one of the focal points of the medical service because much of the interaction with patients is done by nurses. As much as the welfare of patients is an important factor of strategies, neglect of nurses is an impediment to the implementation of the laid strategies.

As mentioned earlier, one of the major problems that nurses face, is the issue of labor shortages, both expected and unexpected. The expected labour shortage is a problem of management as it usually involves the understaffing of nurses. The unexpected labor shortage may emerge due to an increased number of patients at any particular time. This may occur during national disasters such as road accidents, earthquakes, tsunamis, volcanic eruptions, and post election violence among others. As much as nurses may cope well with these situations, the effect of high workload may be overwhelming to them and, consequently, affect the quality of service delivery (Edworthy & Hellier 2005).

What exactly affects the quality of service delivered by nurses? The pressure to attend to a big number of patients causes a chain reaction among nurses. This begins with the buildup of stress on nurses. When the stress reaches a certain level, nurses can become easily irritated by high demands of patients. This may result to a lack of their concentration on patients. Nurses can even become rude to patients. This results to a strong sense of dislike from the patient. The patient then becomes enclosed and not ready to share his or her symptoms with the nurse. This lack of communication is the major contributor to the wrong diagnosis of the patient’s condition. As a result, the patient that needed a little time to recover ends up becoming severe.

The problem of understaffing goes further. It is usually aggravated by bad working environment. Whenever the supporting staff is not sufficient to do other chores such as cleaning, nurses feel a strong sense of neglect and this affects their level of performance. They have to multitask and this lowers their attention to their main duty. When the superior staff are insufficient (this includes doctors, surgeons, and physicians) the workload of nurses becomes harder to deal with. This is because nurses have to step-in to do more complicated works. Some of these works can be beyond their training and, as a result, the level of performance may decrease (Challinor 2012).

The management can help to curb this problem of understaffing in a number of ways. First thing that can be done is to engage in an intensive recruitment and training of nurses to fill the gaps that exist in the department. Other than the recruiting nurses, the number of superior medical practitioners can also be increased. This will ultimately reduce the workload of nurses and thereby increase the quality of their service delivery (Edworthy & Hellier 2005).

The microclimate of high pressure within the community of nurses can be improved by intensive teamwork training. The teamwork can focus on mini-specialization which eases the workload per nurse and leads to a better working environment. The patent satisfaction can be influenced by the level of communication with nurses. For this reason, leaders of medical care have a responsibility of engaging nurses in  training aimed at improving their communication skills (Challinor 2012). As much as a nurse may be highly trained and skilled, the quality of medical service depends on the level of trust that they build with the patient. Trust is the bridge between good and poor service to patients. If trust exists, the communication becomes better. This leads to the willingness by the patient to reveal the most trivial and even embarrassing symptoms that may be crucial in the diagnosis of the disease (Gordon 2010).

Assessments of Patient’s Social and Emotional Needs 

The fact that most nurses were unable to carry out effective assessment procedures in relation to the actual psychological, social, religious, and emotional needs of the patient is in a real sense an embarrassment to the nursing body of the society. It is impossible to care for patients effectively without realizing their needs and fears. In most cases, patients end up facing circumstances that make them lose confidence in the treatment they are receiving. More often than not, patients are more than willing to share their opinions and feelings opinions with a helpful party. It is a disappointment that most of the nurses have no time to listen to patients or, perhaps, give them attention that the patient may require. Due to these reasons the patient lacks confidence in nurses and so the communication barrier develops between the nurse and the patient, hence making it even harder to care for patients (Gordon 2010).

The assessment process is very important due to the fact that it forms the scientific oriented basis for designing of a satisfactory nursing care strategy. Apart from performing physical assessment procedure, the social and emotional assessment procedure that focuses on patient’s attitudes, emotions, religion, moods and relationship ties should be performed as well. They are beneficial to patient’s recovery process since enable nurses to care well for patients in accordance to patient’s individual needs. It is very important for nurses to perform patient’s assessment procedure with the gravity it holds (Crawford 1997). Though the assessment process is more effective when built on trust between the nurse and the patient , the process is formal in nature. In order to effectively use assessment results, there is a need for proper documentation of the assessment data collected by nurses. The data collected should be based on actual perceptions about patient’s condition in relation to nurse’s view. The nurse should take time to spend with patients to know and understand them well. This will enable them to carry out effective and correct assessment procedures on patients (Crawford 1997).

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There is a need for nurses to focus on assessing psychological, emotional, social, as well as the spiritual needs of patients in order to develop the patient-centered care. In a bid to carry out an effective assessment, nurses have to focus on actual needs, abilities, and preferences of the patient. The processes should not only be carried out through interviews and observations, but also by means of nonverbal communication that aid in improving the relationship between the nurse and the patient. In order to carry out an effective assessment process about the actual needs of respective patients, there is a necessity for building trust that patients have towards nurses. This is important to enable the patient to share openly their feelings, fears, and their personal needs with nurses. The information shared by patients on the basis of trust is in most cases useful for the general assessment process (Sherwood 2001).

It is, therefore, important for the nursing body to understand the fact that the patient-centered care is focused on the identification of needs and showing respect to patients. The patient-based must be tailored in a way that meets each patient’s individual needs and leads to the patient’s satisfaction. The appropriate patient-centered care can only be achieved by carrying out an effective assessment procedure to determine actual needs of patients.

Importance of Communication in Patients’ Assessment Procedure

The fact that nurses failed to establish an effective communication with the patient is extremely disadvantageous for the assessment process. This is due to the  insufficient effective communication between the patient and the nurse which results in either incomplete or inaccurate assessment process. It is only through communication that the patient-centered care can be realized because patients based views are communicated to nurses. In addition, during the actual development, open communication between the patient and the nurse is essential to assess the level of pain and other discomforts that the patient may be experiencing. Research has confirmed that acknowledging patient’s physical, social, and emotional needs can have profound outcome on the patient’s health status (Malaney 1998). Hence, as indicated by Griffith, it is necessary to establish efficient communication that goes beyond the professional and formal communication between the nurse and the patient to achieve the best patient-centered care (Griffith 2004).

Communication is an effective tool in the initial assessment of the patient. In order to understand the actual health condition of the patient, it is necessary for the nurse to understand the historical records of the patient on the subject matter. The patient should be comfortable enough to open up and explain the history of his medical condition to the nurse. This is made possible through the means where the nurse asks appropriate questions and listens carefully to the patient. As Rea points out, the nurse should be able to have patience and time to establish comfortable communication grounds necessary for performing appropriate assessment procedure (Rea 2008).

It is necessary for the nurse to pay attention to patient’s condition and his/her overall impression. The nurse should be able to understand the actual health condition of the patient through judging patient’s looks and actions. In relation to the impression perceived, the nurse should communicate with patients in accordance with their physical as well as a psychological state. In addition, the nurse should be able to communicate in a language that patients can easily comprehend. This is because the use of technical and professional terms is not well perceived by patients. In a bid to develop effective communication that comes in handy in the efficient caring for patients, the nurse has to bring himself or herself to the level of the patient. The best way is to find a common and comfortable subject of discussion that the patient can comfortably engage in, hence creating a friendly atmosphere around the patient. The ease in communication is necessary if the assessment procedure is to effectively caried out. In addition, it is only possible to perform assessment procedure about the mental condition of the patient through communication. The information on mental and psychological condition of the patient is extremely important for creation of the patient-centered care and satisfaction of their individual needs (Ranse & Arbon 2008).

The actual practice of patient-centered care requires that nurses establish an effective therapeutic relationship with respective patients. It is a confirmed fact that the quality of the existing relationship between nurses and patients is dependent on the communication between them that is developed over time after several encounters. It is important to note that having effective communication skills is not the actual determinant of the relationship, but rather the factor that eases communication as well as develops trust among the patient and the nurse. In this case, the assessment procedure is effectively carried out and hence the patient-centered care is improved with the help of effective communication.


In order to improve patient-centered care and satisfy general patients’ needs, it is important to increase the number of nurses caring for patients. In addition, social and emotional needs of patients have to be taken into consideration in line with their physical needs. In order to achieve efficient and improved care for patients, there is a need for a good patient-nurse relationship that can only be created through effective communication. The nurse is required to pay attention to patient’s perspective as well as spend time with the patient to carry out effective assessment that is necessary for providing appropriate care to patients.

Code: Sample20

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