Anita Davis Boykins, DNSc, FNP-BC, PMHNP BCCore Communicat.docx

Anita Davis Boykins, DNSc, FNP-BC, PMHNP BC
Core Communication Competencies in
Patient-Centered Care
Abstract: Effective communication between the patient
and nurse is an essential requirement for nursing practice
and for patient-centered care. Nursing faculty that teach
in undergraduate and graduate nursing programs play
a signiflcant role in preparing the nursing workforce to
communicate effectively and provide patient-centered care.
Patient-centered care, interprofessional collaboration, and
informatics are necessary knowledge, skills, and attitudes
for nurses across educational levels in order to meet the
needs of patients, and improve the quality and safety of the
health care system environment. The focus of this article is to
provide information on core nursing competencies for effective
communication and to discuss communication tools used in
patient-centered care, interprofessional collaboration, and
informatics.
Key Words: Communication, Nurse, Patient-Centered Care,
Interprofessional Collaboration, Informatics
In the last decade the Institute of Medicine (IOM) hasreleased
reports that address quality and safety in healthcare systems,
health professions and nursing (IOM, 1999,
2001,2003a, 2003b, 2010). A core component of quality care
is patient-centered care. Patient centered care is care based on
a partnership between the patient, their families, and the health
care provider that is focused on the patient's values,
preferences,

and needs. Effective communication between the patient and
health professionals is an essential requirement for patient-
centered care (IOM, 2001). Furthermore, health professions
education should include core competencies in patient-centered
care in order to meet the needs of patients and the changing
health care system (IOM, 2003a). Nursing faculty play a
significant role in preparing the nursing workforce to provide
patient-centered care and to communicate effectively. Patient-
centered care, interprofessional collaboration, and informatics
are necessary knowledge, skills, and attitudes (KSAs) for pre-
licensure nurses and nurses returning for graduate education in
order to communicate effectively and to improve the quality and
safety of the health care system environment (Cronenwett, et
al., 2007; Cronenvvett,et al.,2009; Massachusetts Department of
Higher Education Nurse of the Future Competency Committee,
2010)). This article will synthesize core nursing competencies
The ABNF Journal
for effective communication and patient-centered care and
discuss communication tools used in patient-centered care,
interprofessional collaboration, and informatics. Existing
communication competencies from nursing and health
professional resources are interrelated and important for
nursing faculty in curriculum development, and it is equally
important for nursing students to comprehend the concept of
communication when providing patient-centered care.
EFFECTIVE COMMUNICATION
The American Nurses Association (ANA, 2010)
delineates standards of professional nursing practice.
Professional competence in nursing practice includes not only
psychomotor and clinical diagnostic skills, but also proficiency
in interpersonal and communication skills. The registered
nurse is expected to communicate in various formats and in

all areas of practice. Communication is one of the standards of
professional nursing practice (see Table 1). Communication is
also addressed in four other standards of professional nursing
practice: Assessment; Implementation; Collaboration; and
Environmental Health (ANA, 2010).
Skill in communication has been described as
communication that is effective, appropriate and therapeutic
(Massachusetts Department of Higher Education Nurse
of the Future Competency Committee, 2010). Effective
communication is the creation of meaning in communication
in which patients and health care providers exchange
information so that patients are able to actively participate in
their care. The communication involves a two-way process of
expressive and receptive communication so that the message
and resf)onsibilities of both the patient and health care provider
is understood (The Joint Commission, 2010). Therapeutic
communication is mutually respective communication and
has a health related purpose. Examples of nursing core
competencies for effective, appropriate, and therapeutic
communication knowledge and skills are listed in Table 2
(Massachusetts Department of Higher Education Nurse of the
Future Competency Committee, 2010). Nursing students must
demonstrate therapeutic communication knowledge and skills
prior to graduation. One of the core competencies is that the
nurse must use clear, concise, and effective written, electronic,
and verbal communication (Massachusetts Department of
Higher Education Nurse of the Future Competency Committee,
2010).
Spring 2014
Table 1. American Nurses Association Standards of
Professionai Nursing Practice

Standard 11.Communication
Assesses communication format
preferences of healthcare consumers,
families, and colleagues
Assesses his or her ov(/n communication
skills in encounters with healthcare
consumers, families, and colleagues
Seeks continuous improvement of
communication and conflict resolution
skills
Conveys information to healthcare
consumers, families, the
interprofessional team, and others in
communication formats that promote
accuracy
Questions the rationale supporting care
processes and decisions when they do
not appear to be in the best interest of
the patient
Discloses observations or concerns
related to hazards and errors in care or
the practice environment to the
appropriate level
Maintains communication with other
providers to minimize risks associated
with transfers and transition in care
delivery

Contributes her or his own professional
perspective in discussions with the
interprofessional team
American Nurses Association. (2010). Nursing:
Scope and standards of practice, p. 54.
PATIENT-CENTERED CARE AND COMMUNICATION
The IOM report (2001 ), Crossing the quality chasm: A new
health system for the 21" century, targets improving the health
care system, structure and processes for changing the health
care environment, and principles for redesigning the health care
system. Patient-centered care is one of the aims for
improvement
of the health care system; using information technology and
preparing the workforce are areas recognized to change the
health care environment; and patient-centeredness is one of the
principles for redesigning the health care system. Patient-
centered
areas for redesign include:
1. Care is based on continuous healing relationships
2. Care is customized to patient needs and values
3. The patient is the source of control
4. Knowledge is shared and information flows freely
5. Decision making is evidence-based
6. Safety is a system priority
7. Transparency is necessary
8. Needs are anticipated
9. Waste is continuously decreased
10. Cooperation among clinicians is a priority
(IOM,2001.pp.3-4)
In order to improve, change, and redesign the health

care system and meet standards of professional nursing
practice, the nurse has to assess barriers to communication.
Barriers to communication between the patient and the nurse
may be related to language, developmental level, medical
condition/disabilities, learning styles, psychosocial, literacy,
financial and cultural factors (ANA, 2010; Massachusetts
Department of Higher Education Nurse of the Future
Competency Committee, 2010). In addition, communication
barriers may be experienced by the nurse with other health
care professionals and within the health care system. The
nurse has to be willing and capable of understanding the
different styles of communication used by patients, families,
and other health care professionals; communicate with
the patient, family and systems during transitions in care;
and use information technologies for health teaching and
promotion to patients in a variety of settings. The nurse also
communicates environmental health risks and strategies
to reduce exposure to these risks to patients, families,
and communities (ANA, 2010). The nurse continuously
advocates disease prevention, Wellness, and promotion of
healthy lifestyles, including a focus on population health
when providing patient-centered care (IOM, 2003a).
Patient-centered care is addressed in the Healthy
People 2020 topic area, health communication (HC)
and health information technology (HIT), as it relates
to the objective, satisfaction with health care providers'
communication skills and health literacy (U.S. Department
of Health and Human Services |USDHHSl,n.d.). Table 3
displays the objectives in the Healthy People 2020 HC and
HIT topic area. Health communication is defined as the study
and use of communication strategies to inform and influence
individual and community decisions that affect health. One
communication strategy is the use of plain language to
cleariy communicate health information and improve health
literacy (USDHHS, n.d.). Literacy is a part of language and

is important in patient-centered care and when working with
teams. Literacy encompasses reading and health literacy
(Interprofessional Education Collaborative Expert Panel,
2011).
Health literacy is the degree to which individuals have
the capacity to obtain, process, and understand basic health
information and services needed to make appropriate health
decisions (USDHHS, n.d.). Individuals that experience
health literacy problems receive less preventive care and
have poor understanding of health problems and care,
increase use of emergency and inpatient services and
increase rates of rehospitalization, decrease adherence to
medication schedules, decrease participation in medical
decision making, higher medical costs, and inefficient mix
of health care service use (Berkman et al., 2004; Berkman
et al., 2011). Health literacy is also a tool that is used in
health promotion, disease prevention, management of
chronic illnesses, and quality of life (American Association
of Colleges of Nursing |AACN],2011). Social marketing,
one of the objectives in the Healthy People 2020 HC and
HIT topic area (USDHHS,n.d.), is another tool for health
promotion and disease prevention. Social marketing is
the use of marketing techniques (product, price, place,
promotion) to promote health behaviors of a specific target
audience in order to improve health or benefit society
(Andreason, 1995).
The ABNF Journal Spring 2014
Table 2. Therapeutic Communication Knowledge & Skills
Nurse of the Future: Nursing Core Competencies

• Uses clear, concise, and effective written, electronic and
verbal communica
• Understands visual, auditory, and tactile communication
• Impact of ones' own communications style on others
• Understands the physiological, psychosocial, developmental,
spiritual, and
communication
• Understands tbe nurses role and responsibility in applying
principles of acti
• Chooses the right setting and time to initiate conversation
• Assesses the patient's readiness/willingness to communicate
• Assesses the patient's ability to communicate
• Assesses barriers to effective communication (language,
developmental lev
anxiety, learning styles, etc )
• Makes appropriate adaptations in own communication based
on patient anc
• Assesses the impact of use of self in effective communication
• Establishes rapport
• Actively listens to comments, concerns, and questions
• Demonstrate effective interviewing techniques

• Provides opportunity to ask and respond to questions
• Assesses verbal and nonverbal responses
• Adapts communication as needed based on patienf s response
• Able to distinguish between effective and ineffective
communication with ps
tion
cultural influences on effective
je listening
rel, medical condition/disabilities,
i family assessment
itients and families
Used with Permission: Massachusetts Department of Higher
Education Nurse of the Future Competency Committee.
(2010). Nurse of the Future Nursing Core Competencies.
Boston: Massachusetts Department of Higher Education,
pp. 27-28.
Table 3. Healthy People 2020
Objectives in Health Communication and Health Information
Technology Topic Areas
Health Communication
Health Literacy

Satisfaction with health
care providers'
communication skills
Individuals involvement in
their health care decision
making
Receipt of providers'
recommendations for
personalized health care
resources
Social support
Health Information
Technology
Internet access
Electronic personal health
management tools
Quality of internet health
information sources
Electronic health records in
medical practices
Access to online health
information
Users of health information
technology
Best practices in health
protection messages
Social marketing in health
promotion and disease
prevention
U.S. Department Health and Human Services Office of Disease
Prevention and Health Promotion, (n.d.). Healthy People 2020.

The ABNF Journal
Nurses assess factors that influence the patient and
family's ability to learn including readiness to learn,
preferenees for learning, and levels of health literacy. The
nurse also has to demonstrate qualities of mutual respect,
compassion, and collaboration when communicating with the
patient, family, and other health professionals regarding the
patient's care and the nurse's role in providing care (ANA,
2010).
INTERPROFESSIONAL COLLABORATION AND
COMMUNICATION
Interprofessional collaboration in the professional
work environment has been recognized by nursing, dentistry,
medicine, doctor of osteopathy, pharmacy, and public health
professional organizations as a vital component to safe, high,
quality, accessible, patient-centered care (Interprofessional
Education Collaborative Expert Panel, 2011).
Interprofessional collaboration is working across healthcare
professions to cooperate, collaborate, communicate, and
integrate care in teams to ensure that care is continuous and
reliable (IOM, 2003a). The nurse should be able to build
communication and leadership skills in praetice settings, to
function effectively within nursing and other interprofessional
teams, to foster open communication, to demonstrate mutual
respect, and to engage in shared decision making to achieve
quality care (American Association of Colleges of Nursing
[AACNI, 2008: Cronenwett, et al., 2007; Cronenwett,et al.,
2009). Most importantly, the patient should participate in their
eare through shared decision making (IOM, 2003b).
Spring 2014

Table 4. American Nurses Association Principles for Social
Networking
• Nurses must not transmit or place online individually
identifiable patient information.
• Nurses must observe ethically prescribed professional patient
— nurse boundaries.
• Nurses should understand tbat patients, colleagues,
institutions, and employers may view postings.
• Nurses sbould take advantage of privacy settings and seek to
separate personal and professional information
online.
• Nurses should bring content that could harm a patient's
privacy, rights, or welfare to the attention of
appropriate authorities.
• Nurses should participate in developing institutional policies
governing online conduct.
American Nurses Association. (2011 ). Principles for social
netwotkitig and the nurse: Guidance for the registered
nurse.
One of the core competencies for interprofessional
collaborative practice is interprofessional communication.
Teamwork and collaboration requires that the nurse is able to
communicate effectively with the healthcare team, patients, and
caregivers to integrate safe and effective care within and across

settings (AACN, 2008; ANA, 2010). Health professionals
and health care systems should also actively collaborate and
communicate to ensure an appropriate exchange of information
and coordination of care (IOM, 2001).
Examples of communication that involves appropriate
exchange of information and coordination of care are
hands-off communication, chain-of-command, and error
discIosure(AACN, 2008). SBAR (Situation-Background-
Assessment-Recommendation) is a technique for
communicating critical information that requires immediate
attention and action concerning a patient's condition It is used
as a communication technique, shift report hand-off, critical
situation call to a provider, in specialty nursing areas, and as
process/ quality/improvement.
1. Situation- Briefly describe the current situation. Give a
clear, succinct overview of pertinent issues.
2. Background-Briefly state the pertinent history. What got us
to this point?
3. Assessment-summarize the facts and give your best
assessment. What is going on? Use your best judgment.
4. Recommendations-What actions are you asking for?
What do you want to happen next (Institute for Healthcare
Improvement, n.d.).
The nurse coordinates care by communicating with the
patient, family, and systems during transitions of care (ANA,
2010). An example of coordination of care is reflected in The
Joint Commission National Patient Safety Goals (2013) for
health care settings. Improving communication and medication
safety are two goals where the nurse has to coordinate care
through communication with the patient, family, and systems.

Regardless of the health care setting (ambulatory, behavioral
health care, critical access hospital, home care, hospital, long
term care, office-based surgery), one of the ways identified
to ensure medication safety is recording and passing along
correct information about a patient's medications. The nurse
should consistently maintain and communicate accurate patient
medication information. An example of the patient safety goal,
improvement in communication, in hospital and laboratory
settings involves getting the important test results to the right
The ABNF Journal
staff person on time. Another example of the patient safety
goal, improving communication, is identified as improving
the effectiveness of communication among caregivers (The
Joint Commission National Patient Safety Goals, 2013). Being
competent in interprofessional communication requires that
the nurse communicate with patients, families, communities,
and other health professionals in a responsive and responsible
manner that supports a team approach to the maintenance of
health and the treatment of disease (Interprofessional Education
Collaborative Expert Panel, 2011).
INFORMATICS AND COMMUNICATION
Informatics is a core competency for all health
professional's education and incorporates mastery of new
communication technologies including integrating and
coordinating care (IOM, 2003a). Informatics is the use
of information and technology to communicate, manage
knowledge, mitigate error, and support decision making
(Cronenwett et al., 2007; Cronenvvett et al., 2009; IOM,
2003a). The Technology Informatics Guiding lîducation
Reform (TIGER, 2009) initiative in nursing was formed to
improve nursing practice, education, and the delivery of patient
care through the use of health information technology. Basic

computer competencies, information literacy, and information
management are competencies of the TIGER model. The
nurse is expected to have knowledge and skills in information
management in order to deliver quality patient care (AACN,
2008). The nurse also uses information technology to provide
health teaching and health promotion and disease prevention
information to patients in a variety of settings (AACN,
2011) and coordinates continuous care through information
technologies. Evaluation of health information resources for
laypersons and health professionals should be conducted by
the nurse in order to translate scientific evidence to practice
(AACN, 2008).
Health information technology (IT) or electronic health
(E-health) is the use of information and communication
technologies to improve health and health care (Office of
Disease Prevention and Health Promotion [ODPHPl, n.d.).
Information and communication technologies, resources, and
principles of learning are also used to teach patients and others
(AACN, 2011). Health care professionals can provide patients
access to care over the Internet, by telephone, and other means
other than face-to-face visits (IOM, 2001). E-health provides
patients internet access to online communities and support
groups, health information, health self-management tools,
Spring 2014
personal health records and is a means of communication
with health professionals. The nurse is expected to engage in
an array of technologies that support patient care including
electronic health and medical records, patient monitoring
systems, and medication administration systems (AACN,
2008). The Electronic Medical Record (EMR) or Electronic
Health Record (EHR) used in health care systems is not only

used to provide patients access to their personal health record
but it is a clear, concise documentation of care and improves
communication and collaboration with other health care
professionals. Information technology is not only used to
communicate patient specific clinical information but is also
used to communicate with other health professionals through
e-mail.
HIT is also used in the exchange of health information
among health professionals in an electronic environment and
is a regulated by laws that protect health information and
health information messages under the 2000 Health Insurance
Portability and Accountability Act (HIPAA) Privacy Rule.
Online social networks is one the most recent modes of social
media in the health care arena. Social networking sites are
online communities where individuals can interact with
others with similar interests. Interactions can occur in various
settings including chat, email, video, file-sharing, blogging,
and discussion groups (Center for Disease Control and
Prevention, [CDC], n.d.). The American Nurses Association
(ANA, 2011) and the CDC (n.d. ) recently implemented
principles, guidelines, and best practices for social networking.
Likewise, the National Council of State Boards of Nursing
(2011) has issued a white paper on the use of social media.
Best practices in health protection messages and identifiable
patient information and other privacy issues are addressed
by the national agencies. The ANA principles for social
networking are in Table 4. Interprofessional communication
through information and communication technologies requires
the health care professional to choose effective tools and
techniques to facilitate discussions and interactions that
improve interprofessional teams functioning (Interprofessional
Education Collaborative Expert Panel, 2011).
SUMMARY
In summary, the IOM report (2003a) addressed changing

the work environment and defined attributes of patient centered
care. Key aspects of patient centered care are that the nurse
or health care professional identify, respect, and care about
patients differences, values, preferences, and expressed
needs; relieve pain and suffering; coordinate continuous care;
continuously advocate disease prevention, Wellness, and
promotion of healthy lifestyles including a focus on population
health; listen to, cleariy inform, communicate with, and
educate patients; and involve patients in decision making and
management. As nursing faculty prepare nurses to work in
various roles and settings, core competencies in communication
should be met by the nursing student regardless of educational
level. Communication tools including patient-centered care,
interprofessional collaboration, and informatics are important
for improving patient outcomes and delivering high quality and
safe care.
REFERENCES
American Association of Colleges of Nursing. (2008). The
essentials
of baccalaureate education for professional nursing practice.
Washington, DC: Author,
American Association of Colleges of Nursing, (2011 ), The
essentials
of master's education in nursing. Washington, DC: Author.
American Nurses Association. (2010), Nursing: Scope and
standards
of practice .Secoad Edition. Silver Spring, MD: Author.
The ABNF Journal
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networking and the nurse: Guidance for the registered nurse.
Silver Spring, MD: Author.
Andreasen A. (1995). Marketing social change: Changing
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Summary _040509 .pdf.
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vvvvvv.healthypeople.gov/2020/default.aspx
Anita Davis Boykins, DNSc, FNP-BC, PMHNP BC, is an
Associate Professor in the College of Nursing at the University
of Southern Mississippi [USM) where she teaches in the family
nurse practitioner [FNP) and psychiatric mental health nurse
practitioner [PMHNP) programs and is Director of the Doctor
of Nursing Practice [DNP) program. Dr. Davis-Boykins may be
reached at: Tel: 601-266-5468; Fax: 601-266-6643; or e-mail:
[email protected]
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