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Active Listening

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Last Update: May 8, 2022.


Communication is a two-way process and good communication requires many skills. The two-way process consists of a person that will provide information to another person in the form of verbal, written, feelings, or expressions. The person sending the information is considered the sender, and the person receiving the information is considered the receiver. It is imperative that the receiver gives feedback to the sender to inform the sender that they received all of the information the sender was trying to relay. This type of communication does not come naturally and needs to be practiced and perfected to create professional teamwork and great patient relationships required for positive outcomes. Good communication will allow teams to effectively solve problems and decrease patient safety errors. In the healthcare arena, many workers are surprised by the difficulty of this task, which adds stress to the work environment. In the operating room, for example, everyone is very busy and task-oriented towards a good patient outcome and this focus allows teammates to answer questions with very short answers so that they can continue with the tasks they were performing. Short answers can be interpreted or misconstrued which causes more stress within the team. [1]


When the sender relays the information, feelings, or ideas that they want to communicate to the receiver, the receiver cannot just acknowledge that they heard or saw the information. The information may be perceived as positive or negative and can change the outcome that the sender wants to get. To be effective, the receiver must provide feedback to the sender. Feedback is a response from the receiver that includes an acknowledgment but also a recap of what they perceived from the sender. By recapping the thought, the sender has an opportunity to agree that the message was received correctly or to restate their original intentions for clarification. This process allows the receiver a chance to also ask questions for their understanding of the message. This type of communication and clarification process does not take any additional time or time away from the tasks being performed but instead allows for much better patient care.[2][3][4]

Issues of Concern

Many additional factors can get in the way of effective communication with a two-way communication process and they can inhibit “active listening.” The delivery of a sender’s message is just as important as the content of the message. The tone of a message can be misinterpreted very easily, which is why a feedback mechanism is necessary. Verbal communication is written or oral and contains an underlying tone that can have a dramatic outcome on the receiver’s interpretation of the message. This can lead to many conflicts not only in the workplace but also with the patients being cared for. In the operating room, answers are usually required to be very brief and contain the most accurate information but the tone with which that information is delivered is important as well. The tone of the information or feelings behind the words of the sender can cause misunderstandings and miscommunications. The written form of verbal communication can create more negative feelings because of an implied tone compared to communication that takes place face-to-face, which tends to be more straightforward. It is easy to misinterpret a tone simply from the written words; this happens many times in the surgical environment because teams are detailed, task-oriented, and state their messages to only reflect the information wanting to be delivered. Pleasantries are usually left out.[5][6]

Another factor is nonverbal communication, which includes body language, touch, and silence. The body language applies to both the sender and the receiver; either party can exhibit good or poor body language. A person’s body language can show their true emotions on the subject matter even when their words may be saying something different. Some body language examples include walking abruptly away after receiving or giving information, rolling of the eyes, sighing, shaking heads, lacking eye contact, placing hands on hips, and having a rigid posture. Touch can be used to express empathy or control. In most instances, the action seems innocent but some may find it unacceptable. Personal boundaries must always be adhered to for team members and patients. Finally, silence sends a strong message that may indicate the person is contemplating the message. The message may have left them speechless or in total shock which, in turn, rendered them speechless. During this time, it is important to allow the person to process the message and to give them time to contemplate a response. Dead space does not always need to be filled with idle chatter.

Clinical Significance

Before a receiver can give good feedback, he or she must have positive listening skills and allow the sender to confirm message delivery. There are several tips to be a good listener: 

  1. Focus on the sender.
  2. Listen to the message, not what you want to hear.
  3. Do not start judging the sender if your relationship is not solid. Watch the sender’s body language to assess information about the sender’s attitude about their message. 
  4. Make sure to repeat back in your own words what you thought you heard them say.
  5. Ask clarifying the question if needed to help you understand the message. 
  6. If the sender seems to start to go off-topic, redirect the conversation to the original issue/concern. 
  7. While listening to the sender, do not let yourself get sidetracked or make assumptions. 
  8. Finally, never start formulating a response before you have heard the entire message.

Active Listening requires participation. Our teammates and patients will greatly appreciate this improved communication tool.

Enhancing Healthcare Team Outcomes

Cultural competence is important in the healthcare field and can play a role in active listening. Working and communicating with people from other cultures can alter the communication techniques outlined above. People from different cultures have their own set of "norms," and they do not necessarily conform to what people in the United States see as the "norm." Medical professionals need to attend training programs or informational sessions to understand different cultures, especially in the demographic region that they serve. These training sessions should be ongoing and include speakers of different ethnic backgrounds to speak on behalf of their culture and communication styles.[7][8] Interpreters are a widely used service for patients with language barriers and while they contribute to better patient satisfaction, the role of active listening, such as body language and gestures can still maintain a sense of connection for the patient-provider relationship.[9] People deserve to preserve their cultural values and everyone needs to be respected for who they are. Training, knowledge, and cultural awareness allow for better teamwork, communication, and overall better patient outcomes.[10]

Review Questions


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Payton J. Improving Communication Skills within the Nephrology Unit. Nephrol Nurs J. 2018 May-Jun;45(3):269-280. [PubMed: 30304620]
Simon C. The functions of active listening responses. Behav Processes. 2018 Dec;157:47-53. [PubMed: 30195899]
Shepherd SM, Willis-Esqueda C, Newton D, Sivasubramaniam D, Paradies Y. The challenge of cultural competence in the workplace: perspectives of healthcare providers. BMC Health Serv Res. 2019 Feb 26;19(1):135. [PMC free article: PMC6390600] [PubMed: 30808355]
Coelho KR, Galan C. Physician cross-cultural nonverbal communication skills, patient satisfaction and health outcomes in the physician-patient relationship. Int J Family Med. 2012;2012:376907. [PMC free article: PMC3389700] [PubMed: 22792459]
Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2003 Jul-Aug;118(4):293-302. [PMC free article: PMC1497553] [PubMed: 12815076]
Govere L, Govere EM. How Effective is Cultural Competence Training of Healthcare Providers on Improving Patient Satisfaction of Minority Groups? A Systematic Review of Literature. Worldviews Evid Based Nurs. 2016 Dec;13(6):402-410. [PubMed: 27779817]
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Bookshelf ID: NBK442015PMID: 28723044


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