E-ISSN:2320-8686
P-ISSN:2321-127X
RNI:MPENG/2017/74037

Research Article

Communication Barriers

International Journal of Medical Research and Review

2025 Volume 13 Number 2 Apr-Jun
Publisherwww.medresearch.in

Communication barriers encountered by the undergraduate nursing students and the newly admitted patients while interacting with each other in the tertiary care hospital of Bhopal.

Anila E1*, Aiswarya S2, Aksa Biju3, Anagha E4, Aarsi Kulshrestha5, Anamika Priya6, Verma M7
DOI:https://doi.org/10.17511/ijmrr.2025.i02.06

1* Anila E, B.Sc. (H) Nursing Student, Nursing College, All India Institute of Medical Sciences, Bhopal, India.

2 Aiswarya S, B.Sc. (H) Nursing Student, Nursing College, All India Institute of Medical Sciences, Bhopal, India.

3 Aksa Biju, B.Sc. (H) Nursing Student, Nursing College, All India Institute of Medical Sciences, Bhopal, India.

4 Anagha E, B.Sc. (H) Nursing Student, Nursing College, All India Institute of Medical Sciences, Bhopal, India.

5 Aarsi Kulshrestha, B.Sc. (H) Nursing Student, Nursing College, All India Institute of Medical Sciences, Bhopal, India.

6 Anamika Priya, B.Sc. (H) Nursing Student, Nursing College, All India Institute of Medical Sciences, Bhopal, India.

7 Mamta Verma, Associate Professor, Nursing College, All India Institute of Medical Sciences, Bhopal, India.

Introduction: Communication is a lifelong learning process. Clear communication means the information is conveyed effectively between people. As a part of training for nursing service, nursing students have to communicate with patients focusing on the patient's needs and problems. Many nursing students face communication difficulties with their facilitators and patients during their clinical learning. This study aims to determine the communication barriers encountered by undergraduate nursing students and newly admitted patients in the tertiary care hospital of Bhopal and to find out the association of the communication barriers with the selected socio-demographic variables.

Methods: A descriptive, cross-sectional study was conducted among 138 undergraduate nursing students and 73 newly admitted patients. The barriers were assessed with the help of a self-structured questionnaire and the association was analyzed with frequency, percentage, distribution and Fischer’s exact test.

Results: Among nursing students, 68.8% reported moderate communication barriers, and 21% faced severe barriers. Among patients, 36% experienced moderate communication barriers and 24.7% of them faced severe communication barriers. This study also concludes that there is a significant association between the level of communication barrier with the course and year of study of undergraduate nursing students and with the highest level of education of the patients.

Conclusion: Furthermore, it was also concluded that the most significant barrier between the nursing students and the admitted patients was the psychological barrier with those patients who did not neither maintain eye contact nor show interest and with those nursing students who did not maintain a good eye contact nor let them express their ideas, respectively.

Keywords: communication barriers, undergraduate nursing students, newly admitted patients and tertiary care hospital

Corresponding Author How to Cite this Article To Browse
Anila E, B.Sc. (H) Nursing Student, Nursing College, All India Institute of Medical Sciences, Bhopal, , India.
Email: 		Anila E, Aiswarya S, Aksa Biju, Anagha E, Aarsi Kulshrestha, Anamika Priya, Verma M, Communication barriers encountered by the undergraduate nursing students and the newly admitted patients while interacting with each other in the tertiary care hospital of Bhopal.. Int J Med Res Rev. 2025;13(2):27-33.
Available From
https://ijmrr.medresearch.in/index.php/ijmrr/article/view/1541

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-03-01 2025-03-05 2025-03-13 2025-03-21 2025-03-29
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nill Yes 12.39

© 2025by Anila E, Aiswarya S, Aksa Biju, Anagha E, Aarsi Kulshrestha, Anamika Priya, Verma Mand Published by Siddharth Health Research and Social Welfare Society. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Int J Med Res Rev 2025;13(2)27
Download PDFBack To ArticleIntroductionMaterial and MethodsResultsDiscussionConclusionReferences
Anila E et al. Communication barriers encountered by the undergraduate nursing students

Introduction

Communication is a means of persuasion to influence others so that the desired effect is achieved. -Aristotle. Communication is a multidimensional, complex and dynamic process closely related to the hospital environment where expression of feelings occurs. [1] Effective communication is an important element in the quality of nursing care which help in informed decision making, care, autonomy, adherence and involvement in treatment and therefore patient health outcomes are improved.[2] While nursing education integrates theory and practice, many students encounter communication challenges, these obstacles hinder their ability to connect with patients This study focuses on identifying and addressing the communication difficulties faced by nursing students and patients to enhance interpersonal relationships and improve the quality of care. Clinical learning environment is an interactive network of forces that influence the learning outcomes of nursing students within the clinical setting, where they have the opportunity to transform theoretical knowledge into various skills and abilities significant for patient care by interacting with patients. [3]. Certain research studies show that nursing students face communication difficulties with their facilitators and patients during their clinical learning which include; lack of knowledge and training, low self-efficacy and confidence, poor emotional and cultural regulation, disregard for patient privacy, language differences, unfriendly, negative interactions with ward staff, heavy workload and uncooperative patients/family. [3]

These obstacles hinder effective interactions with patients emphasizing the need to address communication difficulties to enhance care quality and interpersonal relationships. The review of the literature identifies significant barriers to communication between nursing students and patients, supported by various research findings. A cross sectional study revealed that unpleasant past experiences with patients (mean score: 4.11) and the use of technical jargon by nurses (mean score: 3.28) were the primary barriers to effective communication. The thematic analysis also emphasized the need for more staff recruitment, adequate time allocation for patient interaction, and regular communication skills training​.[4].

Effective communication is important to maintain good interpersonal relationships between nursing students and patients. In this study, we aimed to determine the barriers to communication encountered by nursing students and patients.

Material and Methods

A descriptive, cross-sectional, quantitative study was conducted among 138 nursing students and 73 patients at AIIMS Bhopal. Prior permissions were taken from competent authorities.

Sample and sampling technique

The study sample of both undergraduate nursing students and newly admitted patients was selected using convenient sampling techniques.

The sample size was calculated using the formula,

N =Z2 P(1-P)

  d2

Where, n- sample size, Z-static level of confidence (95%) is 1.96, P- expected Proportion or prevalence, d- precision,

Sample size for nursing students= (1.96)^2×0.1(1-0.1)/(0.05)^2

= 138.29 ~ 138 ( nursing students)

Sample size for patients= (1.96)^2 ×0.05(1-0.05)/(0.05)^2

= 72.99 ~73 ( Patients)

All the undergraduate nursing students who have got minimum 6 months of clinical exposure and are willing to participate in the study and all newly admitted patients of the medical and surgical ward at the time of data collection were included in the study. All the undergraduate nursing students who are not willing to take part in the study and whose clinical postings have not been completed for at least 6 months and the patients who are under 18 years of age, critically ill and unable to respond, differently abled and mentally challenged were excluded in the study.

Data Collection Tools

A self-structured questionnaire of newly admitted patients of medical and surgical wards of AIIMS Bhopal. The questionnaire had three sections:


Int J Med Res Rev 2025;13(2)28
Anila E et al. Communication barriers encountered by the undergraduate nursing students

  • Section 1: Demographic Data: For both nursing students and patients.
  • Section 2: Questionnaire to assess communication barriers encountered by undergraduate nursing students /newly admitted patients. It contained 10 items in the questionnaire for nursing students and 12 items in the questionnaire for newly admitted patients.
  • Section 3: questionnaire to assess the common communication barriers encountered by both undergraduate nursing students and newly admitted patients. It included 9 items.

  The reliability of the tool was established through Cronbach’s alpha, and the validity was confirmed by nursing and subject experts.

A pilot study was also conducted to ascertain the feasibility of the study before the main study.

Ethical Considerations

Ethical approval was obtained from the Institutional Human Ethics Committee with LOP No IHEC/SR/2024/Apr/05. Informed consent was obtained from all participants.The confidentiality and privacy of the subjects were also assured during and after data collection A verbal informed consent was also collected before data collection. Subjects were given full freedom to withdraw from study at any point in time. However, the reason for nonparticipation was ascertained.

Data Collection and Analysis

Data from the participants was collected in July 2024. The participants were provided with a participant information sheet and informed consent was taken before data collection. Analysis of data was done using IBM SPSS 20 Software. Frequency and percentage distribution were done for the socio-demographic data of the participants. The data included 138 undergraduate nursing students and 73 newly admitted patients of AIIMS Bhopal. The effect was analyzed at the level of significance (p<0.05). Descriptive statistics was used to analyze the data. In descriptive statistics frequency and percentage distribution were used to analyze different types of communication barriersand levels of communication barriers encountered by nursing students and newly admitted patients while interacting with each other.

Fisher exact test is used to find the association between socio demographic variables with levels of communication barrier encountered by nursing students and newly admitted patients.

Results

Findings related to the Socio-Demographic Characteristics of the sample population under study

Nursing Students:

The finding of the study reveals that among 138 undergraduate nursing students, Majority of the students were of B.Sc.(H) Nursing 2022 and 2021 batch (35.5%) are from North West (Rajasthan, U.P, Haryana, Uttarakhand, Delhi, J&K, Punjab and Gujarat) India (50.7%) belongs to age group of 21 – 23 yrs (68.1%) of Hindu religion (87.7%)

Patients:

The findings of the study reveal that among 73 patients, the majority of the patients are age 49 and above (32.9%), are female (52.1%), of Hindu religion (89%) from Madhya Pradesh (94.5%) and mainly speaks Hindi (97.3%) and having secondary educational level (45.2%).

Findings related to frequency and percentage distribution of communication barriers

The present study revealed that based on scoring 68.8% of nursing students have encountered moderate communication barriers whereas 21% and 14 percent of them had severe and mild communication barriers respectively.

The most prevalent communication barriers according to the nursing students were psychological barriers as the nursing students were facing difficulty communicating effectively with those patients who did not maintain eye contact and show interest(76.8%).

The other commonest barriers found are Physical Barriers 76.1% reported discomfort affecting communication and Personal Barriers: Lack of knowledge (39.9%) and confidence (45.7%).TABLE 1 According to newly admitted patients, 57.5 % of them have moderate communication barriers, 24.7% have severe and 17.8% have mild communication barriers. From the present study which was conducted,


Int J Med Res Rev 2025;13(2)29
Anila E et al. Communication barriers encountered by the undergraduate nursing students

it has found that the majority of the patients (91.8%) stated difficulty communicating with those nursing students who don't give them reassurance and support regarding illness (Psychological barrier). Other most prevalent barriers were found to be not maintaining eye contact and do not show interest (psychological barrier 87.7%) and does not allow to express feelings ( psychological barrier 79.5%).TABLE 2

Association with Socio-Demographic Variables

Using Fisher's exact test, it was found that socio-demographic variables such as course and year of study of the nursing students and the highest education level of the newly admitted patients have a significant association with the level of communication barriers with p values 0.019 and 0.028 respectively. TABLE 3 & 4


Table 1: Percentage distribution of communication barrier encountered by nursing students and common communication barrier concerning nursing students.

Communication barriers faced by undergraduate nursing studentspercentage
Interpersonal barrier- I feel the age gap between the patient and me acts as an interfering factor in the communication process.25.4
Physical barrier- I feel time limitation is a hindrance to establishing a meaningful communication with the patient.35.5
Perceptional barrier – I feel that being guided by a clinical supervisor/ instructor is important to establish good communication with the patient.65.2
Personal barrier- I feel my lack of knowledge is a barrier to communication with the patient39.9
Personal barrier- I feel my lack of confidence is a hindrance to effective communication with the patient.45.7
Personal barrier- I feel that the academic workload acts as a barrier to therapeutic communication with the patient49.3
Perceptional barrier- I feel the need of assistance (moderator) while communicating with the patients in their colloquial/ dialects.38.4
Physical barrier- I feel difficult to communicate effectively with the patient when I am in physical discomfort76.1
Perceptional barrier- I feel uncomfortable to communicate with the patient who already has some knowledge regarding health aspects.32.6
Perceptional barrier- I feel fearful in communicating with the patient who is diagnosed with communicable diseases.37
Linguistic barrier- I feel the linguistic difference is one of factor hindering my communication with the patient.43.5
Cultural barrier- I feel that the cultural beliefs of the patient can be one of the barriers to effective communication.32.6
Gender barrier- I feel uneasiness while communicating with patients of the opposite gender.20.3
Physical barrier- I feel the environment (noise, smell, etc) of the clinical setting is itself a barrier to the communication process.33.3
Psychological barrier – I feel encouraged to communicate with those who maintain eye contact with me and show interest.76.8
Emotional barrier- I feel my emotional issues are a barrier to effective communication with the patient.37.7
Perceptional barrier- I feel reluctance to communicate because of unpleasant past experiences with the patient.39.9
Personal barrier- I feel it is difficult to engage in direct communication when the patient responds aggressively or rudely.69.6
Psychological barrier- I feel discouraged to communicate with the patients when they treat me with negative attitude.68.8

Table 2: Percentage distribution of assessment of communication barriers encountered by the newly admitted patients and common communication barriers concerning newly admitted patients

Communication barriers faced by newly admitted patientspercentage
Interpersonal barrier- I feel uncomfortable talking with those nursing students who never greeted me while starting the conversation.60.3
Interpersonal barrier- I feel the reluctance to share my information when the nursing students do not explain to me the reason for the visit.69.9
Linguistic barrier - I feel difficulty understanding the conversation as the nursing students use more medical terms while communicating.69.9
Physiological barrier - I feel uncomfortable when the nursing students do not pay attention or interrupt me while I am talking to them.68.5
Physical barrier - I feel uneasy communicating with the nursing students who approach me when I am in discomfort due to a disease condition.56.2
Physical barrier - I feel comfortable disclosing my matter with nursing students when privacy during conversation is well-maintained86.3
Psychological barrier - I feel it is hard to communicate with the nursing students who shows unpleasant body language such as making faces while communicating.72.6
Psychological barrier - I feel it challenging to engage in communication when I am not encouraged to express my ideas.79.5
Psychological barrier- I feel encouraged to communicate with those nursing students who gives me reassurance and support regarding my illness.91.8
Personal barrier- I feel it challenging to communicate when excessive information was given to me at a single time.71.2
Perceptional barrier - I feel difficulty to rely on information given by nursing students as they are not experienced.50.7
Perceptional barrier - I feel reluctant to share my information repeatedly when the same question is being asked by multiple personnel in different occasions.69.9

Int J Med Res Rev 2025;13(2)30
Anila E et al. Communication barriers encountered by the undergraduate nursing students
Linguistic barrier- I feel the linguistic difference is one of factor hindering my communication with the patient.60.3
Cultural barrier- I feel that cultural belief of the patient can be one of the barriers to effective communication.27.4
Gender barrier- I feel uneasiness while communicating with the patients of the opposite gender.26
Physical barrier- I feel the environment (noise, smell, etc) of the clinical setting is itself a barrier to communication process.61.6
Psychological barrier – I feel encouraged to communicate with those who maintain eye contact with me and show interest.87.7
Emotional barrier- I feel my emotional issues are barrier to effective communication with the patient.47.9
Perceptional barrier- I feel reluctance in communicating because of unpleasant past experiences with the patient.27.4
Personal barrier- I feel it difficult to engage in direct communication when the patient responses in aggressive or rude manner.69.9
Psychological barrier- I feel discouraged to communicate with the patients when they treat me with negative attitude.75.3

Table 3: Fischer’s Exact value between the communication barrier encountered by the undergraduate nursing students and selected socio-demographic variables

(N=138)

VariablesLevel of communication barrierFischer’s exact valueP value
Mild (19-31)Moderate (32-44)Severe (45-57)
Course and year of studyB.Sc. (H) nursing 2023 batch424211.4120.019*
B.Sc. (H) nursing 2022 batch93412
B.Sc. (H) nursing 2021 batch13715
Native state and languageEast and North East India21246.7630.321
North West104911
Central1125
South1229
Age17-20yrs52027.8940.08
21-23yrs96421
24-26yrs-116
Above 26yrs---
ReligionHindu1484236.7530.293
Muslim-32
Christian-74
Others-1-

Table 4: Fischer’s Exact value between the communication barrier encountered by the newly admitted patients and selected socio-demographic variables.

(N=73)

Socio-Demographic VariableLevel Of Communication BarrierFischer Exact ValueP Value
Mild communication barrierModerate communication barrierSevere communication barrier
Age
1. 18 – 28
2. 39 – 38
3. 39 – 48
4. 49 and above		2
2
3
4		12
7
6
19		4
4
8
2		10.0140.106
Gender
1. Male
2. Female		6
5		23
21		6
12		2.0570.382
Religion
1. Hindu
2. Christian
3. Muslim
4. others		10
0
1
0		39
0
5
0		16
0
2
0		0.1871.000

Int J Med Res Rev 2025;13(2)31
Anila E et al. Communication barriers encountered by the undergraduate nursing students
Socio-Demographic VariableLevel Of Communication BarrierFischer Exact ValueP Value
Mild communication barrierModerate communication barrierSevere communication barrier
Native State
1. Madhya Pradesh
2. Others		10
1		40
3		18
0		1.4970.476
Languages Known
1. Hindi
2. English
3. Others		10
0
1		43
1
0		18
0
0		5.0720.339
Highest Level Of Education
1. Illiterate
2. Primary
3. Secondary
4. Higher Secondary
5. Graduation and above		0
0
3
8
0		7
1
15
5
16		4
2
8
1
3		15.0760.028*

Discussion

The findings indicate that both nursing students and patients face moderate to severe communication barriers, which can impede patient-centred care. In the present study, it was found that the majority of nursing students were facing difficulty communicating with those patients who don't maintain eye contact and show interest (76.8%) and physical discomfort ( 76.1%) was the second most common barrier faced by them. A study done by Y Neelima showed a similar finding that the most common communication barrier is the physical discomfort experienced by the nurses and the contradicting finding is a negative attitude of the patients in comparison to the present study. [4] In another similar study published in 2018; “Barriers of the Nurse-Patient Communication affiliated to Kurdistan University of Medical Sciences”, the most important barrier was found to be cultural differences between nurses and patients (62.2%) followed by lack of time. Physical discomfort was found to be the highest barrier and the least was found to be the negative attitude of the patient towards the nurses. [5]

A supporting finding from the study conducted by Sethi and Rani (2017) concluded that psychological support and the positive attitude of nurses towards patients were encouraging to build therapeutic communication.[6] A similar study by Maame Kissiwaa Amoah V showed workload and shortage of time as potential communication barriers, [7]while another study conducted by Awe O,


emphasized the importance of clinical instructors and the provision of a successful orientation period to improve communication skills.[8] The study aligns with previous research that highlights the importance of addressing communication barriers through targeted interventions, including communication training for nursing students and cultural sensitivity programs in healthcare settings.

Conclusion

Results of the present study conclude that 68.8% of nursing students have encountered moderate communication barriers and the most prevalent communication barriers according to the nursing students were psychological barriers as the nursing students were facing difficulty communicating effectively with those patients who did not maintain eye contact and showed interest According to newly admitted patients, 57.5 % of them have moderate communication barriers and it has found that the majority of the patients stated difficulty communicating with those nursing students who don't give them reassurance and support regarding illness (Psychological barrier). It was also found that socio-demographic variables such as course and year of study of the nursing students and highest education level of the newly admitted patients have a significant association with the level of communication barriers. Communication barriers are a significant challenge for both nursing students and patients in clinical settings. By understanding and addressing these barriers and correcting them, the healthcare workers can improve the quality of care and patient outcomes.


Int J Med Res Rev 2025;13(2)32
Anila E et al. Communication barriers encountered by the undergraduate nursing students

Statement of Competing Interest: The authors declare that they have no conflict of interest.

Funding: Nil

Permission from Institutional Research Board: Yes

References

1. Sung-Ok C, Park Y-J. The study on the communication barrier for nurses in clinical settings. J Korean Acad Fundam Nurs. 1999 Jan;6(1):130–40. [Crossref][PubMed][Google Scholar]

2. Fite RO, Assefa M, Demissie A, Belachew T. Predictors of therapeutic communication between nurses and hospitalized patients. Heliyon. 2019 Nov 1;5(10):e02665. doi: 10.1016/j.heliyon.2019.e02665. PMID: 31720457; PMCID: PMC6838810 [Crossref][PubMed][Google Scholar]

3. Norouzinia R, Aghabarari M, Shiri M, Karimi M, Samami E. Communication Barriers Perceived by Nurses and Patients. Glob J Health Sci. 2015 Sep 28;8(6):65-74. doi: 10.5539/gjhs.v8n6p65. PMID: 26755475; PMCID: PMC4954910 [Crossref][PubMed][Google Scholar]

4. Neelima Y, Begum J, Ali SI, Pattnaik S, Sharma D, Asuvi S, et al. Perceived Barriers of Communication between Nurses and Patients in a Tertiary Care Hospital. Indian Journal of Public Health Research & Development [Internet]. 2020 July 25 [cited 2021 Feb 8];11(7):1009–15. Available from: [Article][Crossref][PubMed][Google Scholar]

5. Ardalan F, Bagheri-Saweh MI, Etemadi-Sanandaji M, Nouri B, Valiee S. Barriers of nurse-patient communication from the nurses’ point of view in educational hospitals affiliated to Kurdistan University of Medical Sciences. Nursing Practice Today [Internet]. 2018 Sep 7 [cited 2024 Jan 5];5(3):326–34. Available from: [Article][Crossref][PubMed][Google Scholar]

6. Sethi D, Rani MK. Communication barrier in health care setting as perceived by nurses and patients. Int J Nurs Educ. 2017;9(4):30–5. Available from: [PDF] ijone.org [Crossref][PubMed][Google Scholar]

7. Awe O. Communication Barrier during Clinical Placement: Challenges and Experiences of International Nursing students [Internet]. www. theseus. fi. 2014 [cited 2024 Jan 5]. Available from: [Article][Crossref][PubMed][Google Scholar]

8. Maame Kissiwaa Amoah V, Anokye R, Boakye DS, Gyamfi N. Perceived barriers to effective therapeutic communication among nurses and patients at Kumasi South Hospital. Lee A, editor. Cogent Medicine [Internet]. 2018 Apr 2;5(1):1–12. Available from: [Article][Crossref][PubMed][Google Scholar]

Disclaimer / Publisher's NoteThe statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of Journals and/or the editor(s). Journals and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.


Int J Med Res Rev 2025;13(2)33