Chapter 1 – Introduction to Communication and Communication Theory in Nursing

Transaction Model of Communication

The Transaction Model of communication (see Figure 1.5) differs from the Transmission and Interaction Models in important ways, including the conceptualization of communication, the role of sender and receiver, and the role of context (Barnlund, 1970).

The Transaction Model of communication describes communication as a process in which communicators generate social realities within social, relational, and cultural contexts. In this model, nurses don’t just communicate to exchange messages; they communicate to:

  • Create relationships.
  • Form intercultural alliances.
  • Shape self-concept.
  • Engage with others in dialogue to create communities.

In short, you don’t communicate about your realities; communication helps to construct your realities.

The roles of sender and receiver in the Transaction Model of communication differ significantly from those in the other models. Instead of labeling participants as senders and receivers, the people in a communication encounter are referred to as communicators. Unlike the Interaction Model, which suggests that participants alternate positions as sender and receiver, the Transaction Model suggests that you are simultaneously a sender and receiver.

For example, when you first meet a client, you send verbal messages saying hello, who you are, and why you are there. Before you are done your introduction, the client is reacting nonverbally. You don’t wait until you are done sending your verbal message to start receiving and decoding the nonverbal messages of the client. Instead, you are simultaneously sending your verbal message and receiving the client’s nonverbal messages. This is an important component of this model because it helps you understand how you can adapt your communication. For example, in the middle of sending a verbal message, you can adapt your communication in response to the non-verbal message you are simultaneously receiving from your communication partner.


Figure 1.5: The Transaction Model of Communication


The Transaction Model also includes a more complete understanding of context. The Interaction Model portrays context as physical and psychological influences that enhance or impede communication. While these influences are important, the model focuses on message transmission and reception. Because the Transaction Model of communication frames communication as a force that shapes your realities before and after specific interactions occur, it must account for contextual influences outside of a single interaction. To do this, the Transaction Model considers how social, relational, and cultural contexts frame and influence communication encounters.

Here is a short description of each context:

  • Social context refers to the stated rules or unstated norms that guide communication. As you are socialized into the nursing profession, you learn rules and norms for communicating, which are often referred to as communication strategies and principles. Some common rules that influence social contexts in nursing include being truthful during your conversations, being patient and encouraging the client to speak, demonstrating empathy, speaking clearly, making eye contact, and so on.
  • Relational context includes the previous interpersonal history and type of relationship you have with a person. You communicate differently with someone you just met versus someone you’ve known for a long time. Initial interactions with people tend to be more highly scripted and governed by established norms and rules. As a nurse, you should always engage in communication in a professional manner because the nurse-client relationship is a professional one, not a personal one.
  • Cultural context includes various aspects of identity such as gender, ethnicity, sexual orientation, class, and ability. While you may be able to identify some aspects of the cultural context within a communication encounter, there may also be cultural influences that you can’t see. A competent communicator shouldn’t assume they know all the cultural contexts a person brings to an encounter, because not all cultural identities are visible. Some people, especially those with identities that have been historically marginalized, are highly aware that their cultural identities influence their communication and influence how others communicate with them. Conversely, people with identities that are dominant or in the majority may rarely, if ever, think about the role their cultural identities play in their communication.

You need skills to adapt to shifting contexts, and the best way to develop these skills is through practise and reflection.

Nursing Example

A 42-year-old client and her partner are attending a fertility clinic awaiting intrauterine insemination with donor sperm. It is the client’s third attempt at the procedure, and she is becoming concerned that she may never get pregnant. The stress of getting pregnant has weighed on the client and her partner. They got into an argument on the way to clinic and are not speaking to each other. Both the client and her partner are South Asian and have experienced both racial and sexual discrimination in their past encounters with the healthcare system. A 59-year-old nurse of European decent enters the room and both the client and her partner are on their phones and barely look up at the nurse. The nurse is polite and completes her care plan. The nurse interprets their lack of attention as indifference to the situation and does not bother to counsel the client and her partner further, assuming it is not necessary. The nurse also assumes they have no questions, because it is their third attempt at the procedure.

Analysis: This example sheds light on the sort of nuances involved when communicating with clients. In this case, the nurse reads the lack of eye contact and engagement as a social convention that relays disinterest. From a relational standpoint, the nurse was unfamiliar with the couple and relied on a brief encounter, combined with information from the client’s chart. From a cultural standpoint, a shared understanding and space is needed to engage in discussions affected by culture. In this case, because of the social and relational misalignment, it was not likely the nurse and client/partner would engage in meanings of culture and socio-political context in relation to their care.

Pros: This approach offers more breadth and understanding of how intra-personal, inter-personal, and contextual factors are at play in communication. People often make assumptions predicated on these contextual factors, and therefore it is important to acknowledge these elements in practising and learning about good communication.

Cons: This approach requires analysis and critical reflection. It requires a broader understanding of historical, political, and social structures that affect communication. The specific factors affecting a particular communication encounter may or may not be possible to uncover.


Attribution Statement

Remixed with original content and adapted, with editorial changes, from:

Communication in the Real World: An Introduction to Communication Studies by University of Minnesota. Licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.


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Introduction to Communication in Nursing Copyright © 2020 by Edited by Jennifer Lapum; Oona St-Amant; Michelle Hughes; and Joy Garmaise-Yee is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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