There are many theories about interpersonal communication. One of the earliest theories is the idea that communication can be represented as a linear process (Miller and Nicholson [186]):

This Linear Model of communication makes certain assumptions, such as the receiver being a willing participant in the process and open to receiving the message, and that all messages will be clear and the sender certain about their purpose (McCabe and Timmins [170]). However, such a model is unidirectional so is more relevant for electronic media and not necessarily representative of the complexity of human communication.

The Transactional Model is more useful, recognizing that human communication is a simultaneous process, so each person involved is a communicator rather than just a sender or receiver (McCabe and Timmins [170]) (Figure 5.3). In addition, the model recognizes that the interpersonal context or environment affects the process significantly, as does the channel of communication (i.e. whether it is visual, aural/vocal, gustatory/taste, olfactory/smell, touch, or kinesic/interpretation of motion). This theory helps nurses to reflect on the multifaceted nature of communicating with patients and so recognize the many factors that can affect an effective process.

An aim of interpersonal professional communication training is to support and maintain the patient's optimum level of communication while remaining aware of the impact that the disease and its management may have on the patient's ability and/or motivation to speak. It is also important to be aware of the different coping styles and attitudes of the patient and key people in their life, as well as co‐morbidities, disease progression, fluctuating cognitive abilities and treatment side‐effects. All these factors demand a flexible approach when supporting communication throughout the patient pathway (Dwamena et al. [86], White [283]).

Non‐verbally, people communicate via gestures, body language, posture, facial expression, touch and the items they surround themselves with, such as their personal possessions, which will include their clothing and accessories, means of entertainment (e.g. books and digital media) and photographs in the hospital environment. Communication can be heavily influenced by a multitude of external and internal factors, for example immediate environment, illness, mood, self‐esteem, gender, class, status and culture. The influence of these factors needs to be carefully considered in each circumstance.