Over the past few decades, concern has grown that nurses may often be ineffective communicators and that deficiencies exist in terms of communication skills teaching in nursing training. The effectiveness of communication training programs does not only depend on the program characteristics, but might also be affected by a range of other variables and thus a need has arisen for the new approach to the issue that is taken in the present research, that combines qualitative and quantitative approaches and focus on nurses point of view. The research studies the differences in the perception and the performance of communication skills among the 175 nurses working in the three different clinical areas in the Sheba Rehabilitation Medical Centre in Israel. The research tools were constructed according with the data gained in each of the three research stages and includes: interview tool, observation tool and the nursing activities questionnaire.                 
The main findings of the research showed that the geriatric areas nurses emphasize the instrumental activities importance and the psychiatric area nurses the communication activities. The rehabilitation area nurses are similar in most of responses to the psychiatric area nurses. Geriatric area nurse's communication skill performance is lower than the performance of the psychiatric and the rehabilitation areas nurses.
The conclusions are that the clinical area and the ward environment influence the nurse-patient communication process. There is a need for environment changes and areas related nurse's communication skills training programs.
The research shed a new light on the nurse-patient communication issue and may be a source of change in nurses' performance and training. It also offers a foundation for subsequent investigations and further research.
     

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