Relevance to clinical practice. Nurses should be mindful of how patients' disease trajectory and psychological state affect communication. Nurses should also take patients' cultural background into consideration when approaching sensitive topics. Language and cultural induction classes should also be made available, especially for overseas trained nurses working in Singapore. Nursing Associations in Singapore need to work on programmes that will increase the prestige of nursing. Further research involving a more representative sample is warranted to understand how Singapore's 'user-pays' health care system affects effective nurse-patient communication.