The Value and Necessity of Effective Communication Skills ...



The Value and Necessity of Effective Communication Skills in Psychiatric NursingTrina SkinnerStenberg College May 26, 2012Development and implementation of effective communication skills as a life-long practice is essential to a healthcare professional attaining success in the holistic-health oriented discipline of psychiatric nursing. Cultivating active listening and attending skills and the expression of empathy are examples of components required to create an environment based on effective communication in psychiatric nursing.Development and application of ‘active’ listening and attending skills are fundamental aspects of effective communication skills in psychiatric nursing. Both listening and attending are described as “by far the most important aspects of the counseling process” (Burnard, 2005), the counseling process being built on a foundation of effective communication. Both listening and attending are vital skills and may be explored in great depth separate from one another. However, they function together to create an optimal environment for the birth of effective communication skills. Listening is defined as “the process of ‘hearing’ another person” (Burnard, 2005). The process of ‘hearing’ is not exclusive to what a person is communicating verbally, but involves a wide range of communication methodology. (Burnard, 2005) has broken the process of listening into three main categories to consider in one’s attempt to engage in ‘active listening’. The first, linguistic aspects: refers to speech and the “actual words” chosen by a client in a therapeutic interaction with a psychiatric nurse. The second category to consider is Paralinguistic aspects: represented by all aspects of speech with the omission of actual words spoken by a client, some examples include, volume, tone, range, etc. The third and final category to consider in ‘active listening’ is Non-verbal aspects: commonly referred to as “body language”, concerning the way a client may express him/herself through use of his/her body. Some examples of non-verbal communication include, a client’s affect, spatial consideration (in relation to the psychiatric nurse), and use/lack of eye contact. The ‘listener’, in this case (the psychiatric nurse) should be aware of each category and the specifics that each entail. The more comfortable the nurse becomes with identifying these important aspects of listening both in regards to a client and within his/herself, the more the nurse works to refine his/her listening skills, ultimately resulting in more effective communication.Attending is defined as “the act of truly focusing on the other person [in this case the client]” (Burnard, 2005). The process of attending involves a psychiatric nurse’s conscious self-awareness of what the client is attempting to communicate with him/her through (the client’s) spoken words, speech patterns, and body language. Attending may be a less familiar term than listening, as it is more commonly constructed in a professional therapeutic relationship, whereas listening is a skill that most of us begin to learn or attempts are made to teach us early on in life. That being said, attending, is a vital aspect of effective communication in a one-on-one nurse/client relationship. Attending is described by (Martin, 2010) as “the supportive service that a counselor [psychiatric nurse] must provide. Failure to do this will mean the client is not being supported fully, and may not feel able to disclose or make progress.” (Burnard, 2005), attempts to explain the process of attending by way of a diagram that explores “three possible zones of attention”. Zone one: “attention out” represents a nurse’s attention as being entirely focused outside of themselves and their surrounding environment, attention is fully focused on the client and what he/she is communicating. In Zone one: attention out, (Burnard, 2005) explains that this type of focused attention may be practiced by means of implementing simplified methods of meditation. For example, he suggests carefully studying an object in the room and all the details that it possesses, maintaining sole focus on the object, thus “focusing one’s attention out”. When the observation is complete, the ‘observer’ is to note what occurs in the mind immediately following this exercise. Noting any thoughts and feelings that may arise in the mind’s eye; by doing so the nurse/observer naturally progresses into Zone two: “attention in” where the nurse is preoccupied with his/her own thoughts and feeling, at this level the nurse is only capable of paying partial attention to the client and what he/she is attempting to communicate. (Burnard, 2005) contends that it is imperative to the attending process that the nurse be able to “move freely between Zone: one and Zone: two” through this freedom of movement between the two zones, the nurse is able to practice developing and fine-tuning the skill of “attending out” in which his/her attention is fully focused on the client by developing awareness of how and when the shift from Zone one: “attention out” to Zone two: “attention in” occurs. Through this course of action nurses learn the fruitful act of self-discipline and begin to consciously redirect their attention outwards on the client when they notice the process of retreating into their own “internal domain” has occurred. The final phase of this three-fold approach regarding the skill of attending is Zone three: “attention focused on fantasy”. In this Zone, the nurse becomes preoccupied with attempting to analyze the client and interpret that client’s personal reality. At this point the nurses concentration is focused on his/her perception of what is taking place and what the client is experiencing from the nurses perspective, rather than attending to the client to understand what he/she is experiencing. (Burnard, 2005) states that in Zone three, “ideas and beliefs that we [nurses] have bear no direct relation to what is going on [at the present moment] but concern what we [nurses] think or believe is going on”. Zone three: attention focused on fantasy as one may assume can be extremely detrimental to the nurse/client relationship. The nurse is no longer perceiving the client as they present themselves, but rather as a projection of that the nurse has created in his/her own mind about the client and their perception of reality. At this critical stage of misguided attention, the therapeutic interaction between the nurse and client is severed as the nurse is no longer working from an objective frame of mind based on the communication provided by the client in attempt to pursue effective therapeutic/treatment methods, but rather by way of the nurses own reflection of what he/she believes to be the experience of that client. If the nurse has developed a distorted view of the client’s reality and what he/she is communicating outward, any attempts at establishing effective communication have ceased and some serious redirection of the nurse’s attention as well as his/her aim or intention must occur in order to salvage the nurse/client relationship and restore effective communication. Making assumptions is one of the most disabling blocks to effective communication, such as those that a nurse may draw on in Zone three; regaining control of his/her attention and retreating back to a state of full attentiveness is vital in this case. Ironically, ‘wrong assumptions’ may prove to be valuable in that a nurse has the ability to gain a deeper sense of self-awareness and learn from his/her mistakes in future interactions with this client or others. This opportunity to grow and learn from one’s mistakes is reflective of the importance of developing critical thinking skills for the purpose of implementing safe and effective psychiatric nursing practice.A further example of an invaluable aspect of nursing practice that contributes to the development of effective communication is the expression of empathy that a nurse may extend to a client in order to attempt to understand and offer genuine support for the mental distress a client in psychiatric care may be experiencing. Empathy is defined by (Burnard, 2005) as “the ability to enter the perceptual world of the other person [client]: to see the world as they see it…an ability to convey this identification of feelings to the other person [client]”. There is considerable debate over whether empathy is a learned skill or an innate personal quality, and in turn whether or not a person can develop the ability to empathize. Regardless of the controversy surrounding what category the concept of empathy falls under, it is recognized universally as a concept that it critical to the effectiveness of therapeutic communication in a nurse/client relationship. Expression of empathy is especially important if we consider the varying levels/degree of psychological distress mental health clients may experience/suffer from, that the psychiatric nurse will be subjected to working with the client to amend throughout his/her nursing career. (Reynolds) explains that “empathy is crucial to all forms of helping relationships”, a statement that most definitely applies to the discipline of psychiatric nursing which is based in its entirety on “helping relationships”. (Reynolds) explains that in order for empathy to prove successful, the client must develop conscious awareness of the nurse’s (empathetic) communication to facilitate the ability to know whether or not they (the client) are being understood. (Reynolds) goes on to state that “Accurate empathy is a form of interaction, involving communication of the [nurse’s] attitudes and communication of the [nurse’s] understanding of the patient’s world”. Research suggests that nurses who engage in empathetic communication regularly and effectively, adopt approaches of therapy/treatment that focus on the present moment and inclusion of the client’s resources, more so than those nurses who express empathy less frequently and were “found likely to confront patients with pathology rather than with their resources” (Reynolds). Psychiatric nursing as a discipline has fought throughout history and will continue to fight into the future to promote a more holistic health oriented model of therapeutic interaction and care that depends on effective communication in nursing. Opposing traditional nursing practice built on a foundation of biological/pathological principles with great focus on medical based practice. The above research findings suggest that empathetic communication supports the holistic-based model in which therapy is collaborative and ideally involves the client as the main catalyst in his/her recovery, an important principle supported by the discipline of psychiatric nursing. (Burnard, 2005) further elaborates on the ideas discussed above when he states “the empathetic approach is underpinned by the idea that…the client in the end…will find his own way through… his own idiosyncratic answers to his problems of living”. Although various controversy and debate continues to ensue over the nature of empathy and theorists continually struggle to explore the concept in more tangible terms, at the end of the day, empathy is still regarded a highly influential phenomenon in the promotion of holistic health and healing in psychiatric nursing and as a powerful tool of effective communication within the discipline.In conclusion, the invaluable skills of listening and attending and application of empathetic expression are absolutely paramount in demonstrating the necessity of the development and implementation of effective communication skills within psychiatric nursing. In the midst of my research for this essay I came across a passage from (Burnard, 2005), in which he interconnects the arguments presented in this essay, to support the value of effective communication. While discussing empathy and our inability to truly empathize with a client as he deduced it would mean actually becoming that person, which is clearly impossible, (Burnard, 2005) goes on to explain that “We can however, strive to get as close to the perceptual world of the other by listening and attending…We can also learn to forget ourselves temporarily and give ourselves as completely as we can to the other person [empathetic expression]”ReferencesBurnard, P. (2005). Basic principles and considerations. In Counselling Skills for Health Professionals (4th ed., pp. 104-106). Cheltenham, United Kingdom: Nelson Thornes.Burnard, P. (2005). Counselling skills I: Listening and Attending. In Counselling Skills for Health Professionals (4th ed., pp. 132-148). Cheltenham, United Kingdom: Nelson Thornes.Martin, A. (2010). Attending Skills. The Counsellor’s Guide. Retrieved from , B. (n.d.). Developing Empathy. In P. Barker (Ed.), Psychiatric and Mental Health Nursing: The craft of caring (2nd ed., pp. 321-328). London, United Kingdom: Hodder Arnold. ................
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