Effective Communication In Psychiatric Nursing



Effective Communication in Psychiatric NursingAngel St.DenisStenberg CollegeEffective Communication in Psychiatric NursingBest practice for a Registered Psychiatric Nurse is characterized by using relevant and effective therapeutic communication skills. The ability to communicate well with patients is not only essential for psychiatric nurses but is the very foundation of patient care. When the door of communication opens at a level both the patient and nurse understand, it creates a pathway for their journey of recovery to begin. At this point the Nurse and patient can walk together into places of revelation and discovery that are vital for holistic patient care. The keys for a nurse to open the doorway of communication are to use culturally appropriate communication, non-verbal & verbal interpersonal skills, adhere to self-awareness while upholding the value & integrity of the communication in the therapeutic relationship. It is important for a nurse to understand the culture of the patient before establishing a route of communication. Cultures are diverse in their traditions and there are different ways of appropriately communicating with others. What might be a well-accepted way of communicating in one culture may be offensive in another. Learning as much as you can about the patient’s culture is an essential tool in cultural encounters. There are in fact three steps that can assist a nurse to bridge these indifferences. The first step is (Park et al, 2011) “Cultural Brokering”. In this step the nurse educates the patient in the western mental health model. This way there are no surprises and it alleviates any false expectations the patient may have. An example of this is with an Asian American patient. In this situation the nurse would describe the type of doctor that would be performing a certain procedure to give the patient a grid of what is to come. One other example with the same patient the nurse would use a less confrontational and more “indirect” form of communication in turn this would be traditionally comforting. The second step is (Park et al, 2011) “Supporting Families in Transition.” It is traditional in some cultures for the family members to step in and care for another member that becomes ill. This is seen in the Asian culture. Nurses in this circumstance would then take this into consideration and involve the patient’s family members to join in on discussions. It is also traditional in this culture for the family to be part of the illness management. In this case the nurse may incorporate different tasks for family members to help out in the patient treatment. It is important to note however that in some instances families can get “overinvolved” in which case this would jeopardize the patient’s recovery. The nurse must use proper judgment and boundaries when making decisions to ensure that the patient’s best interest is always at hand.The third step is (Park et al, 2011) “Using Cultural Knowledge to Enhance Competent Care”. To find out as much as you can about the culture by consulting a (Park et al, 2011), “vast network of alliances such as members of the cultural group”. For example, (Park et al, 2011) partnering with a herbalist to educate the family (that is familiar with herbal medicine) regarding herbal medications for psychosis treatment. (St.Denis, 2013), “When the nurse increases their knowledge of the patient’s culture it also helps to increase their depth of empathy towards their patient because they have a clearer understanding of where they are coming from.” The proper usage and mix of non-verbal and verbal interpersonal skills when communicating with a patient are essential for a registered psychiatric nurse. Non-verbal communication consists of body language, touch, and listening skills. Verbal skills consisting of voice, language, tone, and word emphasis are all factors in how the communication will play out. When using proper body language the nurse strives to maintain a comfortable level of eye contact with their patient. This helps the patient feel like the nurse is giving them their full, undivided attention. Burnard writes (Burnard, 2005), “Conscious use of eye contact can ensure that the client feels listened to and understood but not uncomfortable.”(p.140). Other forms of body language such as facial expressions, body gestures and proximity between the nurse and the patient can also show a patient that the nurse cares and is attentive to them. Something as simple as offering a smile to the patient may just be the ice breaker for the relationship. On the other hand if the patient sees that the nurse is frustrated, annoyed and has the look that they are too busy for them the patient may not want to engage in any sort of conversation. The patient may put up walls and have the attitude that the nurse isn’t really interested in what they have to say so why should they let the nurse into their world. (Morrissey & Callaghan, 2011) “In practice, both clients and mental health nurses send many messages and clues through their non-verbal behaviour. It is therefore important that mental health nurses are aware of their own non-verbal body language before they can explore clients’ non-verbal behaviour.” Touch that is offered in a respectful and sincere way can break barriers between the nurse and patient. A nurse reassuring a patient by placing their hand on the patient’s shoulder, holding a patients hand or offering them a hug when needed is another way that a patient may feel closer to the nurse. Morrissey and Callaghan write that (2011) “Similar to other therapeutic interventions, touch should always be used genuinely and for the client’s best interest.” It is important to note boundaries with touch. It is not however appropriate to use touch with every patient. (Morrissey & Callaghan, 2011), “Respect the client’s culture, age, ethnicity and gender; for example do not assume that it is OK to touch older clients or children without their permission. Also, in some cultures, it is unacceptable to be touched by people who are not intimate unless it is in the administration of specific physical care.” The nurse must use their own discernment, and knowledge of the patient before deciding to implement touch with their patient.Using active listening skills will help a patient feel “heard” and “important”. When a patient feels this way it opens another door for effective communication. There are many ways a nurse can enter into active listening. The first way is it ensure that the nurse is sitting or positioned in a way that shows the patient their attentiveness. For example, sitting directly in front of one another, or in close proximity with the patient. The second way is to allow the patient to speak without interrupting them, allowing the conversation to flow. When a nurse interjects with advice or attains to give direction this creates a blockage and the patient may feel condemned. On the other hand, if the nurse steps down to the patients level, supports the patient by doing things like nodding, saying “hmmhmm”, or “tell me more…” this allows the patient to dig deeper. Nurses have many tasks at hand, when a nurse gives their patient the gift of time and allows them to describe their story in their own way it doesn’t go unnoticed by the patient. When a patient feels accepted, heard, and that what they are saying is of importance this builds a layer of trust between the nurse and the patient. Once trust is established communication flows in like a river! This enables the nurse to discover the patient in greater depth, leading to a more complete recovery.Verbal skills are also important in effective communication between a nurse and their patient. First of all tone of voice can project an underlying emotion behind it. Using a loud and aggressive tone puts up a wall between the nurse and patient. Whereas using a soft, gentle tone can show the patient that the nurse cares about them. It is interesting to note that when working with acutely psychotic patients Len Bowers suggests (Bowers, 2010), “Tone of voice should be caring and quiet, interactions short and frequent, with persistence shown in efforts to communicate.” Another way verbal skills are effective is to re-cap verbally what a patient is saying when in conversation. This is a form of active listening and improves flow of conversation for the patient. It is important to note that when working with a patient that has somewhat of a language barrier the nurse can change the way they speak by slowing their words down, enunciating words clearly, use of hand gestures and appropriate language that is at the level of the patient. Using these skills with this type of patient is a great way to ensure clear communication is a success.Adhering to self-awareness is an essential component of best practice in registered psychiatric nursing. A nurse needs to understand their own values, belief system, ethics, strengths and weaknesses before entering into a therapeutic relationship with a patient. In regards to the importance of using self-awareness in nursing Jack and Smith write (Jack & Smith, 2007), “It involves recognising what we know, what skills we employ and what limitations affect our ability to intervene. It can also enable us to present ourselves as knowledgeable, expert in some areas and as still learning but supportive in others.” In doing this the nurse creates healthy boundaries and are less susceptible to cross over and blur lines that can affect recovery for the munication skills are a necessity to clearly understanding the patient’s needs. Nurses that place a high level of value and engage in increasing their skills in this area will benefit from closer connections with their patients. There are always ways that one can improve on their communication skills. There are communication workshops, groups that incorporate role play, a nurse may also use a mentor or a peer to glean from what works for them. Another great way for a nurse to improve on their communication skills is through clinical supervision. This is a safe and confidential setting in which the nurse can reflect and verbalize patient issues with a supervisor. In conclusion, the effectiveness of communication lies ultimately first hand with the nurse in practice. It is worth the effort for the nurse to acquire the skills needed in order to make open communication a reality in their patient care. Reflecting upon what was useful in one situation and what didn’t work in another is a great way the nurse can refine these skills. Once the nurse enforces what they have learned and applies it to the therapeutic patient relationship it creates a stepping stone for communication to build on. Collins writes (Collins, 2012), “Excellent communication skills and empathy, combined with an unflappable nature and an ability to take a firm approach when necessary, are basic requirements for anyone considering working in this field.” Using the keys of understanding to unlock knowledge of what the patient needs by using effective communication skills establishes a partnership between the nurse & patient that can lead to a successful outcome for both.ReferencesBowers, L. (2010). How expert nurses communicate with acutely psychotic patients. Mental Health Practice, 13(7), 24-26. Retrieved from , P. (2005).Counselling skills 1: Listening and attending. Counselling skills for the health professionals. (4th ed). (p. 140). Cheltenham, UK: Nelson Thornes Ltd.Collins (2012). Mindful matters. Canadian Nurse, 108(3), 34-36. Retrieved from , K., & Smith, A., (2007). Promoting self-awareness in nurses to improve nursing practice. Retrieved from , J., & Callaghan, P., (2011). Communication skills for mental health nurses. (pp. 1-15). Retrieved from , M., Chesla, C. A., Rehm, R. S., & Chun, K. M. (2011). Working with culture: culturally appropriate mental health care for Asian Americans. Journal Of Advanced Nursing, 67(11), 2373-2382. doi:10.1111/j.1365-2648.2011.05671.xSt.Denis, A. (2013, July 23).Cultural issues in mental health 101-6 forum. Stenberg College. Retrieved from ................
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