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Communicating Care is Essential to Psychiatric Nursing

Shawn Limber

Stenberg College

Therapeutic Relationships and Communication Skills

Mary Jordan

May 27, 2012

Abstract

Therapeutic relationships are the cornerstone of Psychiatric Nursing, and are the fruit of effective communication skills. Communicating is an aspect of everyday living that can be focused into a therapeutic medium that constructs healing in health care environments. Nurses are mandated to foster therapeutic relationships by employing effective communication practices. Caring for patients in a manner that reflects empathy and genuine caring requires conscious use of communication skills designed to integrate and reflect patient needs. Effective communication skills are a therapeutic benefit to patients in health settings.

Communicating Care is Essential to Psychiatric Nursing

Communicating is to relationships what breathing is to the circulatory system, if you can’t do it, it won’t work. Communicating is the heart of living in relationship with others, and is a basic human necessity. Psychiatric nurses embody skillful communicating as a means of creating therapeutic environments, where they are role models for therapeutic relationships. With out skilled communication that includes self-awareness and empathy; mental health nursing would not serve as a healing practice.

Describing communication is like describing the act of breathing; visceral, continuous and essential, easily overlooked as part of the everyday human experience. Communication is a complex process, ambiguous and constructed; it defines cultures and organizes human living. (Littlejohn, Foss, 2008) Communications theorist Robert T Craig, asserts that “communication constitutes reality”, as the “primary process by which human life in experienced,” Littlejohn, Foss (2009, p. 5). Despite the complexity of communication the premise of sending and receiving messages is very basic, oblivious exchange. Messages are sent that define basic needs, information is received and an exchange is established.

This interactive exchange is expanded by behaviors that constitute effective communication, creating, exchanging and interpreting information. (Littlejohn, Foss, 2008) As this process develops in a conscious mode, effective communication is conveyed that is rooted in self-awareness and is impelled by conscious participation. Conscious communication is the basis for healthy relationships, and when applied effectively is transformational. (Levin 2000) Consciously participating in communication can define and alter an atmosphere. It is this transforming aspect of communication that is the mandate of psychiatric nursing.

Personal connections and therapeutic alliances are the foundation of support that psychiatric nurses provide in a clinical setting or community outreach, such is reflected in standards of Psychiatric Nursing Practice. Practice standards for psychiatric nurses in Canada clearly defines, as standard no. 1, that “A Registered Psychiatric Nurse: Acts as a role model for positive professional, interpersonal, and therapeutic relationships.” (2010) This modeling of therapeutic relationships is indicated through communication that applies self-awareness as a professional practice. The initial standard also includes communication qualities that are recognized as collaborative, ethical and effective for meeting the objective of creating community collaboration and interpersonal therapeutic relationships. RPNC (2010) Standards of practice for psychiatric nurses also includes boundaries for professional communication, the intention of which is protecting client safety nursing professionalism. These boundaries include limits around personal and professional relationships and professional discretion regarding terminating and initiating interpersonal and personal relationships. The practice standards also include theory of communication as a basis for professional practice RPNC (2010) towards a collective and educated definition of effective communication. The U.K. Nursing and Midwifery Council stipulate that within the communication and interpersonal realm nurses must, “Communicate safely and effectively.” (Webb 2011 p ) Based on standards of practice, skillfully administrated communication is an essential aspect of nursing care.

Building therapeutic relationships is a requirement for psychiatric nursing; personal awareness is an underlying requirement in developing those relationships. Phillip Burnard, claims that “the fact that the professional forms close and personal relationships with her clients emphasizes this need for understanding of the self.” (2005 p.80) He suggests two predominant ways to develop self-awareness, one is the process of introspection, or listening to one’s self. Reflective journaling is a personal communication strategy to develop inner voice and enhance self-reflection. (Hsu, Wang, n.d.) This process of hearing and knowing one’s own voice is an intrapersonal aspect of communication, intrapersonal recognition is paramount to understanding interpersonal relationships. Burnard also suggests accepting feedback as a means of personal development. Within the psychiatric nursing practice this process is referred to as clinical supervision. He acknowledges the affects of engaging with emotionally distressed individuals, and promotes self-awareness through intrapersonal work or receiving input from professional mentors as a means of minimizing these stressors. (Burnard, 2005) Communicating well with one’s self is an essential aspect of communicating effectively with others.

Listening skills are necessary for effective communication. Listening is a quality that patients identify as an important quality for nurses. (Barker, 2009) Hearing and taking in what patients have to say requires a focused quality that begins with taking time and being available to listen as a start. Other aspects of listening effectively include: awareness of body stance, presenting as open to the patient, using suitable eye contact, and responding with sincere facial responses. (Webb, 2011) Sensitivity around when to listen and responses are set the tone in client patient relationships and help establish patient trust and expectations. (Barker, 2009)

Bill Reynolds, author of the chapter, Developing empathy in the text, Psychiatric and Mental Health Nursing the craft of caring, begins the chapter with the statement that “Empathy is crucial to all forms of helping relationships.” (Reynolds, 2009, p. 321) Reynolds claims that empathy is a form of communication that conveys the nurse or helper’s attitude toward and understanding of the patient’s domain, nurses use empathy as a means of effectively communicating with patients. Reynolds goes on to state that that there is no basis for helping outside of the essential component of empathy within the nurse patient relationship. (Reynolds, 2009)

Successfully being able to communicate an understanding of the patient’s conveyed feelings follows several stages: receptivity to the patients verbal and non-verbal communication, the ability to relate to the patient’s perspective, and then follow up with the ability to communicate this perceived understanding back to the patient. The patient is next encouraged to confirm or dispute the nurse’s perception of the patient’s communications. This process breaks down to a fluid interaction in which the nurse considers, interprets and assesses the accuracy of their interaction with the patient. (Barker, 2009) This process of checking in for accuracy is essential and enhances the client’s freedom of expression in a non-judgmental manner. It is the freedom within the non-judgmental relationship that warrants the sense of genuine caring and propels the patient towards her own personal reflection.

Empathy is a reflective practice. Empathy like communication is a constructed process; therefor qualities of the communicators are exposed within the interaction. For this reason, empathy must be genuine, (Barker, 2009) it is the sincere nature of empathic communication that exposes the vulnerability of the caregiver and reflects a warm and caring attitude. Empathy requires reflection; the caregiver must mirror the patient’s reflective statements as means of shedding light on the patient’s personal perspective. Empathy is fertile ground for trust, nurses foster trust by consistently conveying respect for patient’s concerns. Trust is necessary for non-defensive communication that allows the patient to express feelings and needs to begin. (Reynolds 2009)

Changes within health care have made nursing communication essential, as medical systems have shifted from a paternalistic Doctor directed endeavor, to patient centered care. Patients are viewed as knowledgeable and participating in their own treatment and care. This shift toward informed patients has followed communication trends of increased accessibility to health information. Nurses participate in this process as catalysts for patient self-care through presenting information and developing patient trust. Health communication encourages patients to express their needs, and participate in their own care through asking questions, and encourages patient acuity regarding their own conditions and treatment. (Webb, 2011)

Nursing is a healing practice, Lucy Webb, author of, Nursing: Communication Skills for Practice, presents the argument “that communication between the nurse and the patient is therapeutic in itself. Additionally, good communication aids the process of healing and care”. Webb (2011, p. 16) Research has shown beneficial results of effective communication skills amongst psychiatric nurses, including improved health outcomes. (Kameg, Mitchell, Clochesy, Howard, Suresky, 2009) Studies have also correlated high empathy and health improvements and found that patient centered care responsive to patient input and reflective of patient preferences, also improves health outcomes (Reynolds 2009) Patient compliance and patient satisfaction are also increased as result of therapeutic relationships based on effective communication, at the same time hospital stays are decreased. ( Kameg, et al. 2011) Nurse’s therapeutic use of self facilitates positive health outcomes for patients.

Communication is a complex yet every day part of our human experience. For communication to be effective as a medium for healthy relationships, communicators must be aware of the purpose and consequence of an intentional message. Psychiatric or mental health nurses tailor their communications within their labor to foster therapeutic environments and promote healing relationships with clients. Standards of practice within the psychiatric community mandate nurses to communicate skillfully as a manner of professional practice. Psychiatric nursing bodies recognize that safe and effective communication is fundamental to forming therapeutic relationships and places standards for ethical and professional behavioral. Developing therapeutic relationships, through skillful communication is a mandate for psychiatric nurses. Essential skills development that incorporates empathetic listening, self-awareness and genuine caring, are necessary for forming these connections with clients or patients. Patient centered health care is a benchmark for nurses involved in the healing pursuit of therapeutic communication. Mental health care nursing is void of its craft without the attributes of skilled and effective communicating.

“References”

Barker, P. (2009) Psychiatric and mental health nursing the craft of caring (2nd ed.) London U.K. Hodder Arnold

Burnard, P. (2005). Counselling skills for health professionals (4th ed.) Cheltenham, UK: Nelson Thornes

Hsu, Y., Wang, M. Reflective Writing Application in Nursing -- An Example of Reflective Journal Writing. Tzu Chi Nursing Journal, 11(1), 66-71.

Kameg, K., Mitchell, A., Clochesy, J., Howard, V., & Suresky, J. (2009). Communication and human patient simulation in psychiatric nursing. Issues In Mental Health Nursing, 30(8), 503-508. doi:10.1080/01612840802601366

Levin, L. (2000) Conscious communication. Connecting With Ourselves and Others, Copyright Leon Levin, London, Ont.

Littlejohn, S., Foss, K. (2008) Theories of human communication (9th ed.), Belmont, CA Thompson LearningYu-Yun, H., & Mei-Chin, W. (2012).

Pedersen, D. (2011). Psychiatric Disorders/Interventions: Psychiatric Interventions: Therapeutic Use of Self. In , PsychNotes: Clinical Pocket Guide, 3rd ed Philadelphia, Pennsylvania: F.A. Davis Company.

Reynolds, B. (2009) Developing empathy. In Barker, P. (2009) Psychiatric and mental health nursing the craft of caring (2nd ed. pp. 321-328) London U.K. Hodder Arnold

RPNC. (2010). Code of ethics &standards of psychiatric nursing practice. Retrieved from

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Webb L. (2011). "Introduction to Communication Skills" in: L.Webb (eds) Nursing: Communication Skills for Practice. Oxford University Press. pp.3-19

isbn: 978-0-199582-72-3 url:

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