Running Head: COMMUNICATION SKILLS WITHIN PSYCHIATRIC NURSING

Value and Necessity of Communication Skills within Psychiatric Nursing. Student Name: Dermot Connolly Stenberg College

COMMUNICATION SKILLS WITHIN PSYCHIATRIC NURSING Value and Necessity of Communication Skills within Psychiatric Nursing. Effective listening, empathy, care and self awareness are not qualities we all process, yet they are important qualitys needed for effective communication within the field of psychiatric nursing. Effective communication involves the correct interpretation of verbal and non verbal

communication skills. It involves the sending and receiving the correct messages to the patient in a process that allows for the building of a therapeutic relationship that is used not only to treat the patients illness, but also to treat the patient as a whole person. The development of a therapeutic relationship through effective communication encourages the patient to explore their own feeling and examine their problems in a process which enables them to play and active role in their own treatment. Through effective communication, the psychiatric nurse promotes the building of a relationship between themselves and the patient. As this relationship develops, effective treatment plans can be established where the root cause of the patients illness is explored and treatment goals are set.

The building of a successful therapeutic relationship rests on the foundation of a strong communication relationship between the patient and the psychiatric nurse. Barker described the therapeutic relationship as the cornerstone of nursing practice with people who are experiencing threats to their health (Barker, 2003 p139). He divided Therapeutic relationship into three phases. The first phase he called the Orientation Phase, where the nurse and the patient are first acquainted and the relationship of trust is formed. During this phase, the nurses can expect to experience some resistance from the patient as the communication barriers are broken down. (Barker, 2003 p139). In order for the orientation phase to be successful, the nurse must first

COMMUNICATION SKILLS WITHIN PSYCHIATRIC NURSING approach it with what Burnard described as the necessary personal qualities of the effective counseller (Burnard, 2005 p102). These qualities include having an unconditional positive regard for the patient, being able to recognize and express feelings of sympathy and empathy, and having feelings of warmth and concreteness towards the patient, where the communication relationship is developed in an honest and open atmosphere. (Burnard, 2005 p102). The second phase is called the working phase where the patient develops an understanding of his problems and works with his nurse towards a common goal to resolve them. Transference and countertransference are both common communication roadblocks synonymous with the working phase.

Transference is typically expressed by the patient towards the nurse as emotions or feelings from a past relationship that surface during the process of therapeutic communication. Countertransference represents the emotions felt by the nurse as a result of this transference. (Barker, 2003 p168). The final phase of the therapeutic relationship is the resolution phase. During this phase, the communication relationship is terminated and the patient is weaned off the process allowing him to regain a state of complete independence. As a psychiatric nurse, care must be taken during this phase to recognize that the termination of communication can often be interpreted in a similar manner to a bereavement or loss and must therefore be handled with compassion. (Barker, 2003 p142). Recognition of the three phase of therapeutic relationship is extremely beneficial to a psychiatric nurse as it allows them to recognize and address the common roadblocks to communication that can exist as they progresses from one phase to the next.

All form of communication can be classified as being either verbal or non verbal. While we are all familiar with the various forms of verbal communication, their effectiveness as a

COMMUNICATION SKILLS WITHIN PSYCHIATRIC NURSING

communication tool in psychiatric nursing is not so well recognized. Verbal communication isnt just about holding a conversation with a patient. It involves actively listening to what the patient has to say and being in attendance with the patient as he says it. Burnard classified attending into three phases. He called the first phase the attention out phase, where the psychiatric nurse is in complete attendance with the patient during the communication process. During this phase, both the patient and the nurse benefit as both are free from distractions and can fully engage in the therapeutic process. The second phase is called the attention in phase where the patient has only the partial attention of the psychiatric nurse resulting from thought distraction. The final phase is the fantasy phase where the psychiatric nurse is developing theories about the client instead of giving the patient their full attention. (Burnard, 2005 p132). Active listening is of equal importance in term of verbal communication. The process of active listening is more than just hearing the words that are being spoken; it involves developing an understanding into each aspect of the patients communication. These aspects include the recognition of the patients non verbal forms of communication otherwise known as body language. The ability of the psychiatric nurse to recognize active listening and the phases of attending is an important part of any communication process as ineffective listening and attending can break down the nurse / patient communication relationship. (Burnard, 2005).

As a psychiatric nurse, the ability to recognize and interpret non verbal form of communication can be a very effective tool in all interactions and communications with a patient. The use of eye contact, hand gestures, tone of voice and body position can all give indications as to the internal emotion of a patient. The correct interpretation of these signs can enhance the communication process between the nurse and the patient. For example, signs of

COMMUNICATION SKILLS WITHIN PSYCHIATRIC NURSING anxiety can be interpreted if a patient is fidgety or is shaking their foot more than normal. Signs of anger or frustration can be interpreted where a patients fist is clenched or in a rigid seating position. While it is important for the psychiatric nurse to recognize the patients non verbal forms of communication, recognition of the nurses own non verbal forms of communication is equally as important. This is best achieved through the process of self awareness where the psychiatric nurse must recognize and understand their own values and believes and develop the ability to distinguish them from that of their patients. Through the communication process the

psychiatric nurse will learn of the values, cultures and believes of their patients and caution must be exercised so as not to pre-judge the patient based on those believes, especially if they differ in any way from that of the psychiatric nurse.

Effective communication in the field of psychiatric nursing is a therapeutic process where the patient is empowered to actively engage in the exploration and treatment of their own illness. The skills acquired as a psychiatric nurse look to both recognize and develop these communication skills to further develop the therapeutic process. Skills such a verbal and non verbal communication, effective listening and self awareness all contribute to developing an understanding of the root cause of the patient illness and through empowerment, guide the patient along the path to recovery. Through effective communication, the psychiatric nurse can develop a greater understanding of the patients values, beliefs and culture while also becoming aware of their own judgments through the process of self awareness. Mental illness has progressed a great deal over the years; patients are no longer seen as incapable of helping themselves. On the contrary, through the process of effective communication, patients are now seen as instruments in their own recovery.

COMMUNICATION SKILLS WITHIN PSYCHIATRIC NURSING References: Barker, P. (2003). Psychiatric and Mental Health Nursing. The craft of caring. (2nd Ed). Hodder Arnold Burnard, P. (2005). Counselling Skills for Health Professionals. (4th Ed.). Nelson Thornes Ltd. London, United Kingdom. Gibson-Mee, S. (2011). Communication skills to improve clients experience of hospital. Learning Disability Practice. 14 (9), 28-30.