Therapeutic Communication In Mental Health Nursing

Introduction

In a mental health environment, the creation of a working link between the practitioner and patient is paramount. The interaction between a nurse and a patient is aimed at improving the wellbeing of the patient. The interaction is dependent on the interaction of feelings, thoughts and actions of each individual and the patient feels better when all of his/her specific needs are fully considered in the relationship (Jones, 2015). Nevertheless currently, there has been more emphasis on how patient interrelate with practitioner in practice, in order to achieve results that are positive (Nursing and Midwifery Council “Great Britain”, 2015).

In delivering excellent care, nurses operate on six main values which are commonly known as the 6 C’s. These are compassion, communication, commitment, care, competence and courage (Cummings & Bennett, 2012). This approach is important in that it helps a patient to express their feelings and ideas in a way that create acceptance and respect. This is achieved by nurse giving friendly gestures to patient, listening to the client and ensuring he/she gets enough privacy. In addition, it enhances the patient's comfort as it encourages a feeling of safety as well as increases their trust in the nurse (Jones, 2015). Good therapeutic communication helps to create a feeling of understanding and care to a patient. I have chosen this encounter and patient due to her traits where she needs support all the time and fact that she has communication problems which would help me appreciate therapeutic communication and also learn some valuable lessons.

This study will adopt the Gibbs reflective model due to its usefulness in helping people learn from circumstances they experience, especially when things fail (Moon, 2013). This study will discuss therapeutic communication models taking into account the patient’s background, and critically discuss therapeutic encounter in the provision verbal and nonverbal communication, a reflection regarding the therapeutic encounter as well as some of the lessons learned from it.

Description

Based on the NMC 2015 code of conduct, every patient has a right to privacy and confidentiality therefore nurses should respect these rights by avoaiding disclosure of the patient information wich is regarded confidential and not to be shared with any other party. Therefore, for this study, I will use a pseudonym and none of the client confidential information will be revealed.

The main reason for this communication approach is to help assist Mary (pseudonym for privacy purposes) who is a female service user with individual needs linked to hygiene. To be familiar with care plan, I first read Mary’s documentations. This is a practice based on the Heron`s six intervention analysis which give information on how to arrange for communication (Sloan & Watson, 2001).

Mary age is 70 years, and she is suffering from dementia, Huntington’s disease, and schizophrenia. Her mental and physical needs possibly have impacted her ways of relating with people. She is mainly suffering from auditory Hallucinations, Confused thoughts and disorganized speech, disorders in movement, troubles in movement, memory problems, and Changes in speech. I didn’t know Mary until one morning when my mentor informed her that I will be helping her with her care.

The Therapeutic Encounter

This refers to the contact between individuals which is designed to enhance the health of one or more of the people involved in a therapeutic relationship (Pinto et al., 2012). During this period, therapeutic communicative link is the foundation situations in healthcare and it’s critical to the nurse’s role in shaping and establishing positive results which are also relevant to reveal kindness, truth, empathy, when taking care of people (Banning et al., 2006).

With schizophrenia, dementia and Huntington’s disease, Mary’s care plan indicated that she could not even perform simple personal hygiene care needs. The factors that led to this encounter with Mary include the inability to self-support without aid and the requirement to be taken to the show on a wheelchair due to Huntington disease that has physically affected on her.

Additionally, her poor mental condition is another factor leading to this encounter and which made the whole activity a bit challenging when it comes to relating information while communicated to her. This made her interaction and assistance difficulty especially the task to the shower on the wheelchair.

Memory problems-particularly remembering recent events is described as a challenging factor in this encounter. it is as a result of Huntington disease which affected her ability to think and which develops a challenging condition for an individual to act on information being communicated to them (Carlozzi & Tulsky, 2012).

Lastly, her auditory Hallucinations, Confused thoughts, and disorganized speech were other factors that made this encounter possible. Sometimes Mary lost contact with the real world and this meant that effective communication and medication had to be applied. This involved approaching Mary in a supportive manner which paved way to a productive conversation. At some point, her speech would be disorganized and at times be very emotional if someone does not understand what she is trying to say.

Therapeutic communication is important to both patient and nurse as it assists in advancing the emotional and physical health of the patient. In this case, due to the nature of Mary’s condition, various strategy such as active listening, seeking clarification, giving recognition and giving broad opening were used to assist the patient to express their idea and feelings in a manner the establish respect and acceptance. From the 6C.s in the nursing approach, I knew this would help Mary to feel comfortable, safe and increase the trust between me and her (Bowlby, 2012). I knew it would also help her feel that I was caring and understands her.

I knew that Mary from her condition of schizophrenia, she had difficulties remembering where she was and understanding her condition. Insel (2010), state that during an active psychotic episode, people with schizophrenia may not understand that they are sick. This made it necessary to apply the first C-care. This refers to delivering help to an individual as well as improving the health of the whole community (Bowlby, 2012). To apply this, I approached Mary to explain to her, her condition and for a long time, we had a discussion on how I would be of support all the time she needs help. I knew this, she would build trust and a compassionate relationship with Mary. The challenge that she would rarely remembered anything by next day and I had to repeat this severally in a week.

Nevertheless, commitment was significant. This refers to adhering to a plan without fail (Jones, 2015). To enhance this, I adopted a plan to check out Mary every half an hour to ensure that she was fine and doesn't feel neglected. We discussed some real-life situations as well as her conditions to make her understand the condition and as well create a sense of compassion to her. Sometimes, I would stay in the hospital until late to keep Mary Company and ensure she feels comfortable. As per Insel (2010), regardless of health condition of people with schizophrenia, caregiver can support such a person by being available for them and having normal conversation with them though it should be short and clear.

On communication, we had various communications each day. Communication is basically the exchange of information by writing, speaking as well as using some other medium such as telephone and television (McQuail & Windahl, 2015). For example, one day I arrived in the morning and Mary looked so confused. I moved close to her and smiled at her. She smiled back (I felt merry). I was eager to know what was troubling her, and then she started a conversation.

• Mary said “my daughter, I forgot everything all of a sudden, I can’t even remember what your name is (smiling)”.
• Me: Morning Mary (Laughing to draw her attention), I am Jane, one of the student nurse on the shift. I want to find out if you can remember our last conversation? Last time we talked about some conditions related to dementia which makes someone forgetful. Which is normal. (Nodding)
• Mary: replied… so do you mean I am okay? (Touching her head)
• Me: (Nodding) I replied... Don’t worry Mary.
• Mary: I was worried you will be angry that I don’t remember your name.
• Me: no! No! do not worry marry, I understand. So are you ready to have a shower now? Alternatively, you would prefer it later?
• Mary: absolutely yes (that boosted my courage).
• Based on my understanding communication with Mary was aimed at winning her trust and ensuring she feel loved all the time. Based on the circumstance of Mary experiencing hallucinations and sometimes being annoyed, I had to show courage while facing her to ensure she trusts me. Based on the international council of nurses (2012), a confident health practitioner practice effectively and collaboratively and their work have positive impact on the patient and the society. Lastly, to all communication with Mary, I had to be competent. I answered all questions courageously to create an impression that I was competent in whatever I was doing. Being competent in whatever one is doing attract trust and understanding to that individual.

Based on this communication which involved caring, winning trusts and feeling of understanding, Mary was able to share her daily feelings and emotions, at one point; she even revealed to me that she wanted to commit suicide which I took early interventions such as making sure no risky item were left in her room especially during the night and keeping her company until late night to help her. Based on Mishara & Kerkhof (2013), state that if one believe someone is in danger of committing suicide, it is important to assure they are not alone most of time and also all objects and chemical that may pose risk should be removed from sight of such individual. For the rest of the days, I had the trust of Mary and medication to her became easier since she felt respected and was able to perform some of her daily activities. When asked if due to her privacy whether she would consider doing her personal care, and the bathroom activity alone, she always insisted on my presence.

Reflection on the Therapeutic Encounter

The Gibbs reflective cycle is an important tool in thinking systematically about an experience such as the encounter that I encountered during my practice. This section will involve an explanation of some feelings, thoughts that I have encountered during my interaction with Mary and how it has impacted my practice.

Based on this encounter, my primary objective was to build a trusted therapeutic relationship with Mary in order to assist her with daily personal care during the observational placement. I am happy that Mary was able to trust me as her caregiver and assistants and started to appreciate herself and being able to do some of her daily activities. She even went ahead to involve me in her personal conversations which I believe were of importance as long as this conversation is involved. Though based on the therapeutic communication which is used to promote the wellbeing of a patient in a nursing care profession while helping the nurse to gain the trust of a patient. This strategy helps patient believe that nurse care and understand them and that they are concerned about their issues. Communication takes many forms and can be written, verbal, nonverbal etc. (Wachtel, 2011). Based on Van et al., (2010), Mary's condition especially dementia could affect how she feel, behave and think and this means due to her forgetful nature, she needed more than verbal and non-verbal communication therapy. Some notes for her to read could be more effective especially when she forgets everything suddenly.

Also, I applied the 6C’s concept in order to support Mary. The starting point is the use of communication skills that seemed to be more effective. Being able to communicate effectively, require essential life skills such as good listening to allow mary express herself. For instance, the use of these skills during an initial assessment on the ward enables professions to understand the patient’s issues (Casement, 2013). Some of the communication skills involve active listening, touch, empathy that are valuable in order to communicate effectively. Based on the condition of Mary where she faced difficulties in speech and fact that she may get annoyed if one does not respond to what she was saying, listening skill was very vital. Nonverbal communication is not least in this case. it refers to body language such as eye contact, smile, hand gesture etc. (Mehrabian, 2017). Mary condition required these skills which I was forced to use daily to create an impression of understanding her as well as creating trust between us. For example, I sometimes used hand gestures to ask her if she was comfortable with me being around her while taking shower, which she nodded.

Moreover, competence, compassion, courage and commitment are other skills that students need to practice. I applied these essential skills during my interactions with Mary, and they assisted and enabled me to focus on what was best for Mary recovery. They allowed me to build an excellent relationship with Mary. Confidence is also relevant and key to a student as it refers to showing that, one believes in what they are saying and this creates a sense of competence as per the 6C's which I applied in this encounter. It goes together with a friendliness which refers to the use of a friendly tone while talking to an individual or even questioning them about something. It is crucial especially in face to face communication. (Ha & Longnecker, 2010).

The therapeutic approach used was based on the condition of Mary, her nature of being forgetful and sometimes being annoyed, I used communication therapeutically. Communication is an interactive process in human beings which consist of the sharing of information, message, and emotions from one person to another (Arnold & Boggs, 2015). The process of being connected and related to human being mostly occurs due to communication (Bowlby, 2012). Communication comes in different forms which can be spoken word, written words and nonverbal communication such as body gestures. For this reason, communication therapy was used to enhance the relationship and create a unity which will result to change of behaviour, trust among other valuable traits in patient care.

Creation of trust as a medical professional, I was sure that it would make Mary feel comfortable, cared and sometimes tell her experience and thoughts which is vital for her treatment. This means, as a nurse, there is the importance of supporting patient feelings as well as wellbeing (Linderholm & Friedrichsen, 2010). Arnold & Boggs (2015), state that, the goal of therapeutic communication is to help an individual/ patient feel cared and understood as well as establishing a relationship in which the patient is able to feel free to express any concern and feelings and this formed the main reason for choosing this technique. Research has stressed the importance of communication amongst healthcare professionals and a patient as essential in position of power and control other than just a mare mutual talking and verbally exchanging message (Grol et al., 2013).

All that I did was important in demonstrating aspects of the 6C's. To start with this activity was meant to assist Mary with personal care during my observational placement. The fact that we had regular discussion and conversation made Mary feel comfortable, valued and respected (NMC, 2015). Additionally, it helped Mary to feel secured, looked after and cared which created a trust between Mary and health care professionals, which showed a concept of care as per the 6C.s approach.

Additionally, I was able to talk to Mary and my regular communication to her made her develop a sense of compassion towards me while on the other hand showing a sense of commitment. I was able to shape up my relationship with Mary via the use of simple patient-centered communication skills and non-verbal skills. Utilizing several skills is essential in engaging a patient in the therapeutic relationship and activities i.e. comprise sharing, comforting, teaching, informing and communicating (Campbell, 2007 p. 91). This author further maintains that it is the beliefs and values of the individual that make them unique and person-centered nursing acknowledges beliefs, values, wants, needs and desires. Patients also gained relationship based on their therapist that give them the feeling of safety (Mallinckrodt, 2010). Based on my understanding, dealing with Mary especially when she inquire for information, I needed to be competent and knowledgeable in answering her questions otherwise she would take me to be a practitioner who does not even understand what she was doing. With this I can confidently say, I demonstrated an aspect of 6 C's approach in taking care of Mary.

Main learning from this therapeutic encounter

a. What are the main learning points for you?

The first aspect of my learning is Communication, it is essential device in the healthcare environment and specifically with the mental health patients since without it meaningful assistance will be challenging to create therapeutic relationships and understand the needs of people. I also learned that by the use of therapeutic communication, a nurse can help a patient express his feelings and ideas in a manner that create respect and acceptance. This will in turn make the patient develop comfort, feeling of safety and increase his/her trust to the health care professional. Throught with this, I have also learned that, several factors need to be taken in to consideration such as assessing the verbal and nonverbal communication needs of the patient, values, and beliefs of the patient among others. Lastly, I have discovered that to be successful in therapeutic communication, several communication skills such as active listening, being friendly, being courageous among other skills are essential when applying therapeutic communication.

This therapeutic encounter relate to all other encounters since all include interaction with people. Individuals interact and form a relationship via communication. I believe developing good communication skill is important in all field in my career since all encounters will always be similar.

As a result of this reflection activity, I have realized that in my career, communication skills are of critical importance. I have also learned that with effective communication while maintaining respect, one can win patients respect and trust and this is important in treating/taking care of a patient. For this reason and the failure to consider all aspect of communication in this case, I intend to do more research on communication skills especially therapeutic communication as a personal study to come up with excellent skills in dealing with patients. Considering that not all patients understand verbal communication, I also consider enrolling for a sign language certificate course to ensure all the time, I communicate to my clients well and that I build trust. Some of the skills that I require to advance in my career include giving a broad opening which directs patients to decide what to talk for example asking a patient what is on their mind that day would give the patient ability to choose on what to talk. Secondly, I need to advance my listening skills. From my experience with Mary, lack of good listening skills can make some patient annoyed and this is a way of losing the trust of an individual. The skills of seeking clarity are important and I require dealing with it to ensure it’s well developed in me. Lastly, there is a need to develop on observation as communication skills since sometimes actions talk better than words.

Looking for further insights on The Use of Magnesium in the Treatment of Depression? Click here.

REFERENCES

• Arnold, E.C. and Boggs, K.U., 2015. Interpersonal relationships: Professional communication skills for nurses. Elsevier Health Sciences.
• Banning, M., Hill, Y. and Rawlings, S., 2006. Student learning in care homes: this article explores the use of nursing homes as practice placements for pre-registration nursing students. Although initially disappointed that they had not been allocated to acute hospital settings, students changed their views as they became more familiar with the learning environment. Nursing Older People, 17(10), pp.22-25.
• Bowlby, J., 2012. Attachment, communication, and the therapeutic process. In A Secure Base (pp. 175-197). Routledge.
• Carlozzi, N.E. and Tulsky, D.S., 2013. Identification of health-related quality of life (HRQOL) issues relevant to individuals with Huntington disease. Journal of Health Psychology, 18(2), pp.212-225.
• Casement, P., 2013. On learning from the patient. Routledge.
• Cummings, J. and Bennett, V., 2012. Compassion in practice: Nursing, midwifery and care staff: Our vision and strategy. NHS Commissioning Board, London.
• Grol, R., Wensing, M., Eccles, M. and Davis, D. eds., 2013. Improving patient care: the implementation of change in health care. John Wiley & Sons.
• Insel, T.R., 2010. Rethinking schizophrenia. Nature, 468(7321), p.187.
• International Council of Nurses., 2012. The ICN code of ethics for nurses. Switzerland international council of nurses.
• Ha, J.F. and Longnecker, N., 2010. Doctor-patient communication: a review. The Ochsner Journal, 10(1), pp.38-43.
• Jones, J., 2015. 2 Nursing Therapeutics. Foundations of Adult Nursing, p.35.
• Linderholm, M. and Friedrichsen, M., 2010. A desire to be seen: family caregivers' experiences of their caring role in palliative home care. Cancer Nursing, 33(1), pp.28-36.
• McQuail, D. and Windahl, S., 2015. Communication models for the study of mass communications. Routledge.
• Mehrabian, A., 2017. Nonverbal communication. Routledge.
• Mishara, B. and Kerkhof ., 2013. Suicide prevention and new technologies: evidence based practice. Springer.
• Moon, J.A., 2013. Reflection in learning and professional development: Theory and practice. Routledge.
• Nursing and Midwifery Council (Great Britain), 2015. The Code: Professional standards of practice and behaviour for nurses and midwives. NMC.
• Pinto, R.Z., Ferreira, M.L., Oliveira, V.C., Franco, M.R., Adams, R., Maher, C.G. and Ferreira, P.H., 2012. Patient-centred communication is associated with positive therapeutic alliance: a systematic review. Journal of physiotherapy, 58(2), pp.77-87.
• Sloan, G. and Watson, H., 2001. John Heron’s six‐category intervention analysis: towards understanding interpersonal relations and progressing the delivery of clinical supervision for mental health nursing in the United Kingdom. Journal of Advanced Nursing, 36(2), pp.206-214.
• Van, J., Kenis, G. and Rutten, B.P., 2010. The environment and schizophrenia. Nature, 468(7321), p.203.
• Wachtel, P.L., 2011. Therapeutic communication: Knowing what to say when. Guilford Press.