Communication in Psychiatric

COMMUNICATION IN
PSYCHIATRIC/MENTAL
HEALTH NURSING
OLUFUNKE ADEYEMI-ADELANWA
MENTAL HEALTH NURSE PRACTITIONER
Learning outcomes
All
students should be able to
1.
Define communication
2.
Describe the types of communication
3.
Describe the communication process
4.
Describe the therapeutic communication skills

used in psychiatric/Mental health nursing
5.
Demonstrate an understanding of the use of

communication skills in psychiatric/mental health
clinical practice.
Definition
Any means of exchanging information or

feelings between two or more people with
the main purpose of obtaining information
or and influencing others(Kozier&Erbs
2008).
Types
Verbal:
The use of words to collect information,

express feelings or convey ideas. It is mainly
conscious though can be enhanced or implicated
by non verbal cues.
Non
Verbal: the non use of words but gestures,

body movements, tourch and physical
appearance. It is less consciously controlled and
tends to give more accurate picture of situations
especially in mental health.
Communication process
Barriers to communication
Relevance of effective Communication

in psychiatry/mental health nursing
Its
an essential component of every care or

treatment intervention, it can be described
as the bedrock. Peplau,(1952) referred to it
as the basis of every intervention.
The
nuts and bolts or building

blocks(Morrisey$Collaghan 2011)
Relevance contd
It helps to develop a positive nurseclient relationship
It equips the nurse with the appropriate
communication tools to care
effectively.
Effective collection of assessment data.
Relevance contd
It
ensures prompt intervention
It
promote changes that promote health.
It
facilitate proper evaluation of interventions

and outcomes
It
helps to prevent legal problems associated

with practice.
THERAPEUTIC COMMUNICATION
Every
behaviour is meaningful, purposeful

and goal directed. The entire communication
process is client centred. Effective
communication skills is highly required in
psychiatric/mental health care. Since one
size doesnt fit all, the knowledge of the
various skills and there applicability is highly
important.
Communication skills
Listening
Paraphrasing
Summarising
Questioning
Non
verbal skills such as touch and silence
Listening
Active
Listening- An essential skill that could be

very therapeutic on its own. It provides an
opportunity for the client to tell his/her story. A
cognitive, behavioural and affective process that
has to be developed through practice. It is very
different from hearing.
LISTENING
All
internal and external distractions have

to be tuned out. Full attention is given to
what the person is saying with the intention
of understanding every message. A quiet
space that enhance confidentiality is
needed.
Verbal
and non verbal cues might be needed to

assure client that you are still with him/her and
encourage continuation.
Such
as nodding your head, leaning forward,

maintaining good eye contact, looking interested
and concerned.
Verbal
cues include: Mmm, Yes, Absolutely, I see,

Oh Really, e.t.c
SOLER POSITION
Egan(2010)
identifies certain non verbal skills that

the mental health nurse needs to utilise during
listening.
S-
sit facing client squarely
O-
open posture, arms and leg uncrossed
L-
leaning at times towards the person
E-
eye contact without staring
R-
relaxed posture
LISTENING FOR NON VREBAL

COMMUNICATION
Examples of non verbal communication

Eye
contact such as staring or avoidance.
Facial
expression such as frowning, smiling,

clenching or biting lips, raising eyebrows.
Body
movements, posture, gestures, fidgeting.
Physiological
responses such as perspiring,

breathing rapidly and blushing.
Appearances
such as dress code, make ups and
adorning.
Voice
such as tone, volume, accent and pauses.
importance of listening
Clients
feel cared for, significant, respected and

accepted
Able to connect with caregiver thus establishing a
sense of trust.
Express emotions and release tension
Able to participate in care planning
Make sense of experiences
Give feedback about care
More free to ask for help
paraphrasing
Paraphrasing
is repeating exactly what the

patient said in the nurses words. Meaning
of what is said is unchanged. It shows that
the nurse has been listening. It is also used
to check for clarity and ensure
understanding of what has been said.
summarising
A shorter
version of what the client said, rallying

the main points together. It is most useful when
there are lots of information given, it is
sometimes necessary to let the client know, its a
summary.
It
helps to clarify issues, reassure the client while

giving him/her an opportunity to correct
misunderstandings.
questioning
Also
referred to as probing skills, OPEN

ENDED questions are mostly always
recommended and usually begin with when,
what, how, who or where. The use of why
should be avoided as it tends to put the
patient on a defensive stand
CLOSED
ENDED questions limit the client options

mostly to a yes or no response. Dialogue is
restricted and the client is boxed in other poor
method of questioning include, LEADING,
EITHER/OR, MULTIPLE AND THE WHY question.
Question
can also be poorly timed, the right

question, the right way but the wrong time.
TOURCH
A form
of non verbal communication used to

break down barriers and reassure client. It can
be expressive or procedural but must be used with
the utmost caution with care and respect in
focus.
Offer
tourch respectfully based on patient need

not yours
Tourch contd.
Respect
client culture, age, ethnicity and
gender
Be
mindful of client personal stand on

tourch
Be
aware of your own level of comfort and

be sincere. Its okay not to be okay
SILENCE
Silence
helps the client to gather thoughts, give a

sense of respect and support. Every time the
client keeps quiet is not always an invitation for
the nurse to speak. Pausing for a while before
making any intervention could be helpful. Its
equally important not to extend it unnecessarily.
Use of appropriate skill after period of silence
could be very therapeutic.
bibliography
Berman,
J. A., Erb, G., Kozier, J. B., $ Synder, S.

(2008). Fundamentals of Nursing (8th ed.) Prentice
Hall. New Jersey, NJ:
Callaghan,
P., Morrissey. J. (2011). Communication

skills for Mental Health Nurses: An introduction.
New York, NY: Open University Press.

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COMMUNICATION IN

MENTAL HEALTH NURSE PRACTITIONER

students should be able to

Describe the types of communication

Describe the communication process

Describe the therapeutic communication skills

Demonstrate an understanding of the use of

Any means of exchanging information or

The use of words to collect information,

Verbal: the non use of words but gestures,

Relevance of effective Communication

an essential component of every care or

nuts and bolts or building

ensures prompt intervention

promote changes that promote health.

facilitate proper evaluation of interventions

helps to prevent legal problems associated

behaviour is meaningful, purposeful

verbal skills such as touch and silence

Listening- An essential skill that could be

internal and external distractions have

and non verbal cues might be needed to

as nodding your head, leaning forward,

cues include: Mmm, Yes, Absolutely, I see,

identifies certain non verbal skills that

sit facing client squarely

open posture, arms and leg uncrossed

leaning at times towards the person

eye contact without staring

LISTENING FOR NON VREBAL

Examples of non verbal communication

contact such as staring or avoidance.

expression such as frowning, smiling,

movements, posture, gestures, fidgeting.

responses such as perspiring,

such as dress code, make ups and

such as tone, volume, accent and pauses.

feel cared for, significant, respected and

is repeating exactly what the

version of what the client said, rallying

helps to clarify issues, reassure the client while

referred to as probing skills, OPEN

ENDED questions limit the client options

can also be poorly timed, the right

of non verbal communication used to

tourch respectfully based on patient need

client culture, age, ethnicity and

mindful of client personal stand on

aware of your own level of comfort and

helps the client to gather thoughts, give a

J. A., Erb, G., Kozier, J. B., $ Synder, S.

P., Morrissey. J. (2011). Communication

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