Fostering recovery and wellbeing through therapeutic
Table 2.4 Communication skills central to recovery-orientated practice (Shepherd et al., 2009)
Ten top tips for recovery-orientated practice
Communication skills required of mental health nurses Listen actively to help the person make sense
of their mental health problems
Active listening. Do not interrupt, pay attention, be non-judgemental, do not give direct advice, clarify anything that is not clear, provide enough time, do not undermine the person’s situation Help the person identify and prioritize their
personal goals for recovery
Demonstrate a belief in the person’s existing strengths and resources in relation to the pursuit of personal goals
Brainstorm all possible goals and help person rank-order chosen goals
Acknowledge and reinforce strengths and resources
Use empathic statements, for example
‘When I faced a similar issue, doing exercise helped me get through it’
Identify examples from your own ‘lived experience’, or that of other service users, which inspires and validates their hopes Pay particular attention to the importance of
goals that take the person out of the sick role and enable them to contribute actively to the lives of others
Identify non-mental health resources – friends, contacts, organizations – relevant to the achievement of their goals
Provide tips on how to navigate and access these resources, for example give people a list of local amenities that they can access Encourage self-management of mental health
problems (by providing information or reinforcing coping strategies)
Consider informative interventions (see Chapter five). For example, you might provide a handout showing different ways of coping with stress
Discuss what sort of therapeutic interventions the person wants, respect their wishes where possible
Outline possible interventions to help them on their way if necessary, for example if the person likes exercise then you could recommend a brisk walk each day for 30 minutes
Behave at all times so as to convey an attitude of respect for the person and a desire for an equal partnership in working together, indicating a willingness to go the extra mile
See the sections on values and culture-based communication above for helpful hints
While accepting the future is uncertain and setbacks happen, continue to express support for the possibility of achieving these self-defined goals thereby maintaining hope and positive expectations
Continue to acknowledge and reinforce the hopeful journey the person is taking towards their recovery
Reflections on communicating positive mental health nursing Ask yourself:
r what examples can I recall from practice that have helped people lead meaningful and satisfying lives that promote their sense of wellbeing?
r what actions have I taken with people to show that I am communicating in a values, culture and evidence-based manner?
r when talking with people challenged by psychotic episodes, what ac- tions have helped me to foster therapeutic communication?
r when I consider a recent therapeutic encounter, how did I develop, maintain and end this encounter in a way that transformed the experi- ence for me and the person with whom I was working?
r what can I learn from actions to promote my own sense of wellbeing that might help people in my care?
Conclusion
In this chapter, we argue that therapeutic communication requires mental health nurses to demonstrate a values-, culture- and evidence-based approach to practice, an approach that we call ‘positive mental health nursing’. It re- quires mental health nurses to apply the art, craft and science of nursing and other disciplines to consider what works for whom, where and under what conditions the practice of mental health nursing might flourish. It is likely, even in a world where new roles in mental health emerge to challenge them, that mental health nurses will be called upon to show that mental health nursing still matters. The chance to adopt positive mental health nursing gives nurses an opportunity to show that they can help people lead meaningful and satisfying lives and promote their sense of wellbeing.
Reflective questions
1 Consider Fulford’s (2004) seven features of values-based communication.
How can you demonstrate these in your everyday work?
2 What five skills might indicate to others that you are an evidence-based practitioner?
3 Why are the core attitudes, values and skills in developing, maintaining and ending therapeutic encounters central to how you communicate with others in a therapeutic setting?
4 What skills might you use to foster the recovery of people in your care?
3 Reflection and communication
Introduction
Reflection is an important component in the process of becoming a mental health nurse as well as a recommended element of continuing professional de- velopment post-registration. Its value in contributing to mental health nurses’
learning and development is recognized and supported by the nursing profes- sion. This chapter will examine the concept of reflection, its usefulness in enhancing nurses’ learning, as well as its value in developing the skills re- quired for effective communication. We will also outline various strategies that aim to help the mental health nurse to develop his/her ability to become a more reflective communicator in clinical practice.
Learning outcomes
By the end of this chapter, you should be better able to:
1 Describe the concept of reflection
2 Demonstrate an understanding of how reflection can be used to en- hance learning
3 Demonstrate how reflection can be used to enhance effective commu- nication in clinical practice
4 Use reflection in clinical practice