The clinical setting provides a rich learning resource for both pre- and post- registered mental health nurses. However, experience alone is not the key to learning. Learning from experience in clinical practice involves reflection.
While all of us have the potential to reflect, it is not an innate ability. Learning how to reflect on practice and develop the ability to become a more reflective practitioner requires time, commitment, and an open-mindedness to examine one’s own practice, thoughts, feelings and responses. The process of reflection may at times be challenging and evoke feelings of discomfort and self-doubt.
Nonetheless, engaging regularly in the process of reflection with your chosen reflective strategy and with the support of your mentor or others will assist you to gain confidence and learn from your increasing exposure to different and challenging experiences of mental health nursing. Learning to become a reflective practitioner is part of the nurse’s ongoing professional and personal development. Reflection and reflective practice is part of a life long approach to learning.
Practice activity: reflecting on practice
The aim of this activity is to help you to monitor and develop your ability to become more reflective in your day-to-day practice as a mental health nurse.
Think back on the last week of your clinical placement and identify an interaction that you had with all of the following:
r service user
r family member/carer r friend of service user.
Having identified the specific interactions, now answer the following ques- tions. When you do so:
r be as truthful as you can and try not to censor your thoughts or feelings r you may wish to write brief notes about your thoughts, feelings, observa-
tions, questions in your reflective journal and use them to discuss with your mentor
r it is important to note that some of the questions may prompt further ques- tions, in such instances we encourage you to add or adapt the question(s) accordingly
r be mindful to take care of yourself; reflecting on specific experiences or events can evoke painful and uncomfortable feelings.
Questions for reflecting
1 What did you like about your communications/interactions with the ser- vice user, carer/family member or friend?
2 What did you not like about your communications/interactions with the service user, carer/family member or friend?
3 What skills do you currently hold?
4 Which of the interactions stands out for you and why?
5 Which interaction would you describe as your best and why?
6 Identify one thing that you have learnt from your interactions with the service user, carer/family member or friend?
7 If you could ‘rewind’ your interactions in practice, what would you do differently and why?
8 How do you know that your interactions with the service user, carer/
family member or friend were effective?
9 Identify one communication skill or intervention that you want to de- velop/practise having reflected on your interactions.
10 Complete the following: if I were a service user, I would appreciate if nurses communicated more effectively by. . .to me.
11 Complete the following: if I were a carer/family member, I would appre- ciate if nurses communicated more effectively by. . .to me.
12 Complete the following: if I were a friend of the service user, I would appreciate if nurses communicated more effectively by. . .to me.
Conclusion
There is little doubt that reflection and reflective practice play an important role for both pre- and post-registered mental health nurses’ ongoing learning and development. However, reflection is a complex, demanding, life-long, pur- poseful activity. For the mental health nurse, it demands time, commitment and an openness to share and learn new ideas. As with most acquired skills, learning how to reflect takes time, practice and support from both nurse edu- cators and nurse practitioners. Similar to other teaching and learning skills, it can be underused, undervalued and/or used ineffectively. Caution is therefore advised when implementing the use of reflective practice so that it enhances both the mental health nurse’s ability to become a more reflective commu- nicator. Although several studies provide support for the continuing use and development of reflective practice, there is a need for more empirical research to explain and support its effectiveness particularly in the area of mental health nursing.
Reflective questions
1 In your own words, how would you explain the concept of reflection?
2 What strategies or tools have you used to develop your ability to be more reflective, for example keeping a reflective diary, discussion with senior col- leagues and how effective have they been in promoting your skills as a reflective practitioner?
3 What factors might encourage and/or discourage you from sharing your reflections with nursing colleagues in your practice area?
4 Reflecting on your current clinical placement, identify a communication issue(s) that you have reflected on. What have you learnt from this activity and how might you use this learning to develop your interpersonal skills in practice?
4 The therapeutic use of small talk: phatic communication
Introduction
Throughout this book, we examine how mental health nurses can communi- cate effectively with people in their care. We draw upon various therapeutic models of communication, counselling and therapy, and consider their ap- plication to the everyday therapeutic encounters that confront mental health nurses. Many of the chapters examine what might be called formal therapeutic approaches, guided by systematic application, and that often require further education and training in order for them to be practised safely, competently and efficiently. They also have a pre-determined and agreed end point.
However, many of the interactions mental health nurses have with ser- vice users are phatic communications – ordinary conversations that are free, aimless, social intercourse or (more commonly known as) small talk. These conversations seldom have a pre-determined outcome and involve nurses be- ing with or attending to service users. They occur frequently and they can be found when studying the tasks that mental health nurses undertake in the course of their work, e.g. administering medication. While referred to as ordinary, studies of these conversations have increasingly shown them to be extraordinary, effective and appreciated by service users. We examine these encounters in this chapter. In particular, we consider:
r the concept of phatic communication r its use and value in mental health nursing r the evidence behind its use
r the link between phatic communication and brief ordinary and effective communication
r the application of these approaches in mental health nursing.
Learning outcomes
By the end of this chapter, you should be better able to:
1 Describe what is meant by phatic communication 2 Use phatic communication (small talk) effectively 3 Examine the concept of therapeutic use of self
4 Demonstrate the use of self in everyday communication