This is a fantastic book, absolutely packed with almost everything a mental health nurse needs to know about communication skills. Applying the Three Phases of MI in Mental Health Care 154 Applying MI Theory to Communicate Using MI 155 .
About the Authors
Acknowledgements
Preface
Next is the use and value of phatic communication and brief habitual and effective communication in mental health nursing. The next four chapters focus on issues related to cross-cultural communication, helping professional relationships, assertive communication, and conflict resolution in mental health practice.
Introduction
Learning outcomes
Interpersonal skills
Developing the ability to listen and seek to understand the client's experience is a challenge for the novice mental health nurse. In addition, when the client answers, the mental health nurse does not know which question the client has answered.
Using skills in practice
Why are you late?'; 'Why did you say that?' Such questions can make a person feel defensive and/or irritated. Below are some practical examples of why questions and how these questions could be asked more effectively.
Conclusion
For example: I liked best that I listened, although at times I was tempted to ask a question. This would have helped me to stop worrying that I would forget what the client said and as a result, not listen to the client.
Reflective questions
Values-based communication
Values-based practice is a core component of the Department of Health's (2004) common Core Competencies required of the mental health workforce, from mental health nurses at the point of registration, as outlined in the Chief Nursing Officers' Reviews for Mental Health Nursing (DH, 2006; Scottish Executive, 2006) and Nursing Council and Mid-grates (NMC, 2008) learning outcomes for mental health nurses and the new NMC standards for pre-registration nursing. A review of research evidence with mental health service users shows the importance they place on meeting mental health nurses who hold values that will help service users achieve recovery (Bee et al., 2007).
Culture-based communication
Mental health nurses often work in multicultural settings and interact with people from different cultural and ethnic groups. When working with people from different cultural and ethnic groups, the following communication problems can arise.
Evidence-based communication
Skills for evidence-based practice
Therapeutic communication: what works, for whom and under what conditions?
For example, if you use the person's first name without their permission, they will find it offensive. If you work with the person in other settings, be aware of safety issues and the need to respect that you are a guest in the person's environment.
Fostering recovery and wellbeing through therapeutic communication
Communication skills required of mental health nurses Actively listen to help the person make sense. The chance to adopt positive mental health nursing gives nurses the opportunity to show that they can help people lead meaningful and fulfilling lives and promote their sense of well-being.
Understanding reflection – what is it?
In the 1930s, John Dewey, an American educator, gave one of the first explanations of reflection. However, we believe that using reflection in practice can offer potential for professional and personal development and learning.
The reflective process
The mental health nurse must be aware of such limitations when considering reflection in the context of clinical practice and developing reflective practice. But we are also aware that for learning to occur, the mental health nurse will require structure, guidance and support as well as an openness to use different strategies that promote the ongoing development of reflective skills and reflective practice.
Models of reflection
I was not aware of the client's needs and just started talking without thinking and using me. Framework for reflective practice (Rolfe et al., 2001). model of reflection, by Rolfe et al. 2010), uses a questioning approach to facilitate the nurse to reflect on the three stages of the reflective process.
Fostering reflection and reflective practice
For learning to take place, the purpose of the reflective writing must be stated clearly and concisely from the outset so that the focus is on the process and not the product (Craft, 2005). The following example illustrates a critical incident that occurred outside of the nurse's clinical practice and yet prompted significant learning for Louise, a third-year mental health student nurse.
The role of the reflective facilitator
As a teaching and learning strategy, the purpose of the reflective practice group is to help nurses reflect and examine their beliefs, actions and practice. Essential to this experience is the facilitator's ability to help the mental health nurse overcome such fears.
Organizational factors and reflection
The reflective practice group usually takes place in the clinical setting with a senior or more experienced member of staff acting as facilitator. For some nurses, having the opportunity to hear different perspectives to choose from can be a positive learning experience and enhance the mental health nurse's reflective skills (McGrath and Higgins, 2006).
Learning to become a reflective practitioner
There is no doubt that reflection and reflective practice play an important role in the continuing learning and development of pre- and post-registration mental health nurses. Caution is therefore advised when implementing the use of reflective practice in order to improve the mental health nurse's ability to become a more reflective communicator.
Phatic communication
Using phatic communication in mental health nursing
Consider the following example of a phatic interaction you might have with Mary, a service user with whom you work. The emphatic conversation shown in the second example illustrates the difference between a professional helping relationship that you have with a service user and the phatic nature of a personal helping relationship that you might have with a friend.
Brief, ordinary and effective (BOE) communication
Providing accurate advice, instructions, information and professional opinions to service users, carers, relatives and colleagues; and, if necessary, to groups of colleagues or service users/carers/relatives. Place each core skill into one of the five key components of developing, maintaining, and concluding therapeutic sessions.
Therapeutic use of self
You can assess your level of self-esteem using a standard questionnaire such as the Rosenberg Self-Esteem Scale (Rosenberg, 1965). How do you think your level of self-esteem affects your ability to use yourself therapeutically.
The efficacy and effectiveness of small talk
To use yourself therapeutically, it is thought to be important to be open, aware, have a strong self-concept, and display high levels of self-esteem and confidence. The final part of this chapter will review the evidence for the efficacy and effectiveness of small talk in communication.
Category Intervention Analysis
The Six Category Intervention Analysis
An intervention is a recognizable part of verbal and/or non-verbal behavior that is part of the practitioner's service to the client (Heron, 2001, p. 3). Purpose: Prescriptive intervention is intended to direct the client's behavior through demonstration, advice, suggestion, command, suggestion, command, insistence.
Applying Six Category Intervention Analysis
The following clinical scenario illustrates an interaction where the mental health nurse uses authoritative and facilitative interventions. Nurse: 'Your community mental health nurse told me you didn't go to day care.'
Degenerate use of interventions
As it is, this intervention illustrates the mental health nurse directing the client to describe her recent experience of self-harm. These are interventions whereby the interventions are motivated by the practitioner's self-interest regardless of the interest of the client.
Learning to use the six categories
Harry: 'It's hard for him; there is unfortunately still a lot of stigma around mental health problems/illness.' [Informative]. 3 Explore some of the issues and challenges for nurses when working with interpreters in mental health.
Understanding culture
Niamh was aware that Mrs Cohen was Jewish and had ordered kosher meals as requested. Mrs Cohen explained slowly and with great difficulty that she and her sister, Ruth, came to Britain during the Second World War.
Culture and mental health
Although there is evidence to support a strong relationship between ethnicity and mental health patterns, it is limited and offers few explanations for these observed relationships (Iley and Nazroo, 2001). So far in this chapter we have outlined the concept of culture and its relationship to mental health.
Culture and mental health nursing
It helps the nurse to move from ethnocentrism (the perception that one's own culture is the best) to ethnorelativity - respecting the equal value of all cultures (Byrne, 2008). However, there is a lack of empirical evidence to support claims that culturally competent nursing facilitates the development of positive health outcomes for ethnic minorities and helps reduce ethnic health disparities (Warren, 2003).
Communicating across cultures
Becoming aware of your own values, beliefs, prejudices and practices in relation to BME people is essential, even if it is sometimes uncomfortable and challenging, to identify, confront and eliminate your biases, stereotypes and prejudices. However, the lack of attention to the role played by the nurse's own ethnicity and cultural perspective in nursing interventions, including communication skills, which seems to show an inherent ethnocentricity, has been criticized (Price and Cortis, 2000).
Working with interpreters
Communication in this situation between mental health nurses and the client cannot take place without an interpreter. This is particularly important in a mental health context, where the client's precise meaning and intent will be paramount.
Learning to be culturally competent and capable
This was helpful in understanding Ibrahim's family's reluctance to visit or engage with mental health services. Mental health nursing consists of a professional helping relationship in which good interpersonal skills are used to develop, sustain, and conclude therapeutic encounters in a caring, competent, and compassionate manner.
Patient-centred care – what is it?
Person-centered therapy (PCT), originally known as client-centered therapy, was developed by the American psychologist Carl Rogers more than half a century ago (Rogers 1961). In this case, the focus of mental health nursing is caring for the person on the receiving end of that care.
Understanding empathy
For example, listen with interest to the customer and at the customer's pace, rather than listening with interest to satisfy your own self-interest. This is what is often referred to in the literature as staying within 'the client's frame of reference'.
Models of empathy
We will now briefly look at some models of empathy that focus on different stages of the empathic process or components of empathy.
Empathy or sympathy?
However, similar to the use of other communication skills, when using a sympathetic response it is important to be aware of one's body language, the tone of the response, timing and context which can influence the therapeutic effectiveness of the intervention.
The use of empathy in practice
In general, these factors consist of nurses' skills, nurses' education, and the culture of the organizational environment. The following is an account of the reflections of Rachel, a third-year nurse who later realized that she had unwittingly manipulated her interactions with a client to avoid discussing the client's feelings.
Learning the skill of empathy
She recalled a feeling of panic at the time and quickly thanked John for showing her the photo. We can talk later.''
Congruence
Unconditional positive regard
Setting and maintaining boundaries
It is important to be aware of your tone and body language, for example tone of voice, facial expression. I noticed that you tend to ask important questions at the end of the session.
Attributes of effective helpers
10 I evaluate together with the person that they have achieved the goals they set at the beginning of the session. This chapter will examine the role of assertive communication and its application in mental health practice.
Understanding assertiveness
In such situations, choosing a passive approach may be the best and safest response, as shown in the following scenario. For example, assertive behavior consists of a person's belief that he/she is okay and equally that the other person is okay; therefore, the assertive position is "I'm fine - you're fine" (Berne, 1975).
The benefits of being assertive in practice
Factors that affect nurses’ level of assertiveness
He was satisfied with his ability to present the customer's issues clearly and concisely to the team. He wanted to discuss his client's concern further, but was afraid to challenge the consultant.
Using assertiveness skills in practice
It is important to be consistent - that is, to be true to yourself and to the other person. One strategy that might help you do this is to ask yourself what you don't want.
Assertive responses
This is when you move to the next stage, which is to repeat your statement or request calmly until it is understood and accepted by the other person. I want you to inform the nursing staff when you want to go to the hospital store.
Learning to use assertiveness skills
Undoubtedly, assertiveness is often misunderstood and misused by mental health nurses and other health professionals. This chapter examines the nature, sources, causes, and consequences of conflict that you may encounter as a psychiatric nurse, and different communication styles that can help you prevent conflict or manage it in a therapeutic way.
The nature, sources, causes and consequences of conflict
Conflict between nurses and doctors about the most appropriate form of care Intragroup conflicts Disagreements within groups Conflict between nurse managers.
Types of conflict
Sources of conflict
The sources in Box 9.1 provide examples of the different taxonomies of conflict that Speakman and Ryals (2010) report. Next to each source, indicate whether you think it is an example of an affective, cognitive, or process conflict.
Consequences of conflict
Speakman and Ryals (2010) review this evidence and show that conflict can have both negative and positive consequences, ie. Having examined the nature, sources, causes, and consequences of conflict, we will now turn our attention to communication strategies that will help resolve conflict.
Conflict resolution
Bacal (1998) in Preventing Conflict in the Workplace: Using Cooperative Communication distinguishes between cooperative communication - communication that prevents negative conflict - and conflict-causing communication, that which promotes conflict. Ask yourself questions such as “What am I feeling?” “What could be my contribution to the conflict?” “What am I thinking about this?” Consider whether you are experiencing any physical symptoms from the conflict.
Building Trust
Affection Trust
3 How can you use Pardey's seven skills to resolve conflicts in your work as a mental health nurse.
Solution-focused interventions
The first session in an SFBT intervention appears crucial for understanding the client's concerns and for setting goals (future hopes) to address these concerns. To use the scale, ask the client to identify where they are on it, ie.
The efficacy and effectiveness of solution-focused brief therapy
In CBT, a client is helped to recognize patterns of distorted thinking and dysfunctional behavior and is helped through systematic discussion to develop behavioral tasks to evaluate and modify the distorted thoughts and dysfunctional behavior. The process of CBT will be greatly influenced by the nature of the client's presenting problems.
The efficacy and effectiveness of cognitive behavioural approaches
Cognitive restructuring – this involves helping the client change negative thoughts to more realistic ones. If the client fails a driving test and they conclude that they are a failure, ask them to identify things where they succeeded in counteracting the negative conclusion.
Using cognitive behavioural approaches in mental health nursing
Finally, ask David to identify the strength of his belief in the warm thought from 0, little belief, to 10, the strongest belief. For this thought, ask David to write down the evidence for and against this thought.
Problem-solving interventions (PSI)
The efficacy and effectiveness of PSI
For example, “What do you think will help you to go for a walk every day?” Most mental health nurses, some with little additional training, can use many of the interventions shown in this chapter with relative ease.
What is motivational interviewing?
MI is to help people recognize how unhelpful thoughts can shape behavior, challenge those thoughts, and thus change behavior.
Self-motivational statements
Check with the customer if you are unsure, for example 'can I just check if I understood you correctly. Give the client's reflection as a statement, not a question, for example 'so you are more anxious when you are around certain friends than others.
Applying the three phases of MI in mental health nursing
First, ask your friend to identify any aspects of their lifestyle that they want to change. 6 To make a list of things they can do to change their diet/get more exercise/spend more time on cultural pursuits.
Applying MI theory to communicating using MI
Self-efficacy is the client's belief that they have the confidence to change their exercise behavior, even under adverse conditions such as being too tired. You can assess the client's self-efficacy levels by asking five simple questions (Callaghan et al., 2010).
Evidence-based MI
1 What is the role of the mental health nurse in using the ABC approach to reduce incidents of violence in a mental health unit. 3 At each of the six stages of change, what is the key role of mental health nurses.
2006) Culturally competent mental health nursing, in: Callaghan, P. eds) The Oxford Handbook of Mental Health Nursing. Working with people with substance abuse problems, in: Callaghan, P., Playle, J. eds) Mental Health Nursing Skills.
Index
