REFLECTING ON YOUR CLINICAL EXPERIENCE IN MENTAL HEALTH, DISCUSS HOW YOU WOULD ESTABLISH AND MAINTAIN EFFECTIVE COMMUNICATION WITH PEOPLE IN NEED OF HEALTH CARE
The nurse-patient relationship is a key aspect of mental health nursing. The Nursing and Midwifery Council (NMC) recognise the importance of the nurse-patient relationship in the NMC Code of Professional Conduct in that registered nurses are responsible for ensuring that they safeguard the interests of the patient and develop and maintain appropriate relationships. (Castleford, 2004 and NMC, 2006)
A critical element of effective health care delivery is competent communication in the form of professional knowledge, attitudes and values which combine to create interpersonal skills set for nurses. (Rungapadiachy, 1999) Communication occurs at both a general level as well as a therapeutic level. At the general level communication can be regarded as a complex process of sending and receiving verbal and non-verbal messages that allows for exchange of information, feelings, needs, and preferences. Therapeutic communication on the other hand is a purposive, patient centred approach in the context of patient care to help patients identify, resolve, or adapt to health problems. (Castleford, 2004 and Rungapadiachy, 1999)
Rungapadiachy, (1999) suggests that therapeutic communication involves skills such as listening, attending, responding, trust, disclosure and feedback. Barriers such as overuse of medical terminology, sympathy rather than empathy, arguing and disapproval should be avoided.
A useful model through which to explore communication in nurse-patient relationships in mental health is that of Peplau’s psychodynamic framework wherein nursing is seen as a four-phase, therapeutic and goal directed interpersonal process between nurse and patient. Peplau (1992) argued that people with mental health needs have traditionally followed a biomedical model of care in that they have been managed with psychoactive drugs that address patient symptoms rather than a psychodynamic approach. The psychodynamic focus is on the interpersonal process itself and not the nurse or patient as individuals. This means that a nurse’s role is seen as both educative and therapeutic in the movement of patient towards health. Peplau’s four phases in the development of the nurse-patient relationship are orientation, identification, exploitation and resolution. (Jones, 1996, Peplau, 1952, and Peplau, 1992)
Naish (1996) argues that effective communication is essential in the delivery of appropriate nursing care but that structural factors such as ward organisation and management style may inhibit responsive care. The clear implication is a need for continuity of care by the same nurse through the phases. The nurse and patient have changing goals and roles as they pass through each phase which is iterative in nature. Peplau (1952) described the phases as overlapping and interlocking as the nurse facilitates the patient’s movement towards health. (Castledine, 2004 and Jones, 1998)
The first phase, orientation, occurs when the pa