Running head: THE VALUE AND NECESSITY OF COMMUNICATION SKILLS
The Value and Necessity of Communication Skills within Psychiatric Nursing.
Sasha Yunick
Stenberg College
1
THE VALUE AND NECESSITY OF COMMUNICATION SKILLS
2
The Value and Necessity of Communication Skills within Psychiatric Nursing.
The value and necessity of communication skills within psychiatric nursing goes beyond
important. When people think of psychiatric nursing, they should know that majority of it is
based on effective communication between the nurse and the patient. A successful relationship is
based on effective communication between two or more parties, and to have a trusting
relationship between a nurse and a patient, those communication skills have to be quite fluent.
There are many reasons for communication skills being valuable within psychiatric nursing, but
there are a few reasons which are most valuable and necessary. The first form of communication
skill which is one of the most important to have within psychiatric nursing is patient-centered
communication. This is when the nurse reassures the patient so that they know their main focus
is to see them as a whole and that they are not just there to complete a specific ‘task’. To do so
there must be patient-centered communication and not just task-centered communication,
meaning that the nurse should ask about how the patient feels and not only focus on the signs and
symptoms. The second important communication skill to master is non-verbal communication.
This skill will allow nurses to make progress with patients who aren’t responding to verbal
communication, and it will also make them aware of their body language so they don’t come off
a certain way to some of the more sensitive patients. Lastly, another one of the most valuable
reasons for communication skills is to reduce the chance of the patient from becoming frustrated
or aggressive while in treatment as this can be common. This essay will proceed to go further
into detail about each one of these communication skills and why they are especially important
within psychiatric nursing.
THE VALUE AND NECESSITY OF COMMUNICATION SKILLS
3
Patient-centered communication is about seeing the patient as a whole. The nurse should
seek the understanding of a patient by exploring all aspects of that person, and not just seeing
what’s in front of them by only focusing on the illness. Nurse’s need to take into account every
detail and need of that patient including their values, beliefs, and the reasons behind what has
brought them in for treatment. Patient-centered communication involves talking to and treating
each patient as an individual, using open and honest communication, and being genuine. Even on
a nurse’s busiest of days, they should take the time to show concern for their patients. The
patient should feel as if they can ask the nurse any question and not feel threatened or judged by
what the answer may be. The more open and honest the nurse is with the patient, the more open
and honest the patient will become with the nurse. Nurse’s should try to seek out the reasoning
behind what has brought the patient in by genuinely exploring the patients concerns, and being
open to offer whatever information they wish to know about their illness. Patient-centered
communication allows the patient to be a partner in making the decisions which best meet their
needs. In any type of care, offering patient’s choices and allowing them to make their own
decisions will be extremely beneficial. They won’t feel like a child who has someone making
decisions for them and telling them what to do. One study (McCabe, 2004) showed that by not
using patient-centered communication it could have quite a negative effect on the patient’s
security, well-being, and outcome. When nurses are task orientated it makes the patient feel like
the nurse doesn’t care, which is probably true if they are focusing only on the illness and aren’t
viewing the patient as a whole. Patients who were interviewed during the same study (McCabe,
2004) said that they formed special bonds with the nurses whom they perceived to be the most
genuine. Patients are just like all other people in the sense that they can tell when someone truly
cares or when they are being genuine or not. In psychiatric nursing or any nursing for that matter,
THE VALUE AND NECESSITY OF COMMUNICATION SKILLS
4
the care should be centered around the patient. The key to conquering patient-centered care is the
communication between the nurse and patient. The more the nurse gets to know the patient and
creates a bond where the patient trusts the nurse, there will be significant progress. To do so the
nurse needs to get to know all different aspects of the patient’s life through good communication.
By using patient-centered communication, the better chance of creating a bond with the patient,
and the better bond the nurse creates with the patient, the better chance for progress and
recovery.
Non-verbal communication is just about as important as patient-centered communication
in psychiatric nursing. There are so many contributing factors to non-verbal communication, and
they are all equally important. Within psychiatric nursing, non-verbal communication is not only
about your facial expressions, body posture or movements. These are all very important, but
there are many more important factors such as your actual physical appearance (clothing), using
touch, and making silent gestures to patients. For basic non-verbal communication skills, the
SOLER model (Gerald Egan) is wonderful to follow. S - Sit squarely facing the client, O –
Observe an open posture, L – Lean forward toward the client, E – establish eye contact, R –
Relax. These are all key components to focus on in a non-verbal situation with a patient, the
situation will become much more calm and relaxed with these movements. In saying that
physical appearance is important, it does not mean what someone looks like as a person, but how
they choose to dress and present themselves. When being professional in a nurse/patient
situation, it would be very inappropriate to be dressed in a low cut shirt, short skirt and have long
fake nails shimmering in the light. This will only cause distraction to the patients, and it will act
as a barrier to their progress and your own, especially with a male patient if you are a woman.
Knowing when to use touch can be tricky sometimes. The nurse should be aware of both the
THE VALUE AND NECESSITY OF COMMUNICATION SKILLS
5
patient and her own boundaries, and also know when the appropriate time to use touch with a
patient. Some patients may feel very uncomfortable with a nurse touching them, and for others it
could work as a healing process. Using gestures with an elderly patient who has dementia, or
someone who is very confused can work wonders. If you tell a patient who has dementia that you
would like them to sit down, they will most likely not understand. It’s basically like listening to a
skipping tape for them, it just doesn’t make any sense. But if you model it for them and make
gestures to sit down, they will more than likely understand and copy what you are showing them.
Sometimes verbal communication may not be going anywhere with a patient, and the nurse
could suggest to the patient that they write their thoughts and feelings down on paper. Even
mentally healthy people get nervous talking to strangers and would prefer to email or write them
a letter. It’s only human to occasionally feel uncomfortable speaking out loud about some things.
Using silence on the nurse’s end can sometimes be successful too because it allows the patient to
continue to talk and tell their story without any interruptions. The nurse can then reassure the
patient that they are still tuned in and listening by head nodding or using “mmhmms” and “ah’s”.
Non-verbal communication is a very important skill to have within psychiatric nursing as it
opens up windows for other opportunities when verbal communication is not responsive.
One other crucial reason for having great communication skills within psychiatric nursing
is to prevent a patient from becoming frustrated or aggressive. It’s easy for a nurse to blame a
patient’s frustration or aggression on the “mental illness” itself and ignore the fact that they’re
not treating the patient as a whole. In a study (Duxbury, 2005) about what causes patients to
become aggressive, majority of the patients responded by saying that it was brought on by the
nursing staff. Within psychiatric nursing it is especially important for nurses to refrain from
ordering the patient around or commanding them to do things. This may cause frustration or
THE VALUE AND NECESSITY OF COMMUNICATION SKILLS
6
aggressiveness, but it will also likely put a stop to any chance of forming a therapeutic
relationship with them if they see you as more of an authority figure. During the study the
patients and nurses were both asked about how they could prevent and deal more effectively with
the aggressiveness. The patients advocated for better training amongst the nurses in therapeutic
communication skills, while the nurses advocated for greater attention to organizational deficits.
This goes to show that there is already a miscommunication between the patients and nurses as to
what they both believe to be the cause of aggression. This also brings me back to the importance
of patient-centered communication, and how it can prevent aggression. One of the very
unfortunate things is that a patient may be prescribed medications that they don’t actually need
due to the nurse not meeting their needs. A nurse may continue to have poor communication
skills with a certain patient, and set them off every time they have contact. This is not fair to the
patient because they’re the ones suffering the consequences, and meanwhile it’s something that
can be prevented with proper communication skills on the nurse’s part. According to the patients,
frustration and aggression is brought on majority of the time by the nursing staff, so by nurses
focusing on their communication skills these aggressive outbursts may be prevented. Nurses
need to remember that poor communication between two cognitively well individuals can turn
nasty if words aren’t chosen wisely. Some patients may be a little more sensitive about what a
nurse says to them because of their mental illness, but the aggressiveness is not coming on
strictly because of the mental illness itself. The key here is to have a good relationship with the
patient based on good communication to prevent frustration and aggressiveness.
Communication skills within psychiatric nursing are extremely necessary and valuable.
Patient-centered communication should be the only way of communicating with a patient. This is
the only holistic approach in communication between a nurse and patient which is strictly
THE VALUE AND NECESSITY OF COMMUNICATION SKILLS
7
focused on the patient and not the “task”. Patient-centered communication is key in the journey
to recovery for a patient. Non-verbal communication skills within psychiatric nursing can do
wonders from using simple basic skills such as the SOLER model, or using gestures and
modeling movements to an elderly person who has dementia. Non-verbal skills may also allow
for better progress with a patient who is not responding to verbal communication. Fulfilling the
needs of a patient, seeing them as a whole, and using a patient-centered communication approach
may prevent many aggressive outbursts. Nurses need to remember that they shouldn’t just
assume that a patient’s aggression is because of their illness. There may be many underlying
factors that the nurse is responsible for and doesn’t even realize it. Communication within
psychiatric nursing is what will take a nurse to their furthest limits, and will work as their
deadliest tool. As long as a nurse uses the proper techniques and keeps it to patient-centered
communication, they will have a much better progress with a patient than a task centered nurse.
Patient-centered communication skills, non-verbal communication skills, and the communication
skills needed to prevent a patient from being frustrated or aggressive are a necessity to have
within psychiatric nursing. These skills will take a nurse far, and hopefully take a patient far in
their recovery process as a result.
THE VALUE AND NECESSITY OF COMMUNICATION SKILLS
8
References
Caris‐Verhallen, W. M., Kerkstra, A., & Bensing, J. M. (1999). Non‐verbal behaviour in nurse–
elderly patient communication. Journal of Advanced Nursing, 29(4), 808-818.
Duxbury, J. (2002). An evaluation of staff and patient views of and strategies employed to
manage inpatient aggression and violence on one mental health unit: a pluralistic design.
Journal of Psychiatric and Mental Health Nursing, 9(3), 325-337.
Duxbury, J., & Whittington, R. (2005). Causes and management of patient aggression and
violence: staff and patient perspectives. Journal of Advanced Nursing, 50(5), 469-478.
Epstein RM, Borrell F, & Caterina M. (2000). In New Oxford Textbook of Psychiatry (Edrs.
Gelder MG, López-Ibor JJ, Andreasen NC), Oxford University Press. Communication
and mental health in primary care.
McCabe, C. (2004). Nurse–patient communication: an exploration of patients’ experiences.
Journal of clinical nursing, 13(1), 41-49.
Mercer, S. W., & Reynolds, W. J. (2002). Empathy and quality of care. The British Journal of
General Practice, 52(Suppl), S9.
Stewart, M. (2001). Towards a global definition of patient centred care: the patient should be the
judge of patient centred care. BMJ: British Medical Journal, 322(7284), 444.