Core communication

skills in mental health

nursing
Introduction
Communication in mental health nursing is an essential component of all
therapeutic interventions. The knowledge and interpersonal skills that a nurse
uses to communicate are essential aspects of helping the person who is experi -
encing mental health problems or distress, as well as facilitating the develop-
ment of a positive nurseclient relationship. This requires the mental health
nurse to use a range of appropriate and effective communication and engage -
ment skills with individuals, their carers and other significant people involved
in their care. This chapter examines the verbal and non-verbal communication
skills that are most relevant to mental health nursing, and illustrates how each
skill can be used in practice.
Learning outcomes
B the end of this chapter, ou should be better able to!
" describe the components of therapeutic communication skills
# demonstrate an understanding of how the different communication skills can be
used in clinical practice
$ use interpersonal skills in clinical practice.
Interpersonal skills
%ffective interpersonal skills are central to a mental health nurse&s abilit to
form a sound therapeutic alliance and to the role of mental health nurses
'(eplau, ")*#+. ,n mental health nursing, communication skills form the basis
of ever intervention. -ood interpersonal skills are what each mental health
nurse needs to make nursing happen. These skills are the building blocks or, as
.tevenson '#//0, p."/)+ describes them, 1the nuts and bolts the basic
techniques and principles in which everone engaging in clinical practice in
mental health needs to be fluent&. ,n order to communicate effectivel the
mental health nurse needs to work towards being proficient in using the basic
2 Communication Skills for Mental Health Nurses
communication tools2 this means knowing what skill s3he is using and wh, and
being able to move skilfull from one skill to another as and when the purpose
of the interaction requires. ,n addition, given that different clients have different
needs, it is inevitable that mental health nurses will use different skills with
different clients in various mental health settings. 4s .tevenson '#//0, p."/)+
points out, 1one si5e does not fit all&.
,nterpersonal skills that are commonl used in mental health practice are
described below. %ach skill is explained and supported with specific examples
and exercises. These descriptions are b no means intended to be exhaustive or
prescriptive but instead we aim to provide the general principles for the use of
each skill presented. %ach skill is described as a stand-alone piece of
communication2 however, it is important to remember that when used in
practice, these skills will be used interdependentl. 6urthermore, 1when all the
skills are being used together, the mental health nurse provides the proper,
respectful conditions that facilitate a positive change to occur& '.tickle and
.tace, #//), p.78+. The following communication skills will be explained!
9 listening
9 paraphrasing
9 summari5ing
9 questioning
9 non-verbal communication.
Listening
:istening is the most important skill and often the most challenging. ,n our
experience, mental health nurses often worr about what the are going to sa,
what questions the should ask, or whether the have asked the right question.
;hile such concerns are common and understandable for the newcomer to
mental health nursing, these thoughts can distract the mental health nurse from
listening to the person who is talking. <ne of the common mistakes made b
novice mental health nurses as well as experienced nurses is to talk too much.
;hen we are talking, we are not listening= The best and the most therapeutic
thing to do is to sa less and listen more. >ental health nurses and indeed other
helping practitioners, however, often find this difficult. <ne common reason for
this is that man mental health nurses believe the are not doing anthing when
the are just listening 'Bonham, #//7+ and as a result the underestimate the
value of simpl listening and more importantl its therapeutic effect. :istening
to a client does not mean that ou are doing nothing2 instead, ou are allowing a
space for the person to talk. .tevenson '#//0, p.""/+ echoes this and states that
1even if the mental health nurse does nothing but listen, there is likel to be a
therapeutic effect&. .everal studies have also reported that people who used
mental health services value having the opportunit to tell their stor and more
importantl being heard '?ensen, #///2 @ai and Crosland, #//"2 >ole, #//$2
@oivisto et al., #//72 -ilburt et al., #//02 Aopkins et al., #//)+.
Core communication skills in mental health nursing 3
:istening helps clients to!
9 feel cared about and accepted
9 feel significant and respected
9 feel heard and understood
9 connect with other people
9 establish a sense of trust with helper's+
9 feel less isolated and alone
9 make sense of their current situations and3or past experiences
9 ask for help
9 give feedback about their care
9 express emotions and release tensions
9 participate in their care planning.
:istening is clearl an essential component of effective communication as
well as being one of the most important interventions the mental health nurse
can offer to a service user. Aowever, listening means more than Bust hearing the
words spoken b the person, it involves active listening '>cCabe and Timmins,
#//C+. :istening activel means giving our full attention that is phsicall,
mentall and emotionall which needs to be communicated to the person who
is talking. %ffective listening is therefore a cognitive, behavioural and an
affective process '4rnold and Dnderman Boggs, #//$+. Eeveloping a capacit
to listen, and tring to understand the client&s experience is a challenge for the
novice mental health nurse. .imilar to acquiring an new skill, learning how to
listen effectivel takes time and plent of practice.
:istening involves the following!
9 providing time for the person to tell his3her stor
9 offering a quiet and private space, free from distractions to listen to the
person
9 listening with the purpose of understanding the person&s message
9 giving full attention b focusing on what the person is saing
9 tuning out external distractions, such as background noises
9 tuning out internal distractions, such as thoughts about what to sa next.
:istening skills involve using a range of verbal and non-verbal continuation
prompts for example, verbal prompts include!
9 1>mm& 1Fes&
9 14bsolutel& 1, see&
9 1(lease continue& 1<h&
9 1.a more about& 1Geall&
9 1-o on& 1.o&.
Hon-verbal behaviours include!
9 showing it in our face, for example facial expression, looking interested and
concerned2 maintaining good ee contact
4 Communication Skills for Mental Health Nurses
9 showing it in our bod movements, for example nodding of head, leaning
forward.
Listening to non-verbal communication
>uch of the communication that takes place between people is non-verbal. <ur
faces and bodies are extremel communicative. Being able to read nonverbal
messages or bod language is an important factor in establishing and
maintaining relationships 'Carton et al., ")))+.
Bod language includes man different aspects of non-verbal behaviour,
including!
9 ee contact such as staring, avoiding ee contact
9 facial expressions such as frowning, smiling, clenching or 1biting& lips, rais-
ing eebrows
9 voice, such as tone, volume, accent, inflection, pauses
9 bod movement, such as posture, gestures, fidgeting
9 phsiological responses, such as perspiring, breathing rapidl, blushing
9 appearance, such as dress.
,n practice, both clients and mental health nurses send man messages and
clues through their non-verbal behaviour. ,t is therefore important that mental
health nurses are aware of their own non-verbal bod language before the can
explore clients& non-verbal behaviour. ,n practice, however, we ma not alwas
be aware of the non-verbal messages that we communicate and, more
importantl, how the might affect our interactions and relationship with clients,
their families and work colleagues. 6or example, how often have ou said 1Its
not what s/he said, but its the way it was said or alternativel someone has
said to ou 1its not what you said, but its how you said it&I
%ffective helpers therefore need to learn 1bod language& and how to use it
effectivel in their interactions with clients, while at the same time being careful
not to over-interpret non-verbal communication '%gan, #/"/, p."78+. 4lso, when
working with clients from different cultural backgrounds, it is important that the
mental health nurse is mindful of and sensitive to different practices concerning
the use of ee contact and gender, and modif his3her bod language
accordingl. 6or example in a number of cultures, including 4frican and 4sian,
maintaining ee contact with someone who is in a position of authorit is likel
to be 1interpreted as a demonstration of an equalit that is disrespectful and
inappropriate& '.ull and Eallas, #//*, p.*+.
Hon-verbal communication either on its own or together can influence verbal
communication in the following was!
9 confirm what is being said verball, for example when talking about the
recent death of her father, the client looked sad and became tearful
9 confuse what is being said, for example when telling the client she wanted to
hear his stor, the nurse kept looking at her watch and fidgeting with her pen
Core communication skills in mental health nursing
5
9 emphasi5e what is being said verball, for example when talking
about his anger towards his famil for 1forcing him to come into
hospital&, the client clenched his fist and banged the table
9 add intensit to the verbal message, for example when asking for
extra medication to stop the voices, the client stood up and put his
hands over his ears and shouted 1, want them to stop, , want them to
stop.&
The SOL! position
%gan '#/"/, p."$*+ identifies certain non-verbal skills summari5ed in the
acronm .<:%G that can help the mental health nurse to create the thera-
peutic space and tune in to what the client is saing. These are!
S: sitting facing the client squarel, at an angle
O: adopting an open posture, arms and legs uncrossed
L: leaning 'at times+ towards the person
F: maintaining good ee contact, without staring
R: relaxed posture.
4s with all interpersonal skills there are a host of things that can
hinder the abilit to listen attentivel. .ome of these include!
9 distractions in the room, for example noise from TJ or radio
9 seating, for example uncomfortable place to sit and listen
9 temperature of room, for example feeling too cold or too hot and stuff
9 lack of time
9 listening to self rather than to client, for example worring about
what ou are going to sa next, how the client might respond to what
ou sa
9 hearing the client talk about things that ou find difficult to believe,
for example that the voices are instructing them to sa or do specific
things
9 hearing the client talk about ver painful experiences that ou find
ver emotionall difficult to hear, for example accounts of phsical,
pschological or sexual abuse.
;e will now look at how using a simple framework can help the
listener to structure and organi5e their conversations with service users,
their carers and others who care for and support them.
Listening to verbal communication
Aaving a framework when listening to a person&s stor helps to develop
1clinical mindfulness& and assists the listener to organi5e what the person
has said 'Bricker et al. #//8, p.#*+. The following provides a framework
to help ou focus both our listening and attending with a view to
gaining a greater understanding of the person and their stor.
" Communication Skills for Mental Health Nurses
#rame$ork %or listening and attending to clients
Scenario& Louise
Louise: 1.o man things have happened since , was discharged from the
da hospital two months ago. , broke up with Aarr, m bofriend, and ,
moved to a new flat. , reall like where , live now, it is smaller but the
neighbours are ver friendl and helpful. There have been a couple of times
when , have been upset and cried a lot, but , know , did the right thing.
Aarr and , were alwas arguing about mone and his drinking. , used to be
afraid that he would hit me. Ae never did but , do not want to be alwas
afraid. Ae keeps phoning me, he wants us to get back together. , miss him,
Kees fill up with tearsL but , told him , do not want him back. , am much
happier now2 no more arguments and , am looking forward to lots of things.
, am going on holidas with m sister .haron and her famil. The are so
good to me.&
Nurse: 1>m . . . mm&, leaning forward
9 Experiences: The client ma talk about their experiences, such as what has
happened, for example :ouise was discharged from the da hospital two
months ago. .he broke up with Aarr, her bofriend, and moved to a new
flat2 or what is currentl happening in their life, for example :ouise is going
on holidas with her sister .haron and her famil.
9 Behaviours and patterns of behaviour: The client ma talk about how
the behaved or responded to a certain situation's+. The mental health nurse
ma also be interested in observing how the person is responding while
telling his3her stor. 6or example, Aarr keeps phoning :ouise, he wants
them to get back together. .he misses him Kees fill up with tearsL but she
told him she doesn&t want him back.
9 Thoughts and patterns of thinking: This ma include what beliefs the
have about themselves, other people, events in their lives, as well as what
sense the make of their own and others& behaviours. 6or example, there
have been a couple of times when :ouise has been upset and cried a lot, but
she believes she has done the right thing. .he and Aarr were alwas
arguing about mone and his drinking. :ouise was afraid that he would hit
her. Ae never did, but she doesn&t want to be alwas afraid.
9 Feelings e!otions and !oods: This refers to the client&s description of
his3her feelings as well as the feelings the are expressing as the tell their
stor. 6or example, there have been a couple of times when :ouise has been
upset and cried a lot2 she misses him Kees fill up with tearsL but she told
him she does not want him back. .he is much happier now.
9 Strengths and resources: ,t is important when listening not to focus onl
on problems2 clients also have strengths and resources.
,n the above scenario, :ouise&s strengths include optimism and determi-
nation. <ther strengths ma include humour and friendliness. Gesources
include, for example, :ouise&s helpful neighbours and her sister. <ther re-
sources ma include famil, friends and pets.
Core communication skills in mental health nursing '
9 Non"verbal !essages: 4s previousl discussed, there are non-verbal cues, such as
facial expressions, bod movements and voice tone, which ma confirm or den what
is being spoken. Hon-verbal behaviours can mean a number of things and caution
needs to be used when reading non-verbal behaviour. 6or example, on observing the
client&s behaviour of pacing up and down the ward, the mental health nurse might
conclude, incorrectl, that the client is anxious or angr, whereas the client later
explains that she feels ver cold and is walking up and down to keep herself warm.
Source: 4dapted from Cull '"))#+
The following box consists of a list of behaviours and characteristics that a good
listener might demonstrate 'Bonham, #//7, p. #"+.
The help%ul person
9 is quiet for most of the conversation, for example allowed ou to do most
of the talking
9 is encouraging, for example demonstrates b their bod language that
the understand what ou are saing. The nod and maintain ee contact
without staring and appear interested
9 sits or stands in a similar wa to ou and at a comfortable distance from
ou, not too close or not too far awa.
9 appears relaxed to what ou are saing, asks to repeat or clarif some-
thing to make sure that the understand ou
9 might sometimes repeat back to ou what ou have said or summarise
what ou have said to ensure sure that the understand ou
9 might conve a sense that the are 1in tune& with what ou are saing or
experiencing
9 does not Budge ou
9 gives ou ample time to talk
9 leaves ou feeling respected
(ractice e)ercise
9 Think of a time when you experienced or observed someone to be very
helpful in practice.
9 dentify which of the above behaviours were used.
* Communication Skills for Mental Health Nurses
Touch
Touch, as a form of non-verbal communication, is an important component of
therapeutic communication. ,n mental health nursing, touch can be used as a
means of reassuring and3or breaking down barriers between nurse and client
'-leeson and Aiggins, #//)+. Touch can be instrumental or procedural, whereb
the use of touch is necessar or deliberate, for example administering an
inBection, taking a client&s pulse or blood pressure, bathing or dressing a client.
,n contrast, 1expressive& touch is non-procedural, more spontaneous and a
demonstration of affection, for example holding a client&s hand, placing a hand
on a client&s shoulder ';atson, ")8*+. 4s with all communication skills, touch
needs to be used with care and respect. Before using touch, mental health nurses
need to consider the following points.
9 <ffer touch respectfull based on the needs of the person as opposed to our
own needs. 6or example the nurse asks the distressed client 1;ould ou like
me to hold our handI&, rather than the nurse initiating holding the client&s
hand to alla his3her own feelings of discomfort and3or assuming that the
client wants or needs to be touched.
9 Gespect the client&s culture, age, ethnicit and gender2 for example do not
assume that it is <@ to touch older clients or children without their per-
mission. 4lso, in some cultures, it is unacceptable to be touched b people
who are not intimate unless it is in the administration of specific phsical
care.
9 Be mindful that clients who experience mental health problems or distress
ma require special consideration when using touch, as their responses ma
not alwas be predictable, for example if a client believes that 1all females
want to harm him& it is important that the client&s personal space is respected,
particularl b female nurses.
9 Be aware of our own level of 'dis+comfort and be genuine when using
touch, for example if ou are uncomfortable about using touch then it is
better for the client and ourself that ou do not force or impose the use of
touch without seeking permission.
9 .imilar to other therapeutic interventions, touch should alwas be used
genuinel and for the client&s best interest.
Silence
Being able to be silent and still with the client, particularl when s3he is dis-
tressed, demonstrates the abilit to be present and with the person 'Benner,
#//", p.*/+. Aowever, this can often evoke some discomfort for both the mental
health nurse and the person in distress. 4s a result, silences can often feel longer
than the actuall are, especiall if the person finds them uncomfortable.
:earning to 1sit with& silence requires practice. <ne wa of learning this skill is
for the mental health nurse to practise pausing for five seconds before making an
intervention '.tickle and .tace, #//)+. This can help the mental
Core communication skills in mental health nursing +
health nurse to refrain from filling the space b speaking and et not allow the
silence to be too long to cause possible distress for the client. ;ith time and
much practice, learning to be comfortable with silence becomes easier and ou
will begin to notice the positive impact it has on our interventions. 4s a
therapeutic intervention, the use of silence is a wa of communicating respect
to the client and, as a result, can conve the following messages, as outlined
b .tickle and .tace '#//), p.*"+!
9 the person is important to ou
9 ou have time for the person
9 this interaction is more than a normal conversation
9 our interventions are considered
9 it is <@ to be with the person without feeling the need to do something.
;hile listening is important, it is usuall not enough the client also wants a
response. The following refers to the skills of responding verball to service
users. These are called reflecting and probing skills.
!e%lecting skills
Geflecting skills are those skills that help the mental health nurse to focus on the
client&s perspective, and as such encourage person-centred communication. The
main principle in using reflective skills involves identifing the person&s core
message and offering it back to them in our own words. ;hen using reflective
skills, the mental health nurse follows what the client is saing that is, aiming to
be person-centred rather than directing the interaction and imposing what s3he
believes to be important, which is nurse-centred communication. %ffective use of
reflective skills can facilitate exploration, build trust, and communicate
acceptance and understanding to the client.
(araphrasing
(araphrasing involves expressing the person&s core message in our own words.
;hen using paraphrasing, essentiall the meaning is not changed but the words
are different. (araphrasing is a valuable tool in that it demonstrates to the client
that the mental health nurse is listening and has heard what s3he has said, which
can feel ver supportive and therefore therapeutic. (araphrasing can also be used
to check clarit and understanding rather than using questions, as illustrated in
the following examples.
Example 1
#oe: >m. K(auseL , don&t know reall, , mean, , suppose if there is something
ou would like me to talk about , would be happ to do that, but as , said, it
does feel hard to focus and be here.
Nurse: ,t seems that it is easier to follow instructions now.
,- Communication Skills for Mental Health Nurses
#oe: >m, es, es, , think that is right. , do not feel ver able to think ver
clearl now, and , have been a bit forgetful over the last couple of weeks. ,
forgot m kes the other da, which is ver unusual for me.
Example 2
$%lan: Kwith an angr toneL , suppose , felt uncomfortable when m brother
asked me to lend him the mone. ,t is not because , do not have the mone, ,
can afford it. , don&t know wh , was angr, but ,, don&t want to seem miserl.
Nurse: Fou felt annoed when he asked ou and didn&t want him to think ou
were mean.
$%lan: Fes, that&s right , did feel annoed . . . but , also felt guilt . . . Ae is m
oungest brother and he has no one else.
Summari.ing
This skill involves offering the client a prMcis or summar of the information that
s3he has given. 4 summar is essentiall a longer paraphrase, however it should
not be presented as a list of facts. .ummari5ing can be a ver useful intervention,
particularl if the person in distress has given ou a lot of information. 6or the
client, hearing a summar of what s3he has said can help to clarif and reassure
them that the nurse has heard correctl. ,t also gives the client the opportunit to
correct an misunderstandings, elaborate further as well as hear the main points
of their stor. ;hen using a summar ou ma begin b saing something like
1.o, to sum up, ou have mentioned several issues concerning... &
(robing skills
)amples o% open /uestions
9 ;hen did ou first hear the voicesI
9 Aow man voices do ou hearI
9 ;hat do the voices sa to ouI
9 ;hen are the voices loudestI
9 ;ho knows that ou hear voicesI
9 Aow do ou feel, when the voices sa ... I
9 ;hat were ou doing when the voices became louderI
9 ;hat helps ou to cope with the voicesI
(robing skills involve questioning. The most useful forms of questions are open
ended and begin with 1when&, 1what&, 1how&, 1who& or 1where&. 4sking an open-
ended question invites a full descriptive response. 6or example, if ou were
exploring a person&s experience of hearing voices, ou might use some of the
following open questions.
Core communication skills in mental health nursing ,,
The following illustrates examples of other categories of questions, which
can be used when working with clients and their families3carers. These include
the following!
9 cognitive questions2 these focus on the person&s thoughts or beliefs
9 affective questions2 these focus on the person&s feelings, mood or affect
9 behavioural questions2 these focus on the person&s behaviour or actions
9 time-orientated questions focus on issues relating to time, such as past,
present and future.
Other use%ul open /uestions
Cognitive questions! ;hat do ou think about when ou have
a panic attackI
;hat did ou think would happen when
ou took the overdoseI
;hat do ou think causes the voices
to sa those thingsI
4ffective questions! ;hen ou were told about our son&s
diagnosis, how did ou feelI
Aow do ou feel when the voices call
ou namesI
Aow do ou feel after ou have
inBured 'cut+ ourselfI
Behavioural questions! ;hat did ou do when ou had the panic
attackI
;hat does our son do when he
gets angrI
;hat can ou do to reduce the
stress caused b the voicesI
Time-orientated questions! ;hat did ou do in the past that helped
ou to manage the voicesI
;hat can ou do now to reduce the urge
to cut ourselfI
;hat could ou do in the next two hours
to keep ourself safeI
0nhelp%ul /uestions
Dnhelpful questions include the following.
,2 Communication Skills for Mental Health Nurses
Closed questions
These are questions that limit the other person&s options and often onl give the
option of a 1es& or 1no& response, for example!
9 Eid ou take our medicationI
9 Aave ou seen the doctorI
9 Eo ou hear voicesI
9 Eid ou go to the hospitalI
9 Eo ou like our parentsI
4lthough closed questions are useful when gathering information, the have
limited value and do not encourage dialogue, and as a result reduce the op-
portunit to engage with the client. <veruse of closed questions can also set up a
pattern of 1questions and answers&, which can be hard to break.
<ther questions, which are unhelpful in encouraging dialogue and person-
centred communication, include the following.
Leading questions
4s the name suggests, these questions involve imposing our own perspective or
being suggestive, for example 1, don&t think ou are ver happ with our
husbandI& rather than, 1Aow do ou feel towards our husbandI&, which
encourages person-centred communication rather than nurse-led communi-
cation.
Multiple questions
These involve asking two or more questions at once, for example 1;hat did the
doctor sa when ou told him about our panic attacks2 did he suggest
reviewing our medication and did he refer ou to the anxiet management
groupI& ,t is not surprising that this can be confusing and unhelpful for the
client. ,n addition, when the client answers, the mental health nurse will not
know which question the client has answered.
Either/or questions
These questions are both leading and restrictive because the options put forward
are what the nurse has chosen and, as with multiple questions, the involve two
questions, for example 1;hat do ou want to do, go for a walk or attend the
anxiet management groupI&
The why question
The 1wh& question tends to invite an answer rather than a description or an
exploration. ,n addition, the use of 1wh& ma appear interrogative and as a
result ma evoke a defensive answer from the person. 6or example, how might
you feel and respond if ou were asked the following 1wh& questions!
Core communication skills in mental health nursing ,3
1;h were ou lateI&2 1;h did ou sa thatI& .uch questions ma cause the
person to feel defensive and3or irritated. Therefore, it ma not be surprising that
the following wh question might evoke such a limited response!
Nurse: 1;h didn&t ou take our medicationI&
&lient: 1Because , forgot.&
Poorly timed questions
4s with all interpersonal skills, timing is critical to asking effective
questions. 6or example, if a client who is ver distressed relates having an
argument with his father and the nurses asks, 1;hat did ou sa that might
have contributed to the argumentI& it is unlikel that the client will be
willing to explore his own behaviour at this particular time and ma feel
unheard b the nurse.
:earning to ask questions without using 1wh& can be challenging and require
patience and plent of practice. The following illustrates some practice
examples of 1wh& questions and how these questions might be asked more
effectivel.
'(h%) *uestions +lternative phrasings
;h didn&t ou take our ;hat stopped ou from taking
medicationI our
medicationI
;h did ou discharge ourself
from hospitalI
;hat happened that led ou to
discharge ourselfI
;h do ou get anxiousI ;hat do ou think causes ou to
feel anxiousI
;h did ou sa thatI ;hat made ou sa thatI
0sing skills in practice
4s with most acquired skills, learning how to use the different interpersonal
skills and use them effectivel takes time, practice, motivation, and the courage
to make mistakes and be imperfect. There are no verbal formulas or magical
sentences that will solve clients& problems. %quall, there are no set 1right or
wrong& or 1good or bad& communication skills. ,nstead, there are useful and non-
useful skills and interventions. :earning how to communicate effectivel in
practice will present mental health nurses with different learning opportunities
and challenges2 but in order for lifelong learning to take place we strongl
encourage ou to take some time to think about each interaction, our
communication skills and their therapeutic effectiveness. The following
,4 Communication Skills for Mental Health Nurses
questions provide a simple framework to help ou evaluate our interactions in
clinical practice.
(ractice e)ercise
Take some time to think about a recent interaction that took place during your
clinical practice. !eflect on the following "uestions and #ot down your
thoughts$ ideas and feelings in your #ournal. Try to be as specific as possible in
your answers$ as illustrated below. %ou may also wish to spend some time
reflecting on your answers with a colleague or your mentor.
!e%lective /uestions
" ;hat did , like best about m use of interpersonal skillsI
6or example! , liked best that , listened even though at times , was tempted to
ask a question.
# ;hat did , like least about m use of interpersonal skillsI
6or example! , liked least that , asked a closed and leading question a few
times.
$ ,f , were to do this interaction again, what would , do differentl and whI 6or
example! , would summari5e what the client said to me. This would have
helped me to stop worring that , was going to forget what the client said, and
as a result , didn&t listen to the client.
7 ;hat have , learnt from this interactionI
6or example! , learnt that , need to practise the use of summari5ing.
Conclusion
This chapter has outlined the different verbal and non-verbal skills that are
used in mental health practice. These interpersonal skills can be learnt and
used in various clinical encounters. ,t is not enough, however, simpl to learn
communication skills and techniques2 the must be integrated into our own
stle of working as a mental health nurse. 4s with all new learning, this will
require time, practise and a willingness to be open to feedback from clients
and colleagues about our use of different skills and their therapeutic impact
in practice. ;hile we hope that this chapter is useful to ou in developing
our repertoire of communication skills, it is not intended to be the onl
source of learning. Hevertheless, we hope it provides a useful framework to
identif and clarif what skills ou are using and, more importantl, to
consider its usefulness in developing our communication skills as a mental
health nurse.
Core communication skills in mental health nursing ,5
!e%lective /uestions
" ;hat tpe of questions should not be used or at best should be used sparingl,
and for what reasonsI
# ;hen using the skill of listening in our practice, identif three things ou
found rewarding and challengingI
$ ;hat three communication skills do ou want to improve and for what
reasonsI
7 Aow would ou explain to a colleague that 1wh& questions should be used
sparinglI