Verbal and Non-Verbal Communication Skills in Mental Health Nursing - Essay Example

? Verbal and Non-Verbal Communication Skills in Mental Health Nursing Nursing is one of the most crucial responsibilities in the Economy as no country can experience growth and development with a sick population; therefore, all governments invest heavily in their health facilities. Nurses play a very important role in a patient treatment, as they are the ones who spend most of the time with patients acting as a link between the patients and doctors. It is therefore important to ensure that there is constant communication between nurses, doctors, patients and other hospital staff, which takes the form of verbal and non-verbal with each having its own advantages and disadvantages. Poor communication constantly occurs in hospitals and is believed to be responsible for a majority of hospitals treatment errors that cause death to many patients (Harrison and Hart, 2006). These communication breakdowns are likely to occur at specific points especially when breaking news to patients regarding their health, when doctors are being informed by nurses about patients’ health, when there is a medical emergency that requires quick treatment and during diagnosis and prescription of treatment. Various reasons have been found to lead to these lapses of communication that leads to wrong diagnosis and treatment as well as patients not being informed of their condition properly (Shives, 2008). Poor communication in hospitals has occurred frequently due to a lack of proper hospital policy in place to ensure that there is a basic protocol followed in the general treatment, resulting to nurses using different methods of treating. These errors could occur during discharge procedures as well as the report methods used during admission of emergency cases (Minott, 2008), as both nurses and doctors use different standards of measurement in report filling, making prescriptions and document handling, errors of interpretation are likely to occur. Hospitals might not bother to teach their ideal mental model framework to nurses in order to guide them to and other medical staff to have a similar thought process concerning treatment procedure. Consequently, the staff will go about their treatments in different methods due to their different backgrounds and line of thoughts. Hence, a mental model framework is imperative for the comprehension of verbal and non-verbal cues as well as for staff to share meaning and be able to develop common knowledge (Davidson and Blackman, n.d.). Lack of rules for face-to-face or any other verbal communication such as via telephone could also result in communication barriers forming during treatment especially while changing shifts. Different patients will respond differently to the rapport used by medical staff and although it is difficult to find a universal tone of conversation to use in conversation, it must be noted that it can result in patience feeling uncomfortable communicating as well as shutting down due to a feeling of disrespect or prying by the doctor. The use of vague language and unclear syntactic and pragmatics will also result in the misdiagnosis of patients and the inability of fellow staff members comprehending the sincerity of the patients’ illness (Byrne and Byrne 1992; Morrissey and Callaghan, 2011). A differing opinion on what is necessary and what is not is a serious impediment to effective communication between both patient-staff and staff-staff briefing. This is because different opinions have often led to scenarios where vital patient information about welfare is left out as either the patient or the nurses available feel that it is not necessary to explain some details especially if the affected area is very private or if it appears that they are healing and do not want to seem petty. This is more common during oral communication and emergency treatments than when viewing their chart files as different people will have various thoughts on what is important and what is not and information can be forgotten or left out. Infrequent communication by staff due to various reasons including in-hospital politics, rivalries and a lack of culture of communication will also result in a breakdown of communication and prevent information regarding the patient from being shared by the doctors treating (Dellasega and Volpe, 2013). A hospital like other institution is prone to personal emotions and desires getting in the way of professionalism and disagreements can get in the way of quality treatment in situations where a nurse might decide to leave information which while not leading to death makes the following nurse look incompetent as she struggles with the patient without that knowledge. The other distractions in the hospital that could result in patients and nurses not communicating properly include phone calls, reminders going of as well as interruption by other members of staff going about their own operations (Garber et al, 2009). Finally, the mental state of the nurse must be taken into consideration, since if the nurse is exhausted due to exhaustion and other factors, then they are bound to not be as aware as they normally are and will miss information when providing care. Frequently handing of patients from one clinic to another or from one physician to another can cause a patient to feel as though they are no longer treatable and hereby cause them to stop being open with their current handler. Furthermore, handing of patients from staff member to another also results in loss of information, as each new handler has to develop a new history with the patient. This can occur if the patient is being transferred from their local doctor to a specialist and vice versa (Scalise, 2006). Hence, there should be set standard reporting procedures that the hospital staffs are to follow when reporting information to their fellow members of staff as well as a standard procedure for questioning patients on their current state of wellbeing. The importance of having a standard question and answer format is to reduce ambiguity that occurs when treatment is being issued especially when dealing with mental patients who might not have details that have an ordered arrangement. This will include questions that are relevant to the respective departments and to communicate this to respective members through various means and it is often preferable when the members of staff are requested to come up with the required standards, as it will give them more motivation to follow the guidelines set (Lindenau-Stockfisch, 2011). Through the intervention of management, office politics must be reduced in order to allow for effective communication between members of staff. It is important for management to make all members of staff understand that they are not in competition with one another and that in house fighting will only be to the detriment of the patient (Serven, 2002). Moreover, strategic initiatives must be started by the management in order to improve communication; this could include team-building activities as well as seminars and workshops on co-operation. Implementation of the teach-back method in nursing has been shown to be very successful in nursing. The teach-back method requires the use of some visual representation of the side of the patient as they share their information with the hospital staff. The patient by use of verbal sentences even if mixed-up will describe to the nurse or doctor what their previous condition was and how they are adjusting to it (Czaja and Sharit, 2012). This is especially important in cases of readmission where the patient is dealing with a different group but in the same hospital. Before being discharged the patient is given a brief history of their diagnosis and treatment including some of the medical terms that are used by medical staff. When being re-admitted the patient is then able to give a comprehensive report regarding themselves to the new group. One advantage is that the patient has a model of their condition, which guides the nurses on a treatment model similar to the one they were treated with or if not to use that same model, the nurses can understand the previous line of thought followed in the patients’ treatment and thus identify what went wrong in the treatment. The teach-back method has been very successful especially in cardiovascular cases that required readmission. The patients of low-income neighbourhoods who had suffered heart problems were informed of their condition through brief interactive sessions with medical staff through teach back techniques. Upon future evaluation, it was revealed that patients who had been through these interactive sessions had had better recall in both long and short-term evaluation. The evaluation of the case study was done by dividing the participants into groups based on whether they had been taught or not and it was found that those taught had better knowledge (Czaja andSharit 2012). The SBAR – technique is a non-verbal set of procedures used by medical staff to evaluate the state of their patients. SBAR is an acronym for Situation Background Assessment Recommendation and although initially developed for military organization has proved very effective for hospital treatment protocol. The situation assessment is inclusive of the first time the patient is receiving care at the hospital that is, Admissions. The nurse has to look at the environment of the patient to determine the ailments he/ she is suffering from especially in mental patients. The situation stage involves identifying with the patient by exchanging names, identifying their place of residence, person to contact in case of emergency (Westwood et al, 2012). The patient also identifies their age and date of birth in order for future recommendations on drugs. In cases where the patient cannot communicate the staff can use their documents such as identity card and driver’s license to fill in with their admission form. After the situation has been clarified, the nurses can move to background information about the patient that includes an assessment of vital signs. An evaluation of the patients mental status must be undertaken to see if the patient is alert and aware of their current location and whether they are cooperative or not or if they are confused and therefore are neither. The nurses must also confirm whether the patient is lethargic or not and if it is impeding their ability to swallow and hold conversation. In case the patient is comatose then the nurses must also see if the body is naturally responding to stimuli and if their eyes are closed. Background will also include evaluating their skin quality and temperature as well as if the patient needs oxygen or can breathe on their own (Pillow, 2007). After receiving full information regarding the patient’s background, the nurses are to perform an assessment of the patient, which involves a review of all the data acquired during the background and situation stage to come up with a correct answer to the patient’s ailments. The medical staff should determine whether the patient is going to get worse if they will get better with sufficient bed rest. This stage does not involve any medical procedure and is usually done by the doctors (Fabre, 2008). The severity of the patient’s ailment is what is deliberated and any other vital information hospital staff feel they have that was not covered in the medical examination is presented for discussion such as if the patient has not had a history of a certain disease. The final step is the recommendation where the medical staff decides what the best course of action is as regards to treatment. In case the patient condition is severe they will be taken into critical care however if not then the family of the patient can be allowed to visit. In case no recommendations have yet to be made the doctors can consult the family of the patient on their medical history and re-evaluate the treatment procedure recommended (Pillow, 2007). Several methods can be used to evaluate the successful implementation of the SBAR tool. Outcome measures and analysis are described below for three main outcomes of this project: staff perceptions of team communication and patient safety culture, as well as patient satisfaction and safety reporting. Prior to the implementation of the SBAR the management could have an assessment undertaken regarding staff opinion on those key areas and after its completion another evaluation could be undertaken. The management can also look at safety reports prior to the implementation of SBAR and afterwards and it should be expected that there is a decrease in the number of accidents occurring during treatment (Velji et al, 2008). Shift skipping communication refers to the communication that occurs between two members of staff who do not operate during the same shifts and there is a gap between the two workers. This will mean that one of the workers is not relayed to the information that the others have received. Shift skipping communication also occurs when information is relayed to two nurses on consecutive shifts but the third does not have the information relayed to them. An item of machinery might malfunction and the first nurse notices and calls for repairs, the repairs are done over the second shift and so the new nurse has nothing to report to the nurse on the third shift (JCR, 2008). Shift skipping communication if not controlled can result in a communication breakdown between the nurse and patient. The patient might make a request to the first nurse who follows up on it with the second but does not relay this information to the third. The skip sift method of communication should include a form to include details .The form can also be electronic and should have a check list to include the standard procedures done on the patient as well as other miscellaneous requests fulfilled and any changes done to the room. Applications have already been made to perform this task and the implementation is what is left (Jones and Groom, 2011). Hospitals must also draft policies that regulate the random application of initials and shorthand in the patient forms to make it easier for different staff members to comprehend what is written. Implementation of technology at various institutions would greatly improve the non-verbal communication especially with mental patients who cannot express themselves properly. The use of machinery to monitor their health state has resulted in improved services in public hospitals (Thompson, 2003). By use of cat scans and other devices doctors can see what is wrong with patients who cannot express themselves, and therefore decide the best course of action even if no verbal communication takes place (Mcintyre and Mcdonald, 2009). Modern day applications also exist to test the cognitive and spatial ability of patients as well as quick urine samples that can be used to cheaply check if they are taking their medication. The effectiveness of communication during shift skipping communication can be gauged by an evaluation of the number of cases of misdiagnosis and errors that occur on the forms after the shifts are completed. Management can also observe the protocol followed when various nurses fill these forms. The implementation of technology must be done with caution as errors could result in programming, cause an overdose of medication, and eventually lead to death. The hospital is required to perform test runs on new machinery in order to ensure that they are of the desired standard. They must follow this up with an evaluation of employees using the machines in daily operations to ensure that all are competent to operate them without assistance. Hospitals must strive to reduce the number of people that a person has to pass through in case of admission until discharge. This can be done by establishing standards for patient hand offs instead of them being done arbitrarily (Chassin 2009). By identifying the data elements needed to provide high quality care to patients moving from one setting to another, and establishing the expectations of the sending and receiving teams for transfer of information and care hospitals could significantly reduce the number of doctors working on one patient. This would also be advantageous for the hospital as it would save time spent on treatment of a single patient as the doctor is not constantly relearning their history. In conclusion, communication is vital for the effective treatment of mental patients. There are many causes that leads to a communication breakdown in hospital and these are; lack of a mental framework for communication, cultural difference between the patients and doctors, and disagreements of what is important and what is not between hospital staff. With the use of proper technology, SABR tools and proper verbal communication, the information shared between medical staff and patients can greatly increase and improve the quality of treatment in hospitals. All hospitals must work towards this goal, as the challenge of better health care is one faced by countries all around the world. References Harrison, A. & Hart, C. (2006), Mental Health Care for Nurses: Applying Mental Health Skills in the General hospital. New York: John Wiley & Sons. Byrne, A. & Byrne, D. (1992), Psychology for Nurses: Theory and Practice. South Yarra Macmillan Education AU. Chassin, M. (2009). Implementing and Sustaining Improvement in Health Care. Joint Commission Resources. Czaja, S. J & Sharit, J. (2012) Designing Training and Instructional Programs for Older Adults.CRC Press Davidson, G & Blackman, D, (n.d.) The role of mental models in the development of knowledge management systems. International Journal of organizational behaviour. vol 10(6) 757 – 769. Dellasega, C.& Volpe, L. (2013), Toxic Nursing: Managing Bullying, Bad Attitudes, and Total Turmoil. Minnesota: Sigma Theta Tau International Fabre, J. 2008 Smart Nursing: Nurse Retention and Patient Safety Improvement Strategies. New York: Springer. Garber, J. S. et al, (2009). Avoiding Common Nursing Errors. Philadelphia: Lippincott Williams and Wilkins JCR (2008). Handoff Communications: Toolkit for Implementing the National Patient Safety. Joint Commission Resources. Jones, S. & Groom, F. (2011). Information and Communication Technologies in Healthcare. Boca Raton: Auerbach Publications. Lindenau-Stockfisch, V. (2011), Lean Management in Hospitals: Principles and key factors for successful implementation. New York: Diplomarbeiten Agentur  Mcintyre, M. & McDonald, C. (2009). Realities of Canadian Nursing. Philadelphia: Lippincott Williams & Wilkins. Minott, J. (2008), Reducing Hospital readmissions. Academy Health. Retrieved from http://www.academyhealth.org/files/publications/ReducingHospitalReadmissions.pdf Morrissey, J. and Callaghan, P. (2011).Communication Skills for Mental Health Nurses:An Introduction. New York City: McGraw-Hill International. Pillow, M. (2007), Improving Hand-Off Communication. JCR- Joint Commission Resources. Scalise, D. (2006). Clinical Communication and Patient Safety. Hospitals & Health Networks. Retrieved on July 15, 2013 from http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/PubsNewsArticle/data/2006August/0608HHN_gatefold&domain=HHNMAG Serven, L. B. 2002. The end of Office Politics as Usual: A Complete Strategy for Creating a More productive and profitable organization. New York: Amacom. Shives, L. R.(2008). Basic Concepts of Psychiatric-Mental Health Nursing. Philadelphia: Lippincott Williams & Wilkins Thompson, T. L. (2003). Handbook of Health Communication. London: Routledge Velji, K. et al. (2008). Effectiveness of an Adapted SBAR Communication Tool for a Rehabilitation Setting. Healthcare quarterly (Toronto, Ont.) 11(3 Spec No.):72-9. Westwood, J. et al, (2012). Medicine Meets Virtual Reality 19: NextMed. IOS press Read More