Communication skills Archives - Mental health 360°

10 attributes of a good mental health nurse

What makes an excellent mental health nurse?

Coloured image of several pairs of hands up in the air, holding uni caps and certificates — Mental health nursing graduation

A fellow-blogger is considering a career in mental health nursing and asked what skills they would need in order to become a good mental health nurse. Forget skills for a moment, I’d suggest that certain attributes are required of good mental health nurses (RMN’s).

Perhaps you are or you’ve been a patient and you’re not sure what to expect of RMN’s? Whether or not you’re engaged in the mental health field, wouldn’t it be amazing if everyone had these attributes? Okay, that’s a big ask. But having these attributes can help make a difference; even in your own lives and relationships. ..

MH nursing is the most rewarding job ever, trust me. It’s a highly respected career and there’s always a demand for skilled RMN’s. It’s often demanding, challenging, stressful, and exhausting, but it’s never boring. If you’re considering a career in this exciting, ever-growing area of nursing, you’ll need to think about the attributes needed for mental health nursing.

Attributes of a good mental health nurse

Words of Angela Mayou - People might not remember your name but they will never forget how you made them feel.

It’s a given that RMN’s need a sound knowledge of the theories of mental health and illness. They also need to understand and apply current legislation, paying attention to the protection of those who are vulnerable. Furthermore, nurses must use their knowledge of patients to handover to multidisciplinary teams effectively, to ensure continuity of care.

However, there’s so much more needed to nurse patients who experience mental illness, and who are often distressed or confused. So now it’s time to put the knowledge books aside and think about the attributes of a good RMN.

Empathy helps patients with mental illness

Coloured image of lady with big afro hair smiling - writing about empathy — Empathy

Good RMN’s must have the ability to put themselves in someone else’s shoes, walk a mile in their shoes. Imagine the single parent being admitted to hospital and her children having to be fostered out? Or the married man whose wife leaves him — because of his clinical depression. What about the man who dresses as a female and everyone laughs at him? Try putting yourself in any of their shoes.

Try not to use platitudes like “Time is a great healer.” to someone who’s just lost their mum/dad or “It will all look brighter in the morning.” to someone who’s depressed. At best you’ll sound insincere and at worst, condescending.

Don’t offer unwanted or ill-informed advice either. Who wants to hear “Oh my mum’s neighbour’s grandson had that and he used to ………..” Or “When my friend had depression, she ……..” then go on telling your own story. This isn’t empathy. It’s not about you, or your friend! It’s for and about the patient, or the person standing in front of you.

Being Non-judgmental is essential

Black image writing You are not alone on this journey, about judgement — Non-judgemental

Of course, it’s in our nature to judge, and it can be a good thing, it’s how we make sense of our world. Sometimes we all make snap decisions about a person; based on their colour, race, religion and even small things like how they’re dressed. But doing so is not an attribute of a good mental health nurse.

Being judgemental alienates us from others, which is no good in a mental health environment because patients need to be able to trust that you’ll do your very best for them, regardless.

Good mental health nurses, and indeed people, need to look beyond the presenting facade and immediate appearance, behind which they’ll often find very human and tragic struggles.

You can help your patients by providing kind, nonjudgmental care that acknowledges all aspects of their makeup. Nonjudgmental, holistic care affirms the dignity of your patients and helps them have a voice in their healthcare, (Arkansas University, 2017).

You can disagree with a patient’s or friend’s choices or strong opinion but do it in a non-judgemental way. You could say something like “I hear what you’re saying and I appreciate your opinion, but I see it differently. Tell me why you think …………”

Communication skills are a key requirement for every good mental health nurse

Slide talking about an effective communication process — Want to brush up on your Communication skills

Excellent communication skills are a must when working with confused, maybe angry, depressed, manic, or psychotic patients and their families. In fact, I think we can all learn about better communication skills.

We all, especially mental health nurses, need to be able to actively listen, to stay in the moment with the patient or their families. So, don’t immediately start preparing your answer to their questions — listen to the end of their ‘story’. The clue is often there; a small add-on from the patient —right at the end — but it may actually be the problem causing them the most grief.

Remember, there is so much going on for say a newly admitted patient, and their needs may be complex, often requiring support in several areas. They may be too fatigued to deal with things like finances and bills or pets, so you’ll need to communicate these needs to the multidisciplinary team.

Speak Clearly

You must be able to speak clearly and concisely to the patient, asking if they need clarification or more time to think about what you’ve just said. Active listening and paraphrasing what the patient just said, makes them feel heard, understood and cared for. This is crucial attribute of a mental health nurse.

You need to be able to look, to see the patient, and sometimes the family dynamics, in order to gather information.

Observe facial gestures to see whether they’re smiling, nodding, frowning. Observe their posture; are they slumped, sagging shoulders, dressed appropriately for the weather. You might observe that the patient smells unclean and his teeth haven’t been brushed. You might notice that the patient is sweating or has a fever, and understand that you have to take action.

“By using your eyes, ears, nose, touch and knowledge of what is ‘normal’ for the people you care for, you can identify potentially serious changes in mood and mental state and take action early on.”
The Royal College of Nursing (RCN)

Compassion

“Compassion is usefully described as a sensitivity to distress together with the commitment, courage and wisdom to do something about it.”
Cole-King & Gilbert, 2011

It’s a genuine sympathy for hardship or suffering. It’s kindness and the simple act of showing it can make a world of difference in a patient’s day. RMN’s come into people’s lives when they are in distress and vulnerable, and how they treat patients, and their families can leave a lasting impression.

Accepting differences and finding things in common help you relate to a patient/person, and what they might be going through. You’ll be showing them a kindness they might not get elsewhere, and despite them being mentally unwell, they will appreciate and remember it.

Leaving your own world at the front door, and just being there in the moment with a patient encourages openness and mutual trust. These small acts impact on a patient’s emotional responses and their view of the care they are to receive.

Sometimes mental health nurses are the only person they have to listen to them and take their illness seriously, which is why compassion is key. It’s always at the forefront of what nurses do.

Treating yourself and your colleagues compassionately goes a long way too. If we can’t look after ourselves, how then do we look after patients?

If you are a nurse commitment must be on your list

Commitment in nursing is about providing the best care available at all times. You must commit to building positive and trusting relationships with colleagues and patients and their significant others to promote continuity of care.

A nurse must be able to make the patient and families feel valued and cared for, and feel safe in the nurses knowledge and skills. Therefore a good mental health nurses must stay up to date with all relevant practice and be committed to lifelong learning.

Continuing professional development that focuses on compassion will enable delivery of excellent patient-centered and evidence-based care. Moreover, good mental health nurses must commit to taking good care of their own physical, emotional and mental health. If a nurse is not okay, how can they expect to look after their patients

How a good mental health nurse must have the ability to stay calm in a crisis

If you can keep your head when all about you are losing theirs ………. by Rudyard Kipling comes to mind. It’s imperative that qualified mental health nurses have the ability to remain calm when dealing with emotional outbursts or challenging behaviour.

Being calm will be beneficial to both you and the patient. If you’re panicking or flapping about, the patient will feel it and they too might become distressed.

Knowing how to interact effectively with different types of people will help to de-escalate or diffuse a potential risk situation and avoid having to use ‘Control and Restraint’ techniques on a patient.

Emotional intelligence: A mental health nurse must have the ability to understand her patient’s emotions

Coloured image of female sitting on edge of mountain - Understand and manage your own emotions — Understanding your emotions

Emotional Intelligence (EI) is described by two researchers (Peter Salavoy and John Mayer) as the ability to

recognize, understand and manage our own emotions
recognize, understand and influence the emotions of others

In practical terms, this means being aware that emotions can drive our behaviour and impact people (positively and negatively), and learning how to manage those emotions – both our own and others – especially when we are under pressure.

An RMN, must remain calm and use their EI if there’s ever a challenging situation where a patient becomes aggressive or physically threatening. You’d need to take in everything and everyone around you immediately to ensure the safety of the patient and others.

Noticing, understanding, and managing one’s own and other’s emotions can be used to effectively engage the patient and bring calm to the situation. You might say to the patient “I hear what you’re saying……. I can see that you’re angry. What can I do to help? What would you like me to do?” “Would you like to sit with me and I can listen?” What else might you say?

Adaptability – Nursing in a fast paced environment

Adaptability or willingness to change in order to suit different conditions is necessary in an ever-changing work environment, particularly in nursing. An RMN will meet people who are often misunderstood by society, including their friends and family. Therefore, RMN’s need to adapt quickly and easily to new patients, different disorders and changes in moods.

There’s also new students, new mental health nurses, change in Junior Doctors every six months, new procedures and policies…………… The list is infinite end ever-changing, as is mental health environment. RMN’s must be flexible, be curious, be open-minded, and able to see ahead and have a plan B.

The above attributes are essential though this list is not exhaustive. There are are many more personal characteristics such as being warm, engaging, and considerate.

Over to you

I wish I could say I observed all the above in practice during three years of study and fifteen years of working within mental health. What do you think? I’d be interested to hear your thoughts and I’m happy to answer any questions.

Related: How to care for the mental health of the nurses in your life in these trying times (1). This was me: My mental health nursing career (2)

How to improve your verbal communication skills?

Do you struggle with verbal communication skills?

My previous lack of verbal communication skills

I was terribly shy in my teens and if I met someone new I’d blush bright red. I’d become anxious, start to panic and feel faint. That made me feel even less confident in making conversation. I never knew what to say as an introduction or how to end a conversation effectively. If I was asked a question I couldn’t think of an appropriate response and my silences might have appeared rude. Job interviews were a nightmare as I giggled nervously (hysterically) throughout.

However, fifteen years in Human Resource Management and fifteen more in mental health management hugely improved my verbal communication.

In a recent post we looked at good Listening Skills and today, we’ll address verbal communication skills.

What is verbal communication skills?

The ability to convey or share ideas and feelings effectively during conversation; to be able to talk and be understood. Therefore developing good verbal communication is necessary for both our personal and work life. Learning this skill will enable you to cultivate healthy relationships with loved one, friends, families, colleagues and even our boss.

Effective verbal communication skills include more than just talking. Verbal communication encompasses both how you deliver messages and how you receive them.

4 main types of verbal communication skills

NHS Leadership Academy’s 1st annual
conference — image by
Leadershipacademy.nhs.uk

Public Communication is normally where one person holds the stage, addressing larger groups of people i.e. Annual conferences or election campaigns.
Small-Group Communication takes place when there are more than two people. This is where everyone participates and interacts with the others in the group i.e. team meeting or group therapy.
Intrapersonal Communication is private and restricted to yourself. It’s like your self-talk, using your imagination or visualisation. Imagine talking to mum on the phone and she tells you she’s cooking your favourite meal, the aroma might come to mind.
Interpersonal Communication takes place between two people like a one-to-one chat between nurse and patient or you and your boss, in order to communicate your needs or any actions required.

For now we’re going to address Interpersonal Communication; a one-to-one chat or simply a conversation between two people, as that’s what occurs most often for us, like talking to the cashier in your local shop or a neighbour.

The importance of verbal communication skills

Would you believe that approximately 65% of our communication is nonverbal?

However, while only 35% of our communication is verbal (conversation), it is still the basis of all communication so we mustn’t neglect its importance.

The classic words of John Donne in 1624 ‘No man is an island’; roughly translated means no one is truly self-sufficient and we need the company and closeness of others in order to grow. While you may know of a recluse who functions solely alone, the rest of us generally have to be around people. Working and living in harmony, ‘fitting in’ and engaging with others is basic human need.

One of the best ways to fit in, engage with new people and build good relationships is via a two-way conversation. Developing rapport, which sometimes happens naturally, is essential and one of the first steps to relationship building. You can start building rapport by finding common ground or creating shared experiences with the other person.

From my professional experience, I know that nurses are expected to display empathy, compassion, kindness, genuineness (being authentic), self-awareness and a non-judgemental attitude when building relationships with patients.

However, these skills are easily transferable to all areas of work and personal life and can quickly be achieved by non-professionals. If you can be authentic, warm, open and friendly you’ll be able to verbally communicate with just about anyone.

Socratic Questioning skills you might find useful

Another achievable verbal communication skill (which might be used by nurses) is displaying a quiet curiosity and asking gentle probing questions. This technique is called Socratic Questioning (469 BC–399 BC). It’s a form of cooperative, argumentative dialogue between individuals and is based on asking and answering questions to stimulate critical thinking (Wikipedia). Being curious, acting a little bit dumb and getting people to think of the answers to their questions or problems for themselves.

Questions for clarification — Perhaps in response to someone crying, “I know he’s cheating on me.” You’d question “Why do you say that?“
Questions that probe assumptions — In response to a friend saying “He’s out late, he must be cheating.” You might ask “What could we assume instead?” or “You seem to be assuming.”
Socratic questions that probe reasons and evidence — In response to a person saying “You’re always letting me down.” You could ask “What would be an example?” or “Tell me on how many occasions I’ve done that.” or “When did I last do that?“
Questions about viewpoints and perspectives — Replying to someone saying “I’m not going back into hospital, I hate it” You could ask “What would be an alternative?” or “What would your Care Team think about that?”
Questions that probe implications and consequences — In response to a friend explaining “The staff are a bit………, you know…. so I can’t go back into hospital.” You could gently probe, “What are you implying? What will happen if you don’t go back?“
Questions about the question — Perhaps in response to a patient/friend saying “I’m so miserable all the time, do you think they’re all fed up with me.” You might respond “How would somebody else/ you mum/ your answer this question? And “Why?” or “Why is this issue important?“

Potential pitfalls during conversation we need to be aware of:

Unfortunately, in our busy worlds, at work or at home, with technology all around us, we’re easily distracted by noises or visual diversions. Is no wonder we make the following errors:

Excellent communication skills —
image by People2people.com.au

Sometimes we talk too much, often waffling or filling space. We feel we need to fill the silence with chatter — we don’t! It’s okay to have 10-15 seconds of silence, just relax and sit with it. This will give you the time to think about what you’re going to say next.
We’re often unable to put our ideas across so that the other person understands – take a breath, exhale slowly then inhale just as slowly and start again. Don’t be afraid to say something like “I’m not sure how to explain this so it makes sense, but I’ll give it a go.” One instance maybe if the other person does not speak the same language and we can’t get our point across. However, we may be able to resort to some sort of non-verbal communication.
We resort to jargon/colloquialism/slang – jargon occurs a lot with doctors, nurses and scientists. The medical/nursing field also use acronyms like ECG, ECT and CBT which can confuse, embarrass and alienate people who are unfamiliar with our medical/scientific/nursing terms. Colloquialisms come in where people speak with local words and phrases which can leave other people out of conversations. Computer language and the technical side of WordPress are completely lost on me – I need plain and simple messages here.
We don’t think before we speak, we just dive straight in. When your words are negative, demeaning, harsh or inconsiderate you may be seen as a miserable, angry and mean spirited person who sees only the bad and not the good in life or people. Take a breath and a couple of seconds to think about what you’re going to say. You are what you say — your words hint at your thoughts, values and beliefs and saying the wrong thing at the wrong time might hurt or anger others.
We don’t talk enough; If you’re unsure what the other person is talking about, ask them to repeat or rephrase it or tell them you don’t understand what they’ve just said. Most people don’t actually mind – they get the opportunity to hear themselves speak again….. If you’re short on things to say, try bringing up topics that you enjoy and are somewhat knowledgeable about. Open up and say what you think, share how you feel or share one of your own experiences i.e. if the other person tells you about their golf trip that weekend and you know nothing about golf, you could say “Ah, yes, the weather was good wasn’t it. We took advantage of it and went fishing/paddling in rock pools,” — don’t just stand there nodding and smiling.
Going off on a tangent (and not being able to get back on track). Apologise and stop for a second. Tell them “Ooops, I’ve gone off track, what was I/you saying?”
Being unable to give the other person the information they need to join in the conversation or to respond i.e. by giving yes or no or even one-word answers, you’re not inviting the other person to respond. Try to expand on a ‘yes‘ when asked something like “Do you work for Smith & Smyths?” You could say “Yes, I work in the post room and I’ve been there for almost a year now. What about you?”
Not listening enough. Ernest Hemingway once said: “I like to listen. I have learned a great deal from listening carefully. Most people never listen.” Don’t be like most people. Actively listen and don’t just wait impatiently for your turn to speak. When you listen, you might find something of interest that you can discuss further — when it’s your turn to speak.

How to improve your communication
skills — image by Nu.edu/resources

Whatever you are doing, the way you use your verbal communication skills, sets the emotional tone for any future relationships. Just think; chatting with a new person might lead to a great friendship, a brilliant new partner, a friendly colleague or an amazing business lead.

Do you recognise any of the pitfalls in verbal communication? Anyone got any hints or tips for effective verbal communication with new people? I really enjoy reading about your experiences.

Tag: Communication skills

10 attributes of a good mental health nurse

What makes an excellent mental health nurse?

Attributes of a good mental health nurse