Effective Communication and Counselling in Mental Health Nursing

This paper discusses the principles of effective communication and appropriate counselling model in mental health nursing to ensure an effective recovery of the patient.

Running head: MENTAL HEALTH NURSING
MENTAL HEALTH NURSING
Name of the Student:
Name of the University:
Author Note:

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Introduction:
Mental health issues are perceived as a negative stigma by the society. As stated by
Fortinash and Worret (2014), issues related to mental health are often stigmatized and looked
down by the members of the society. This accounts for the primary reason why access to
mental health care services has still remained poor. As stated by Webster (2014), mental
health issues such as schizophrenia which is ideally defined as a type of psychosis and is
characterized by symptoms such as hallucinations and disordered thinking is perceived
mostly as a societal stigma. It should be noted in this context that schizophrenics are mentally
unstable patients who are unlikely to cause any harm to the general population and are in
need of mental health care services. However, on account of the bizarre approach as well as
the unpredictable and irrational behaviour exhibited by the patients, the patients are perceived
as a threat to the society and fall prey to societal discrimination. In addition to this, print
media as well as social media invariably portrays mental health patients to be involved in
heinous crimes which further fuels the stereotypical criteria related to mental health patients.
Therefore, it can be mentioned in this regard that on account of lack of education and
awareness about mental health illness and the fear spanning mental health illnesses, care
professionals as well as people in general find it most difficult to communicate with patients
suffering from mental health disorders. It is extremely important for care professionals to
build a strong therapeutic relationship with the patients and at the same time communicate
effectively so as to ensure quality in terms of service provision. Further, it is important to
understand that mental health patients are unable to behave according to the set societal
norms on account of their limited insight and judgement ability. It is therefore, integral for
the care professionals as well as the associated family members to ensure that the patients are
treated in a respectable and dignified manner so as to ensure a positive recovery. This paper
deals with the analysis of an interview held with a mental health patient who was presented

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by his family member to the emergency department. The paper delves deeper into the
principles of effective communication and appropriate counselling model in order to ensure
an effective recovery of the patient.
Discussion on the communication process:
Mental health nursing professionals as well as care professionals must ensure that
they communicate effectively with a patient who is suffering from a mental health illness.
The components of effective communication comprise of elements such as treating the
patients with dignity and respect. Research studies on positive psychology suggests that the
mental health care professionals must ensure that the patients feel respected and must be
actively listened to in order to ensure their involvement in the mental health recovery process
(Videbeck & Videbeck, 2013) . Care professionals must be extremely cautious while dealing
with mental health patients who experience psychotic episodes such as hallucinations or
delusions. Care professionals must empathise and make the patient understand that they are
able understand their problems. It should be noted in this regard, that the hallucinations or the
delusions experienced by the patient forms their share of reality and therefore care
professionals must try to empathise with the patient and not make a judgemental comment.
Also, while dealing with patients that experience paranoia, care professionals must provide
appropriate space (Webster, 2014). Also, care professionals must not judge patients on the
basis of their intelligence level and must be considerate (Raab, 2014). Mental health nurses
must try to evaluate the root cause of the mental health problem and make appropriate
referrals and discuss appropriate community support options with the family members of the
patient (Fortinash & Worret, 2014). Also, while dealing with a violent patient or patient
experiencing an adverse mental health disorder, the care professional must set limits to the
conversation and ensure that the conversation does not yield an adverse outcome (Webster,

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2014). Upon facing an adverse clinical incident, the care professionals must call for help and
contact the security or colleagues so as to deal with the situation.
Reflection on the counselling approach used by the Mental Health Nurse:
During my previous clinical placement, 43 year old MX presented to the emergency
clinic with her 15 year old son JB. MX mentioned that JB had been acting extremely weird
since the previous week. She mentioned JB not attending school and being confined to his
room. She also JB to be listening to loud music late at night till the wee hours of the morning
and not sleeping during the night. She also mentioned JB had been refusing all the major
meals and had been avoiding talking about his problem with his family members. After
consulting with a friend, MX decided to present JB to the emergency department of the
mental health clinic and had a hard time convincing him.
On closely evaluating the condition of the patient, I first assessed the pre-interview
considerations that included examining the purpose of the patient’s visit to the care clinic.
Clearly the patient had been presented by his mother to the emergency unit by his mother as
he had been behaving strangely and had not been interacting normally with his parents.
The patient was seen in shabby clothes with a black ‘V’ neck T-shirt and lose
trousers. The patient’s appearance was untidy and his hair was unkempt. Further, the patient
belonged to the aboriginal and Torres Islander community and prior to conducting the
interview, I was sceptical about conducting the interview, as I felt that the patient might not
be comfortable in my presence. Also, I did not have a comprehensive understanding about the
cultural and ethnic history of the indigenous aboriginal community. Therefore, prior to
conducting the interview, I asked MX if she was fine with me doing the assessment and to
that she relented. I conducting the patient interview inside the clinic, where I greeted JB and
introduced myself to him. I further told him the purpose of the interview and before

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conducting the interview, sought his consent. He ascended his consent and only then I started
off with the interview process. I also mentioned to him that I would be sharing the
information provided by him with the multidisciplinary team of professionals in order to help
him with his problem. During the pre-interaction stage, I felt that JB was comfortable in my
presence and hence I believe I was able to communicate effectively with him and at the same
time was able to display cultural competence while dealing with the patient.
The second stage or the orientation stage comprised of greeting the patient and
building a rapport with the patient. In order to build a positive therapeutic relationship with
the patient, I introduced myself and considering the fact that my patient was a minor, before
conducting the interview process, I engaged in some informal conversation such as, ‘how has
everything been?’ and ‘how has the year so far turned out?’ I made use of these questions in
order to make the patient comfortable and acquire the trust of the patient so as to maintain an
open communication with the patient. I then mentioned to JB, that I would be asking him a
few questions, which if he would answer correctly would help me in understanding his
problem and accordingly I would be able to solve his problem. He was quiet for a while and
gave me a penetrating look and then affirmed his approval.
Throughout the interview process, JB maintained a closed body gesture and
occasionally maintained eye contact. Occasionally he seemed anxious and was seen to fidget
with his hands. He was aligned to the time, place and purpose of the interview and on the
basis of his ability to count backwards and address serial 7s, it was evident that the patient’s
insight and judgment ability was not impaired. However, the JB occasionally seemed
disturbed and distracted during the interview process and was seen to mumble on his own. On
asking him, what was wrong, he mentioned about ‘voices’ that warned him not to step out of
home or ‘they’ would kill his mother and everyone he loved. After mentioning about the
voices, JB pleaded me not to share the same with his mother or anyone else as they would

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come to know about it and would destroy everything. He also mentioned refusing to eat or
sleep as the voices told him to do so and agreed to play loud music in order to silence the
voices that disturbed him. Also, the thought content or the thought perception of the patient
did not reveal suicidal ideation. Also, the patient’s mood appeared to be low and overall he
appeared to be distressed.
Interview Analysis:
Upon analysing the quality of interview with the patient, it could be evaluated that the
patient was experiencing auditory hallucinations. It could further be analysed that on account
of voices, the patient found it extremely difficult to focus on his life and the voices created a
significant distress and turmoil in him that had resulted in diminishing the quality of his life.
Also, on the basis of the interview conducted it can be mentioned that JB was not aware
about the voices being auditory hallucinations. JB was sure that the voices existed in reality
and was deeply affected by the consequences that could happen if he went against the voices.
On the basis of the observations and the assessment, the differential diagnosis of JB
suggested that he was suffering from Schizophrenia. As per Jauhar et al. (2014),
Schizophrenia can be defined as a chronic as well as severe mental health disorder that
critically affects the normal ability of a person to think, feel and behave (Velthorst et al.,
2015). Schizophrenic patients seem to have lost contact with reality and often experience
symptoms such as auditory or visual hallucinations that might seem extremely disabling
(Denborough, 2014).
Therefore, on the basis of the MSE evaluation and the interview analysis, the care
goals for the patient comprise of the following considerations:
 Instilling the belief that the voices did not exist in real
 Ensuring proper intake of balanced meal

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 Ensuring proper sleep
 Restoring the normal life of the patient
In order to address the care goals, a multidisciplinary approach was undertaken where referral
was made to a dietician and a psychotherapist. In addition to this, a family centred approach
was undertaken where the family members of the patient was involved in the process of
decision making as well as the planning of the intervention strategies (Vetere & Dowling,
2016). A major barrier was experienced in the adaption of the family centred approach, as
JB’s father refused to participate in the process as he was not fluent in English and at the
same time believed that JB had been playing pranks and did not require any treatment
intervention pertaining to mental health.
The barrier was effectively addressed by making referral to an aboriginal mental
health community nurse. The aboriginal community nurse effectively imparted health literacy
to JB’s parents and educated them about mental health disorders and also discussed about
JB’s mental health condition with them. Upon being educated about the issue, JB’s parents
agreed to offer his support in the treatment process. The treatment process for JB included a
dietician. The rationale for the same being, on account of his symptoms, the patient had
refused his major meals that had made him weak and at the same time resulted in major
weight loss. The dietician typically made use of effective diet plans in order to ensure that JB
consumed appropriate meals and also monitored the effectiveness of the diet plan by keeping
a track of the patient’s weight. Further, a referral to a psychotherapist was also made. The
rationale for the same being making use of a combination of psychotherapies such as
cognitive behavioural therapy as well as narrative therapy in order to facilitate therapy.
Research studies indicate that the use of narrative therapy in Schizophrenic patients helps in
assessing the underlying reason that had led to the emergence of the symptoms (Roe et al.,
2014). Further, the principle of narrative therapy makes use of freedom of narration about

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negative experiences that could have potentially led to the emergence of the mental health
issue. Upon analysing the narration, psychotherapists make use of therapies such as cognitive
behavioural therapy to assist recovery (Velthorst et al., 2015; Denborough, 2014). In this
context, it should be noted that the foundation of the cognitive behavioural therapy is based
on the concepts of human emotions such as perceiving thoughts, feelings, physical sensations
as well as actions. CBT or cognitive behavioural therapy assists the patient to overcome
problems in a step-wise manner by fragmenting the problems into smaller parts. CBT in
combination with pharmacological intervention has been studied to promote recovery among
patients suffering from schizophrenia.
Appropriate communication approach used:
Assisting a patient suffering from a mental health illness such as Schizophrenia can be
extremely challenging. In this the Peplau’s Nursing Theory approach was followed in order
to build a therapeutic relationship with the patient. The Peplau’s nursing theory can be
defined as the nursing care model that stresses upon the establishment of a collaborative
relationship between the patient and the care professionals so as to encourage patient-
engagement so as to involve the patient in the process of self-care (Butts & Rich, 2013). In
this case, the principles of the Peplau’s theory was used to identify the needs of the patient.
This was achieved by actively listening to the concerns and the experience shared by the
patient. Also, prior to conducting the interview, a self-assessment was carried out in order to
ensure that whether or not the patient and the family member was comfortable with the
quality of care provided. Health literacy was imparted both to the patient and the family
members by making referral to an aboriginal mental health community nurse in order to
ensure that culturally effective care was provided and at the same time assure that the care
process followed a shared decision making process. A multidisciplinary team approach was
undertaken for the recovery process after browsing through the evidence base in order to

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ensure positive recovery of the patient (D’antonio et al., 2014). Also, the complete treatment
process was documented and the patient was discharged after ensuring that the patient was
equipped with self-management strategies and in order to monitor the progress follow-up
sessions were organized (Townsend & Morgan, 2017).
Theoretical and Practical values of the Preferred Counselling Model:
Peplau’s theory essentially makes use of the person (the patient JB affected with the
problem), the environment including the physical and the cultural environment that sum up
the surroundings of the patient, health (as perceived by the patient) and nursing (the process
of offering assistance) to help the patient recover from the illness. The theory mentions that
care professionals must be able to identify the patient problems by conferring to the
principles of nursing (Kitson et al., 2013). Also, care professionals are expected to make use
of the principles of human relations that arise at all levels of experience. In this case, the
theoretical essence of the counselling model was used by adapting a collaborative approach
and maintaining an effective inter-professional approach with the multi-disciplinary team of
professions that include the community nurse, psychotherapist and the dietician to assist the
patient with the recovery process (Davis Boykins, 2014).
Application of preferred model of counselling to work with patient, groups and families:
The nursing theory was appropriately used in the care process by keeping the patient
at the core of the treatment process. Throughout the care process, a positive patient-nurse
relationship was maintained. This was critically evident at the termination phase, when
during the discharge phase, JB wanted to the care professionals involved in his care
professionals to keep in touch. This suggests that a strong patient-care professional
relationship had been built on the core elements of dignity, love and trust. Also, the family

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members of the patient were actively involved in the care process as the treatment process
was planned in consultation with the family members.
Understanding a therapeutic relationship:
Typically the nurse-patient relationship built with the patient spanned over the four
phases of orientation phase, identification phase, exploitation phase and the resolution phase.
The orientation phase comprised of conducting the all-inclusive assessment of the patient in
order to gain understanding about the physical, mental and emotional needs of the patient and
accordingly co-relate it with the patient needs. The second phase included the identification
phase, where the care professional offered assistance to the patient to identify his health
issues and internal conflicts and develop a mutual understanding about the patient’s
problems. The third phase includes the exploitation phase, where a strength based approach
was followed in order to facilitate recovery of the patient and the final stage or the resolution
phase where the discharge plan of the patient was appropriately planned.
Appropriate strategies and interventions used for contemporary counselling:
Psychologists have focused on the maintenance of a strong therapeutic relationship in
order to provide assistance with mental health illness issues. Contemporary counselling
strategies suggest that in order to foster an effective counselling process, psychologists must
make use of the five components of innovation, boldness, compassion, mystery as well as a
unique label to the devised therapeutic intervention (Chen et al., 2013). Typically, the use of
a miracle question, making use of the empty chair, transference interpretation, virtual reality
and primal therapy can be deemed effective contemporary counselling therapy techniques. In
addition to this, the use of sand play, head on collision, voice dialogue and paradoxical
intervention cab help in conducting an effective counselling session and help the patient
express without any barrier (Raab, 2014).

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Reflection:
Therefore, on the basis of my clinical experience, I can say that I was able to
effectively plan the recovery of the patient. I was able to make use of the effective
communication skills and at the same time was able to make use of the Peplau’s nursing
theory in order to ensure a positive recovery process of the patient. In the entire care process,
I performed the role of a stranger where I first met the patient and created a comfortable
environment for the patient so as to help him share his issues. I also performed the role of a
repository or a resource where I used my knowledge to make appropriate referrals. I
performed the role of a teacher and a counsellor when in collaboration with the community
nurse I imparted health literacy to JB and his family members about his mental health issue.
Further, I also performed the surrogate and the leadership role where I taught the patient self-
management strategies in collaboration with the multidisciplinary team and at the same time
ensured that the patient’s condition improved gradually and a speedy recovery could be
achieved.

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