Effective Communication in Mental Health Care | Case Study

• BHARI PALIKHE

Amanda is a young woman who has been heard yelling who looked confused and anxious. When she was handed over to the emergency department the young women looked tense and walking through the hospitals passage wringing her hands and responding to sounds and movements as her eyes staring intensely towards the ceiling and staff members. She had her hair colored with segment of pink and blue with was not well groomed and matted. She also had a number of piercing on her face over the nose, lips and eyebrows. She is unable to sit still and ignoring her mother’s request to relax and sit beside her side. Although she seems to ignore her mother’s request she seems to be responding to the emergency department staffs request to go to the bed she has been allocated where she has been insisting on keeping as much distance and physical contact .She is hesitating to enter the cubicle/bed as she feels entering into a trap where she had to be reassured by her mother to go to the cubicle. She, is has been glaring at the ceiling and her behavior changes at an instant where she has changed her focus giving a glare at the clinician. Her mother realizes the situations that she has been concerned with the presence of the clinician as she feels more and more irritated an gives her the assurance that the people over there are for her help and not to harm her. Her pupil seems to be extremely dilated as she begins wringing her hand and begins to sweat. According to Mary (Amanda mother) over the last 12 months ever since she dropped out of the university studies her life has taken a significant change as she has become isolated .As, the communication broke down among the friends and she felt like she was the one that’s been isolated as she tried to counter the situation by listening to loud music in her bedroom without trying to find a solution to her isolation with her parents. She has a disheveled and dirty feel to when she comes home after extended period stay outside the home. She also has developed eating and sleeping disorders and behaving like something is not right.

Cognition describes the level of consciousness. Here we need to consider the memory (immediate, recent, remote and orientation of the person to time, place and person), concentration and abstract thinking. Cognition is dependent on perception. Perception is the method of acquiring, understanding, choosing, and organizing sensory information. It can also be defined as process by which health professionals need to understand and organize sensation to produce a meaningful experience with awareness. When the medical staffs decided to have a quick chat with Amanda to access her situation and treatment, she looked terrified and was certainly disoriented. It seemed that she was not aware of her surroundings and didn’t know why she was there at the first place. But, when the medical staffs explains that she was there for her treatment and the treatment was confidential she shows them all the picking s that she had and starts giggling and screaming which gives a clear indication that she has lost her focus and her attention shifts in an instant without her being able to control the shift. Here, the patient certainly shows a low level of concentration. She changes her attention from one state to another in no time and with no level of authority. One moment she is taking something and the very next moment she is thinking about something else which has no relevance at that particular point of time This means her mental health status is nowhere near where it need to be for giving consent for her treatment so her mother (next-to-keen) has to give consent for her treatment to go ahead. As, Amanda was not able to concentrate and her thoughts changes as she was not aware her location and tries to go into the past some of which are thought to be imaginary or may have come from substance abuse and there seems to be a very low level of consciousness on her part so it has to be assumed that the patients ability to make decisions, choices or think regarding her treatment has been diminished

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Hearing can be described as the action of distinguishing sound and accepting sound waves or vibrations while on the other hand listening is to hear a sound and understanding what it meant to be. In communication process is a common system where we exchange symbols, signs behavior’s between two or more individuals. It can be verbal, non-verbal and symbolic. Listening can be related to as a process of assigning meaning to the vocal signals. Effective listening skills are mastered through training (Stewart, 2005).Hearing on the other hand is the physiological element of listening. It is one of the most important part of communication and involves,

• Receiving
• Attending
• Understanding
• Responding
• Remembering

Understanding

Effective communication begins with understanding. In the case of Amanda, she is in a state where she is not able to communication effectively with the staffs of the emergency department. The staffs must try to understand the strange behavior shown by Amanda like winging of the hand, staring at the ceiling, shouting, making loud noise ,hearing loud music ,not talking to parents and crying as a part of a problem. The health professionals now has to take these factors into consideration as a part of their understanding process before trying out different sets of predefined rules and also innovate in case required in order to have a effective communication so that they would be able to understand the real problem she is going through and develop strategies for the treatment.(Chapter 3: The Process of Listening, nd).

Responding

Listening is only effective when it is responded upon. Response may be

• Responses to direct verbal communication(written or spoken)
• Responses seeking clarification
• Responses that paraphrase
• Responses indicate if the message is understood or not.

In the case of Amanda, when the staffs decide that they will have an interview with it seemed that she had a very little amount of consciousness and she was unable to figure out where she was and for what reason. As the clinician approached her for interview she asked them where she was and why she was there for. As this point of time the clinician responds to her question by saying she was there for her treatment. This is a part of effective communication and response. (Chapter 3: The Process of Listening).

Nursing is not only a caring profession but it is also evidence based in practice .The nurses used to be the first point of contact and has remained the same beside the rise a technology in the nursing field. Communication can be seen as a medium of transferring messages and understanding meaning.(Wilson and others, 1995).

In therapeutic communication, a nurse needs to seek an elicit a response from the patient which is not only beneficial to a patients mental health of a but alsohelps in promoting constructive relationship between the nurse and the patients, towards achieving a goal. Nurses are required to respond all the content of patient’s verbal messages and the feelings and their assessment of the situation before taking appropriate action demanded by the situation. Professionalism, Confidentiality, Trust, Availability, and Sympathy are some of the known emotions associated with therapeutic communication. (Potter, Patricia A., Perry, Anne G., Co. 2003, Basic Nursing Essentials for Practice, pg. 123, Mosby). To establish a nurse patient relationship with the above attributes, a, nurse must assess the overall situation during their communication and they should be trained to do so and determine the best therapeutic approach. Amanda has been admitted to the emergency department as she has been suffering from psychiatric disorders she feels like she has been brought to whole new world and was not able to find out the reason for her being brought there and her anxiety level is increasing as she sees more and more of the people who she doesn’t know. As her anxiety level increases the she feels that she has been abandoned or that there was no one there that really cares about her and her feelings. The clinician from the department are able to see the patient providing care and knowing there problems and their needs as if that was their own which will allow them to build a nurse patient relationship where the patient can feels that the things they are doing are for his/her that will lead them to trust the people involved in the treatment and the patients entire spectrum could be changed for a better result. Another scenario here in providing therapeutic communication is when the mother is constantly obstructing and causing interruptions as she is unsure what will happen to her daughter. Now it’s up to the nurses and paramedics to provide her with effective communication so she can understand the reasons for her daughter being taken to the hospital for her own good.

Clinical handover as we know is the transfer of information and professional responsibility and accountability between individuals within the entire system. It focuses on the passing over of information and measurement of safety and quality during the transfer. Nursing handover is one of the most important parts of the health care system. Graduate and seasoned nurses are often looking for new ways to improve their reporting skills with training and shared experiences. Effective handover is an integral part of a patient recovery process, however there are known difficulties in thinking, doing and communication. We need to consider key elements like leadership, value, participants, time and place and processes involved to organize an effective handover between health professionals from different disciplines. Leadership in the case of handover may be classified as being responsible for what is being done and also providing guidance in overall process. Handover is only effective only when it is a must for the health of a patient so staffs from the department who has the patient must assess the situation and go ahead only when they think that is the best way for patient’s recovery. Transferring a patient from one department to another need a the involvement of patients and their family members at all times and an simple and effective plans communication is also needed. However, it is the responsibility of the medical staffs to get the time and place right for the handover as it is only effective when they get it right.

Handover allows the other department to take over the patient and start their part of the recovery process so it is important for them to know what was going on before they took over the responsibility. Although it seems a straight forward approach there are various known and adhoc difficulties face by the staffs involved in the medical handover. Confidentiality and objective information are two of the major hurdles that staffs face during a handover process. To negate these difficulties a handover process will have to use a common language mainly between the teams that are involved in the process so as to eliminate a communication gap. They also need to develop a sharing their experiences as this will allow them to work as a cohesive group with one negating the others weak point by their experiences and also a need of standardized approach is essential as this will minimize mistakes as every individual is following the same set of standards at all times.

In the case of Amanda when the paramedics have been called upon when she was looking dazzled and anxious with shortness of breath. When the paramedics decide to take the patient from her home to the hospital and handover the patient to the related department, the paramedics needed to handover all the information they have acquired during the whole process from the point receiving the call until the emergency department takes over. However, handover could be improved by the by the use of common language between the paramedics and the staffs of the emergency department sharing experiences and developing standardized approaches.

References:

Kline, J A 1996, The Process of Listening. Retrieved on 4 May 2014 at <www.au.af.mil/au/awc/awcgate/kline-listen/b10ch3.htm>

Hungerford, C, Clancy, R, Hodgson D, Jones, T, Harrison, A, Hart, C, 2006, Mental Health Care: An Introduction for health professionals, pg.64-68.

Stewart, Gwen, 2005, Listening skills. Retrieved on 5 May 2014 at <http://www.leehopkins.com/types-of-nonverbal-communication-listening-skills.htm >

Potter, Patricia A., Perry, Anne G., Co. 2003, Basic Nursing Essentials for Practice, pg. 123, Mosby

Owen, C and Hemming’s, L and Brown, T, Lost in translation: Maximizing handover effectiveness between paramedics and receiving staff in emergency department, Emergency Medicine Australasia, 21, pp. 102-107.Retrived on May 6, 2014 at < http://onlinelibrary.wiley.com/doi/10.1111/j.1742-6723.2009.01168.x/full>

Kimmel, N, 2007, Therapeutic Communication in the Nursing Profession Retrieved on 5 May 2014 at<http://ezinearticles.com/?Therapeutic-Communication-in-the-Nursing-Profession&id=594747>

Jensia, I, 2008, The Difference Between Listening and Hearing Retrieved on 5 May 2014 at <http://voices.yahoo.com/the-difference-between-listening-hearing-2019974.html>

Lampert, L, Tips on Effective Nursing Handover Retrieved on 6 May 2014 at <http://www.ehow.com/info_8208545_tips-effective-nursing-handover.html>

Implementation Toolkit: Standard Key Principles for Clinical Handover, 2009 Retrieved 6 May 2014< http://www.archi.net.au/documents/resources/qs/clinical/clinical-handover/implementation-toolkit.pdf>