Student Identification Number: 13141516

Programme Title: BSc Nursing

Module Code: NRS 411

Module Title: Communication and therapeutic relationships

Site: Exeter/Cornwall/Plymouth

Module Leader: Sue Linsley

Submission deadline date: Monday 13th February 2020

Word Count: 1235

Disclaimer: In accordance with policy and legislation all names have been changed

to maintain confidentiality.
Within mental health nursing, the Nursing and Midwifery Council stresses the

importance of communicating clearly and effectively, both verbally and non-verbally

(2018). Peplau (1952) stated that effective communication skills are central to sound

interpersonal skills and fundamental to the role of mental health nurses.

Interpersonal skills are the “nuts and bolts” of forming a therapeutic relationship

aiming to provide the conditions to facilitate the person to make a positive change

(Stevenson, 2008, p.109).

Myles and Richards (2006) formulated a structure for developing, maintaining and

ending therapeutic encounters. The aim of the introduction is to begin to develop a

relationship. Within the introduction, the nurse should help the person feel relaxed

and demonstrate the ability to build a rapport with the person. Initially, I was nervous

as to how to initiate the discussion and how to get across the necessary information

without merely talking at the person. Despite this, I think I was successful at

appropriately introducing myself to the patient, “Maddie”, as a student mental health

nurse. I also checked their name and asked if they have a preferred name which

they are more comfortable being referred to as. When introducing the session to the

person I clarified the time frame we would have together and mentioned that I would

tell them when the session was nearing its end so as not to finish abruptly and allow

us time to round up what we had discussed. When doing this I did use hand gestures

without the deliberate attempt which may have been unsettling for the person. This

reminded me of the importance of body language and non-verbal communication.

I attempted to adopt Egan’s SOLER model of seating position, open posture, leaning

slightly towards the client, good eye contact without staring and adopting a relaxed

posture (Egan, 2010). Reflecting on the conversation most of these elements had

been completed with the exception of open posture as I was seated with my legs
crossed. I recall being aware of this during the discussion but I did not want to

disrupt the flow of conversation through moving. However, if I were to repeat this I

would ensure I sit with an open posture to make myself appear more available.

In addition to non-verbal communication, I demonstrated how various methods of

verbal communication can be used to discuss with a patient and build a therapeutic

relationship. For example, I used Rogers’s (1992) core conditions of unconditional

positive regard, empathy and congruence.

A key element of forming a therapeutic relationship is to actively listen to the person.

This demonstrates that you care and want to help them by giving them your full

attention (Morrissey and Callaghan, 2011). I think that I was able to give Maddie the

appropriate space to allow her to talk to me, free from distraction or interruption, and

give her the time to explain what she is struggling with currently.

As part of active listening, I used open-questions to give Maddie the opportunity to

answer in as much detail as she felt comfortable in doing so and allowing me to get a

wider picture of what she feels she is struggling with. When I felt it would be useful to

gain more knowledge about certain aspects she had mentioned, I would ask probing

questions, (Egan, 2010) such as when she mentioned her GP putting her on anti-

depressants I questioned whether or not she felt these had been effective. This was

not a good question as it merely provided a yes or no answer, as an alternative I

could have asked “How did you find taking the antidepressants impacted your

mood?”, fielding an open but focused question (Egan, 2010).

In the conversation I tried to make sure that I was reflecting and summarising

throughout (Morrissey and Callaghan, 2011). This meant identifying what the person

is communicating through picking up on particular words or phrases and either

paraphrasing what was said/ verbalising what I thought to be implied by this to elicit
more detail. Paraphrasing, allows me to check my understanding and also show

attention and attending (Sanders, 1994). These techniques provided Maddie with the

opportunity to correct and/or add information. I think I did this well in my conversation

with Maddie, and ensured not only empathy but that I was getting an accurate idea

of Maddie’s “story”.

In my collaborative conversation I think I effectively used Heron’s facilitative

interventions (1990). For example, when Maddie expressed that she did not feel

worthy of help I used the supportive intervention to affirm her worth and value as a

person and telling her that she is worthy and deserving of receiving support.

Prior to leaving and after summarising what I had learnt from Maddie in our

conversation, I asked her what she would like from our next discussion. We decided

that we could further explore the options of support that would be available to her

during her admission. This was based on the person-centred approach letting the

patient have direction over their treatment (Rogers, 1992).

In my final summary and round off with Maddie, I congratulated her on being open

with me and congratulated her on taking the steps towards getting support. To

improve this, I could have brought in information from earlier in the discussion

regarding her art and drama and “cheerlead” building on a context of competence to

encourage and validate her (de Shazer,1988) .

On reflection, I am aware that I missed opportunities where I could have used further

specific therapeutic interventions such as the “Miracle Question” (de Shazer, 1988).

This would have given me further insight into what Maddie wants for her individual

recovery and enable the team to work with her towards achieving these goals.

I am satisfied with my efforts to establish a therapeutic conversation and feel I was

warm and genuine. However, I think I was overly-conscious that this was the first
collaborative conversation Maddie had had on the unit so I used it to get to know her.

This meant I missed opportunities where I could have questioned more and used

specific interventions. I am also aware I need to work towards improving my

confidence, at times I was not confident in my own abilities during the conversation

which prevented me from doing things which could have improved the interaction.

The session has highlighted areas of improvement for practise.

References:

De Schazer, S. (1988) Clues: Investigating Solutions in Brief Therapy. New York: Norton.

Egan, G. (2010) The Skilled Helper. 9th edn ed. Pacific Grove, CA: Brookes/Cole.

Heron, J. (1990). Helping the Client. London: Sage Publications.

Morrisey, J. and Callaghan, P. (2011) Communication Skills for Mental Health Nurses: An

introduction. Berkshire: McGraw-Hill Education.

Nursing and Midwifery Council, (2018) The Code: Professional standards of practice and

behaviour for nurses, midwives and nursing associates, London: Nursing and Midwifery

Council.

Peplau, H. (1952). Interpersonal Relations in nursing, New York: Putnam.

Richards, M. A. (2006). Clinical skills for primary care mental health practise, s.l.: University

of Lincoln.

Rogers, C. (1992). The necessary and sufficient conditions of therapeutic personality chnage.

Journal of consulting and clinical psychology, 60(6) pp

Sanders, P. (1994) First Steps in Counselling. Manchester: PCCS Books.

Stevenson, C. (2008) Therapeutic communication in mental health nursing, Dublin:

Psychiatric/Mental Health Nursing: An Irish perspective.

Name/Exam No: Registration No: Submission
13141516 Deadline date: 13th February 2020
Programme: Mental Health Nursing Site: Exeter/ Cornwall/ Plymouth Academic Level: 4
Module Title: Communication and forming therapeutic relationships Module Code:
NRS 411
Cohort: Sept 2019 Submission: 1st X 2nd 3rd Module Teacher/Marker:
(please circle) Sue Linsley

The written critical reflection on your collaborative conversation

Theoretical knowledge and the principles of communication skills described. 30% 21
In addition an illustration of the importance of communication in the delivery
of health and social care is provided.
Evidence of understanding and effective application of communication and 30% 21
engagement skills including demonstrating awareness of barriers and
boundaries
Evidence of self-awareness and personal insights into application of 25% 19
therapeutic engagement
Appropriate literature and references cited. (Refer if none cited) 15% 9
Total Marks / 70%
100%
Feedback for your 1000 word critique is highlighted below:
Outstanding - Comprehensive coverage of relevant issues.

Extremely well informed knowledge base relevant to assignment. 86-100%

Very clearly written, logically structured and presented.

Critical discussion of current issues and their influence on practice.

Excellent application `of theory to practice.

Evidence of consistently safe and exemplary standard of practice.

Excellent - Thorough coverage of relevant issues.

Well informed knowledge base relevant to assignment. 70-85%

Clearly written, logically structured and presented.

Discussion of current issues and their influence on practice.

Excellent application of theory to practice.

Evidence of consistently safe and high standards of practice

Very good- your descriptions are based upon a broad range of relevant
knowledge and reading. Theory consistently applied to practice.
60-68%
Describes relevant issues.

Awareness of current issues and their influence on practice.

Clearly and logically presented and structured

Incorporates evidence of safe and consistently well-applied practice.

Good- you utilise appropriate and relevant theory.

Consistent application of appropriate theory to practice. 50-58%

Incorporates evidence of safe practice.

Well-structured and developed presentation.

Clearly expressed

References and/or supporting material generally accurate.

Satisfactory- Meets the criteria and requirements of the module assessment 40-48%

Meets module specific criteria. Pass

Meets relevant Learning Outcomes for module.

Some appropriate and relevant theory described.

References and/or relevant supporting material generally accurate.

Some relevant knowledge applied to practice.

Evidence of safe practice (described).

Structure and presentation not always clear.

This does not fully meet the criteria and requirements of the module assessment Refer

Does not meet module specific criteria or relevant learning outcomes.

Limited range of relevant theory. 30-38%

Frequent referencing errors and/or inappropriate use/selection of supporting

materials.

Inappropriate description and application of theory to practice.

Poor understanding of practice issues.

Lacking in logical structure and sequencing.

Evidence of unsafe practice

Refer

Clear Failure to achieve a pass grade - Unreferenced and/or no supporting

material.
29% and
Lacking any relevant theoretical content. below
Poorly organised presentation.

Difficult to read and follow.

Unsafe practice

What was good about your work

This was engaging and clearly presented. You clearly understand the principles of active
listening and the frameworks adopted, as well as the importance of effective communication
as outlined in your introduction– well done.
You applied the literature appropriately and also demonstrated good self-awareness, showing
excellent insight on your part. You were effectively able to examine the conversation with
appropriate reflections as to what went well and which may need further focus – I especially
liked that you recognised the confidence issues– well done.

Areas for development

To enhance this it is really about attention to detail so being mindful of capitals, punctuation
etc. at points. There is room to adopt a more ‘analytical’ academic style at points as this is a
critique so making it a little more discursive in preparation for level 5
Be mindful of references/literature sources Myles and Richards was not in the list. Also pay
attention to the Harvard style and be pedantic about your list there was a couple of missing
pp, publishers and location etc .
Overall an enjoyable read covering the salient points and addressing the learning outcomes
– well done.

Word count Included for Essay: Yes Confidentiality/Anonymity maintained

or consent included: Yes
Marker
Essay & Conversation Marker: Sue Linsley 14/02/2020

Moderator Comment#* I agree with Marks and commentary – well done.

Tracey Cassidy 15/02/2020