Conversations with patients: Reflections from a student nurse

As my first year at University comes to a close, I sat back and reflected on my conversations with patients and the use of key communication skills. My work as a student mental health nurse is varied. I have completed assessments, been involved with group workshops as well as 1-2-1 therapies. 

Putting theory into practice

In University, our lecturers teach us the theory of communication skills. We then have to try and practice them in clinical practice when having conversations with patients, which is hard, particularly when faced with challenging situations. You can’t always remember everything you are supposed to say. But what I have learned is that the ‘one size fits all’ approach doesn’t work. We can’t have stock phrases and follow a controlled approach to communication. You have to adapt your communication to the person you are interacting with. But there are key skills we can use to help us.  

Good communication skills

To communicate well is to have good listening skills, including active listening, awareness of non-verbal communication, and building a good rapport and professional relationship. It is tricky when first starting out as a mental health student nurse to get the balance right, and at times it can be pretty stressful. I think it is important that we take some time to reflect on our verbal and non verbal communication to help us improve our skills. 

Other key listening skills

Additionally, some of the key communication skills within counselling are reflecting, paraphrasing, clarifying, summarising and immediacy, all of which can result in clear, defined and stable care if used well. We have to be present and show the person we are talking to that we are there with them at the moment. These skills are essential regardless of the clinical situation, but I think they are vital when assessing a patient for care. 

Assessing patient care

Assessing a patient to provide holistic and inclusive care can be tricky. I am learning through my reflections and conversations with patients that they often feel as though they are being passed from pillar to post in mental health services. It may be that they don’t quite fit the criteria for one service and need a referral to another team. In such situations, it is essential the patient knows what is going on and can make informed choices. 

To aid continuity of care, it is helpful if the team assessing the patient’s needs continues to provide the patient’s care where possible. The patient should know who their care coordinator will be to ensure key working relationships between the patient and nurse. Consistent communication is essential throughout their care. The care coordinator should agree to regular reviews of care with the patient whilst they need support. Reviews of care are essential, mainly because patient needs and preferences are varied and can fluctuate over time. 

Patients should know that they can: 

  • See a copy of their care plan at any time 
  • Ask for a review of their care
  • Talk about their treatments if they have any concerns. There is often more than one option available.
  • Raise concerns 
Other key learning points for students

When I reflect on what I have learned so far in my training, I would share the following insights with those who are just about to embark on this journey:

  • Withhold your judgements
  • Show understanding by being empathetic and sympathetic where appropriate 
  • Tailor communication based on patient preferences – follow their lead
  • Respect privacy and confidentiality
  • Respect a patients right to complain 
  • Don’t be afraid of silence; it allows time for patients to think and to raise any more concerns 
  • Allow time for questions through the conversation and not just at the end
  • Voice to patients where you may be concerned and be honest
  • Allow time to prepare before meeting a patient. Read their notes so that you are familiar with them.  
  • If you don’t understand something the patient says, don’t be afraid to ask them to clarify what they said. 

Finally, Abi has shared some stories with us about her personal experiences of dealing with anorexia.  If you want to read more from Abi, please click this link.

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