Research and Study Skills: Interpersonal Skills to build a therapeutic relationship in mental health nursing

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        Research Methods and Study Skills        

SID: 1113769



In mental health nursing, effective communication and excellent interpersonal skills is the backbone of all aspects of patient care (Bach and Grant, 2010, p9; Dougherty and Lister, 2008, p54). The National Institute of Clinical Excellence (NICE, 2011, p2-4) recognise that communication is a part of clinical excellence, stating that interpersonal skills, the way professions practice and interact with service users about their treatment and care, is essential in shared decision-making and promoting independence. The Department of Health (DoH, 2010, p13) and the Royal College of Nursing (RCN, 2012) agree, stating that shared decision making should be the norm in clinical practice and nurses should put people at the centre of their own care, supporting them to make informed decisions. This idea is also emphasised in the Nursing and Midwifery Council Code (NMC, 2008); that a healthcare professional should acknowledge and respect that people can and will contribute to their own care and wellbeing, with the right support. The NMC (2008, p3) also states that professionals should listen to service users and respond to their concerns and preferences. This implies that communication is a reciprocal process that involves the interchange of both verbal and non-verbal messages to express feelings, information, ideas and knowledge (Dougherty and Lister, 2008, p54).

The purpose of this essay is to review and critically analyse the literature and research in regards to my topic. This process has made me think of encounters in practice. In my previous clinical placement I went to an acute admission ward (NMC, 2008, p3).Simpson (2009, p404)   identifies the development of a supportive nurse-patient relationship with people in acute distress is an important goal for nurses working in acute care.  This process, along with my clinical placement experience, highlighted how challenging it can be to form therapeutic relationships with people suffering multiple and often complex presentations of distress (Simpson, 2009, p404). This made me consider how interpersonal skills and communication skills interact within this context. This experience has led me to investigate the evidence base behind the use of interpersonal skills to help build a therapeutic relationship with clients suffering with mental health problems.

Literature Searching

Good literature searching skills are important for healthcare professionals so they can find and critically evaluate relevant pieces of research. Using this they can compile the best available evidence to care for service users (Fulton and Krainovich-Miller, 2010, p61; NMC, 2008, p6). This is fundamental for registered practitioners because they are accountable for their actions and omissions (RCN 2012; Aveyard and Sharp, 2009, p10; NMC, 2008, p1).  

To assist in articulating my clinical question, I used the Patient, Intervention, Compare and Outcome (PICO) model by Richardson at al. (1995) (Lewis et al. 2011;Fulton and Krainovich-Miller, 2010, p62; Godshall, 2009, pp 197-199). Huang, Lin and Fushman (2006) state that it is essential for a clinical question to have well-articulated PICO elements. This helps the researcher to make evidence-based decisions and find high-quality evidence. It also allows healthcare professionals to structure clinical questions and find patient-specific information (Huang, Lin and Fushman, 2006). Furthermore, the PICO model supports concepts such as patient-centred care (RCN, 2012; DoH, 2011, p16) and treating patients as individuals (NMC, 2008, p3).

I used a key word search in ‘Google’, searching ‘Communication’ and it brought up 204,000,000 results. This highlighted the breath and ambiguities in the subject topic. O’ Dochartaigh (2007, p1) states that students’ heavy reliance on online sources means that they miss high quality academic sources elsewhere.

Using the databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medical Literature Analysis and Retrieval System Online (MEDLINE), I utilised the use of CINAHL Headings and Medical Subject Headings (MeSH) to search different components of my clinical question. I used these databases because they consisted of more than 750 nursing and allied health journals and more than 600,000 full text articles, making them a key resource (Anglia Ruskin University, 2011a).

During my literature search to find quantitative studies relevant to the subject was problematic. Papastarrou, Efstathiou and Charalambous (2010) agree, stating that there is an abundance of studies using a qualitative approach with the aim of gaining subjective insight into therapeutic relationships. Furthermore, this helps explains why systematic reviews of literature and random controlled trials are considered to the source of the best quality, scientific evidence (Godshall, 2009, p16-17). Looking at quantitative studies made me consider the topic and the usefulness of having loads of statistical data. This consideration and the literature searching process informed my decision, to include a lot more qualitative pieces of research  in my literature review.

 To find contemporary literature discussing interpersonal skills explicitly was challenging. Considering the fact that pre-registration nursing students are assessed using the interpersonal skills profile (Anglia Ruskin University, 2011b, see Appendix A) and NMC Cluster skills, which includes ‘Care, Communication and Compassion’ (2010 p80; Bach and Grant, 2010, p10), it was problematic to find text books published within the last 10 years discussing the subject in detail.

Whilst it is important for healthcare professionals to keep their skills and knowledge up-to-date to ensure safe practice (Anglia Ruskin University, 2011b, see Appendix A section 2; NMC, 2008, p6), this implies that literature should be contemporary. I initially started my literature search only looking at evidence published within the last ten years and although I have used these in the literature review, it requires interpretation to apply it to interpersonal skills. Several pieces of key evidence, looking the topic in detail were published in the 1990s and it was these documents that informed the decision to extend the date restriction to cover literature published within the last twenty years and include the best available evidence. In my opinion this highlights a gap in the current evidence base because changes in society and technology could have had an impact on the interpersonal processes and how professionals form therapeutic relationships. This is not discussed explicitly in reference to interpersonal skills in much of the literature published within the last 10 years.

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What are Interpersonal Skills and how to they relate with Communication Skills?

The literature is unclear and ambiguous about how communication and interpersonal skills overlap with each other. Upon interpretation, the two skills are linked very closely: Whilst communication skills are the portrayal of a message verbal and/or non-verbally, interpersonal skills are the techniques used by a healthcare professional to develop a therapeutic relationship (Oxford Dictionary, 2007, p547; Dougherty and Lister, 2008, p54). An interpersonally skilled professional is having the knowledge and experience to help relieve a distress, by looking at client’s personal attributes and circumstances to know what communication technique ...

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