Communication Skills

Patients, families and MDT

Effective communication is fundamental to therapeutic relationships, patient safety, and MDT collaboration in mental health nursing.

Active Listening

With Patients

Active listening involves giving full attention to the patient, reflecting back what you hear, and demonstrating understanding through verbal and non-verbal cues. It is the foundation of the therapeutic relationship.

Techniques

*Maintain appropriate eye contact
*Use open body language
*Reflect and paraphrase
*Avoid interrupting
*Tolerate silence
*Summarise key points

Examples

"So it sounds like you have been feeling very overwhelmed since last week — is that right?"

"I can hear that this has been really difficult for you."

Therapeutic Use of Self

With Patients

The deliberate and conscious use of one's personality, insights, perceptions, and judgements as part of the therapeutic process. Central to mental health nursing practice.

Techniques

*Self-awareness and reflection
*Empathy and compassion
*Maintaining professional boundaries
*Congruence and authenticity
*Unconditional positive regard

Examples

"I want you to know I'm here and I'm listening."

"That must have taken a lot of courage to share."

SBAR Communication

Within MDT

Situation-Background-Assessment-Recommendation (SBAR) is a structured communication tool used for handovers, referrals, and escalation. Recommended by NHS England and NICE.

Techniques

*S: State the current situation clearly
*B: Provide relevant background information
*A: Give your clinical assessment
*R: State your recommendation or request

Examples

"Situation: Mr Jones on Ward 4 is becoming increasingly agitated. Background: He was admitted 3 days ago with acute psychosis. Assessment: His mental state has deteriorated. Recommendation: I would like you to review him urgently."

Breaking Difficult News

With Families

Delivering difficult news requires preparation, privacy, honesty, and compassion. The SPIKES protocol provides a structured approach.

Techniques

*S: Setting — ensure privacy and appropriate support
*P: Perception — assess what they already know
*I: Invitation — ask how much they want to know
*K: Knowledge — share information clearly and honestly
*E: Emotions — respond to emotional reactions
*S: Strategy — agree on next steps

Examples

"I have some difficult news to share with you. Would you like someone with you?"

"I want to be honest with you about what we are seeing."

De-escalation Communication

With Patients

Verbal de-escalation is the first-line response to agitation or distress. It aims to reduce arousal and restore calm through communication.

Techniques

*Calm, low tone of voice
*Non-threatening body language
*Validate feelings without agreeing with behaviour
*Offer choices to restore sense of control
*Avoid confrontation or power struggles
*Use the person's name

Examples

"I can see you are really upset right now. Let us find somewhere quiet to talk."

"You have every right to feel angry. Can you tell me what has happened?"

Motivational Interviewing

With Patients

A collaborative, goal-oriented style of communication designed to strengthen personal motivation and commitment to change. Evidence-based approach for medication adherence, substance use, and lifestyle change.

Techniques

*Open-ended questions
*Affirmations
*Reflective listening
*Summaries
*Eliciting change talk
*Rolling with resistance

Examples

"What would need to be different for you to feel ready to try this?"

"It sounds like part of you wants things to change."

Family and Carer Communication

With Families

Families and carers are key partners in mental health care. Communication must be respectful, informative, and mindful of confidentiality boundaries.

Techniques

*Obtain consent before sharing information
*Use the Triangle of Care framework
*Provide carer assessments
*Signpost to carer support services
*Involve carers in care planning where appropriate
*Be honest about limitations

Examples

"We really value your involvement in John's care. With his consent, I would like to share some information with you."

"I can hear how worried you are. Let me explain what we are doing to help."

Handover Communication

Within MDT

Safe handover is a patient safety imperative. Structured handover reduces errors, ensures continuity of care, and supports clinical decision-making.

Techniques

*Use SBAR or ISOBAR structure
*Highlight deteriorating patients first
*Include outstanding tasks and risks
*Confirm receipt of key information
*Document handover in notes
*Use read-back for critical information

Examples

"Before I hand over, I want to flag that the patient in Room 3 has been expressing suicidal ideation — I have documented this and informed the on-call doctor."