Novice Psychiatric Nurses’ Communication Strategies

Abstract

  • Purpose: The purpose of this paper is to explore communication strategies that can enhance novice nurses’ capacity to work in acute care psychiatric settings.
  • Methods: An integrative literature review was conducted to analyze selected research articles that studied the barriers to effective communication that novice nurses encounter.
  • Findings: Nurses encounter several challenges while working in acute care psychiatric settings, which results in their diminished capacity to establish effective communication with?. The primary factors that may cause difficulties are the lack of preliminary training, poor social and psychological awareness of own and patients’ emotions and needs, and high levels of stress. Novice nurses may not be aware of the risks and challenges associated with psychiatric nurses and find it difficult to interact with psychiatric patients, which results in poor patient outcomes, increased depressive symptoms in nurses and patients, and the lack of effective communication.
  • Research limitations/implications: Some of the existing studies on communication skills for nurses do not consider the experiences of novice nurses specifically. Recommendations for practice, education, and future research have been suggested to enhance the knowledge about novice nurses’ experiences in psychiatric wards and the barriers to communication they encounter.

Introduction

Providing care in psychiatric units in acute care hospitals may be challenging for all medical professionals, especially for novice nurses. Hagen, Knizek, and Hjelmeland (2017) note that staff members lacking competence, including those with less than one year of experience, may be unable to understand the signs of exacerbation in the mental state of patients they frequently encounter on acute care units. Moreover, it may be hard for novice nurses to develop a collaborative approach to care and utilize the forms of communication that can be understood by a patient (Tofthagen, Talseth, & Fagerström, 2014).

Unfortunately, the majority of educational institutions in nursing do not offer in-depth training in communication for psychiatric care. This means that, although novice nurses may have good clinical skills, their ability to perform high-quality care might be limited without obtaining proper communication competencies that strengthen their capacity to interact with psychiatric clients experiencing acute states of psychosis or agitated behavior.

The study by Hezaveh, Rafii, and Seyedfatemi (2014) addresses this issue as well, underlining that inexperienced nurses may encounter difficulties in building connections with patients and their families, especially individuals of the opposite sex. It means that the unpreparedness of newly graduated nurses to work in psychiatric units is a serious problem that should be addressed and discussed.

Although this problem has been reported in several studies, it has not yet been resolved. It has been observed that the lack of competencies and inflated expectations can contribute to the possibility of depression and burnout in novice nurses (Hezaveh et al., 2014). Often, partly because of staff shortages, nurses do not need to have specialized training when appointed to work in mental health care units.

It means that many of them may be unaware of the complex communication issues associated with psychiatric care (Hezaveh et al., 2014). It is necessary to point out that interaction with patients may be the primary source of stress due to the nurses’ lack of preparedness to it. Moreover, as many nurses may experience patient violence in mental health units, communication competencies can have a crucial role in their safety (Kourkouta & Papathanasiou, 2014).

The goal of this SPAR project is to explore the challenges novice nurses may encounter in psychiatric care concerning communication, using an integrated literature review. The project is designed to recommend ways that might enhance the personal and professional growth for new nurses in psychiatric care.

In this SPAR project, I analyzed the available current studies to suggest strategies for the improvement of new nurses’ capacities to work with patients that have mental health issues. This analysis aims to explain the difficulties novice nurses may encounter while working in psychiatric units and, on that basis, to develop a set of recommendations for communication techniques that may improve new nurses’ performance.

Significance

It is necessary to address and discuss the communication challenges new nurses in psychiatric care may experience in addressing patient needs for several reasons. First, working with individuals experiencing complex behaviors, such as being in a psychotic state, requires being capable of ensuring a safe hospital environment, protecting patients from harmful activities, and ensuring that their needs are met, which underlines the importance of the nurse’s role in treatment.

Nursing practice, especially in psychiatric units in acute care hospitals, involves discussing individuals’ concerns and feelings, which is aimed to stop negative behavioral patterns from occurring and ensure inpatients’ fast recovery. However, new nurses may lack professional communication competencies in dealing with these demands (Hezaveh et al., 2014). Second, the issue of lacking communication competencies may contribute to the possibility of burnout, depression, and other negative issues in novice nurses. Unpreparedness to work in acute care hospitals may result in low job satisfaction and a lack of dedication.

The mental health of nurses experiencing these issues may decrease, manifesting in negative emotions such as anxiety, fear, anger, blame, and lack of motivation (Ramezani, Gholamzadeh, Torabizadeh, Sharif, & Ahmadzadeh, 2017). Moreover, they may encounter patient violence, which can also contribute to the problem of lacking adequate communication competencies (Kourkouta & Papathanasiou, 2014). Finally, it is necessary to discuss the impact of poor communication on patients. It is evident that individuals in an altered mental state may have an inadequate perception of care and hence may experience negative feelings about it that should be carefully addressed.

Sebergsen, Norberg, and Talseth (2016) point out that being in a dialogue with nurses and being understood by them and involved in planning their treatment are the crucial factors that can significantly improve individuals’ satisfaction with and response to care. The environment in psychiatric units in acute care hospitals may cause additional stress for individuals as well. Thus, nurses need to develop communication strategies to manage patients’ negative emotions by discussing their concerns and providing adequate support.

Nurses’ Communication Competencies – Conceptual Framework

The domains that are used to describe novice nurses’ competencies were used as a conceptual framework for this integrative literature review. The Canadian Association of Schools of Nursing (2015) notes that novice nurses should provide care according to professional standards, work in collaboration with patients and their families, and utilize a person-centered approach. It is impossible to implement these domains without certain communication skills, as they are vital for therapy, treatment, and rehabilitation of the individuals (Kourkouta & Papathanasiou, 2014). To explain the significance of proper interaction with patients, this study will address the outcomes of poor communication and its effect on both patients and novice nurses.

This investigation will fill a need that has been articulated by theorists who have been writing in this field. For example, the study by Amoah, Anokye, Boakye, and Gyamfi (2018) shows that the barriers to effective therapeutic communication include the lack of nurses’ competencies in communication with their patients. Varcarolis (2016) provides extensive research on the role of nurses’ interaction with individuals and presents the results of poor communication.

This study, therefore, corresponds with the ideas that have been suggested by prior scholars and are outlined in the competency framework for nursing education (Canadian Association of Schools of Nursing, 2015); its intellectual goal is to define the challenges and possible outcomes of communication and suggest the strategies for its improvement.

Purpose and Research Question

Providing care in psychiatric units in acute care hospitals may be challenging for all medical professionals, especially for novice nurses. Hagen, et al. (2017) note that staff members lacking competence, including those with less than one year of experience, may be unable to understand the signs of exacerbation in the mental state of patients they frequently encounter on acute care units. Moreover, it may be hard for novice nurses to develop a collaborative approach to care and utilize the forms of communication that can be understood by a patient (Tofthagen et al., 2014).

Unfortunately, the majority of educational institutions in nursing do not offer in-depth training in communication for psychiatric care. This means that, although novice nurses may have good clinical skills, their ability to perform high-quality care might be limited without obtaining proper communication competencies that strengthen their capacity to interact with psychiatric clients experiencing acute states of psychosis or agitated behavior.

The study by Hezaveh et al. (2014) addresses this issue as well, underlining that inexperienced nurses may encounter difficulties in building connections with patients and their families, especially individuals of the opposite sex. It means that the unpreparedness of newly graduated nurses to work in psychiatric units is a serious problem that should be discussed and addressed.

Although this problem has been reported in several studies, it has not yet been resolved. It has been observed that the lack of competencies and inflated expectations can contribute to the possibility of depression and burnout in novice nurses (Hezaveh et al., 2014). Often, partly because of staff shortages, nurses do not need to have specialized training when appointed to work in mental health care units. It means that many of them may be unaware of the complex communication issues associated with psychiatric care (Hezaveh et al., 2014).

It is necessary to point out that interaction with patients may be the primary source of stress due to the lack of nurses’ preparedness to it. Moreover, as many nurses may experience patient violence in mental health units, communication competencies can have a crucial role in their safety (Kourkouta & Papathanasiou, 2014). These factors define the area of improvement, which forms the focus of this SPAR project. The project is designed to recommend ways that might enhance the personal and professional growth for new nurses.

This integrative literature review analyzes selected studies that examine ways to enhance the communication competencies of new nurses in psychiatric care to provide high-quality care while working in psychiatric units in acute care hospitals. For the project, nurses will be considered novice if they have less than one year of experience.

The focus of the integrative literature review will be on recommended communication strategies nurses may use during their practice and the factors associated with them that may enhance nurses’ capacity to work with patients having mental illnesses and who are hospitalized on acute psychiatric units. Therefore, the research question will be: What communication strategies can enhance new nurses’ (having less than one year of experience) capacity to work with patients having mental illnesses who have been hospitalized in acute care psychiatric settings?

Methodology

The integrative literature review was used to investigate the topic and examine the research question. This method is appropriate as the issue has already been discussed in the literature. The integrative literature review allowed for providing insights into the communicative competencies novice nurses may need to acquire by analyzing past evidence-based and theoretical works (Torraco, 2005). The study was performed according to the methodology proposed by Whittemore and Knafl (2005).

Based on the methodology proposed by Whittemore and Knafl (2005), the steps that were utilized for the integrative literature review include an adequate literature search, and data evaluation and analysis. During these stages, the search focused on the integration of ideas, and the methodological and theoretical value, as well as the relevance of the various study findings, were considered according to conceptual reasoning. Based on the analysis uninformative literature was excluded.

The integrative literature review provided a systematic approach for the study and generated a reliable and credible basis for the knowledge generated within this SPAR project. The literature review was utilized to collect and review available reports on the topic to determine the current findings on the issue. The review was guided by the theoretical framework of nursing competencies. In the remainder of the chapter, I present the search and selection strategies I have used and I conclude the chapter with an overview of the selected studies that were retained for analysis. A discussion of the approaches and findings from these selected studies will be presented in chapter 2.

Search Strategy

An initial literature search was conducted to identify articles that were relevant to the topic. The keywords used for the search were novice nurse, nurse-patient communication, socialization, empathy, psychiatric patient, mental health nursing, feedback, professional competence, and therapeutic communication. The articles that discussed the related topics, such as the risks for nurses working in psychiatric units in acute care hospitals were also considered.

The databases used for the research were Medline, SAGE, PsycINFO, and CINAHL. Medline is the largest bibliography of peer-reviewed scholarly works including those on nursing, which offers a wide selection of relevant data and allowed a comprehensive approach to investigation. SAGE database was selected as there is a vast variety of works on nursing, health, and medicine available. PsycINFO incorporates the works in the field of psychiatry, which is directly related to the topic.

The CINAHL bibliography concentrates on the articles for nurses and nurse educators specifically, which could help to identify possible inconsistencies in current studies on communication competencies in psychiatric care. The literature search was not limited to the presented databases as it also utilized textbooks on inpatient psychiatric nursing and foundations of mental health nursing. The included articles were mostly those published within the past five years. The study included the classic works on the topic as well to examine the problem from both contemporary and older perspectives. The geography of the study was not limited to allow for a broader view of the topic.

Search terms were used both alone and in combination with one another. After the first stage of the review, the results included 41 articles from four databases. The sources were later investigated to identify their relevance to the topic and exclude uninformative literature; the findings were reduced to sixteen articles. After further investigation, more articles were excluded as they considered topics generally relevant to issues of communication but not related to psychiatry specifically or they focused on psychiatry but not specifically on issues of communication and therefore did not address the research question for this SPAR fully. As a result, eight articles were retained out of these sixteen articles. These eight selected articles will be described and examined in more detail in chapter 2.

In summary, the studies included in the integrative literature review are those by:

  • Bowers (2014),
  • Bowers et al. (2015),
  • Aust and Bradshaw (2017),
  • Mani and Abutaleb (2017),
  • Amoah et al. (2018),
  • Martin and Chanda (2016),
  • Hagen et al. (2017),
  • Ramezani et al. (2017).

Bowers and his colleagues (2014, 2015) address the Safewards Model used for reducing conflict and ensuring containment rates in acute psychiatric units. Aust and Bradshaw (2017) discuss the role of mindfulness interventions for psychosis. In the article by Mani and Abutaleb (2017), the role of nurses’ communication skills is addressed. Amoah et al. (2018) address the obstacles to effective therapeutic communication between nurses and patients.

Hagen et al. (2017) stress the significance of support for nurses working in psychiatric units. Ramezani et al. (2017) focus on patients’ aggression and suggest that medical institutions should support learning and conducting effective communication. Finally, Martin and Chanda (2016) discuss the effectiveness of therapeutic communication stimulations in working with mentally ill patients. This set of studies was selected as they address the topic from different perspectives while suggesting standard and alternative approaches to care and communication. My initial review of the articles within this chosen body of literature suggested that they contained timely and relevant findings.

The integrative literature review provides a systematic approach for the study and creates a credible basis for the project. The reporting approach was based on the tendencies observed in the obtained findings and guided by the theoretical framework of nursing competencies and communication skills. A detailed discussion of each of these studies (Table 1) will be provided in chapter 2.

Table 1: Overview of the studies included in the literature review.

Study Title Author(s) Year Study Design Common Themes
1) Safewards: A new model of conflict and containment on psychiatric wards Bowers, L. 2014 Theoretical model Acute care
Aggression
Inpatient issues
Patient violence
2) Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomized controlled trial Bowers, L., James, K., Quirk, A., Simpson, A., Stewart, D., Hodsoll, J. 2015 Randomized controlled trial Mindfulness
Severe mental illnesses
Therapy
Psychosis
3) Mindfulness interventions for psychosis: A systematic review of the literature Aust, J., Bradshaw, T. 2017 Systematic review Mindfulness
Psychosis
4) Communication skills of novice nurses at a psychiatric hospital in Saudi Arabia Mani, Z. A., Abutaleb, M. 2017 Quantitative
Survey
55 participants
Communication skills
Aggressive behavior
Mental illnesses
Nurse-patient interaction
Psychiatric nursing
5) Perceived barriers to effective therapeutic communication among nurses and patients at Kumasi South Hospital Amoah, V. M. K.,
Anokye, R., Boakye, D. S., Gyamfi, N.
2018 Quantitative
Survey design
112 participants
Nursing
Therapeutic communication
6) Mental health nurses’ experiences of caring for suicidal patients in psychiatric wards: An emotional endeavor Hagen, J., Knizek, B. L., Hjelmeland, H 2017 Qualitative
8 participants
Mental health nurses
Psychiatric nursing
7) Mental health clinical simulation: Therapeutic communication. Martin, C. T., Chanda, N. 2016 Quantitative:
Quasi-experimental
28 participants
Mental health nursing
Therapeutic communication
8) Challenges of nurses’ empowerment in the management of patient aggression: A qualitative study Ramezani, T., Gholamzadeh, S., Torabizadeh, C., Sharif, F., Ahmadzadeh, L. 2017 Qualitative
20 participants
Psychiatric nursing
Aggression

Findings From the Literature Review

The focus of Chapter 2 will be on the findings from reviewing eight articles included in the integrative literature review. In this chapter, I will describe each of the selected studies, using a systematic and planned approach to summarize for each selected article1) the main objectives, research question, and ideas, 2) the main findings and recommendations, and 3) a brief discussion of the strengths and weaknesses of the approaches.

As mentioned in Chapter 1, the selected articles are those by Amoah et al. (2018), Aust and Bradshaw (2017), Bowers et al. (2014, 2015), Hagen et al. (2017), Mani and Abutaleb (2017), Martin and Chanda (2016), and Ramezani et al. (2017). The selected articles will be discussed in alphabetical order. First, I will analyze each of the sources based on their main ideas and approaches. Then, I will present the findings of the studies and the recommendations suggested by the authors. Finally, I will analyze the strength and weaknesses of the articles and the approaches their authors utilized.

Barriers to Effective Therapeutic Communication among Nurses and Patients

Amoah, V. M. K., Anokye, R., Boakye, D. S., Gyamfi, N. (2018) Perceived barriers to effective therapeutic communication among nurses and patients at Kumasi South Hospital. Cogent Medicine, 5.

The study aims to examine the barriers to effective communication among nurses and patients. The main idea of the authors is that ineffective therapeutic communication can result in not only misunderstanding, dissatisfaction with the care, and frustration of both parties, but also in misdiagnosis, which can lead to severe health complications. The main goal of the article is to identify the obstacles that may lead to nurses’ inability to interact with patients and vice versa. The approach utilized in the study is quantitative; the design is descriptive. The authors used questionnaires with closed-ended questions to identify perceived barriers to communication among nurses. The study involved 72 registered nurses and 40 patients.

The findings of the study were divided into three categories. The first one, nurse-related categories, presents various barriers to communication, including being overworked, shortages, patients’ negative attitudes, and noncompliance to treatment as the most significant ones. Notably, some of the least reported challenges were the lack of communication skills and age differences. The second group, obstacles related to the health system, includes workload as the primary barrier to effective communication.

Notably, both nurses and patients considered this factor the most significant. Finally, the barriers to communication reported by patients include such aspects as individuals’ anxiety, physical discomfort, and pain, which were perceived as the most significant ones. Age and gender difference was stated as the least significant obstacle to successful interaction among nurses and inpatients.

To eliminate the negative effect of the identified barriers, the authors suggest the measures hospital authorities should take. First, it is crucial to ensure that the workload for nurses is reduced and a safe and comfortable environment for both nurses and patients is provided. Second, it is necessary to employ more nurses to ensure a patient-centered approach and the high quality of care for each individual. Moreover, hospitals should collect feedback from patients to identify their perceptions as to the flaws of the existing care systems. Lastly, hospitals’ authorities should encourage their personnel to improve the quality of their interaction with patients and provide training on effective communication strategies.

The primary strength of the article is that it presents the issue both from nurses’ and patients’ perspectives. It also suggests that it is possible to eliminate or at least begin to resolve the problem by the implementation of suggested changes to the existing policies in hospitals. The weakness of the article is the convenience sampling technique was used in the study, which limited the number of participants. This factor could have affected the responses provided by nurses and patients.

Mindfulness Interventions for Psychosis

Aust, J., & Bradshaw, T. (2017). Mindfulness interventions for psychosis: A systematic review of the literature. Journal of Psychiatric and Mental Health Nursing, 24(1), 69-83.

The main goal of the study is to prove that mindfulness interventions for the treatment of psychosis can result in improvement of the quality of care and, in some cases, enhance the impact of other psychological interventions. These interventions may include mindfulness-based stress reduction (MBSR) techniques, acceptance, and commitment therapy (ACT), mindfulness-based cognitive therapy (MBCT), acceptance-based cognitive-behavioral therapy (ABCBT), and compassion-focused therapy (CFT). To analyze the effectiveness of these practices, the authors performed a systematic review of the existing literature on the topic.

The findings of the article suggest that mindfulness interventions may have a positive impact on hospitalized patients’ quality of life. For example, the implementation of the ACT may prevent hospital readmissions, improve patients’ symptoms, and reduce the distress associated with them. The utilization of the ABCBT is also reported to be beneficial for individuals’ mental state compared to traditional methods of care.

The authors also note that mindfulness therapy may reduce depressive symptoms and the ones caused by the obsessive-compulsive disorder in individuals with psychosis. The CFT may reduce depression in patients whose conditions are within the schizophrenia spectrum.

The main advantage of the study is that it includes randomized controlled trials and provides vital information about mindfulness interventions that nurses can use in their practice. The study suggests that nurses should combine and implement several interventions, for example, mindfulness group therapy and integrated rehabilitation treatment, to improve patient outcomes. Consequently, it will enhance their relationships with patients and ensure effective communication and interaction. These methods can contribute to individuals’ health as well. The possible disadvantage of the study is that the systematic review was primarily conducted by a single researcher, which is associated with a high risk of bias.

The Safewards Model

Bowers, L. (2014). Safewards: A new model of conflict and containment on psychiatric wards. Journal of Psychiatric and Mental Health Nursing, 21(6), 499-508.

The author suggests the Safewards Model, a comprehensive tool that is aimed to propose methods that can reduce the risk of harm for personnel working in psychiatric units. The main goal of the study is to show how the model can be implemented into practice to improve patients’ and staff’s safety. The purpose of the utilization of the model is to reduce aggression, medication refusal, self-harm, and suicide attempts, which are significant phenomena nurses have to deal with in psychiatric nursing practice. The Safewards model indicates the factors that trigger conflict and suggests the methods of their elimination. The factors are divided into several groups and include those related to the patient community and those that are present outside the hospital, as well as those related to the individuals’ physical environment, staff team, patient characteristics, and regulatory framework.

The author suggests several recommendations within the framework of the Safewards Model. They include education, training, and clinical supervision of nurses, the improvement of the hospitals’ physical environment, increased checking routines and intermittent observations, nurses’ involvement in patients’ lives, the management of patient-patient interactions, and targeted therapeutic interventions. The study concludes that nurses should be able to recognize psychotic symptoms and have expert knowledge about them.

The primary strength of the research is that it proposes a model that aims to explain conflicts and containment methods for nurses, which seems more comprehensive than models that analyze the challenges of psychiatric nursing separately. It also shows that some aspects of practice may be changed when the model is implemented to achieve better communicative and health outcomes of patients; they include increased monitoring of patients and engagement in care, as well as attention to their personality traits. Its weakness is that the study does not provide information on the effectiveness of the model.

The Safewards Cluster Randomized Controlled Trial

Bowers, L., James, K., Quirk, A., Simpson, A., Stewart, D., & Hodsoll, J. (2015). Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial. International Journal of Nursing Studies, 52(9), 1412-1422.

The objective of this study is to evaluate the efficacy of the interventions suggested by the Safewards Model, discussed in the previous article, that are aimed to eliminate conflicts in acute care psychiatric units. The main idea of the article is that patients admitted to psychiatric hospitals may show risky and challenging behaviors, including self-harm, aggression, and refusal to eat or drink. Most current methods used to create a safe environment in psychiatric units only address conflicts or containment but are not consider these factors together.

Therefore, the authors note that Safewards interventions should be implemented in practice as they can reduce negative outcomes of nurse-patient interactions and the challenges associated with individuals’ health conditions. To conduct the study, Safewards interventions were implemented in nursing practice. The nurses mutually agreed upon behavioral standards for patients and personnel, the use of a de-escalation model, scanning of bad news individuals may receive, sharing of personal information between patients and staff, and regular meetings among individuals and personnel.

The findings of the study show that Safewards interventions reduced the conflict rate by 15%; the containment rate was reduced by more than 25%. It is necessary to mention, however, that less than 50% of the checklist forms used during the study were returned. Nevertheless, the results suggest that Safewards interventions may decrease conflict and containment rates and prevent patients’ injuries and violence, as well as increase individuals’ satisfaction with care.

The strengths of the study are that it used a generalizable sample size, active control for expectancy, independent statistical analysis, and the visible effect on conflict and containment rates. The primary weakness of the study is the large quantity of missing data, which was more than 35%. Moreover, it was impossible to implement all of the proposed interventions within a short period of research.

Nurses’ Experiences of Caring for Suicidal Patients

Hagen, J., Knizek, B. L., & Hjelmeland, H. (2017). Mental health nurses’ experiences of caring for suicidal patients in psychiatric wards: An emotional endeavor. Archives of Psychiatric Nursing, 31(1), 31-37.

The purpose of this study is to show how psychiatric nurses utilize their skills while recognizing and responding to self-harm and suicidal behaviors of the patients. The main idea of the research is that providing care to suicidal patients can be emotionally demanding and may trigger painful feelings in nurses and other medical professionals. It is a necessary task for nurses to assess individuals’ suicide risk and perform necessary interventions to prevent suicide.

However, many nurses involved in care for suicidal patients try to reduce interactions with them to avoid emotional discomfort. In the research, the authors analyzed how nurses reacted and responded to suicidal behavior and managed the emotional challenges of working in psychiatric units. The approach the authors used to conduct the study was personal interviews with nurses, during which they were asked to describe their experience involving suicidal patients and their behavior.

The study presented several findings regarding nurses’ experiences in working with suicidal patients. First, it reported that individuals’ suicidal behavior and acts evoked feelings of sadness, helplessness, anger, anxiety, frustration, and fear. Patients’ suicide attempts were perceived as signs of failure and nurses’ inability to establish effective communication. Notably, some nurses reported that they felt relieved when individuals took their lives, which shows that nurses may experience exhaustion and burnout.

Second, some of the interviewed nurses reported that they were alert and sensitive to patients’ emotional states, which allowed them to prevent individuals’ self-harm. Nurses were able to respond to patients’ non-verbal communication that often allowed them to relieve psychological pain, inspire hope, and save people’s lives. Notably, personnel that lacked competence or clinical experience encountered challenges in understanding suicidal cues.

Moreover, nurses reported that they had to control their emotions to appear confident and calm, which involved suppressing negative feelings. Some of them, however, noted that maintaining such behavior was challenging and sometimes resulted in their inability to conceal emotions in front of their patients. Self-delineation was also perceived as a significant method to balance emotional involvement in care and professional distance. Nurses tried to distinguish between their own and patients’ feelings and discussed their concerns with their colleagues to reduce the negative effects of their practice.

The strong point of the study is that it shows the challenges psychiatric nurses may encounter during their work with complex psychiatric patients, offering a first-hand perspective on it. As the research involved interviews, it allowed nurses to express their concerns and thoughts freely, which may not be possible during surveys. The weak point of the study is that it did not specify what communicative methods nurses used to manage patients’ negative emotions and psychological pain.

Communication Skills of Novice Nurses at Psychiatric Units

Mani, Z. A., & Abutaleb, M. (2017). Communication skills of novice nurses at psychiatric hospitals in Saudi Arabia. Journal of Nursing and Care, 6(4), 2167-1168.

This study is aimed to describe novice nurses’ perceptions of communication skills and nurse-patients relationships. The primary idea of the research is that the lack of communication capacities of new mental health nurses may lead to the inability to provide high-quality care particularly because of the complexity of mental health diseases. The authors note that working in psychiatric units may involve individuals’ violence and unpredictable aggressive reactions, which shows that acute care hospitals may present an unsafe environment for both nurses and patients. A survey questionnaire was utilized to research an effective method of self-reported data collection.

The findings of the study show that nurses who worked in mental health units for more than one year felt confident to interact with psychiatric patients. On the contrary, establishing communication was challenging for novice nurses. They reported feeling uncomfortable during emotionally charged situations and being hesitant to approach patients that showed aggressive behavior. Notably, nurses also stated that nursing college programs did not provide the necessary knowledge of psychiatric nurses and claimed that more training and education were needed. Moreover, they reported that it was crucial to interact with patients in a kind manner and avoid leaving them alone.

The strengths of the study include its detailed description of nurses’ experiences in psychiatric units from their perspectives and the consideration of nurses’ additional comments on their practice. Moreover, the results were presented in tables that can be used to compare the experience of novice nurses to those of experienced ones. The weaknesses of the research are that it was conducted in only one hospital and the sample size was small, which does not allow for the generalization of the study.

Mental Health Clinical Simulation

Martin, C. T., & Chanda, N. (2016). Mental health clinical simulation: Therapeutic communication. Clinical Simulation in Nursing, 12(6), 209-214.

The main idea of this study is that therapeutic communication ensures the establishment of healthy, trust-based, and stress-reducing relationships between nurses and patients. Ideally, individuals should share their concerns, experiences, thoughts, and necessary health-related information with nurses, who can then respond to their needs. The authors suggest that therapeutic communication is a significant part of psychiatric nursing.

They propose the use of mental health simulation to enhance nurses’ confidence and communicative capacities, decrease patients’ anxiety, and increase their self-reflection in the future. The study used a quasi-experimental design and was performed before and after nursing students’ mental health clinical orientation to evaluate the significance of a simulation.

The results of the research show that students felt more confident while interacting with individuals after mental health simulation; their scores on therapeutic communication test increased after orientation. Moreover, they became less anxious about interacting with real patients in the future. Notably, before simulation, students had reported feeling helpless, terrified, and unprepared to help patients. The interaction with real patients allowed them to learn how to ask relevant questions, see the symptoms of mental illnesses, and develop communicative strategies.

The recommendations of the study for the implementation of the simulations include providing students with reading assignments and lectures to prepare them for hospital experience, recording the simulation to allow them to review their actions, making standardized patients unknown to the students, and utilizing individualized debriefings. Moreover, it is necessary to develop a simulation schedule to ensure that nursing students’ actions are coordinated.

The primary strength of the article is that the authors conducted two evaluations, which allowed for the comparison of the results and the estimation of the students’ experiences before and after simulation. Moreover, the participants’ recommendations and commentary were considered to suggest the methods of improvement for future practice. The weakness of the study is that students were only allowed to interact with one standardized patient; the rest of them were actors. Besides, participants from only one nursing program were chosen, which might distort the results of the study.

Challenges of Nurses’ Empowerment in the Management of Patient Aggression

Ramezani, T., Gholamzadeh, S., Torabizadeh, C., Sharif, F., & Ahmadzadeh, L. (2017). Challenges of nurses’ empowerment in the management of patient aggression: A qualitative study. Iranian Journal of Nursing and Midwifery Research, 22(6), 442-448.

The main idea of the article is that organizations should pay attention to nurses’ empowerment in the management of patients’ aggression. The lack of medical institutions’ support may lead to nurses’ inability to control challenging situations and patients’ aggression, as well as implement appropriate methods of care. The identification of the challenges of empowerment may increase organizations’ awareness of their potential failures and ensure efficacy in the delivery of optimal and safe care. The study utilized semi-structured interviews with nurses to analyze the perceived challenges of their empowerment.

The findings of the research were divided into several categories. The first one, inefficient organizational policies, included limited human resources, mandatory shifts, and the lack of protective equipment. The insufficient number of staff reduced nurses’ authorities in the management of patients’ aggression, ignorance about individuals’ needs, and fatigue. Mandatory shifts contributed to personnel’s exhaustion, and the shortage of warning bells led to the decreased level of safety of nurses and patients.

Another group of reported challenges presented the lack of psychological and financial motivation. Inadequate job growth was also listed as a perceived difficulty; it included the organization’s inability to implement training programs and the lack of clinical guidelines for nurses. The final category of challenges, deficiencies in the organizational culture, included inadequate autonomy and authority of nurses, the lack of the culture of primary prevention, and the culture of blame and fault after an incident. Nurses noted that due to these aspects, they were unable to manage the episodes of patients’ aggression rapidly, and experienced a decrease in the quality of their work and professional efficiency.

The primary strong point of the study is that the authors consider the issue from nurses’ and organizational perspectives, which means that the findings may be relevant for the nurses working in other medical organizations. The article helps to understand that organizational empowerment may assist nurses in the management of patients’ aggression and learn how to communicate with them. Moreover, the results were divided into several groups, which allows the hospitals to develop strategies for improvement based on each category specifically. The weak points of the study are the small sample size and possible nurses’ inability to reveal the challenges due to their fear, which could potentially influence the directions of the findings.

Summary

The review of the articles shows that there are many challenges associated with working in psychiatric units in acute care hospitals. Some of them include patients’ violence and unpredictable behavior, as well as the lack of nurses’ preparedness to practice and communication skills. The methods of managing such complex patient behaviors can include, among others, the utilization of the Safewards Model, the increase in an organization’s empowerment of nurses, the development of mental health clinical simulations, better training opportunities, and efforts to decrease nursing shortages.

The study by Mani and Abutaleb (2017) concentrated on novice nurses’ experiences specifically; the authors concluded that more experienced nurses perceived their work as less challenging compared to new nurses, which demonstrates the significance of the development of communication strategies for novice nurses. It is evident from the findings of these studies that there are barriers to effective communication between nurses and patients, which include being overworked, patients’ aggression and negative attitudes, shortages, as well as the lack of training, motivation, and confidence.

Discussion of the Findings

This chapter will summarize and discuss the key recommendations on ways to improve or better master communication strategies for novice nurses in psychiatric practice. This chapter is the next step in the integrative literature process, during which the recommendations made in the selected articles will be presented and analyzed.

The discussion will reveal whether the findings of the literature review are supported in other literature and how they can enhance new nurses’ capacity to work with patients having mental illnesses, who have been hospitalized in acute care psychiatric settings. This chapter aims to connect the findings of the literature review with the possible solutions that can be proposed for novice nurses.

Several recommendations may be offered based on the findings of the literature review. In this chapter, four sub-topics will be addressed, that is an improvement of nurses’ psychological and social awareness, strategies for stress reduction, communication strategies, and improvement of training programs for nurse students. In his chapter, both communication strategies for novice nurses and recommendations for educational institutions in nursing and medicine are suggested. The chapter addresses the recommended improvements of the educational programs for nurse students, as they can create a basis for nurses’ knowledge of effective communication skills.

The first significant issue is nurses’ social and psychological awareness of their own and patients’ needs. The strategies of its improvement are suggested as enhancing the capacity of nurses to be socially and psychologically conscious, and such capacity is connected with communication skills. Then, approaches to stress reduction are addressed because it has been found that effective communication is difficult to achieve if nurses experience stress-related health conditions and burnout. Thirdly, the necessary communication competencies and skills for novice nurses are addressed, including those related to verbal and non-verbal means of communication and listening skills.

Improvement of Nurses’ Psychological and Social Awareness

Mani and Abutaleb (2017) suggested that nurses should enhance their psychological and social awareness when approaching patients. This recommendation is supported by Foster, McCloughen, Delgado, Kefalas, and Harkness (2015). The latter authors note that social awareness, as well as self-awareness, an ability to maintain social and professional boundaries and manage emotions, are the standard qualities that are crucial for nurses.

Social awareness may include the understanding of individuals’ needs and empathy for them, the ability to comprehend social situations quickly, to interact with others effectively even during complicated situations. Psychological awareness is related to the willingness to be open to communication and understand the significance of communication and discussion of one’s problems.

Several methods can be used to improve novice nurses’ social awareness (Foster et al., 2015). Some of them are connected to the enhancement of communication strategies. For example, nurses may practice the assessment of individuals’ emotional states. While working in psychiatric units, it is necessary to consider not only patients’ words but also the emotions they show to identify their concerns and their mental state. Moreover, nurses must assess their feelings as well.

To do so, they can reflect on what emotions they experience while interacting with particular patients and the causes of these emotional responses. Social awareness may also help novice nurses to assess how more experienced nurses interact with patients, and what emotional connections they create, in a sense seeing them as role models. Such an approach can allow nurses to learn what communication techniques and approaches are effective and may be implemented to practice and avoid possible communicative failures. It is also necessary to learn to view situations from other people’s perspectives. For example, in psychiatric units, patients often show unpredictable responses to nurses’ actions. Empathy may help nurses to analyze potential reasons for such behavior and reduce possible stress caused by it.

Psychological awareness is related to social awareness and is also a vital capacity that novice nurses should develop. This point of view is supported by the study by Saito, Takeda, Yamagishi, Kubo, and Kitamura (2017). The authors note that psychological awareness or mindedness is “the willingness to understand self and others”, as well as the understanding the necessity of discussing one’s problems and access to their feelings (p. 44).

Novice nurses must improve their psychological awareness to enhance their performance and communicative capacities. Novice nurses should stay conscious of their actions and the possible results of them. For example, when they approach an aggressive patient, they must realize that should remain calm and assess their responses to the individual’s behavior. They may also benefit from opportunities to debrief their experience in planned discussions with a mentor, for example, during their initial months or year of transitioning into practice (Tiew, Koh, Creedy, & Tam, 2017).

Strategies for Stress Reduction

It is necessary to suggest strategies for stress reduction along with those aimed to improve nurses’ communication with patients as these issues are interconnected. For example, Aust and Bradshaw (2017) suggest the use of mindfulness interventions including mindfulness-based stress reduction (MBSR) techniques, acceptance, and commitment therapy (ACT), mindfulness-based cognitive therapy (MBCT), acceptance-based cognitive-behavioral therapy (ABCBT), and compassion-focused therapy (CFT).

These strategies may help both nurses and patients as they are aimed to assist a person in the management of challenging situations and negative emotions. It is also crucial to mention that nurses may undergo cognitive behavioral therapy as well to prevent the interference of their life experiences with their perceptions of patients and their actions.

Several other strategies for stress reduction may be suggested. For example, nurses may consider practicing meditation as such an intervention has proven to have a positive impact on stress reduction. Its primary advantage is that it is possible to practice it at any time and place. Along with breathing exercises, such a technique may reduce stress, improve the quality of sleep, and reduce the symptoms of anxiety and depression (Van der Zwan, de Vente, Huizink, Bögels, & de Bruin, 2015).

Nurses may also consider having short breaks when they feel that it is impossible to remain calm while interacting with a patient; this may be especially necessary for patients whose behaviors tend to provoke violence and other negative reactions in individuals.

It is necessary to point out that nurses should avoid ignoring their feelings and reflect on their responses to each challenging situation, as was also mentioned in the previous section. Stress reduction strategies might facilitate or enhance nurses’ opportunities for reflection. The study by Hagen et al. (2017) proves that an avoidance strategy causes the suppression of negative emotions, which can lead to increased anxiety. Jennings (2017) supports this recommendation as it shows that the deletion of emotions may result in nurses’ inability to establish close relationships with the patient and lead to negative health outcomes.

To avoid such outcomes for novice nurses, Hagen et al. (2017) suggest to implement self-delineation and discuss the challenging situation with colleagues, which seems similar to opportunities to debrief. Such an approach is reasonable as it eliminates nurses’ proneness to ignore their feelings and provides them with an opportunity to share their concerns, receive feedback on their actions from colleagues, and feel relieved.

Another technique for stress reduction is the implementation of exercise, which was not suggested by the initial literature review but is shown to have a positive impact on individuals’ mental state. For example, the study by Van der Zwan et al. (2015)shows that regular physical activity can make the most significant effects compared to other stress reduction techniques. Novice nurses may do simple exercises during breaks, including short walks, as well as implement sports into their weekly routine. Such intervention may not only improve their physical health but also allow them to eliminate their emotional responses to stressful situations.

Communication Strategies

Effective communication strategies are key for successful nurses’ interaction with patients. Novice nurses may not have enough experience and education to develop the necessary communication capacities, which stresses the significance of enhancement of communication strategies in the review of the existing literature on the topic.

The findings of the literature review suggested the following strategies for communication: the use of a de-escalation model, scanning of bad news individuals may receive and eliminating the impact of this information, and sharing of personal thoughts and feelings between patients and staff (Bowers et al., 2015; Martin &Chanda, 2016). Such recommendations seem reasonable as they might imply the elimination or at least reduction of patients’ aggressive behavior and negative responses to triggering situations.

Several additional recommendations may be suggested to enhance communication capacity. First, nurses should consider both verbal and non-verbal means of communication while approaching their patients (O’hagan et al., 2014). They should pay attention to their body language and posture to show that they are open to interaction and are ready to help. While working in psychiatric units, it is necessary to avoid triggering negative feelings or emotions in patients.

To do so, it is crucial not to show the body language that may be perceived as aggressive or threatening, such as frowning, long gazes, and crossed arms (Bry et al., 2016). Novice nurses should actively listen to their patients and utilize their language choices and voice tone to provoke the feeling of familiarity and safety (Doas, 2015). Individuals should not be made to feel inferior to the nurse because of the nurse’s overly formal language as it too may cause aggressive responses and violence. By using verbal language that is understandable to a patient, nurses show their openness to communication and the desire to establish trust-based relationships and help a person to recover (Bry et al., 2016).

As for listening skills, novice nurses must show that patients’ concerns are important to them. By providing individuals with the opportunity to share their thoughts, nurses may learn what aspects of practice may be improved, as well as eliminate the causes of patients’ unpredictable behavior in the future. Active listening should involve asking questions and responding to people’s concerns (Doas, 2015).

For example, if a patient is upset because their family does not visit them in the hospital, a nurse must show the person that such feelings are understandable and that it is natural to be upset in this case. It is necessary to mention that, in the process of establishing therapeutic communication, nurses should allow patients to choose the topics of conversation. Individuals should feel that nurses are always available to them.

As working in acute care units may involve risks such as patient violence, novice nurses must learn how to manage them. For example, they should avoid responding to individuals’ aggressive behavior with a similar level of intensity, as that may provoke violent actions and even result in severe health outcomes (Burshnic, Douglas, & Barker, 2018). Instead, nurses should learn to quickly analyze what situation could trigger such actions and try to discuss it with a patient and eliminate it in the future.

Some of the communication strategies that are less commonly used by many novice nurses have a crucial role in interaction with patients in psychiatric units. For example, nurses need to speak slowly to ensure that individuals understand the information that they want to convey (Toronto, 2016). Moreover, it is vital to speak clearly and calmly, as loud noises may provoke patients’ aggressive behavior or be perceived as threatening. Novice nurses should always remember that mentally ill patients may show unpredictable behavior and respond to situations unexpectedly; thus, it is vital to use all available methods of communication to avoid it.

Improvement of Training Programs for Nurse Students

The findings of the literature review show that the lack of training in communication competencies in the nurses’ basic nursing education may be a significant barrier to effective nurses’ communication with patients (Mani & Abutaleb, 2017). The recommendations on communication strategies for novice nurses cannot be suggested without a consideration of this factor, as the challenges for novice nurses are exacerbated if nursing students have not received enough training and, therefore, are unprepared for working in psychiatric wards.

The significant role of training is evident from the articles by Hezaveh et al. (2014) and Amoah et al. (2018). As a result of the lack of training, nurses may have misguided expectations considering mental health nursing; they may be unable to predict individuals’ behavioral patterns, misunderstand patients’ reactions to nurses’ actions and treatment, and as well may find the identification of triggers of violence challenges. Therefore, educational programs should address the communication issues associated with working in acute psychiatric care settings and teach future nurses to manage and overcome them.

These findings are supported by other research on the topic. For example, Heckemann et al. (2015) note that the implementation of aggression management training may result in the improvement of confidence and attitude. The participants of the mentioned study reported that with the help of training, they were able to identify and predict aggressive behavior in patients, feel safer in their workplace, and improve non-physical intervention skills and coping capacities (Heckemann et al., 2015).

Moreover, the authors suggest that nurse students may lack competencies in management, detection, and coping with aggressive behavior. It means that nurses entering practice may experience the same challenges, which stresses the significance of preliminary training that addresses the issues nurses may encounter in the future and should be able to manage.

To ensure that nurses can use effective communication strategies, it is necessary to provide them with the basic knowledge of the aspects of psychiatric nursing (Canadian Association of Schools of Nursing, 2015). First, educational institutions must include courses on the peculiarities of psychiatric practice in their programs for future nurses. Students need to recognize the nature of patients’ physical and mental conditions and the approach they are to use to manage them.

During the courses, the following topics should be considered: individuals’ potential behavior and their triggers based on their mental state and health conditions, the challenges that may occur during communication, and the methods of their elimination. Second, educational institutions should provide information on the capacities nurses should develop to be able to manage the challenges. For example, the courses should implement situational training that will allow nurses to test their abilities to handle a difficult situation, show compassion, and remain calm. For those students who may perceive such work as challenging, educational institutions may establish personalized training, aimed to address individual traits that may prevent students from performing their duties in the future.

Moreover, as suggested by Martin and Chanda (2016), methods of mental health simulation should be implemented to ensure that nursing students can improve their confidence and have realistic expectations about their future practice. Educational institutions can develop training programs in collaboration with hospitals, which will ensure that the students have an opportunity to learn under real-life conditions. Such an approach can also help to reduce the number of nurses that are uncertain about the choice of their future career or cannot estimate their ability to manage challenging cases. The important point to consider would be to limit the number of actors participating in simulations to ensure that nurses have an opportunity to receive as real-life an experience as possible.

Conclusion

In summary, the findings of the integrative review and existing literature on the topic show that several key aspects or factors may have an impact on nurses’ ability to interact with patients effectively and should be facilitated or addressed for novice nurses­.

The first factor that may affect their communicative capacities is the lack of preliminary training for psychiatric nurses. The findings of the literature review show that many novice nurses do not realize what challenges they may encounter while working in psychiatric units, what aspects mental health illnesses are associated with, and what behaviors individuals may show due to their conditions. Consequently, the primary recommendation is the implementation of training for nurses, during which they may have an opportunity to discuss the challenging issues related to their future practice and learn how to manage them.

The second factor that may affect nurses’ communicative capacities is their social and psychological awareness. Nurses should learn to assess individuals’ emotional states and responses, as well as the causes that could lead to their actions. They should analyze not only patients’ words, but the emotions they show to find the possible reasons for their behavior. Moreover, they should analyze their thoughts and feelings and avoid suppressing their emotions, as it may result in burnout, inability to perform their tasks, and stress-related negative health outcomes.

To suggest strategies for effective communication, it is also crucial to address the stress-reduction techniques, as nurses may not be able to interact with patients while experiencing high levels of stress. The suggested strategies include the implementation of breathing exercises and meditation, which may be performed during breaks and at any place, as well as self-delineation. The findings of the literature review suggest significant interventions including acceptance and commitment therapy, cognitive therapy, and compassion-focused therapy. Moreover, nurses may implement physical activity as part of their stress-reduction strategy.

Communication strategies for novice nurses should take all of the factors discussed above into consideration. Moreover, nurses must use all means of communication, including verbal and non-verbal ones, as well as active listening. Nurses should also pay attention to the tone and the sound of their voice to avoid being perceived as threatening. Nurses need to remain calm when individuals show aggressive behavior to eliminate possible risks of patient violence.

The primary goal of a novice nurse should be to serve as a person, whom patients can trust and discuss their concerns with, while not suppressing their feelings. This way, they can establish healthy and productive communication and stable relationships with individuals.

Conclusion and Recommendations

The research question for this project considered the communication strategies that can enhance novice nurses’ capacity to work with patients having mental illnesses who have been hospitalized in acute care psychiatric settings. The research question was: What communication strategies can enhance new nurses’ (having less than one year of experience) capacity to work with patients having mental illnesses who have been hospitalized in acute care psychiatric settings? The method chosen to address this question was the integrative literature review.

This literature review aimed to recommend ways that might enhance the personal and professional growth for new nurses based on the existing studies on the topic. The search in Medline, SAGE, PsycINFO, and CINAHL databases resulted in a selection of 8 studies by Amoah et al. (2018), Aust and Bradshaw (2017), Bowers et al. (2014, 2015), Hagen et al. (2017), Mani and Abutaleb (2017), Martin and Chanda (2016), and Ramezani et al. (2017).

These studies showed various barriers to communication that novice nurses might encounter that included patients’ violence and unpredictable behavior, the lack of nurses’ preparedness to practice, the lack of organization’s empowerment of nurses and training opportunities, as well as shortages and work overload. In each study, several recommendations for improvement were suggested. In what follows I will provide recommendations for practice, administration, education, and future research based on the findings of the integrative literature review.

The findings of the integrative literature review show that several factors cause obstacles to effective communication for novice nurses. The primary one is the lack of their social and psychological awareness of their own and patient’s emotions and needs. Because of it, nurses may be unable to comprehend challenging situations and respond to them quickly, show empathy, and identify individuals’ concerns.

The second factor that may negatively influence nurses’ communicative capacities is work-related stress novice nurses experience. Finally, the third significant factor is the lack of preliminary training for psychiatric nurses, which results in their lack of awareness about the aspects of working in psychiatric units and patients’ behaviors associated with their conditions. Therefore, the research question is answerable as it is possible to suggest the enhancement of communication strategies based on the findings of the literature review.

Several methods were suggested to enhance nurses’ capacity to interact with patients effectively. One of them was the Safewards model suggested by Bowers et al. (2014, 2015). Other ways for improvement included the use of mindfulness interventions, such as MBSR, ACT, MBCT, ABCBT, and CFT (Aust & Bradshaw, 2017). Moreover, the assessment of own and individuals’ emotional state, the use of a de-escalation model, self-delineation, and active listening techniques were suggested.

However, the analysis of the findings suggested that the communication strategies for novice nurses should be proposed based on the existing risk factors associated with working in acute care psychiatric settings. It seems impossible not to consider the significance of the external barriers to practice, such as work overload and the lack of training, as they may affect nurses’ communicative capacities significantly. It is also vital to note that nurses may lack communication skills while having necessary clinical knowledge.

Moreover, many of them may not be mentally and emotionally prepared to work in acute care settings, which may result in the low level of their performance, avoidance of interaction with patients, as well as expose them to risks associated with working in acute care units. Considering this, the suggestions for practice, administration, and education, as well as recommendations for research may be proposed.

Suggestions for Practice, Administration, and Education

As novice nurses may encounter significant challenges caused by the lack of education, social, and psychological awareness, as well as high levels of work-related stress, it is vital to offer recommendations considering each of these factors. Below, I list several suggestions for the methods novice nurses, educational, and medical organizations may use to enhance nurses’ communicative capacities and, consequently, their performance and patient outcomes in psychiatric wards.

Suggestions for Practice

  • Nurses should enhance their social and psychological awareness by paying attention to patients’ emotions and feelings. The strategies for improvement may include analyzing individuals’ behavior, body language, the tone of voice, as well as reflecting on the situations that may lead to patients’ frustration. One of the techniques that can improve nurses’ awareness is debriefing; regular meetings among hospitals’ personnel and discussion of cases can eliminate the lack of consciousness (Martin & Chanda, 2016).
  • Novice nurses need to assess their emotional state too, which they may do by reflecting on feelings they experience while interacting with patients, and discussing their emotional responses with their colleagues. For example, nurses may use self-delineation techniques to define their fears, concerns, and negative emotions (Hagen et al., 2017).
  • Nurses should implement strategies for stress reduction, which may include mindfulness interventions, such as meditation, as well as yoga and regular exercise. If I were a leader of a unit, I would establish weekly group sessions that would include exercising and discussions.
  • Novice nurses need to avoid suppressing their emotions as it may lead to depressive symptoms and the inability to communicate with patients effectively. Thus, nurses should accept their negative feelings, and discuss their negative experiences with their colleagues. For example, they may consider psychotherapy sessions, or practice mindfulness interventions, such as journaling and meditation (Aust & Bradshaw, 2017).
  • While interacting with psychiatric patients, novice nurses should remain calm and pay attention to their body language and the tone of their voice (Toronto, 2016). They should show empathy and a positive attitude, as well as be open to communication. Nurses need to remember that patients’ aggressive behavior may be triggered by the feeling of unsafety and neglect, as well as by negative memories. Considering this, novice nurses should avoid responding to individuals’ behavior with a similar level of intensity and try to manage the situation calmly.
  • Novice nurses should implement active listening methods while interacting with patients to show that they are open to the discussion and provide individuals with an opportunity to share their thoughts. They should ask questions and respond to patients’ concerns while ensuring that their feelings are valid (Doas, 2015). Moreover, novice nurses should not doubt patients’ words as it may trigger violent behavior in patients. The primary recommendation is to see each patient as a valuable person whose concerns should be heard and addressed.

Suggestions for Administration

  • Health authorities should try to improve nurses’ working conditions to eliminate high levels of stress. To do so, they may consider reducing work hours and offer paid leaves. Moreover, they should ensure that there is no lack of staff to avoid work overload for novice nurses. If I were a leader of the unit, I would suggest performing interviews with each nurse to learn their preferences regarding schedule and workload and develop a working system that meets the nursing staff’s needs.
  • Acute care hospitals’ authorities may offer discussion sessions for the hospital’s staff to allow them to share their concerns, thoughts, as well as the communication strategies they use to interact with patients. Such sessions may be a part of in-hospital training programs for nurses aimed to improve their performance in psychiatric settings (Surr, Smith, Crossland, & Robins, 2016).

Suggestions for Education

  • Educational institutions need to improve training programs for nursing students. They can establish courses on the peculiarities of psychiatric practice, aggression management training, and situational training (Heckemann et al., 2015). The primary recommendation is to consider not only the aspects of working in psychiatric wards but discuss the real-life cases that may present challenges for novice nurses.
  • The implementation of mental health simulation programs as a part of nursing courses would be a significant step to enhance novice nurses’ ability to predict individuals’ behavioral patterns, understand patients’ reactions to nurses’ actions, and identify the factors that may trigger violence.

Limitations of the Review and Recommendations for Research

There were several limitations to this integrated literature review and the examined studies. First, some of the existing studies on the topic discussed the barriers to effective communication but did not include recommendations. On the other hand, the studies suggested models for conflict reduction, such as the Safewards model, as well as mindfulness interventions, such as MBSR, ACT, MBCT, ABCBT, and CFT.

Second, some of the examined studies did not consider the needs of novice nurses in particular. However, it is vital to mention that most of the literature addressed the general risks and complications associated with psychiatric nursing and provided a valuable basis for recommendations.

The mentioned limitations allow for several recommendations for future research. First, it is vital to study the experiences of nurses that have worked in psychiatric settings for less than one year. The research on this topic may allow for changes in the existing training programs for nurses, as well as the adjustment of hospitals’ policies to meet novice nurses’ needs. Second, medical organizations should conduct their studies to recognize the challenges novice nurses encounter and the causes for them. The findings of the studies may help to establish flexible schedules and reduce work overload. Finally, the surveys and control trials should include more novice nurses as their experiences may be different from those of nurses working in psychiatric settings for longer periods.

Conclusion

Novice nurses may experience challenges in interacting with patients while working in acute care psychiatric settings. The barriers to communication may be caused by the lack of preliminary training, which results in inadequate expectations regarding psychiatric nursing, poor social and psychological awareness of own and patients’ emotions and needs, and work-related stress. Based on these factors, it is possible to suggest strategies that may improve novice nurses’ communicative capacities. They include the use of verbal and non-verbal means of communication, active listening to patient’s concerns and needs, and the implementation of stress-reduction techniques.

The recommendations for medical and educational institutions include the implementation of mental health simulation programs, the establishment of courses on the peculiarities of psychiatric practice, as well as situational and aggression management training. These suggestions may eliminate the existing barriers to communication and improve novice nurses’ communicative capacities and patient outcomes.

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