Navigating between Compassion and Uncertainty – Psychiatric Nurses’ Lived Experiences of Communication with Patients Who Rarely Speak

Abstract

Caring conversations are considered essential in psychiatric and mental health nursing. However, some patients are more or less silent and rarely express themselves verbally. This can be challenging for nurses who also need to find ways of communicating with these patients. Therefore, the aim of this study is to describe psychiatric nurses' lived experiences of communication with patients who rarely speak. Five nurses were recruited from a psychiatric nursing home. Participants were encouraged in interviews to reflect on their experiences of caring for patients who are more or less silent. The transcribed interviews were subject to a phenomenological hermeneutic analysis. The findings are reflected in three main themes: (i) giving space for the unspoken narrative, (ii) remaining in uncertainty, and (iii) being in reflective vigilance. The themes were synthesised and reflected on in the light of Fredriksson's theory of caring conversations. The comprehensive understanding reveals that nurses' understanding of the patient's unspoken narrative relies both on compassion and a willingness to engage, but also on a preparedness to remain in the uncertainty of not knowing. Balancing good intentions and the fear of one's own shortcomings requires reflections not only in actions during encounters with the patient, but on actions. When nurses can apprehend and respond to what the patient expresses non-verbally, a joint narrative can emerge.

Experiences of ward atmosphere in inpatients with intellectual disability and mental illness: clinical implications for mental health nursing

“…These results suggest that use of and adherence to concrete signifiers, such as keeping appointments and being physically and visually available for patients, may be one way to reach through to patients in ways that go beyond spoken language (Donner and Gustin 2020 ). Joint activities with staff may be another, including systematic observation of patients’ reactions to stimuli and activities, while using gestures, posture and facial expressions to communicate (Birnbaum 2017 ).…”

“…For example if the patient does not want to get out of bed and seems sad, the nurse may interpret this and attempt to put their experience into words ‘I see that you want to stay in bed today. I wonder if you are feeling sad or afraid.’ However, these approaches require mental presence, creativity and continuous reflection by nursing staff, going beyond technical and procedural approaches (Donner and Gustin 2020 , Birnbaum 2017 , Bakken and Smeby 2004 ).…”

“… 2014 ). Donner and Gustin ( 2020 ) described the experiences of psychiatric nurses working with individuals who have difficulties communicating verbally, finding that nurses’ understanding of the unspoken narrative relied on compassion and willingness to engage while remaining in the uncertainty of not knowing. Furthermore, the participants in the study by Donner and Gustin conveyed that even though a person may have difficulties in verbally communicating their needs, this does not mean that they are unaware of their needs or what they find helpful.…”

“…2007 ), such behavioural equivalents may differ considerably between individuals. Thus, symptom recognition remains complex and challenging in mental illness in individuals with ID, and this complexity needs to be managed in mental health nursing in this population, including attention to the symptom presentations and experiences of each specific individual (Taua and Farrow 2009 , Donner and Gustin 2020 ).…”

Case study: identification of anxiety and subsequent intervention in an adolescent male with autism, severe intellectual disability and self-injurious behaviour

“…Discussions among staff about how to understand Philip’s verbal utterances and other behaviours were encouraged (Donner et al. 2020 ). The emphasis on interpretation of Philip’s communication was implemented during the first week of the admission and was a particular focus during shift changes.…”