Introduction
This essay aims to explore and critically reflect on an experience involving a non-verbal patient in a mental health hospital setting, using Gibbs’ Reflective Cycle (1988) as a structured framework. As a nursing student, understanding and effectively communicating with non-verbal patients is essential for providing compassionate, person-centred care, particularly in mental health contexts where communication barriers can exacerbate feelings of isolation or distress. The essay will outline the context of the encounter, followed by a step-by-step reflection using Gibbs’ model, which includes description, feelings, evaluation, analysis, conclusion, and action plan. This reflective process will draw upon relevant literature to examine the challenges and opportunities of non-verbal communication, as well as its implications for nursing practice. By engaging with this reflection, I aim to demonstrate a sound understanding of communication in mental health nursing, highlight areas for personal and professional development, and consider how such experiences inform broader care practices.
Context of the Encounter
The encounter took place during a clinical placement in a mental health hospital as part of my nursing training. I was assigned to support a patient, referred to as Patient X to maintain confidentiality in line with the Nursing and Midwifery Council (NMC) Code (2018), who was non-verbal due to a combination of severe anxiety and selective mutism. Patient X, a middle-aged individual, had been admitted following a mental health crisis and exhibited minimal verbal interaction, relying primarily on gestures, facial expressions, and occasional written notes to communicate. My role involved assisting with daily activities, observing their emotional state, and facilitating communication with the multidisciplinary team. This experience was both challenging and enlightening, as it required me to adapt my usual communication methods and develop a deeper understanding of non-verbal cues.
Gibbs’ Reflective Cycle: Description
Using Gibbs’ Reflective Cycle (1988), I begin with a description of the specific incident. During one particular shift, I was tasked with supporting Patient X during a routine activity—assisting them with a meal in a communal dining area. Initially, Patient X appeared hesitant to engage, avoiding eye contact and showing visible signs of discomfort, such as fidgeting and looking away. I attempted to offer reassurance through calm verbal prompts, but these were met with no response. Noticing their unease, I shifted to non-verbal communication, such as maintaining a relaxed posture, offering a gentle smile, and gesturing towards the food to encourage participation. After several minutes, Patient X pointed to a specific item on the tray, which I interpreted as a preference, and I responded by providing it to them. This small interaction marked a breakthrough in establishing trust, though the overall encounter remained limited in depth.
Gibbs’ Reflective Cycle: Feelings
Reflecting on my feelings during this encounter, I initially felt frustrated and uncertain due to the lack of verbal feedback from Patient X. As a student nurse, I am accustomed to relying on spoken communication to build rapport, and the silence felt like a barrier. However, as I adapted my approach, I experienced a sense of empathy and determination to understand Patient X’s needs through their non-verbal cues. Indeed, observing their slight nods or frowns became rewarding, as these subtle signals provided insight into their emotional state. At times, I also felt anxious about misinterpreting their gestures, worrying that I might unintentionally cause distress. This mix of emotions highlighted the complexity of caring for non-verbal patients and underscored the importance of patience and emotional resilience.
Gibbs’ Reflective Cycle: Evaluation
Evaluating the encounter, there were both positive and negative aspects. On the positive side, my shift to non-verbal communication strategies, such as using gestures and maintaining an open posture, seemed to reduce Patient X’s initial discomfort and facilitated a small but significant interaction. This aligns with literature emphasising the value of non-verbal communication in building trust with mental health patients (Stickley and Freshwater, 2006). However, the interaction was limited, and I struggled to fully gauge Patient X’s emotional needs or preferences beyond the immediate context. Additionally, my initial reliance on verbal prompts was arguably less effective, indicating a gap in my preparedness for such scenarios. Overall, while the encounter had moments of success, it also revealed areas for improvement in my skills and confidence.
Gibbs’ Reflective Cycle: Analysis
Analysing the situation, several factors contributed to the outcomes. Firstly, my initial frustration may have stemmed from a lack of prior training in non-verbal communication techniques specific to mental health settings. As McCabe and Timmins (2013) note, effective communication in nursing often requires tailored approaches, particularly when verbal interaction is limited. Secondly, the environment—a busy communal dining area—may have heightened Patient X’s anxiety, making engagement more challenging. Research suggests that environmental factors, such as noise or unfamiliar settings, can significantly impact mental health patients’ ability to communicate (Barker, 2004). Furthermore, my eventual success in interpreting Patient X’s gestures indicates that non-verbal cues, when observed carefully, can be powerful tools for understanding patient needs. This aligns with Peplau’s theory of interpersonal relations, which emphasizes the nurse-patient relationship as central to care, even in the absence of verbal dialogue (Peplau, 1997). Generally, this analysis suggests that both personal and situational factors influenced the encounter, highlighting the need for adaptive skills and environmental awareness.
Gibbs’ Reflective Cycle: Conclusion
In conclusion, this reflection has illuminated the challenges and opportunities of working with a non-verbal patient in a mental health hospital. The experience demonstrated that while verbal communication is often a default approach, non-verbal methods can be equally, if not more, effective in certain contexts. However, it also revealed my limitations in preparedness and confidence, which impacted the depth of interaction with Patient X. Drawing on literature, it is clear that communication in mental health nursing is multifaceted, requiring a blend of empathy, observation, and adaptability (Stickley and Freshwater, 2006). This encounter has therefore been a valuable learning opportunity, prompting me to critically assess my practice and consider how theoretical knowledge can be applied to real-world scenarios.
Gibbs’ Reflective Cycle: Action Plan
Moving forward, I have developed an action plan to address the identified areas for improvement. Firstly, I will seek additional training on non-verbal communication techniques, such as workshops or online modules offered by reputable organisations like the NHS or universities, to enhance my ability to interpret and respond to patient cues. Secondly, I plan to engage more proactively with reflective practices, using models like Gibbs’ cycle to regularly evaluate my clinical experiences and identify patterns in my learning needs. Additionally, I will collaborate with mentors and peers during placements to gain feedback on my communication skills, particularly in challenging situations. Finally, I aim to deepen my understanding of environmental influences on patient behaviour by reviewing relevant literature and discussing strategies with experienced staff. By implementing these steps, I hope to build greater competence and confidence in providing person-centred care to diverse patient groups.
Conclusion
In summarising this reflective essay, the use of Gibbs’ Reflective Cycle (1988) has provided a structured approach to critically examining my interaction with a non-verbal patient in a mental health hospital. The process revealed both strengths, such as my adaptability in using non-verbal cues, and weaknesses, including my initial reliance on verbal communication and limited preparedness. By drawing on academic literature, I have contextualised these findings within broader nursing theories and practices, highlighting the importance of tailored communication strategies in mental health care. Ultimately, this reflection has underscored the significance of continuous learning and self-awareness in nursing, with implications for improving patient outcomes through empathetic, informed practice. As I progress in my studies and career, the insights gained from this experience will inform my approach to complex care scenarios, ensuring that I remain responsive to the unique needs of each individual.
References
- Barker, P. (2004) Assessment in Psychiatric and Mental Health Nursing: In Search of the Whole Person. 2nd ed. Cheltenham: Nelson Thornes.
- Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Education Unit, Oxford Polytechnic.
- McCabe, C. and Timmins, F. (2013) Communication Skills for Nursing Practice. 2nd ed. Basingstoke: Palgrave Macmillan.
- Nursing and Midwifery Council (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. London: NMC.
- Peplau, H.E. (1997) Peplau’s Theory of Interpersonal Relations. Nursing Science Quarterly, 10(4), pp. 162-167.
- Stickley, T. and Freshwater, D. (2006) The art of listening in the therapeutic relationship. Mental Health Practice, 9(5), pp. 12-18.
