Introduction
Effective communication is a cornerstone of nursing practice, particularly in mental health settings where patients often face complex challenges in expressing their needs and emotions. This essay reflects on a specific case study of a patient in a mental health hospital diagnosed with a personality disorder exhibiting abnormal behaviour and selective mutism, focusing on the nursing interventions required to address communication barriers. Utilising Gibbs’ Reflective Cycle (1988), a widely recognised framework in nursing education, this reflection will explore the experience, emotions, evaluation, analysis, conclusion, and action plan related to the care provided. The purpose of this essay is to critically examine the communication challenges faced by the patient, assess the effectiveness of the interventions applied, and consider how such experiences inform future practice. By drawing on recent academic literature and evidence-based practices within the last decade, the essay aims to demonstrate a sound understanding of mental health nursing while highlighting the importance of tailored communication strategies in improving patient outcomes.
Description of the Case Study
The patient, referred to as Mr. A for confidentiality, is a 34-year-old male admitted to a mental health hospital following a diagnosis of borderline personality disorder (BPD) with associated abnormal behaviours, including impulsivity and emotional dysregulation. Additionally, Mr. A exhibits selective mutism, a condition where an individual becomes unable or unwilling to speak in specific situations despite having the ability to do so (American Psychiatric Association, 2013). In Mr. A’s case, he often refused to communicate verbally during interactions with staff, particularly when distressed, resorting instead to non-verbal cues such as gestures or written notes. This communication challenge was exacerbated by his environment—a busy inpatient ward with frequent staff changes—and his situational stressors, including conflicts with peers. As a student nurse, I was tasked with engaging Mr. A during routine assessments and supporting his therapeutic interventions, which necessitated innovative approaches to overcome his selective mutism and build trust.
Feelings and Thoughts
Initially, I felt overwhelmed and uncertain when interacting with Mr. A. His lack of verbal communication made it difficult to gauge his emotional state or immediate needs, and I questioned my ability to connect with him effectively. Furthermore, I experienced frustration during moments when my attempts at communication—such as asking open-ended questions—were met with silence or avoidance. However, over time, I began to feel more empathetic as I observed subtle cues, such as his body language and occasional written responses, which suggested underlying anxiety and a desire for control in interactions. Reflecting on these feelings, I recognised the importance of patience and the need to adapt my approach rather than relying on conventional communication methods.
Evaluation of the Experience
Evaluating the experience, several aspects of the interventions were positive. For instance, providing Mr. A with a notebook to express his thoughts in writing proved to be an effective alternative to verbal communication, allowing him to share concerns at his own pace. Additionally, maintaining a calm and non-confrontational demeanour during interactions appeared to reduce his anxiety, as evidenced by his increased willingness to engage over time. However, there were limitations to the interventions. On occasion, I failed to interpret his non-verbal cues accurately, leading to misunderstandings about his needs. Moreover, the busy ward environment often hindered the consistency of care, as staff rotations meant that Mr. A had to repeatedly adjust to new faces, arguably exacerbating his communication barriers. This highlights a key limitation in the inpatient setting, where establishing rapport can be challenging.
Analysis of the Situation
Analysing the situation through the lens of recent literature, communication challenges in patients with personality disorders are well-documented. According to Bateman and Fonagy (2016), individuals with BPD often struggle with trust and emotional regulation, which can manifest as withdrawal or selective mutism in high-stress environments. In Mr. A’s case, his mutism may have been a coping mechanism to avoid perceived threats during interactions. Furthermore, the environment of the mental health ward likely contributed to his communication difficulties. As noted by Cleary et al. (2016), inconsistent staffing and high-pressure settings can undermine therapeutic relationships, particularly for patients who require stability to feel secure.
The interventions I employed, such as using written communication, align with evidence-based strategies for managing selective mutism. For instance, Kotrba (2015) suggests that alternative communication methods, including writing or gesturing, can reduce pressure on patients and facilitate gradual engagement. However, I could have incorporated additional strategies, such as structured sessions using visual aids or involving a speech and language therapist, to further support Mr. A’s needs. This analysis underscores the complexity of addressing communication challenges in mental health nursing, where patient-specific and environmental factors must be carefully balanced.
Conclusion from the Reflection
Reflecting on this experience, it is clear that communication challenges in mental health patients, particularly those with personality disorders and selective mutism, require a highly individualised approach. The use of alternative communication methods was partially successful in engaging Mr. A, yet inconsistencies in the ward environment and my initial lack of skill in interpreting non-verbal cues limited the effectiveness of care. This reflection has highlighted the importance of empathy, patience, and adaptability in nursing practice, as well as the need to critically assess both personal and systemic barriers to effective communication. Ultimately, this experience has deepened my understanding of the nuanced needs of mental health patients and the critical role of tailored interventions in fostering trust and improving outcomes.
Action Plan for Future Practice
Moving forward, I intend to develop a more robust skill set for managing communication challenges in mental health settings. Firstly, I will seek additional training in non-verbal communication and selective mutism through workshops or online modules offered by reputable organisations such as the NHS or the Royal College of Nursing. Secondly, I plan to collaborate more closely with multidisciplinary teams, including speech and language therapists, to ensure a comprehensive approach to patient care. Additionally, I aim to advocate for environmental adjustments in inpatient settings—such as reducing staff rotations where possible—to provide greater consistency for patients like Mr. A. Finally, I will continue to engage in reflective practice using Gibbs’ model to critically evaluate my interventions and identify areas for growth. By implementing these actions, I hope to enhance my ability to support patients with communication barriers and contribute to more effective, person-centred care.
Conclusion
In conclusion, this reflective essay has explored the nursing interventions provided to Mr. A, a mental health patient with borderline personality disorder and selective mutism, using Gibbs’ Reflective Cycle. The analysis revealed both strengths and limitations in the communication strategies employed, highlighting the importance of alternative methods such as written communication and the challenges posed by the inpatient environment. Critically, this experience has underscored the need for adaptability, empathy, and continuous learning in mental health nursing. The implications for future practice are clear: nurses must develop specialised skills to address individual communication challenges and advocate for systemic changes to support therapeutic relationships. By doing so, we can better meet the complex needs of mental health patients and improve the quality of care delivered.
References
- American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5). American Psychiatric Publishing.
- Bateman, A. and Fonagy, P. (2016) Mentalization-Based Treatment for Personality Disorders: A Practical Guide. Oxford University Press.
- Cleary, M., Hunt, G. E., Horsfall, J. and Deacon, M. (2016) Nurse-patient interaction in acute adult inpatient mental health units: A review and synthesis of qualitative studies. Issues in Mental Health Nursing, 37(2), pp. 66-79.
- Kotrba, A. (2015) Selective Mutism: An Assessment and Intervention Guide for Therapists, Educators & Parents. PESI Publishing & Media.
