Barriers to communication between Mental Health Nurses and their patients: a systematic review of the literature

Abstract

Background: Effective communication between mental health nurses and patients is critical for positive health outcomes and patient satisfaction (Aryankhesal et al., 2019). Various barriers, however, can impede effective communication in this context. Understanding these barriers is key to enhancing communication and, ultimately, outcomes for patients (Martínez‐Martínez et al., 2019) via the delivering of high- quality mental healthcare. Objectives: This dissertation aimed to systematically review evidence on communication barriers between mental health nurses and patients. The specific objectives were as follows: 1) Explore the impact on care quality and patient outcomes due to poor communication; 2) Understand the causes and types of barriers; 3) Identify communication barriers from nurses' and patients' perspectives; 4) Assess proposed strategies to address barriers in order to improve patient outcomes. Search Strategy: A comprehensive search strategy was developed and executed across a number of major databases including MEDLINE, CINAHL, Cochrane Library, PsycINFO and EMBASE. Additional manual searching of reference lists of included studies supplemented the database search. The search was limited to studies written in English and published between 2013 and 2022 that examined various aspects of communication barriers, including causes, types, impacts, and strategies, specifically within the context of mental health nurse-patient interactions. Both qualitative and quantitative primary research, as well as reviews, were considered eligible for inclusion. Results: The systematic search and screening process identified six studies that met the eligibility criteria for final review and analysis. All six studies utilised qualitative 8 approaches with sample sizes ranging from 9 to 85 participants. The studies represented diverse geographic contexts, including Finland, USA, China, Iran, Canada, and Belgium. Three key themes were identified from the synthesised data via thematic analysis: 1) Communication barriers stemming from factors related to nurses, patients, and healthcare organisations; 2) Underlying causes encompassing stigma, language barriers, technology gaps, clinical environment, and workload; 3) Proposed strategies emphasising training programmes, optimising workloads, addressing personal biases, and addressing disparities in digital access to enhance communication. The review highlighted that prevailing communication barriers negatively impact therapeutic nurse-patient relationships and the overall quality of mental healthcare. Conclusion: The findings revealed that communication barriers in mental healthcare settings are multidimensional, arising from an interplay of personal, interpersonal, and organisational factors. Evidence-based training programmes, cultural competency building, workload adjustments and thoughtful technology integration could help attenuate existing barriers and enhance communication quality. Sustainable solutions, however, should be comprehensive rather than piecemeal or fragmented. This review makes a robust contribution to the empirical evidence regarding an important yet underexplored topic, with meaningful implications for enhancing clinical practice, education, and health policy. Future research could further build on these findings using quantitative, qualitative, or mixed methods approaches.