Structural impediments to effective communication.

Interestingly, none of the mental health nurse authors that I have consulted, understand the nurse-patient relationship as establishing the parameters for facilitative communication which, to a large extent, opens up or circumscribes further therapeutic possibilities. In other words, the nurse is seen as the initiator of both relationship development and communicative interactions; and the person of the nurse seems irrelevant in that they have skills to learn and techniques to apply. Furthermore, if communication is problematic, it seems to be assumed that such difficulties arise from the patient or from the inadequacy of the nurse's technique, and never from the personal attributes of the nurse.