How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 64
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Moral foundations
There was considerable cohesion in subjects’ responses under this heading, with most being generic
across all symptom domains. Five different aspects of the moral stance that nurses took were
apparent and well represented in the interview data.
Notice, do not ignore (19/28)
This was expressed in a variety of responses to patients’ behaviours, including not ‘forgetting’
about apathetic patients, ‘allowing them to be left out’ or ‘leaving them to rot in their beds’, giving
as much attention to the negative symptoms (apathy/withdrawal) as the positive (all others); talking
to patients about their hallucinations and delusions, rather than ignoring them, changing the topic
when patients brought them up, or ignoring the patient as ‘too unwell to try and engage with’, as
‘even if it’s nonsensical it is still communicating’; giving ‘extra attention’ to those who are anxious
or agitated, rather than less, not ‘sending them to their room and just leaving it’. Noticing meant not
dismissing patients’ symptoms, overtly writing them off to patients as ‘not real’ or ‘symptoms of
your mental illness’, as ‘dismissing their reality would be a big no, no I think on the whole’. The
consequences of so doing are to generate antagonism and a sense of abandonment: ‘to dismiss their
symptoms out of hand is going to make it very confrontational and they’re not going to feel that
you're listening to them or helping them in any way … destroying a relationship’. Ignoring
symptoms meant that nurses would preclude understanding ‘how, what their experiences are and
how the symptom is affecting them in their function and in their emotional state’, and this in turn
meant that no therapeutic work could be undertaken. In addition, noticing symptoms prevented
nurses from making mistaken assumptions about patients’ experiences: ‘what people describe as
hearing voices or hallucinating is often, what we consider those things to mean isn't necessarily
what the patient or the client considers them to mean’.
Encouraging, supportive and gentle (23/28)
Being gentle with patients meant ‘not shouting’, but rather going to the patient giving him or her
quiet advance notice and suggestions about what they might like to do, having a low emotional
content and a slow, quiet approach. It also meant not being rushed, but ‘respecting the pace at which
it is comfortable’ for the patient concerned, and avoiding any sense of ‘force’, ‘argument’ or
‘pushiness’. One respondent referred to a ‘sandwich’ technique, in which the patient is listened to
and heard first, nurtured, prior to suggestions being offered about helpful things to do, or what
needs to be done now. Being supportive was also about not being ‘domineering, or taking control,
telling people what’s good for them’, but using a more passive, sympathetic and suggestive style of
approach such as ‘just put it into that, let’s see if this helps’. Similarly, when information is needed
‘you don’t bombard them with a lot of questions, you perhaps just gently tease things from them’.
Encouragement was also about feeding back positive judgements, evaluations, reassurance and
reminders: ‘highlighting their abilities and their skills and the positive issues that they can look
forward to will make any tasks easier, increasing their self confidence and motivation’. Others
emphasised the combination of ‘understanding’, ‘sympathy’ and ‘encouragement’ to do things.
Sometimes the degree of support rises to the point where nurses do things for patients where they
simply cannot do them themselves, for example washing them. Being encouraging, supportive and
gentle means giving patients ‘space’, taking ‘time’ and requires ‘staff availability’, however not
doing them was recognised by nurses as likely to exacerbate anxiety and hence other psychotic
symptoms.
Empathy and concern (19/28)
“Let them know that you’re genuinely, concern, show genuine concern, be empathetic to them. Be
there for them, getting them to know that you’re concerned about their wellbeing and you’re, you
want to help them and support them at the difficult times, for them to get better.”
This was seen as a fundamental element of every approach to patients, and was talked about in a
number of different ways, including seeking to ‘understand more what the patient is going through’,
being ‘compassionate’, ‘empathetic’, warm’, ‘expressing concern’. More everyday terms used were
being ‘motherly’ or ‘friendly’, and definitely not expressing boredom in response to patient
symptoms or distress. Without this ‘caring attitude’ it was recognised that patients would not trust
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