How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 74
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Set interaction limits (3/29)
Nurses recognised that patients with these symptoms could be very demanding and request more
staff time than could possibly be given to them. They therefore suggested that if this was an issue,
limits should be placed on how often the staff would converse with the patient, and/or on the
duration of those conversations:
‘before … I tell them I go five minutes and five minutes only, or ten minutes and ten minutes only’.
Reduce stimulation (3/28)
Excessive stimulation was seen as likely to make the agitated or overactive patient worse. Such
stimulation could come from nurses trying too hard to make contact with patients, for example by
following a pacing patient, placing such a patient on special observation, or asking them to do more
things.
Upset/distress
Reveal self (2/28)
Being prepared to mention one’s own experience of distressing events, not to look for sympathy for
oneself, but in order to establish a good rapport.
“That's really upsetting, I know when somebody died, when my uncle died I was really upset about
that. I wouldn't be adverse about saying, there's a shared humanity here that we have, we share some
of this experience and what you’re going through is really human and normal, and it's important that
we are here together to just survive this.”
Limit unnecessary interaction (2/28)
At the point at which someone is acutely distressed, it is not a good time to be asking too many
questions or trying to communicate too much information.
Aggression/irritability
Get them sat down (4/28)
Nurses suggested that if you could get the patient to sit down with you, then this had a calming
effect that enabled more reasonable conversation: ‘you can't feel quite so pumped if you're sat down
talking to someone’.
Get the patient to write (2/28)
Communication through writing was seen as a possibility, a way for the patient to express
themselves without the risk of them losing their temper in a closer interaction with staff:
‘getting them to write down their frustrations and the reasons why they’re becoming angry’.
Maintain clarity (3/38)
Making sure that the patient had a good understanding of what was happening and what you are
doing, preventing as far as possible any misunderstandings that might heighten or trigger the release
of anger. So, for example, nurses suggested checking with the patient how they understood what
was going on and why you were talking with them, in addition ‘even if you think they're not
listening, or can’t hear you is to continue to explain to them about why you're doing it and actually
what you're doing.’ Partly this was about recognising that irritability and aggression affect the
ability to concentrate, listen and take in information, and this ‘makes them more irritable and
aggressive’, so extra effort has to me made to keep everything clear by the use of copious
explanations.
“They’ll probably make assumptions about what you are saying, so I think it’s really important to
let them know exactly what you're saying, check that they’ve heard you.”
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