How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 96

This book is in B&W, not color - Print page in Grayscale for Correct view! Whilst communicating, or in order to do so effectively, nurses had to regulate their own emotional responses to what patients were doing and saying. They deemed it most important not to display any anxiety in the face of acute psychotic symptoms, patients’ psychological distress or their overt hostility and aggression. Being calm and receptive in the face of such patient behaviours was deemed more likely to reduce them – becoming anxious more likely to amplify them. Similar recommendations were given about becoming frustrated or irritable with patients uncooperativeness, lack of progress or resistance to actions which would benefit them. Finally an optimistic outlook was considered valuable and motivating for patients (as well as fellow nurses). Attempting to get things done with patients (e.g. get them to get up or go to bed, eat, drink, wash, take their medication etc.) required a whole range of additional and different interaction techniques, including making suggestions rather than ordering patients to do things, giving reasons for the task, being flexible, maximising choice, prompting, encouraging, giving positive feedback, rendering assistance, and in some circumstances being assertive and forceful. When resistance was based upon delusions, a degree of collusion was allowed by some nurses if balanced by the patient’s needs for care. For thought disorder, using gestures as a means of communicating what was to be done was considered helpful. Talking about symptoms with patients was the single largest domain in the interviews. Absolutely fundamental to all symptom areas was the need for nurses to hear what patients’ experiences were, accept them, and seek to enter and understand their effect on patients with caring and respect. This was clearly a foundation for nursing practice, and was the starting point for all other interactions about symptoms. Following this, for apathetic or withdrawn patients, it was judged helpful to mutually explore causes, agree a care plan, develop a routine and purpose, and then take a step by step approach. For hallucinating patients, stress management, distraction, bolstering coping and in some cases casting doubt or challenging the hallucinatory content were considered good approaches. Gentle questioning or direct challenge were also sometimes deemed appropriate for the deluded patient. Collusion was not recommended, however sometimes it was considered appropriate to ignore the delusions or find workarounds so that patients’ needs could be met. In the case of upset and distressed patients, interviewees talked about staying calm, keeping patients talking, persisting to find out the cause, and taking action to relieve the cause or exploring other solutions with the patient. Responses on agitation, overactivity, irritability and aggression were not clearly distinguishable and were therefo re considered together. The expert nurses recommended exercise, distraction, relaxation, avoidance of confrontation, explaining the reasons for actions and rules, negotiating advance directives and forceful containment. Novel findings? This study set out to uncover any tacit or traditional knowledge amongst practicing nurses about how to communicate well with those in a state of acute psychosis. The first assessment of the results must therefore be on what or whether anything new has been discovered. How much of the material above simply repeats the content of nurse training, reflecting the zeitgeist of psychiatric nursing practice, and how much hidden expertise has been uncovered? How much is the above information novel, and how much is an elaboration of the recent knowledge history covered in the introduction? The pattern of responses and themes in the interviews does indicate that the contents are not widely known. While some techniques were present in two thirds of the interviews, many others were only present in one third or less. And those interviewed were nurses considered to be particularly expert at dealing with patients suffering from acute psychosis. This does not prove the contents are new or undocumented material. It does prove that there is likely to be a considerable number of the techniques described above which are not known by most psychiatric nurses (and therefore not utilised). The low numbers of expert nurses reporting some techniques also indicated that further interviews might yet find additional material of value. Those low numbers additionally indicated that our findings might be of significant use to nurse educators in the future. We specifically asked our interviewees not to tell us about ‘textbook communication skills’, as these were felt to be already widely known by nurses and a significant part of nurse training. These were still mentioned in passing by most nurses, supporting our assumption that they are well known and have been well assimilated into practice. However our research interest was to move beyond For [email protected] Property of Bookemon, do NOT distribute 98