How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 54

This book is in B&W, not color - Print page in Grayscale for Correct view! Contents Inpatient nursing care and interaction This study of interaction Moral foundations Preparation for interaction and its context Being with the patient Nonverbal communication, vocabulary and timing Emotional regulation Getting things done Talking about symptoms Lessons for practice Appendix – the interview schedule References Inpatient nursing care and interaction Acutely mentally ill people present their conversational partners with a perplexing range of behaviours and challenges to normal social interaction. Their mood might be one of euphoria and elation, with thoughts running through their head at speed, skipping from topic to topic as a spun stone skips over water. Or they might be deeply depressed, full of thoughts of guilt and painful emotions, with both speech and movement considerably slowed. Alternatively all their emotions might be flattened, dampened, unresponsive or incongruous. They might be obsessed with strange ideas and interpretations of the world and what is going on around them, with these beliefs often about a hostile world. Coupled with these delusional beliefs may be auditory or other hallucinations, commenting on what is going on around them, instructing, abusing, or generally interfering with their ability to think. In addition to the distraction caused by hallucinations, their thinking processes and verbal abilities might also be directly affected by a variety of thought disorders. They may be irritable, incongruous, unpredictable, and perilous conversational partners until their illness stabilises. Some people experience only one acute episode of the conditions currently called schizophrenia and manic depressive psychosis, which then gratifyingly resolves over time and never recurs. Others experience periods of wellness in between relapses and recurrences, whereas yet others have the conditions chronically with continuous symptoms, and experience exacerbations on top of this. All such people generally receive help, care and support largely in the community. However during periods of acute illness, when they are at higher risk of coming to harm, harming themselves, or possibly harming others, when they have little in the way of social support, when they live in a rejecting and stigmatising community, they are likely to be admitted temporarily to an acute psychiatric ward (Bowers et al. 2009). A proportion of these admissions are compulsory using mental health legislation. Such admissions are most likely to last about three weeks in the UK, and allow their condition to be assessed, appropriate treatment given, their physical healthcare and daily living needs to be attended to, and their safety maintained (Bowers 2005). Although psychiatrists regularly visit and see patients, and occupational therapists provide structured activities, most of the 24 hour care for patients is provided by a mix of qualified and unqualified nursing staff. However advice and information is scarce on how nurses should interact with acutely psychotic patients so as to effectively keep them safe, assess their needs, deliver treatment and provide physical healthcare. In the following sections we review the recent development and history of inpatient care in order to pull together what information exists. Nurse-patient interaction Over the past fifty years there have been a number of research studies about nurse-patient interaction on acute psychiatric wards, coupled with theoretical work about the nature of psychiatric nursing derived from neoFreudianism. On the plus side, the work of the nurses is generally highly regarded by patients (Rogers, Pilgrim, & Lacey 1993), and nurses can relate many critical incidents where their interaction with patients has been highly valuable (Cormack 1983;Flanagan & Clarke 2003). The nurse-patient relationship is generally seen as central to the provision of good inpatient care, and the widespread acceptance of this is generally due to the For [email protected] Property of Bookemon, do NOT distribute 56