How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 63

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THIS STUDY OF INTERACTION
The interviews
The aim of our study was therefore to seek to identify nurses’ skills and methods in working with acutely
psychotic patients which were not already well-known or formally taught. We were looking for traditional
practice learnt perhaps from watching others, tacit knowledge not previously formulated, and to draw upon
expertise gained through experience. We worked with the managers and nursing leadership of three London
mental health NHS trusts to initially identify a few practicing qualified psychiatric nurses who were
acknowledged experts in working with acute psychotic patients. We then interviewed them, also asking them to
nominate others whom they knew and thought of as particularly expert, a strategy known as snowball sampling.
The nurses identified were currently working in community and inpatient posts, and we collected 28 in total.
Just over half (53%) of the sample were female, with most currently working in the community (75%). Roughly
equal numbers came from each of the three Trusts involved in the study. The interviews were all digitally
recorded and transcribed so that we could analyse them with the aid of specialist computer software (N6).
Our interviews were semi-structured, in that they consisted of a framework of fixed questions, however the
interviewer had freedom to follow leads and diverge from the schedule when appropriate. We devised the
questionnaire based on our experience, round table discussions about the nature and pattern of acute psychosis,
reviews of research instruments to measure illness severity (Theodoridou et al. 2008), and on parallel work to
construct our own scale (the Nursing Observed Illness Intensity Scale). The full interview schedule is in the
appendix to this monograph.

Analysis
All interviews were firstly read in detail by the Principal Investigator (LB). Initial coding followed the structure
of the interviews, where subjects were asked in turn about communication with apathetic and withdrawn
patients, then hallucinating patients, deluded patients, thought disordered patients, agitated or overactive
patients, upset and distressed patients, and irritable or aggressive patients. All statements by subjects were then
coded at a finely grained level under each of these categories. These were then grouped under each symptom
area into eight preliminary domains: preparation-context; initiation; style-approach-values; content-durationfrequency; metacontent (talk about the symptoms not aimed at reducing or ameliorating them)-therapy; selfmonitoring; coerce-assert-persuade; and task accomplishment. These code headings were then assembled in a
large table (symptom areas as columns and preliminary domains as rows) and discussed with the research
collaborators, the City University MH research team, and Dr Rose McCabe as an external expert in the area.
Several plans for higher level groupings of the data were examined and discarded at this stage. The division of
strategies into core versus periphery was discarded because the dispersion of codes meant that any ‘core’ was
extremely small. Division into basic, intermediate and advanced strategies was also abandoned, as there were no
criteria within the data on which to base such distinctions. Instead some of the preliminary domains were
merged, others kept and some divided to produce seven themes, whilst acknowledging significant overlap.
In terms of presentation, it was decided to present the common themes across symptom categories first,
followed by material which was specific to the patients presenting specific symptoms. Codes were determined
to be common themes if they existed across at least three symptom areas. The pattern was followed for all
domains except ‘talking about symptoms’, which generally contained only specific material. As the analysis
progressed, it was possible to collapse a number of existing codes into larger categories. However some codes
remained as being mentioned by only one interviewee, and unless they were judged as yielding a particularly
valuable insight, they are not included in the analysis below.
The next five chapters cover the main findings from the inte