How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 66

This book is in B&W, not color - Print page in Grayscale for Correct view! ‘any member of the public would be laughing’. One interviewee reported: ‘when I see it, trust me, I deal with it, I don’t like it. You should never disrespect people’s beliefs even if you know that they are delusional beliefs.’ It also meant a commitment to trying to establish and hear the patients’ point of view, rather than just control their behaviour through verbal instructions; being polite and apologetic to angry and agitated patients. One subject explained that this was the opposite of a confrontational and authoritarian style, and that the same thing can usually be communicated in ‘a respectful quiet manner’. Respect was also about not being condescending, critical, demeaning, treating patients like children or ‘making them look silly in front of their friends’. Instead it is about giving them as much independence and responsibility for themselves as possible, while at the same time acknowledging their personal reality and symptomatic experiences. “This man for example, he would write things out by hand. And I’d get them typed up. And they were very delusional. But what was fascinating if you read them, and he had certain beliefs about how nurses should interact with patients. He wanted to give the ward something as a professor of ethics. So I got them typed up. And when they were hand written they looked complete, it was all big writing. But when you typed them and read them, although they were delusional, you could make sense of th em in a weird sort of way. And I think by treating him with respect you can get to a core of something he’s trying to communicate, and I think it’s that level of respect, it’s that level.” Preparation for interaction and its context Again, most of the material under this heading was generic to patients exhibiting all symptom areas. However some of the specific choices were differently nuanced, and these are described below where relevant. Observe first (20/28) Before choosing to try to interact with a patient, it was recommended that the nurse ‘observe’ or ‘read’ the situation, ‘gauging how somebody is’. This would allow the patients level of distraction by hallucinations, mood, agitation, irritability or other symptoms so that the appropriate approach can be made. To do this required nurses to ‘have some experience in reading into presentation, symptoms and how to deal with each presentation’, looking at their behaviour, facial expression, movement, perspiration, respiration, hygiene, neatness and other nonverbal cues. It was accomplished by ‘being peripheral … taking a seat, watch for a bit, get a sense of what’s going on, how that person’s impacting on other people’. Such observation, reflection and assessment continued once conversation was started, so that the nurses’ responses could be continually adjusted to the patients’ behaviour: ‘one moment she was charming, the next moment she was quite aggressive and I think that, I noticed the longer the conversation was going on the more it, she was inclined to become aggressive just because of the impatience’. One nurse referred to this as ‘treading very carefully’ because patients could respond in unpredictable ways due to their symptoms. Consult case notes (9/28) The previous case record was a source for three very useful pieces of information. Firstly the patient as a person, their ‘background’ and interests, thus yielding potential topic for conversation or type of activities that they would be more likely to respond positively to, or which could be used to counter some of their symptoms. Secondly, it provided information on what interventions and approaches ‘had worked in the past or hadn’t worked in the past’ with this particular person. Lastly, the record provided information on the level of risk posed by the patient, whether they had been violent in the past and to what degree, what things are likely to ‘make the person more irritable’, or whether ‘their bark was worse than their bite’ and they could be approached with a greater degree of confidence. “You have to gather as much information as you need in order to have any kind of contact or interaction with a patient with any diagnosis”. For [email protected] Property of Bookemon, do NOT distribute 68