How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 67

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Consult friends and family (9/28)
Either to provide information on patients usual interests in order to utilise this to facilitate
conversation, build relationships and set achievable goals for improvement, or in order to elicit
support and help for the patients themselves. It’s about trying to hook in to see if there are any
hooks in what they're interested or what they’ve been interested in in the past, ring their parents to
see if you can find out”.
Choose the right nurse (16/28)
Sometimes it was important to choose the right nurse to make the approach. This was perhaps
particularly important in choosing who would lead on trying to de-escalate tense situations, but was
also relevant for choosing who would be more likely to be able to ‘give reassurance’ to a distressed
patient, calm an agitated patient, or win co-operation from a reluctant patient for medical
investigations or whatever. The relevant issues for such a judgment were the nurses’ age, gender,
culture/ethnicity, relationship with the patient, available skills, and sometimes intangible elements
to do with the interpersonal styles of individual nurses and how they fit with the patient concerned.
“If someone’s very distressed or there’s been very bad news then that’s certainly appropriate time
for nurturing … if you’ve got someone who’s able to do that at that point then often more
experienced member of staff or someone in, older. So even someone just, who they get on well
with. So hopefully you’d be looking at who was, who you consider the most appropriate person to
be.”
Choose the best time of day (14/28)
Nurses noted that symptoms could ‘alter quite a bit even during the course of the day’, and ‘that
would alter what you can do with them’. Energy levels could also fluctuate, influencing the likely
success of trying to get a task or activity completed, as well as engage successfully in conversation,
or patients could be more relaxed at certain times. Nurses therefore looked for ‘windows of
opportunity’ to get things done.
Choose location (22/28)
Selecting the right environment for conversation was deemed to significantly affect the likelihood
of success. Several aspects were mentioned, the most frequent being trying to secure a location that
did not over stimulate the disturbed and symptomatic patient. Corridors on the ward were
considered particularly problematic, because ‘there’s lots of other stuff going on’ and ‘you’re dead
in the water’. Too much stimulation from other activities, people, noise and conversations was
thought to exacerbate psychotic symptoms such as irritability, overactivity and hallucinations:
‘the wards are so chaotic that if in your head you’re very chaotic at that time, then obviously the
chaos of the ward and the hustle and bustle of every day living is going to be, it’s going to be,
exacerbate those symptoms’.
Drawing the patient into a low stimulus environment was thought to be particularly important for
angry patients who needed to be de-escalated and calmed. A further gain fro