How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 77

This book is in B&W, not color - Print page in Grayscale for Correct view! “You have to be so un-agitated. You have to be like a block of ice really, like a block of stone, and that’s tone of voice, eye contact, where you place your hands, how much you move around, quick movements, the whole bit. You are like this great big boring slab of humanity in the face of this excited dot.” Touch/close vs. No touch/distant Nurses were cautious about advocating the use of touch. For apathetic withdrawn patients, one nurse suggested that ‘sometimes actual physical contact or reassuring physical contact, just by touching somebody’s hand or physical touch can be important’ however they also acknowledged that ‘if you come and sit too close to somebody who’s not ready for that, that can be incredibly intimidating’. In relation to hallucinations another nurse mentioned that ‘people when they’re very psychotic are, probably their spatial, their need for space is probably a little bit larger than normal, not true of everyone but it could be’. Interviewees were more likely to recommend or view touch as positive for patients who were upset and distressed (8/28): ‘and sometimes just putting maybe your hand on their shoulder to support them while you talk to them calmly’. However even here two nurses expressed caution, with one saying this had to be appropriate to the relationship’ rather than just the normal behaviour of the nurse concerned, and another saying that ‘it’s such an emotive thing … some people don’t want to be touched’. When it came to aggression and irritability, they were clear that personal space should not be ‘encroached’, and patients should not be touched (3/38). Short interactions (19/28) Somewhat in contrast to statements about patience, and giving adequate time to people without rushing them, nurses also emphasised the need for brief and focussed interactions. Perhaps the duration of the interaction reflected its purpose, with task and information seeking/giving likely to be shorter than relationship building and assessment interactions: ‘you really have to be very focussed on the task that you’re doing, so kind of very brief in your interventions’. Or perhaps it was that even gentle and slowly-paced interactions could still be conducted briefly, for example one nurse spoke about ‘small doses’ and ‘give the patient time’ within the same response. Keeping the interaction short was about fitting it to the individual patient, making it ‘tolerable for the person’, within their cognitive capacity or not adversely impacting on their mental state, for example ‘over simulating’ the overactive patient, engendering distress in a thought disordered patient who cannot understand what is being said, or igniting aggression from someone who is highly irritable ‘because usually, when people are very irritable, agitated, going on about things actually increases their irritability’. However changing mental state during interaction could also indicate a need for the nurse to change strategy rather than curtail the interaction: ‘usually been that when people are very agitated or feeling irritable or aggressive it’s usually because they’re quite distressed or frightened or disturbed by what’s going on around them, or the environment that they're in, so it’s usually a sign to maybe change something or do something a bit differently for them, or your interaction with them’. Brevity was also about making the interaction tolerable for the nurse, ‘trying to spend a length, any significant length of time with them would probably not work, and I think I would probably end up feeling frustrated’, and a pragmatic means to end a conversation that might otherwise have no reasonable end point: ‘and listen to them, but not forever because otherwise you’re one nurse, or one mental health professional down in the team because they will take you away for the full day’. Some of the nurses spoke about setting these boundaries by giving the patient timings in advance: ‘from the outset saying, I’m just going to see you for 15 minutes, and then trying to get into a conversation with them’. Frequent interactions (15/28) One way to provide time to patients whilst keeping interactions short was to increase the frequency of contact, ‘consistently going back’ and ‘building up a regular pattern so there is a familiarity there’. Nurses indicated that with this strategy it was necessary to remember the content across contacts, developing continuity despite fragmentation, and continuing (or reinitiating) tasks started For [email protected] Property of Bookemon, do NOT distribute 79