How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 79

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something and it’s, oh my God that must have been terrible, how dreadful’. It was important to
convey the message that the nurse could ‘tolerate’ the patient’s distress, ‘being calm and receptive’,
as ‘quite often distress is related to something that might well be very difficult to hear as well’.
Across the psychotic symptom spectrum, ‘seeming relaxed around the experience’ was said by
nurses to be likely to ‘help reduce it’, in addition modelling ‘good behaviour’ for the patient by
communicating that you are ‘comfortable’, ‘confident’ and ‘secure’. Acute anxiety can warp nurses
behaviour towards certain patients ‘they are terrified, they’re paralysed by her agitation because
they know anything, anything even slightly provoking will cause this massive explosion. So it
makes people not be honest with her, or give in to her very quickly where it’s not necessarily the
right thing to do, so it’s hard’. In crisis situations, where patients are shouting and waving their arms
around, it is quite natural for nurses to be frightened, however it was reported to be better if they
‘model a more effective way of dealing with it and be able to stay calm … and to emotionally selfregulate’. It could take nurses years to learn this skill, but once they could ‘channel any anxiety or
navigate that anxiety into quite a peaceful state’, ‘steady’, ‘appear unfazed’ and ‘in control’, they
were more likely to be successful in de-escalating such situations. However this was found to be
extremely difficult by some, and one nurse reported that with one terrifying patient ‘it was actually
a supreme effort to not make my fear of him very obvious’. Nurses’ anxiety was not just about
patient behaviour, it was also about failure, particularly failure when on display in the ward day
room with patients and trying to interact with difficult and challenging patients, a feeling of
‘pressure to do well’. Not being anxious in this situation meant being able to take the risk, and being
willing to publicly fail.
No frustration or irritation (25/28)
As with anxiety, reducing the expression of frustration was said to be important across the full
symptom spectrum, but was particularly relevant to dealing with aggressive and irritable patients.
The sheer amount of time and energy it takes to accomplish a simple task, for example obtaining a
patient’s menu preferences for the next day when he or she is thought disordered, can generate
considerable frustration. Such responses could generate a kind of vicious cyc