How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 80

This book is in B&W, not color - Print page in Grayscale for Correct view! Getting things done When a person is acutely psychotic, they can be very difficult to manage. It is the nursing task to make sure that deluded, hallucinating, overactive, agitated and sometimes distressed people get sufficient sleep, get up in the morning, wash and attend to personal grooming, wear appropriate clothes, eat and drink sufficiently, etc. In addition attempts have to be made to build a relationship with them, foster social contact between patients, engage them in organised activities. At the same time nurses have to ensure that they take their prescribed medication, don’t leave the ward without permission, see various visiting professionals such as psychiatrists, avert or diffuse arguments between patients and prevent them from harming themselves. Suggest, not order (24/28) “But if you're just going in and using one blanket expectation for all and not really thinking about why it might be hard in one way for one patient and hard in a different way for a different patient then actually I think that, that means that they're maybe only complying because they may be frightened not to or intimidated into complying and actually it probably doesn’t help build the relationship and ... mean that they can achieve their next goals. So, yeah the inability to think about them differently and individually and work out what works best for that, I think that means that you’re more likely to get resistance and more likely to get people who maybe just comply because they’re a bit afraid not to.” The nurses reported that suggestions were better than dispensing orders, because they were more likely to elicit cooperation and helped to grow the relationship with the patient concerned. So, instead of telling people to get up or wash, the verbal formulae for ‘putting across a suggestion’ that were more likely to work were: ‘it’s 8 o’clock in the morning, are you going to get up now, do you want to have a shower?’; ‘this is usually the time where we do this and do you want to do that?’; ‘would you like to eat, would you like a change of clothes?’. This was the opposite of ‘being bossy’, ‘pressurising’ people, being ‘too domineering, or taking control, telling people what’s good for them’, telling them ‘what to do’. Even asking could be tricky on occasion, as ‘ if you ask them to do something that just by the mere fact that you’re asking them to do something they will become irritable’. Critical approaches, coupled with unrealistic targets for what patients could accomplish, with an undercurrent of anger and irritation from the nurse, were not likely to be successful, and might ‘provoke patients’ or evoke ‘resistance’. Worse still was ‘shouting’, ‘manhandling’, ‘threatening’ sanctions such as withdrawal of leave, and physical force such as ‘grabbing by arms and dragging and that’s just, that’s just terrible, trying to force people into things’. “Unsuccessfully has been to try and take over, and not really allowing the patient to think but sort of imposing a plan on them … very unsuccessful. I can think of an occasion where I did get very, very caught up in the patient’s anger and abuse, and she was extremely agitated … I’d rather it hadn’t have happened, because it was totally unproductive and it made me really think, I’m never doing that again because it didn’t make me feel any better, it didn’t make the client feel any better, it didn’t achieve anything.” Give reasons (15/28) “Things are really bad at the moment but it’s really important that we keep you hydrated, we keep you with some food because we are working to really help you and improve things for you. It’s important that we keep you physically fit as well because things are really difficult at the moment. So you’ll be trying to persuade them that we’ve got to try and do something about their physical health as well.” To generate motivation for and compliance with necessary tasks, nurses would give reasons and rationales for the behaviours they wished to elicit from patients. So the need to take medication and what effects and advantages it might have would be freely discussed with patients, as would the benefits of eating regularly, drinking enough fluid, having a bath, etc. Some really fundamental and obvious things might need to be spelled out for the patients, such as ‘eating and sleeping can help you cope with this challenging, distressing situation’, and getting dressed might help because For [email protected] Property of Bookemon, do NOT distribute 82