How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 82
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step’ as mentioned by nurses was that of gradually increasing expectations about what patients
would do, as they recovered from their acute symptoms: ‘so it went from the non verbal, well it
went from the isolation, to the non verbal, to watching TV together, to talking, to coming out and
eventually eating in the dining area … it was a very gradual and a slow process over a matter of,
couple of months’.
“To make a bed for example, and to ask them in terms of helping me precisely what I want them to
do, so it’s not just, oh help me make the bed. It’s, can you get the pillow out of its pillowcase? Can
you put the pillowcase on? Really breaking down tasks and making it very simple for them to be
able to understand and achieve, and, yeah so very focused, very specific and probably not anything
that’s going to go on for too long.”
Avoid, defer or postpone tasks (13/28)
Somewhat similar to choosing the right time of day, there were times that it was better to avoid
when trying to complete a task with the patient, for example when he or she is especially agitated,
irritable or upset: ‘just leave the tasks that I know are going to cause conflict’ or ‘calm them down
before you actively involve them in things’. So non-essential tasks could be avoided and postponed
to later in the admission, and even essential tasks such as getting the patient to eat and drink could
be carefully timed to maximise the chance of success: ‘but they might be hungry later on and I will
be able to give them some sandwiches, some toast, some biscuits, or whatever is available’.
Maximise task choice and attractiveness (16/28)
Ordinary everyday tasks can be made more attractive with some care and preparation. For example
one nurse described making bathing easier for patients: ‘if you say, I’ve run you a bath and I’ve put
lots of nice soaps in it … I’ve got this really nice new bubble bath and I’ve got some nice clean
towels’. This approach to improving patients’ hygiene was recounted in almost identical terms by
several of the nurses. Alternatively if the important thing is to get the patient engaged in any
activity, then having a wide range of things to do can assist in finding something that he or she can
respond positively to, ‘just offering something that might interest them’ and ‘you’ve got to offer
them choices’. “I had somebody who was very withdrawn, wasn’t interested in any communication,
but had a dog and just trying to sort out a dog has made him come out of the shell and from the little
things, the door will open”.
Prompting (10/28)
Being with the patient while the task is getting done, and giving gentle reminders and prompts,
almost like a form of coaching: ‘shall we do this now’. Even more basically, some patients might
need reminders to continue to eat and consume the food on their plate, or drink what is in the glass
in front of them on the table: ‘it’s trying to gently remind them to keep on course with the task
they’re doing rather than going off all over the place, without pressurising them, to gently remind
them oh, you were having
your dinner’. Such prompts are ‘just a reminder to bring somebody back into the here and now,
rather than whatever else is happening, the other distractions in the persons mind’. As an
alternative, a written list of instructions can be provided: ‘if they’ve got a simple task like making a
sandwich, if you write it out in five statements … they can keep going back and looking at it, and
seeing what they're supposed to be doing’. The prompts and reminders help patients stay on track
when they are overactive and their thoughts skip from topic to topic too fast, or when thought
disordered or distracted by hallucinations.
Positive feedback, encouragement (13/28)
Recognition of the difficulties patients experience and praise of their progress towards
accomplishing a task, were critical ways to keep them motivated to complete the task in hand: ‘it’s
positive reinforcement, you do something good, you make that person feel good about what they do,
I think that works’. Constant reassurance that they are doing well, coupled with acknowledgement
of the effect their mental state has on their ability to do such mundane tasks. Highlighting their
abilities and successes can help energise patients, as ‘even if it’s only a very small goal, to the
patient it might be really, really big’. All this has to be accomplished without being patronising,
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