How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 82

This book is in B&W, not color - Print page in Grayscale for Correct view! 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, For [email protected] Property of Bookemon, do NOT distribute 84