How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 85

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could still also be asked about their feelings and experience: ‘I would look at actually getting them
to describe their feelings and how they feel, what’s going on for them within’. Respecting that
experience involved not putting such patients under pressure ‘to be what they are not’ by an
approach which is ‘too animated’ or ‘forcefully’ putting them ‘in social situations that they might
not handle at that point’. It also meant not ‘ignoring’ the apathy and withdrawal as if it were not
there, but talking about it, ‘acknowledging how they’re feeling’ and approaching them for durations
and activities that they could reasonably tolerate. Several of the nurses spoke about apathy and
withdrawal being meaningful behaviours with reasons, and stated that ‘you had to acknowledge
that’ and try to ‘understand the position they are in’ because ‘it’s always a different reason for why
they are withdrawn’.
“I think it’s important, if they are withdrawn there might be reasons for it, and you need to
understand what reasons they are. They might be scared, they might be worried about any
environment, they might not know what’s going on, and so you have to respect that.”
Mutually explore causes (7/28)
Nurses indicated there were ‘hundreds of reasons’ why someone might be in this condition, and in
addition to acknowledging and respecting it, it was necessary try to ‘to work out from them why or
explore the reasons with them, why they’re feeling the way they’re feeling’. One way of getting to
this information was by suggesting a task or activity to them, and then exploring their feelings about
it or reasons for declining: ‘say think about what might be beneficial, exploring why they haven’t
done that, exploring why, if there’ve been concerns why do they think other people are concerned’.
Alternatively nurses might offer the interpretation that their experience is a ‘symptom of the illness
they may suffer from’.
Negotiating and agreeing a care plan (7/28)
Nurses said this was far preferable to using force or trying to coerce the patient to do things. Instead
they advised negotiation, ‘forming a plan with the patient’ and they argued that this approach based
on ‘kindness’ worked better. Such a plan had to be realistic in terms of what was expected from the
patient given their mental state. Such agreements ‘to try to do something together’ could not
necessarily be reached quickly with apathetic and withdrawn patients. One nurse described several
days of trying to maximise and increase contact with such a patient who was virtually mute, in an
unwashed and dishevelled condition and spending all of her time in her bedroom. By utilising every
possible opportunity, eventually the patient spoke to her, and once communication was established a
care plan was written and discussed with her, which she agreed to. Only then was it possible to get
her into the bath on a consensual basis: ‘just that relationship that existed between me and her
enabled me to actually succeed in that’.
Structure, routine and purpose (5/28)
A number of different means to accomplish this were reported, including establishing a reward
structure of some sort, utilising desired activities such as going for a walk, out to the shop, leave
opportunities or progress towards discharge. Alternatively plans and timetables for the day could be
agreed, diaries of activity kept so that progress can be made visible. Rating scales could be used and
the results placed on a wall chart in the patient’s ro