How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 90
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delusions could be soft and malleable, enabling nurses to argue and present evidence that was
quickly reassuring for the patient, by checking under beds, in rooms and cupboards etc., for the
threats the patients believed were there, or demonstrating that the things with which patients were
preoccupied were not actually occurring. Reassurance in such cases tended to only work on a short
term basis, ‘because it comes back very quickly’, but was helpful to the patients concerned.
Don’t collude (17/28)
Agreeing with the patient about the veracity of their delusions, perhaps in order to avoid difficult or
tense conversations, or for fear of what might happen if they challenge the delusion, or to get the
patient to go along with a particular course of action. This was not seen as acceptable behaviour.
Many nurses indicated that this was primarily a matter of being honest with the patient. While not
wanting to dismiss or deny their delusions, nurses could not allow themselves to confirm them
either. So if a patient put them in a position where they had to express a judgment, the nurse would
say things like ‘I understand that these are the thoughts you are having’ but that the belief was not
shared. In this way nurses could maintain themselves as a ‘reference point’ for patients.
Ignore the delusions (6/28)
With fixed and longstanding delusions, some nurses indicated that it was better to ignore them and
give up on any attempts to change them: putting them on the back burner and not putting an
emphasis on them sometimes can be really useful as well’. Instead they suggested ‘looking again at
what might be meaningful activities in his day, and what he might like to do, and being positive
about other activities’, ‘making the most of bits that aren’t affected by the delusion’.
Find workarounds (9/10)
When the delusions are of an intensity of nature that they interfere with patients’ daily lives,
particularly basic functions like eating, drinking and washing, then ways to work around the
delusion have to be found. Several nurses spoke about dealing with patients who thought the food
and/or drink was being tampered with or poisoned, and suggested allowing the patient to select his
own food, tasting it first for them, or providing it as supplied in sealed containers that the patient
can undo themselves.
Thought disorder
Overall, thought disorder was not clearly understood by all the interviewees, and advice on how to
deal with it and respond to it as a topic rather scant. Several interviewees considered that thought
broadcasting and thought insertion (with related delusional ideas) were thought disorders.
A number of different suggestions were mentioned by only one interviewee as opposed to several,
including: distracting the patient; reminding them they have got through this experience before; not
challenging the thought content; explaining the physiological cause; and helping family and friends
to understand.
Acceptance and listening (15/28)
Nurses answers did not so much focus on thought disorder as a topic of conversation or a
therapeutic target; instead they circled around what it was like to try to engage in normal
conversation with a patient who was severely thought disordered. In this regard it was noted that
‘the conversation can veer very quickly to all kinds of places’ and ‘cover some very whacky
themes’, nevertheless to stay with the conversation meant ‘you could have a social connection with
a person when perhaps that’s quite rare for them’. To accomplish this required nurses to give plenty
of time for the patient to express themselves, be ‘calm’, ‘non threatening’, ‘not putting too much
pressure’ and ‘not bombard them with questions’.
“I follow people's tangents that they go on, I'll just go with them on the ride essentially. And often I
think people on the surface are not making much sense, but … even if you range over many topics
you often will, it will fall around particular themes which then gives you an insight into who that
person is, and what's most important for them as well. And also how that style of thinking is
affecting them as well, and what's preoccupying them and how that might get in
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