How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 93

This book is in B&W, not color - Print page in Grayscale for Correct view! “I’ve had a client before who when he's felt the mania coming on, he's gone running, because he was a runner anyway, so he'd go and jog for three or four miles, and come back and feel a lot calmer about things.” Distract, calming activity (9/28) If a patient is becoming irritable or agitated, it can sometimes avert escalation, or even resolve the situation, if they are distracted by engagement in other activities. Nurses suggested ‘watching a movie’, ‘playing pool or table tennis’, ‘a jigsaw puzzle’, ‘listening to music’, ‘looking at the paper’, ‘walking or pacing’, cup of tea or coffee, converse about other non stressful topics such as their ‘family or job’ or recent nice events on the ward. Request lowered arousal (6/28) When a patient is becoming more irritated and agitated within the course of an interaction with staff, they might not be fully aware that they are raising their voice and starting to shout. It is possible at this point to ‘just ask them to, I am here, I am listening and I want to help you to think but actually I can't really understand what you're saying when you're shouting, you might want to sit with me or you might want to talk to me more quietly and then maybe I can think about what you're saying’. Relaxation (7/28) Simple relaxation techniques could be offered and taught to patients, including slow, deep breathing: “I've seen nurses do relaxation techniques that I would never have thought that someone that agitated would be able to manage and they have managed it so yeah, as I say I was quite surprised, I didn’t think at that level of arousal that relaxation would work but it did’. Don’t argue or confront (14/28) Becoming aggressive, raising one’s voice with all the accompanying body language, was widely reported to be counter productive. This was referred to in different ways, including being ‘threatening’, ‘inflexible’, ‘confrontational’, ‘over challenging’, ‘laying down the law’, ‘too hard’, or ‘pushy’. Relationship leverage (7/28) A pre-existing good, trusting relationship with the aroused patient can help any crisis calm down much more quickly. Nurses recounted specifically referring to and using their previous relationship with the patient who is aroused, reminding them who they are and how long they have been working together: ‘you can refer to your relationship you have with them, you can say we, I know this is something that keeps cropping up and really rubs you the wrong way, I remember we spoke about that … people are less likely to try and take a swipe at you for a start’. Give choices, empower (14/28) Once the initial complaint or issue had been thoroughly explored and defined, the interviewees spoke of the necessity to involve patients in decision-making and finding an acceptable resolution. Such resolutions could result in issues being raised with the patient’s consultant psychiatrist or other practical changes. Involving patients and giving them options gave them ‘routes out of the situation’, and meant they were not placed in ‘a psychological corner’ from which they might come out fighting. Finding compromises and solutions through negotiation meant that nurses had to be ‘flexible’ rather than rigid about ward rules, what could and could not be done. Where the high arousal was a consequence of psychiatric symptoms, it was not so easy to find ways to solve them, other than enhancing the patients own coping strategies or other interventions as explored in previous sections, whilst waiting for treatment to take effect. For [email protected] Property of Bookemon, do NOT distribute 95