How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 94

This book is in B&W, not color - Print page in Grayscale for Correct view! “If you give them a choice at all time, they may remain very agitated but at least then it can be channelled hopefully in the most, safest way.” Explain what the rules are and the reasoning behind them (15/28) To the aroused, irritable patient, any constraints on their behaviour can elicit angry outbursts. Nurses gave examples such as asking the patient to go to bed at a reasonable hour, eat, wash, wear sufficient clothing, not expose themselves, not come into the ward office, not shout be abusive or racist, not threaten or bully others, not leave the ward, not damage the furniture and fittings, etc. Demands from patients could also be unrealistic given the workload of the ward or other constraints. The nurses stressed that it was most important to explain to patients why these boundaries existed, and to explore with patients ways that their needs and desires could be met without the rules being broken: ‘it’s just giving them reasonable boundaries but most importantly saying why you’re giving them the boundaries’. Several nurses mentioned that instructions could be given quite forcefully, without the nurse themselves leaking any anger, frustration or irritation: ‘firm but not threatening’, ‘assertive but not aggressive’. It was possible to be forceful ‘without shouting at someone who is already irritable and aggressive, and telling them what they’ve got to do, it can provoke patients’. “Honesty and empathy and if that means that you’re trying to get somebody to avoid doing something that they want to do then you have to explain that that’s what it is you’re trying to achieve for them.” Describe consequences (5/28) Nurses also stated that it was sometimes necessary to explain to patients what would happen if they continued to behave aggressively or became physically violent. These nurses suggested that patients could feel ‘out of control’ and needed the staff to show competence, confidence, and the ability to contain their behaviour. They spoke of explaining ‘consequences’, ‘repercussions’ and being a ‘little bit inflammatory, a little bit threatening’. References in the text made clear that these consequences included severe containment methods (restraint, coerced medication, seclusion). Forceful containment (16/28) In acute situations, where necessary to preserve the safety of patients and those around them, nurses spoke about manually restraining the highly aroused patient, given sedating medication (by injection if necessary), or placing the patient in seclusion. However three nurses’ recounted incidents where they had seen patients restrained too quickly, before any discussion had taken place with them about why they were angry, and objected to this, considering it to be poor practice. Debrief later (7/28) When there has been a violent incident, then at a later point, perhaps the next day, this needs to be explored and discussed with the patient concerned, ‘you need to try and let me understand what’s going on, how can we stop that from happening again’. This process involved asking the patient what had happened, to give reasons for behaving the way they did, and exploring with them what the consequences were for others and themselves, all with a view to increase the patient’s empathy, understanding, anger management skills and social skills in conflict expression. Perhaps also identifying trigger points where interventions could be made by the staff and patient together at an earlier stage, should the situation be repeated. This was also an opportunity for the staff to explain to the patient why they did what they did (for example, seclude the patient for an hour), in an attempt to prevent the patient from ‘holding any grudges’. If there has been a conflict between two patients, then a similar process can be undertaken: ‘I’ll always get them to sit down and talk to each other’. Advance directives (8/28) Outside of a crisis situation, when the patient is relatively well, not agitated, overactive, irritable or aggressive, then is the time to negotiate what to do and how to handle the situation should it recur. The patient can then choose what he or she feels is the best strategy that is most likely to succeed. One nurse gave a detailed account about how such an advance directive could be negotiated, with For [email protected] Property of Bookemon, do NOT distribute 96