How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 99

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base, and was not formally embarked upon as a matter of systematically producing reductions in
psychotic symptomatology. With the other two types, psychotherapy with acutely ill patients tended
towards simplistic and basic applications of the most fundamental techniques. The impression given
from the interviews was that these were delivered in an ad hoc and sporadic manner by individual
clinicians, rather than being an overall framework within which the whole nursing team worked.
This observation remains valid even though interviewees occasionally mentioned wards where, for
example, hearing voices groups were held regularly. Strikingly absent was any mention of
psychoanalysis or the associated idea of defence mechanisms, although these might provide a rich
resource for understanding and construing patient behaviours.
The nursing focus to a far greater extent was focused upon being with patients in a supportive way
as a moral necessity and duty to those in psychological distress.. Beyond that, the priorities were
keeping patients safe, assessing their mental state, delivering medical treatment and physical care.
Communication was a vehicle to accomplish these important goals, through establishing
relationships and finding ways to negotiate and manage the hurdles posed by psychotic symptoms.
Psychotherapeutic strategies to directly counteract or reduce symptom were a much smaller part of
the overall picture of daily nursing care.
There is little in the way of evidence for the efficacy of any psychotherapy for inpatients with acute psychosis.
The only studies which have been conducted are those utilising cognitive behavioural approaches, and although
these have reported good results, they are insufficient in number and size for a high level of confidence in their
findings. Trials with inpatients present enormous difficulties. When patients are very ill, they often do not have
the capacity to give informed consent. Cooperation with therapy can be poor, and inpatient stays are relatively
short. Even the implementation of psychotherapeutic ideas into the general practice of inpatient psychiatric
nursing can be difficult (McCann & Bowers 2005). Nevertheless this is an important area for further
development and research as, if effective applications can be found and proven, they might pay big dividends in
reducing patients’ length of stay in hospital and separation from their normal everyday lives.
Some implications
What would be the outcome if all nurse-patient interaction was informed by and applied the techniques reported
by this study? They would certainly seem to enhance the possibility of cooperation and collaboration between
nurses and patients. If so the delivery of medication, accuracy of assessments, and physical health status of
patients might all be improved. It also seems logical to conclude that aggression and violence might be reduced,
either through the easier accomplishment of necessary tasks with patients, or through more effective and rapid
de-escalation with irritable, agitated and aggressive patients. As the risk of suicide amongst inpatients is as
much of a problem with psychotic patients as it is with those who are depressed (Bowers, Banda, & Nijman
2009) it is a possibility that better communication would reduce social isolation and hence risk. Finally it might
be supposed that patients who are in receipt of such a highly skilled approach might have a greater satisfaction
with the care they receive and potentially be more willing to be admitted to hospital on subsequent occasions,
without the use of legal detention. Whether this broad range of benefits can actually be delivered remains a
matter for further research.
The contents of this book are derived from interviews with expert practicing nurses about
interaction with acutely ill patients within service delivery settings. However the authors have
increasingly come to recognise that what is described here could be widely useful to other
professionals who have to deal with acutely mentally ill people (police, ambulance personnel, social
workers, general practitioners and psychiatrists), and to family and friends of the mentally ill, many
of whom have few sources of concrete advice on how to deal with the situations they face in their
daily contact with people who suffer psychotic disorders.
Increasing the skill set of nurses who deliver care to patients in inpatient wards will require some
changes to nursing education. Pre-registration nursing education will need to move beyond the basic
communication skill set which is currently taught. While the content of this still remains very valid
and applicable, this research has described additional techniques and strategies which it would be
valuable for every nurse to have &VF