"Everyday engagement"

The Mental Health Nurse: ‘I connect with my patients by absorbing their history’

Wednesday, January 27, 2016

Jess* is a Deputy Ward Manager in an NHS mental health unit. We spoke to her about communicating with the patients in her care and the everyday skills that help her do her job. Here’s her story. 

Mental health wards are different to general wards.

We spend a lot of time engaging with the patients. Most of my patients are older so this includes everything from helping them get up and wash to having a cup of tea and a chat.

You have to embrace your inner chameleon.

Knowing the best way to speak with each of your patients is the key. I’m naturally quite bubbly and jovial. Some people appreciate that, but some patients prefer to be addressed formally.

The only way to figure out which is by absorbing their history, speaking to their family and trial and error. You have to be adaptable.

Listening is the most important skill.

Some people don’t understand how much validation and stating the obvious helps. You’re massively influencing each patient’s life – sometimes against their will – so it’s important that you acknowledge their feelings and show you value them.

The trick is to approach every situation thinking – ‘what’s the least restrictive option here?'

Never underestimate the power of a cup of tea.

It makes an amazing distraction. If a patient is distressed I have a clear process to follow. First, check the environment – get them in a room by themselves if you can. Nobody likes to be embarrassed. I’ll offer them a cuppa and try to find out why they’re unhappy.

A lot of confused people just want to have their frustration recognised. ‘I’m sorry you feel upset,’ has immense power. If I can do something to help them I’ll do it, no problem – if I can’t then I’ll find the next best option.

If someone wants cigarettes or to go to the beach and they can’t, I’ll offer to go to the shop for them, or sit in the garden with them as a compromise.

If they become a risk to themselves or others, the only option may be medication or some time in an environment with reduced stimuli. Getting the communication right is crucial at this point, but we’re all human and mistakes happen.

After incidents like this, it’s important to debrief with your team. And when your patient is ready, with them. 

Always take the least aggressive option.

The trick is to approach every situation thinking ‘what’s the least restrictive option I can take?’

Say you have a confused patient who believes she’s still in her house and used to take pride in keeping it tidy – you could give her a rag and let her help you clean. It’s keeps her calm and gives her a sense of control. There are many activities like this that help your patients express themselves.

Communication is essential in this environment – it’s no good coming in and not interacting

Making a connection can be difficult – but worth it. 

We had one gentleman with dementia and underlying infections. He was aggressive and resistant to treatment. He just screamed and tried to hit the nurses.

I could see that he was really frightened and confused – my gut told me that he was in pain. I sat with him for three nights, trying to get him to eat and take his medication. On the second day he ate a piece of toast and that felt amazing. I felt like there was a connection there, like we’d turned a corner.

The third day, he asked me for a cup of tea and teased me a bit about my accent. I was so happy to hear him talk I didn’t mind. And I was right – he was in pain.

At first he was scared but I said ‘I’m going to help you, I won’t leave you alone’.

I helped him wash and use the bathroom, then put him to bed and held his hand. When he woke up the next day he spoke in full sentences and we chatted for hours. Afterwards he thanked me and he’s one of the few patients who still remembers me when I see him.

Mental health isn’t all about pills and drugs... it’s more about changing people’s attitudes and helping them resolve problems

My staff have a shared language.

Maybe it’s because we rely on non verbal communication with our patients, but you learn to see the signs that someone’s having difficulties. If they’re struggling the rest of the team tries to protect them and lighten their load so they have an easier day.

When a patient is upset and a nurse is getting worn down, all it takes is a look to show them you can take over. It’s a smooth transition and there’s no shame – they just weren’t the right person at the time. A new face will do wonders to calm a patient.

Openness is essential in this environment – it’s no good coming in and not interacting with your crew. People who don’t join in don’t last long.

Communication over medication.

Mental health isn’t all about pills and drugs. Medication plays a part but really it’s about changing people’s attitudes and helping them resolve problems – finding the root cause of their distress.

You need a lot of patience and enthusiasm to do this job. You’re going to have bad days where you don’t want to go in to work. But then you’ll have amazing days where you realise how much you love what you do.

About the project

The Everyday Engagement project is a series of interviews exploring the ways people communicate and connect in day-to-day life.

We want to learn about the instinctive skills and insights used in different professions, especially from people who deal with a spectrum of human emotion.

If you’ve got a story to share please get in contact.

More in this series:

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