nursingforsocialjustice

If you work in mental health and you do not know the meanings of the words transference and counter transference, and/or you do not know what the implications for experiencing transference or counter transference are on your practice please look them up. Understanding of both are integral to your nursing practice.

It’s a problem if everyday at work most of the patients in your care are not only angry, but angry at the health care staff that are trying to help them. The basis of the entire nursing profession is care (see the works of Sister Simone Roach for more on this). If you do not know who Sister Simone Roach is, I strongly encourage you to read her work (for example see:https://online.stmary.edu/rn-bsn/resources/the-5-cs-of-caring). However, I think that this begs the nurse to ask the question, “why are the patients in my care area (or the patients in my care) so angry when I am trying to help them,” and come to some understanding about what this anger is all about. We need to get past a description and try and understand the what underlies it. We need to get past “patient agitated” and get to a place of using our genuine curiosity to understand why, and also how to help.

I will share a short anecdote. I was working a shift once, when the relationship between the staff and the person providing care was not therapeutic, in fact many of the the relationships with many of the patients in the person’s care were not therapeutic. And the attitude that the person giving care took was as such: “if they like me, then I’m not doing my job right” (that may or may not be a direct quote). And, in my head I asked the question, “what exactly is your understanding of your job, and how do you think you can possibly do a relationship-based job, where therapeutic trust and rapport is the central feature, when you have established none of those things with the people you are caring for?” From my perspective, it seemed that there was some misunderstanding of the caregiver role.

I am going to go out on a limb and take what I think may be an unpopular opinion here, but, if you are the person who feels so unlucky because almost every shift you work someone is screaming at you, or some sort of adverse incident happens, much more so than to your co-workers, then it might not just be that you are unlucky. Thinking about this is part of reflective practice. There may be a need for some serious self-reflection, seeking of peer feedback, and clinical supervision to get to a point where skills are developed to build therapeutic rapport and foster trust and respect patient and person providing care.

I will leave you with this practice exercise.

In your next patient interaction try using these:
Genuine Curiosity
Tell me more about that.
Help me understand how you came to that decision
What did that mean to you?

Instead of these:
Judgement
Why did you do that?
You should have done…

And leave space for the patient/client to answer. Count to 10 in your head if you have to.

Peace,

Michelle D.