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67. Ward culture of empathy

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Tea and empathy

Introduction

Mental health inpatient care is rooted in empathy – the ability to share in another’s emotions. This is the personal quality, and professional skill, that is most cherished by patients (but sometimes difficult to maintain when under intense and sustained pressure). Arguably, all the 77 ideas have empathy at their heart, whether it’s struggling to see a situation from the perspective of a highly disturbed, angry, potentially violent patient or imagining what it’s like for patients and visitors to hang around for hours waiting for the dreaded ‘ward round’. We love ward staff.

The core nursing qualities of compassion, caring, comforting, and kindness are rooted in one’s capacity for empathy, as well as all starting with a k sound. According to Webster’s New World Dictionary, “empathy” is “the ability to share in another’s emotions or feelings.” It is composed of two Greek words that mean “affection” and “feeling.” When people receive empathy, they feel loved and cared about. In other words they sense our compassion.

It’s one thing to start the shift off in a highly empathic frame of mind and mood. But it requires exceptional personal qualities, resilience and imagination to sustain this through the shift when some patients will be behaving in ways which are highly provocative and sometimes threatening. This is where mentalising is so crucial and helpful. (see Idea #7 Mentalising and features below). The more that staff can put themselves in the patients’ shoes and see things from their perspective, the better they can hold onto their sense of empathy – and thus their professionalism and sanity! Idea #10 Creative Communicating looks at practical strategies for maintaining one’s empathy in situations where patients (or carers, consultants…..) are behaving in very difficult ways.

Clinical empathy

“Often confused with compassion, sympathy, and other benevolent emotions, clinical empathy involves emotional resonance, but is distinguished by curiosity. Whereas sympathy involves feeling as if one were ‘in the same boat’ with another, empathy involves curiosity about another’s distinct experience. Vividly and specifically imagining another’s distinct world becomes possible with careful, attuned listening.”From ‘Narrative Medicine

Ward examples

  • Empathic (and therefore effective) leadership: Not simply telling or instructing staff but showing, role-modelling and coaching. For example, the ward manager does the patients’ breakfast each morning.
  • We can’t give what we don’t get. (Staff need to have caring, supportive management.)
  • Seeing in patients stuff that’s very painful in ourselves. Being able to use this therapeutically.
  • The displays a large poster displaying a list of emotional words which helps broadens everyone’s emotional vocabulary.
  • “At any given moment I try to become aware of the combination of strong feelings and emotions I’m experiencing: anxiety, suspiciousness, stress etc. Then I imagine these being intensified by 100% and it gives me an idea of how the patients I care for must be feeling”.

Empathic Wards

Being imaginative

  • Energetically considering what it is like for this patient at this moment
  • Finding creative ways of communicating with patients who are hard to engage
  • Using time with a patient on special observation to gently help them explore what led up to this
  • Making a special effort to welcome and reassure visitors
  • Consciously using body language and facial expressions to let patients know you appreciate how much distress they are experiencing
  • Understanding how much patients’ pets, plants, photos and plush toys mean to them
  • Displaying patients’ artwork in a validating way

Being honest

  • Knowing it’s okay to not know the answer
  • Giving honest feedback
  • Appropriately telling the patient how you feel
  • communicating your ‘sensings’
  • Knowing own limitations
  • Being gentle with yourself

Being mindful

  • Being aware of own responses
  • Sensing meaning
  • Ask patient focus group what empathy means to them
  • Introduce mindfulness sessions for staff
  • Regularly check in with your own experiencing

Being present

  • Relax more
  • Visualise parking own stuff before interacting
  • Feeling “at home” with patient
  • Focusing on what’s right in front of you
  • Being HERE, NOW
  • Being playful

Being accessible

  • “Checking in” with all patients
  • Approachability
  • Knowing that not all patients will approach you
  • Stating that ‘it’s okay to ask for help” on a poster
  • Display list of emotional vocabulary (see below) for staff and patients to see
  • Use a variety of means for expression, like art

Patient examples

  • We used to plan difficult events a long way in advance to help me prepare. It felt extremely supportive.
  • To me, the staff made the biggest difference to my day 🙂
  • I try to do something kind for myself at least once a day
  • I found when the ward worked together positively it gave me all the support I needed.
  • Sometimes it was hard to talk to staff if I felt worried about another patient. I felt like I was ‘telling on them’ but it was always handled very delicately and I would like to think others would do the same for me. In fact, they did.
  • I was gently encouraged by staff to start caring for myself. It was hard at first, but it got easier as each day past.
  • I preferred to spend a lot of time in my room and the staff understood this.
  • I was sensitive to other patients wishes. If they don’t want to talk, just smile and walk away and give them space.
  • If I found someone a bit too much I would go and occupy myself with an activity or speak to a member of staff.
  • I had a good cry on my second day in hospital. I wanted to cry in private so I was given a quite place and space to do this by staff. It released so much tension.
  • I really wanted to only have a short stay on the ward. So I took all the advice and help I have been offered by staff. It made such a difference.
  • A lot of the staff do go the extra mile. I don’t know how they put up with it all but they must be special kind of people. They’re definitely very patient.
  • The other patients are friendly and the staff are nice, too. There’s always someone on the ward to have a natter with.
  • I found it great when I could engage with staff in conversation that was completely unrelated to anything around me… I guess it made me feel more ‘normal’ and that there was a lot more to life than the illness.
  • I met some very nice and friendly people on the ward, both patients and staff. It’s nice to just sit around and drink tea with people.
  • You think that all staff have had a sheltered life and that they’re untouchable. But actually when you get to know them you realise we’re all in the same but and that’s kind of comforting.
  • I felt the staff understood that we were individuals as well as a group and made sure we each had our own time.
  • Not feeling judged is crucial in feeling understood.
  • When things were bad on the ward, it could quickly spiral out of control but when things were good the results were amazing. What a rollercoaster ride.
  • Occupational therapists can be great, preferably younger in age and streetwise. They speak to you like a close friend talking about unrelated topics of interest if necessary as a distraction. They show interest and understanding in them throughout the time spent with them.
  • Sitting outside with a member of staff is a nice thing to do.
  • You lose your normal routine when coming to the ward. But staff will help you start and stick to a routine while in the ward which helps.
  • I think that feeling like you are respected is very important and being listened to.
  • When you in hospital you’re at your rock bottom. But it’s there that you learn a lot about yourself. It takes some courage to face it all. But you’re never alone.
  • The staff were excellent, informative and caring and did their best with some very difficult situations.
  • I found that a certain level of understanding by others – that it is hard to be positive all the time – helped me accept the times when I just needed to pause for a moment.
  • The special people in my life are those that have kept the faith when I have all but given up.
  • The ward’s like a beacon. Finally there are people who understand.
  • I lost a lot of close friends when I was ill. They didn’t understand or want to understand why I felt the way I did. So on admission I felt pretty lonely and lost. The belief and insight I got from the staff and other patients was invaluable in helping me deal with this
  • When you see things others don’t and hear things others can’t – it is extremely frightening and lonely. Staff, friends and family were so patient and believed that this wouldn’t be forever. They helped me believe that too.
  • The staff didn’t judge me so for the first time in my life I could relax and not feel under pressure to meet everyone’s expectations.
  • After getting distressed the one thing that restores my hope is a cup of tea, a biscuit and a chat.
  • If in doubt ask someone if they want a cup of tea. I found that gets you talking with other people.
  • Whenever it rained we would all organise a cosy get together. Sometimes we brought our duvets from our rooms and get some snacks and just watch a DVD. It was lovely.

 

A little note from Marion Janner (founder of Star Wards)

Basically, if a patient is freaking out, this can provoke an almost reflex freaking-out response in staff, sometimes seen in the mayhem that can ensue when a patient cuts. As the mentalising gurus put it, non-mentalising begets non-mentalising. It is precisely at the time when patients have lost it that staff most need to very consciously hold onto their calm and reason. To keep mentalising! Two people yelling at each other is not a good situation! One of the deeply impressive aspects of inpatient care is that for the great majority of the time, staff do manage to stay calm in the face of huge and multiple provocations and perceived and actual threats.

 

Categories: Empathy, Wardipedia
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