Emotion Matters€¦ · Expressing emotions Emotions don’t exist in isolation 2 Emotions Intended...

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Emotion Matters A Resource for Health & Social Care Professionals working with Adults with Long Term Physical Health Issues Click anywhere to continue

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  • Emotion MattersA Resource for Health & Social Care Professionals working with Adults with Long Term Physical Health Issues

    Click anywhere to continue

  • About this resourceEmotion Matters has been developed as a joint project between the Psychology Directorate (Physical Health and Psychological Interventions teams) and the Self-Management Team in NMAHP in NHS Education for Scotland. The aim of this resource is to increase understanding and awareness of the psychosocial implications of living with a long term condition as well as provide some skills that will enable holistic, collaborative and person centred care.

    The module takes up to an hour to complete.

    Who is this resource for?Emotion matters is for all health and social care professionals working with adults with long term physical health issues.

    A resource for working with children has been developed by NHS Education for Scotland’s Children and Young Person’s team in the Psychology Directorate.

    How to use this resourceEmotion matters can be used in a number of ways:l If you are a team leader or clinical manager you could

    use this tool with your staff members as part of CPD or teaching and development work.

    l As part of your induction or CPD. If you are a member of staff working through the module, we would encourage you do the module with a colleague or member of your work team to get maximum benefit from the exercises. In the exercises you will see we have mentioned working with a ‘buddy’ .

    l Throughout the sections we will direct you to links that you can follow if you want to explore any of the topics in more depth.

    l It may be helpful to use this module alongside the following resources:

    © NHS Education for Scotland 2018. You can copy or reproduce the information in this document for use within NHSScotland and for non-commercial educational purposes. Use of this document for commercial purposes is permitted only with the written permission of NES.

    http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4021345/NESD0010%20Psychosocial%20Interventions1.pdfwww.effectivepractitioner.nes.scot.nhs.ukhttp://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/self-management.aspxhttp://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/self-management.aspx

  • What is a Long Term Condition?Long term physical health conditions, or chronic diseases,are conditions that last a year or longer, impact on aperson’s life, and may require ongoing care and support.Common long term conditions include epilepsy, diabetes,heart disease, chronic pain, arthritis, inflammatory boweldisease, asthma and chronic obstructive pulmonary disease(COPD).

  • ContentsSection 1Introduction 4

    Section 2Emotions 11

    Section 3Adjusting to a long-term physical condition 27

    Section 4A good collaborative relationship 38

    Section 5Tools 45

    Section 6Handling distress 60

    Section 7Looking after yourself 68

  • Introduction 1

  • 1Intended Learning Outcome

    Have an understanding of the psycho-social aspects of long term conditions, and the impact it can have on a person and apply this to your routine clinical practice.

  • 1You may wonder how thinking about emotions can be relevant to your role in working with people with long term physical health conditions.

    The Health and Social Care Alliance (formerly Long Term Conditions Alliance Scotland) held a series of events to capture the experiences of people with Long Term Conditions and their carers. This was published in a report in 2011 called ‘Emotional Support Matters’.

    Their key finding was: People with long term conditions want holistic support that includes emotional and psychological support as part of an integrated service and not just as an ‘add on’.

    The report further shows that offering holistic support means practitioners offering empathy, support for self management, collaborative relationships where knowledge is shared, and individual needs and values are respected and considered. It also means seeing people with long term conditions as more than their condition and understand that they have lives, dreams, ambitions, families, friends and hobbies. In other words, understanding the bigger picture – there can be times when a long term condition impacts on life, and times when life impacts on a long term condition!

    Click on this link to access the entire document: http://www.jitscotland.org.uk/wp-content/uploads/2014/11/Emotional-Support-Matters.pdf

    http://www.jitscotland.org.uk/wp-content/uploads/2014/11/Emotional-Support-Matters.pdfhttp://www.jitscotland.org.uk/wp-content/uploads/2014/11/Emotional-Support-Matters.pdf

  • 1Lets hear a bit more about people’s views:

    I’ll never be ableto do all of this

    Don’t be scared toask about how I feel

    Human kindnessgoes a long way

    I wish they hadasked me how he

    was coping

    Listen . .Give me time

    [email protected]

    Emotional support . .It’s not an add-on extra

    Will you listento me . . Yes, Iam frustrated

    Harm can beemotional too

    [email protected]

    https://vimeo.com/69073697

  • 1Our role as health and social care professionals, in supporting a person with LTC, is to try to use our professional skills to help minimize any restrictions or difficulties. The LCTAS report says loud and clear that people with LTC want us to work in partnership with them and to focus on their life as a whole and not a narrow aspect of their condition.

    The can of wormsIt is not uncommon for health professionals to shy away from asking questions about emotions for fear of opening up a can of worms or feeling unqualified to manage people’s responses. If you listen to people with long term conditions they are not asking you to suddenly become a counsellor or psychologist. They want you to be an expert in your area but ask that you acknowledge they may have strong feelings (anxiety, frustration, distress) relating to their condition. They want you to offer compassionate support and take their emotional needs into account when treating their physical symptoms.

    This resource aims to help with this, by helping you to understand more about emotions, increase your confidence in acknowledging emotions and the impact they have on a person with a long term condition, and give you some tools and tips that you can use.

    It is based on a ‘strengths’ or ‘assets’ based approach that means working collaboratively with people’s strengths so that together you can find the best outcome and the way to move forward.

    Remember just because someone has a long term condition doesn’t mean that they have a mental health problem, but having a long term condition can throw up psychological challenges and the right kind of support can help a person manage their condition.

    What’s the Evidence

    The Policy Context

    http://www.kingsfund.org.uk/publications/long-term-conditions-and-mental-healthhttp://www.health.org.uk/https://www.mentalhealth.org.uk/publications/living-better-report-summaryhttps://www.nice.org.uk/guidance/cg91http://www.gov.scot/Publications/2007/12/11103453/0

  • 1Summary

    l People with long term conditions have feelings and emotions about their condition.

    l They want us to acknowledge and work with their feelings more

    l Being aware and offering emotional support can be very helpful for a person with a long term condition when dealing with particularly challenging aspects of their conditions.

    l Working together in a way that acknowledges the strengths a person with long term conditions has is the most useful way of supporting someone going through a challenging time and can improve health outcomes. It also sets the scene for working collaboratively which is the best way to improve treatment and care.

  • EmotionsWhat are they?Expressing emotionsEmotions don’t exist in isolation

    2

  • 2Emotions

    Intended Learning Outcome

    Have an understanding of emotions, how they are expressed, the thoughts and beliefs that people hold about their health and apply this to your routine clinical practice.

  • 2Emotions

    l How do you respond to the emotions, fears or worries of the people you work with?

    l Do you feel confident in knowing how to respond?

    l Do you sometimes try to change the subject or latch on to the least threatening part of what the person is saying?

    l Do you jump in and try to make the person feel better or less worried?

    l Do you sometimes plough on and continue to focus on what needs to be done in the time you have?

    l Do you try to reassure the person or tell them it’s OK?

    l Are you worried you may open a can of worms and not know what to do then?

  • 2Emotions

    Emotions – what are they?

    Emotion (noun) – a strong feeling deriving from your circumstances, mood, or relationships with other people.

    It is normal to ‘feel’ something about everything we do and we are so used to this that we don’t even consciously think about what we are feeling. Let’s spend some time now thinking a bit more about emotions...

  • 2Emotions

    sadhappycrossguiltyshockedmiserablefrustratedokayashamedangryscaredexcitedragingupsetterrifiedcalmfrightenedpanickymixed-uphopefuldespairingnumbdevastated

    Exercise 1You will see that within this bag are a whole lot of emotions. Have a look at them.

    Indicate whether you think the emotion listed opposite is positive or negative’.

    Go through the list again and select the emotions you would be happy to deal with in your consultations and the ones you really don’t want to have to deal with or would not feel confident dealing with.

    Why are the feelings you ticked difficult to deal with?

    Pos

    itive

    +

    Neg

    ativ

    e–

    Hap

    py to

    de

    al w

    ith3

    Not

    hap

    py

    deal

    ing

    with

    7

    Activity justmakes my pain worse

    This is allmy fault They can’t

    fix my back

    I just need to push myself

    My breathing is bad,I should just stay still

    Mixed up

    I just can’t tell howit’s going to be . .

    NumbHopeful

    Devastated

    Upset

    Terrified

    Calm

    Frightened

    Angry

    Scared

    Excited

    Raging

    Shocked

    OK

    Frustrated Ash

    amed

    Happy Sad

    Cross Miserable

    Despairing

    [email protected]

  • 2Emotions

    Emotions can be seen to be like the keys on a piano – there are a wide range of them and some are ‘lighter’ whilst others ‘heavier’ or to put it another way, those that we find easier to deal with than others.

    Emotions are usually understandable reactions to events or beliefs.

    Feelings are not ‘right’ or ‘wrong’. Feelings don’t exist in isolation, and they can vary in strengthand intensity, as well as how long we experiencethem for.

    It can be hard to listen to someone who is expressing strong or ‘heavy’ emotions as we often feel the strength of the emotion and don’t know what to do, or are afraid that the situation may get out of control and we will not be equipped to deal with it. But if you think about it, have you ever known this to be the case? What is it that you are really afraid of or uncomfortable about?

    You might worry that if someone starts crying or gets upset that you have done something wrong. This is unlikely to be the case!

    As we heard in Section 1 people with long term conditions don’t expect you to suddenly become a counsellor or psychologist, they just want you to acknowledge the impact that feelings or emotions can have on them.

    What we are talking about is integrating questions or tools into your current practice where you can make space for asking how people are feeling and then showing them that you take this seriously.

    If you think someone needs additional psychological help there are ways to refer them on, see Section 6 for more.

  • 2Emotions

    Exercise 2It may be useful to think a bit about being in someone else’s shoes... imagine you have been working very hard to do ‘all the right things’ with your health only to go to an appointment to hear that in spite of your efforts your condition has worsened which will have serious implications in your life.

    List the emotions you would feel – you can use the Bag of Feelings to help.

    Do you think these emotions are normal in the context of the news you have just received?

    What do you expect (or would you like) the health professional to do about them?

    The relationship between emotions and physical health is complex. News about our health, or key times like diagnosis or illness progression, can stir up a range of strong emotions that are an understandable reaction to the challenges and restrictions that long-term health conditions cause. We also know that our emotions about these challenges and restrictions can also change – we can feel very ‘up and down’ and have good days and bad days.

    https://vimeo.com/69079830

  • 2Emotions

    Expressing emotions

    We can worry that asking about emotions will lift the lid on whatever a person had been bottling up and emotions will come pouring out. Or we might notice someone is upset and ask how they are – they respond ‘I’m fine’.

    What’s best? To encourage people to express emotions or to encourage people to keep their emotions to themselves?

  • 2Emotions

    Two myths that seem to exist about this –

    I’m feeling - I needto tell you everything!

    I’ll be keepingthis to myself

    [email protected]

    ‘These myths are like two ends of a spectrum – one suggests we should keep things bottled up, the other that we should express all our feelings. Neither of these is strictly true or applies in all situations. We all have our own emotional style and ways of managing emotions.

    What we do know is that people who have emotional support manage better and have better health outcomes.

    I’m feeling - I needto tell you everything!

    I’ll be keepingthis to myself

    [email protected]

  • 2Emotions

    When it comes to expressing emotions the key is to find out what works best for each person:l some people find it hard to talkl some people are keen to talk

    How do you find this out?It can be as simple as asking:

    “Would you like to talk more about this?”or

    “Some people prefer to talk about how they feel and some don’t – what about you?”

    The answer to this question should be respected – don’t push – now may not be the right time and you can ask another time.

    If you are unsure you can just take a pause. Being silent for a few moments is a simple way of giving permission to the person to talk.

    https://vimeo.com/69086295https://vimeo.com/69086295

  • 2Emotions

    Emotions don’t exist in isolation….You may well be thinking that emotions aren’t the only aspect to a person, and this is true! Let’s consider how emotions fit into the wider picture.

    Let’s start with an example to illustrate this:

    You are woken in the night by a noise. The wayyou respond – the emotions you feel and theway you behave, are not caused by the noiseitself but by what you think the noise means.

    If you think ‘that must be the cat coming in’ youare likely to feel annoyed or irritated and youwould pull up the covers and go back to sleep.

    If you think ‘Oh no! It’s a burglar’ you would feelfrightened, your heart might start racing yourbreathing become rapid. You start listening forevery tiny noise – you are unlikely to be able togo back to sleep!

    If you think ‘that’s my child falling out of bed’you feel instantly alert – jump out of bed and goto see if they are ok.

    This example shows how thoughts, feelings, physical responses and behaviours are interlinked.

  • 2Emotions

    Have a look at the diagram below:

    What wedo

    Howwe

    think

    Howour body

    reacts

    Howwefeel

    How we thinkThe way we think about our health can be very powerful in both a positive and a negative way.

    How our body reactsOur thoughts and feelings can produce very real physical sensations in our body.

    What we doOur feelings and physical sensations can also impact on what we do, e.g. feeling low stops us from doing exercises that help manage our condition.

    How we feelThe way we think, what we do and our bodily sensations impact on how we feel.

  • 2Emotions

    What wedo

    Howwe

    think

    Howour body

    reacts

    Howwefeel

    Example 1 Mrs Jones is struggling with the exercises she has been given to help with her arthritis.

    Let’s look at some examples of the these inter-connections in the physical health setting.

    (roll mouse over each of the four titles)

  • 2Emotions

    What wedo

    Howwe

    think

    Howour body

    reacts

    Howwefeel

    Example 2 James has diabetes and is very concerned about injecting in front of people.

    (roll mouse over each of the four titles)

  • 2Emotions

    What wedo

    Howwe

    think

    Howour body

    reacts

    Howwefeel

    Example 3 Mr Fraser has COPD and seems to be struggling to cope.

    These diagrams show how thought, feelings, bodily reactions and what we do all influence each other (roll mouse over each of the four titles).

    When you are trying to figure out what is going on for a person with a long term condition it can be useful to look at these four aspects and how they may be interlinked.

  • 2Emotions

    Exercise 3Think about your own experience of health and help seeking.

    Do you get very anxious about being unwell believing that only a doctor can help?

    What are attitudes and beliefs in your family about whether you should go straight to the doctor if you feel unwell, or whether you should try as hard as possible to ‘fix’ yourself before going to the doctor as a last resort?

    Are there any ‘sayings’ or phrases in your family about the way illness should be dealt with, or what others should be doing to help things?

  • 2Emotions

    Underpinning our thoughts are a set of beliefs.

    The impact of health beliefs on health and treatmentWhat we believe about something can be very influential in how we view it and what frame of mind we have. Let’s think about this in the context of what we believe about a long term condition.

    A person who believes that ‘nothing is going to help me’ is unlikely to keep appointments and stick with a treatment programme. Helping people develop an awareness of their thoughts and beliefs and how they link to their well-being can make a significant difference to the outcomes of their treatment.

    A person who believes that they have little control over their illness may not engage in the work you plan. Helping them explore the things they can do and doing these things in a way that ‘gets around’ the illness or helps them confront their fears can often help them find control where none was believed to exist.

    More about beliefs

    Section 4 will talk more about adjustment to having a health condition and Section 5 describes some tools to help you explore beliefs further.

  • 2Emotions

    Respecting different culturesIt is important when thinking about beliefs that you take into account that people who come from a different cultural background to you may hold quite different beliefs, especially in this area of illness, treatment and the role of the family.

    A note about health anxietyWhen people are adjusting to a change in their health, they can feel very anxious about symptoms in their bodies and sometimes become very vigilant in monitoring every sensation that doesn’t feel ‘normal’ or ‘usual’. This is part of a normal adjustment process and reassurance from specialist health teams can often be very useful to help the person adjust. For example when someone has had a heart attack, they may feel very worried about how much exercise they do and monitor their body’s reactions to exercise very closely. This is understandable but should settle down with the correct advice.

    This is different from someone with no physical health condition feeling fearful about developing a disease. For both situations people may feel the physical symptoms of anxiety. These can include a pounding heart, difficulties breathing, sweating, ‘butterflies’ in stomach, dry mouth – all of which can be easily interpreted as symptoms of either a worsening condition or another condition.

    The main difference is whether someone has an underlying health condition and is adjusting to it, or whether someone doesn’t have a physical health condition but fears getting one. If you are working with someone with the latter, it may be useful to get some advice from a mental health practitioner (see Section 6).

    Summary

    l Acknowledging emotions is important in working with people with long term conditions

    lPeople who have emotional support have better outcomes

    lEmotions are closely linked to what we think, how our body reacts and what we do

    lBeliefs will impact on our health and treatment

    lIt is important for us to understand how people think, or the beliefs they hold about their health and treatment

  • Adjusting to a long-term physical conditionAdjustmentIt’s a process... and it’s normalResilience

    3

  • 3Adjusting to a long-term physical condition

    Intended Learning Outcome

    Have an understanding of the adjustment process for a person with a long-term health condition, the importance of resilience and apply this to your routine clinical practice.

  • 3Adjusting to a long-term physical condition

    AdjustmentWhen people get new information about their health, they need time to take in what the information means. They may want more or less information about this and have different ways and styles of coping – checking this out with them is key.

    Over time they need to process what is happening to them, what it means for their life and to make necessary changes. This is called adjustment and, while challenging, is completely normal. In this section we will learn more about the process of adjustment through meeting James.

    Exercise 4

    What are the challenges facing James?

    How do you think he is feeling right now?

    How has James tried to face these challenges so far?

    Video clip

    (with actor James)

    James is 26 years old and has been struggling for some time with his health.

    https://vimeo.com/69089508

  • 3Adjusting to a long-term physical condition

    What you can see is that James has tried to understand what the news about his health means both in terms of treatment practicalities, as well as what challenges his condition will mean in other areas of his life.

    He has also tried to put in place ways of dealing with these challenges. It is completely normal therefore that he has been experiencing a range of feelings to do with his current situation.

    https://vimeo.com/69091059

  • 3Adjusting to a long-term physical condition

    James is coping in the best way he can at the moment and it is clear that there is still a way to go. People will tackle health challenges and cope with them in different ways – it is very normal for people to have different coping styles, and also to have good and bad days when going through an adjustment process.

    There is also a range of adjustment ‘tasks’ people may face depending on their health condition, life and circumstances. These adjustments could involve:

    l serious changes may need to be made to their lifestyle e.g. work

    l possible changes in their role in the family

    l how they need to change behaviours e.g. eating, exercising

    l what treatments do they need and how are they going to get it….who, where, what

    l establishing relationships with new health professionals

    l needing to attend hospital or special clinics frequently

    Let’s go back to our DVD clips and find out more about how people have managed this adjustment process and what has made a difference.

    This process of adjustment can lead to a wide range of emotions. It may be a process with ups and downs and often involves people having to make changes that can make them initially feel uncomfortable. You can help by:

    l acknowledging these emotions for example saying ‘I can see that this is difficult’…. Or ‘it seems to me that you are finding it tough to …’

    l helping people express their thoughts, feelings and concerns related to their health and treatment

    l work out together what the person needs and what resources they already have that help them

    DVD clip

    https://vimeo.com/69144872

  • 3Adjusting to a long-term physical condition

    l Sometimes people have very strong reactions to their condition, or to the treatment proposed, that seems out of proportion in your experience. If you are working with someone who responds in an extreme way it is worth considering that this person may have suffered some kind of trauma, or significant event, in their life that provokes this response. If you

    Summary

    l adjustment is a natural process that people will go through especially at key points in the illness journey

    l adjustment can involve trying out different ideas/routines to find out the what works – people need to experiment

    l adjustment may produce gains and losses and things can take time to settle – that’s natural.

    l people will feel anxious and unsettled during this process

    Alert!

    have concerns like this discuss this with a senior team member or with the GP.

    l As we said above for most people there will be a period of time struggling to adjust and this is normal

    – a small number of people may not adjust to their situation and appear ‘stuck’ – in this situation people may need some further help and it is good to know what psychological help is available to people you work with see (Section 6 – Handling distress).

  • 3Adjusting to a long-term physical condition

    Resilience - working with strengthsWe used to think that stressful events and difficulties damaged us. More recent thinking suggests that stress in our lives, whilst challenging, is not necessarily damaging and can even produce positive growth. However, in order to be able to meet these challenges, we need to have resilience. Resilience can come from our own inner strength, key relationships or key beliefs that we hold.

    In this section we will think about how we can support people with long term physical health conditions and how we can help them:

    l mobilise their resources andl build resilience

    Exercise 6(Do this with a buddy if you are able)

    Think about a particularly difficult or challenging time in your life. How did I get through it?

    What helped?

    What did not help?

    https://vimeo.com/69146063

  • 3Adjusting to a long-term physical condition

    You may have noticed, in both you andyour buddy’s example, that you get throughchallenges by a combination of your ownstrengths but also from the support of keypeople in your lives.

    This support can be both direct and indirect and it could be emotional and/or practical. For example if we are going through some difficult treatment practical support like someone helping us with washing can be of great help, as can be someone just sitting with you to keep you company. It can also be very comforting to know that people are thinking about you.

    Resilience, or the ability to keep going through life’s challenges, is often nurtured in relationships, because it is our relationships that provide meaning in our lives. This applies to people with long term conditions especially when the condition results in someone not being able to link in with key people in the way they are used to, they may need to reconnect in a different way.

    ExampleA grandmother who enjoys playing with her little grandchildren and who can’t do this anymore because of her COPD, thinking through with her what other things she could do with her grandchildren like reading them stories instead.OrA man who can’t play rugby at the same level anymore because of his heart condition, but helps with coaching instead and still goes to the pub with the team after their games.

    This can often be about still feeling connected to the people and activities that they find important in spite of the difficulties the condition can impose on them. It can also be feeling that there is still a place or role in the family or interest that can maintain feelings of self worth.

    People with long term conditions and their families have a lot of strengths and talents, often because of what they have been through. It is important to work in partnership with them, offering support in the areas they ask for.

  • 3Adjusting to a long-term physical condition

    What do you need to be able to move forward? When thinking about resilience it is helpful to think about how the challenges the person is facing fits with the resources they have – both their own strengths and resources and the strengths and resources those close to them can offer.

    It is realistic to assume that everyone will have peaks and troughs in their journey – and in some cases the person may need more support from you and your team. Knowing who to ask for support when it is needed can be a big relief to people and their families.

    What helps build resilience?Communication - Good clear communication is vital as it reduces confusion:

    l being clear about what, when and who will be involved in treatment; what is your role and the role of your team; when and how can people contact you how often will you visit

    l providing information as requested and not bombarding people with information they don’t want.

    l directing people to written information so they can return to it later

    l answering questions e.g. what are recovery prospects and what limitations might the person have to live with, or queries from family members

    l being clear and honest when there are no answers; signposting to other services or support groups where appropriate

    Shared decision making:l there is growing evidence that structuring decision

    making in a way that prepares people well for medical consultations helps people understand and make better decisions about their health care. (ref: Hacking et al paper on shared decision making )

    Collaborative problem solving Finding out about problems and then working together to try to solve them can be very useful in getting over challenges.

    Helping people to think ahead about what obstacles there might be is useful in planning and avoiding crises.

    You can find out more about this in Section 4 – developing a collaborative working relationship, as well as linking to this Self Management Resource developed by NES.

    Build confidence and offer hopeWhen someone is adjusting to having a LTC their confidence can be low. They can feel that they have lost their skills and even their role in life, which can happen if they are unable to work or carry out roles they used to do.

    Working positively with and helping someone to see that there is a way through these difficulties, can be very helpful and bring about a more hopeful outlook and the necessary adjustments.

    Seize opportunitiesEspecially when a person has a long term condition with a bleak outlook, seizing opportunities can be key. This literally means taking the opportunity to do something that is positive

    http://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/self-management.aspx

  • 3Adjusting to a long-term physical condition

    or pleasurable at the moment and enjoying it, rather than putting it off until they feel better or stronger or... Everyone needs to have pleasurable or rewarding things happening to keep their spirits up and it is important that people with a LTC are not cut off from this and can have a good quality of life.

    HumourBeing unwell and adjusting to the future with a long term condition is a serious business and we have talked a lot about acknowledging people’s emotional distress. What is also true is that many of us use humour to lighten the load. Sometimes people and their families and carers need permission to have a little light hearted relief and use humour to help them along.

    RespiteEveryone needs time off from the things in life that are stressful and this is just as true for people with physical health problems. So taking time to have a ‘LTC free zone’ can be very useful.

    ExampleIf the person has a condition that fluctuates encourage them to use good periods to do something enjoyable. It might not sound like much to us but it is a small way that people can feel more in control of their life.

    Respite might also be more concrete e.g. either the person who has the LTC or their partner or carer needing to get away from their situation for a short break. This can be vital in everyone being able to ‘keep on keeping on’.

    Activities that have meaning and valueHaving a long term condition may mean the person having to accept that they have not got as much energy or ability as they would like. Prioritising engaging in activities that have meaning and value means helps get the most out of their limited reserves and then making time to rest and recover.

    Relationships as LifelinesWe often have people in our lives who we can describe as lifelines – people who love and support us and really help us through difficult times. These kinds of relationships really help us get through persistent or difficult stresses.

    Not becoming isolatedLiving with a long term condition can mean that someone becomes cut off from usual support. This could be because they are no longer going out as much or attending work. Being isolated is not good for morale and part of your work can be about supporting someone to reconnect with their social support or to make new connections.

    Where people have no close networks Peer Support can be of benefit – you might know of local support groups that people can connect to.

    Note: It is not vital that everyone has a lot of people around them and some people prefer to live more solitary lives. This is different however to being isolated which is not being connected to any people or things that are meaningful or sources of support. People who are isolated in this way can have much poorer health outcomes.

  • 3Adjusting to a long-term physical condition

    SpiritualityHaving a connection to some form of spiritual belief can be a great help when going through difficult times. This can be through formal religion or just through feeling at peace with ones self. There is also evidence emerging that relaxation, meditation and mindfulness approaches can be very helpful when managing a long-term condition.

    Making meaning and reciprocityIt can be common for people with long term conditions to try to make sense or meaning about their lives with a long term condition. This is often a process linked in with adjustment and is quite normal. Part of this process over time can be getting involved in areas of society that in effect ‘give back’ to others. Examples of this can be joining a 5k run to raise funds for a charity, or championing a cause because of one’s own or family member’s experience of a particular condition.

    These ideas about resilience come from Froma Walsh’s work on the Family Resilience Framework.

  • 3Adjusting to a long-term physical condition

    Summary

    l adjustment is a process people often go through when they have a long term health condition – it can take time and has its ups and downs but is completely normal.

    l adjustment to having a health condition can lead to a wide range of emotions – some can be strong emotions

    l people have strengths and resources of their own and key relationships can all help to develop the resilience that is needed living with a long term condition

    l What can I do? Health and social care professionals can

    offer support in the adjustment process by being aware of it and helping where appropriate. This can involve helping people to express their thoughts feelings and concerns related to their health, supporting them in achieving their goals, providing the necessary information they may need in terms of new treatments, or making sure that people can get access to whatever support may be useful for them to achieve their goals.

  • 4A good collaborative relationship

  • 4A good collaborative relationship

    Intended Learning Outcome

    Have an understanding of the importance of relationships when working with a person with a long-term health conditions and apply this to your routine clinical practice.

  • 4A good collaborative relationship

    For people with long-term conditions, the cornerstone of effective self management is to have a good collaborative relationship with their health care providers. This means both parties will work hard to achieve the goals of the person with a long-term condition, each contributing their own areas of expertise.

    This is backed up by research that shows that the quality of a working relationship is of enormous importance in any interaction and can have a direct impact on how successful your work will be.

    In this section we are going to think a bit more about what a good collaborative relationship is and provide some tips and guidelines for you to consider.

  • 4A good collaborative relationship

    Who knows best?In the past people had the view that ‘doctor or health professional knows best’ which made the person with a long term conditions passive, and developed expectations that the doctor or health professional is the expert who needs to take charge and fix everything.

    This is a view that has for the most part thankfully changed but it is important for us to always remind ourselves that to work collaboratively our interactions and relationship with a person with a long term condition is a ‘joint venture’ with no one person knowing it all.

    We may have skills in our own professional field, but the person we are working with has knowledge too. They know their own condition; what motivates them and what doesn’t; what they could reasonably achieve and what is unrealistic, and they will have strengths we are not aware of.

    So we bring some expertise and the person with the long term condition brings some expertise and the idea is to collaborate to find the best ways forward rather than being the professional being ‘in charge’.

    Exercise 6Reflect on a time when you were a patient.

    a) How did the health professional collaborate with you?

    b) Did this make a difference to you?

    c) How has this influenced the way you collaborate in your work with people?

  • 4A good collaborative relationship

    What are the qualities of a collaborative relationship?We know that getting to know about the person with a long-term condition feels is important in order to be able to support them in achieving their goals and having a good quality of life, but what are the qualities of a good collaborative relationship?

    l person feels listened to and understood

    l person is contributing to the conversation and their own self management

    l both asking questions

    l you feel you are not doing all the work

    You will find that when you have a good collaborative relationship it is easier to get the information you need – not harder, consultations are more positive and relaxed, the person with a long term conditions feels a sense of autonomy and feels their view is valued.

  • 4A good collaborative relationship

    Getting the groundwork right

    Structure your consultation:l Try to structure your time by setting a joint agenda.

    This involves you being clear about what you had in mind to use the time for, as well as what the person you are seeing has on their agenda, and then agree on what you will cover.

    l Don’t be tempted to leave the emotional bit until last!

    l Time constraints – if you have more on the agenda than you are going to be able to deal with in one go, re-prioritise for the current appointment and agree what you are going to cover the next time you meet.

    l Planning - sometimes it can be useful to put a little more time aside for a certain type of appointment or consultation e.g. when you have just met, or when there is a new treatment plan or development in a condition that needs discussion. This can relieve pressure on shorter appointments.

    Ensure your listening environment is appropriate:l Take a moment to check the environment is right to

    talk.

    l Privacy – for both you and the person it’s not comfortable to talk about emotions if there is no privacy. Try to find a way to make the situation you are in as private as possible. This can be tricky on busy wards and on home visits when people are coming and going.

    l Noise and distractions – can these be minimised at all? There is nothing worse than trying to talk when their dog is bounding around the living room or the hospital gardeners are mowing the lawn right outside the window and you can’t hear a word the person is saying.

    Key actions in a good collaborative relationship:l listen – see Section 5

    l let the person tell their story

    l be interested

    l show you understand

    l show care and compassion

    l be positive

    l make a plan of action together

  • 4A good collaborative relationship

    How would I know if I was drifting away from a good collaborative relationship?

    l finding yourself trying to persuade a person to do what you think they should do

    l trying to get the person to see things from your point of view

    l talking about yourself more than the person – being quick to share your experiences or stories

    l starting your sentences with ‘I think’ or ‘you should’

    l talking in a way that implies negative judgement – ‘she is just wasting my time’ ‘he doesn’t help himself’

    l getting into a pattern of using ‘flirtation’ to manage the interactions

    l using humour a lot of the time to deal with feeling uncomfortable

    l spotting signals that you might be more involved than you need to be to do your job e.g. finding that you get very emotional (tearful, angry, frustrated) when you talk about or think about the person; finding yourself sharing confidences or seeking advice/opinions from the person; finding it’s you who feels better after sharing experiences; looking forward to seeing someone because you want to share with them what has been going on since you last met.

    Everyone struggles with some of the people they work with and it is unrealistic to think we can like all the people we work with equally.

    What’s important is to be aware of how we respond to people and if we notice that we are drifting into unhelpful patterns then it is important to stop and reflect on this and to talk to colleagues or supervisor about it, and always act within your professional code of conduct.

  • 4A good collaborative relationship

    Summary

    l Good collaborative relationships can increase the effectiveness of your interventions

    l A key aspect is that each party brings expertise to the relationship and listens to each other.

    l These relationships are different to personal relationships.

  • 5ToolsTool 1 - ATMTool 2 - SWIFT

  • 5Tools

    Intended Learning Outcome

    l Be familiar with the tools ATM and SWIFT

    l Be familiar with using Ask Test Out Modify technique to develop person centered goals for a person with a long-term condition and apply this understanding to routine clinical practice

    l Be familiar with the SWIFT tool to gain a more holistic perspective and to identify how the long-term condition is impacting on different areas of the person’s life and apply this to your routine clinical practice.

  • 5Tools

    In this section we are going to think about how you can address emotions in your day to day work by showing you two tools you can use when wanting to develop more of an emotional ‘language’ or ‘perspective’ – really these are the building blocks you can use in developing a good collaborative relationship with people you are working with.

    We would encourage you to go through each of these tools to make sure you understand them and then try them out. We suggest you do this with a colleague first in a role play situation, so that when you use them with people you are working with you feel confident.

  • 5Tools

    The quickest and simplest way for us to get to know about people’s thoughts, feelings and concerns about their health and treatment is to be willing to ask about them e.g. “Can I ask what you are concerned about?”

    Don’t guess, don’t assume you already know and don’t think it’s not an issue just because the person has not mentioned anything.

    Important rule about asking questions - don’t ask if you don’t know why you are asking!

    This ATM tool is really the foundation of your psychosocial practice – to make sure that you listen actively, understand what the person you is saying and modify your plans accordingly.

    Each section of ATM has a film clip to illustrate the skills and a reflective tool to help you think about putting the tool into practice.

    Ask T utest ouT Modify

    So what about this,this, this and this . . ?

    OK - What would a really good

    question be . .

    Is she goingto say anything?

    [email protected]

    So what about this,this, this and this . . ?

    OK - What would a really good

    question be . .

    Is she goingto say anything?

    [email protected]

    Ask T utest ouT ModifyAsk T utest ouT Modify

  • 5Tools

    How do you ask?You use your communication skills effectively. Yes, yes we know that every time we do any training they talk about communication – but that’s because it works!

    The first building block of this is to establish rapport (see Section 4). Take a moment to think about, or discuss with your training buddy, the ways you establish rapport.

    This can start with something simple like smiling, or involve a brief introduction about who you are and what your role is, and asking to find out a bit about the person you are seeing.

    An invitation to talk such as “tell me about what has brought you here today?” – “I have some information here from your doctor – could you tell me in your own words how you are.”

    Don’t forget that when weare asking questions, it isimportant to look at theperson and show that you areinterested in what they haveto say.

    Ways of asking questions:l There are different ways you can ask questions that

    will elicit different responses. The types of questions you use can often be informed by the type of answer you are looking for.

    l Closed questions are helpful when you need to get facts “how bad is your pain from one to 10”, “what medication are you on”, “where you able to sleep”.

    l Open questions help you to find out more from the patient’s point of view “tell me more about that”. These questions will help you to seem interested and curious about what is going on for the person. Studies show that these types of question gather much more information than a series of closed questions.

    l You will probably find, like almost everyone else, you are more used to using closed questions.

  • 5Tools

    Exercise 7Open and Closed Questions - What’s the Difference?Below is a list of closed questions – try to think of a way to re-phrase the question to be an open question – then click on the question mark in the right hand column for our example of an open question version.

    Closed Questions

    Are you managing your treatment?

    Do you need any help?

    Have you been sleeping well?

    Are you worried about your condition?

    Are you worried about the future?

    Open Questions

    Cochrane, Riedel, Stuckey, Hewitt, Murray and Hacking (2011) Used by permission from authors.

  • 5Tools

    The DVD clips below on the left demonstrate using closed questions and the corresponding open question is shown on the right. Can you notice any difference in the quality of the answers?

    Follow-on ExerciseIf you want to practice making your questions ‘open’, good starters are:l How does that make you feel?l Tell me more about…l What do you understand about…

    Try out using closed and open questions with a buddy or with a patient to see if there are differences in the response you get.

    You can use the reflective tool on the next page to help you.

    Video clip

    (open and closed questions)

    TipBy Asking open questions people may start to get emotional and it might feel a bit uncomfortable. Don’t panic! Sit for a moment. Pausing won’t make anything worse – rushing to tidy emotions away can leave people thinking you don’t care.

    (Section 6 explores ‘tears’ and ‘anger’ in more detail)

    View more Closed questions View more Open questions

    https://vimeo.com/69093980https://vimeo.com/69146486https://vimeo.com/69146720https://vimeo.com/69146787https://vimeo.com/69146812https://vimeo.com/69093172https://vimeo.com/69094489https://vimeo.com/69094890https://vimeo.com/69095430https://vimeo.com/69095900

  • 5Tools

    What could you do to make sure you use open questions more frequently in your work?

    Reflective Tool

    When you used open questions what was different from when you used closed questions?

    How did you make sure that you were using open questions?

    If you wanted to take this reflective practice exercise a bit further - could you tape a session and then do a reflection on it or ask a colleague to sit in with you and observe your practice?(Consult local guidelines on gaining consent for taping sessions and for staff to sit in on sessions)

  • 5Tools

    This involves checking you understand what the person has told you. You do this by summarising what the person has said and taking time to understand the impact of the events that have happened. This can also be called reflective listening. An accurate summary will give the person confidence that you have heard what’s been said but also give them the opportunity to correct any misunderstanding and again this will improve rapport.

    Checking you understandWhen feeding back to someone to make sure you have listened properly you can use phrases like:

    l Could I take a pause here to check what you have said...

    l From what I understand you are saying that...

    l Let me see if I understand...

    l It sounds like you...

    l So you feel...

    l As I hear it you...

    Ask T utest ouT ModifyAsk T utest ouT ModifyAsk T utest ouT Modify

  • 5Tools

    Clarifying – phrases you could use:

    l Let me see if I understand you... (same as above)

    l Could it be that you are saying

    l What I think I am hearing

    l Correct me if I’m wrong but

    l ...is that what you mean?

    ExamplePatient – “My life is so busy. Everyone seems to expect that I will drop things I need to do and do everything for them.”

    Clarification – “So people’s expectations that you will see to their needs before yours means you never have time for your own needs.”

    ValidatingSometimes it can be important to make a comment that shows you understand what a person has been through. This can be done by using a technique called validating. It involves thinking of and commenting on the way the person has managed a difficult time in a positive manner. Examples of this can be:

    l Gosh, I can see you have been through a really challenging time...

    l It is amazing how positive you have been...

    l Considering all you have on your plate, you seem to have coped really well...

    l It sounds really important that you were able to...

    https://vimeo.com/69146869

  • 5Tools

    c) Can you identify times you used silence or a pause in the session? What effect did it have?

    d) Was there anything about the person (how they behaved, what they said) that let you know they felt listened to?

    Reflective Tool

    Reflect on a recent session you have had.

    a) Try to identify things you said that helped to test out your understanding of what the person said. Did you check, clarify, validate?

    b) What helped you get a better understanding of the situation?

    If you wanted to take this reflective practice exercise a bit further - could you tape a session and then do a reflection on it or ask a colleague to sit in and observe you?(Consult local guidelines on gaining consent for taping sessions and for staff to sit in on sessions)

  • 5Tools

    So you have now asked and tested out, the person has told you what is going on in their lives, and have had the opportunity to ensure you have listened correctly and commented back.

    How does this impact on your treatment plans or goals? Do you need to modify plans/goals to take account of the emotional impact on the person?

    Do you need to:

    l Make small changes to the treatment regime e.g. timing of medication, so that someone is not missing out on picking their child up from school?

    l Help to set new goals or solving setbacks with current goals ?

    l Help to pace the day/week to conserve energy – using their little amount of energy to do things that are rewarding will improve mood?

    l Help to find more support or feel more connected with friends and family – people often become low because they are not seeing/talking to friends/family because they see themselves as a burden. This could also involve making links with voluntary or peer support groups (www.aliss.scot.nhs.uk)?

    l Get clarification or information about a persons condition or treatment by linking in with GP’s, specialists or other members of the multi disciplinary team?

    Modifying your plan/goals will work best if it’s a collaborative exercise (see section 3 and 4).

    TipYou don’t have to fix everything on the spot. Make sure you have understood the person and say you’d like to think about this, or perhaps talk to others involved in their care, and then get back to them.

    It is much better to demonstrate this kind of thoughtful care rather than rushing in with a hasty solution or making promises you can’t keep.

    Ask T utest ouT ModifyAsk T utest ouT ModifyAsk T utest ouT Modify

    http://www.aliss.scot.nhs.ukhttps://vimeo.com/69147065

  • 5Tools

    Can you identify questions or statements you used that helped to work together to agree these changes?

    Reflective Tool

    Reflect on a recent session you have done.

    How did you go about making any changes to the treatment plan or goals?

    If you wanted to take this reflective practice exercise a bit further - could you tape a session and then do a reflection on it or ask your colleague to sit in on a session and observe you?(Consult local guidelines on gaining consent for taping sessions and for staff to sit in on sessions)

  • 5Tools

    It might be useful to discuss with your buddy or a colleague what self-help resources or self help organisations might be helpful to the people you are working with. These links will help:

    Living with long-term conditions - resourceshttp://www.nhs.uk/Planners/Yourhealth/Pages/Livingwith.aspx

    The Alliancehttp://www.alliance-scotland.org.uk/?rfrm=ltcas

    Summary of ATM:

    l Ask – how to ask different types of questions

    l Test Out – check you understand/clarify/validate

    l Modify – how to alter your plans/goals together

    http://www.nhs.uk/Planners/Yourhealth/Pages/Livingwith.aspx http://www.alliance-scotland.org.uk/?rfrm=ltcas

  • 5Tools

    SWIFT Check Up

    The SWIFT Check Up is a tool that you can use to build up a picture of a person’s key relationships, how they are coping, how things are going at work and at home as well as give you an idea of things they like to do. It provides a useful framework that you can use to gain a holistic perspective about the people you see.

    You can start at any point in the circle - depending on whether it is a first consultation or follow up. Click on each section for an example of questions you can use.

    SWIFT can be integrated into notes by using this template. You can also click here to view a summary of SWIFT.

    Remember if anyone raises any issues whilst you are using SWIFT it would be good to use skills covered in ATM to summarise what someone has said and make an action plan if any issues have been raised that need follow up.

    Work/Home

    Illness/LT Condition

    Friendsand family

    Things I like to do

    The SWIFT Check Up

    Stress/coping

    https://vimeo.com/69147253

  • 5Tools

    Exercise 8Think of someone you are working with and try to work out how much you actually know about them under each of the five areas of SWIFT.

    Then try a SWIFT Check Up with at least 3 people you are working with.

  • 5Tools

    Summary

    l In this section we have shown you two tools – ATM and SWIFT

    l We have also emphasized that for any of these tools to work it is important for you to establish and nurture a good working relationship with the people you work with.

    l Try them out! Use the reflective tool! You might want to do this with your manager as part of your KSF/PDR process or agree with a colleague that you will try out using the tool and discuss together how that went.

  • Handling distressThis section deals with more specific situations and concerns you may have. 6

  • 6Handling distress

    Intended Learning Outcome

    Understand how distress can present in clients and identify when to alert other services to the need for further intervention.

  • 6Handling distress

    What do I do if someone is very upset and starts crying?

    If someone starts crying we can feel unsure what to do. Should we ignore the tears and carry on, should we stop and hand them a tissue? Should we change the subject and think of something completely unrelated or light to talk about?

    It is first important to realise that crying is not necessarily a bad thing. Crying is a way of showing us that a person is upset and if they are doing it in front of you this may mean that they trust you enough to show you a more vulnerable side of themselves.

    l Having tissues can be very useful, it gives the person something soft to wipe away their tears, and it acknowledges that tears are not unexpected - it is OK to cry.

    l Giving a person time to express what they are feeling can be very useful; saying something like – “I can see this is very upsetting for you” can give a message to the person that you can see and acknowledge their distress.

    l It is also useful to devote a bit of time to letting the person express how they are feeling. So in this regard ‘pausing’ the consultation until they are ready to continue can be useful. As you may have found in practice the person doesn’t expect you to solve all their problems but to just acknowledge and

    accommodate their feelings. Holding yourself back for a few moments more than you might usually with your pause will also give an impression that it’s ok to cry.

    l As you know when you have been upset and may have cried, it is not something that lasts for hours – usually it is quite short lived, but it can be comforting for the person to know that you are not afraid of their tears and are not ignoring them.

    l If you are concerned that the person seems very distressed even after having some time to express themselves it may be useful to find out what support they have (click here to go back to SWIFT tool) and if there are other difficulties they are having which may need more support.

    l If you continue to feel worried you can speak to your supervisor, the person’s GP or someone in your team who deals with psychosocial issues.

  • 6Handling distress

    What do I do if someone is angry?In the same way that crying is not necessarily a bad thing and can give you an indication about how someone is feeling, anger can be the same and can show us that someone is feeling very upset and bothered about something.

    Anger is a powerful emotion and it’s important to remember that it has all sorts of causes which can include: feeling anxious or nervous; dealing with grief; being in pain; coming off certain medicines or drugs; feeling under threat; feeling that you are being ignored or not taken seriously or being under the influence of alcohol or drugs.

    A person with a long term condition might have lots of these things going on for them as they try to adjust to their condition, treatments and the impact this is having on their life right now.

    Being on the receiving end of anger or just being a witness to it can be tough and it’s really difficult not to take it personally when it is directed right at you. Anger tends to be catching, but staying calm yourself can help both of you. If you get angry as well, things can quickly escalate.

    l First thing to do is pause. Don’t try to push on through this it will only get worse.

    l Let the person know that you see they are angry/frustrated/upset and let them know you would like to understand and help e.g. “I can see that you are very frustrated/angry/upset by this….. can we just stop for a minute and see if I can understand what is going on?”

    l At this point you might find it helpful to take a deep breath and then relax yourself – this helps you to feel calmer.

    l Use your ATM tool to explore a bit more with the person and to demonstrate that you have heard what they are saying.

    l Only once you think the person is calmer and you are on the right track should you move to looking for possible solutions together. Jumping in too soon to fix things can make the person frustrated again.

    l If the person is having real problems calming down you might suggest that you or they step away for a moment (you could also say you will come back in 5 minutes time to give them time to try to calm down)

    – or that you just sit in silence for a bit until they feel calmer. Sometimes suggesting that they pause and count to ten can be useful.

  • 6Handling distress

    l If the situation is not calming down and if you are feeling vulnerable because of their anger towards you remember that the NHS has a no tolerance policy to aggression and that you can end the session and come away if you feel under personal threat.

    l This is clearly a situation that you should talk to your manager or supervisor about and you should be aware of any policy or procedures covering the management of aggression and violence at work.

    l If the person is able to talk with you about their anger and they acknowledge that this is not an isolated incident and that they are finding themselves angry a lot of the time you might want to suggest some self help materials: http://www.mentalhealth.org.uk/publications/cool-down/ or anger management help there may be available locally.

    http://www.mentalhealth.org.uk/publications/cool-down/http://www.mentalhealth.org.uk/publications/cool-down/

  • 6Handling distress

    What if I am worried they might want to kill themselves?It can be very worrying when you hear someone say something like – “what’s the point, I might as well not be around” and you start to wonder whether they are feeling suicidal. It is normal to have concerns about what to do that may include worrying that talking about suicide may be putting ideas into someone’s head, or worrying that talking about it may lead to you feeling very out of your depth without knowing what to do.

    Feelings that life may not be worth living can range from being a fleeting thought to thoughts that dominate a persons’ life. It is important that you feel able to understand if someone is at immediate risk or not and what you should do to get them more help.

    SafeTalk offers training in this area (see link) and we would encourage you to complete the half-day training:http://www.chooselife.net/Training/safetalk.aspx

    As they say on their site thoughts of suicide are understandable, personal and complex and most people with thoughts of suicide want to live.

    l If you are concerned about someone’s state of mind, for example, that they may be considering harming themselves or someone else it’s important to bring this to the urgent attention of their GP (or medical team in an in-patient setting), or mental health professional involved.

    l Where you have done Safetalk or Storm or other suicide risk training you should follow the guidance given in training and be sure to document your actions.

    l It is important to raise this with your supervisor or line manager.

    http://www.chooselife.net/Training/safetalk.aspx

  • 6Handling distress

    Traumal Sometimes a person we are working with has had a

    previous traumatic experience which starts to impact on how they are responding to a current health challenge. This is usually seen as the person reacting in a very strong way to something that is happening, or going to happen, in terms of their long term condition or as a result of their treatment.

    l The way we can know that there might be something else going on is by thinking of the strength and intensity of their reaction – and that this feels out of proportion to what we would normally see.

    l This may indicate is that the person has had traumatic experiences in their life that make their responses to distress seem quite different to those you usually encounter.

    l It is useful to reflect on this with colleagues and think about what might be going on. If you have concerns like this about someone raise this in your supervision /1:1 or discuss with the GP.

    l If a person has previously experienced trauma, a mental health professional may need to become involved either in a consultancy capacity or directly seeing the person to help them through what could be a frightening and difficult time for them.

    l You don’t have to deal with Trauma but it helps to understand how it might impact on your work e.g. someone who finds being touched very difficult and may need to be supported through particular aspects of treatment.

    Mental health difficultiesAs we have said a person with a long term physical condition will not necessarily have mental health problems. However, people with mental health difficulties can have a long term physical condition, and people with long term conditions can be susceptible to anxiety and depression and may well benefit from support from a mental health professional.

    If someone you are working with has a mental health condition, it can be important to find out a bit more about this. For example is this condition well managed; does it impact on how they may manage their long term physical condition; how will their long term physical condition impact on their mental health difficulties.

    It may also be useful to find out whether there are any mental health professionals involved in the care of the person you are working with that you may link in with, obviously with their permission.

  • 6Handling distress

    Limits of my roleNo one is expecting you to be a psychosocial expert – just to include this perspective in your work. In order to do this you commit to always trying to listen actively, communicate clearly and work collaboratively. You may then use the tools we have suggested in order to develop a good all round view of your person with a long term condition and establish good foundations for a good working relationship.

    However, you are fundamentally there to do the role prescribed by your profession and this should be the main focus of your interaction. If you feel like your person with a long-term condition needs more psychosocial input suggest this to them and refer them on to someone who can offer them more psychosocial input. It is always useful to work out who this could be.

    Exercise Either in your team group or with a colleague work out who you would be able to refer someone onto if you had concerns about them and thought they could benefit from some psychological support. Your first port of call could be the person’s GP, or if you are working in a specialised service find out if there is a clinical psychologist or social worker attached to the team. Once you have done this, check with your team leader that this is the correct policy. There are also links online to support, e.g. Scottish Government ‘Steps for Stress’ (stepsforstress.org) and Glasgow Steps (http://wellbeing-glasgow.org.uk)

    ComplaintsOn occasion people get upset about the treatment they are having or about a particular health professional that they feel has not treated them well. In this case you should make sure that the person has access to the complaints procedure and you should make your best attempts to understand the nature of their grievance and to take this seriously.

    Most NHS and social services organisations will have a complaints procedure and training in how to respond to complaints.

    Remember every complaint is an opportunity to learn about how we can do things better next time!

    http://www.stepsforstress.orghttp://wellbeing-glasgow.org.uk

  • 6Handling distress

    Summary

    l When people get upset there are simple things that we can do that can make a big difference.

    l Taking time is worth to understand emotions and can improve the outcomes for a person overall.

    l When a person is expressing suicidal ideas – it is important to ‘contain’ the situation and alert the relevant services.

  • 77Looking after yourselfTime | When something is particularly distressing |Support, debriefing and consultation | Reflective practice

  • 7Looking after yourself

    Intended Learning Outcome

    Be able to reflect on routine clinical practice and identify the personal impact of working with people with long-term conditions.

  • 7Looking after yourself

    This last section looks at how working with people with long term conditions can affect you and ways you can look after yourself.

    Time

    We have made suggestions about new tools you could use to include a more holistic approach to your practice. We know from experience that one of the concerns people can have is where to find the time to use these new tools?

    l One answer is to take time to reflect and sit down with your colleagues to talk about this. Think about what the benefit would be if you used some of these tools. Then think about when the best time would be to use them.

    l The information you need about history and background etc is not going to change much and so needs only be asked once. This can mean scheduling a slightly longer initial or second appointment to get to know the person first might actually save time overall.

    l It can depend on your work setting and what sort of appointments you can offer – if you work on a busy ward with lots of demands you may need to try to work out the best way to use the time you have.

    l It may be a good plan to introduce tools as part of your personal development plan (for NHS staff only: KSF or IPDR).

    When something is particularly distressing

    There are times, like when things are going on in our own lives, when listening to distress at work can be much more difficult than usual.

    It could also be that an aspect of your work triggers thoughts and feelings about events in your own life.

    When this happens it can be hard to listen and keep focused as it can be very upsetting. It can also be very tempting to share your experiences with the person you are seeing, even though it may not be helpful to them.

    Sometimes we can also feel overwhelmed with sympathy or sadness or even feel upset at what someone is going through.

    If this happens, it’s important to be aware of what is upsetting you and how you are being affected.

    Support, debriefing and consultation

    With this in mind, it is important that you know who is there to offer you support.

    Whether it is to be able to debrief after an upsetting consultation or to consult a colleague or psychosocial professional to discuss your concerns about someone you have seen, or take a difficult case or situation to supervision, it is important you know who you can speak to.

    On the following page there’s an exercise you can do to clarify who is there to support you.

  • 7Looking after yourself

    Here are some ideas about ways you can look after yourself and areas of support you could utilise:

    Not taking things personallyAlthough easier said than done, it is important to realise that if you see someone who is upset, frustrated or angry that it isn’t necessarily directed at you personally. It is important for you not to take things personally, and realise that it is just a person who is having a difficult time.

    Discussing this with someone can help give you a bit of distance – and some things just look better tomorrow than they do today – don’t always strike whilst the iron is hot.

    Remember we all have good days and bad days – some days everything seems difficult or negative and a night away from a hard day can give a new perspective in the morning!

    DebriefingDebriefing with a colleague can be very useful. Having time out to make a cup of tea or coffee and sit quietly for a few minutes can also be helpful.

    SupervisionMost NHS and partnership organisations have a policy where everyone has access to supervision. This is very important and can often be your first port of call when needing to discuss issues about psychosocial wellbeing and emotions. Talking things over with someone else helps achieve clarity, and lets you share some of your concerns and frustration about our work. If you don’t have access to supervision, your line manager may also be someone you can speak to.

    Reflective practice

    Setting up or joining a reflective practice group can be helpful as you not only get the support of your colleagues and learn different ways of handling difficult situations, you also often realise you aren’t alone – other colleagues may also have had a difficult time.

    Personal issuesIf you are finding that work is causing more stress to you than usual, or than you think is healthy then you should talk about this with your line manager or with Occupational Health. This can apply if you feel you are becoming overloaded with stress or where seeing someone has raised some personal issues that you would like to talk through.

    Many NHS boards and partnership organisations have stress management options for their own staff and these can be really useful. Don’t forget that it’s important to have a good work/life balance.

    Zero toleranceIt is important to stress that the NHS and partnership organisations have a zero tolerance policy in terms of behaviour or language that is not acceptable and if you feel that someone you have seen has crossed this line, it is important that you follow the necessary procedures to ensure this is dealt with and does not happen again.

  • 7Looking after yourself

    Exercise 10Make a note of the following:Who supports me in carrying out my role? Do I know how to contact them? Are they accessible? Would I be comfortable discussing these issues with them?

    If I have had a difficult or distressing consultation, who would I speak to in order to debrief?

    Who are the psychosocial professionals that I could go to if I have concerns about someone I have seen? Is this ok with them?

    If by doing this exercise you realise that you do not have enough support in place, discuss this further with your line manager or supervisor. We would encourage you to get the correct support in place – don’t leave it until you need it!

    Make a note to discuss this and put the support in place.

  • 7Looking after yourself

    Summary

    l Time – planning when you might do emotional work

    l Taking care of yourself is important

    l Knowing where to take things to talk about difficulties

    l Having a support system at work

  • Revised January 2018

    NHS Education for ScotlandWestport 102West PortEdinburgh EH3 9DN

    tel: 0131 656 3200

    www.nes.scot.nhs.uk

    S1S2S3S4S5S6S7SWIFT Check Up

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