Way back in 1981 I was a guinea pig in the “new modular scheme of training” where all nurses shared a common foundation programme for the first 18 months. So our first year at college consisted of learning things like the anatomy the eye and useful practical skills like making beds and injecting oranges. We then spent several months as slaves on medical and surgical wards. All essential stuff for us budding RMNs. You can imagine how excited we were when in our 2nd year we got our first actual lesson (they weren’t yet called lectures) in psychiatric nursing! We had a great tutor who had spent years nursing on the wards. One of the practical skills he told us about was how to display empathy, how to let someone know you had some idea of what they were feeling. He cited some good examples and also recounted a real incident with a patient where he displayed empathy by saying “That must have been very frightening for you”.
A few days later, along with three of my classmates, I went on placement to the acute admissions unit at the bin. It was a therapeutic community which focussed almost exclusively on group work. Like everyone else in the ward we had to attend the 9am community group. We were all anxious to make a good impression on our first day and when one of the patients recounted an anxiety attack she had suffered during the night we got our chance. There was silence after she stopped speaking and we racked our brains to remember what we had learned in college. Empathy! Of course, empathy! We recalled the tutor’s words and suddenly the silence was broken as four student nurses said in perfect unison “That must have been very frightening for you”.
It didn’t just sound fake and phoney, it sounded like we were taking the piss. I was utterly mortified and was determined never make the same mistake again. As the group stared at us in disbelief, I immediately made up my own new “empathy phrase” for future use. Later in the group, attention was focussed on a man who had lost a lung due to cancer and was now severely depressed, convinced he was riddled with cancer despite having the all clear from the medics. One of the staff nurses was trying to get him to focus on the reality of his situation and asked “is there anything you used to do when you had two lungs that you can’t actually do anymore?” The man pondered for a while, then said “Well yes, actually there is. I used to play the saxophone and I can’t do that anymore”. Quick as a flash and obviously without realising the dreadful pun, I threw in my new empathy phrase… “That must have been a great blow for you”.
Superb title and even better post. Great to see you`re still on form, Mo. I`ve been wondering what you`ve been up to as I haven`t been able to get on to your blog for sometime ??.
Classic.
I have to say, there seems to be some absolutely dreadful counselling training going on out there. Not on my course: I’ve had some very good training in this area, but my girlfriend took a counselling course through her local adult education centre. All they taught about was paraphrasing and summarising! They pretty much insisted that this was all you do with a client!
Now, I’m happy to concede that summarising and paraphising are useful tools. But they’re a tool in the toolbox, not the be-all and end-all of counselling. When people try to counsel someone by *only* summarising and paraphrasing, they wind up sounding like a bloody robot.
I quite enjoyed my motivational interviewing training, and I’ve used that with a few clients. The trainer was rather amused by the fact that apparently the Prison Service wants to make motivational interviewing the language prison officers should use in their daily conversation with prisoners. He thought this was funny because one of the stock questions is “Where do you see yourself in two years time?”
Prison Officer: “Where do you see yourself in two years time?”
Prisoner: “Erm….still here? I’ve still got three years to go!”
Sorry OSB. A local blogger from my small rural town recognized me on my blog. Bearing in mind my ongoing criticism of GPs, shrinks and in particular receptionists, I thought it best to lock down my blog before they read it and banned me from the health centre. Unfortunately after reading “invited members only”, the few readers I had took this as a personal insult and have now left the “Cult of Mo”.
I have to agree with you Z about the counselling training. I remember one “counsellor” who’s whole armoury of skills lay in repeating the patient’s last three words. “Last three words?”… yeah she looked concerned, frowned and repeated their last three words with a questioning tone. “A questioning tone?”… yup, she did this for an hour at a time and the patients would talk at length about whatever came into their heads. “Into their heads?” Unbelievably people never seemed to notice her abysmal ploy. She was highly respected, indeed folks often felt much better after one of her sessions.
LOL that post is bloomin’ hilarious!
I have to say though, you can’t teach someone to have empathy – you either got it or you don’t. Sad to say most psychiatric doctors and nurses that I have met don’t.
There was this ward manager I met once. He’d obviously had the empathy training. He smiled, nodded, and said “mmmm” in all the right places, but it was so false and irritating, I didn’t feel like he was listening at all. Horrible man.
Very funny post Mo, I understand entirely where it is coming from.
I would like to think I have empathy, but to be able to show the person I am with is another matter.
I have had lessons on counselling and of building therapeutic relationships, I understnad the jargon, but whenever I try to show empathy in the manner of “you must have been very upset” etc. it sounds rehearsed and fake, although I am told it will come more naturally in time!
Mr Man’s wife I can’t agree with you regarding psychiatrists – most that I have met have demonstrated lots of empathy. I fully agree about the nurses not showing any though, but whether this is just my impression, based on the fact that they never actually talk to patients at all, is open to question.
Regarding empathy and psychiatrists (not nurses!):
Why do people feel it is so important ? Surely we would want someone who knows what they are doing and can take an objective look at whatever is happening, while treating with respect.
Empathy though … makes me think of touchy feely psychiatrist, which is a little disturbing.
Some of the best psychiatrists I have known (well respected by their clients) have had very limited empathy. While some of the worst have had buckets of empathy but been frozen and unable to make hard decisions and challenge effectively.
I’ll go back to making myself look pretty for the weekend now. Myself and Mental Partner are going out
Ariel, I agree some are very good, we’ve just been very unfortunate to meet a lot of bad ones! The one Mr Man sees now is excellent though.
Sorry Mental Nurse but I have to disagree with you; the psychiatrist Mr Man sees now has it all. She is empathetic and yes, even touchy feely at appropriate times, and yet objective and very knowledgeable, and although we have clashed over issues not relating to Mr Mans care I have bucket loads of respect for her. She is the only professional that Mr Man has felt able to really open up with about his symptoms.
Feel free to disagree with anything I post Mr Mans Wife. I know I do often
Not sure where I stand on the psychiatrists and empathy discussion. I do think that in some circumstances they can get away with lacking empathy but if they also have a characteristic such as being risk averse that could be a recipe for disaster.
The far more important issue is the one raised by Ariel. Nurses do need empathy, it will enable them to recognise the NEED to be outside of the office. Either we are recruiting the wrong people, possibly because we now value academic potential above the rather indefinable qualities required to nurse. Or we are recruiting the right people but the paperwork burden is preventing them from setting foot beyond the office door. Both scenarios are unacceptable. Things need to change.
Either we are recruiting the wrong people, possibly because we now value academic potential above the rather indefinable qualities required to nurse. Or we are recruiting the right people but the paperwork burden is preventing them from setting foot beyond the office door.
Personally I’d say more the latter than the former. None of the students on my course signed up for the nursing degree because they want to be an office monkey filling in endless CPA forms.
Whichever it is, you’re quite right. It’s unacceptable and needs to change.
*clears her throat*
Zara, you trying to tell me nurses spend all that time in the office doing paper work? Lol, that’s the funniest thing I’ve heard in ages. I witnessed a lot of things looking through the window of the office door while my knocks on the door were being ignored – paper work wasn’t often one of them.
Thank you Mental Nurse. You’re not argumentative like OSB are you?
I’m not sure its academic trainees or CPA forms that keeps nurses in the office but one thing’s for sure, it’s not new- Goffman described it very well in ‘Asylums’, describing the ward offices of the 1960′s (50s even?). As I recall it, his view was something to the effect that by being behind a closed door, nurses reinforce their identity as part of the nurse group, and assert their power over the patient group- hence going out and sitting with patients can feel rather threatening (though of course it actually decreases the risk of violence).
Psychiatric training inhibits empathy initially by giving you lots of other things to think about in the clinical encounter; if you are worrying about getting the history, the diagnosis etc. you tend to be distracted from actually listening. Once you get confident, you will get back to your natural level of empathy- which is pretty variable, like nurses and everyone else.
Mr Man’s Wife
I wouldn’t deny that there are nurses and HCAs who will lurk in the office as a way of avoiding talking to patients. Some wards seem to have more of it than others. I think to a certain degree it seems to depend on the staff culture of a particular ward. Also it can vary from shift to shift, depending on whether or not the nurse-in-charge at that particular time will tolerate it or not. Some will make a point of shooing people out of the office if they think they’re lurking there to avoid having to do anything constructive.
One thing I will say is that I consider it my job to be out on the ward floor unless I’m specifically required for something in the office, and if there’s nothing I’m particularly needed for, I go to find a patient to socialise with.
I’d like to added something to psychlist’s comment that “going out and sitting with patients can feel rather threatening (though of course it actually decreases the risk of violence).” Avoiding the patients by lurking in the office drinking endless cups of tea doesn’t only increase the risk of violence. It also makes a nurse’s job a lot more boring.
This is getting interesting. We brushed on this before when CPNurse recollected that in the `70`s there was no requirement at all for a RMN to pick up a pen during their shift. Nowadays, an acute RMN would NOT attract any criticism from management for spending an entire shift engaged in paperwork. That`s a staggering transition and has to be a contibutory factor towards nurses not being visible beyond the office door. It`s also a nonsense. We are way beyond the tipping point. I could devote my life to absorbing all the paperwork in the ward office but I would be destined to fail, and fail miserably.
More interesting still is Z`s reminder that confining yourself to the office is simply boring. Too many activities are thwarted by the pseudo intellectuals demanding to know “what`s the evidence base ?”. That`s before the health and safety gestapo pour a vat of cold water on things. I`m going to loathe myself again but I have to concede that Malcolm was sooooo right in his definition of therapy. Come on nursing staff, get off your arses, get out of the office and engage in ANYTHING which has the potential to do good and is unlikely to cause harm. Who cares if there`s an evidence base ? Who cares what the gestapo says ?. If there`s an activity you enjoy – creative writing, orienteering, bird watching, mushroom picking, scavenging on the beach, volleyball – bring it into work and share it with your patients. Does anyone remember FUN ?.
If there`s an activity you enjoy – creative writing, orienteering, bird watching, mushroom picking, scavenging on the beach, volleyball – bring it into work and share it with your patients. Does anyone remember FUN ?.
Quite so.
Just randomly, that made me think of the spoof Daily Mail headline, “What is this sick ‘FUN’ craze that is spreading through our young people?”
Zara, you’re quite right of course “it seems to depend on the staff culture of a particular ward”
[...] Mental nurse looks at nursing training as it was 25 years ago. [...]