I’ve been having so many issues with my site over the last week and I’m unable to comment or ‘like’ other peoples blogs. I’m so frustrated and it’s really getting me down as I love to put my tuppence worth in 😉 I’m still waiting for support from WordPress — aarrgghh!
Hence this post, Fibbing Friday, which I grabbed from my blogging pal Liz at My wellbeing and learning journey here. I loved her fun answers so, in an effort to cheer myself up, I thought I’d give it a go.
1. What was the significance of the little white dot on the TV screen at 11 pm? It was used to hypnotise you into going to bed every night at the same time, so no one would have any excuse for turning up late to school or work i.e. “I slept in” 2. Who were the Woodentops? They were UK’s largest Kitchen Fitters. 3. What is meant by the Gravy Train? It carries Bisto to all the major stores. 4. Who sang about flowers in the rain? The Stone Roses with Sheena Easton. 5. What do the initials MP stand for? Miserable Pillock. 6. What was Jiminy Cricket’s job? This one had me ‘stumped’ for a moment but then I remembered, he served tea at the Oval. 7. Why are diamonds measured in carats? Because they were originally found in vegetable patches. 8. What do Kimball and Hammond have in common? Both are names of organs – heart and lungs 😉 9. What is a swizzle stick? A twisted lollie on a stick. 10. What are chick peas? Green eggs.
Looking forward to you joining in and reading your answers. All other comments appreciated too — Do you like, love or hate this kind of post?
Electroconvulsive therapy (ECT) is an invasive type of brain stimulation that’s sometimes recommended for severe depression if all other treatment options have failed, or when the situation is thought to be life threatening, (NHS).
ECT, given to depressed patients under anaesthesia, sends electrical pulses to the brain through electrodes applied to the head. The electrical stimulation triggers a seizure, which seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions. Repeated a few times a week for a short period, ECT eliminates depressive symptoms for an extended time in many patients, Brainwise, 2018.
“ECT is the most effective treatment available for severe and treatment-resistant depression, but it requires anaesthesia and can cause side effects like memory loss,” says Irving Michael Reti, M.B.B.S., M.D., director of the Brain Stimulation Program.
Who invented ECT
There’s much written about the invention of ECT but I love and have used excerpts from this article written by Robyn Wilson for the Independent, 2017 — Once upon a time in April 1938, a team of Italian medical researchers got ready to do one of the most controversial things that medicine had ever seen. They’d attempt to heal a mentally ill patient by applying a jolt of electricity through his brain. They didn’t know if he’d live or die but it was a risk they were willing to take.
Leading the team was 61-year-old Ugo Cerletti, and his assistant, Lucio Bini who, together had been working on the intriguing new medical machine they were soon to put to use.
In a large, secluded room they shaved the patient’s head and stretched him out on a bed. They attached two electrodes to his temples, placed a rubber tube in his mouth as a bite-bloc and flicked the switch of Cerletti and Bini’s device.
The team braced themselves as the electrical current coursed through the man’s head. He let out a small spasm and then bizarrely burst into animated song. Interesting, amusing certainly, but it wasn’t a seizure.
They tried again, increasing the voltage, until finally the patient went into what was a rather dramatic convulsion; face purple, mouth clenched, fists balled, heart racing. The medical staff all nervously watched on, fearing his death. Until suddenly the man slumped back, still. His breathing was steady, regular.
Right then, they knew they had completed what they had set out to do. After two years of research, they had proven that an electrical current could be used to induce a seizure without it resulting in the patient’s death; a seizure that, as they had hoped, would go on to relieve the patient’s symptoms.
They had just given birth to electroshock therapy and psychiatric medicine would never be the same again.
Modern day ECT
Today’s ECT involves going to a general hospital, where the patient is given short-acting anaesthesia (including a muscle relaxant) before ECT is administered. The targeted (and very low-level) electric jolts, it’s said, stimulate the brain to address everything from depression to dementia-related outbursts of anger (something I haven’t seen it used for).
In my first post as a mental health nurse I’d developed a good therapeutic relationship with a lady who had bipolar disorder and during the depression phase she felt hopeless and suicidal — it was pitiful to see. Over the years she had been treated with several courses of ECT and this time, she requested more. When it was agreed she could have ECT she asked if I, as her nurse, would accompany her.
I’d only ever seen Jack Nicholson in One Flew Over The Cuckoo’s Nest — and I cried watching that — so I wasn’t looking forward to observing Lyn having ECT. Oh my word, I thought I was going to have a panic attack as they pressed the button and she went into a seizure which lasted around 80 seconds. The ECT nurse must have noticed as she gave me a comforting shoulder rub and a smile that said she understood.
I waited for Lyn to come round in the recovery room with another nurse who took regular observations (obs) i.e. blood pressure, temperature and pulse to ensure Lyn wasn’t experiencing any unusual side effects. When she woke from the mild anaesthesia Lyn was drowsy but able to get into a waiting wheelchair with support from me and the other nurse.
Once back on the mental health ward I was to observe Lyn throughout my shift, taking hourly obs and asking her how she felt; documenting everything in her notes and on charts. She remained drowsy and confused for a few hours and her memory lapsed, she was unable to concentrate and complained of a headache, for which she was given paracetamol.
Shock and horror
I was about 15 and terrified when my mum went into hospital — well, an asylum actually. I later learned she’d been suffering with clinical depression which was treatment resistant. When I became a mental health nurse, I was telling mum about ECT when she confessed that she’d been in an asylum once before, when I was about 4-5, and on both occasions, she’d had ECT.
I’m glad I had more awareness and insight into ECT when mum told me because I would have thought, like most people, it barbaric, inhumane. She said she didn’t remember too much about it all — long-term memory loss? Or perhaps she just shut it out for all those years? Still, it had relieved the depression and her mood had improved.
My conclusion on ECT
I’d accompanied Lyn on six more occasions and my anxiety lessened each time as I saw how much her mood improved — and I realised that ECT is actually more civilized than I’d been led to believe.
I’m not sure it would be my choice of treatment but then again, I’ve been lucky that medication and talking therapies were, and still are, beneficial to me — they’ve helped me out of a massive black hole — on more than one occasion.
Would you be able to explain what ECT is to other people now? What do you think of ECT? Is there anything I missed? I am happy to answer your questions. In the meantime, you might like to read more about depression here.
This article was first posted on the Blogger Community here – thanks to Saumya and Niki; authors on this blog. Why not drop in and say hi to some fellow-bloggers.
Wow! How lovely. Debby over at Debby SEO nominated me for the Mystery Blogger Award and I love it — thank you Debby.
Debby SEO offer budget search engine optimization services and free SEO tools so you can increase your organic rankings. They say “We are the Unicorn among a sea of donkey SEOs.” They’ve been providing resources for actionable SEO and content marketing since 1998. So if you’re in need of SEO expertise help, why don’t you pop on over for a chat
Answer the questions provided by whoever nominated you
Nominate 10-20 bloggers
Notify your nominees by commenting on their blog
Ask your nominees 5 questions of your choice with 1 weird or funny question
Share a link to your best post
This award was created by Okoto Enigma
Three things about me
I was a Human Resource Manager for many years prior to having a lengthy psychotic depression. During my recovery I first trained in massage then studied full-time to become a mental health nurse, followed by further studies because I always felt like I didn’t know enough. However, I went on to have a successful and very rewarding career in mental health nursing before becoming a Ward Manager which, to me, was the best job in the world. Never a dull moment and very humbling, working with some amazing patients and fantastic colleagues.
I was a single parent to two amazing grown up sons who also loved to study and are both doing well in their medical careers. Proud mummy moment 🙂
In 2011, I was struck down with a rare neurological disorder (Transverse Myelitis), which meant medical retirement from the job I loved. Of course, I’m mad at having the disorder, along with mental ill health but hey, what can you do? As my sons say “Mama, life – is – life!
You can read more here, if you wish. And if you want to know more about my blog and why I started it, you can read it here.
Now we turn to the questions set by Debby
1)Have you ever smiled at a stranger and then wished you hadn’t? Why or why not? Oh, I’ve smiled massively at many a stranger, believing I knew them — then realising I didn’t — they must have thought “Who is that mad woman, grinning at me like a Cheshire cat?”
2) What is your favorite SEO plugin for WordPress? Do you fully understand SEO’s and their functions or benefits? My plan doesn’t allow for plugins 🙁 And nope, I don’t understand fully SEO’s and their functions or benefits.
3) If you could shop for free at any store, which store would you choose and why? It would have to be Selfridges for me because they sell almost anything and everything I need or want — from the franchises that sell clothes to the furniture department. I could shop there all day!
4) If you could make one thing illegal, what would it be? Walking on the wrong side. Aaarrgghhhhh! In the UK, we always used to keep to the left but now, particularly in London, people just bombard you on the stairs down in the tube stations. What happened to good old fashioned manners and stick to walking on the left? It’s not difficult!
5) Have you ever had SEO work done, and if so were you happy with the results? If you did the work yourself how did you do? Nope, never. I wouldn’t know where to start.
Okay, now for my questions
Have you or anyone you know experienced psychosis? If so, would you tell us a little bit about it please? If not, what is your understanding of psychosis?
What do you think you would do if you suddenly started to hear voices that no one else hears or see things that no one else can see?
What would you say or do if your best friend told you he/she felt suicidal?
Is there anything you need/want to know about mental illness or recovery?
What would you do if you thought you’d never get caught?
My journey through psychotic depression, which is part of a series and you can read Part IV here.
Thanks again for reading this post ’til the end, I love you guys, if you are reading this and haven’t subscribed yet make sure to press the “follow”. This way you don’t miss out on new posts. In the meantime, I’m happy to read any comments and answer your questions.
Note: Is anyone else having problems with WordPress lately? I’m unable to ‘like’ or comment on lots of blogs.
I want to say a huge thank you to all who commented, made suggestions and helped me to choose my new blog name. You were super helpful and really kind, taking time to read my post, checking out my ideas and coming up with lots of your own.
My initial favourite blog name was Mental Health from all sidesand some of you agreed, so I’m going to use that as part of my tagline.
However, when Sadagopan at Pointless & Prosaic came up with Mental Health 360°, it made sense to me, with several of you in agreement. So there we have it.
Now all I need, and I’m going to be really cheeky here, is to ask if you would help spread the news through any of the social media channels you use? I’d really appreciate you helping me promote my new blog name in any way possible.
Thank you also for your thoughtful comments about my content and for now, I will continue along the same lines. However, along the way, I’m happy to have any more suggestions about what you’d like to read on my blog.
My last few posts have been about Communication skills in various forms, something you might find helpful in any situation:
Each year World Bipolar Day takes place on 30th March and this year members of the public across the globe are being encouraged to use social media to help disseminate information and get the event’s hashtags trending on social media.
World Bipolar Day is designed to raise awareness worldwide of bipolar conditions and to work to eliminate social stigma whilst providing information to educate and help people understand the condition. Hence this post.
1. What is Bipolar
It’s normal to experience a wide range of feelings and moods. At some point we might feel incredibly excited or happy, then another time we feel low, anxious, tearful or downright flipping miserable.
Bipolar disorder (known previously as manic depression) is a mental health condition where people experience extreme highs, called mania, and intense periods of sadness or depression. These phases of mania and depression are called episodes, and can shift rapidly.
Bipolar disorder is a serious mental illness and can affect a person’s thoughts, feelings, mood, energy, behaviour and overall functioning but it can be treated.
There are three types of Bipolar Disorder
Bipolar I — a person will experience at least one episode of mania lasting longer than a week. They might also have experienced depressive episodes, although not everyone does.
Bipolar II — a person would experience both episodes of severe depression and symptoms of hypomania.
Cyclothymia is where a person who has experienced both hypomanic and depressive mood states over the course of two years or more and their symptoms aren’t severe enough to meet the criteria for a diagnosis of Bipolar I or Bipolar II.
2. What is hypomania and mania
Hypomania is a milder version of mania that lasts for a short period (usually a few days)
Mania — overactive and excited behaviour — is a more severe form that lasts for a longer period (a week or more)
Someone might have hypomania and/or mania on their own or as part of another mental health problem –including bipolar disorder, postpartum psychosis (after childbirth) seasonal affective disorder (where mood is affected, most commonly in winter), or schizoaffective disorder.
3. Symptoms during manic phases of Bipolar
The symptoms of mania typically include several of the following:
Racing thoughts — are typically one of the first symptoms during a manic phase. Racing thoughts may be the inability to concentrate and include rapidly changing ideas.
Feeling overly exhilarated — an overly euphoric or elevated mood is one of the most common bipolar mania symptoms. However, in some cases, instead of an exhilarated mood, individuals experiencing mania might be extremely agitated.
Higher energy — increases to abnormal levels. For example, someone with mania moves quickly from one activity to the next, not finishing them but have lots of amazingfanciful ideas
Sleep difficulties — People with mania generally feel that they need less sleep and it wouldn’t be uncommon for someone with mania to stay awake for more than one night, cooking or cleaning, or only sleep a couple hours a night, but report they’ve slept well.
Pressured speech — the tendency to talk quickly and loudly and often accompanies racing thoughts. They rarely stop to let anyone else talk. The person might want to share their whimsical ideas urgently, without making sense and saying inappropriate things.
Inflated self-esteem — is more than just being self-assured and overly confident. Rather, it’s an unrealistic and exaggerated sense of being superior or of self-importance. Someone might think that they have supernatural abilities or can achieve impossible things, such as writing Michael Jackson’s hits.
Engaging in risky behaviors — behaving impulsively, spending money they can’t afford or take part in dangerous or risky behaviours like misusing alcohol or drugs, reckless driving or having unprotected sex.
Some people find their mania entertaining, pleasurable and engage in risky sexual relationships or behaviours. Or they might find them distressing, unpleasant or uncomfortable and some dread the onset, perhaps knowing what’s coming next.
4. Professional experience of Bipolar Disorder
In my job, as Mental Health Nurse and Ward Manager, I only ever met one female patient who didn’t enjoy the mania. At the Day Hospital (DH) we had a group of women who’d all had many episodes of mania over the years. They got together regularly, regaling everyone with their tales of shopping sprees on credit cards they wouldn’t have to pay.
They loved including me in their “Nutter’s Group” because of my previous mental illness and they’d curl up in hysterics with each new adventure; like Sharon who spoke very well and would apply for all sorts of high flying jobs — and get them, when she was manic. Words just flowed effortlessly for her and she’d often be out shopping in Kensington (a posh part of London), collecting store cards along the way, and arrive back at the DH laden with bags of goodies, only to give them all away.
The one lady who dreaded any impending mania was terrified she’d go back and stalk a married man that she’d worked with, but was dismissed because of her behaviours. Whenever she became manic she stalked him; persistently phoning, emailing, and writing to his family, believing that he loved her, not his wife. It was quite a big case in the media some years ago — the last straw was after she’s sent him and his wife a package holding a used sanitary towel as proof of his love for her.
5. Mood swings in Bipolar Disorder
Mania might sound exciting and moreish but what follows is soul destroying and heartbreaking to watch. Take a look at the chart below and see the midline — that’s classed as normal mood and the short squiggly line shows that, like in most of us, moods go slightly up and down, depending on the circumstances i.e. we get excited when we’re going to a wedding or we feel down if we’re going to a funeral perhaps.
But in Bipolar, the person’s moods swing violently – see how high the squiggle goes — then how low it drops — possibly way down beyond anything most people might experience in their lifetime.
Unfortunately, during my fifteen years, several patients made attempts to die by suicide because they couldn’t bear the devastating drop in mood. The lady who stalked her colleague was always devastated and so embarrassed by her behaviour during the manic phase, she would feel suicidal as her mood dropped.
6. Symptoms during a depressive phase of Bipolar
During the depression phase of bipolar disorder, someone might:
Feel empty, sad, worried
Have trouble concentrating or remembering things
Have a hard time making even minor decisions
Have little to no energy to do normal things
Feel like you don’t enjoy anything, even things they used to enjoy
Eat too little or too much
Sleep too little or too much
Have a hard time getting out of bed
Think about suicide or death
A person could have all of these symptoms or some of them. Someone with bipolar disorder can sometimes feel very sad but also full of energy. The surest sign of a phase of depression is that you feel down for a long time — usually at least for 2 weeks. You might have these episodes rarely or several times a year, Webmd.com.
Most people who have a diagnosis of Bipolar will have been prescribed mood-stabilisers medication and, while it’s important to adhere to their medication regime throughout the various phases, they must also maintain contact with their Mental Health Team who will be able to monitor their moods and adapt their medication as appropriate.
7. Self-help strategies for bipolar disorder
Monitor your mood — daily, including factors such as medication, sleep and anything that might be impacting on your mood. You may be able to download a chart or and app to help you do this.
Stick to routine — important in keeping your mood stable. In order to maintain stability, organise a schedule and try to stick to it regardless of your mood.
Build a good support network — friends, carers and family can be there if you’re struggling or just need someone to listen. They might also be able to offer another perspective on your mood and help you cope day-to-day.
Limit stress — where possible and try not to take on too many other commitments.
Sleep hygiene — disturbed sleep can have a negative impact on mood. Try to get into a sleep routine.
Take your time in making decisions — or ask a trusted friend to help you make decisions if you’re feeling impulsive and want to go on a shopping spree
Join a support group — it might be reassuring to hear from people who are experiencing similar symptoms or circumstances. Support groups can offer great advice and comfort.
Exercise. Regular exercise is helpful as a way to help manage mood and mental state.
Relaxation is effective in reducing stress.
Avoid or reduce alcohol and drug intake — which can make our mood worse. If you’re on medication, alcohol and drugs can be particularly dangerous. Talk to your psychiatrist, your Mental Health Team or GP.
Only take prescribedmedication — and don’t make changes to medication without talking to your Doctor or psychiatrist.
Make a wellbeing plan — Perhaps you’ve made one of these with your care team and given a copy to close family or friends? You can record your plans for how you’ll manage your routine, how to manage any highs or lows, and contact details if you need help.
Ensure you have asuicide safety plan. Prepare how to manage low moods and suicidal thoughts. Keep your contact details list close to hand for emergencies.
If you or someone you know is experiencing the above symptoms, please contact your GP, Doctor, your local Mental Health Team immediately. You might like to read the useful Mental Health Contacts List here for various UK agencies and organisations who are able to offer advice and support.
In the meantime, look after yourselves and each other. As always, I’d be delighted to answer any questions and read your comments or suggestions. I certainly need something to keep my mind off the dreaded V word ‘cos although I know it’s important to keep up to date, I’m finding it all really worrying and quite depressing.
I’ve been thinking about this for a while and I suppose, maybe like some of you, I was a bit hasty when I first started my blog and quickly named it Mental health from the other side.
I initially wanted to discuss mental health nursing from my own perspective so I thought my blog name covered it. However, my blog has evolved over the last five months and I’ve been discussing my own mental health, together with mental health and mental illness in general. So, in hindsight, while my current blog name says ‘from the other side’, I’ve been thinking, what ‘other’ side?
I wasn’t even sure that technically (i.e. it could be done on wordpress) I could change my blog name and I certainly didn’t know how to, but with some sage advice from my wonderful blogging pal Hugh at Hughs news and views, I’m going to try. However,
I need your help
I have a few new blog names in mind and I need your help in deciding which one ‘cos I want to get it right this time. You are the amazing peeps who read my blog and you might have a better idea of what to call ‘me’? It’s been on my mind a while now and I think I know which one I prefer and I do like the word ‘sides’ in it but I just can’t settle. Help?
Mental health from both sides
Mental health from all sides
Mental health from different sides
Mental Health from various sides
All things mental health
Another thing I might need to change is the tagline under my blog name? Do you think so?
While I’m asking for your help renaming my blog, I’d like to ask if there’s anything else you think I could be writing about? I have my diaries and lots more I could write about; I could write for England 😉 What would you like? Would more nursing tales be interesting? Is there something I’m missing or am I writing too much. How does my blog look to you?
It’s a big ask, but I’ve asked for it, so give it to me straight — even though I’m scared. However, constructive criticism and all comments will be appreciated.
Following my previous post on How and when to say sorry (here), a fellow-blogger friend commented “I’m not guilt free and I try to apologize when I realize I’ve misstepped. Problematic for me with my lacking social skills is I am not always quick on the uptake to recognize a social faux paux.” Great timing Nikki — now I get to expand on the title of another post “Never miss important social cues again” stored like, forever, in my bulging draft folder.
What are social cues?
Social cues can be either verbal or nonverbal hints which can be positive or negative, (Wikipedia). These cues guide social and other interactions and let us know that the other person or a group is not interested in our conversation. These cues can tell us that someone feels offended by what we’ve said or perhaps they’re really excited by our explanation. Social cues can include:
facial expression — without a doubt, the most telling—and common—nonverbal means of communication is through facial expressions like eye rolling, downturned lips, flared nostrils, looking bored, showing disgust, fear, animosity or we might be smiling and showing approval. However, we’ve all seen a fake smile — that one that doesn’t reach the eyes 😉
body posture — is critical in making a strong impression. How we sit or stand is important in how we’re seen by others. Slouched or facing the floor might display indifference, uncertainty, or even weakness while, conversely back straight and head held high exudes confidence, assurance, and strength. However, we’ve all seen soldiers on parade – exuding confidence and assurance? when they’re actually terrified of their Sergeant screaming in their face.
speech isn’t just what we say, but also how we say it, using inflection, pitch, tempo (controlling speed of speech) and tone of voice to convey anger like shouting. Also included here might be huffs, puffs, tutting and heavy sighs. There isn’t a teenager, uh — anywhere who hasn’t done this.
proximity — how close or far away we are from a person. Someone might step back from us if they’re afraid or if they’re standing close or leaning in, it might be because they’re interested in what we’re saying. We all have our own ‘intimate space’ and we’re choosy who we let in there. Have you ever thought — “get out of my personal space!”
gestures — are used to communicate important messages, either in place of speech or together, in parallel with spoken words. Remember though, that gestures are culturally specific and can have very different meanings in different cultural or social settings. For instance, in Brazil, Germany, Russia, and many other countries around the world, the OKsign is a very offensive gesture because it is used to depict a private bodily orifice. So when it comes to gestures, the wisest advice might be to keep your fingers to yourself! (Huffpost.com, 2013). In the UK, we all know someone who talks with their hands. Then there’s pointing or arms crossed looking impatient or hostile. There’s also the kids foot-stomping, which most of us have seen at some point.
body language – we shake our head, clench our fists, stare out the window, turn away from our speaker perhaps showing disinterest — say in school, university or meetings, and even with stroppy teenagers.
physiological changes are often the most associated with discomfort, shyness and anxiety, for example blushing, flushing, shaky hands or sweating are a giveaway that someone’s ill-at-ease. If you’ve ever had to give a presentation at work, you’re probably familiar with some of these social cues.
Nonverbal cues speak the loudest
In a previous post ‘How to improve your verbal communication skills’ (here), you may remember that a huge 65% of our communication skills are nonverbal.
Therefore, it’s not only important to be aware of what someone says, but we desperately need to be aware of how they say it too. The trick here is to remember — nonverbal (body language) cues actually speakthe loudest.
This might appear odd because it seems glaringly obvious, but it isn’t, not to some. In fact, we’ve all missed cues at some point. For example, in the midst of an argument we probably missed the process of what’s going on around us and stormed ahead no matter the other person’s response. We’ve not registered their shock, surprise, horror or utter silence. We’ve missed their cues to either pull back or stop.
Nonverbal cues occur instinctively
Now we understand that body language is the use of expressions, proximity, mannerisms, physical behaviour to communicate nonverbally, did you know:
nonverbal communication occurs instinctively rather than consciously (but it can be learnt)
that whether you’re aware of it or not, when we interact with others, we continuously give and receive wordless cues
these messages don’t stop when we stop talking either
even if we’re silent, we’re still communicating nonverbally
All of our subconscious nonverbal actions send powerful messages to others, which can build trust, put people at ease and draw them to us, or we might confuse, offend and undermine what it is we want to convey.
In the absence of reliable information about a person, all we really have is the nonverbal cues which offer a look into their likely behaviours or actions.
Social and nonverbal cues in action
For example, at work in my role as a mental health nurse, our Rapid Response Team (RRT – a team of around 6-8 mainly large male nurses who would attend to a ward when they had an aggressive or violent patient) instinctively all stood tall, heads back and arms crossed, staring at the said patient.
Unfortunately, our RRT’s nonverbal communication was intimidating to the patients at best and threatening or provoking at worst. The patient didn’t know these men — with their threatening body language — or that they were there to help — so it didn’t inspire trust in the patient. In fact it often made the patient want to lash out, either in fear or sometimes in defiance. Staff were missing social cues these presented by the patient.
Therefore the RRT first had to be made aware of their how their nonverbal communication appeared. This was done during the debriefing meetings following an incident where it was fed back that their posture was inappropriate and unacceptable.
Secondly, the Control & Restraint Department (responsible for the RRT’s training) was informed of how this practice was coming across on the wards. Staff went on refresher courses where they carried out mock incidents, using a more relaxed posture when approaching patients.
Effective nonverbal communication can be learnt
Okay, so while it’s said that nonverbal communication is spontaneous and generally can’t be faked — it can be taught and learnt, as above.
To enable us to develop and maintain successful/good relationships, it’s not only crucial that we have good speaking skills, but also a clear understanding of the nonverbal cues that accompany conversation. It goes without saying that we need to be aware of how we ourselves come across to others.
Having an awareness or even a control of your own nonverbal communication could prove advantageous in a business or work environment and certainly if you’re working with the public. This awareness is definitely beneficial if you have difficulties within your personal and family relationships.
If you’re worried you’re missing social cues, ask someone you trust and respect to give you honest constructive feedback on whether you’ve been able to read their nonverbal hints appropriately.
Watch films or tv programmes, paying particular interest in the nonverbal communication that occurs between two people or groups of people. See which of the above and how many cues you can identify.
Notice how they express friendliness and positivity by maintaining an open posture. See how they stand with their legs hip-distance apart and keep their torso exposed as opposed to covered with crossed arms, keeping their head raised and relaxing their facial expression.
Being aware of nonverbal communication
If you recognize that a colleague, friend or family member you’re speaking to has a case of the jitters and they’re struggling to make themselves clear, try to make them feel at ease. Let them have some time and don’t interrupt until after they’ve finished speaking.
If someone’s raising their voice at you, take a step back and with your arms out, palms down and say calmly, quietly and firmly, “Please, don’t raise your voice to me.”
You could go on further “I can’t hear” or “I can’t understand what you’re saying when you’re shouting at me.” When they do stop shouting, and they will — they’ll be shocked by your actions — you can ask them to repeat what they were saying.
If someone does continue to shout or rant, repeat the nonverbal cues and tell them – you are going to walk away (and do it, whether it’s to another room, the bathroom).
Don’t be afraid of asserting yourself, calmy, quietly and firmly to say “You’re scaring me.”, “It makes me feel ………… when you shout at me.” No one can argue with your feelings; their yours and you own them.
Watch out for the other person’s nonverbal cues to gauge the situation. This will give you clues as to whether they want to continue in this vein or whether they’re calming down, willing to listen to you.
If you’re still struggling with communications skills, these posts might help:
You ever had that “Ah! When and how do I say sorry” moment?
We’ve all had a bad day at the office, on the shop floor or the ward, sometimes with the kids or the family, or that insensitive friend, when we just want to take someone’s head off their shoulders. Yes?
I’m guessing you didn’t literally take anyone’s head off, but maybe you raised your voice, hurled some insults, gave some dirty looks, tuts and sighs? Perhaps you stomped around, bashed your laptop shut, slammed a few drawers or doors for effect? Once you’d taken a few deep breaths, had a cup of tea or a glass of wine, slumped into your car seat or relaxed in a warm bath, you calmed down.
Then it’s Ah!When and how do I say sorry? Let’s find out more:
Insincere or unnecessary apologising
The Guardian (2019) said “In Britain, we over-apologise out of politeness.” and we do. It comes easily. But some apologies are totally unnecessary and often insincere i.e. we say sorry when someone bumps into us or we say to our waiter “I’m sorry, but my food is cold.” We call work and say “I’m sorry, but I don’t feel well.”
Constant apologies, particularly at work might undermine someone’s confidence in you; in a meeting you say “Sorry, I’d like to interrupt you.” Why apologise? Or when you have to deliver an important but boring directive to your team i.e. “Sorry, but we have to complete audits by……….” Just tell them the message “We have the annual audits to be completed by…….”, which sounds way more confident and you needn’t be sorry about directives from someone or somewhere else.
Some people just apologise to relieve their own guilt or shame at the way they behaved and are not necessarily genuinely upset by the hurt they caused the other party. Others might apologise to escape punishment like someone in court hoping to get a lesser penalty.
Even our politicians and world leaders apologies are carefully worded and often insincere. They’re seen only to be protecting their image rather than concern about their message.
A genuine apology
It’s generally more difficult to say sorry when you actually have something to apologise for. Psychology Today (2016) said “A genuine apology offered and accepted is one of the most profound interactions of civilized people. It has the power to restore damaged relationships, be they on a small scale, between two people, such as intimates, or on a grand scale, between groups of people, even nations. If done correctly, an apology can heal humiliation and generate forgiveness.”
When to say sorry
Immediately, if possible but at least at the earliest opportunity. It’s unfair on the other person or group of people and it only drags out your ensuing feelings of possibly anxiety or upset at causing hurt in someone you care about or respect.
When it’s your fault. Sometimes if you really have done something wrong, it truly needs an apology. And in those situations, by all means, take responsibility! Own it!
Evoking tears or other distress in others tells us that we’ve overstepped the boundaries of what’s acceptable to the injured party. If it’s a friend, someone else we care about or respect, we don’t want to alienate them, lose their friendship, end the relationship or lose respect at work. We know we have to come up with some kind of apology to repair the damage and get the unpleasant matter behind us all.
I think we’re all aware how maddening it is, not to get an apology from someone who’s hurt us.
How to say sorry
Show genuine remorse over your actions by, and this is important, telling them first “I apologise” or I’m sorry”.
Genuinely and freely, not waiting to be asked; recognising the damage/hurt you’ve caused. You might say something like “I’m really sorry I said/did that. I can see how hurt/upset you are.” or “I apologise for hurting your feelings and I want to fix this.”
Show and sound like you mean it – your body movement, your eyes, your hands, your tone of voice. You need to show the other person that you really do understand and care about their feelings and their experience of what happened. Ask them their take on the situation and how it made them feel.
Take responsibility for your words, actions or behaviour – admit that you were rude, wrong, ignorant or downright spiteful
Repair the damage – make amends. Tell them how you’re going to fix things “I’ve heard and understand what you’ve said and I’ll make changes for the future.” Ask how them how to, if necessary “What can I do to make it right/better/change things?”
Promise that it won’t happen again and you need to keep this promise. The definition of a promise “a declaration that one will do or refrain from doing something specified.” Make the promise concrete and you’re sure you can commit to the action or expectation.
How not to say sorry
“I’ve already said sorry.” or “You know I’m sorry.” or “My dad said I had to say sorry, so……….” These kinds of apologies just cheapen whatever follows and if someone tells you to apologise, you’re giving their apology, not yours.
Don’t make excuses for your behaviour/words – “I was only trying to tell you…….”
Don’t try to justify your words/behaviours – “I was just trying to help you.” and “I was just playing devil’s advocate.” “I was just joking.” You’re trying to tell them that how they felt wasn’t important cos ‘it was just for fun.’ Really? Because, it obviously wasn’t fun for the hurt person.
Don’t use the “you know” kind of apologies like “Oh you know I’m like a bull in a china shop.” or “you know I forget sometimes.” You’re trying to belittle their hurt or their experience as though they shouldn’t be upset.
The same goes for “I Know” apologies like “Yeah, I know I shouldn’t have……” It’s like “Well, why did you then?” and you’re not really owning up to the damage you’ve caused to the other person.
Bullying apologies are dreadful too, like “Okay, I get it – sorry!” and “Drop it now, it’s done – sorry!” or “Sorrrry – duh!” with the eyeroll.
I’m sure there are many more ways to apologise or ways of how not to apologise. I hope some of these points help and I’m open to more suggestions or your comments. What was the last insincere apology you gave or received?
You can read the backstory About Me to give you an understanding of how I got to here………. how I loved mental health nursing – then I got sick
I was on the road to recovery from my own mental illness when I realised I wanted to study. I wasn’t sure I was clever enough and I wasn’t sure what I actually wanted to study.
Studying massage part-time
I thought I’d start small so took evening and weekend courses in Shiatsu, followed by Swedish Massage, Seated Massage, Aromatherapy and finally, Indian Head Massage. I loved it and so too did my family and friends, who I practised on.
I had the massage table, the massage chair, the fluffy white towels and a full kit of aromatherapy oils. However, despite passing all my exams with distinction, I couldn’t ask for money. I just loved providing massage, but I realised it would never be a paid job.
Studying to become a mental health nurse
In February 1997 I’d seen a large advert looking for General Nurses to study at my local University and Hospital. This didn’t so much interest me but, right at the bottom of this ad, there was a few lines about becoming a Mental Health Nurse. It just felt so right and I knew my own experience of mental illness would help to make me a good nurse.
So, during my own recovery from, what I learnt was, a lengthy psychotic episode, depression, anxiety and anorexia (which you can read here), I applied to train as a Mental Health Nurse.
On becoming a mental health nurse
After three long years of study, I worked successfully as a Mental Health Nurse in various settings before eventually becoming a Ward Manager. I was already working more than double my previous hours but now earning half the salary but I didn’t care — I’d found my purpose, my reason to get out of bed.
However, despite being a qualified MH nurse, I still felt that I just didn’t know enough, that I was a fake and I’d soon be found out. This drove me to attend further specialist courses including the one-year Thorn Nursing programme which taught nursing interventions for schizophrenia and a Cognitive Behavioural Therapy (CBT) course for psychosis.
Outside of the NHS, I also trained to become a Mental Health First Aid (MHFA England) Instructor, a Mental Health Awareness Trainer, Mental Health First Aid Youth and Mental Health Armed Forces Instructor.
Working in various mental health settings
I was enjoying every aspect of my job and had the honour of working with some amazing people; patients, families and their carers, together with colleagues from lots of different disciplines. I spent time working in the community, visiting patients in their own homes and seeing how they lived when they were ill and well.
I worked on various acute in-patient mental health wards where patients could be extremely unwell, distressed, chaotic, occasionally angry and aggressive towards staff and others. Unfortunately some had to be restrained for the safety of both patient and others. Whilst it can look quite alarming, nurses tend to take the brunt of the drops to the floor, ensuring patient safety at all times. Our patients were acutely unwell, experiencing:
panic attacks, depression and/or anxiety disorders as well as obsessive compulsive disorder (OCD), borderline personality disorder (BPD) and post traumatic stress disorder (PTSD)
severe mental illnesses like schizophrenia, bipolar disorder and schizoaffective disorders
Acting as ward manager for three years with the elderly was definitely an experience but it wasn’t always easy as many patients had both mental and physical illnesses. The lack of family or visitors on this ward saddened me and of course, often patients had to be transferred to general wards, where sometimes they’d pass away – which always broke my heart.
I’d worked in A&E which was fast-paced and never a boring moment; working with disturbed patients, the Police, distressed families and community colleagues. Then with the Home Treatment Team (HTT) and in the Mental Health Emergency Department where we’d see patients in various stages of illness who needed support, perhaps admission or to go home with the HTT.
Duty Senior Nurse
From Band 6 (Charge Nurse) upwards you’re on the rota to carry out two shifts a week as Duty Senior Nurse (DSN), which could be early, late or night shift and you have responsibility for the whole mental health hospital.
Despite The Mental Health Code of Practice saying a patient in crisis should only ever be transferred to hospital by an NHS vehicle, quite often an extremely psychotic and aggressive patient arrived in a police van, in handcuffs. It was always great when the patient recognised you, calmed down and agreed to walk in with you, rather than being practically dragged in by the police.
Unfortunately I’ve been on DSN shift when the police come to tell you bad news such as they’d found a body somewhere, it would be one of our missing patients. Or they came to ask you to identify a missing patient who had died by suicide. Once they came to tell me of a double suicide and I was raced off to the scene to identify the patients.
Favourite mental health settings
One of my favourite places was the Day Hospital (despite a bully of a manager), where we saw up to seventy patients each day, who all came to attend various therapies and activities. This was part of their recovery and they might been referred from an in-patient ward in preparation for their discharge.
I loved being able to use all the knowledge and skills I’d gained together with my own personal experiences to support our patients. Part of my role was training less senior staff from both the day hospital and the ward, something I got a lot of satisfaction from. And of course, I enjoyed the positive feedback.
Another favourite and sadly my last post was as ward manager on an all female acute in-patient ward. It was an absolute nightmare when I first arrived, the ward was in chaos! It was initially managed by three male staff, the ward manager and two Band 6 nurses. The patients had previously been allowed to yell and swear at staff; they’d tried to attack them, thrown dining table and chairs around and generally behaving badly.
Some of the nurses were said to be worried about my arrival and chose to transfer to other wards, which saved me the job of managing them on the Capability programme. Some had attitude problems and didn’t like that I’d adhere to Company policies regarding the Trust Dress Code; no inch long nails, no big dangly earrings, wearing id, their inappropriate dress like tight leggings and vest type tops. If I hadn’t already known the staff, I would have wondered who were nurses and who were patients.
My Personnel Management skills came in handy as I was well aware of the need to know company policies and procedures. I was able to use them to guide me through how to manage patients abusing our staff and the ward. During my first year our team was able to reduce the number of violent incidents on the ward by 74%, something we were all very proud of and actually gained recognition for it.
We were to present our ‘work’ at Head Office, after which I was asked to present it to all Ward Managers within the Trust. I was so excited and even more so when our Nursing Director suggested that in the future, I become more involved in training staff from Band 4 – 7.
The onset of my physical illness
Within days of that presentation I was struck down with a rare disorder – idiopathic (cause unknown) Transverse Myelitis (TM), which is normally caused by a virus but, despite the hundreds of tests, mine wasn’t, hence the idiopathic.
According to Mayoclinic.org, TM is an inflammation of both sides of one section of the spinal cord. This neurological disorder often damages the insulating material covering nerve cell fibers (myelin).
TM interrupts the messages that the spinal cord nerves send throughout the body. This can cause pain, muscle weakness, paralysis, sensory problems, or bladder and bowel dysfunction.
Due to my physical disability and ongoing mental health problems I am no longer able to work in the job I loved and even after nine years I still miss it terribly.
I became physically disabled overnight and though the NHS paid full salary for six months and half salary for six months, they still ought to have kept my job open. However, they needed a Ward Manager and after around nine months they replaced me.
It was then that the snotty young HR dogsbody decided that medical retirement was the best option. I was devastated at losing the job I loved but I was too exhausted both physically and mentally to fight — in hindsight, I wished I taken them to a tribunal — just to wipe the smirk of the HR dogsbody’s face. You know that look, when someone thinks they got one over you, which she did in this case.
I often reflect on some of the most amazing and inspiring patients, remembering some of their journeys and the extremely difficult changes they made on their personal road to recovery. I’ll never forget how humbling it was working in mental health — and I like to think I made a difference during the course of my nursing career.
As mental health nurses, we see people at their lowest point, emotionally, which makes us very significant, not only in their survival, but also their growth. Along the way, sometimes our lives are even changed because we feel their struggle, so it sharpens our emotions as well as our skills, and sometimes in rare cases, it can touch our lives as well — Anon
I hope this might help and inspire both students and nurses alike — aim high and be the best nurse you can be.
I went off on holiday to Spain and so wanted to keep in touch with you all — until I got sick, again (for over a week). I couldn’t even sit up to read or to make comments on all your posts.
After that, we had to move homes as our friend’s (Charlie) massive and extended family were all arriving for his birthday celebrations in a few days time. We went to stay at another mutual friend’s villa and I soon realised that he had no wifi so I couldn’t use my laptop – oh boy, did I need it!
Backstabbing and bitching
It turns out that none of the extended family groups liked each other so they all bitched constantly behind each other’s backs – but not in front of Charlie, so he wasn’t aware.
During one of Charlie’s intro parties, I’d made food which his kids and grown up grandkids devoured with their fingers, dipping stuff into various sauces when there was shouts of “Oi, don’t f*cking double dip – that’s f*cking disgusting you stupid cow” and from someone else, there was “Yuck, triple dipping – what you f*cking doing?” Interspersed with several bitch and C words. Nothing to do with us, but it was late and we left them all to it anyway.
Next day, at a restaurant, I made the terrible mistake of trying to pinch a chip from a young lad’s plate (the boyfriend of one of Charlie’s granddaughters) but sadly and shockingly it quickly spiralled out of control.
He screamed “Don’t f*cking do that you f*cking stupid bitch?” then stabbed at the chip viciously with his fork and shoved it in his mouth. He shouted “Why did you f*cking do that? You’re f*cking disgusting” so aggressively that it made me jump and had the whole restaurant staring at our table in disbelief.
I quickly apologised and said I’d never do it again when his girlfriend joined in with even worse expletives. I apologised yet again and, as we were by the door, I left the restaurant feeling embarrassed. My hubby followed quickly and said “That’s it, we’re going.” Although I knew I’d overstepped the mark, I was still upset by the ensuing outrage.
I was also furious because I had forsaken my best friend’s mum’s funeral to attend Charlie’s celebrations – obviously I’d booked the holiday before I knew about the funeral date.
During all this, I’d had a severe toothache caused by a Spanish dentist filling a gaping hole in my tooth without taking any x-rays. I’d had an abscess which then needed antibiotics for five days before I could have any further work done. With a new dentist, full x-rays and my tooth now removed, I felt a bit tender but relieved of the agony so decided I wanted to fly back to the UK, miss Charlie’s party and attend the funeral – as I should have done in the first place.
However, I had no wifi. I had to call a friend, in tears, and she managed to book me a last minute flight to London for Friday. Although I felt really bad for Charlie, I just couldn’t spend any more time with the trailer trash extended families.
I am so glad that I chose to fly home and that I did attend the funeral to support my bestie. It was a beautiful service and a warm sunny day where we celebrated Marion’s life and said our goodbyes. Lots of family and friends that I hadn’t seen in years returned to my bestie’s home to continue sharing fond memories and funny stories about and with Marion.
Though I was considering going back to Alicante, I’ve heard that the coronavirus is there so I need to check out any risks first. If I can’t get back into Alicante, it means my hubby’s can’t get out 🙁
So, with all that behind me and regardless of whether I return to Spain, please accept my apologies once again and I’ll be reading all your latest posts as soon as I can.