Tips on Nursing Patients
Why is family support important?
Family plays a crucial role in a patient’s recovery process, especially during the early stages of psychosis. Studies have found that family support is particularly important during a patient’s first onset, such as encouraging patients to seek help, supporting them to continue receiving treatment, and facilitating them to take their medication on time and to improve their social lives. Family members’ knowledge of the disorder also affects the way they take care of the patient.
Studies have found that the more knowledgeable a caregiver is about the disorder and the relevant drugs, the more effective they are when it comes to supporting the recovery of patients.
Other than being knowledgeable about the disorder and medication, it is also important for the family to know how to communicate with the patient. The appropriate communication style can help avoid conflicts. Being caring, encouraging and giving the patient an appropriate degree of freedom are all essential for the patient to lead a fruitful and independent life.
In case of mild conditions, to have a supportive environment for rehabilitation, most of the care of patient happens at home. This is because integration into the community is a key outcomes to be achieved. Family and friends are therefore playing a crucial role in this process by giving care, support and encouragement.
Suggested skills and attitude towards patients with psychosis
Caretakers and family’s care is helpful and essential towards the healing process of the patient. However, there might be situations of difficult communication or negative emotions when caregiver’s concern is misinterpreted as anxiousness by the patient.
Sometimes, some family members tend to show negative emotions like frustration or anxiousness due to concern. We should be more aware of these emotions during communication and try to express these feelings in an alternative way. Communication is a form of art. Other than using language and actions to show your thoughts and feelings, effective communication also leads to a form of emotional exchange, resulting in a closer relationship between the caregiver and the patient.
The following are some common techniques and things to be aware of:
| Attitude | Action | Example |
| Think and judge from a positive view point | Focus on the patient’s talents and improvement, encourage him/her frequently | O ‘I really appreciate your courage and patience to accept this therapy’ O ‘You really helped a lot with the housework, you are so considerate to your family!’ |
| Replace judgments and comments with care and consideration | Show care and support to patients, avoid judgment and harsh comments | O ‘You look a bit tired, is something bothering you?’ X ‘I don’t like your attitude, you refuse to answer any questions!’ |
| Use caring action and language effectively | Show your concern and acceptance through language and action | O ‘You don’t look very happy, is something wrong? Let’s go take a walk!’ O ‘I wrote you a letter, read it when you have time!’ |
| Listen patiently and encourage each other | Listen to the patient before speaking, strive to understand his/her struggles and difficulties | O ‘Yes, I understand that these situations will make you frustrated’ X ‘Stop complaining! You’ve been throwing a fit about your problems all afternoon.’ |
| Strive to grow open-mindedly | Learn more about the disease, avoid blaming the patient’s character for his/her actions | O ‘Maybe the medications is the cause of your drowsiness and lack of concentration.’ X ‘Why are you not working? You are so lazy!’ |
| Express yourself patiently and give him/her space to express themselves | Repeat patiently when not understood, avoid talking when not in a good mood | O ‘Did you bring an umbrella?’ ‘Do you need an umbrella?’ O ‘I understand that you are very angry, lets take a break and talk about it later?’ |
| Be aware of your own expectations and standards | Avoid over-estimations; be flexible about expectations to avoid unnecessary stress | O ‘If you are too tired to work, would you mind helping me with some housework?’ X ‘You’ve been doing well in school all along, you can do better if you work harder!’ |
| Be open and enthusiastic about communication | Create conversations and open up chances for emotional connection and support, try to stay focus on one topic each time | O ‘I have a new colleague at work today, how about you?’ X ‘My expectations are simple, first…….’ |
Should I look after the patient at long-term?
When the patient’s circumstance is rather severe, they may need more caretaking from family members. If the patient’s condition has improved, we can encourage them to learn to live independently.
Some of the caregivers reckon that the capability of the patient is greatly affected by the disorder, thus tend to overprotect or spoil them. This will damage the patient’s ability to be independent and may cause them to be reliant on the caregivers, which affect the recovery process negatively.
Family members may be upset by the sudden onset of psychosis in the patient. Some family members may even consider themselves to be responsible for the patient’s condition, and try to compensate them. They may become overly concerned about the patient’s mental state, and put in all their time and effort on the patient; or become overly affectionate and protective. Family members’ concern, compensation and protection are all due to their love for the patient; however, we have to understand that excessive caring and protecting can impact the patient negatively, such as causing them to be dependent or even feel stressed.
Therefore, during the recovery phase we can try to let the patient try and learn independently, and encourage them to take care of themselves. When it comes to everyday situation, family members may ask for the patient’s opinions more often and allow them to make their own decisions, so that they can practice living independently and taking care of themselves. At the same time, we can try to learn more about psychosis’ negative symptoms and the side effects of medication, so that we can try to help the patient overcome these problems positively. We also have to be careful not to spoil and overindulge the patient. We can encourage them to see their friends more often, strengthen their relationship with others, and reconnect with reality.
Some of the families may not be able to take care of the patient at home; they could encourage them to participate in courses involving life-skills training; this may allow the patient to learn how to look after their own life and manage their finance, as well as to maintain a stable career. If they feel that this is too much to handle, or that the patient may require more practicing regarding how to live independently, we may consider supported hostel services. If you would like to learn more about the units that provide the supported hostel service, please click here.
What should I do if the patient is reluctant to see the doctor or take medications?
Some patients may refuse to see the doctor or take medications due to reasons such as thinking that they are not sick, fear of being labelled if other people found out about their condition, or concern about the side effects of medications etc. However, it is really important for the patient to seek medical help as soon as possible, and take medications as instructed. If a patient can seek help early on, they would not need to take as much medications, it is less likely for complications to occur, and that the outcome of their recovery would be more ideal. If the patient does not take medications as instructed, it may increase the risk of relapse.
Therefore, with a supportive and respecting attitude, family members can try to figure out the reason why the patient is unwilling to go see the doctor/go to their doctor appointments, and their opinions and feelings on medications. If needed, family members may accompany the patient to their doctor appointments; or to seek help from doctors or social workers with them, so that there are chances to clarify any misunderstandings, and could work out a solution together.
Sometimes, the patient is reluctant to go to the doctor because they don’t think that they are sick. Family members can try to encourage the patient to seek help by using reasons that are less stigmatising, such as the patient’s lack of appetite, trouble sleeping, or weight loss etc. Family members may also consider seeking help from social workers after a period of time of persuading.
If the patient is unwilling to take medications, family members can try to discuss the medications with regard to the patient’s opinions (i.e. medication alleviates insomnia), and not necessarily make the patient agrees that they are ill. It may also be helpful to let people who are more influential to the patient to remind them about taking medications. If the patient refuses to take medications due to the side effects, family members may ask the patient if they could join their next doctor appointment so that they could explain the side effects to the doctor. Family members can also show appreciation towards the patient’s compliance to medication-taking instructions verbally.
Tips for Caregivers: Encouraging them to take medications as instructed
- Fight side effects with care
(Family members should show that they care about the patient’s experiences with the meds’ side effects)
- Learn about medications together
(Family members and patient should learn more about psychiatric drugs together)
- Explain consequences patiently
(Explain patiently the consequences of not taking meds on time)
- Treat medications with a calm attitude
(Encourage the patient to see taking meds as a part of their daily routine)
- Memorise by simplifying instructions
(Encourage the patient to take meds at fixed times, i.e. after every meal, in order to decrease the chance of them forgetting their meds)
- Remind patient to take medications
(Family members should remind the patient to take meds on time, but try to avoid stressing them out)
- Change of medication amount is no big deal
(Encourage the patient to handle the doctor’s suggestions for increasing the amount of meds calmly)
- Don’t deceive patient into taking medications
(Family members should not deceive the patient into taking meds, i.e. mixing them into meals, as it may be counterproductive)
What should we do when the patient is experiencing delusions or hallucinations?
When delusions or hallucinations occur, they often lead to negative emotions such as fear, anxiety, irritability and agitation, which may affect their daily lives, or cause them to act differently. Although these hallucinations and delusions can be very hard to understand and may appear unreasonable to most people, they are very real to the patient. Therefore we should first find a quiet and private place (i.e. turn off the television), and then consider the following while trying to communicate with the patient:
- Enquire about the patient with an open-minded attitude (i.e. “you look really nervous, what is worrying you?”)
- Speak clearly and slowly, try to use short sentences and be precise
- Be patient and allow the patient to have time to respond
- Do not argue with the patient over the validity of these delusions and hallucinations, because to them these experiences are very real. On the contrary, try to empathize with the patient by imagining their situation, and acknowledge the negative emotions caused by these delusions or hallucinations (i.e. “If I felt like I was being watched all the time, I would be scared too.”)
- Do not have to pretend that you experienced the delusions or hallucinations too. Do not agree with them
- Do not make demands or blame the patient, and it is unnecessary to debate about what to do
- Do not stare at the patient for an extended period of time
- Lead and encourage the patient to talk about facts or actual events
If necessary, we can consider recording the patient’s emotional or behavioural changes and informing the relevant professionals about them. If the situation is severe and urgent (threatening the patient’s safe or those around them), we need to seek help from the police, professionals or social workers.
What should I do when the patient lacks motivation?
To most people, liveliness and interest in life come naturally; therefore we may not pay special attention to our work, study, daily life and social interactions as they are part of our everyday lives. However, the negative symptoms of psychosis may cause patients to lack the motivation to handle these seemingly usual aspects in life; other people may perceive these behaviours as laziness or attempt to escape from responsibilities. If family members are feeling helpless, the below suggestions could be considered:
- Don’t blame or force the patient to do what they are not willing to do (i.e. work or study)
- Listen to the patient’s explanations and feelings; try to understand if they refuse to work, study, or interact with people due to their symptoms, side effects of medication, lack of confidence, discrimination against mental health issues etc.
- If the problem is caused by symptoms or side effects of medication, please inform the professionals.
- If they lack confidence, working or social skills, professionals can refer them to activities like social group, vocational training etc.
- Compliment the patient’s good qualities and improved behaviours
- Let the patient understand the importance of self-care and having a healthy social life
- Establish reasonable and practical goals with the patient (i.e. the number of times they groom themselves each day, shop for new clothes together, greet at least 2 people a day, help with housework, participate in different courses, talk about their interests or childhood memories with other people etc.), appropriate compliments could be given during the process.
