WEBVTT
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Coming up on the Eakin IQ podcast.
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What's your thoughts around when a patient may appear angry or perhaps withdrawn or sometimes they just completely disengage?
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And what, in your professional opinion, what do you think might actually be happening to them emotionally?
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So the first thing for the stoma nurse to do is not personalise it.
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Yeah.
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Do you see the way he's looking at me and his attitude?
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I'm only here to help and whatever.
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See what's happening to the person going, he is very vulnerable, and actually he's he's not struggling with his stoma, he's struggling with his vulnerability.
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Yeah.
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And he's not doing okay.
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So the next thing is uh after not personalising it, is to step out of the power struggles.
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Welcome back to this episode from ECANIQ, where we're again joined by leading psychotherapist Brona Starr.
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Welcome, Brona.
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In today's episode, we're going to explore some behaviours that can feel challenging for healthcare professionals.
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Moments when patients appear angry, withdrawn, or disengaged.
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These reactions can sometimes feel challenging, but they're often rooted in deeper feelings that may be more difficult to express or experience.
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So Brona will help us look beyond the behaviour and how we can support the patients.
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Okay, Brona, you're very welcome.
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Thank you.
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So my question then is what's your thoughts around when a patient may appear angry or perhaps withdrawn or sometimes they just completely disengage?
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And what, in your professional opinion, what do you think might actually be happening to them emotionally?
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Yeah, so um I imagine typically you're you're talking about early stage.
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Absolutely, in those very early post-operative days and weeks, yeah.
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What what often happens is the person is in in shock and the person's in crisis as well.
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Um and we often don't see the best of a person, so there's a lot of dependency, there's a lot of meltdown, and then the anger and withdrawal can mask fear and shame and vulnerability.
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And um now again I'm gonna generalize here, but culturally women are better with vulnerability.
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Okay.
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We're allowed to be vulnerable.
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I'm sorry to interrupt, but what does what what do you mean by that, as in, you know, or what makes you think that that women are more able to show vulnerability?
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Well, I think we all have the same vulnerability.
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And we we tap into as human beings, but women are culturally supported to express their vulnerability and name their vulnerability.
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And you know, if a if a girl or woman is upset, she'll talk about it, she'll name it, she'll be crying, she'll be taking support.
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Whereas we culturally there's more repression with men, so you don't do vulnerability, and you um man up, big boys don't cry, you just get on with it.
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Um so you know, having medical procedures, having a stoma, there's a lot of vulnerability attached to that, and now this person has a lot of identity vulnerability, social vulnerability.
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You know, the thing of you know, being out in the world and just not having that full ownership of your body and your identity and who you are.
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So there's a lot of masking fear, there's a lot of shame, um, there's a lot of loss of control, and culturally maybe isolating for a man if uh uh anyone but men maybe in particular.
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Um so that can show up as resentment, as shutdown, as maybe looking at you, you know.
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So you're you're the stomach air nurse and you're in here to help me.
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We're having a consultation, and I am disengaged, or I look at you like I could tick your head clean off.
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Um so the first thing for the stoma nurse to do is not personalise it.
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Yeah.
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Um do you see the way he's looking at me and his attitude?
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I'm only here to help, and whatever.
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Um see see what's happening to the person, going, he is very vulnerable, and actually he's he's not struggling with his stoma, he's struggling with his vulnerability.
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Yeah, and he's not doing okay.
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So the next thing is uh after not personalizing it, is to step out of the power struggles.
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So I'll give you an example of because I work with teenagers a lot.
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So I have this boy that comes in and his parents have made him come and he he sits and he flops down in the chair and he doesn't want to come and he's sitting with his hood up and he's not gonna say a word.
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Um and there's this very big power struggle in the room, and unless I address that power struggle, we're gonna have a lot of trouble.
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So I will turn around and I say, I'm I guess you don't want really to be here today.
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I imagine it wasn't your decision to come, and now we have the softening down.
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Yeah, so that power struggle needs to be named.
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Um so maybe saying something like, you know, I imagine you don't want to be here today.
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I imagine there's a last place on earth you want to be sitting here, like sitting in front of a stoma nurse having a conversation about this stoma bag, like um, because that's what he's feeling.
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Is I don't want to be here.
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Um but when you name it, you'll see this often, you'll probably see more eye contact from that person.
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Um and then the the validating feelings again around you know, this is really hard.
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You're you're a 45-year-old man.
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I mean, I I've seen men, you're actually doing better than a lot of men that I know, you know, maybe a little bit of affirmation there.
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That uh a lot of these men your age, you know, it is it is absolutely devastating.
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Um now he may feel worried about exposure, so then I'll come in and say, Look, you don't have to say anything.
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I'm not you know, we're we're we're not getting into you don't have to, but I I just want to let you know that what you're going through is is horrible, it's it's really, really stressful, and you know, if you weren't stressed, that that would be um so he probably won't say anything to you, but there may be more engagement, and then throughout that consultation, because you have to do that pragmatic getting to the um you know how he has to manage the stoma or whatever those things are, but even just saying, Look, I am really sorry, starting with an apology, I am really sorry to even have to have this conversation with you, because neither of us want this to be happening.
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So you join him in in his reality of I can't accept that, I can't accept this stoma, and you go, you know, I'm finding it really hard to accept that you've got a stoma, it's it's so hard.
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So moments of joining like that, that um he doesn't want to talk about it, and you go, you know, I'm kind of reluctant to talk about it as well.
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I'm really sorry that we have to have this conversation.
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So once that that acknowledgement will create a little bit more open, and then you go, but here we are.
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Yeah, but here we and that here we are is the pragmatic.
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Um and then just continue everything that you need to do again.
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I'm not medically trained, so I don't know what those things are.
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Let's say it's like how to change a stoma bag.
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Um I I don't want to change my stoma bag, so when we even the name stoma bag, he doesn't want so I would say you know, even the name stoma is really hard for people to hear, and you'll see the nod of the head.
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And I'm gonna show you how to do the stoma bag now, and you don't even want to do it because you don't want a stoma, that makes so much sense.
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Like what and so I imagine that there's a party you going, just leave me alone.
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You name how he's feeling.
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Yeah, he's sitting there going, Leave me alone, get out of my room, and you go, I imagine you're sitting there going, Leave me alone, I just want you to go.
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But here we are, and you've got this stoma, and it's gonna need to be changed.
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I mean, this is so hard.
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So you're naming all those dilemmas all the time, and each time you name one, then he'll let you do the next little bit.
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So here's here's how you see look, this is this is it is horrible to have to do this, but here's how you do it.
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You actually do this and this and this.
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Look, I'm I'm really sorry that we're here, and this is so hard.
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And maybe talking generally as well about you know, other men your age, you know, and I have to say, you're actually doing better than most, you know.
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I had a man in here last week and he just broke down in tears.
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And I imagine that that may be your experience or whatever.
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Um so what do you want that you know, those difficult converse consultations, you want the person to feel a little bit more human without being exposed?
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They're not probably not going to get into a conversation with you.
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Okay.
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The difficulty is when they are brittle with anger and they want to make complaints about everybody, and that consultant, and this nurse, and that one, and you, and stuff like that, and they're very aggressive.
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Um it's very difficult to bring that person down and to then go and do your pragmatic, here's how to change the stoma.
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So, what you might want to do is approach that in two sections.
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So you go and have a chat for five or ten minutes with them to maybe introduce yourself or whatever, and you do that validation.
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Like, this is really terrible, and imagine you're in shock and it's a nightmare.
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Um and I'm gonna come back later on to show you how to do the stoma, and that's gonna be really hard because you don't want to do that, but but we gotta do it, and um rather than trying to do it now.
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So that's uh yeah, so divide it into two on the same day, obviously by the same day in an ideal world.
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Even five five minutes, leave them for half an hour and come back for another five minutes or something like that.
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And just a thought that came up for me there is with for that disengaged patient who just will not does not want to accept, does not want to know their stoma, how long do you do you have before to acknowledge that and to give them the space before probably as a stomach care nurse we have to to move on to the next session?
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Any advice around that?
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So I would name the dilemma.
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I say you know, on the one hand, and you put the two hands up in on the one hand, you I get, I really get where you're coming from.
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Again, not personalising it, that you uh really do not want to have this dumb and you don't even want to look at it, and it is like it's so it's like horrific for you, it's traumatic.
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Use those words, it's brutal that you have that, because that's how he's feeling, and then on the other hand, you gotta figure out how to use it, and you're you're gonna have to change it.
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You can't just like ignore it.
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That is so hard.
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That's a massive dilemma because if it's something else, you know, you let's say you you've you you've got uh you know one of your toes cut off and you don't want that toe cut off, but you can live your life with kind of ignoring that um to the best of your ability, but actually you can't ignore the stoma, and that is one of the hardest things for men your age having a stoma, is you have the surgery, and once the surgery's finished, that's just the start of it.
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And you know, if you weren't feeling angry and outraged by it, like you know, it's it's just so natural to feel that.
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So, what I do is give him the dilemma or her the dilemma that I've named that this is so hard for you, and yet you've got to do it, and though it's very difficult to do it.
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So, I'm gonna leave you with that, and I'm gonna come around in a half an hour and we're gonna chat about the stoma bike.
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That's gonna be a really tough conversation with for you, and you're probably gonna feel really angry inside, and you're not gonna want to have the conversation, but we gotta have the conversation.
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Marie, what's coming to mind there is the if you if you want to get home, the policy is that you have to do two bad changes independently, so that might be a good one as well.
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Absolutely.
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I I don't have I I would I would love not to have this conversation with you, but I don't or the policy is great.
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So blame the policy, blame the nurse manager, blame the consultant, blame it's not me because you don't want to personalise it to him, but you do want to personalise it to you as well.
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Because you say, I have to do this, I I have got to, he's gonna get angry with you.
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Yes, yeah, um, so that that piece just takes the aggression away.
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Yes, it gives him a little goal as well to get home as well.
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Absolutely.
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I think that brings to a close this.
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I think it's no, no, that was really, really interesting.
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Thanks so much, Bruna.
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I really enjoyed that one.
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Thanks for the invite.
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Thank you.
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Coming up on the Eakin IQ podcast.
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What's your thoughts around when a patient may appear angry or perhaps withdrawn or sometimes they just completely disengage?
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And what, in your professional opinion, what do you think might actually be happening to them emotionally?
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So the first thing for the stoma nurse to do is not personalise it.
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Yeah.
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Do you see the way he's looking at me and his attitude?
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I'm only here to help and whatever.
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See what's happening to the person going, he is very vulnerable, and actually he's he's not struggling with his stoma, he's struggling with his vulnerability.
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Yeah.
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And he's not doing okay.
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So the next thing is uh after not personalising it, is to step out of the power struggles.
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Welcome back to this episode from ECANIQ, where we're again joined by leading psychotherapist Brona Starr.
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Welcome, Brona.
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In today's episode, we're going to explore some behaviours that can feel challenging for healthcare professionals.
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Moments when patients appear angry, withdrawn, or disengaged.
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These reactions can sometimes feel challenging, but they're often rooted in deeper feelings that may be more difficult to express or experience.
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So Brona will help us look beyond the behaviour and how we can support the patients.
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Okay, Brona, you're very welcome.
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Thank you.
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So my question then is what's your thoughts around when a patient may appear angry or perhaps withdrawn or sometimes they just completely disengage?
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And what, in your professional opinion, what do you think might actually be happening to them emotionally?
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Yeah, so um I imagine typically you're you're talking about early stage.
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Absolutely, in those very early post-operative days and weeks, yeah.
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What what often happens is the person is in in shock and the person's in crisis as well.
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Um and we often don't see the best of a person, so there's a lot of dependency, there's a lot of meltdown, and then the anger and withdrawal can mask fear and shame and vulnerability.
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And um now again I'm gonna generalize here, but culturally women are better with vulnerability.
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Okay.
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We're allowed to be vulnerable.
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I'm sorry to interrupt, but what does what what do you mean by that, as in, you know, or what makes you think that that women are more able to show vulnerability?
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Well, I think we all have the same vulnerability.
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And we we tap into as human beings, but women are culturally supported to express their vulnerability and name their vulnerability.
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And you know, if a if a girl or woman is upset, she'll talk about it, she'll name it, she'll be crying, she'll be taking support.
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Whereas we culturally there's more repression with men, so you don't do vulnerability, and you um man up, big boys don't cry, you just get on with it.
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Um so you know, having medical procedures, having a stoma, there's a lot of vulnerability attached to that, and now this person has a lot of identity vulnerability, social vulnerability.
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You know, the thing of you know, being out in the world and just not having that full ownership of your body and your identity and who you are.
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So there's a lot of masking fear, there's a lot of shame, um, there's a lot of loss of control, and culturally maybe isolating for a man if uh uh anyone but men maybe in particular.
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Um so that can show up as resentment, as shutdown, as maybe looking at you, you know.
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So you're you're the stomach air nurse and you're in here to help me.
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We're having a consultation, and I am disengaged, or I look at you like I could tick your head clean off.
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Um so the first thing for the stoma nurse to do is not personalise it.
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Yeah.
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Um do you see the way he's looking at me and his attitude?
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I'm only here to help, and whatever.
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Um see see what's happening to the person, going, he is very vulnerable, and actually he's he's not struggling with his stoma, he's struggling with his vulnerability.
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Yeah, and he's not doing okay.
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So the next thing is uh after not personalizing it, is to step out of the power struggles.
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So I'll give you an example of because I work with teenagers a lot.
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So I have this boy that comes in and his parents have made him come and he he sits and he flops down in the chair and he doesn't want to come and he's sitting with his hood up and he's not gonna say a word.
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Um and there's this very big power struggle in the room, and unless I address that power struggle, we're gonna have a lot of trouble.
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So I will turn around and I say, I'm I guess you don't want really to be here today.
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I imagine it wasn't your decision to come, and now we have the softening down.
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Yeah, so that power struggle needs to be named.
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Um so maybe saying something like, you know, I imagine you don't want to be here today.
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I imagine there's a last place on earth you want to be sitting here, like sitting in front of a stoma nurse having a conversation about this stoma bag, like um, because that's what he's feeling.
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Is I don't want to be here.
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Um but when you name it, you'll see this often, you'll probably see more eye contact from that person.
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Um and then the the validating feelings again around you know, this is really hard.
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You're you're a 45-year-old man.
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I mean, I I've seen men, you're actually doing better than a lot of men that I know, you know, maybe a little bit of affirmation there.
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That uh a lot of these men your age, you know, it is it is absolutely devastating.
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Um now he may feel worried about exposure, so then I'll come in and say, Look, you don't have to say anything.
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I'm not you know, we're we're we're not getting into you don't have to, but I I just want to let you know that what you're going through is is horrible, it's it's really, really stressful, and you know, if you weren't stressed, that that would be um so he probably won't say anything to you, but there may be more engagement, and then throughout that consultation, because you have to do that pragmatic getting to the um you know how he has to manage the stoma or whatever those things are, but even just saying, Look, I am really sorry, starting with an apology, I am really sorry to even have to have this conversation with you, because neither of us want this to be happening.
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So you join him in in his reality of I can't accept that, I can't accept this stoma, and you go, you know, I'm finding it really hard to accept that you've got a stoma, it's it's so hard.
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So moments of joining like that, that um he doesn't want to talk about it, and you go, you know, I'm kind of reluctant to talk about it as well.
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I'm really sorry that we have to have this conversation.
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So once that that acknowledgement will create a little bit more open, and then you go, but here we are.
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Yeah, but here we and that here we are is the pragmatic.
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Um and then just continue everything that you need to do again.
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I'm not medically trained, so I don't know what those things are.
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Let's say it's like how to change a stoma bag.
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Um I I don't want to change my stoma bag, so when we even the name stoma bag, he doesn't want so I would say you know, even the name stoma is really hard for people to hear, and you'll see the nod of the head.
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And I'm gonna show you how to do the stoma bag now, and you don't even want to do it because you don't want a stoma, that makes so much sense.
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Like what and so I imagine that there's a party you going, just leave me alone.
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You name how he's feeling.
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Yeah, he's sitting there going, Leave me alone, get out of my room, and you go, I imagine you're sitting there going, Leave me alone, I just want you to go.
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But here we are, and you've got this stoma, and it's gonna need to be changed.
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I mean, this is so hard.
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So you're naming all those dilemmas all the time, and each time you name one, then he'll let you do the next little bit.
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So here's here's how you see look, this is this is it is horrible to have to do this, but here's how you do it.
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You actually do this and this and this.
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Look, I'm I'm really sorry that we're here, and this is so hard.
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And maybe talking generally as well about you know, other men your age, you know, and I have to say, you're actually doing better than most, you know.
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I had a man in here last week and he just broke down in tears.
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And I imagine that that may be your experience or whatever.
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Um so what do you want that you know, those difficult converse consultations, you want the person to feel a little bit more human without being exposed?
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They're not probably not going to get into a conversation with you.
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Okay.
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The difficulty is when they are brittle with anger and they want to make complaints about everybody, and that consultant, and this nurse, and that one, and you, and stuff like that, and they're very aggressive.
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Um it's very difficult to bring that person down and to then go and do your pragmatic, here's how to change the stoma.
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So, what you might want to do is approach that in two sections.
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So you go and have a chat for five or ten minutes with them to maybe introduce yourself or whatever, and you do that validation.
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Like, this is really terrible, and imagine you're in shock and it's a nightmare.
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Um and I'm gonna come back later on to show you how to do the stoma, and that's gonna be really hard because you don't want to do that, but but we gotta do it, and um rather than trying to do it now.
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So that's uh yeah, so divide it into two on the same day, obviously by the same day in an ideal world.
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Even five five minutes, leave them for half an hour and come back for another five minutes or something like that.
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And just a thought that came up for me there is with for that disengaged patient who just will not does not want to accept, does not want to know their stoma, how long do you do you have before to acknowledge that and to give them the space before probably as a stomach care nurse we have to to move on to the next session?
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Any advice around that?
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So I would name the dilemma.
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I say you know, on the one hand, and you put the two hands up in on the one hand, you I get, I really get where you're coming from.
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Again, not personalising it, that you uh really do not want to have this dumb and you don't even want to look at it, and it is like it's so it's like horrific for you, it's traumatic.
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Use those words, it's brutal that you have that, because that's how he's feeling, and then on the other hand, you gotta figure out how to use it, and you're you're gonna have to change it.
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You can't just like ignore it.
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That is so hard.
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That's a massive dilemma because if it's something else, you know, you let's say you you've you you've got uh you know one of your toes cut off and you don't want that toe cut off, but you can live your life with kind of ignoring that um to the best of your ability, but actually you can't ignore the stoma, and that is one of the hardest things for men your age having a stoma, is you have the surgery, and once the surgery's finished, that's just the start of it.
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And you know, if you weren't feeling angry and outraged by it, like you know, it's it's just so natural to feel that.
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So, what I do is give him the dilemma or her the dilemma that I've named that this is so hard for you, and yet you've got to do it, and though it's very difficult to do it.
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So, I'm gonna leave you with that, and I'm gonna come around in a half an hour and we're gonna chat about the stoma bike.
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That's gonna be a really tough conversation with for you, and you're probably gonna feel really angry inside, and you're not gonna want to have the conversation, but we gotta have the conversation.
00:12:06.879 --> 00:12:16.799
Marie, what's coming to mind there is the if you if you want to get home, the policy is that you have to do two bad changes independently, so that might be a good one as well.
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Absolutely.
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I I don't have I I would I would love not to have this conversation with you, but I don't or the policy is great.
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So blame the policy, blame the nurse manager, blame the consultant, blame it's not me because you don't want to personalise it to him, but you do want to personalise it to you as well.
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Because you say, I have to do this, I I have got to, he's gonna get angry with you.
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Yes, yeah, um, so that that piece just takes the aggression away.
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Yes, it gives him a little goal as well to get home as well.
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Absolutely.
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I think that brings to a close this.
00:12:45.919 --> 00:12:49.519
I think it's no, no, that was really, really interesting.
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Thanks so much, Bruna.
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I really enjoyed that one.
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Thanks for the invite.
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Thank you.
