Clinical eye: Learning curve

Discovering that we can’t impose our own timetable on clients is a vital lesson, says our nursing columnist Ishbel Straker.

The feelings I have about the first client who broke my ‘nursing heart’ will never leave me. I was given this lady as the first on my student caseload and I believed –with an authority that can only come from naivety – that I was going to be the catalyst of change in her life.

I was going to instigate the promise of hope for the future and be the indication of how the best was yet to come in her life. I met her for our first of six sessions, pen and paper shaking in hand, mentally prepared to keywork the addiction right out of her. I was ready to listen and set those achievable goals that would enable her to move just that little bit further forward, and we would look back at the end of the six weeks with astonishment at how far she had come.

None of you reading this will be surprised to hear the story didn’t end in this way, and after the third session I received a phone call from this client who was not only intoxicated but highly abusive. She blamed me for her lack of success, her inability to sustain her sobriety and for all the wrongs she had ever suffered.

I remember the devastation I felt, the absolute disappointment that my foolproof plan had not worked and the confusion that this sweet lady I sat with each week, to whom life had been so cruel, could become so personal. I sat with my mentor who talked to me about their experience and we reflected on these emotions and how he used them to improve his practice for his clients. At the time I did not believe him – I was overwhelmed and uncertain that I would ever have belief in my skills as a practitioner but also a blind trust that all are capable of change.

Of course he was right and each similar occurrence gave me a deeper understanding and enabled me to be a more skilled nurse. It taught me to truly reflect on my practice and consider the effect my clients had on me, but most importantly it taught me that there is nothing that I could ever do, or say, for anyone who is not ready to change, and that clients must do it for themselves and nobody else. Especially not me.

Ishbel Straker is clinical director for a substance misuse organisation, a registered mental health nurse, independent nurse prescriber (INP), and a board member of IntANSA.

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