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'I saw your behaviour as a form of communication'

A challenging experience with a violent patient taught nurse Hazel Molyneux why forming a rapport can be vital

A challenging experience with a violent patient taught nurse Hazel Molyneux why forming a rapport can be vital


Communication is not always verbal but can be expressed by behaviour. 
Picture: iStock

One evening, you were distressed and had severely injured a staff nurse. There were a number of experienced nurses, support staff, consultants and senior nurses who had all tried to de-escalate the situation. 

You had been encouraged to take PRN sedatives, which just made you angrier. Innocently, I came over to your ward.

And there I was, with my heart in my mouth. One of the smallest nurses approaching one of the tallest and strongest patients. As a new face, I gave you a big smile and asked if you were all right, hoping to dissolve your frown. You smiled back and we began to talk. 

Listening and respect

You let me into your world and gave me your perspective of that evening. I listened. You told me how you had been wronged by someone you trusted and that now you were locked in what you thought was a pub and could not get out. You were confused but that didn’t matter. This was your perspective and I validated that it hurts when someone you trust lets you down. 

We talked at length about the importance of giving and receiving respect, and your eyes continued to brighten. 

I noted your pain so we sat together. I offered you pain relief and you asked me what I had. I explained that I was a nurse and that I had a lot. I brought you pain relief and your other medications. We continued to talk. 

Focusing on you

Then a new consultant came to talk to you. You launched yourself at him. He left and again we talked. I supported you to your room. Due to my size you had your hand around the back of my neck, using me as a crutch. 

I didn’t ask you to remove it – we had trust. When we passed the nursing station, staff were asking: ‘Has he taken those meds?’ 

Respectfully, I blanked out the questions and focused on you. You went into your room and you rested. The tablets could wait. You just needed someone to relate to you.

You taught me

This experience with you has shaped my ethos that often we just need to look at life from another’s perspective; look at what you and others are trying to communicate to us with your behaviour, and be there as a listening ear or an observing eye. Because in the end that is what behaviour is: another form of communication. 

It is not always necessary to use restrictive practices as we are all human and there is power in being able to relate. 

You taught me that no matter how small I feel, it does not take the biggest person to respond to the most challenging situations. You taught me that it is okay to feel that the situation is unsolvable; that it is okay to feel intimidated by aggression. But to be brave. 

You taught me to persevere and never stop trying to understand the feelings of those I work with, whether they have words or not. 


Hazel Molyneux is a qualified learning disability practitioner at the Learning Disability Intensive Support Service, 2gether NHS Foundation Trust. In June she was among those who addressed a Health Education England event at Westminster to mark this year’s centenary of learning disability nursing

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