Therapeutic relationships and storytelling in mental health settings
Jess Wilson was recently highly commended in the Mental Health Practice category of the RCNi Nurse Awards – here’s why.
Ward sister Jess Wilson used storytelling to improve patient relationships in mental health settings – leading to a highly commended nod in the Mental Health Practice category of the RCNi Nurse Awards
Nurses using traditional oral storytelling in forensic psychiatric hospitals in England and Wales are reporting that it helps to distract patients from stressful situations, reduces anxiety and can be used to de-escalate volatile situations.
Trained by mental health nurse Jess Wilson, the nurses and support workers have found that by simply telling a story, they can create a positive atmosphere and significantly improve the relationship with their patients.
Ms Wilson, a ward sister at Elysium Healthcare, trains clinicians to use oral storytelling without reading. The versatile technique can be used in planned groups or spontaneously with an individual needing one-to-one support.
‘Violent and aggressive behaviour can have an impact on the nurse-patient relationship,’ Ms Wilson says. ‘Yet that therapeutic relationship is the cornerstone of care delivered and nurses found that traditional oral storytelling provides a tool which meets patients needs on their journey to recovery.’
She first realised what oral storytelling could bring to the therapeutic relationship when she was a staff nurse on special observations with a patient in a forensic hospital.
‘No one seemed able to develop a therapeutic relationship with her,’ Ms Wilson says. ‘All she wanted to do was destroy everything – herself by self-harm, others by assault, the environment by smashing it up, and any meaningful relationships by being hostile and confrontational.’
She sat on the floor and said to her nurse: ‘I’m bored – what are you going to do about it?' On impulse Ms Wilson said: ‘I could tell you a story.’
‘As soon as the words came out of my mouth I regretted them, thinking she would feel patronised, causing an escalation in aggression and hostility. But I was wrong – she stayed cross legged on the floor and said “go on then”.’
Put on the spot, Ms Wilson frantically searched her brain for a story. ‘I started with “Once upon a time” – and told her a fairy story I vaguely remembered from my childhood. When I finished with ‘happily ever after’, she asked me to tell her again.’
Ms Wilson’s second telling of the same story was more confident and she found she enjoyed it. Afterwards the patient relaxed and engaged in conversation with the three nurses in a way she had not previously.
That evening Ms Wilson researched mental health nursing and storytelling, but could find no evidence to work from. But she discovered that she could learn how to tell stories and decided to take a weekend course.
On her return to work she started to tell stories as part of group sessions. In response to patient requests, she set up a storytelling club on weekends and evenings.
When nurses on other wards became interested, she trained 36 nurses and other members of the multidisciplinary team how to use storytelling in their practice over the next two years.
Ms Wilson decided to start building the evidence base and, having seen the benefit storytelling was bringing to its patients, her employer funded her master’s degree in professional practice research.
In her research Ms Wilson interviewed seven of the 36 clinicians and support workers she trained, using semi-structured interviews that were thematically analysed.
She says the study indicated that storytelling helped the development of a positive therapeutic relationship, which became more open and collaborative. It also showed that learning storytelling as a skill improved nurses’ practice.
One nurse reported that telling a male patient a story would settle him, adding: ‘It was particularly good for him because up until then the only kind of response was observation lounge, seclusion and “as required” medication and stuff.’
Another nurse reported using it successfully in seclusion. ‘I use it for everything... groups and individuals.’
Elysium Healthcare chief nurse Keith Barry says he and his colleagues are proud of Ms Wilson and her storytelling.
‘A patient came to the clinic where I was doing the medication. Instead of asking for the usual “PRN lorazepam” she asked for “PRN story”. She slept that night without extra medication’
‘She is a truly compassionate, motivated and dedicated nurse. I have watched Jess develop storytelling over the years and seen its success. Patients find it non-threatening and even the most difficult-to-engage patients have participated, which can then open doors to other interventions.’
Ms Wilson was recently highly commended in the Mental Health Practice category of the RCNi Nurse Awards, the profession’s top accolades, and her work has begun to attract international attention.
Closer to home, Abertawe Bro Morgannwg University Health Board in Swansea invited her to take part in a residency for ten days to introduce the storytelling concept to the Caswell Clinic in Bridgend.
Funded by the NHS and the Arts Council Wales, it culminates in the International Storytelling for Health Conference this month [June]. Ms Wilson is one of four storytellers invited to the residency, but the only one in a forensic hospital setting and the only nurse.
But it is the difference that storytelling makes to patients that is most important to Ms Wilson. Asked what she is most proud of, she recalls a night shift, following the usual routine – handover, allocation of tasks and then starting the 10pm administration of medication.
‘A patient came to the clinic where I was doing the medication. It was usual for her to ask for some medication to help settle her racing thoughts before bed. On this occasion however, instead of asking for the usual “PRN lorazepam” she asked for “PRN story”. She slept that night without extra medication.’
Storytelling in practice
Misty White is the clinical of lead of a low security rehabilitation and recovery unit who has been working in mental health nursing since 2005.
She has recently taken part in Jess Wilson’s training in using oral storytelling to build better relationships with patients in mental health settings.
‘At first, my colleagues and I were ambivalent about the training and unsure as to what role it may play in practice due to having not previously come across it,’ she says. ‘I voiced these views to Jess. She explained how she had got into storytelling, which I found interesting. On being told a story myself, I found it thought-provoking, relaxing and was surprised at my ability to concentrate on just the story itself.
‘When I returned to the ward my patients wanted me to tell them a story. So I told four of them the story I had learned that morning – although I struggled to remember details. But we learned on the training that nobody else knew the story I was telling, so I was able to adapt what I could remember.
‘I was surprised to find the patients actively listening awaiting the outcome.’
Following the two days of training Ms White has a positive view of storytelling and the therapeutic benefits it can have.
‘Storytelling will also enable me to tackle subjects with patients where they have difficulty in expressing emotions – areas such as grief, loss and relationships. Hearing a story will enable them to explore their own emotions and provide them with an opportunity to express themselves in a unique way.’
The Mental Health Practice award is sponsored by Cygnet Health Care