nursing groups in inpatient psych setting

[candrn60]

I am a seasoned CVICU RN now finding myself in an adult inpatient psych setting. I am interested in learning more about doing groups with the patients. I welcome any suggestions or ideas of topics that have been helpful. Thanks for your input.:wink2::wink2:

[PsychMaven]

Psych patients are obviously very different from what you are accustomed to and you should definitely make sure that you are comfortable with your switch and the population before delving into anything. Leading a successful group means meeting members at their level of functioning by educating, forming strategies, teaching skills, connecting to others struggles and successes, reframing unhealthy beliefs, and offering hope.

Basic Groups Models & Examples

• Psychoeducational: knowing your illness, medication management, nutrition, dual diagnosis, symptom management, or relapse prevention.
  

* Structured educational group, a good bet for a new group leader.

• Cognitive/behavioral: distress tolerance, communication skills, behavioral planning, affect/emotion regulation, or stress reduction.
  

* Structured group based in behavioral therapy-derived skills aimed at modifying cognitive and/or behavioral processes; must have knowledge of specific therapies.

• Interpersonal: interpersonal relationships, grief and loss, self esteem, narrative life stories, or family issues.
  

*Largely unstructured, these groups can get incredibly emotional. You must be able to close the doors that are opened during a session so do not bite off more than you can chew.

Leading a Group:

Planning:

• When planning a group, you should have an objective statement so it is really clear to you what you want to accomplish. I was taught that the best size for a group is 7 +/- 2, so 5-9 people is ideal.
  
• Be comfortable with yourself and the subject. Choose a group treatment model that suits your style and strengths.
  
  

Beginning:

• Introduce yourself, the group topic, and ask patients to go around and introduce themselves; I like to ask people to introduce themselves and say how they are feeling which gives me an idea of the tone of the group as well as eliminates some anxiety on the patient's part.
  
• Do not choose a person to start, allow someone to volunteer to introduce him/herself first and then continue in a circular pattern. This allows you to "diagnose" the group dynamic and identify one of the group's leaders (you are the formal leader, but patients will emerge as dominant members as opposed to the isolates). "Scapegoats" may sometimes arise and are often the most ill person in the group, subject to open attack. These patients often serve as the vehicle for crystallizing group issues.
  
• Determining the level of leadership that is needed is vital to the group. If a high level of structure is necessary, asking an open question such as "how are you communicating with your treaters?" may be helpful. If a low level of structure is necessary, promote group leaders as they emerge.
  

The "work" of the group:

• Think of each group as having its own climate, leaders, and process.
  
• I was taught to operate by the idea that the group is a microcosm and that each member represents an important role to the group. To kick a person out of the group is to kick out an entire role, possibly one vital to the group's process.
  
• Share your leadership role with others.
  
• Expect some moments of silence and use them. While uncomfortable, these moments punctuate the experience and often open up opportunities for different group members to interject or shift the focus momentarily.
  
• Monitor yourself, especially if you find yourself speaking frequently, and remember that feedback is often most effective when delivered softy and respectfully.
  
• If conflict arises, work hard to understand the person's perspective. I often say something like "I'm glad you could express that."
  
• Don't reject the rambling on and on of patients, but be sure to contain it.
  
• Reach out to group members if they are quiet or reserved.
  
• Connect members by forming relationships that are helpful or caring, saying things like "can anyone relate to that?" after a statement or "would anyone like to comment to someone else?"
  
• Highlight issues that promote the hope and recognize the pain of group members.
  
• Always thank group members after a contribution.
  
• Trust the group.
  

Ending:

• Allow patients time to disengage.
  
• Establishing a ritual ending can be helpful, for example asking patients to say how they felt about the group or even give a rating of their personal satisfaction.
  
• Follow up on feelings about the group, asking for more feedback about how to make it a more satisfying experience.
  
• Thank everyone for participating in the search for meaning and support.
  
  

This really only skims the surface of group work, but I hope that it will be helpful in starting you off. You will often be impressed by the goodness of others as well as your own awkwardness in not knowing what to say or how to be helpful, expect and honor this. Try to enjoy yourself, you are privileged enough to be included in some of the most intense and meaningful experiences in people's lives. Good luck!