THE ST. JAMES' JOURNAL

Remotivation
 
It is not a word I like very much; my dislike goes back to my early days as a student nurse and of painful sessions leaping about the entertainment hall clutching a medicine ball and being belted around the ankles with a skipping rope, urging patients to dress in shorts and sandals and staggering around the hospital grounds at the 'double' at 7.15 a.m., trying to convince them and myself that it would do us a lot of good. I never did manage to convince myself, and judging by their lack of enthusiasm, I did not convince them either.
 
Psychiatric progress in the last few years has brought forth more acceptable methods. We may no longer have bulging muscles, bruised ankles and fresh complexions, but patients no longer go home at week-ends just to get a rest from hospital activities.
 
With a ward full of very mixed patients the task of remotivation is not an easy one. A great deal of planning and enthusiastic interest from fellow workers is required to make it a success. Drugs play an important role, they help to make patients more accessible for psycho-therapy and more responsive to nursing care.
 
It is essential for the nurse to have an understanding attitude towards her patient, to take an interest and try to get the patient interested in what she is trying to do; she must have the ability to cope with any situation without getting flustered and a sincere wish to help. This must be essentially a combined effort and when concentrating on deteriorated patients, not too ambitious or tiring for them.
 
It is possible that the most energetic thing she has done for a long time is to amble round the garden and walk aimlessly around the ward. It is hard to imagine these ladies running a home, bringing up children, washing, cooking or maybe doing a job outside the home. But before their illness, presumably they lived a full and normal family life. In most cases their previous activities have been forgotten, even to the simple process of dressing and washing themselves. How tragic this is and how pitiful to see an old lady who has forgotten how to do the simplest things that a normally healthy person can do without much thought. We can comfort, dress and feed them but with real interest and greater understanding we can do a lot more. We are not here to teach in a formal manner but to try and gently awake sleeping memories.
 
Too much at first should not be attempted. One can take two patients when performing normal ward routine. At first the duster will probably float out of the window or be used for some other useful purpose. A broom may make a good resting post or even a club that might be directed at you. One might even have to dodge a flying saucer if the patient does not like washing up, but do not despair; at least one is getting some response and be consoled with the undeniable fact that psychiatry has made more progress in the last half century than ever before and if it is any help, one may be aiding further in the next half century.
 
Encourage your patient to take a pride in her appearance. A new hair style, a little make-up, a pretty dress and lots of unstinted praise. With patience and persistence the nurse finds herself stimulated to take a greater interest and pride in what she is doing. Next try her at knitting and if it is found that she is using the needles to poke in her neighbour's ears or spear the goldfish with, one can safely assume that she was never able to knit anyway and it would be wiser to direct her interest in some other activity. Do not make the mistake of expecting the patient to concentrate on one job for long periods—five or ten minutes is quite sufficient to begin with and when it is found that she is responding, something more ambitious can be tried. If there is shopping to do for the ward, take one or two patients with you. Not only are they getting a chance to make contact with the world outside the hospital, but they are also getting a change of scenery which is bound to stimulate them a little. Encourage them to do their own shopping, choose their own clothes and plan whenever possible their walks and social activities.
 
Results of this work may take a long time to bear fruit, but with co-operation from patients and staff, it can be very rewarding and satisfying.
N. S.
 
Spring 1965
 

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