Section 4: Troubleshooting

Things aren’t going to plan. Feeling down? Stressed? Frustrated? Maybe moving to your placement has left you feeling lonely, isolated or confused?

Some of the following ideas might help you through these problems. Also make sure you fill in the Mental Health Strategies magnet before you leave for placement and put it in an easily accessible place!

Problem-solving strategy one

Something many of us tend to do, perhaps without even thinking about it as ‘problem solving’, is to talk to others about our problems. It is important to put in place support networks before starting your placement – these could be friends, family or colleagues. It is a good idea to keep a physical or mental list of two or three people you know you can call if things aren’t going well. Make sure you have their contact numbers close by. Sometimes “a problem shared is a problem halved” can be true and simply having someone to discuss your problem with may help you to work through it and feel better.

While on placement you may like to talk to someone face-to-face, depending what is bothering you this could be a fellow student or your placement supervisor. It is also important to have your own doctor, a GP. If you really start to find you’re struggling don’t wait, book in to see a professional, be this your own GP or the local doctor. They have lots of experience and can work through things with you or give you referrals to all the right places.

Problem-solving strategy two

Identify sources of stress

Make a list of all the things in your life causing you stress or problems. Rank them in order of impact on your life. Categorise each one as requiring ‘immediate action’, ‘future action’ or ‘ignore/adapt to’ (see the time management strategies).

If your list is too long or intimidating, address the easier ones first. Some issues may need to be put on the back burner in order to give you time to examine the problem and decide on the best course of action.

Analyse the problem

Write the problem on a piece of paper. Draw two circles around it – a large outer circle and a smaller inner circle.

The large outer circle is your circle of concern. Note down the elements of the problems that are beyond your control.

These are elements that you will have to come to terms with without letting them erode your peace of mind.

The smaller circle is your circle of influence.

Within the smaller circle, note down the elements of the problem that you have some power to influence or change in some way. These are the elements that you can start to do something about.

During the process of addressing the issues in the smaller circle, you may find that some of the elements in the larger outer circle come under your control. By the same token, you may find issues you thought you could address are not really within your control.

Problem-solving strategy three

Identify the problem and condense it to one word or sentence. Think up as many possible options to solve the problem as you can. Weigh up the good and bad points about each option. Consider the consequences of each option. Decide which one is best and commit yourself to carrying out this option.

Once you have decided on a course of action, it may help to break it down into several smaller steps. Work through the plan one step at a time. If it doesn’t work, consider the outcomes of the first solution and consider alternative options, then try again.

If nothing works, you may need to accept that you cannot change the situation. Sometimes this can’t be helped, so consider strategies that will help you live with the situation as it is. This may mean implementing practical strategies to protect your wellbeing in the face of the stressor, changing your attitude to the stressor or implementing good self-care strategies.

Problem-solving strategy four

Begin with the end in mind. Identify your desired outcome. Imagine your situation could magically change. What would the situation look like once the problem had been solved? What changes can you make to bring that about? With a clear goal in mind, you can plan and hopefully bring your desired outcome into a reality.

Feeling down?

Changing the way you think and feel about a situation will influence how you feel and behave in response to it. By changing how you think, you can change how you feel about a particular situation. Try some of the strategies below.

  • Try to think positive thoughts. Look for and notice any positive attributes, no matter how small, in any given situation.
  • Be as fair to yourself as you would be to others. Imagine a good friend is describing the situation that you are experiencing and imagine what advice you would give them. Follow your own advice.
  • Imagine you are several years into the future. How much will it really matter then?
  • Confront your fear. Exaggerate the situation. Paint a worst-case scenario – what’s the worst thing that can happen? How likely is it?
  • Don’t let negative thoughts get out of control. If you notice yourself constantly painting worst-case scenarios and interpreting situations in a negative manner, say to yourself – ‘STOP!’ Pause and then take a fresh and more balanced look at the situation.
  • Analyse the ‘self-talk’ that may lead to you feeling more stressed about a situation. Change the ‘self-talk’ to a more positive interpretation. For example, instead of thinking ‘This person drives me nuts’, try replacing it with ‘I can cope with this person’ and notice the difference in the way you feel in response.
  • If you have a particular worry that keeps popping into your mind, make a plan to allocate some ‘worry time’ to it each day. Schedule this, say for half an hour in the evening. Put off worrying about whatever it is until you sit down to have your ‘worry time’. This will allow you to concentrate on the tasks at hand and minimise the amount of worry in your day.
  • Assess your strengths and weaknesses. Accept yourself as you are, warts and all. No one is perfect or without human frailties.
  • Keep a ‘journal of gratitude’. Note down pleasant moments or experiences in your day. This might be as simple as the way the morning light falls in your kitchen or the smell of being in the country. Although a simple strategy, it can have a powerful, positive effect on your perceptions, how you feel, what you notice and the amount of pleasure your experience during each day.
  • Don’t struggle to control situations that are beyond your control. Sometimes the best thing to do is to ‘let go’ and accept ‘what is’ rather than ‘what you would like it to be’. Let go of your expectations. Go with the flow.
  • At the end of the day, take 10 minutes to acknowledge what you have achieved and give yourself credit for it. Don’t waste time feeling guilty about what you could not do.
  • Try to discipline yourself to work during work time and allow yourself to relax at the end of each day.
  • Above all, get in a good laugh at least once a day.

Angry?

It’s possible to learn to cope with anger and frustration.

Before you get angry

  • Remember you are responsible for your own feelings. No one can make you feel anything that you don’t want to feel.
  • Identify those events and behaviours that can trigger your anger.
  • Avoid ‘setting yourself up’ to get angry.
  • Develop coping strategies to diffuse your anger reactions before you lash out at others. Counting to 10 is a cliché AND it works. Take a few deep breaths. Leave the situation if you don’t need to be there. In the longer term, you can go off alone to cool down, get stuck into some exercise and use relaxation techniques.

When you feel anger coming up

  • Acknowledge the anger, it is a normal emotion. Acknowledge that it is there.
  • Use the coping strategies you have developed to defuse the anger and cool off a bit.
  • Think about the situation. Is there anything you need to do? Is there a threat to your wellbeing that needs to be addressed? Was the anger just a result of your overall stress?
  • Try to achieve a calm state of mind before working out a plan to deal with the problem. Use your mindfulness strategies to keep yourself in the moment and try to let the anger pass you by. Just because it is there doesn’t mean you need to let it take over. Just allow space in your mind for it to sit there. Think about how it makes you feel and breath. Just be in the moment.
  • Try and remove yourself from the situation that is upsetting you and use your troubleshooting strategies.

When a cowpat flies

Coping with difficult or traumatic events

To help cope with the aftermath of a traumatic event, arrange some time out and talk with your support network about the event and your reactions. Friends, family, peers, mentors and supervisors are all good choices. Sometimes it may be difficult to find someone to talk to because of the lack of anonymity in rural locations or you may wish to speak to someone outside your social network. In these cases, resources such as the CRANAPlus Bush Support Services 1800 805 391 (24-hour Freecall) may be useful.

Further resources are available at the end of this guide in Section 8.

Feeling isolated?

Working and studying alone can leave you without some of your familiar support networks. Opportunities to get reassurance from others experiencing similar situations may be limited in some placement locations.

A sense of isolation may be reduced by working with a mentor, networking with local and regional health organisations and networking with other students on rural placements. If you’re not sure where to look to find these contacts, your Rural Health Club is a great place to start. You can find out who your local club is on the NRHSN website.

Also, when you’re on placement, make sure your university is aware of any issues due to isolation. They may be able to help you find others in similar situations and provide important assistance with issues associated with your placement, such as housing or telephone access.

Keeping safe

When on a rural placement, it is important to consider your personal safety, just as you would anywhere. Use the tips below as a starting point to consider other issues that may arise.

  • Make an informal risk assessment for yourself, considering issues such as transport, accommodation (including the availability of a phone) and supervision.
  • Don’t walk around the town or community by yourself at night in unlit or isolated areas.
  • Ask a local mentor about the places that should be avoided in the community for cultural or safety reasons.
  • Observe the local customs in terms of culturally appropriate dress.
  • Lock your accommodation at night or when you aren’t there during the day.
  • Tell someone where you are going and when you expect to be back, even by SMS to a friend.
  • Ensure that you have the appropriate driving skills if driving over unsealed roads and tell someone if you do not feel confident.
  • When beginning your placement, ask about safety procedures, personal alarms and the location of a safe room in the event of an aggressive patient.
  • Do not approach or confront an aggressive patient or community member, ensure your safety first, and follow the advice of your supervisors.
  • Do not get involved or take sides in personal disputes between community members.

Going online

You can surf the internet for some strategies and assistance.

Refer to Sections 8 and 9 of this guide for a list of useful websites and telephone numbers.

Always remember that the strategies and suggestions above are just that. It is important to see your GP or other medical support people if you are struggling to cope. They can help you to put in place plans and discuss things such as medication and referrals with you. If you’re worried about placement you could even touch base before you go – to make sure you have strategies in place to deal with any challenges that may arise.

 

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