Behaviour Supprt Worker NBT Southmead Hospital Working as a behaviour support worker and supporting patients with acute head injuries developed all aspects of my communication skills. My patients tended to present with memory loss, disinhibition, lack of environmental perception, especially risk and a combination of aggression of passivity. Therefore, the first contact was important to gain trust. I used my skill from motivational interviewing, and sometimes this meant not saying anything. I would just observe the patient and respond to their verbal and non-verbal communications. I feel that I learnt the most when I made progress with patients that were unable to speak either due to neurological deficit or they could not speak English. For example, one of my patients could not talk or use his left arm. Over the course of 5 months, I worked with him, his family, speech and language therapist, physiotherapist and occupational therapist to improve the use of his arm and eventually, he began to speak. He was transferred to a specialist hospital, but he came back four months later to thank me for my belief in him and said that I helped him to speak again.

I improved sales by 320% within the first six months. This was undoubtedly achieved by developing my fitness team. I carried out weekly 1-2-1 with my team and slowly trained them in the use of Motivational Interviewing; essentially, they could help guide their client through ambivalence to change. It was clear that most persons starting the health club were fearful and anxious about change. A such I also sought out advance training in Motivational Interviewing to develop my skills. My clients were predominately persons with acute and chronic health conditions. For example, one client had fibromyalgia. We initially worked on her psychology and goal setting, making here goals intrinsic and autonomous. During our training sessions, we would improve her functional movement range and develop strength. Within six months she had 85% of her normal functionality and was able to go on her walking holiday. I also work with the local community offering free health and wellbeing advice at local events. I also had a bi-weekly radio slot taking about current health, fitness and nutrition topics.

I worked on two mental health units. My main role tried to promote physical activity and nutrition for the service users. This job was particularly difficult in that the motivation from patients was very low, due in the main because of antipsychotic medication. Progress was slow, and this wasn't easy at times to deal with. However, I used what I had learnt within motivational interviewing and also my passion for self-determination theory. I carried out a cross-section analysis of will participant to determine barriers to exercise and nutrition. The results showed a perceived lack of autonomy and competence as the main determinants. As such, I worked with the psychologist and psychiatrist to help positively raise awareness of unhealthy behaviours. Within six months, I had 6 patients participating in activities inside outside of the unit. I also worked with services outside of the unit to improve motivation for my patients. For example, I made arrangements for the YMCA to run a pool and coffee morning where my patients would participate in weekly pool competition.