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Improv, Intuition & Dementia: A Miracle Moment from the Frontlines of Nursing Alzheimer’s Patients

Although most of my work these days as a nurse is in writing and consulting, I still do a little per diem work as a staff RN on a secure, (locked) unit with moderate to advanced residents who have some form of dementia.  I love working with this population, partly because my expertise in communication and collaboration is very helpful here and also because I am fascinated by what I see as elements of humanity and relationship that are still very much alive for my patients.  In addition, I also take Improv classes for fun and for various social and emotional learnings that I believe theatre games are richly endowed with!

Having said all of that, I’d like to share a story about a new resident who was having such a despairing time in her first few days with us and how a wonderful LNA named Kandis and I helped her to adjust.

Sally was alternating between sobbing and lashing out as she walked down the hall with her very unsteady gait.

“I want to go home.  Get away from me! Where’s my husband?  You’ve done something with him”

She wouldn’t use her walker and almost every step was precarious.

(I hate when people fall.  Naturally, I don’t want them to be hurt and in all honesty, it adds at least an hour to my work with monitoring, reporting and documenting.  We have a saying in the industry, “People have a right to fall”.  I can buy it to a certain degree, but only if we are doing EVERYTHING we can to prevent it!)

Anyways, Sally was inconsolable. Can you imagine her pushing on the door, setting off an alarm, pushing me and/or the LNA away?  Almost falling, sobbing and not able to understand why or where she was.

I find that often it helps to simply validate the patient’s concerns, but my efforts, “You want to go home.  You don’t want to be here.  You’re worried about your husband”, etc were simply not effective.

Since none of my usual approaches were working, I let my intuition take over along with my trust in Kandis and her intuition!

I put on a very stern face and tone, and turned to them using authoritative body language with my hands on my hips, (I am the Charge Nurse after all!), and said,

“Young ladies!  You are going to get in big deep trouble if you keep up this behavior.  It is time to quiet down and I expect you both to do so!

Sally stopped sobbing, wide-eyed and looked at me and then Kandis.  Kandis, too was a little wide-eyed looking at me, but quickly got it. She gently took Sally by the arm and said, “We better go sit down or we’re going to get in trouble”.

Sally went with her and they sat together quietly for a little while.  Later that night, Kandis and I took turns walking Sally up and down the hall with a box of tissues.  Validating her seemed more effective by then.

Miracle Moment?

In reflecting on it later, I think it was a ‘miracle moment’ with Sally. Although we were much too busy to appreciate it more then, I have come to wonder, why was it so effective?  What was it we did?  And, I think the answer lies in relationships.  When I scolded BOTH of them, Sally automatically had a friend.  She was in whatever she was in WITH someone.  THIS, she could understand.  Along with that, a structure that on level she could  trust.

Someone was in charge and she wasn’t alone!

Sally’s process of adjustment was much easier after that night and I think the role that Kandis and I played was key!

Do you have any thoughts on what might have happened in this “miracle moment”?  I’d love to hear from you!

Guest post by Beth Boynton RN, MS

Beth Boynton, RN, MS, is a nurse consultant, author, and teacher specializing in communication and collaboration among healthcare professionals and within organizations. She offers interactive workshops, leadership coaching, a ‘whole systems’ approach for culture change efforts, and a new method for building ‘people skills’ called ‘Medical Improv’. She has recently completed her second book, a core text called: Successful Nurse Communication: Safe Care, Healthy Workplaces, and Rewarding Careers which is scheduled to be published by F.A. Davis Publishing Co. Spring 2015. She writes about related issues at, “Confident Voices in Healthcare” blog. Her video, “Interruption Awareness: A Nursing Minute for Patient Safety,” and blog have drawn audiences from all over the world. She is trained in the Professor Watson Curriculum for Medical Improv through Northwestern University Feinberg School of Medicine. She has one grown son who is works in India, loves improv, Zumba dancing, walking, and swimming, and lives in Portsmouth, NH.

You may view Beth's online continuing education course - 4 Essential Strategies that Promote Patient Safety. This is a 2 contact hour course that features Beth in 10 short video's designed to engage and teach the student.  This instructional continuing education course is designed for nurses who are in direct care or middle management positions in hospitals; long-term care facilities, and other frontline in- and out-patient practice settings.  Despite 15 years of national focus on improving patient safety outcomes, we continue to have staggering statistics involving preventable deaths, illnesses, and injuries that are due to medical errors. And because communication breakdowns and associated problems with inter-professional relationships have long been major contributors to these alarming problems it is imperative for nurses to develop skills and promote positive interpersonal dynamics. Respectful interactions and effective communication seem simple on paper, yet successful efforts to practice them in the field remain elusive.  In this course, students will examine patient safety statistics and root cause analysis data in order to understand the scope of the problem and how persistent issues with communication and human dynamics are interfering with providing safe care.  This foundation will provide the incentive to commit to exploring and practicing communication strategies that will help to solve them. A basic knowledge of assertiveness, listening, and emotional intelligence is required as students take a ‘deeper dive’ with Beth Boynton, RN, MS to develop their abilities to:  set limits, delegate tasks, and give and receive constructive feedback.

Posted: 7/7/2015 12:50:26 PM
great post, reminds me of some of my dementia patients.
12/3/2015 10:38:25 PM

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