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

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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 of 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!

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  • Mary Daigle

    Beth,
    Great senario! Sometimes authoratative voices are helpful when all else fails. The downside is when “others” assume you are being mean or unprofessional due to their lack of understanding the disease of dementia/Alzhimers. I have known this to be Good cop bad cop. As for the saying, ” They have a right to fall” another misunderstanding, all it should mean is if all else fails with re-directing/nothing else is working then the best you can do is take a step back and pray that they do not fall! Sometimes the risk of falling is less than the constant in your face approach. We need to be mindfull of where they are mentally (age wise) in their disease. They are afterall going to have slips and falls, as do we. I would have to agree with the mountain of paperwork!

    • Beth Boynton

      Hi Mary,

      Great to hear from you and I enjoyed reading your comment! “Good cop bad cop” is a nice frame for the authoritative approach Kandis and I used in the scenario. I know you know it is a tough balance re: in your face fall prevention and give em space!!! It can be frustrating when people who think they understand working with folks with dementia and may judge without fully appreciating a situation. I wouldn’t be surprised at all if a family member overheard my stern approach with Sally, he or she might think I was being mean.

      I so agree we should do everything possible to prevent and sometimes I think we are so short staffed that we don’t take folks for a walk or are always feeling rushed and that these are ways that an organization that serves dementia clients could prevent falls better.

      Please let me know if you’d ever like to be a guest blogger sometime. A story from your world? I did do another alzheimer’s related post in case you missed it: http://www.confidentvoices.com/2012/02/17/communication-tip-for-working-or-living-with-folks-who-have-alzheimers-or-other-dementia/

      Take care and thanks for writing!
      Beth

  • http://www.lpntrainingprograms.org/lpn-salary/ Les

    Hi Beth (almost said Hi Sally there),

    First time I’ve heard of “everyone has a right to fall?” Not sure I got that part. Anyhow, quick thinking you got there. Good to hear it was effective over empathizing with the patient.

    Cheers.

    • Beth Boynton

      Hi Les,
      You can call me Sally! :)

      Thanks for your feedback. The ‘right to fall’ issue is kind of odd. I think I’ll blog about it one day soon.

      All the best!
      Beth

  • http://www.linkedin.com/pub/peggy-berry/8/989/904 Peggy Berry

    Enjoyed this very much. Sometimes, you just have to play the authority card.

    • Beth Boynton

      Thanks, Peggy! I appreciate your feedback and am glad you enjoyed the piece. The authority card sums it right up! :)
      Beth