When Mrs. Smith Wants to Set Her Hair on Fire! Exploring the gap between honoring a desire & keeping folks safe!

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Sometimes residents or patients want something that seems so dangerous to their own wellbeing or possibly the safety of others, our first and only response is, “No, you can’t do THAT”!

Ok, maybe that example is a bit over the top! 🙂 But, seriously, maybe Mr. Jones is a diabetic who wants a big piece of cake with double frosting, or Ms. Green wants to go horseback riding despite her broken pelvis, or maybe Mrs. Mcgillicuddy wants to smoke a cigarette outside even though it is 10 degrees below zero and there is wild wind blowing, or Mabel on the secure dementia unit is pleading to go home.

What to do when Ms. Green wants to go horseback riding despite her broken pelvis... Click To Tweet

When our patients or residents ask us for help doing something that we think or maybe know shouldn’t happen, our first reaction is often to explain why they shouldn’t or can’t.  When we do this we automatically fall into a power struggle and miss the chance to validate and learn more about those in our care.   With a little savvy communication, we may even be able to help them reach their own decision about not doing something dangerous or discover a compromise like having a small piece of cake or watching a show about horseback riding.

What I’m suggesting here is to do a little mindshift and instead of going in the direction of opposition, lean in to the desire itself.  It may come as a surprise, but wanting to do something, even ride horses with a broken pelvis,  is totally fine.

That piece of cake is calling to you, isn’t it Mr. J.?  You like cake?  Tell me about your favorite kinds.

Do you love riding horses, Mrs. Green?  Tell me one of your favorite horseback riding stories.

You sure miss your cigarettes, don’t you, Mrs. Mcgillicuddy?  How old were you wben you started smoking?  What’s your favorite kind?

I know you want to go home, Mabel.  I don’t blame you one bit.  I do too.  Tell me about your home. 

Or even….

Wow, that sounds pretty wild, Mrs. Smith.  Have you ever set your hair on fire before?  Tell me about it?

Setting realistic limits and offering explanations of why something might not be a good idea can come later.  Meanwhile, you’ll be building a trusting relationship.

Can you think of an example like these where you might try leaning into the desire?

One of the things I love about Medical Improv is the “Yes, and” principle. All activities require us to validate whatever someone else says.  Like exercising a muscle, we practice this part of the listening process.  And it is a world away from giving Mrs. Smith a book of matches!  

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4 Responses to When Mrs. Smith Wants to Set Her Hair on Fire! Exploring the gap between honoring a desire & keeping folks safe!

  1. “Compassion.Love. Kindness”
    This is all what you do. Very admirable seeing you guys taking extra good care with the elderly. More patient are much needed when they time comes that they cannot afford to take care of themselves.

  2. Great article and a great point.
    If I understand you correctly, you are saying instead of just dismissing what they want try to get them to talk about the emotions of why they want to “eat that cake so much” or how they came to love horseback riding.”
    In essence build rapport with them so you would earn the permission to speak into their life.

    • Yes, Thomas. EXACTLY. It shows you care about what they care about. We forget how vulnerable people are in our care and that it is a privilege to be in their space with them. Building rapport so you can ‘speak into their life’ is a great way to put too. Thank you for your insights and feedback.

What are your thoughts?