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Healthcare Training Institute - Quality Education since 1979

Section 9
Track #9: Acting "As-If"

Table of Contents | NCCAP/NCTRC CE Booklet

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Note-Taking Exercise

What is the “Facial Feedback Theory?”

What is the “As-If” Technique?

What was suggested that you do when you approach Wendy
1. 

2. 

What were the three levels of action?
Level 1. 

Level 2. 

Level 3   

Transcript of Track 9

On the last track, we talked about the importance of seeking out and using sources of support.  Seeking out sources of support can be a stress reduction tool, providing that your conversation with your sources of support shifts from a problem-focused discussion to a solution-focused discussion.  Do you agree?

As you are probably aware by now, the solution-focused thinking patterns proposed in this CD set are based upon the basic premise that if you expect the worst to happen, it sometimes does.  For example, if medications and therapy schedules are still conflicting with a resident’s attendance at an activity; ask yourself, “Could this be partly due to the fact that I am expecting other departments not to comply with my request?”

Are you inclined to create negative self-fulfilling prophecies to perhaps protect yourself from disappointment?  In other words, if you expect the worst, you won't be so greatly disappointed if the worst does in fact happen.  

If you feel that part of your stress may be due to your already having decided that you are not going to get what you are asking for; let's try countering your negative self-fulfilling prophecy by doing something called acting as-if.  Maybe you've heard about the acting as-if technique.  If so, let's review.  Here’s how it works.  You behave or act as-if everyone will naturally treat you just the way you want to be treated.  Or, in other words, you act as-if things will turn out exactly the way you want them to.

So how do you act as-if you will get more of what you want?  Well first of all, of course, you have to do the footwork by applying solution-focused thinking regarding…
#1. “What do I want to have happen?” For example, what you may want is to get the CNA, Wendy, to give Effie her yarn winding after she is dressed.
Step #2 in solution focused thinking is asking yourself, How can I get this done?  Your answer might be, for example, talk to my administrator, director of nursing, and perhaps charge nurse about CMS Culture Change Surveyor Guidelines stating all staff is to be involved in activities.
Step #3 in solution focused thinking is asking yourself, what resources do I have?  Your answer might be, past relationships with these people, email reminders, reminders posted at the nurse’s station, building a personal relationship with Wendy, Effie’s CNA, complimenting any attempt Wendy makes regarding providing Effie with the yarn winding you left in Effie’s room.
Step #4 in solution focused thinking is asking yourself, what opportunities are created by this new goal?  Your answer might be, Wendy, the CNA, will provide other residents with activities you have left in their rooms after they are dressed or when they return from a meal.

So let’s say at this point you have accomplished the above four solution-focused activities.  Now, you see Wendy, Effie’s CNA, walking down the hall towards you.  In the past Wendy has not provided Effie with the yarn winding.  To prepare yourself to act as-if you might start by utilizing part of the breathing technique from Track 7, entitled “Instant Calm.” 
           
Then, after controlling your breath, the second step is to consciously smiling in a genuine manner.  By a genuine manner, I mean not a cheesy, toothy, Cheshire cat grin at Wendy; but a warm genuine smile. And actually, there is a physiological reason why you feel better when you smile.  When you use the “smile muscles” at the corners of your mouth, you actually change the direction of the blood flow inside your face in such a way that it causes the temperature of your blood to drop.  This cooler blood enters the region of the brain known as the hypothalamus and causes the release of chemicals that can suppress pain and help a person to feel better.

Cooling the blood promotes the release of endorphins, and give you an emotional lift.  In short, smiling does make you feel better.

Secondly, in addition to smiling, having a physiological reason for you to feel better, when you smile warmly and genuinely others sometimes smile back or treat you differently; perhaps even better.  Agree? 

So let’s get back to Wendy.  As you see her at the far end of the hall approaching you, you are creating a negative self-fulfilling prophecy if your self-talk is something like, “Oh!  Here comes that darn Wendy!  She knows she is supposed to give Effie the yarn winding like we discussed in the Inservice, but she didn’t do it this morning again!”  Because of the negative feelings generated by your negative self-talk, you dodge into a resident’s room to avoid passing Wendy, or worse still, ignore her as you pass.  Do you see what you are doing?  You are treating Wendy as-if you expect her not to comply with your request, as well as increasing stress between the two of you. 

When you hear the musical tone, envision your Wendy, and what happened the last time you saw her.  MUSIC

In a broader perspective, In my mind, your encounter in the hall with Wendy is where the “rubber meets the road,” so to speak, regarding implementation of Culture Change CMS Guidelines in your facility.  Merely giving Inservices and talking to administration and department heads, oftentimes won’t get Wendy to hand Effie the yarn winding.  Agree?

So what do you do?  You act as-if.  How?  You act as-if Wendy of course is going to give Effie the yarn-winding the next time.  So when you pass Wendy, you first take a relaxation breath, and second in your mind you find something about Wendy you genuinely like, and I mean genuinely.  When you pass Wendy in the hall, chances are she may not look at you, as she knows she did not give the yarn winding to Effie.  You smile as Wendy hurries past you and say something like, “Hi, Wendy.  How are things going today?”  Do you bring up the yarn winding?  No, because you are trying to establish a positive connection with her at this point.  However, after three or four more encounters at this connection-building level, and Effie still has not been handed the yarn winding, you might be more direct and say, “Do you recall that Inservice I gave a few weeks ago?  Did you have any questions about giving Effie the yarn winding?”  So in essence, you are acting as-if, of course she wants to comply, but may not understand exactly what to do.

She may reply, “Yes, I understand.” 

If she still is not giving Effie the yarn winding after Level 1, Connection Building, and Level 2, asking if she needs clarification; you might decide to escalate to Level 3.  This time, when you see Wendy, as in the past, you first of all recall in your mind something about Wendy you genuinely like.  For example, maybe Wendy has really thick hair and you admire that.  Now you don’t have to tell her what you are thinking, but your positive thoughts about Wendy will probably definitely affect the kind of energy you project to Wendy.  Do you agree? 

When you hear the musical tone, envision your Wendy.  What is something you genuinely like or admire about her?  MUSIC

You then state in a friendly manner, “Hi, Wendy.  I noticed Effie’s yarn winding was still in the bag taped to her night stand.  Is there some reason why you thought it was a good idea not to give it to her?”  Wendy may reply, “We’re short, and I’m busy!” 

Track 11 provides more specific information regarding how to create additional positive self-talk messages.

Up until now, by acting as-if, or giving her the benefit of the doubt, was an appropriate course of action.  However, the “short and busy” excuse is one that is stressful to deal with, because in fact, it may probably be true.  But the reality is, handing Effie the yarn is part of a CNA’s job, just like helping Effie put on her sweater, or washing Effie’s hair is part of Wendy’s job.

At this point in solution-focused thinking, you need to look at step three, which is asking, “what or who are my resources?”  Given this response from Wendy, your resources are your Administrator and Director of Nursing.  However, only you can decide whether it is appropriate to schedule a meeting, bring a copy of CMS guidelines pertaining to Culture Change, which you can print from the internet.  Also, only you can decide whether it is appropriate to suggest a revision in the CNA job description, revision in the CNA annual evaluation, and revision in the new employee CNA orientation training to include providing residents with activities as well as transporting residents to activities.  When you hear the musical tone, think about what course of action would be appropriate for you.  MUSIC

In summary, this track has suggested after you implement solution focused thinking, you act as-if you are going to get what you want, in this case Wendy to hand Effie the yarn-winding.  If that doesn’t happen, you need to evaluate what other resources are appropriate for you to utilize to reduce your stress in this area.  You may be thinking I thought this was a course in stress reduction.  Getting CNA job descriptions changed sounds stressful to me.  Two courses we offer in our Activity Management series that are a good companion to this one  are: “Facility Team Work  ‘The Impossible Dream’ How to Make it Come True!” and  “Step-by-Step Proven Techniques to Get Department Head& Staff Support.”