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Healthcare Training Institute - Quality Education since 1979

Section 17
Positive Approach, Think He's Helping, Necessity, and Service Project

Table of Contents | NCCAP/NCTRC CE Booklet

 a. Positive Approach vs. Resident's Rights
Positive Approaches to Motivate and How Pushy is too Pushy
Here are examples of what I would term using a "positive approach" with residents,
“And now it's time for…”
“Did you want to go to the Bingo at 1:30 or 2:00?”
“Did you want to go to the Bingo game or did you want to go to the lounge to watch TV?”
“Joe it's time for…” 
The idea behind a positive approach is to give your unmotivated resident a choice between two activities rather than between activity and inactivity. 

A Motivation Success Story
(The following is a recap of a story told on the DVD.  You can skip this if you recall the story or read it if you have not viewed the DVD yet.)
I once had a Men’s Discussion Group, and there was a fellow named Harry whose room was right next to the activity room.  I wanted Harry to come out for the Men’s Discussion group, because two of his former neighbors were in the group.  Even though his room was right next to the activity room, I could not get this fellow out of his bed.  I said to him, “Harry, would you like to go to Men’s Discussion group?”  His reply was a series of grumbles and a "No" in there somewhere. I then said, “Men’s Discussion group, Harry.  Would you like to go?”  Again, his reply was unintelligible, and he was making no effort to move towards the activity room. 

A couple of weeks later I went around with Julie “the best CNA,” and when approaching Harry's room she said, "Okay. Let’s see, it’s time for Harry’s shower."  I thought “Harry’s shower!  How is she going to get this fellow out of his room?  I’ve got to see how she gets him out of bed.”  She went up to Harry, and said, “Harry it’s time for your shower, come on, we’re going, come on let’s go.”  He got up and he went.  I couldn’t believe it!  I had learned something!  When I had another Men’s Discussion Group, I went to Harry and said, “Harry, it’s time for Men’s Discussion Group, come on we’re going.  Let’s go!” And he went! 

So, how pushy is too pushy?  I’ve found that there are some residents to whom you can just say, “And now it’s time for…,” and they will go.  However, there are other residents to whom you say, “And now it’s time for…,” and Effie digs her toes into the tiles, holds onto the wheels of her wheelchair and yells, “I’m not going.”  So along with the idea of simply taking an extremely positive approach of saying “And now it’s time for…,” there is the Resident's Right to Refuse Treatment.  This Resident Right , if you will recall, is the right to be fully informed in advance about care and treatment, and of treatment that may affect the resident’s welfare, and the resident’s well being.  So a surveyor may question an approach that violates the Resident's Right to Refuse Treatment.  In other words, you have evaluated at the time if a resident has a strong preference and says, “No, I don’t want to go to the Men’s Discussion group,” you are not going to say, “You’re going!”  Clearly there is a difference between a Positive Approach and imposing your will.  That’s the key difference to not violating the Resident’s Rights.

Residents to Motivate by offering a "Choice between Two Activities"

Culture Change CNA Inservice:  Brainstorm about residents who CNAs feel could be motivated by “Offering a Choice between two.”

b. Motivate by Thinking He is Helping
Many of you have encountered residents that are alert and able, yet will not get involved in activities.  I once had a resident named Sue who was very alert but would just sit around the activities room all day and do nothing.  I approached Sue and said, "I'm really in a bind and need some help with cutting these stars out to put on people's doors for Independence Day.  Can you help me?"  She took the colored paper from me and agreed to help. 

The next day, Sue greeted me at the time clock and had all of the stars cut out.  Thus, putting her starts up that day was an important part regarding motivating Sue.  She was motivated to get involved because Sue felt I really needed help.  Thus, it is important to demonstrate that you really need the resident's help or they won't do the activity the next time.  That way your Sue will feel that she was in fact a big help and will be motivated to help again.  Agree? 

Welcome Committee & Orientation Walk
a. Resident Welcoming Committee: Do you have a welcome committee in your facility?  Maybe the members are members of your Resident Council.  If you have some alert, congenial, mobile (a.k.a. "CMS Interviewable") residents, you might talk to them about visiting new admissions who are alert enough to be aware of a visit.  Obviously, if a resident is semi-comatose, a welcome committee visit might be demoralizing to the visitor.  After all, they don't want to think about themselves as being that impaired, perhaps in the near future.  They might bring some small craft item, like a flower, and explain where the dining room is, etc.  Obviously you select residents for this welcoming committee who will represent the facility in a positive light. This is just a skeletal outline of all of the options, formats, and possibilities that a Welcome Committee might take on.  Do you have a resident whom you might talk to about the possibility of the need for welcoming new residents to the facility during their first week and would be motivated by welcoming others into the facility?

b. Orientation Walks: One resident might be motivated by taking another resident on an Orientation Walk.  By an Orientation Walk, I mean the ambulatory resident might push a "buddy" around the facility saying, “This is the nurses’ station, this is the dining room,” and so on.  Do you have any alert residents who could possibly be motivated by being told that you need their help to orient a resident to the facility?  If so, list their names below.

Residents to Motivate by telling him or her they are "Helping"

c. Necessity and Service Projects
As mentioned earlier, not everybody is motivated by fun.  As you are well aware, some residents in their 80s and 90s don’t want to play, they want to work.  They are motivated by helping someone with something, rather than playing a game or doing something for fun. So here are some “unfun” ways to motivate your residents.  I acquired this “Job” list from seminar participants.  You might state you need there help to do the following. 

Residents to Motivate by giving them a "Job" to do

Culture Change CNA Inservice:  Brainstorm about residents who CNAs feel might be, or are currently, motivated by doing a “Job.”

Documentation and Resident's Rights
As you are aware, the resident has the right to refuse to perform services for the facility.  To document that you are not violating your Resident's Rights, your Progress Notes might include a quote that the resident said, indicating his or her “need or desire to work.”  In short, if a resident says, "I want to make my bed."  You need to document in your Progress Notes the resident's statement indicating their need or desire to work.

How to Set Up an Assembly Line for a Service Project
Lacing Cards are described in detail in Volume Three of this series. See illustration below.  However, here is a way you can make Lacing Cards into a Service Project via an Assembly Line Method.  By Assembly Line, I mean, instead of having one resident complete the task from beginning to end, several residents are involved doing a portion of the task they are able to do. 

1. Motivation: Tell the residents that you are adopting a children’s daycare and you need the Lacing Cards sewn to do something to help decorate a daycare center. 
2. Tearing out Pictures:  The way that you can set up an assembly line is by having one resident who tears out colorful pictures from magazines. Motivate that resident by telling her, "You are going to be making something out of these magazine pictures for a Daycare Center.”  Tearing out the magazine pictures is a good gross motor movement activity for a disoriented resident, perhaps who does not have fine motor control.  Also, tearing out the magazine pictures is an activity the resident can do in his or her room.  Of course, the CNA is told what the purpose of the activity is so she does not feel the resident is doing something she should not be doing. Ideally, after the CNA performs a certain point of care regarding the resident, the resident is given a magazine and the CNA encourages the resident to continue to tear out colorful pictures.  As mentioned earlier, a stack of magazine pictures really helps you out because you can use these pictures not only for creation of a Service Project like Lacing Cards for a Daycare Center, but for your Assessment Books described in the preceding section, as well.
3. Cutting the Pictures: After you have a stack of torn magazine pictures have another resident who is able to handle scissors go through the pages that have been torn out of the magazine, and cut out the pictures. Then, if you are lucky enough to have an extremely alert resident in your facility, you can have another resident sort the pictures by subject.  If there are some pictures of a rabbit, for example, they can put those pictures into an "Easter" pile. 
4. Glue: Your neatest resident (or your least messy resident) is the one who takes the pictures and glues them on the corrugated cardboard for you. 
5.  Cut Cardboard: Then the cardboard is cut out.  Usually a staff member needs to do this.
6.   Punch Holes: Another part that a staff member will need to do is to punch the holes around the edge of the Lacing Cards.
7.  Lace Cards: As described in Volume Three of this series, affix a piece of Scotch tape on the end of the yarn to facilitate putting the yarn through the holes.
8. Photos: Once you take the Lacing Cards, or other items created, to the Daycare Center, take photos of the items being displayed or used, to act as an additional motivator to alert residents to be involved again.  Thus, it is hoped, for those residents with a long-term memory, when they see that the item they were involved in constructing was actually used, they may be motivated to do the activity again.
Residents to motivate with the idea of "Helping a Children's Daycare Center" via Lacing Cards

Now below create your own Assembly Line for a simple craft that might be provided to a sheltered house for battered women, a children's wing in the hospital, etc.  Residents who are not motivated to do something individually may be motivated if they feel they are part of a group project and/or part of a project that is helping someone outside of the facility.

Residents to motivate with the idea of "Helping " via an Assembly Line Simple Craft

Culture Change CNA Inservice:  Brainstorm about residents who CNAs feel that they could motivate by mentioning “Helping.”.