What stands in the way of your requesting Culture Change in the areas of transporting, scheduling, and activities provided by all staff? How can you create a team atmosphere in your facility?

Five major categories of obstacles
1. Your lack of clarity
2. Your lack of courage
3. Your faulty thinking
4. Your confusion over responsibility
5. Your rationalizing

Awareness is the first step to choice and change. Knowing what you want in the first place is mandatory. Frequently you don’t speak your mind because you have not yet made your mind up. Ways to experience lack of clarity and limit setting: delayed awareness, partial awareness, confused awareness, and total oblivion.

a. Delayed awareness occurs when you realize after the fact that you feel uncomfortable about something. If things only dawn on you afterwards then it is important to recognize the pattern and take the time to check with yourself earlier on. It is an encouraging sign because it is not too late to undo or redo. You get extra time to pull yourself together and rehearse how you want to handle something. Sometimes on the spot it is hard to say what you want.

For example, if you notice once again that Wendy the CNA has not given Effie the yarn winding you left in her room, you may experience a delayed reaction regarding the fact that Wendy has never given Effie the yarn winding. Thus your delayed reaction becomes an obstacle to implementing Culture Change if it continues.

Everyone experiences delayed awareness. In a few words, explain when you have experienced this, perhaps related to Culture Change implementation in your facility.

b. Partial awareness is when you only know part of your reactions. It usually leads to making excuses and not telling the truth because you haven’t told the truth to yourself yet. Sound familiar? Analyze your reactions. Define for yourself exactly what the problem is and what you want to change about the situation, and you will be more effective in your message. Any change you request is not all or nothing; you may be OK with some aspects and not with others.

What was your reaction to the above? (Frustration)

Exactly what is the problem? (Wendy did not give yarn winding to Effie)

What do you want to change? (I want Wendy to give yarn winding to Effie)

What aspects of the change are you ok with? (I would be ok with Wendy giving yarn winding to Effie, to start with, at least once a week after she was transported to her room after meals.)

c. Confused awareness: in addition to delayed awareness and partial awareness, confused awareness can be an obstacle to your implementing Culture Change in your facility. Confused awareness may occur when you have confused or mixed feelings about the situation. For example, the speech therapist, Carol, agreed to change Helen’s therapy time to allow her to attend Crafts. However, once again, she is in Speech Therapy when you go to her room to transport her to Crafts. A simultaneous multitude of emotions may be overwhelming if you don’t sort them out. You may also experience complex conflicting desires at the same moment. You may want incompatible things. Unless you are clear about the priority of what you want to have happen, you are likely to do what is lower on your list of priorities without being aware of it.

Also, not knowing what you want is another route to confused awareness. For example, you may want Culture Change to occur in your facility, but if you haven’t made a list of what specific behaviors and changes are needed, and you will have a confused awareness. Your confused awareness creates an obstacle to your requesting change. Confused awareness occurs when you don’t take the time to figure it out or you aren’t able to make up your mind. Many females have difficulty because they are culturally raised to be people pleasers, to act in a responsive mode to others.

To eliminate the obstacle of confused awareness, list two specific staff behavior changes you would like to see happen regarding the implementation of Culture Change in your facility. Be as specific as you can, listing staff members’ names, time of day or circumstance under which this action will take place, and residents’ names.
Example: Wendy, the CNA on A-Wing, will transport Mary to Bible Study on Wednesday around 1:30.
1. (staff member) __________ will do (task) _______________ with (resident) __________ at (when) __________.

2. (staff member) __________ will do (task) _______________ with (resident) __________ at (when) __________.

d. Total Oblivion is total unconsciousness about your own feelings, reactions and incompetence in the area of implementing Culture Change in your facility. With total oblivion, your problems may be expressed physically via high blood pressure, headaches, or backaches. Your feelings act as a healthy barometer that alerts you to things that need attention. If you stuff your feelings this emotional energy turns inward and may cause physical symptoms.

Summary: to overcome lack of clarity you must take the time to look inside regarding how you feel concerning Culture Change implementation or lack of Culture Change implementation in your facility. You need to see what is and isn’t going on. You may need to take the time to set priorities regularly even when there is no problem at hand.

In the preceding section, you explored the first reason for hesitancy regarding the implementation of Culture Change, that being lack of clarity. Lack of clarity was divided into four different parts; delayed awareness, partial awareness, confused awareness, and total oblivion. In addition to lack of clarity, there are three main feelings that may be keeping you from having the courage to implement Culture Change to its fullest extent in your facility. These might be feelings that may create a lack of courage are guilt, anger, and fear. Guilt, anger, and fear are barriers to taking action, or in short, acting with courage.

a. Guilt - is based on the faulty premise that you must take care of other staff members’ problems or you are a bad person or you are a bad employee. So you may get yourself into the rescue role where you sacrifice your own true desires or feelings to do for others. For example, if Carol, the speech therapist, continually gives you lip service about changing Helen’s therapy time to enable her to attend Crafts, you may feel guilty going to the next level and mentioning this to your administrator.

Write a sentence describing a situation in which your guilt is creating a lack of courage and an obstacle for you to take action concerning the implementation of Culture Change in your facility.

b. Fear
The most common fears that create a lack of courage are:
(1) Fear of hurting others - one of the toughest limit setting obstacles is when the other person is an innocent party, but bothering you anyway. Responsible assertion means you take other’s feelings into consideration, but you don’t self-sacrifice and lie.
(2) Fear of disapproval or rejection - runs many people lives. Fear of other’s saying no to you or your ideas.
(3) Fear of conflict or making matters worse - you fear making a tolerable situation worse or making a scene or making things worse. The risk is two sided - you risk stirring things up as well as clearing things up. You must be willing to risk if you want to live honestly.
(4) Fear of making a mistake or failing – some things are irreversible, but usually this is not the case.

Write a sentence describing a situation in which your fear is creating a lack of courage and an obstacle for you to take action concerning the implementation of Culture Change in your facility.

c. Anger
You feel so angry or frustrated about a situation you want to avoid it.
(1) Your anger or frustration creates a lack of courage.
(2) However, if you stop and think for a minute, sometimes the cause of your anger and frustration is a feeling of hurt or lack of control. By hurt, I mean you may feel insulted or degraded that others are ignoring your Culture Change requests. If that is the case, it is important to recall that events only have the meaning that you assign to them. You may rethink your self-talk from “she doesn’t respect me.” To, “I feel sad for her that she does not understand the importance of Culture Change.”

My initial “hurt” feelings, self-talk message is…

Another way of looking at this situation is…

(3) On the other hand, at the core of your anger may also be a lack of control. Clearly, you cannot make another do something. You can only request. Instead of feeling a lack of control and the resulting anger and frustration, spend your energy analyzing what you can do differently to more effectively get your Culture Change message across.

What is one area in which I feel a lack of control regarding Culture Change?

What is the next step I need to take in this area? (For example, escalate by talking to the administrator again? Or de-escalate by taking time to get to know the CNA better?

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