In addition to lack of clarity and lack of courage, a third reason for hesitancy to request Culture Change and create a team atmosphere in the areas of transporting, schedule changing, and staff doing activities with residents is possibly your faulty thinking. Three types of irrational or illogical thinking are: catastrophizing or blowing things out of proportion; always-never thinking and thinking in absolutes; and must-have thinking.

These areas of faulty thinking can be the cause of emotional false alarms. So once again I am asking you to evaluate your thinking, rather than falling into the rut of blaming others, self-pity, and playing the “Ain’t-It-Awful” game. However, awareness and conscious competence is essential in assuming quality control over your thoughts or self-talk. The exercises in this section should help.
(1) Irrational or Illogical thinking.

a. Catastrophizing involves a lot of "what-if"ing. "What-if"ing occurs when you start to think, “What if the speech therapist gets angry if I request her to change Helen’s schedule so that she can attend Crafts?” or “What if the DON complains to the administrator about my requests concerning transporting?” "What-if"ing leads to a lack of action resulting from fear. You scare yourself into inaction regarding Culture Change. However, the fallacy of "what-if"ing carries a situation to the extremes.

Here are some irrational or illogical basics that lead to catastrophizing. They sound something like this, “When life doesn’t go my way, it is awful!” By stating this to yourself, you feel your emotional discomfort or even misery comes from outside you and you can’t control it. However, as mentioned earlier, feelings are always self-induced and you have a choice regarding how they affect you and how long they affect you. However, if you feel strongly that thoughtless and incompetent staff are somehow bad or defective, you begin to doubt your ability to effectively resist pressure from others, perhaps to do nothing and ignore the implementation of Culture Change.

Write an example of your use of catastrophizing or "what-if"ing regarding Culture Change. (For example, What if the speech therapist gets angry if I request her to change Helen’s schedule so that she can attend Crafts?)

Reword this statement with a realistic evaluation. (For example, What is the percentage chance the catastrophe will happen? If it does, so what? What would a possible course of action be? What really is more likely to happen?)

b. Always-never thinking or thinking in absolutes occurs when you selectively remember only the negative. You also engage in “always-never thinking” when you selectively imagine the future.

Write an example of “always never” thinking regarding Culture Change. (For example, CNAs always forget to give residents the activity left in their room.)

Rewrite the statement in specifics to enable you to create a specific course of action. (For example, Wendy did not give Effie her yarn winding when she was returned to her room after breakfast.)

Now that you’ve gotten out of your always-never thinking, write an action plan based on the specifics above. (For example to de-escalate, you might write, “I will make a point to look for an opportunity to talk to Wendy and get to know her better, creating an opening to explain the importance of Culture Change.” Or to escalate, you might write “I have already established a personal connection with Wendy. She has a clear understanding of what is expected of her. I need to schedule a meeting with the DON.”)

c. Must have thinking is dangerous because it paints you into a corner of very restrictive choice. There are few things we must have - air and water are two of them. Almost everything else you can hold at the level of preference and you are in better shape if you do that. A common belief is that you must have approval from everyone in your facility. Remember the approval of others has nothing to do with your personal worth. Disapproval and rejection are the inevitable result of living in a world where everyone needs to have their own opinion. Regarding Culture Change, you may need to develop an increased capacity to live with rejection.

See if the next idea applies to you. Another must have thought is that everyone must always be in a positive relationship with you to prove you are OK. However, believing you must be perfect and on-top of things at all times creates low tolerance regarding criticism and performance anxiety.

One last must have thought is that you must have things in a certain way to be happy. In other words, if you combine this with the always-never thinking discussed in the previous section, you may find yourself thinking the following in order to be happy.
-- I must have all residents transported always.
---All shower therapy and medication schedules must be changed immediately.
-- All residents must always be provided with all of the activity projects I have left in their rooms.
Do you see how the preceding combination of always-never and must have thinking creates a convenient “escape hatch” for you to throw your hands in the air and say, “Culture Change won’t work here!”

Write a must have thought that you have had. (For example, Wendy must give Effie the yarn winding to comply with Culture Change.)

Write the same thought in specific terms as a preference. (For example, It would be nice if Wendy gave yarn winding to Effie to comply with Culture Change.)

Complete the following related to an area of non-compliance concerning Culture Change in your facility.
It would be nice if… (What specific thing would happen?)

I would be most appreciative if… (What specific thing would happen?)

It would be great if… (What specific thing would happen?)

Be on the look out for must-have thinking. Challenging such assumptions restores a sense of self-composure and also reduces dread regarding failure. It is smart to upgrade to preferring things you currently insist on. You don’t stop caring and doing everything you can to get it, but you do it as a preference not a demand.

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