Calling on Medical Improv to Help an Inconsolable Patient

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Gert was admitted to the locked dementia unit where I was working as a charge nurse on the evening shift. In her late seventies and with progressing Alzheimer’s disease, her husband could no longer take care of her at home. She was alternating between sobbing and lashing out verbally at staff and other residents out as she walked down the hall with a very unsteady gait.

“I want to go home. Get away from me! Where’s my husband? You’ve done something with him”

She wouldn’t use her walker and every step was precarious.

Can you imagine this? Gert pushing on the door, setting off an alarm, pushing me and/or the nursing assistant away? Almost falling, sobbing and not able to understand where she was or why. I was worried about her safety and everyone else’s, including my own.

In my experience working with folks with dementia, it often helps to simply validate the patient’s concerns. Not with Gert. Saying “You want to go home. You don’t want to be here. You’re worried about your husband,” and so on was simply ineffective. She was inconsolable!

I asked Kandis, a very experienced, compassionate and skilled licensed nurse assistant to walk with her, but not too close. Then I put my mind to the problem. Since none of my usual approaches were working, I let my ten years of experience taking improv classes guide me along with a leap of faith and trust in Kandis. I put on a very stern face tone, turned to them using authoritative body language with my hands on my hips, (I was the charge nurse after all!), and said in a commanding tone, “Young ladies! You are going to be in deep trouble if you keep up this behavior. It is time to quiet down and I expect you both to do so!”

Gert stopped sobbing, wide-eyed, and looked at me, then Kandis. Kandis, too, was a little wide-eyed, but quickly got it. She gently took Gert by the arm and said, “We better go sit down or we’re going to get in trouble.”

Gert went with her and they sat together quietly for a little while. Later that night, Kandis and I took turns walking Gert up and down the hall with a box of tissues. She was much calmer, and validating her seemed more effective by then.

In reflecting on it later, I think it was a ‘miracle moment’ with Gert. Although we were much too busy to appreciate it then, I wondered after, why was it so effective? What was it we did? I think the answer is about relationships. When I scolded both of them and Kandis took the cue to align with Gert, she automatically felt that she had a friend. She was in whatever she was in withsomeone.

Someone was in charge and she wasn’t alone!

Gert’s process of adjustment was much easier after that night, and I think the roles Kandis and I played were key.

My improv experiences have helped me to be in the moment with patients and colleagues, read social cues, try out different behaviors and teach communication and collaboration to healthcare professionals. Adapting activities to teach interactive skills is part of an emerging field called medical improv that can help all healthcare providers — not just nurses like myself, but everyone from physicians to phlebotomists — develop positive, therapeutic, interpersonal relationships.

By following a few core principles of medical improv, many activities can be adapted for a new and dynamic way to learn essential people skills.

Core Principles of Medical Improv   

• “Yes and…”
• Help your partner be successful
• You have everything you need
• Celebrate risk-taking
• Truth and facts are not necessary
• Avoid questions

What’s exciting about the principles of medical improv is that most of them could just as easily be rules for general respectful communication and collaboration. For instance, “Yes and…” is often considered the “golden rule” of improv. What it means is that participants agree to say “yes” and accept what their partner offers, while the “and” refers to then adding something to the mix and building from it. Since participants do both in all interactions, they share responsibility for the story they are creating.  In fact, you cannot participate in an improv activity without practicing and developing your interactive skills!

With Gert, Kandis and I improvised a solution that was creative, spontaneous and collaborative. Even though I seemed mean (and I wasn’t entirely truthful — neither woman was actually in any trouble!), it was a safe and effective way to help Gert bond with Kandis and feel safe in her new and very confusing world.

Have you ever used the precepts of medical improv with a patient — even unintentionally? How might you use them in the future?

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