Control issues: helping patients and staff members after a setback

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Tim Mullaney
Tim Mullaney

If you're a leader at a long-term care facility, you're constantly trying to promote persistence in the face of obstacles. Maybe you're trying to motivate a patient to progress with therapy or a struggling nurse aide to improve on the job. I've got one magic word that could help in this effort: Control.

Clinicians and managers should be especially sensitive to how much control patients or staff feel they have when facing a setback, according to recent brain research. 

The investigators scanned people's brains while they played a game in which they experienced setbacks. The setbacks were either due to factors under the participants' control or were uncontrollable. After each one, the participants decided whether to persist with the game or give up.

When people persisted after a controllable setback, the brain's “trial-and-error” region (the ventral striatum) was activated. When people persisted after an uncontrollable setback, the brain's emotion regulation region (the ventromedial prefrontal cortex) lit up.

Not surprisingly, it was more common for people to persist in the face of controllable setbacks. But as long-term care professionals know all too well, many setbacks are not controllable. Illness and injury can strike despite all precautions, turning a routine rehabilitation into a prolonged struggle. The government can slash reimbursement rates or impose mandatory scheduling rules that a scheduling coordinator must comply with. In these cases, people who persist are able to regulate their emotions, such as frustration, the brain research shows.

The lessons here seem pretty obvious. A good manager or caregiver should help people cope with their emotions to keep them going after uncontrollable setbacks. And when possible, leaders should increase their workers' sense of being in control. The study authors themselves described implications for job performance reviews.

“Our findings suggest that institutions that wish to promote persistence must pay attention to the way they deliver performance feedback and the way people perceive such feedback,” stated co-author Jamil Bhanji, Ph.D., a postdoctoral researcher at Rutgers University.

I think McKnight's blogger Jacqueline Vance, RN, provided a great case study of this principle in her “The Real Nurse Jackie” post last week. Vance once was managing a nurse aide who was chronically late. The aide was written up for it, finally prompting a sit-down with Nurse Jackie herself. Only at this point did the worker explain that she could not drop her kids off at school until 7 a.m. — the same time she was supposed to be clocking in at work.

To her great credit, Nurse Jackie perceived that many staff members might be experiencing this type of uncontrollable setback, a scheduling conflict with no apparent solution. She brought together everyone interested in sharing pre- and post-shift childcare and adjusted scheduling to allow them to help each other.

A lesser manager might have seen this as a cut-and-dried case of an irresponsible worker. “It's your duty to get to work on time, it's as simple as that,” the manager might have thought — or even said to this aide. If feedback came strictly in the form of repeated warnings and reprimands, the aide very well might have simply felt frustrated and trapped, leading her to quit. Or be fired. Instead, Nurse Jackie determined how much control the aide actually had in overcoming this setback of habitual tardiness, and figured out a way to give the worker more control over the situation.

So, kudos to Nurse Jackie, and next time one of your patients or staff members is facing a setback, keep in mind her story. The best managers might not keep their workers under control, but in control.

Tim Mullaney is McKnight's Senior Staff Writer. Follow him @TimMullaneyLTC.

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.