Resilience by Design Chapter 5: Perspectives

The choice to move between different perspectives is a skill practised by people who are resilient.

Where, when, and how we place our attention, with respect to ourselves, others, and the context in which we are interacting will influence our thinking, our behaviours, our performance, and our overall quality of experience in work, play, and day-to-day life.

Jill Robinson is an experienced graduate nurse with 30 years of senior operational management experience. She has led multidisciplinary teams across a wide variety of adult health and social care environments, hospitals, residential and nursing facilities. In this story, Jill shared with us, she discusses how she is able to best support a patient suffering severe cognitive decline through accessing different perspectives. 

One thing I have learned from thirty-five years of nursing is that it’s pointless trying to convince someone with dementia that what they’re experiencing are hallucinations. In their world, they are absolutely real and the question becomes how flexible can I become to work effectively with someone in that state?

“Where’s Mary?” “What time is it?” like a stuck record -on and on she went, hour after hour, relentless. And yet it had all started so well–the family home was warm and comfortable, homely and inviting.

I tried everything – TV, reading the newspaper, sitting in the garden, making tea nothing worked ….” Where’s Mary?” “What time is it?” I could feel my blood begin to boil – my head was pounding, I was sweating, my breathing shallow and quick – how much more of this could I take?

Then I walked away into the living room – just for a minute, to break the never-ending pattern of her desperate questions and my increasingly abrupt answers. 

In that moment of quiet I took a deep breath and slowly let it out, then another and then a third, I could feel my heart slow a little and was able to lift my head and take in my surroundings – there on the piano was an old photograph of a beautiful young woman, vibrant laughing long wavy brown hair holding hands, sitting at the same piano with a little girl who was about 6 years old. Elsie came into the room – and for the first time, I noticed her rubbing her hands together – wringing them continuously, her walk was a pace up and down back and forth, back and forth, looking intently out of the window into the distance down the road. For a split second, I was Elsie and in that instant, I knew what Elsie was doing – she was waiting for Mary who was late and should have been home. 

In this sequence of events, Jill is able to regulate her own state by interrupting the loop she was in and adjusting her physiology. This more resourceful frame then allowed her to briefly access a second position – as though she was Elsie – that then gave her the information she needed to frame her next step.

Once again the plaintiff cry went up “Where’s Mary? What time is it? ” I picked the photo up and pointed to the little girl with a quizzical look? Her face crumpled and she sobbed “Mary…Mary …where is my Mary? Why isn’t she home yet?” and with that, she rushed again to look out of the window. 

Mary was her daughter – not the 60 year old daughter who was at a wedding – she was Mary – her 6 year old daughter who hadn’t come home from school and was overdue… maybe even lost… I steadied my voice, looked directly into Elsie’s eyes and firmly and convincingly asserted “Oh Elsie – You remember, haven’t you… she is having tea with her friend and will be home in time for bed tonight.” 

Elsie stopped, and looked perplexed before nodding knowingly and saying “Ahhh”. The pacing, hand wringing and questions ceased and in that blessed moment of relief I asked: “I wonder if you would be kind enough to show me how to play the piano – I hear you are very talented and it will make our day pass so easily.”

The next hour or more was spent listening as Elsie played old tunes, sometimes singing along, fully absorbed in the activity. That’s when I knew I would survive that day.

Taking a moment to access a different perspective on a challenging situation can give you the information you need to not only survive, it can also help you to help those around you.