The Rule of Six

A 500-pound man was admitted to the cardiac floor of a local regional hospital last week. In one of my training programs at this hospital, some of the nurses on the obese man’s unit described how difficult it was to care for him.  They told their fellow classmates that the patient continually pressed the call bell. He would ask for water and as soon as that need was filled he would ask for ice or a pillow.

Demanding patients challenge nurses

These nurses ran back and forth into his room all day and into his first night at the hospital.  When comparing notes at the end of the shift, they determined that the man had not been alone all day due to the quick responses of the staff to his every need.

One nurse’s comments stood out to me as I asked the class to share what enabled them to stay responsive and positive with this assertive  patient.  She described the collaboration she builds with a patient when she is assigned his/her care. To start, she tells each patient  that her goal is to collaborate with them to help them heal. In the case of the obese man, she introduced herself and asked him if she could count on him to partner with her.  When he began to ring for her repeatedly, interrupting the care that she was giving to other patients, she began asking herself what could be the reason that the man was so demanding.  She told us that she considered the following ideas:

  • He was scared to be alone
  • He had lost his sense of control over his life so he needed to try to control things on his unit
  • He might have had inattentive service during another hospital visit
  • He was lonely
  • He didn’t know any better about the ways to be your own advocate while in the hospital
  • He had inadequate insurance coverage and knew he would owe a lot of money for his stay.  He was going to insure he got his money’s worth during the visit.

Not knowing if any of these ideas were true didn’t matter to this one nurse.  By considering what might be motivating the patient to behave as he did, she discovered empathy for him as well as more curiosity about his circumstances.  By not jumping to the conclusion that the patient was acting out inappropriately,  she stayed away from judging him and then getting impatient with the way he was trying to partner with her.

The Oneida Indian tradition has a name for the process the nurse used with this large cardiac patient.  It is called The Rule of Six.  This long-standing part of the Oneida world view represents the idea that for any phenomenon, behavior or event, there are at least six possible  explanations for it.

By CarbonNYC at Flickr Creative Commons

The Oneida believe that if you look for six explanations,  you will not lock into the first interpretation you land on.  When applied to our experiences with people, an automatic interpretation of someone’s behavior  is  often not accurate so the discipline of looking for other reasons for some behavior can widen our options for how to respond.

This nurse’s story highlights how the Rule of Six helped her to be quite agile with a demanding patient.  She was able to avoid frustration and to respond to him with continual compassion and interest.   I’m thinking that the Oneida tradition can help all of us to be more emotionally intelligent when dealing with the varied personalities on our teams and in our organizations.  Let us know what your experience has been using this technique.

Maddie

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One response to “The Rule of Six

  1. Ah, I knew someone I love introduced me to Paula Underwood Spencer and I forgot who! It was you! So thanks, Maddie! She’s one of my angel authors, the ones I’d like to see finding a larger audience though they are gone.

    The other day, my ten-year-old spontaneously applied the Rule of Six to a friend’s baffling behavior, and I was so proud. I hope you are, too.

    See? Your book blesses people long before it is finished, and ripples far beyond your direct readership.

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