Promoting a Nonviolent Health Care Culture. Online Learning. Promoting a Nonviolent Health Care Culture. Video illustrating disruptive behavior, verbal and physical violence Click on Video Link Above. The Purpose of Promoting a Nonviolent Culture Training is….
To educate employees about creating a nonviolent health care culture by examining all forms of violence from disruptive behavior through extreme forms of verbal and physical violence
To support a safe environment for staff, patients and visitors.
Recognize the different types of violence
Understand the effects of violence, occurrence and cost
Define culture and identify a need to shift paradigms
Define assessment of person, situation, environment, self, and co-workers
Discuss the assessment of person, situation, environment, self, and co-workers
Define and discuss therapeutic communication and therapeutic relationship
Explain the crisis cycle and intervention techniques
Explain debriefing of the person and the staff member
Demonstrate basic and advanced intervention techniques
What is your definition of violence?
Think about what your definition of violence is now….what impacts your definition (family, friends, ??)
May occur vertically from a supervisor of greater power towards an employee.
Creating a hostile or intimidating work environment between employees; usually secret behavior
Workplace Bullying is repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators .
Bullying is not tolerated and must be reported.
Do not participate in bullying or stand by and watch other be bullied!
almost always psychological
frequently linked to a staged attack on competent and popular individuals
usually perpetrated behind closed doors and secret in nature
a target of this type of abuse may not realize it for weeks or months, until great damage is done.
shows its face through trivial untrue criticisms of under-performance
repeated, deliberate, disrespectful behavior with the intent of hurting someone else.
Using violent and offensive gestures, postures, facial expressions
Using violent and offensive words and/or threatening violence by employees, visitors, patients or family members
The intentional use of physical force with the potential for causing death, disability, injury, or harm.
The damaging effects of workplace violence are far-reaching and may include:
1. Deterioration in the quality of care delivered
2. Deterioration in the quality of staff relations
3. Low staff morale
4. Increased stress levels and stress-related illnesses
5. Feelings of shock, disbelief, shame, guilt, anger, fear, and powerlessness
6. Depression and self-blame, loss of self-confidence
7. Sleeplessness and loss of appetite
8. Lower levels of job satisfaction
9. Increased costs to employers and the health system
10. Increased absenteeism and sick leave
11. Poor performance and lost productivity
12. Loss of creative problem-solving capacity
13. Loss of staff
More assaults occur in healthcare and social services industries than any other
One million employees are assaulted per year
One thousand are murdered per year
Estimated that ½ of the cases go unreported
Difficult to determine but has been estimated to cost hospital organizations up to $4 billion/year
Intervene early and prevent violence!
• Adhere to your employer’s preventive policies and practices.
• Become aware of and report violent or threatening behavior or other warning signs. Anticipate and prevent an incident!
•Follow procedures established by the workplace violence prevention program, including those for reporting incidents.
Do I need help? If in doubt, get assistance!
Are communication devices in place?
Is there an aggressor?
What can I do to diffuse the situation?
Is the person in touch with reality or not?
Am I calm?
Is there some else that should handle this situation?
Can I de-escalate this situation?
Is my co-worker helpful or will they make this situation worse?
Is there another co-worker I should ask for?
Assessment of the person is an ongoing process and not just related to crisis.
What is person trying to say?
What is his/her purpose?
What is the tone?
Are they able to reason?
Any identifiable precipitating factors?
What is their diagnosis?
What is the design of the building?
How much access does a visitor have?
Is security present and visible?
Does the agency check or ask if visitors are carrying weapons?
Is the reception area visible and easily identified by visitors/staff?
What is the distance between waiting room chairs?
Are activities available to prevent boredom?
Position of furniture in room
Doors- open/closed, entry and exit doors
Where is staff?
Where are the other persons
How do you form a therapeutic relationship with a person if there is a potential for violence?
Proper communication can be difficult to master.
It involves verbal and non-verbal communication
Try the following skills to listen actively….
S= sit facing the patient
O= observe and exhibit an open posture
L= lean forward toward the patient
E= establish eye contact
Reflects that you care!
Violence prevention is assisted with the proper environment: You can try using…
Stress balls Snacks
Massage Chair Aromatherapy
Prayer Books Warm Blanket
Warm Colors Spacious Area
You can intervene at any stage of the crisis cycle to de-escalate violence!
State of being uneasy and uses unproductive use of energy, non-directive behavior
A change in usual behavior
Be supportive, show concern, give eye contact
Help person increase insight/self-awareness
Keep it simple
Shortness of breath
The person becomes angry, anxious, more vocal.
Their movements are quicker.
Be aware of changes in behavior.
Staff may also become more anxious at this point.
Set behavioral limits
give limited choices
Reduce environmental stimuli
Person is physically aggressive, combative
and will require direct physical intervention
Intervene using least restrictive means necessary
Follow policy and procedure
Person is able to communicate with control
and returns to a state of calm and pre-crisis behavior
Appropriate verbal intervention
Allow the person dignity with goal to regain composure
It gives the person an opportunity to process what has happened.
Helps them with coping skills.
You can assess for physical and emotional trauma.
Provides an avenue for staff/person to further develop a therapeutic relationship.
Debriefing must be completed within 24 hours after person is released from seclusion or restraint (Joint Commission standard)
Provides you with an opportunity to process what happened and what could be done differently.
All employees should seek debriefing for all forms of violence.
Provides an opportunity to “vent.”
Those directly involved should be the ones participating in the debriefing.
A manager or counselor can be very helpful with debriefing.
1. Which of the following forms of violence are usually done in secret? physical, verbal, gestures or bullying
2. What is repeated, deliberate, disrespectful behavior with the intent of hurting someone else?___________
3. What violence often occurs before physical violence and often includes offensive words?_____________
4. T or F All forms of violence should be reported so organizations can prevent its occurrence in the future.
5. T or F The damaging effects of workplace violence are far-reaching and may include depression and feelings of powerlessness.
6. T or F It is important to listen carefully to our patients and visitors by establishing eye contact and sit facing the person.
7. T or F The basis of the therapeutic relationship is trust.
8. Tor F If a person becomes angry and anxious you should appear nonthreatening but can set appropriate behavioral limits.
9. T or F If the person becomes physically violent intervene with the least restrictive means necessary.
10. Tor F It is not necessary to debrief with those who were physically violent.