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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….

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Promoting a nonviolent health care culture1
Promoting a Nonviolent Health Care Culture

  • Videoillustrating disruptive behavior, verbal and physical violence

    • Click on Video Link Above.


The purpose of promoting a nonviolent culture training is
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.


Objectives
Objectives is…

Define violence

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


Define violence
Define Violence is…

What is your definition of violence?

Think about what your definition of violence is now….what impacts your definition (family, friends, ??)


Definitions forms of violence
Definitions/forms of violence is…

  • Bullying

    • Creating a hostile or intimidating work environment between employees; usually secret behavior

  • Nonverbal/gesture Violence

    • Using violent and offensive gestures, postures, facial expressions

  • Verbal Violence

    • Using violent and offensive words and/or threatening violence

  • Physical Violence

    • The intentional use of physical force with the potential for causing death, disability, injury, or harm.


Bullying
Bullying is…


Promoting a nonviolent health care culture

  • May occur vertically from a supervisor of greater power towards an employee.

  • May occur horizontally towards someone of equal power. Also known as lateral violence.

  • May include written intimidation through letters, Facebook, notes.

  • Examples include: eye rolling, changing assignments without informing the person, gossiping, isolating, withholding information, intimidation, excessive criticism, and denial of access to an opportunity

Bullying

Creating a hostile or intimidating work environment between employees; usually secret behavior


Bullying behaviors
Bullying Behaviors towards an employee.

  • http://www.bing.com/videos/watch/video/bullying-at-work/263dd594ad8a5207568d263dd594ad8a5207568d-306029265671?q=bullying%20videos%20at%20work&FORM=VIRE5

    • Click on Link Above


Bullying1
Bullying towards an employee.

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!


Bullying2
Bullying towards an employee.

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.


Nonverbal gesture violence
Nonverbal/Gesture Violence towards an employee.


Promoting a nonviolent health care culture

Nonverbal/Gesture Violence towards an employee.

Using violent and offensive gestures, postures, facial expressions

  • Can often occur before verbal or physical violence

  • Don’t ignore the gesture, discuss the frustration, anger, fear, etc.

  • May be able to prevent the escalation of violence with intervention.


Verbal violence
Verbal Violence towards an employee.


Promoting a nonviolent health care culture

Verbal Violence towards an employee.

Using violent and offensive words and/or threatening violence by employees, visitors, patients or family members

  • Often occurs before physical violence

  • Is not tolerated and needs to be reported

  • Can occur from other employees, patients, visitors and staff.


Physical violence
Physical towards an employee.Violence


Promoting a nonviolent health care culture

  • Can occur due to a patients altered medical/mental status towards an employee.

  • Often occurs due to one’s fear, anxiety, confusion and/or anger

  • Can often be prevented with advanced and proper intervention

  • Patient, visitors, family and staff all need to be protected from physical injury

  • All physical violence needs to be reported

Physical Violence

The intentional use of physical force with the potential for causing death, disability, injury, or harm.


Effects of violence
Effects of violence towards an employee.


Effects of violence1
Effects of Violence… towards an employee.

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


Effects of violence in the workplace cont
Effects of Violence in the Workplace towards an employee.(cont.)

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


Occurrence cost
Occurrence /Cost towards an employee.


How often does workplace violence occur
How often does workplace violence occur? towards an employee.

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


Promoting a nonviolent health care culture
Cost towards an employee.

Difficult to determine but has been estimated to cost hospital organizations up to $4 billion/year

Intervene early and prevent violence!


Culture
Culture towards an employee.


Culture1
Culture towards an employee.

  • We all need to perform a self assessment of our personal attitude, values, culture and beliefs regarding violence

    • What level of violence is acceptable in my home?

  • We need to examine discipline culture (nurse, technician, social work, MD) and how it contributes and interacts with other disciplines

    • How do my peers interact in regards to violence?

  • Overarching culture of the organization is important in regards to what is acceptable and unacceptable…you are part of that culture!


Understand your personal culture the culture of those you work close to and the organization
Understand your personal culture, the culture of those you work close to and the organization…..

  • Everyone needs to assist the organization to have a ZERO TOLERANCE for violence….

    • NO BULLYING

    • BEING YELLED AT, SPIT ON, PHYSICALLY INJURED IS NOT OK

    • ALL VIOLENCE MUST BE REPORTED---Do not accept it as OK!


The employee s role is
The employee’s role is… work close to and the organization…..

• 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.


Assessing violence
Assessing Violence work close to and the organization…..


Assessment of impending violence
Assessment of impending violence… work close to and the organization…..

  • Assessment is the act of gathering data to be used in formulating a plan of intervention with the person in crisis to prevent a violent act!

  • Assessment is critical in de-escalating persons quickly.

  • Assess the following:

    • the situation, the person, ourselves, co-workers, and the environment.


What do we assess violence
What do we work close to and the organization…..assess violence?

  • What is happening in the situation

  • How are you responding to the situation?

  • What is our co-worker’s reaction and is it appropriate?

  • What is the person or aggressor feeling?

  • What is going on within the environment?


Assess the situation
Assess the work close to and the organization…..Situation…

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?


Personal and co worker assessment
Personal work close to and the organization….. and co-worker assessment

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
Assessment of the work close to and the organization…..Person…

Assessment of the person is an ongoing process and not just related to crisis.

  • Mental status

  • Emotional status

  • Influence of drugs or alcohol

  • Precipitating factors

  • Culture

  • Support systems- family assessment

  • Non-verbal communication

  • Posture

  • Speech

  • Motor activity

  • Perceived level of crisis


Assessment of the person1
Assessment of the work close to and the organization…..Person…

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?


Assessment of the overall environment
Assessment of the Overall work close to and the organization…..Environment…

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?


Assessment of the environment
Assessment of the work close to and the organization…..Environment…

Possible weapons

Position of furniture in room

Lighting

Noise

Temperature

Doors- open/closed, entry and exit doors

Obstacles

Where is staff?

Where are the other persons

and visitors?


Therapeutic relationship communication and the environment
Therapeutic Relationship, Communication and work close to and the organization…..the Environment


Therapeutic relationship and communication
Therapeutic Relationship and Communication work close to and the organization…..

How do you form a therapeutic relationship with a person if there is a potential for violence?

  • The following elements will support your relationship with the person:

    • Rapport~ relationship that is based on acceptance, warmth, friendliness, and non-judgmental attitude

    • Trust~ Basis of a therapeutic relationship

    • Respect~ Implies the dignity and worth of an individual regardless of his/her unacceptable behavior

    • Genuineness~ Being open, honest, and real

    • Empathy~ Acknowledging how the person feels


Therapeutic communication
Therapeutic Communication work close to and the organization…..

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

R= relax

Reflects that you care!


Therapeutic environment
Therapeutic Environment work close to and the organization…..

Violence prevention is assisted with the proper environment: You can try using…

Stress balls Snacks

Music Games

Massage Chair Aromatherapy

Prayer Books Warm Blanket

Warm Colors Spacious Area

Chapel


Crisis cycle
Crisis work close to and the organization…..Cycle


Crisis development cycle
Crisis Development Cycle work close to and the organization…..


Promoting a nonviolent health care culture

Understanding work close to and the organization…..the cycle can help you intervene to prevent a violent act.

You can intervene at any stage of the crisis cycle to de-escalate violence!


Level 1 pre crisis
Level 1- Pre-Crisis work close to and the organization…..

Person

Your Interaction

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

Offer alternatives

Positive feedback

Help person increase insight/self-awareness

Keep it simple


Examples of early warning signs that violence might occur
Examples of early warning signs that violence might occur… work close to and the organization…..

Restlessness

Agitation

Pacing

Shortness of breath

Sweating

Rocking

Clenching Teeth

Bouncing Legs

Shaking

Crying

Giggling

Singing

Swearing

Wringing Hands


Level 2 defensive
Level 2- Defensive work close to and the organization…..

Person

Your Interaction

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

Be firm

Not threatening

give limited choices

Reduce environmental stimuli


Level 3 acting out
Level 3- Acting Out work close to and the organization…..

Person

Your Intervention

Person is physically aggressive, combative

and will require direct physical intervention

Intervene using least restrictive means necessary

Team approach

Follow policy and procedure


Level 4 tension reduction
Level 4- Tension Reduction work close to and the organization…..

Person

Your Intervention

Person is able to communicate with control

and returns to a state of calm and pre-crisis behavior

Appropriate verbal intervention

Debriefing

Allow the person dignity with goal to regain composure

Calm environment


Debriefing
Debriefing work close to and the organization…..


Debrief with the aggressor
Debrief with the aggressor… work close to and the organization…..

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)


Debriefing for employees
Debriefing for employees… work close to and the organization…..

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.


Check your knowledge
Check your Knowledge work close to and the organization…..

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.