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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 Culture Online Learning
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… 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 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 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 • 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.
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 • http://www.bing.com/videos/watch/video/bullying-at-work/263dd594ad8a5207568d263dd594ad8a5207568d-306029265671?q=bullying%20videos%20at%20work&FORM=VIRE5 • Click on Link Above
Bullying 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!
Bullying 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 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 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.
Can occur due to a patients altered medical/mental status • 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… 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.) 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
How often does workplace violence occur? 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
Cost Difficult to determine but has been estimated to cost hospital organizations up to $4 billion/year Intervene early and prevent violence!
Culture • 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….. • 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… • 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.
Assessment of impending violence… • 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 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… 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 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 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 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… 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… 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 and Communication 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 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 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
Understanding 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 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… Restlessness Agitation Pacing Shortness of breath Sweating Rocking Clenching Teeth Bouncing Legs Shaking Crying Giggling Singing Swearing Wringing Hands
Level 2- Defensive 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 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 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
Debrief with the aggressor… 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)
