FHA PFE Learning Collaborative Stay Calm and Have a Plan: Practical Tips for Handling Communication Crises in Healthcare July 27, 2017
WELCOME!
Team Introductions • Allison Sandera Project Manager and PFE LC Lead FHA allisons@fha.org • John Wilgis, MBA, RRT Director, Emergency Management Services FHA john@fha.org • Sari Siegel, PhD, CPHQ FHA Consultant, Senior Study Director Westat sarisiegel@westat.com
ReadyTalk Webinar Platform Overview
Learning Objectives Attendees will learn: • How to respond to agitated patients, family or surrogate decision makers • How to acknowledge reactions/emotions/feelings • How to avoid inflammatory responses • How to diffuse a tense situation • How to recognize danger signs
What Is Workplace Violence?
Healthcare Workplace Violence Definition: Violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty. From 2002 to 2013, incidents of serious workplace violence were four times more common in healthcare than in private industry on average.
Serious Workplace Violence 2002‐2013
Sources of Serious Workplace Violence
Who’s Receiving the Serious Violence
Serious Violent Event Causes
Types of Workplace Violence 12 Describes the relationship between the perpetrator and the target of workplace violence • Type 1 ‐ Criminal Intent • Type 2 ‐ Patient/Visitors • Type 3 ‐ Co‐Worker • Type 4 ‐ Personal
Risk Factors for Violence 13 • Working directly with • Working alone volatile people • Poor environmental design • Working when • Substance abuse understaffed‐especially • Inadequate security during meal times and • Lack of staff training and visiting hours policies for preventing and • Transporting patients managing crises with • Long waits for service potentially volatile patients • Overcrowded, • Access to firearms uncomfortable waiting rooms
The Bottom Line 14 Violence in hospitals usually results from patients and occasionally from their family members who feel frustrated, vulnerable, and out of control.
Can PFE Help?
Emerging Research: Using PFE as a Workplace Safety Strategy in Healthcare
Stay Calm and Have a Plan: Practical Tips for Handling Communication Crises in Healthcare Susan Kimper, MSN, RN‐BC Director of Psychiatric Medicine NCH Healthcare System
Disclosure I have no actual or potential conflict of interest in relation to this program/presentation .
THE BEGINNING
OBJECTIVES As a result of this talk participants will learn ideas, techniques, and principles of 1. How to respond to upset patients, family or surrogate decision makers. 2. How to acknowledge reactions, emotions, feelings. 3. How to avoid “inflammatory responses.” 4. How to diffuse a tense situation. 5. How to recognize danger signs
EXPERTS WHO’VE INFORMED MY PRACTICE William Edwards Deming: Management consultant quality: Ask the workers because they know. Ida Jean Orlando‐ Nursing Theorist: Thoughts, feelings, perceptions Quint Studer‐ Hospital CEO‐ Healthcare leader: Prescriptive advice for improving many aspects of healthcare. Jean Watson‐ Nursing Theorist: Primacy of Caring; Creating sacred moments David Cooperider‐ Professor, leader, business including healthcare advisor: Appreciative inquiry: leveraging the positive core. Crisis Prevention Institute: Knowledgeable experts on managing crises for 30 years: The Integrative Experience; staff and patient’s are affected in a crisis and you need to match the patient’s behavior with the appropriate staff response. Kirk Lalemand: Business executive: Non‐Violence Psychological and Physical Interventions (NAPPI) Jeff Mitchell: Crisis Incident Debriefing: Professor, National Institute of Crisis Management James Redfield: Author, Professor Four patterns of energy: intimidator, interrogator, aloof and poor me. Wendy Lebov: Managing partner Language of caring, author, lecturer Teepa Snow, Occupational therapist, expert on dementia, Positive Approach to Brain Change Dr. Terry Kimper, Psychologist, cognitive behavioral therapy, EMDR, behavior change, life coaching
WHY DO WE CARE ABOUT STAFF MANAGING CRISES WELL? • IF WE DON’T WE GET: • Poor patient and family satisfaction, complaints and investigations • Poor staff morale and satisfaction • Staff injuries and high worker’s compensation costs • High patient restraint use and patient injuries • Power and control issues • Fear • Staff turnover • Regulatory agencies • Lawsuits
WHY AND HOW???? DOES A CRISIS DEVELOP? Someone is upset, frustrated, angry, sad, afraid. Remember if someone raises their voice or fist they are not thinking clearly they are operating out of their amygdala (emotional mammal brain). • Needs not being met: physical, psychological, spiritual, cultural. • Power and control. • Lack of staff education or insensitivity.
PARTS OF THE BRAIN STAFF NEED TO UNDERSTAND RELATED TO CRISIS EMOTIONS ARE INTENDED TO HELP US TO SURVIVE: Fight, fright, freak, freeze, maternal/paternal love BUT SOMETIMES THEY GET IN THE WAY • Amygdala (Mammal brain) : part of the limbic system in the brain: emotions, stimuli, memory and motivations • Pre‐frontal cortex: (Mr. Spock or Mr. Data) frontal lobe of the brain Responsible for higher‐level thinking skills, like analytical processing and executive decision‐making. Also in charge of assisting with behavior modification. • Hippocampus : part of the limbic system involving our memories. Attaches memories to emotions and senses. • In dementia parts of the brain are dying and no longer functioning.
CREATING A FRAMEWORK FOR ENGAGEMENT, COMMUNICATION AND PROBLEM SOLVING WOMAN WITHOUT HER MAN IS NOTHING WOMAN WITHOUT HER MAN, IS NOTHING. WOMAN: WITHOUT HER, MAN IS NOTHING.
EVERYONE HAS A STORY REMEMBER TO BE NICE AND KIND
GENERAL RECOMMENDATIONS BEFORE APPROACHING AN UPSET PERSON • PROTECT YOURSELF AT ALL TIMES • KNOW YOUR RESOURCES • ASSESS THE ENVIRONMENT • APPROACH SLOWLY • SEEK INFORMATION FIRST • REMAIN ALERT AND NEUTRAL • USE LOW AND SLOW VOICE: ONLY YOU SHOULD BE TALKING TO THE UPSET PERSON • REMAIN RATIONALLY DETACHED, Be like a duck let it roll off, Be like a rhino let it bounce off , be like a rainbow and let it pass through without disturbance. • STAY GROUNDED: Don’t allow yourself to be provoked. Don’t get into power struggles. Don’t bite the hook. Don’t take anything personally.
ENGAGEMENT PHRASE BODY LANGUAGE Neutral body posture with your left or right leg at an angle. (lead with your dominant hip) About their leg length away. CPI calls this the supportive stance. Right or left hand up in a stop gesture but soft with fingers slightly curved. Wave hand slightly then move back into a position near your body. Make eye contact. Move slightly forward slowly. Speak in a low and slow voice. Watch their body language. Say, Hi my name is ____. May I ask your name? Wait for them to respond. Extend you hand to shake their hand if they will. If the patient has altered mental status you can try the Teepa Snow positive approach hand under hand. Remember if they are yelling or cognitively impaired they can’t think logically. Remember why and what are interrogating words. They make people feel defensive.
Scenario You’ve been called to a room with a patient who is yelling and screaming and pacing around the room. There are 4 kinds of anger: Aggressive, defensive, outraged and frustrated. When I arrive I ask who is in charge and what the issue is? The nurse say it’s a 35 year old male who was admitted over night who wants to be discharged because he isn’t getting the medications that he thinks he should be getting and he is threatening to hurt someone. (security has been summoned and they are standing by) I use the engagement approach. When he starts yelling I say, “I’m not yelling at you. You are yelling at me. Can we agree not to yell so I can help you solve this problem. Initially he keep yelling and I say, “You have a choice you can stop yelling or I will have to leave and I don’t want to do that. I really want to help you. You look like you’re very upset and I want to help you. I’m sorry that you are suffering. What is up? What is going on? The patient says he just wants to leave and doesn’t understand why he can’t. I ask if I can come closer and I tell him that I want to help him solve the problem. I ask him if I can sit down to listen to his story. In the end, he was able to calm down and reengage with the staff.
MANAGING A COMMUNICATION CRISIS IS LIKE BEING A BULL RIDER OR BEING ONE OF THE PROS ON DANCING WITH THE STARS There are certain techniques, principals and skills that staff can be taught. In addition, there is an art to knowing how and when to use what technique or skill and when to call for help. Coaching, calming, and redirecting can all be effective in getting to the resolution of the difficulty. Debriefing can be useful in examining what went well and what could be done differently or better and is everyone ok.
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