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Rae Stonehouse. PROtect Yourself! Empowering Tips & Techniques for Personal Safety: A Practical Violence Prevention Manual for Healthcare Workers
Chapter One
INTRODUCTION
William Feather (1889 - 1981) is often quoted as saying “knowledge is power.” Mr. Feather is only partially correct. Knowledge is only power when it is used to achieve a goal. This program takes a proactive approach to minimizing the effects of violence towards those working in healthcare
Definitions:
Chapter Two. OVERVIEW: THE PROBLEM OF VIOLENCE IN THE WORKPLACE
The Most Recognizable Forms of Violence Include:
Violence also includes:
The Impact of Workplace Violence on Workers
Assault/Abuse Directed Towards Care-Giver. An Overview
Definitions of Violent and Aggressive Behaviour
Threats:
Signs of Disturbed Behavior. Quick List
Signs & Symptoms of Aggressive Behavior
Chapter Two Summary:
Chapter Three
ASSESSMENT. Risk Assessment for Violence. Purpose:
History of Violence
Assessment Questions:
Diagnosis: Cognitive Impairment:
Withdrawal Assessment:
Mentally Ill Clients
Risk Factors for aggression in elderly clients:
Criteria: Environment/Milieu of Treatment
Environmental Risks in Community Care:
Criteria: Sensitivity to disruptive events:
Criteria: Staffing/Staff Attitude
Triggers for Aggression:
Violence in the Workplace Self-Assessment
Communication with a Disturbed Individual. General Attitude and Approaches: A.Attitude or feeling state
B.Speech
C.Non-verbal messages
D.Empathic Listening (an active process to discern what a person is saying)
Listening Versus Really Hearing
Chapter Three Summary:
Chapter Four
CRISIS. WHAT CRISIS!
The Nature of Crises
Anatomy of a Crisis
Indicators That Can Characterize. A CrisisProne Person. Quick List
Events That Can Precipitate a Crisis. Quick List
Back to the Anatomy of a Crisis …
Specific Staff Attitudes or Approaches to be Used in the Four Levels of a Crisis
Guidelines for Dealing with Verbal Aggression
Types of Assault
The Effects of Helper Body Language in Resolving a Crisis
Physical Interventions/SelfDefense Techniques:
“Personal Space”
Recognizing a Person in Crisis
Common Signs & Symptoms of Psychological Reactions to Crisis
Problem Solving Method to Deal with Crisis Situations. 1. Assess 2. Plan 3. Implement 4. Evaluate. 1.Assessment:
Use a Team Intervention
Who should be a Team Leader? 1.First person on the scene. 2.Team member with confidence. 3.Team member who knows the client. 4.In many cases, (automatically) the person in charge
Questions a Team Leader should consider in planning intervention:
Potential Problems Encountered by Team Leaders
Legal Aspects and Documentation. Reports should be written immediately after the event by persons involved. Every organization has a different system for reporting. It is important that you are aware of the reporting procedure for your setting. Necessary documentation may include: nursing/interdisciplinary progress notes; Workers Compensation Board Incident Report; facility specific Unusual Incident Report; Facility Licensing report. It is generally recommended that you keep your own private notes of the situation should you need them for future reference. However, it is not suggested that you photocopy reports that you file as they are considered to belong to your employer
Issues to examine in the documentation are:
Incident Review & Post Event Debriefing. These two actions tend to get combined together but actually serve different purposes. Post event debriefing is an informal meeting with the staff involved in the incident immediately following the incident. Its purpose is to make sure that everybody is okay. People respond to critical incidents in different ways. We discuss some of those reactions in greater detail in Chapter Six. Post event debriefing is the time to advise those involved in the incident of the availability of employee assistance programs, if available, should they require professional help in processing their involvement in the crisis. It is also the time to ensure that the proper follow-up documentation will take place
A Safety Check (to be done on an ongoing basis)
Information That Should be Given to the Police. If you the care provider are in danger or the client is in danger, call the police for assistance Call 911 (if this service is available within your region.)
Someone is threatening to harm you. If the person who is threatening you is wielding a weapon (a projectile, a knife, a gun), your life is in jeopardy. You need immediate police assistance. Someone is threatening to harm himself/herself, has the means to do so, and is refusing to go to the hospital. When calling the police what should you say?
Personal/Ethical Dilemmas in Reporting Assaultive Incidents to Authorities
Stressors Specific to Working Shift Work
Stereotypes of Male and Female Healthcare Workers in a Crisis
Fight or Flight? That is the question!
Case Study:
Chapter Five
CAREGIVER BURNOUT
Signs of Burnout
Avoiding the Flames (Avoiding Burnout)
Let’s look at some more specific actions to reduce our chances of burning out
Fighting the Fire
Chapter Six
CRITICAL INCIDENTS
Critical Incident Debriefing
Stress Survival Suggestions
SELF-CARE POST TRAUMA
ADVICE TO MATES AND FRIENDS. If a friend, colleague, or mate has experienced a traumatic event, your behaviour may help in their recovery. Here are some suggestions: 1. LEARN ABOUT TRAUMATIC STRESS. Learn about traumatic stress so you can begin to understand what they are experiencing. 2. ENCOURAGE THEM TO TALK. Encourage them to talk about how they are feeling about the incident, but do not be overly demanding. They may feel that others do not want to hear about their feelings or that you expect them to be able to “handle it.” You need to challenge these beliefs by indicating your willingness to listen. 3. DON’T BE INTRUSIVE. Ask, “How are you doing?” or “How are you feeling?” If they want to talk they will, if not, they won’t. However, by asking, you have sent the message that a “listening ear” is available. If they never want to talk, at some point ask them why. They may be talking to others and your knowing this will help alleviate your stress. If they are not, encourage them to do so. 4. LET THEIR EMOTIONS FLOW. Do not be afraid of the expression of extreme emotion. Many of us have not experienced profound grief and anguish. Seeing someone cry uncontrollably can be a little distressing. A traumatized individual needs to let emotions out. Your supportive presence is often all that is needed. Simply be with them and let them release their emotions. Afterwards, take them for a walk to shed the chemistry of stress. 5. REFLECT YOUR FEELINGS, BUT DON’T TELL THEM HOW THEY’RE FEELING. Share your feelings about the situation. Do not say, “I know how you are feeling,” because you don’t. You may have gone through a similar experience, but not through their experience or as seen through their eyes. You can say things like “I found it tough when I went through a similar experience,” or “I can imagine this must hurt really bad,” or “I feel so sorry for what has happened.” 6. NO FALSE PROMISES. Do not give false promises such as “Everything will be OK.” No one knows the future. See your role simply as a support person, not as a Mr/s. Fix-It. If you do not know what to say, say nothing. In most cases what people need is someone to “hear them out,” not necessarily make it better. Say, “It’s OK to feel the way you do.” Affirm that this has been a horrible tragedy and it makes sense that it will be painful, confusing, or whatever. This helps particularly if you are a peer -- an equal. It feels good to have your co-workers legitimize your feelings
Post-Traumatic Stress Disorder. Definition. Post-Traumatic Stress Disorder (PTSD) is a natural emotional reaction to a deeply shocking and disturbing experience. It is a normal reaction to an abnormal situation. Post-Traumatic Stress Disorder is defined in DSMIV-TR, the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual. For a doctor or medical professional to be able to make a diagnosis, the condition must be defined in DSMIV or its international equivalent, the World Health Organization's ICD10
DSMIV diagnostic criteria. The diagnostic criteria for PTSD are defined in DSMIV as follows: A. The person experiences a traumatic event in which both of the following were present:
B. The traumatic event is persistently reexperienced in any of the following ways:
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) as indicated by at least three of:
Why are we focusing on PTSD?
Chapter Seven
HORIZONTAL VIOLENCE
1.Take ownership for expressing your own needs:
2.Be aware of the impact your comments have — check it out
3.Accept individual’s views and issues with respect
Seven Guidelines for Handling Conflicts Constructively
Chapter Seven Review:
Chapter Eight
BULLYING IN THE WORKPLACE
As an Individual, What Can I Do About It?
Intervention Process for. Horizontal Violence & Bullying. Review. Incident. Gain Control. Find Help. Plan for Action. Document. Confront. Formal Written Complaint. Legal Action
Chapter Eight Summary:
Chapter Nine
WHAT CAN I DO TO PREVENT AGRESSION & VIOLENCE?
Joint Occupational Health & Safety Committee (JOSH) Responsibilities
Secondly, we focus on aggression in our worksites and how we can control and reduce it. Preventing Disturbed Behavior
Preventing Disturbed Behavior. Quick List
Preventing Disturbed Behavior. Environmental Influences. Quick List
Prevention and Management of Aggression. Quick List
Actions to take with specific client groups:
Intervention Techniques to Interrupt Hallucinations
Alzheimer Patients. Communicating with the person with Alzheimer's disease is a challenge. In order to keep them in touch with the people around them, you will have to try to make up for their failing abilities. Knowing how to communicate is important. You need to use different ways of getting your message across, because the person gradually becomes less able to express their ideas in words and less able to understand what is said to them. Gentle touch, body movements, expressions on your face, and tone of your voice can all convey messages to which a person with Alzheimer’s Disease may respond. At the same time, the person can “speak” to you by actions and expressions when they are no longer able to use words well. Communication requires patience and imagination. The following guidelines may help you: 1) Set the Stage: Communication is always easier if other things are not happening at the same time. Keep your environment quiet and calm. For example, a TV or radio is distracting to the person with Alzheimer’s turn it off. 2) Get Their Attention: Approach the person slowly and from the front. Gently touch the person’s hand or arm to help get their attention. Don’t start talking until you know they are ready to listen. 3) Make Eye Contact: If possible, sit facing them or stand in front of them and keep eye contact. This makes it easier for them to understand what you are saying
Risk Assessment
Chapter Nine Summary:
Chapter Ten
COMMUNICATION SKILLS
Pitfalls in Communication:
Personal Qualities/Attitudes/Approaches. We cannot accept responsibility for the disturbed or aggressive behavior of others “Violence can happen anywhere, at any time, to anyone, and under any circumstances . . . Even with the most appropriate intervention by staff members, violent behavior may still occur.” It is very important that staff not blame themselves or each other for the undesirable or disturbed behavior. E.g. “I wouldn’t put up with that nonsense on my shift.”
Chapter Eleven. CONCLUSION
About the Author:
