3/2/2011 The Arkansas Self-Insurance Trust and Mike Johnson & Associates present How to Deal Safely with Combative Behavior • Your phones have been muted to limit distractions. • For best viewing, set your screen resolution to 1024x768. • If the image is not fitting in your screen, go to the Menu and click on VIEW, FIT IN VIEWER. • The audio can be heard by calling 1-866-469-3239 and entering the event number: 927 862 024 and the attendee id that will show on your screen. • Questions/Technical Issues? Please contact WebEx Support at 1-866-779-3239. Today’s Presenter: Darrell Toenjes, ARM, CHSP, CWCP Darrell Toenjes, ARM, CHSP, CWCP Risk Management Consultant Risk Management Consultant – – Healthcare Healthcare Midwest Employers Casualty Company Midwest Employers Casualty Company § 25 years in insurance industry § Corporate Risk Manager, Employee Safety - SSM Health Care § Operations Manager – Sedgwick CMS § National Program Manager – Ascension Health The Arkansas Self-Insurance Trust and Mike Johnson & Associates present How to Deal Safely with Combative Behavior 1
3/2/2011 Objectives • Know the 3 elements in addressing combative behaviors • Learn combative behaviors to recognize • Understand the 3 forms of communication • Review positive reinforcement approaches • Identify risk reduction techniques 3 Elements in Addressing Combative Behavior Recognition Communication Risk Reduction Combative Behaviors to Recognize Irritability Frustration Excessive Anger 2
3/2/2011 Combative Behaviors to Recognize Reactions out Constant Repetitive of proportion demand for questions attention Combative Behaviors to Recognize Refusal of Care Pacing, Yelling, screaming, searching, cursing, threats rummaging Combative Behaviors to Recognize Hitting, biting, Sleeping Sundowning kicking problems 3
3/2/2011 3 Forms of Communication • Direct • Indirect • Reinforcement 3 Forms of Communication • Direct • Indirect • Reinforcement 3 Forms of Communication • Direct • Indirect • Reinforcement 4
3/2/2011 3 Forms of Communication • Direct • Indirect • Reinforcement Direct Communication Direct � Reduce the environmental stimulation � Get the resident’s attention Introduce yourself and call � Indirect the resident by name � Speak slowly with a lower pitch � Use short sentences Reinforcement Direct Communication Direct � Be specific � Introduce topic changes � Avoid open-ended questions � Wait for a response Indirect � Accept the resident’s response Reinforcement 5
3/2/2011 Indirect Communication Direct � Establish eye contact � Show calm and friendly expressions � Use gestures to help Indirect communication Touch the resident, if they � prefer Reinforcement Indirect Communication Direct � Move slowly � Walk along side instead of behind � Speak quietly Indirect � Never appear embarrassed by an emotional display Reinforcement Reinforcement Direct � Give reinforcement immediately following desired behavior � Give reinforcement each time Indirect the behavior occurs � Use reinforcement that is meaningful to the resident Reinforcement 6
3/2/2011 Reinforcement Direct � Do not reinforce without desired behavior � Reinforcement should be short term Indirect Reinforcement Positive Reinforcement Giving Them Attention • Make it part of your routine • Give them praise and appreciation • Admiration – Connect with the person within • Comfort – Give them a hug Risk Reduction Reducing Your Risk of Injury • Always approach the resident from the front • Wait for a signal from the resident before getting too close • Make eye contact • Don’t get cornered – Know where your escape route is • Make sure the resident does not have access to harmful objects • Report potentially dangerous behavior 7
3/2/2011 If you see residents abusing other residents REPORT IT TO YOUR SUPERVISOR Summary • When dealing with combative behaviors utilize recognition, communication and risk reduction in every situation, every time • Remember the importance of providing positive reinforcement and “connecting” with each resident • Always reduce your risk to combative behaviors by implementing the techniques presented today Our special thanks to Karen Clark & her staff at Craighead Nursing Center - Jonesboro, AR And especially to • Theresa Kirksey, RN, RNP • Tammy Wilson, LPN • Pam Wilkes, RN Thanks also to: • Amy Rollins & Staff, Reliance Healthcare • Robert Greene & Staff, Convacare Management 8
3/2/2011 Are there any questions? Darrell G. Toenjes Jack McDaniel Manager of Web Events Safety/Loss Control Healthcare Risk Management Specialist Consultant Midwest Employers Casualty Mike Johnson & Associates Company Phone: 479-876-6916 Phone: 636-449-7159 dtoenjes@mwecc.com mtecsafety@cox.net 9
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