3/2/2011 The Arkansas Self-Insurance Trust and Mike Johnson & - - PDF document

3/2/2011 1

The Arkansas Self-Insurance Trust and Mike Johnson & Associates

present

How to Deal Safely with Combative Behavior

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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

Today’s Presenter:

§ 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

3/2/2011 2 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

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Combative Behaviors to Recognize

Reactions out

• f proportion

Constant demand for attention Repetitive questions

Combative Behaviors to Recognize

Refusal of Care Pacing, searching, rummaging Yelling, screaming, cursing, threats

Combative Behaviors to Recognize

Hitting, biting, kicking Sleeping problems Sundowning

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3 Forms of Communication

• Direct
• Indirect
• Reinforcement

3 Forms of Communication

• Direct
• Indirect
• Reinforcement

3 Forms of Communication

• Direct
• Indirect
• Reinforcement

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3 Forms of Communication

• Direct
• Indirect
• Reinforcement

Direct Indirect Reinforcement

• Reduce the environmental

stimulation

• Get the resident’s attention
• Introduce yourself and call

the resident by name

• Speak slowly with a lower

pitch

• Use short sentences

Direct Communication

Direct Indirect Reinforcement

• Be specific
• Introduce topic changes
• Avoid open-ended questions
• Wait for a response
• Accept the resident’s

response

Direct Communication

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Direct Indirect Reinforcement

• Establish eye contact
• Show calm and friendly

expressions

• Use gestures to help

communication

• Touch the resident, if they

prefer

Indirect Communication

Direct Indirect Reinforcement

• Move slowly
• Walk along side instead of

behind

• Speak quietly
• Never appear embarrassed

by an emotional display

Indirect Communication

Direct Indirect Reinforcement

• Give reinforcement

immediately following desired behavior

• Give reinforcement each time

the behavior occurs

• Use reinforcement that is

meaningful to the resident

Reinforcement

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Direct Indirect Reinforcement

• Do not reinforce without

desired behavior

• Reinforcement should be

short term

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

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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

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Are there any questions?

Darrell G. Toenjes

Manager of Web Events Healthcare Risk Management Consultant Midwest Employers Casualty Company Phone: 636-449-7159 dtoenjes@mwecc.com

Jack McDaniel Safety/Loss Control Specialist Mike Johnson & Associates Phone: 479-876-6916 mtecsafety@cox.net