FHA PFE Learning Collaborative Stay Calm and Have a Plan: Practical - - PowerPoint PPT Presentation

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

From 2002 to 2013, incidents

• f serious workplace violence

were four times more common in healthcare than in private industry on average.

Definition:

Violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty.

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

• Working directly with

volatile people

• Working when

understaffed‐especially during meal times and visiting hours

• Transporting patients
• Long waits for service
• Overcrowded,

uncomfortable waiting rooms

• Working alone
• Poor environmental design
• Substance abuse
• Inadequate security
• Lack of staff training and

policies for preventing and managing crises with potentially volatile patients

• Access to firearms

13

The Bottom Line Violence in hospitals usually results from patients and occasionally from their family members who feel frustrated, vulnerable, and out of control.

14

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.

RECOGNIZING CUES TO CRISIS USE ALL YOUR SENSES Stop, Think, Observe and Plan

LOUD VOICES TENSE MUSCLES RED FACE PACING INTENSE STARING/GLARING RAPID APPROACH/SUDDEN MOVEMENTS OBJECT AGGRESSION BRANDISHING A WEAPON THREATENING ATTEMPTING TO ASSAULT PHYSICALLY STRIKING OR GRABBING

Some Helpful Education Programs

CPI: teaches the Integrative Experience which matches the upset person’s behavior with the appropriate staff response. It also recognizes that in a crisis the staff may be feel threatened and provides with tools and techniques to stay safe. Language of Caring: This program focuses on specific communication techniques that give the staff explicit frameworks for interacting. These helps to insure a positive interaction. Positive Approach(PAC): This program is designed specifically for patient’s with dementia. It teaches staff the physiology of dementia and provides the staff with skills and techniques that work with the parts of the brain that can still be engaged.

WHY TEACH YOUR STAFF TO MANAGE COMMUNICATION CRISES ?

IT WORKS!!!

Questions?

Getting Involved with the FHA PFE Learning Collaborative

First Annual FHA PFE Summit Highlights

Powerful Partnerships: Improving Quality and Outcomes – July 21, 2017 Speakers:

• Beverley Johnson, President and CEO, Institute for Patient‐ and Family‐

Centered Care (IPFCC)

• Thomas Workman, PhD, Principal Researcher, American Institutes for Research

(AIR)

• Julia Lanham, Patient Advocate, Carolinas Health System
• Sari Siegel, PhD, Senior Study Director, Westat

Panelists:

• H. Lee Moffitt Cancer Center & Research Institute
• Health Central Hospital
• Memorial Health System

FHA PFE LC Track Descriptions

Three tracks to choose from

• Track 1: Developing/Enhancing a PFAC
• Track 2: PFAC Sustainability and Expansion
• Track 3: Faculty Advisor/Mentor

How to Get Involved

Formal Participation

• Statement of Interest
• Team Contact Form
• Onboarding Call

Audit

• Team Contact Form
• Onboarding Call

What is Freedcamp?

Freedcamp is a resource sharing and collaboration website that FHA is utilizing for our PFE Learning

• Collaborative. Resources available include:
• Events listing
• Discussion board
• Peer resource sharing
• Articles
• Evidence based resources (guides, toolkits, etc.)

Closing

Next Steps

• Learning Collaborative Sign Up
• Freedcamp
• Next PFE LC Webinar: Aug. 25, 2017, 1 pm ET
• September 19‐20 – WHYB Worker Safety Annual

Conference

– The Westin Lake Mary, Lake Mary, Florida – Details and Registration at: http://www.fha.org/health‐care‐ issues/workforce.aspx

Questions and Follow‐up

• 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

Webinar Evaluation Survey & Continuing Nursing Education

• Eligibility for Nursing CEU requires submission of an evaluation survey for

each participant requesting continuing education: https://www.surveymonkey.com/r/MJSKXMC

• Share this link with all of your participants if viewing today’s webinar as a

group

• Be sure to include your contact information and Florida nursing license

number

• FHA will report 1.0 credit hour to CE Broker and a certificate will be sent via

e‐mail

• We would appreciate your feedback even if you are not applying for CEUs!!
• Web participants can stay logged in as the webinar closes to be redirected to

the online survey (the link will also be provided in a follow up email)

44