Crisis Prevention and Intervention in Healthcare - Essay Example

Essay Inserts His/Her Inserts Grade Inserts (21 02, Outline Introduction2. Verbal and physical maneuvers to diffuse and avoid violent behavior 2.1 Non verbal and verbal communication 2.2 Tension de-escalation 2.3 Anger de-escalation 2.4 Substance abuse de-escalation 2.5 Physical maneuvers 3. Strategies to avoid physical harm 3.1. Escape from behind chocking 3.2. Stance and Front chocking 3.3. Release of arms 3.4. Punching, biting and pulling the hair 3.5. Patients with weapons 4. Conclusion Crisis prevention and Intervention in healthcare 1. Introduction. Crisis in healthcare is unfavorable and could compromise the outcomes of medical intervention as well as create new challenges. Consequently, putting off the chances of a crisis incidence is fundamental. Moreover, there is need to protect self from injuries that can cause decline in motivation and physical injury resulting from aggressive behavior. To expose valuable ways of handling crisis, this essay discusses physical maneuvers to diffuse and avoid violent behavior. It also explains strategies that can be used to avoid physical harm. 2. Verbal and physical maneuvers to diffuse and avoid violent behavior. In managing assaultive behavior different ways of diffusing and de-escalating assaultive behavior are used in an effort to prevent violence. De-escalating assaultive behaviors requires use of technique when a crisis is likely to happen to prevent assaults. 2.1. Non verbal and verbal communication. Clear and effective communication when handling the patient with assaultive behavior should be adopted. When responding to patients communicate verbally and write down the instructions that support conversation to rule out chances of misunderstanding. Explain when conducting a procedure and help them to obtain what they need as Glick et al (2008 p. 126) point out. Leather (1999, p. 169) discussion reveals that, to create and communicate boundaries about treatment and contact is an effective way of diffusing assaultive behavior. Inaddition, explain what to expect and outcomes of staying in hospital, whether staying for long or for a short time. Be consistent in recording decisions and incidents in the hospital. Before implementing a treatment it is necessary to consult other physicians. When talking to the patient ask questions that are open ended and give adequate time to the patient to think and give response. Respect the patient’s space. When the assaultive patients asks questions overlook the challenging ones and redirect them. Use very simple words and short sentences when talking or responding. While the patient is conversing allow them to give their opinion and look away. Be neutral and evade smiling which can be easily mistaken for mockery and stimulate anxiety. Keep away from touching the patient while talking. Reaching out while talking to the aggressive person can be translated as a threat, even though it could be a habit that one does when talking (Forester, 1997, p.42). When they are yelling and talking in loud voice, do not scream to be heard. Remain calm until they take a breath, then talk to the aggressive person calmly. Be selective in responding to questions and attempt to answer the questions. Questions asked can be rudely presented; however, the healthcare professional should be willing to answer. Abusive questions should be ignored and not answered. Explain rules politely. Empathy is shown and not inappropriate behavior. The healthcare professional should practice self control to avoid giving threats and showing that they are angry. 2.2. Tension de-escalation. In managing assaultive behavior the voice used should be polite, low tone and confident. Avoid talking a lot when the patient is irritable. In their study Holmes et al (2013, p. 271) found out that, the healthcare professional can manage behavior and avoid being inflexible. The body language can be controlled to avoid stimulating anxiety. A safe distance can be kept between the healthcare professional and the aggressive patient. Address the patient using their name and use own name. Avoid eye contact with the patient because it may cause them fear and they become uncomfortable. Steer clear of touching the patient and inform them if there is need for treatment. It is wise to obtain the patients consent before administering medication or giving medical examination. Use clear words and attempt to clearly understand their response. Pay attention and listen carefully to every response they give. Be specific when asking and requesting for specific answers. When conversing keep away from giving promises. The healthcare professional can express their desire to help. Assist the patient express their thoughts and divert them from issues causing tension. The situation should be assessed and de-escalating techniques employed before the patients progresses to become assaultive. Tension de-escalation can be achieved by attempting to solve the problem at the moment. The healthcare professional can show empathy and give help if requested. Tension can be reduced by assuring the patient that they are not in danger and will not be hurt. Engaging the patient in a conversation or activity to divert their mind could help. Breathing exercises and relaxation can reduce tension. 2.3. Anger de-escalation. Duxbury and Whittington (2004, p. 476) mentions that, when anger is not managed it can soar into violence. When the patient anger is constantly increasing it may be necessary to walk away and give the patient time to calm down. Let the patient to vent and do not interrupt when they are angry. Be sincere when asked questions. After getting chances to have conversations assure them of confidentiality and seek for their agreement. In some cases it is wise to agree to differ in opinion. Refuse to give in to defensive positions and encourage the patient to cooperate with the assistance being offered. Healthcare professionals can keep quiet or walk away if there are chances of engaging in an argument. Help the patient identify the underlying issues that are causing them to be angry. Healthcare professionals can facilitate boundaries that are practical and participate in implementing them. Avoid a situation that makes the patient sense interrogation. Be firm on the boundaries set and show respect. If verbally assaulted remain calm and shun away from being defensive. Call for back up if caught up in a crisis. One can call for help or leave if de-escalation is not working. Hands should be visible so that it is easy to use them when needed. Putting hands in the pocket may be viewed as an attempt to take a weapon. Use hands appropriately without pointing or shaking fingers. 2.4. Substance abuse de-escalation. Patients who show assaultive behavior and are under the influence of substance can be challenging to handle. Handling them requires patience. The patient can be given time to calm. Examine the area and space and ensure they are safe for the patient and the healthcare professional. When they engage in a conversation, seek to understand them and let them know what others feel. Keep away from the patients who have abused drugs and reduce the frequency of dealing with them. Remain proactive and be positive when it comes to assisting them. It may be impossible to agree; hence, arguments should not be accommodated. 2.5. Physical maneuvers. The healthcare professionals can acquire knowledge on how to deal with the assaultive behavior incidents in their area of specialization. Functional alarms can be installed at accessible positions in the hospital. The furniture can be designed such that there are not sharp ends and they cannot be used as a weapon. The layout of the hospital should be designed in a way that does not allow congestion and overcrowding of patients, visitors and healthcare professionals in a limited space. The rooms, corridors and facilities in the hospital should be ventilated and have enough lighting. Additionally, avoid showing your back to the patient at any time. The healthcare professional should ensure they are placed between the patient and the exit. The way to the exit should be clear from obstruction. The eye level of the patients and the healthcare professional should be at equivalent level. The healthcare professional should stand if the patient is standing and request the patients to sit down so that they sit down. There should be space between patient and the healthcare professional such that the patient cannot stretch their arm and touch the other person. The healthcare professional should not be directly in front of the patient but at an angle. This will enable the healthcare professional to escape in case of an attack. 3. Strategies to avoid physical harm. When developing strategies against physical harm take note of predictive factors and stay alert to take action when exposed to assaultive behavior. When attempts to communicate and de-escalate assaultive behavior are ineffective stop. Safety is a priority and help should be sought after by leaving, calling for back up and informing the authorities. Physical means are used as the final remedy. Strategies to avoid physical harm entail finding practical ways to escape or protecting body from injury. 3.1. Escape from behind chocking. When attacked from behind gather confidence and remain calm and attempt to be in control. Raise both hands above the head. Then, twist to make the attacker lose their grip. While the hands are raised, twist towards the direction of the exit. The legs should be twisted too to ease mobility. The healthcare professional that is attacked can twist hands downwards towards the completion of the twist to make the attacker arms unstable. Upon release move quickly towards the exit, and call the security for assistance right away. Release self by turning if the attacker has chocked from behind and ensure the hands are lifted to make the attacker loose balance and grip. 3.2. Stance and Front chocking. According to Bowie (2009, p. 64), it is appropriate to keep the legs apart and wide, as well as leave the arms open when standing. There should be distance between the patient and healthcare professional. When the attacker is aiming at the head, keep hands crossed over the head for protection. Deflect towards the flow when the aggressor gives blow. An aggressor who is kicking can be difficult to handle. The victim can protect self by turning body so that the kick hits the lateral area of the feet. If the aggressor has attacked from the front, avoid backing up and continue being calm. Raise the hands higher than the head, a move which can confuse the attacker. A space between the shoulder and the neck is created when the hands are raised, causing the attacker to struggle with keeping the grip firm. Begin turning the feet towards the direction of the exit and then the body. While twisting the shoulders turn the hands downwards against the aggressor’s hands; this will make the aggressive patient let go. Bowie (2009, p. 64) adds that, protect the head from being hit when attacked by covering with arms, boards or pillow. Use the legs and feet to push away and prevent the aggressive patient from further attacking if one has fallen down. The arms of the healthcare professional can be twisted towards the attacker if their arms have been gripped by the aggressor. The face and throat should be protected at all times from being attacked. It is wise to master ways of avoiding the blows from reaching eyes and nose. 3.3. Release of arms. The patient can hold the healthcare arms tightly and refuse to let go. It is normal to pull or try to drag away, but this will not help. The most appropriate way to cause an aggressor to let go of the arm is by pushing the hand downward rapidly closest to the floor. Once the aggressor grip of the hand becomes weak, quickly rush towards the escape route. After being free, keep off and call for help (Shepherd, 2001, p. 117). The healthcare workers can use certain words to define the kind of attack and when they need assistance. In case the patient is stronger than the victim, the victim can plead for mercy. Asking for mercy and crying can contribute to release, and can be used instead of yelling or becoming aggressive towards the attacker. 3.4. Punching, biting and pulling the hair. When the aggressor is punching, protect self by preventing them with an elevated shoulder together with the elbow. Moreover, the elbow along with wrist can also be used to block punches. As the aggressor punches move towards their fist to destabilize them. Duxbury (2000, p. 111) suggests that, when the aggressor bites avoid pulling. Bites can be eliminated safely by pushing inside the mouth for them to release. When the aggressor bites push the bite towards the aggressors head in addition to holding their head. When the hair is pulled, make an effort to get hold of the aggressor’s hands and direct them towards the head. Change direction by bending to the front to make them lose balance. If the hair is pooled from the front, contain hair by pulling closer to the scalp and then twist to the front facing downwards. Hair that is pulled can be released by holding the aggressors hands and pushing them down. 3.5. Patients with weapons. Some patients may be armed with guns, knives and objects that can cause injury. To avoid physical harm it necessary to stay away from them. If staying away is impossible the healthcare professional should not reach out for the weapon. Being careful is emphasized. Steer clear of fighting back. If the attacker has a sharp object and attempts to stub or hit, hold their wrists. Hold the weapon with the right hand and use the left hand to gauge their eyes. This exercise requires agility. Move to the attackers back and pull their jaw to the left while attempting to make the aggressor lie down. Let the head of the aggressor go between the healthcare professional’s knees. They can twist thumb and arm to take control of the weapon. If the aggressor is holding a weapon discuss with them and keep distance. Eyes should be kept on the aggressor. When the aggressive patient is holding a gun at a distance, escape by running in wavy or zigzag line and duck if possible. Shouting and yelling to the attacker might not help. Avoid struggling to fight and try to prevent the aggressor from causing injury to the victim or the aggressor. Fauteux (2011, p. 199) insists that, healthcare professionals who are attacked by patients, workers or visitors can use self-defense techniques to protect the body from harm. They can shout for help and run away from violent person as quickly as possible. Healthcare professionals can consider taking self defense classes to acquire the skill. Collaborating with other co-workers to work together and defend on another is important. Following an attack, it is important to report to relevant authorities. Wykes (1994, p. 51), notes that, reporting is necessary because others could be in danger of being attacked. Moreover, the patient may need medical attention. The healthcare professional can report to immediate supervisor and is examined. They may need attention because of being emotionally affected and require treatment if they were injured. The healthcare professional can be released to rest if they have been shaken by the incident and have injuries. 4. Conclusion. Diffusing violent involves using appropriate verbal and non verbal language when communicating with a potentially or violent person. It also involves listening, creating boundaries, and showing empathy. Violence can be diffused using techniques such as tension de-escalation, anger de-escalation and substance abuse de-escalation. De-escalation of violence is achieved by using correct tone and volume when speaking, avoiding confrontation, walking away, calling for help and letting the patient vent. Healthcare professionals show respect and remain patient when diffusing violence. Physical maneuvers to diffuse and avoid violence entail installing alarms at accessible points, good lighting, avoid overcrowding and use furniture that cannot be exploited as a weapon in the healthcare facility. Keep distance and stay close to exit. Strategies to avoid physical harm involve escaping and avoiding the aggressive person. One can free self if they are being chocked, held on the arm, bitten, punched or hair is pulled. One should avoid showing their back and standing close to the aggressive person. Reference List Bowie, V (2009). Coping with violence: A guide for the human services. USA: Whiting and Burch Ltd. Duxbury, J. and Whittington, R. (2004). Causes and management of patient aggression and violence: staff and patient perspectives. Journal of Advanced Nursing, 50(5), 469- 478. Duxbury, J. (2000). Difficult Patients. Oxford: Reed Educational and Professional Publishing Ltd. Fauteux, K. (2011). Defusing Angry People: Practical Tools for Handling Bullying, Threats, and Violence.   New Jersey: New Horizon Press. Forester, S. (1997). The A-Z of Community Mental Health Practice. USA: Singular Publishing Group. Glick, R. L.., Berlin, J. S., Fishkind, A., and Zeller, S. (2008). Emergency Psychiatry: Principles and Practice. Canada: Lippincott Williams and Wilkins. Holmes, D., Rudge, T., and Perron, A. (2013). (Re)Thinking Violence in Health Care Settings: A Critical Approach. Burlington, USA: Ashgate Publishing, Ltd. Leather, P. (1999). Work-Related Violence: Assessment and Intervention. New York, NY: Routledge. Shepherd, J. (2001) Violence in Health Care Understanding, Preventing and Surviving Violence: A Practical Guide for Health Professionals. Oxford: Oxford University press. Wykes, T. (1994). Violence and health care professionals. London: Chapman & Hall. Read More