Crisis Prevention and Intervention in Healthcare - Essay Example

 Crisis Prevention and Intervention in Healthcare 1. Introduction. The management of assaultive behavior in healthcare facility requires enhancing the safety of patients, healthcare professionals and visitors. This paper will discuss general and personal safety measures in the healthcare facility. 2. General safety measures for the healthcare professionals. General safety measures for health care professionals facilitate sustenance of a good working environment and prevention of assaultive behavior. The safety measures should be adjusted according to specific conditions or nature of environment that healthcare professionals work in. General safety measures consist of five elements; administration and healthcare professional support, environmental analysis, risk reduction, training and regular review (Occupational Safety and Health Administration, 2011, p. 14). 2.1. Administration and healthcare professional support. The healthcare administration together with the employees engages in a safety plan. The plan involves appointing teams of healthcare workers, employers, committees and representatives of the safety plans. The healthcare professionals who are expertise in crisis management should be involved. The representation should be fair in terms of department and shifts. Tasks should be allocated to the different stakeholders who may include: employer’s representative, healthcare professionals, security representatives and administrators. Healthcare professionals able to deal with head injury, substance abuse, psychiatry and dementia should be advised to assist in case there is need. A working structure and applicable policies can be designed. The policies should represent diverse needs of the departments and provide procedures to be used in case of crisis. The safety plan should take into consideration the physical, psychological and emotional safety and health of the healthcare professionals. A balance between the safety and health needs of the healthcare professional, patient or visitor should be recommended. Representatives, experts, committees and teams given tasks or responsibility should inquire and understand their responsibility. After getting understanding, they can be authorized and be given resources that will enable them provide administration and support. Representatives, experts, committees and teams should demonstrate accountability. In the case of assault and crisis, the involved parties can be given counseling and treatment. Those who have undergone assault can share their experience. All the stakeholders can give their support in the enactment of the recommended policies. The healthcare professionals ought to be committed to comply with the policies and give feedback. Suggestions on safety and complains should be given the appropriate authority. Cases of crisis should be reported in time and appropriately. The healthcare professionals should be willing to participate in teams, committees or as representatives as well as education programs. 2.2. Environmental analysis. Environmental analysis will consist of an assessment where potential risks are identified. Procedures, threats and factors that motivate crisis are pointed out. The analysis will take into considerations incidents and history of assaultive behavior in the same and other healthcare facilities. The information will be retrieved from compensation claims and patient records. Environmental analysis in the workplace focuses on records, surveys and security details. The records will give details of occurrence of incidents in various departments, healthcare professionals by title, time, activities in progress and frequency of occurrence. The incidents are analyzed and compared with similar reports from other healthcare facilities. Surveys taken on healthcare professionals can be a source of information. The surveys can assist in determining procedures that lead to risks, inadequate measures, inadequate resources, failures, policies and activities that need to be changed. Characteristics of those involved in the assaultive behavior and recommendations are considered. Risky procedures and locations should be identified. Some of the factors may involve physical conditions like the layout of the hospital facility. Isolated locations, lack of communication, security problems and inadequate light that contribute to risk. 2.3. Risk reduction. Risk can be reduced by adopting measures, procedures and administrative work that will assist in preventing and controlling the occurrence of assaultive behavior in the health facility. The administration can make physical changes to the environment. The changes may consist of adequate lighting in dark rooms and increase space where necessary. There should be light both inside and outside the healthcare facility. Alarm system and panic buttons can be installed so that one can get assistance. The phones and radio systems should be working at all times and reliable. The security should be enhanced by using metal detectors so that dangerous weapons such as knives and guns can be detected before they are allowed in the healthcare facility. Places that are identified as high risk can be given video surveillance round the clock. Curved mirrors can be placed in concealed locations and corridor intersections. Areas that are prone to risks include the triage, nurse station, reception and admitting areas. Deep service counters, bullet proof counters and shatter proof glass can be used. A separate room can be used as a safe room when attending to emergencies. For patients who want to escape, high ceiling rooms can be provided. Rooms used for counseling should have alternative exits. Rooms used for treatment or counseling should be locked. The waiting room can be made comfortable with chairs and reading materials. The furniture should be placed properly to avoid falls. The number of furniture in the consultation room and crisis management room should be limited. The furniture should not be fixed or with sharp ends. Avoid placing vases, pictures or trays where they are visible or in high risk areas. The healthcare professionals will require different washrooms from the patients installed with locks. Broken furniture, bulbs, windows and locks should be replaced. Policies should clearly state that assaultive behavior is not acceptable in the hospital. In the case of crisis, a report should be written and the police can be involved. Advice should be given to healthcare professionals on the procedure of reporting and claim after a crisis. Train and place emergency teams where they can assist in case assaultive behavior. Waiting time can be reduced and patients receive timely information when in the waiting room or undergoing a procedure. Visitors to patients should be restricted especially if there is a history of assault. Time to provide meals and attend to emergency should be observed. Information on hospitalized patients should be restricted. Patients including psychiatric patients who are admitted should be supervised. Additionally, the pharmacy should be a controlled area (National Collaborating Centre for Nursing and Supportive Care, 2005, p. 1). Bartholomew (2006, p. 23) adds that, healthcare professionals should be encouraged to work with partners where there is emergency or at night. An evacuation plan should be designed and presented. Patients with assaultive behavior can treated in an open area. After an assaultive incidence the healthcare professionals should receive assistance. 2.4. Training. Mason and Chandley (1999, p. 65) note that, training provides understanding on assaultive behavior, and enables the healthcare professionals to prevent and handle crisis appropriately. Training educates healthcare professional on policies concerning assaultive behavior in the healthcare facility. Additionally, the healthcare professionals will be able to recognize; risks, escalating behavior, warning signs, prevention methods and what to do in the case of a crisis. They will know where to report and how to report an unpleasant incident. Additional information about culture diversity, personalities and various ailments that contribute to assaultive behavior can be shared (Flannery 1998, p. 91). Moreover, they will know how to complain, where to complain and how to get compensation. Training should be given to healthcare professionals, managers, supervisors and security workers. 2.5. Regular review. Record of assaultive behavior should be made. The records should be analyzed to give information on risk factors and patterns of assault. An analysis will provide a basis for identifying gaps that can be made to manage assaultive behavior in the healthcare facility. Important items for record include; type of injury, number of injury, assault, threat, accidents, type of crisis, response to crisis, persons involved, identified problem and solutions. A regular evaluation should be conducted to identify areas that need change and check if policies are being observed. 3. Personal safety measures. Healthcare professionals should assume responsibility for their individual safety. Healthcare professionals need to protect self from aggressive behavior directed by patients, visitors and other healthcare professionals. This can be achieved through: education and training, self defense mechanisms, de-escalating violence, being alert and practicing self care. 3.1. Education and training. Healthcare professionals can engage in ongoing training for their personal benefit as Linsley (2006, p. 32) recommends. The employee will assist in raising awareness of the environment, control in crisis and boost individual confidence. Employees will learn safety places and techniques for conducting self at work. Training will educate the healthcare professionals on the techniques for de-escalating violence. Learning will enable the healthcare professionals recognized factors contributing to agitation and how to protect self. Bibby (1995, p. 56) found out that, education gives the healthcare professional ability to predict behavior and adjust to being neutral to diffuse anger. Likewise, communication skills such as listening and responding appropriately will be acquired. Talk slowly with a low calm and audible voice. The healthcare professionals should cooperate with the organization when asked to join in programs. The policies concerning the working environment should be followed. All incidents should be reported to the appropriate authority so that appropriate measures are made to prevent other assaultive incidents. The healthcare facility puts a lot of effort to prevent and manage crisis. Therefore, reporting to the healthcare institution facilitates development of appropriate strategies against assaultive behavior. Strategies will enable the professionals prevent possible violent attacks. Healthcare professionals should commit self to read and analyze reports carefully to note patients with aggressive behavior. 3.2. Self defense mechanisms. A professional healthcare worker can practice safety by adapting appropriated behavior and choosing to defend self in case of a physical assault. When at risk, they can call for assistance, keep the way clear and escape if possible. Practice patience and encourage conversation. Avoid showing the aggressive person the back, try to chock them from the back and get away. Another ways of protecting self is by chocking the aggressor from the front if they attack from the front. If the person in crisis grabs the arm, try to push the arms downwards then twist towards the escape route. Personal safety measures require a healthcare professional to avoid working in isolation where there are patients with assaultive behavior. Work where others can see you. Avoid entering where people with assaultive behavior can lock you inside. 3.3. Ways of de-escalating violence. For personal protection, a healthcare professional can bargain and apply conflict resolution when facing a crisis. Conversation should be conducted in a calmly with the worker listening to the person in crisis. Confrontation should be avoided and keep away from persistent contact of the eyes. It is wise to stay away from interacting and request for audience. Showing empathy, understanding and showing concern to the assaultive person can reduce tension. Healthcare professionals can use moderate tone, calm voice and correct rhythm when communicating. Redirecting the topic can be another significant method of de-escalating assaultive behavior. Refrain from responding to threats with other threats since it can activate violence. Avoid commanding and when given a chance acknowledge their feelings. Evade walking close, jumping, touching or moving closely to the person with signs of aggression. Avoid touching objects that can become a weapon. Communicate when you want to move or touch them by making them understand. The healthcare professional can request for permission before dressing a wound, changing beddings, taking temperature or recording blood pressure, when conducting medical procedures (Scott et al 2001, p. 61). 3.4. Be alert. The healthcare professional should take into consideration taking precaution when a threat of aggressiveness is imminent. They should enact a safety plan without delay if a patient is assaultive. If the healthcare professionals are threatened, they should avoid using suggestive body language and words that may reveal their feelings to the patient. If the patients detect their feelings they may withhold information, feel threatened and react negatively to the healthcare professional instructions (Hamilton 2011, p. 1). According to Hughes (2008, p. 39), the healthcare professionals should be able to recognize risks and signs that can lead to aggressive behavior. The healthcare professional’s should recognize signs of assaultive behavior. When a person shows frustration, anger and physical gestures showing aggression they can be viewed as a threat. Recognize patients with conditions that cause aggression such as mental illness and head injury. Keep distance if the person with sign of aggression is under the influence of drugs or alcohol and steer clear of things that could provoke them. Remain alert at all time because every situation is unique and should be handled depending on circumstances. Healthcare professionals should analyze situation and patient before beginning to attend to a patient. Exercise vigilance when dealing with the patient. If the person is capable of becoming violent, ask for company. Ensure there is an open exit, and be sure no object or patient is blocking the exit in case you might need it. The healthcare professional should call for help right away if they cannot exit. Watch for objects that can be thrown or used as a weapon. Keep distances to avoid being hit on the head suppose the person in crisis holds an object. Stand away from the patient’s fists. The healthcare professional should not allow the person in crisis push them to a corner. Keep keys away from display. Keys should be hidden because they can provide access to other rooms or aid in escaping. In case the threat on the healthcare professional is persistent, it may be necessary to move their working station and request for security. A time off may be considered if the life of the healthcare worker is in danger. 3.5. Self-care for professional healthcare The professional healthcare workers may become busy and fail to take care of their needs which can contribute to assaultive behavior. With the knowledge of their working environment and challenges, healthcare workers should take care of their emotional, physical and psychological needs. The healthcare professionals should regulate the number of hours in a day so that they are not overworked. After work they should rest and get enough sleep. Evade situation that can cause burnout and fatigue. Healthcare professionals can manage stress by performing hypnosis techniques. The healthcare professionals should take a balanced diet and have regular physical exercises. They can maintain social relations with family and friends for social support. Healthcare professionals should maintain their spiritual relations and stay proactive (National Collaborating Centre for Nursing and Supportive Care, 2005 p. 1). 4. Conclusion. General and personal safety measures facilitate prevention and intervention of aggressive behavior. General safety measures require the administration and healthcare professionals to collaborate in the development plan of policies and intervention of violent behavior. After developing a plan, the selected teams, commissioners and representatives analyze the environment to identify the risk factors. The healthcare facility together with professionals commits themselves in reducing risks that could contribute to crisis. Healthcare employees are trained on the safety measures, warning signs and intervention. Once the plan is implemented it is reviewed regularly and adjusted accordingly. General safety measures require improvement of the physical environment, improved working relations with patients and other healthcare employees, participation in implementation plan and reporting incidents correctly to the right authorities. Personal safety measures encourage healthcare professionals to ensure they get training and competence in assaultive behavior. They can protect themselves using ways of de-escalating violence and self defense mechanisms in case of assault. Healthcare professionals should remain alert to sign of assaultive behavior as well as practice self care. Reference List Bartholomew, K. (2006). Ending Nurse-To-Nurse Hostility Why Nurses Eat Their Young and Each Other. Danvers: HCPro. Bibby, P. (1995). Personal Safety for Health Care Workers (Suzy Lamplugh Trust) Farnham: Ashgate Publishing Limited. Flannery, R. (1998). Violence in the Workplace Managing Assaultive Behavior. New York: Crossroad publishing company. Hamilton, P. M. (2011). Psychiatric Emergencies: Caring for People in Crisis. Wild Iris Medical Education Inc. Hughes, R. (2008). Patient safety and quality: an evidence based Handbook for nurses. Agency for Healthcare Research & Quality. Linsley, P. (2006). Violence and Aggression in the Workplace: A Practical Guide for All Healthcare Staff. Abingdon: Radcliffe Publishing. Mason T & Chandley M. (1999). Management of violence and aggression. Philadelphia: Churchill Livingstone. National Collaborating Centre for Nursing and Supportive Care. (2005)Violence: The Short- Term Management of Disturbed/Violent Behaviour in Psychiatric In-Patient Settings and Emergency Departments. London: National Institute for Clinical Excellence. Occupational Safety and Health Administration (2011). Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers.  United States: U.S. Department of Labor. Scott, S., Chris, W., and Sorensen, S. (2001) Essentials of aggression management in health care. 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