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WORKPLACE VIOLENCE RN Captstone Students: Kaitlin Olson-Adult Health Riika Quernemoen- Emergency Department
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WORKPLACE VIOLENCE

RN Captstone Students:Kaitlin Olson-Adult Health Riika Quernemoen-Emergency Department

OBJECTIVES Define violence and provide specific examples of the different types.

Describe ways to prevent, identify, and respond to violence.

Reinforce the types of resources available to staff when intervention is essential.

Describe the importance of debriefing.

Understand the future of Rice Memorial regarding the issue of violence.

STATISTICS

•Healthcare workers make up an estimated 11.5% of the total workforce and account for the majority of workplace violence injuries

•An estimated 80% of nurses report having been assaulted while on duty

•Every week, 8-13% of Emergency Room nurses are physically assaulted on the job

DEFINITION OF VIOLENCE

According to Rice Memorial Hospital, violence is defined as:An intentional act that includes physical force such as slapping, punching kicking and biting; use of an object as a weapon; aggressive behavior such as spitting, scratching and pinching; or a verbal threat involving no physical contact. Any act of aggression, harassment, violence or intimidation either physical or non-physical by any staff, patient, volunteer, or member of the public is not acceptable.

PREVENTION

•Greet patients with a smile

•Do not cross arms

•Do not interrupt patient

•Use patient’s name often

•Keep patient informed

•Be available to patient

•Praise patient for what is done correctly

•Sit near patient but keep an arms with away

•Do not type or write while patient is explaining main concern

•Use touch only as appropriate

•Exit Route

REASONS FOR DISRUPTIVE BEHAVIOR

•Crowding and long waits

•Sense of entitlement

•Lack of societal controls

• Impaired patients and family members

•Anxiety provoking situations

IDENTIFICATIONIf patient is known to be potentially violent:• Place aggression magnet outside room

• Identify interventions to reduce

• Add FYI flag and communication note to alert team members

HOW TO RESPONDAlways keep body language non-threatening

•Eye level with patient

•Eye Contact

•Hands Down

•Palms Open

•Feet shoulder width apart

•Lean in

•Nod head

HOW TO RESPOND

Patient behavior: Challenging Authority

De-escalation Response• Ignore the question

• Let patient vent

• Respond with: “I can see you are angry”

Patient behavior:Argumentative

De-escalation Response• Specifically identify unacceptable behavior

• Explain why it is unacceptable

• Explain consequences

• “I feel threatened when by your screaming at me. I am asking you to stop that behavior because it is inappropriate.”

HOW TO RESPONDPatient Behavior:

Threatening of safetyDe-escalation Response

• Stand 2 to 3 feet away

• Stand at an angle with an open stance

• Remove any potentially dangerous items

• Always stand between patient and the exit

• Validate patient’s feelings• “I can see you are angry”

• “I know you are upset”

• Use the patient’s name often

• Call Security (ext. 4754)

• Activate Code 6 or Code 600 as appropriate

CODE 6 Dial 666

State “Code 6” with specific location

Initial call: page “code 6” throughout the hospital and contact paramedics on duty by pager (day shift only)

Second call: page “code 6, page 2” contact on-call paramedics by pager and the police dispatcher

CODE 6 RESPONDERS

Day Shift 1 Security officer

1 nursing support tech

1 staff member from Rice Institute Inpatient

1 staff member from Emergency Services Department

Evening Shift 1 Security officer

1 Nursing support tech

1 staff member from Rice Institute Inpatient

1 staff member from Emergency Services Department

1 float pool PCA

Night Shift• 1 Security Officer• 1 Nursing Supervisor• 1 Nursing Support Technician• 1 Staff member from Rice

Institute Inpatient• 1 Staff member from Emergency

Services Department

CODE 6

The first person to the scene will become the leader. No intervention should be attempted until the entire team is present. If enough team members to not respond, a second call should be made to initiate a second page. At the second page, any trained individual should respond.

All staff assigned to the Code Response team will be provided with therapeutic intervention training by a certified instructor prior to responding to any codes.

CODE 600 Any situation where an individual has access to a potentially harmful object or weapon.

Dial 666 and state “Code 600” with specific location

Notify the police switchboard, call 4268

Security officers and police will be in charge of all Code 600 situations. They will follow their own policies and procedures to resolve the situation.

Other members of the code response team must:

Respond to the location

Evacuate area

Secure area

Assist police to location

CODE 600 RESPONDERS

Day Shift

Evening Shift

2 security officers

1 nursing support technician

1 staff member from Rice Institute Inpatient

1 staff member from Emergency Services Department

1 Security officer

1 Nursing support tech

1 staff member from Rice Institute Inpatient

1 staff member from Emergency Services Department

1 float pool PCA

Night Shift• 1 Security Office • 1 Nursing Supervisor• 1 Nursing Support Technician• 1 X-Ray staff• 1 Staff member from Rice Institute Inpatient• 1 Staff member from Emergency Services Department

HOW TO REPORT

•Any violent situation should be reported immediately• At least within 24 hours

•Reports may remain anonymous

•Violence directed at an employee from a patient or visitor should be reported as an Employee Event in RL Solutions

•Violence directed at an employee from another employee should be reported in Professional Conduct in RL Solutions

•Violence that does not involve an employee should be reported under Safety/Security in RL Solutions

INJURY

If an employee is injured on the job, employee must: Report to ER if needed

Complete online safety report

Notify supervisor

Supervisor will investigate incident

Notify bio-med if clinical equipment is involved (ext. 4107)

Notify maintenance if incident involved equipment/building or grounds (ext. 4720)

Inform Employee Health Nurse of all medical appointments and treatments as a result of the situation (ext. 4060)

EMPLOYEE HEALTH

•Employee Health will: Determine what happened

What was done

How it was done

Determine inconsistencies

Determine voids

Determine possible causes

Determine if actions taken were appropriate

Report any employee lost time due to incident to Human Resources within 24 hours

Coordinate with workers comp for missed time and restrictions

Employee Health nurse summarizes and reports to the Environmental Safety committee and Safe handling committee

Environmental safety committee will:

Take action to prevent future occurrences

Review employee safety reports every other month including trend and analysis

LETS HAVE A LITTLE FUN..

INCIDENT #1

Carol is a new nurse working in the medical-surgical unit at Rice Memorial. She is an outstanding nurse-very through, attentive to the needs of her patients, and a great team player. One day, Carol is asked by Sarah, a co-worker, to document she had provided care to patients not assigned to her. Carol declined. The weeks following this incident, Sarah belittles Carol in front of other staff and patients and tells her she should have chosen another career. Sarah continues to speak to Carol in a condescending manner, uses demeaning language, and completely ignores Carol.

What should Carol do?

INCIDENT #2

Susie is hard-working and caring nurse that has worked in the Emergency Department for 10 years. She has been a victim of several forms of workplace violence has always thought violence was part of the job she needed to deal with. While working an evening shift, Susie got a patient with lower back pain. While waiting for the X-ray results, her patient starts getting restless and demanding more pain medication. Susie calmly explains to the patient that he received the maximum dosage of prescribed pain medication and that his next available dose is in an hour. The patient swears at Susie and tells her she is not fulfilling her job as a nurse.

What should Susie do?

INCIDENT #3

Kelly is a float pool nurse who floated to the Emergency Department one Saturday evening. Kelly is assigned to take care for patient who is experiencing a mental health crisis. The patient is with his significant other in the room and Kelly starts gathering a patient history. While the patient is answering the history questions, the patients significant other denies the patients information, stating he is lying and not telling the truth. Suddenly, the patient hits the significant other, pushes Kelly to the floor and leaves the ED.

What should Kelly do?

DEBRIEFING-IS IT IMPORTANT?

Study that surveyed nurses found that 84% of nurses thought debriefing after a stressful incident was considered "very important"

Physiological debriefing helps reduce potential stress responses among staff

Reinforce social support among people who are healthy but who experience acute or abnormal stress reactions to traumatic events

Debriefing usually occurs within 24 hours of the incident should be led by a mental health professional or those trained in the debriefing process

RICE MEMORIAL- WHAT DOES THE FUTURE HOLD?

Broset Violence Checklist- May 2015 tool that can be used by hospital staff (nurses in particular) to predict an acute violence among psychiatric inpatients.

There will also be a system in place that indicates which patients may have more tendencies compared to others

Magnet on patient doorways Alert staff that may not know the patient

REFERENCEShttp://www.psychiatrictimes.com/articles/assessing-violence-risk-psychiatric-inpatients-useful-tools

Rice Memorial Hospital Administration (2015). Disruptive behavior (P & P No. MA-05).

Rice Memorial Hospital Human Resources (2014). Employee safety event reporting (P&P No. RMH-514).

Rice Memorial Hospital Human Resources (2015). Harassment, offensive behavior, and workplace violence (RMH-HR-34).

Rice Memorial Hospital Safety (2013). Code 6 (P&P No. RMH-527).

Rice Memorial Hospital Safety (2013). Code 600 (P&P No. RMH-528).

Zimmermann, P.G. (2013). Workplace violvence and disruptive behavior. Sheehy’s Manual of Emergency Care (11-16). DesPlains,IL: Elsevier.


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