Crisis Prevention Training for Patient Care Techs and Observation Assistants

Abstract

Disruptive behaviors in healthcare threaten the safety and well-being of patients and staff. Although disruptive behaviors have been tolerated in the past, pressure to address and decrease risk of injury has generated increase interest prompting institutions to take action. Disruptive behavior compromises not only patient safety but also patient outcomes (Lorenzetti, Mitch-Jacques, Donovan,

Cottrell & Buck, 2013). Interventions to address safety concerns include providing staff education to empower reporting, and learn interventions to prevent injury. The author will design a class for observation assistants and patient care techs that face personal safety risks. The class designed will create a curriculum which includes objectives, strategies, learning resources that will keep healthcare workers safe and free from injury. Crisis Prevention Training for Patient Care Techs and Observation Assistants

Everyday patients are treated and cared for without incidents in hospital settings. The complicated issues involving our economy, everyday life challenges, and diverse health diseases such as dementia, and alcohol abuse has compounded an individual’s stress level.

These factors increase the likelihood of an outburst, thus, placing patients and healthcare workers at risk. The article, To err is

Human: Building a Safer Health System (Kohn, Corrigan & Donaldson, 1999), reported an increased number of incidences jeopardizing the safety of patients and healthcare workers. Longo (2010) reports that unsafe incidences has led to patient and staff injury, prolonged hospital stays, claims of disability and even loss of life. These factors can affect patient safety.

In certain circumstances, the tendency is to blame patients for risky behavior and healthcare workers for errors in decision-making

(Nath & Marcus, 2006). However, certain diseases are difficult to control (Alzheimer, Dementia, Brain injury), human behavior is unpredictable (Mentally ill and intoxicated patients) and healthcare workers still need to care for all patient population. The focus on strategies targeting education for the workforce group with the least training yet the most interaction with potentially disruptive patients is necessary. The inclusion of attention in understanding how factors contribute to safety incidences and creation of education focused on practical application of techniques in healthcare settings can reduce risk of injury (CPI, 2013). Empowerment of healthcare providers impacts the rate of patient safety incidences on inpatient units (Druss, 2007).

Institution Philosophy: Northwest Community Hospital (NCH) exists to improve the health of the communities we serve and meet individual’s healthcare needs. NCH’s vision is to be known for our focus in providing a comprehensive, patient-centered system of care that surpasses excellence in quality, convenience and service. Cultural value on patient focuses in establishing close connection with patients to maintain health, safety and well-being of individuals (NCH, 2013).

The program is designed to address identified issues in clinical care to promote patient safety. The purpose of the program is to heighten awareness and provide skills to prevent and minimize injury for the observation assistants. The program complies with the legislative mandates and regulatory and accreditation standards set by the Joint Commission (Longo, 2010). The program minimizes the institution’s exposure to liability. Furthermore, the training promotes the NCH vision of providing safety and security of the staff and patients.

Program goal:

The crisis intervention training is designed to teach best practice and evidence based principles in managing disruptive behaviors and difficult situations in the workplace (CPI, 2013). OA and PCT’s will learn how to identify at-risk individuals and families and utilize verbal and non-verbal techniques to diffuse hostile or belligerent behavior in the workplace. The participants will self-examine reaction to a crisis situation and learn skills to control fears and anxiety and avoid injury when dealing with difficult situations. The program is created to address workplace safety, positive communication skills and early intervention through recognition of signs of escalation. Needs assessment:

Lack of appropriate training and poor communication between patient, healthcare providers and families is a contributing factor is linked to safety incidences (Health Canada, 2007). In general, improvement in communication is associated with improvement in safety (Druss, 2007). The Northwest Community Hospital’s (NCH) Safety Committee and Employee Health Department (2013) reports a 3% increase of injuries from Mr. Strong events with forty percent (40%) of the injuries involve Patient Care Techs (PCT) and ten percent (10%) are Observation Assistants (OA). NCH has a Mr. Strong policy, used to summon security to support staff in managing escalating patients and difficult incidents that threatens the safety of staff, patients and visitors. Mr. Strong request are up by 5% compared to 1-2 % in previous years. Mr. Strong post-vention survey reveals an increasing dementia population. The two highest patient populations in Mr. Strong incidents are the elderly (50%), mental health diagnosis (18%), alcohol related (12%) and the rest are related to disgruntled families and other issues.

Crisis Prevention Intervention Programs for nurses, security, mental health staff and Emergency Department personnel are offered at

NCH. The Safety Committee & Violence in the Workplace Committees recommends a program targeting education for the PCT and

OA groups. In addition, Survey of PCT and OA reveal that 60 % value their safety as a priority in their practice (NCH, 2013).

Course description: A crisis is a short period of psychological disequilibrium in a person who confronts a problem that he or she cannot escape or solve with his or her current problem solving skills (Banerjee, Daly, Armstrong, Armstrong, La France, & Szebehely,

2008). This course explores the nature of a crisis including: what makes a situation a crisis, preventing crisis, common problems, and problem solving plans. Crisis prevention training focuses on prevention and offers proven strategies for safely defusing anxious, hostile, or violent behavior at the earliest possible stage. Learn to organize your thinking about how behavior escalates and how to respond appropriately during moments of chaos. Build on content from the Introductory Seminar by reinforcing preventive techniques and practicing the principles of non-harmful physical intervention.

Target Audience: Current and new Patient Care Technicians (PCT) and Observation Assistants (Sitters, OA) at Northwest

Community Hospital

Course learning objectives

Course objective must be written at the appropriate level of the learning domain (Billings & Halstead, 2012).

 After viewing the computer-based training, the Patient Care Technicians (PCT) and Observation Assistants (sitters, OA) will

be able to write down 3 crisis reactions and 3 triggers (Cognitive)

 After viewing the computer-based training, the Patient Care Technician (PCT) and Observation Assistants (sitters, OA) will be

able to list three (3) symptoms of stress and list six stages of the stress cycle (Cognitive)

 After viewing the computer-based training and role playing, the Patient Care Technicians (PCT) and Observation Assistants

(sitters, OA) will be able to demonstrate (1) action plan to prevent crisis (Psychomotor)  After viewing the computer-based training, the Patient Care Technicians (PCT) and Observation Assistants (sitters, OA) will

be able to list 2 key aspects of a good crisis intervention plan (Cognitive)

 After viewing the computer-based training and role playing, the Patient Care Technicians (PCT) and Observation assistants

(sitters, OA) will be able to Apply techniques of defusing situations, including physical safety precaution (Cognitive, Affective

and Psychomotor)

Student Learning Objectives:

Learning objectives should be specific, measurable and attainable (Billings & Halstead, 2012). Objectives are distinguished between the elements of knowledge, attitudes and skills. The interaction between the skill, knowledge and attitude is necessary and just as equally valuable (Govaerts, 2008).

 After viewing the PowerPoint presentation and lecture on day one (1), Patient Care Technicians (PCT) and Observation

Assistants (sitters, OA) will be able to identify and list three signs of stress and match responses to stressful situations

(Cognitive) in a written exam.

 After viewing the computer-based training and role playing on day two (2), Patient Care Technicians (PCT) and Observation

Assistants (sitters, OA) will be able to discuss and verbalize three Do’s and Don’ts in defusing a situation (Cognitive) in a

small group  After sharing, discussion and analysis of case studies and viewing patient situation vignettes in the training session, the OAs &

PCTs will identify potentials for injury from two (2) short vignettes and write down two (2) ways to prevent injury after each

vignette. (Cognitive and Affective)

 After the lecture on techniques of safe distance, OAs and PCTs will demonstrate techniques of safe distance; perform how to

escape certain holds, offering constructive criticism on staff performance during application and demonstration of safety

precaution (Cognitive & Psychomotor).

 After crisis debriefing lecture in Part III, OAs and PCTs will participate in debriefing session ( psychomotor and affective),

and write down three (3)steps in reporting and two (2) resources and complete the quiz (Cognitive)

 After viewing the computer-based training and role playing on day three (3), Patient Care Technicians (PCT) and Observation

Assistants (sitters, OA) will be able to verbalize 3 ways of communicating using learned scripts in situations (Cognitive and

Psychomotor).

Course content & outline:

DAY ONE- HOUR ONE DAY ONE- HOUR DAY TWO- HOUR ONE DAY TWO- HOUR TWO TWO 1. PowerPoint of course 1. Intervention Identification of resources: 1. Role Playing: overview Tools: 1. List of hospital resources:  Situational  Injury statistics  Defusing Do’s  Unit: Charge nurse, Application  Course content and Don’ts Manager, Director  Physical  Objectives  Members of VIWP Responses  Strategies 2. Preventing  Employee health  Verbal responses  Outcome Crisis  HR  Feedback from  Teaching Tools 2. Reporting process participants on 2. Understanding People  Occurrence report online role playing in Crisis 3. Case study  Employee Injury report  Video of patient in crisis Review 3. Review of policy 2. Take-away  Examples of crisis  Violence in the workplace situations  Employee Health Policy 3. Evaluation of  Reasons why crisis program occurs  Stages of a Crisis

3. The Stress Cycle  Identify signs of stress  Ways to address stress  How to handle stress

Learning Resource: Learning Resource: Learning Resource: Learning Resources:  Course outline handout  Do’s and Don’ts –  List of resources  Evaluation of  Short video of patient Defusing  Algorithm of how to escalate program handout undergoing stressful technique issues situation- 10 minute  Scripting on what  List of hospital resources  Stress cycle handout to say in certain handout  Signs of stress handout situations  Policy on Violence in the  Quiz booklet including  CPI video work place handout Part 1- 4  CBT on online reporting  How to fill out employee injury report

Participants course objectives for each day DAY ONE- HOUR ONE DAY ONE- HOUR TWO DAY TWO- HOUR ONE DAY TWO- HOUR TWO Participant will be able to: Participant will be able to: Participant will be able to: Participant will be able to:  Identify the stages of  Identify 3 Do’s in  Demonstrate online  Demonstrate CPI crisis defusing a situation occurrence reporting techniques  Verbalize the stages of  Identify 3 Don’ts in  Demonstrate filling out  Critique responses to stress cycle defusing situation employee form situations  Identify two  Verbalize 3 ways of  Verbalize process of  Learn from role playing precipitating factors to preventing a crisis reporting incidents stress situation  Pass a short quiz about  Name three signs of  Discuss real life crisis policy and reporting stress experiences  Identify ways of  Analyze case study and addressing issue identify opportunities  Verbalize scripting or for improvement verbal response to situations

Method of Instruction:

Keeping in mind the diversity of the audience not only in experience but also in age and ethnicity, a variety of media and learning style strategies will be used. Awareness of the needs of visual, tactile and auditory learner needs is important in ensuring the content, learning strategies and learning domain matches to be effective (Billings & Halstead, 2012). A video and vignette on patient in a stressful situations and demonstration of crisis prevention techniques on de-escalation and physical safety from CPI will attract visual learners. The use of PowerPoint presentation which includes the purpose, needs assessment and the agenda of the class and presented in an organize fashion the major points of the class gives audiences an overview of the content. The use of visual aids and bullets of the content can allow the main points of the class highlighted for easy recollection. Handouts on the Stages of Crisis and Stress cycle along with NCH Violence in the Workplace Policy, employee health Policy and tutorial on online occurrence reporting can provide resource for tactile staff for future reference. Content of de-escalation techniques and communication can be delivered in two forms: the handout and demonstrated in the role playing in the classroom of techniques of safe stance and how to release out of a hold when grabbed by a distressed individual. Role playing is a vehicle to explore emotions, gain insight into one’s values, develop problem solving skill, and explore new outlook into the situation (Billings & Halstead, 2012). According to Amerson (2006), an intrapersonal learner works well observing the actions of others, is usually self-reflective. Physical demonstration assesses the application of the understood concepts. Finally, case study presentations allow the participants to connect the theory to actual situations for easy assimilation to their practice (Billings & Halstead, 2012). Adult social learners can analyze and solve performance-based questions and improve their abilities unlike newer staff that would prefer structures content (Noble, Miller & Heckman, 2008). To conclude, a recap of take-away points is helpful to close the session. Creating a positive learning environment comes from understanding what is presented and also respecting and valuing everyone's contribution to the environment (Billings & Halstead, 2012).

Program Outcomes

Program outcomes are indicators in holding participants accountable for the end result (Peteet, J. R., Meyer, F. L., & Miovic, M. K.

(2011). Decrease PCT and OA injury related to handling difficult patients patients

Empower PCT and OA to educate families by sharing knowledge and skills in handling situations

Share safety tools with other care givers

Conclusion:

A disruptive behavior in an atmosphere that requires individual’s attention to maintain safety is dangerous and should be addressed.

Injury caused by disruptive behaviors can be prevented (Peteet, Meyer, & Miovic, 2011). Addressing this issue requires a collaborative effort and accountability from healthcare workers (Wachter & Pronovost, 2009). Empowering staff with education to heighten awareness of interventions and techniques available to prevent injury is important. Designing an education curriculum requires awareness of the needs of the intended audience. Knowing the needs of the audience can ensure that the learning styles and learning strategies matches the resources provided. The use of creative teaching techniques to maximize interest and learning is the role of educators (Saxton, 2012). Sensitivity to the needs of the audience can ensure success in learning. References

Amerson, R. (2006). Energizing the nursing lecture: application of the theory of multiple intelligence learning. Nursing Education

Perspectives, 27(4), 194-196.

Banerjee, A., Daly, T., Armstrong, H., Armstrong, P., La France, S., & Szebehely, M. (2008). Out of Control: Violence against

personal support worker in long term care. Retrieved from http://www.yorku.ca/mediar/special/out_of_control_english.pdf

Billings, D., & Halstead, J. (2012). Teaching in nursing: a guide for faculty (4th ed.). St. Louis, Missouri: Elsevier.

CPI Institute (2013). Non-violent Crisis intervention. Retrieved from http://www.crisisprevention.com/Specialties/Nonviolent-Crisis-

Intervention

Druss, B. (2007). EMB and Quality Improvement research. Psychiatric Services. 58(10). doi: 10.1176/appi.ps.58.10.125

Govaerts, M.J. (2008). Educational competencies or education for professional competence? Medical Education, 42 (3):234–6. doi:

10.1111/j.1365-2923.2007.03001.x

Health Canada. (2007).The working conditions of nurses: Confronting the challenges. Strengthening the Policy-Research Connection,

13. 1-46. Retrieved from http://www.hc-sc.ca/sr-sr/alt_formats/hpb-dgps/pdf/pubs/hpr-rps/bull/2007-nurse-infirmieres-eng.pdf

Kohn, L. T., Corrigan, J. M. & Donaldson, M. S. (1999). To Err is Human: Building a safer health system. Institute of Medicine.

National Academy Press. Retrieved from http://www.providersedge.com/ehdocs/ehr_articles/To_Err_Is_Human_

%20Building_a_Safer_Health_System-exec_summary.pdf Longo, J. (2010). Combating disruptive behaviors: Strategies to promote a healthy work environment. Online Journal of Issues In

Nursing, 15(1), 3.

Lorenzetti, R.C., Mitch-Jacques, C.H., Donovan, C., Cottrell, S., & Buck, J. (2013). Managing difficult encounters: Understanding

physician, patient, and situational factors. American family Physicians, 87(6).

Nath, S.B., & Marcus, S.C. (2006). Medical errors in psychiatry. Harvard Review of Psychiatry, Harv Rev Psychiatry, 14(4).204-11.

Noble, K., Miller, S., & Heckman, J. (2008). The cognitive style of nursing students: educational implications for teaching and

learning. Journal of Nursing Education, 47(6), 245-253. doi:http://dx.doi.org.library.gcu.edu:2048/10.3928/01484834-

20080601-08

Northwest Community Hospital (NCH). (2013). Safety Committee Report January 2013. Retrieved from www://http://nch.org.

Peteet, J. R., Meyer, F. L., & Miovic, M. K. (2011). Possibly Impossible Patients: Management of Difficult Behavior in Oncology

Outpatients. Journal of Oncology Practice, 7(4), 242-246. doi:10.1200/JOP.2010.000122

Saxton, R. (2012). Communication skills training to address disruptive physician behavior. AORN Journal, 95(5), 602-611.

Stewart, K., Wyatt, R., & Conway, J. (2011). Unprofessional behaviour and patient safety. International Journal Of Clinical

Leadership, 17(2), 93-101. Retrieved from http://ehis.ebscohost.com.library.gcu.edu:2048/eds/pdfviewer/pdfviewer?

sid=1aeb7bc7-8e54-45cf-9523-46352b6c840e%40sessionmgr11&vid=15&hid=7

Tanner, K. & Allen, D. (2004). Approaches to Biology Teaching and Learning: Learning Styles and the Problem of Instructional

Selection—Engaging All Students in Science Courses. Cell Biology Education. 3(4): 197–201. doi: 10.1187/cbe.04-07-0050 Wachter, R.M. & Pronovost, P.J. (2009). Balancing ‘‘no blame’’ with accountability in patient safety. New England Journal of

Medicine, 361(14). 1401–1406.