Conflict Management & Safety Flashcards

1
Q

What is Conflict?

A
  • Occurs between two separate parties when they experience negative emotions to perceived disagreements
  • Has a meaning or underlying cause
  • Can occur between the nursing team, the interprofessional team, or between a client and the healthcare professional
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2
Q

Conflict in the workplace results in..

A
  • A stressful work environment
  • Job dissatisfaction or burnout
  • Low commitment to organization/ profession
  • Low team morale
  • Poor co-worker relationships
  • Diminished sense of well-being
  • Emotional exhaustion
  • Lack of trust
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3
Q

What is Escalation?

A
  • Occurs when the individual feels there is a threat to theirsafety or their own control over a situation
  • Occurs as a response tofear or a threat
  • Clients are at their most vulnerable (with little to no control)
  • Fight or flight can be activated, thinking turns off, act on instincts
  • They want to regain control over the situation
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4
Q

7 Stages of Escalation

A
  1. Calm
    • Clients baseline
  2. Trigger
    • Occurs because of unmet needs
    • Triggers can be a situation they have no control over - illness, accident, or even hunger
    • How the nurse deals with the patient during this stage determines whether client will proceed to next phases or go back to calm phase
  3. Agitation
    • Patients are using maladaptive coping mechanisms (ineffective)
    • The nurse does not actively work with the client to prevent acceleration
  4. Acceleration
    • This is where you determine if you are still able to use nonverbal behaviours, or if you have to move toward physically restraining them
  5. Peak
    • At risk of harm to themselves or others
  6. De-escalation
    • Help the client regain control of their emotions
  7. Recovery
    • Able to start engaging with the client again
      -Ask : What happened? What can we do to prevent this?
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5
Q

Risk Factors for Client Escalation: If the client is…

A
  • Under the influence of a substance or experiencing withdrawal
  • Being constrained (Eg.not permitted to smoke on the unit) or restrained (using physical or chemical restraints)
  • Fatigued
  • Overstimulated
  • Anxious/worried/confused/
    disoriented/scared
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6
Q

Risk Factors for Client Escalation: If the client HAS…

A
  • History of violent or aggressive behaviour
  • A medical and/or psychiatric condition that impairs cognition/judgment
  • A current substance use disorder or alcohol dependency
  • Difficulty communicating needs (for ex. language barrier, aphagia)
  • Ineffective coping skills
  • Lack of social support

- Each individual has their own triggers that can lead to escalation

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7
Q

Risk Factors for Client Escalation: If If a nurse or other professional….

A
  • Judges, labels or misunderstands the client
  • Uses a threatening tone or body language
  • Makes assumptions
  • Does not listen to, understand or respect a client’s values, beliefs,opinions, and/or needs
  • Does not listen to the family’s concerns
  • Does not provide sufficient health information or teaching
  • Does not reflect on the impacts of their behaviour on the client
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8
Q

Signs of Agitation

A

Non-Verbal
- Fidgeting
- Erratic movements
- Pacing
- Aggressive posturestanding over the person, raising an arm at you, puffed up chest)
- Balled up fists
- Shaking
- Entering another individual’s personal space

Verbal
- Raised voice
- Rapid speech
- High-pitched voice
- Cursing/swearing
- Speech content

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9
Q

Ways nurses prevent escalation?

A

1) Establish a THERAPEUTIC RELATIONSHIP

2) Provide client-centered care!

3) Attempt to understand clients’ needs and perspectives
- use open-ended questions

4) Acknowledge theclient’s feelings that are leading to the behaviour

5) Engage in ACTIVE LISTENING

6) Anticipate conflict

7) Create a plan of care to prevent escalation for clients who have had a history of conflict/escalation

8) Reflect on your own values and behaviours that could possibly affect the client in a negative way

9) Using risk assessment tools to identify clients that may be at risk for escalation

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10
Q

Safety Precautions for Nurses

A
  • Always know where your exits are
  • Always stand between the door and your client
  • Never stand with your back to a door
  • No hoodies, sweaters with strings, scarfs, lanyards, necklacesor anything around your neck!
  • Know your unit or organization’s protocols forsafety
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11
Q

What is De-escalation?

A
  • 1 of the most important conflict resolution strategies
  • An approach using a set of interventions and techniques that have been adopted to reduce or eliminate violence and aggression during a period of escalation
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12
Q

Benefits of De-escalation

A
  • Prevents violence
  • Avoids use of restraints
  • Reduces patient anger/frustration
  • Maintains safety of both patients and staff
  • Improves the therapeutic relationship
  • Enables patient to improve coping strategies
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13
Q

What is Self-Awareness?

A
  • Process of understanding your own beliefs, thoughts, motivations, biases, and limitations
  • How you react determines whether the situation further escalates or de-escalates

Involves Reflect on the following:
- What are your personal triggers?
- How do you know you are at your limit?
- How do you react to these triggers?
- How will you manage these reactions?

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14
Q

DO’S Of Non-Verbal Communication

A
  • Appear calm
  • Maintain appropriate eye contact
  • Maintain a neutral facial expression
  • Relaxed and alert posture
  • Minimize excessive body movements
  • Respect personal space
  • Use therapeutic touch with caution
  • Use open body language
  • Remain calm and respectful
  • Consider environmental considerations (ie. Minimizing lighting, noise, and loud conversations)
  • Keep weight evenly balanced (so you cam be agile and move quickly when situations escalate)
  • Keep hands always visible (To show that you are not hiding anything)
  • If client does not want to speak with you
    ○ The nurse can go back in 10-30 minutes once they have calmed down
    ○ The nurse can invite the into their personal space - “you can grab a chair and join me over here”
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15
Q

DONT’S Of Non-Verbal Communication

A
  • Intense or minimal eye
    contact
  • Frown
  • Smile inappropriately
  • Look “closed off”
  • Inappropriategesturing
  • Appear inattentive
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16
Q

DO’S Of Verbal Communication

A
  • Establish verbal contact
  • Engage in active listening
  • Validate emotions
  • Set clear boundaries
  • Keep sentences short and simple
  • Offering choices
  • Allow moments of silence
17
Q

DONT’S Of Verbal Communication

A
  • Avoid asking “why”
  • Excessive questioning
  • Make promises
  • Order or make commands
  • Lecturing
  • Yell at patient
18
Q

4 Verbal Communication Techniques to employ during De-escalation

A

1) Establish Verbal Contact
2) Validate
3) Setting Boundaries
4) Offering Choices

**DO NOT try and problem-solve until the person has calmed down
- Just listen and reflect on what they are saying. Continue to employ strategies to acknowledge and validate their emotions

19
Q

How to Establish Verbal Contact

A

1) Introduction & role
2) Consent - “Can I have a chat with you?”
3) Make it personal - “What us your name?”
4) Establish your intention - “I am here to understand”
5) Seek patient’s perspective - “What’s going on”

20
Q

3 Ways to Validate

A

1) Label the emotion
- Respond to the emotion heard in the person’s voice
- “You seem” or “you sound” or “I hear that you’re angry. Is that correct?”

2) Identify the source of the emotion
- Identify the situation/cue that triggered emotion
- “What is making you feel this way?”

3) Validate the emotion
- “It makes sense that you’d be angry if you feel disrespected.”
- “I can see that you are veryupset about what just happened.”

Effective validation displays empathy

21
Q

2 Ways to Set Boundaries

A

1) Explain your limits
- “I don’t have the power to make that decision”

2) A boundary can be silence
- Don’t directly answer abusive questions → “Why are all these nurses’ assholes?!”

22
Q

How to Offer Choices

A

1) Collaborate - “What can I do to help”
2) Coping - “Have any skills helped you manage when you hav felt this way in the past”
3) Space - “Is there somewhere we can talk about this so I can better understand what is happening?

** DO NOT offer choices if they are in an unable state**

Maximize autonomy by offering choice

23
Q

Decision Tree: Withdrawal of Services

A

REFER TO PHOTO

24
Q

What is a Critical Incident?

A

Critical incident:”Any sudden unexpected event that has an emotional impact that can overwhelm the usually effective coping skills of an individual or a group”

25
Q

What to do After a Critical Incident

A

1) Debrief
- Consult with those involved in the incident, as well as managementwith the intent to bring healing and support
- Debriefing is an important tool for nurses to receive the support they need and the opportunity to identify what went well ad what could be improved upon next time
- Debriefing helps the team improve the clients plan of care and help to prevent future escalation

2) Reflect & Learn
- Recommend future strategies
- Reflect on your own response to the scenario and what lead up to the incident
- A time for you to uncover the clients triggers if you haven’t yet

3) Future Planning
- Develop a plan of care with the client to prevent future incidents