Lecture 7 - Treatment groups and cultural considerations Flashcards
Treatment groups
Goals for Treatment groups
- Summarize what
- Some specific topics include:
- -P(AS), I, C, E, L, P
-Summarize a number of guidelines for starting, leading, and ending treatment groups
Some Specific topics include:
Preparation and homework
- Aggression & violence in health care settings
- Strategies for working with hostile or involuntary members
Introductions
Clarification of roles
Ending a session; ending a group
Legal Safeguards for group facilitators
Professional boundaries with clients
Competence and Empathy
- Counselling what
- Most people what
- C&E are keys to what?
Counselling people with personal problems is neither magical nor mystical.
Most people have the potential to help another by listening and talking through difficulties.
Competence and empathy are the keys to effective counselling.
Preparation and Homework: Leaders to have training in….
- Assessing what
- Comprehensive what
- Specialized what
- I & C
- Principle of what
Assessing human behaviour and human problems,
comprehensive therapeutic intervention approaches,
specialized therapeutic intervention techniques,
interviewing and counselling
principles of group dynamics
Preparation and Homework
- Study the what
- Establish what
- Anticipate what
- Visualize what
Study the literature
Establish group purpose and goals
Anticipate members’ needs and expectations – you may have involuntary group member(s)
Visualize the session
Aggression and Violence in Health Care Settings (Rippon, 2000)
- Violence has become
- Problems with a what
- Student nurses what
Violence has become a significant problem in health care settings.
Problems with a lack of a clear definition of what constitutes aggression.
Student nurses under-reported incidents of assault as they perceived that there was no confidentiality and senior staff did not support their complaints.
What constitutes Violence and Aggression?
- Violence (AHHCV)
- Aggression (CVAISCACP)
Violence
- Action
- High intensity
- Higher severity
- Can be directed at others or self
- Verb
Aggression
- Can lead to violence
- Verbal
- Attitude
- Intention
- Social rules are broken
- Can be directed at others or self
- Adjective
- Can be psychological
- Power imbalance
Aggression and Violence in Health Care Settings
- Intent to do what
- “As an example what”
Intent to do harm is one essential part of the definition.
“As an example fear or lack of perceived control over their future may be manifested in aggression and they may associate health care professionals with this insecurity” (Rippon, p. 458).
Aggression and Violence in Health Care Settings
- “Reducing the sense of what”
- Nurses expect what
“Reducing the sense of fear and providing some control may be sufficient to eliminate any intent and prevent aggressive behaviour” (Rippon, 2000, p. 458).
Nurses expect aggression from family members of clients and physicians but they find it most distressing when it comes from co-workers (fellow nurses).
RNAO Best Practice Guidelines: Preventing and Managing Violence in the Workplace (2009)
Preparing for a meeting with a potentially violent client
- gather what
- Meet in as safe an area or room as possible. Consider these factors: NSAA
- Treat or interview what
- If you cannot choose then what?
- Let security and other staff know what
- Ask a co worker to telephone you at predermined time during the meeting. Give yes or no answers to pre-planned questions such as: ADD
- Give the client what
- Be on what
Gather information about the individual and his or her characteristics. If possible, find out what triggers violent behaviour in this person. Review previous reports and client files or consult with internal or external resources. Respect client confidentiality
Meet in as safe an area or room as possible. Consider these factors:
a) Natural surveillance opportunities
b) Secured furniture and absence of sharp objects or items that could be thrown or used as weapons
c) Access to escape routes
d) Access to panic button or alarm mechanism and telephone
Treat or interview potentially aggressive or upset clients in a relatively open area, while observing client confidentiality and privacy.
If you cannot choose the meeting location, bring a co-worker.
Let security and other staff know when and where you are meeting.
Ask a co-worker to telephone you at a predetermined time during the meeting. Give “yes” or “no” answers to preplanned questions such as:
a) Are you okay?
b) Do you need me to join you?
c) Do you want me to call security or the police?
Give the client copies of documents so that you can keep your distance.
Be on time; waiting can trigger anger.
RNAO Best Practice Guidelines: Preventing and Managing Violence in the Workplace (2009)
Body Language
Employees must pay close attention to the body language of a potentially violent client. A hostile stance increases tension and interferes with verbal communication. When approaching an angry person:
- Stand about one metre (three feet) away (that is, outside the individual’s personal space), on an angle (as opposed to . directly in front of the person) and on the person’s non-dominant side (people usually wear watches and part hair on the non-dominant side)
- Place yourself so that you have a clear exit
- Position yourself on the same physical level; avoid standing over the person
- Use calm body language: hands open, attentive facial expression, relaxed posture
- Avoid pointing or gesturing; make no sudden movements -Avoid touching the person
- Avoid staring eye contact
RNAO Best Practice Guidelines: Preventing and Managing Violence in the Workplace (2009)
Verbal Communication Talking can defuse anger. Here are some strategies to use when speaking with someone who is angry: -Make your first what -Always be what -Use what skills -Confirm your what -Acknowledge what -Use simple what -Always attempt what -Be prepared to what -Avoid what -Look for ways -in a what and what way, explain what -If you feel what
- Make your first contact neutral or non-directive: for example, ask how you can help. This inquiry communicates a sense of normal interaction.
- Always be courteous to clients despite their behaviour. Introduce yourself and call them by name.
- Use active listening skills. Do not interrupt.
- Confirm your understanding of the issue or problem by repeating what the client has told you.
- Acknowledge the client’s feelings and concerns.
- Use simple language; avoid jargon or technical language. -Speak slowly, quietly and confidently.
- Remain open-minded and objective.
- Always be honest. Do not make promises that you cannot keep.
- Keep the client’s attention focused on the current issue. -Use silence as a calming tool.
- Always attempt to explain delays or long waiting periods. Not doing so can be construed as discourtesy.
- Be prepared to apologize as necessary and accept criticism positively.
- Avoid giving commands.
- Look for ways to the help the person save face.
- In a calm and non-threatening way, explain that violence is unacceptable and is not tolerated.
- If you feel threatened, politely and calmly terminate the interaction.
RNAO Best Practice Guidelines: Preventing and Managing Violence in the Workplace (2009)
Terminating an Interaction with an Angry Client
If you feel threatened, or if the interaction is increasing a client’s anger, terminate the interaction immediately.
- Calmly what
- Tell the person what
- Either what or what
- If the person does not
- notify what
- If required what
- Call the what
- If you threaten to what, do what
- Complete an what report
- Calmly but politely interrupt the conversation.
- Tell the person that the conversation is over.
- Either leave or ask the person to leave.
- If the person does not leave, inform a manager or supervisor immediately.
- Notify other staff in the immediate area.
- If required, call the emergency response team. Consider using a silent alarm or code word if your organization uses these.
- Call the police.
- If you threaten to call the police, be prepared to call them.
- Complete an incident report after the employee has received treatment.
Checklist of Risk factors for aggressive behaviour
Client Factors:
LDPFLLFBEALLTTPR
- Language or cultural barriers
- Diagnosis (psychogeriatric illness, mental illness, medical condition)
- Poverty
- Fear
- Loss of control
- Loneliness
- Frustration
- Boredom
- Effects of medications or lack of medication
- Anniversary of a significant event
- Losses
- Lack of information
- Time of day or week
- Task too complicated
- Physiological needs
- Reaction to race or sex of caregiver
Checklist of Risk factors for aggressive behaviour
Caregiver factors
- Unpredictable work load
- Lack of training
- Time of day (mealtime)
- Day of week
- Working alone, especially at night
- Geographic isolation
- Stress
- Body language
- Level of authority
- Lack of staff
- Worker unaware of client’s history of abusive behavior
- Worker unfamiliar with client
- Uniform, appearance, religious jewelry
- Infringement of personal space
- Need to physically touch to provide care
Strategies for working with hostile or involuntary members (Zastrow, p. 438)
- Model what
- Allow what
- Establish what
- Utilize what
- Do not what
- If abuse
- Model respect and treat with respect.
- Allow members to vent their unhappiness over their forced involvement in the group.
- Establish goals that are meaningful to them.
- Utilize the disarming technique.
- Do not subject yourself to extensive? verbal abuse.
- If abuse continues, meet with supervisor to discuss options i.e. termination of participation.
Disarming
-Involves finding some what
“involves finding some truth in what the other person (or side) is saying and then expressing your ‘agreement’ – even if you feel that the other person is largely wrong, unreasonable, irrational, or unfair”.
Relaxing Before Starting a Session
- Some what
- High level of what
- Reduce what
Some anxiety is useful; mental alertness
High level of anxiety reduces effectiveness
Reduce high anxiety levels using relaxation techniques.
Cues Upon Entering the Meeting Room
- Be on
- Opportunity to what
- Opportunity to observe what
Be on time or early
Opportunity to scan setting for possible needs
Opportunity to observe moods and obtain information regarding interests of group
