MOCA Flashcards
What is the Occupational Health & Safety Act (2004)?
We share a responsibility to minimise risks in our work environment.
Training is part of this
• Duty of employer to provide appropriate training
• Duty of employee to attend training
Occupational aggression and violence consists of harassment, bullying, security, clinical aggression.
What is respondent aggression?
- Emotionally directed
- Limited control
- Motivated by fear, frustration & powerlessness
- The goal when de-escalating would be to listen and support to alleviate distress
What is operant aggression?
- Goal directed - motivated by gaining desired outcome
- In control
- Based on manipulation, power and intimidation
- The goal when de-escalating would be to be clear, consistent, to set limits and encourage adaptive ways for the patient to get what they need.
What are the static factors involved in a risk assessment?
- Hx of Aggression
- Cohort–socialmores, style
- Developmental stage, Individual coping skills
- Age
- Drug and alcohol Hx
What are the dynamic factors involved in a risk assessment?
- Mental state
- Psychosocial supports/ stressors (eg: family, friends)
- Physical state–incl. capacity to be violent
- Current pre-occupation with violence, threats
What risks are associated with constraint?
- Trauma experienced by the client & staff
- Risk of injury to staff or client
- Positional Asphyxia
What are signs of exhaustion?
• Chronic fatigue • Anger at those making demands • Self-criticism for putting up with demands • Reduced work performance • Cynicism, negativity & irritability • A sense of feeling overwhelmed/weighed down • Over-reacting easily • Frequent headaches • Weight loss or gain • Sleeplessness and depression • Shortness of breath • Suspiciousness • Feelings of helplessness • Increased degree of risk taking drugs
What are the effects of exhaustion?
Increased exhaustion + decreased tolerance = decreased interpersonal skills
What is emotional exhaustion (burnout)?
“A state of physical, emotional and mental exhaustion caused by long term involvement in emotionally demanding situations.”
What is environmental awareness?
- Particular issues in the environment are known to be triggers for clinical aggression in the workplace.
- We all have a responsibility to be aware of the triggers to clinical aggression in their own clinical area, and to try and minimise the impact of these whenever possible.
What is self-awareness?
• Self-awareness is an individual tendency to pay attention to his/her own emotions, attitudes and behaviour in response to specific situations.
• In the case of health care workers, self- awareness is their insight in into how their emotional make-up influences patient care.
Consider:
• What can influence our reaction to aggressive behaviour?
• How can staff responses contribute to aggressive behaviour?
What is patient awareness/perspective talking?
• Attempt to understand what is causing the patient’s aggression and intervene accordingly
Consider:
• What makes patients angry within your work environment?
• What factors can influence patient aggression in your work area?
What strategies can you use to become self-aware?
- Know your own triggers
- Manage your own emotions
- (anxiety, anger & fear)
- Use self-talk
- Remain calm
- Don’t get personal
- ignore personal insults
- Utilise breathing and muscle relaxation
What are some examples of non-verbal strategies?
• Non-threatening body position • Maintain eye contact • Stand slightly to the side – do not confront • Hands down • Move slowly • Maintain a safe distance • Do not allow yourself to be trapped, or trap the person
What are some examples of therapeutic engagement strategies?
- Empathise
- Validate emotions
- Paraphrase & clarify
- Be honest & don’t make false promises
- Negotiate & problem-solve – aim for a ‘win-win’ situation
- Help the person ventilate & identify coping strategies
- Learn from an experienced colleague
What are some examples of behavioural interventions?
- Give limited choices
- Offer an illusion of choice
- Short, simple, one step instructions
- Allow time to consider
- Repeat yourself, do not assume you have been understood
- Consider other tactics; redirection / diversion, the persons behaviour management plan, time-out etc
- Involve other staff if appropriate
- Model the behaviour you expect the person to use then respond
- Don’t contradict or argue
- Point out consequences in a calm non-threatening way
What are the key differences in communication when the risk escalates?
(crisis communication?
- Self Control
- Active Listening
- Assertive and direct communication
- Preparing for an emergency – communication with the team. Know how to get out/get help/instigate emergency procedures
What are some examples of strategies to maintain self care?
- Recognise the symptoms
- Spend time with other people
- Use your support system
- Talk about your feelings
- Listen to others talking about their feelings
- Use positively strategies from the past
- Avoid additional stress
- Work to follow usual routine
- Exercise regularly
- Eat healthily
- Get enough sleep
- Engage in typical leisure activities
- Seek professional support
What factors should be reviewed when considering using reasonable force?
- Previous history of violence
- Size and strength of the attacker
- Size and strength of the person being attacked
- Whether the person being attacked made every effort to vacate the scene at the first opportunity
- Was the force used to ward off the attack proportional to the force used by the attacker
What are the principals of self defence?
• Be clear about your legal rights & responsibilities
• Be aware of policies & guidelines
• Be mentally prepared and aware of your
surroundings & exits
• Use only the amount of force required to protect and defend yourself
• Protect yourself without causing unnecessary harm to the attacker
• You are accountable for your actions
• Do not take unnecessary risks in the course of your duties
What are your two legal defences when considering physical action?
- Defence of Necessity - requires a belief in the need to act to protect another or protect property.
- Self-Defence - dependent upon using proportional force to protect oneself against imminent danger.
Negligence can only be determined after an event if all FOUR of the following are established:
- Duty of Care - client, family, carers, other staff
- Dereliction of Duty of Care - “The test of Reasonableness”
- Damage - physical, emotional or financial
- Direct Cause - there is a clear relationship
