managing challenging behaviours

Transcription

1 managing challenging behaviours Julie Borninkhof General Manager Primary Care Services & Clinical Psychologist BA (Hons), M.Psych (Clin), MAPS INWMML acknowledges the Wurundjeri people and other peoples of the Kulin nation as the Traditional Owners of the land on which our work in the community takes place. We pay our respects to their Elders past and present. Medicare Locals gratefully acknowledge the financial and other support from the Australian Government Department of Health.

2 definition of challenging contents not easy requiring much effort and trouble difficult to manage or control requiring great physical or mental effort to endure

3 contents what defines a challenging person?

4 research indicates contents The challenging or frustrating patient, is often a distressed high utiliser of medical services, who often has unrecognised mental or physical health problems.

5 contents how do challenging people make us feel?

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7 contents what personal factors impact on our perceptions of challenging people?

8 sense of self & self-trust stress anxiety depression work-life support job satisfaction work-life value work-life efficacy relations with others (home and work) physical health external factors contents

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10 People who feel the world

11 People who absorb People who hold People who talk People who worry

12 Coping Stress Resiliency

13 Stress cycle worry anxiety stress worn out angry Depressed mood frustrated Helpless & Hopeless

14 coping styles problem-focused coping: - try to deal with the cause of the problem. - finding out information on the problem and learning new skills to manage the problem. - aimed at changing or eliminating the source of the stress. - The three problem-focused coping strategies are taking control, information seeking, and evaluating the pros and cons.

15 coping styles emotion-focused coping: - involves releasing pent-up emotions, - distracting oneself, - managing hostile feelings, - meditating or using systematic relaxation procedures. - "is oriented toward managing the emotions that accompany the perception of stress".

16 resiliency resilience is defined as an individual's ability to properly adapt to stress and adversity. Stress and adversity can come in the shape of family or relationship problems, health problems, or workplace and financial stressors, among others. resilience is usually thought of as the end product of an effective coping mechanism... when people are under stress

17 contents we need to remember we are all challenged by the unknown

18 common challenges consumers in person waiting times patient unable to see usual GP unreasonable patient demands rude/aggressive patients intoxicated patients older adults who are domineering/insistent/cognitively impaired minors without parental supervision, disengaged parents, id patients unhappy with service consumers at a distance abusive telephone calls from patients inappropriate behaviour re calls and colleagues privacy GPs making promises they don t keep resistant to medical advice difficult colleagues inappropriate comments to other staff competing demands from different sources

19 Consumers in person Waiting times Patient unable to see usual GP (but can see others) Unreasonable patient demands Rude/aggressive patients Intoxicated patient Older Adults domineering/ insistent/ cognitively impaired Patients unhappy with service Acknowledge feelings (frustration) felt; clear and transparent; refer to varied needs of all patients. Acknowledge feelings (frustration) felt; whilst not ideal this will support in the interim; some patients report feeling relieved to have found a back up GP; electronic records. Acknowledge feelings expressed I can hear you are upset, but.. ; inform of unreasonable request; unable to support if continue to act in this manner. Acknowledge feelings expressed I can hear you are upset, but.. ; inform of threatening nature; point out zero tolerance poster; inform they will have to leave if unable to contain themselves. Do not argue; clearly articulate that it would appear that they are intoxicated and while you are happy to see them when they are able to benefit from time with the Dr, now is not that time; do they need you to contact a support/call a taxi etc. Acknowledge feelings (frustration) felt; I can hear you are upset, but.. ; inform of unreasonable request; unable to support if continue to act in this manner; clear statements and instructions. Acknowledge feelings expressed; ask what they would like you to do to make it better; invite them to submit feedback; remind them that this is a service they pay for and if they are really unhappy they have the right and the responsibility to find another GP/practice that can meet their needs.

20 Consumers at a distance Abusive telephone calls from patients Inappropriate behaviour re calls and I can hear that you are upset; unfortunately I am having trouble understanding you when you yell at me, could you please call me back when you don t feel the need to raise your voice; our practice has a zero tolerance policy to ensure the safety of staff and patients, as a result I will need to hang up on you are you are making me feel unsafe; I need to inform you that I will be documenting that this call has been made and the manner in which you have spoken with me if it occurs again we have a right. As above re calls. With s acknowledge receipt of the and indicate that it will be given to the manager/principle of the practice for consideration. Always notify that a copy has been stored/documented.

21 Colleagues and Consumers Privacy GPs making promises they don t keep Resistant to medical advice Difficult Colleagues Managing staff Competing demands from different sources Privacy is paramount and we are all now bound to the privacy principles. Ensure GP receives feedback repeatedly if need be. Inform them of how the client reports it makes them feel. Reminding patients that they are their own boss and only they can make change in their own lives; You can only offer options and advice; Curiosity re why they came to service if not wanting to make change/ acknowledge issues; Everyone needs time to process and make changes may take 4-6 repeats before it budges (think about smokers quitting or not). Question the individual re the reason they may be acting negatively toward you are you ok today, because I feel like you are being quite disrespectful/abrupt etc.; Let the person know that you are feeling disrespected, violated, bullied etc.; remind them that this your workplace too and you deserve the same respect as others; state how you are feeling (they can not argue this); inform manager/principle etc. if continues. As above always manage others with the same respect that you desire. Document all demands and use to tangibly illustrate the issues and demands you are facing; ensure you are working to your manager only; express competing issues; remember this is work it is not life work supports life!

22 common presentations

23 the person who is depressed i think of my life as a failure i feel miserable and frustrated i blame the world and myself for this situation i feel more depressed there is no escape i feel in despair

24 the person who is anxious contents can appear anxious, fidgety, agitated, breathless, hypervigilant & often angry. may present with multiple physical complaints or irritability and may focus on cardiac or abdominal symptoms. they often complain that not enough is being done. often co-morbidity with depression. may present in the context of a phobia (agoraphobia, social anxiety, fear of ) can be generalised to all areas of life.

25 the person who is panicking appears intensely fearful experiences severe discomfort lives in fear of having another panic attack fears the consequences of panic attacks fears death fears going crazy fears being out of control

26 the person who is angry may feel: needs are unmet disrespected, ignored treated in unpleasant manner argued with frightened & threatened overwhelmed & overloaded out of control

27 the person who is angry wants To be taken seriously To be listened to To be heard To be treated with respect To be communicated to Immediate action

28 anger is only ever the tip of the iceberg! there is always something else going on underneath

29 Hot Buttons Avoid them!!

30 never try to argue with the person with regard to their beliefs this experience is very real for them.

31 self safety be aware of your: body language tone of voice use of words own anxiety & stress levels contents ensure you are not alone with the patient, ask another person to remain with you be aware of your surroundings and the things within it (i.e. medical implements, duress alarms)

32 general safety record, report & follow-up harm to self harm to others harm to you ensure safety of patient, and do not let them leave without adequate supports in place

33 ethical considerations Adults have the right to make decisions about their health treatment. In common law every adult has the right and capacity to decide whether or not to accept medical treatment, although this capacity may vary over time in conditions such as dementia, confused states (delirium), and mental illness. This principle is dependent on the person having "capacity". The concept of capacity is that a person is able to understand and retain information that is material to the decision that they are being asked to consider. They have to be given information about the probable consequences of having or not having the treatment in question. They must have the mental ability to use this information and weigh it up in coming to a decision. The decision about a patient s capacity is generally up to the doctor and they must consider whether the patient has necessary capacity to make each decision at that time.

34 zero tolerance A response to workplace violence and aggression, as defined by the Australian Nursing Federation (VIC Branch) Nurses (and the staff who work alongside them) have a right to work without being subjected to violence and aggression within healthcare environments, visiting health services and other industries and therefore, the ANF, endorse a zero tolerance policy Adopted 2001 Last reviewed 2010

35 call Emergency Departments of Local Hospitals contents Telephone Counselling Services Lifeline (24 Hour Counselling) Suicide Line (State wide helpline) Salvation Army Crisis Line (24 Hours) Kids Help Line (24 Hour Telephone and On-line Counselling for children and young people aged between 5 and 25 years)

36 rules of working with difficult people Where possible never work alone Always seek support and supervision De-brief with a co-worker, or clinician prior to leaving work Remember you have been trained to work with your patients but your family and friends have not. So try not to take work home with you!

37 Remember you have been trained to work with your patients but your family and friends have not. So try not to take work home with you!

38 occupational violence and aggression includes internal or external: verbal, physical & psychological abuse; treats or any intimidating behaviour; physical attack hitting, biting, pinching, scratching; aggravated assault; threats with a weapon or any object; and, sexual harassment & sexual assault. NB: in each instance, can involve actual or implied threat.

39 Under the Victorian Occupational Health and Safety Act 2004, all employees have a right to work in an environment that is safe and without risks to health. It is the responsibility of the organisation, management, co-workers/staff and users of the service to ensure this Act is enforced.

40 strategies display posters and adopt a zero tolerance policy record and report any incident formally sufficient staff numbers and workplace training specialist staff supervision and support safe environment security systems, exits, calming emergency response team critical incident stress management communication within care team monitor and review - ongoing

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