Transcript CRT 2hr Update 2012 inc CCP

CONFLICT RESOLUTION TRAINING
Management of Aggression and
Violence
CONFLICT RESOLUTION UPDATE
TRAINING
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AIM:
To refresh staff in skills dealing with aggression.
OBJECTIVES:
Assess prior knowledge
To be aware of the need to assess the risks involved.
Identify patterns of behaviour in an aggressive
person.
• Explore communication models.
• The importance of stance, proximity and non verbal
communication.
CONFLICT RESOLUTION
TRAINING
• 1. Name five common causes of aggressive
behaviour, in your work area.
• 2. When assessing risk of aggression or violence;
name five observable signs of the risk being high.
• 3. Name four, of the five phases of the arousal /
assault cycle.
• 4. What two forms of communication are there ?
And which is the dominant ?
• 5. Identify six communication skills or techniques.
• 6. How might communication breakdown ?
• 7. When dealing with an aggressive individual, what
ethnic / cultural diversity issues do you need to
consider ? Name two.
• 8. What happens to personal space, when an
individual becomes aggressive ?
• 9. What is reasonable force ?
Conflict Resolution Model
Stages of Aggression
Verbal agreement
Verbal dis-agreement
Passive (e.g. walks away)
Active (e.g. makes a stand, takes a seat)
Aggressive (obvious verbal and physical)
Violent (reaction often physical action )
What Causes Aggressive
Behaviour? – Physical
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Organic Disorders including dementia and epilepsy.
Urinary Retention
Pain
Inter-cranial causes including malignancy, head injury
and acute stroke.
• Organ Failure – cardiac, respiratory, renal or hepatic
failure.
• Alcohol, drugs, medication.
What Causes Aggressive
Behaviour? – Staff Centred
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Lack of or breakdown in communication
Staff interaction (arousal cycle)
Lack of experience or training
Staff feeling devalued
Lack of knowledge (cultural diversity, mental capacity act.
Etc)
• Lack of flexibility
• Are you considered a threat?
• Does client have a negative view on profession
What Causes Aggressive
Behaviour? – Environmental
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Car parking issues
Waiting times
Lack of Facilities
Lack of Privacy
Noise levels
Temperature
Availability of weapons
Possible Antecedents of Violence.
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Facial expression is tense or angry
Eye contact, aggressive body language
Erratic movements, flagging
Increased volume of speech , over controlled speech.
Building support
Increased restlessness, bodily tension, pacing, hot footing,
stancing up.
Possible Antecedents of Violence.
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Self reporting angry or violent feelings
Verbal threats or gestures.
Animated arms, finger pointing
Lowering of chin.
Balance awareness (line up)
Refusal to communicate, withdrawal
Mono syllabic behaviour
Thought process unclear, poor concentration.
Delusions or hallucinations with violent content..
Core Care Plan
Restraint, Violence and Aggression
Care Plan
Commencement
Date
Care Plan
Completion Date
Problem
Patient may require restraint to ensure their safety or the safety of others
Patient is assessed as a risk of violence and aggression
Goals
To maintain the safety of self and others
To ensure de-escalation interventions have been attempted prior to restraint
To ensure the least restrictive restraint is used
To maintain good assessment and record keeping
Other Individual Goals
Sign, Designation Date
and Time
Interventions
FURTHER ASSESMENT OF PROBLEM
Assess and document all underlying psychological causes of challenging behaviour, violence
and/or aggression for example: Anxiety, Acute Confusional State, Mental ill health, Manic
episode, Psychosis, Hallucinations.
Assess and document all physical causes of challenging behaviour, violence and/or aggression
for example: Infection, Head injury, Pain, Medication, Unsettled sleep pattern, Alcohol and/or
drug misuse.
Assess and document all underlying social and environmental causes of challenging
behaviour, violence and/or aggression for example: High stimulus environment, high noise,
high lighting, Recent altercations, Recent receipt of bad news, Disempowerment.
Document if these are transient / short term and reversible or established, longer term
challenges.
FURTHER CONSIDERATIONS
Consider the need to risk assess against the RCHT Procedure for the Safe and Supportive
Observations of Adults.
RESTRAINT
Assessment of Mental Capacity should be demonstrated as per Trust Policy when restraint is
required - document the assessment and outcome in the evaluation sheet.
Persons implementing restraint must reasonably believe that restraint is necessary to prevent
harm and the level of restraint used is proportionate in response to the likelihood and
seriousness of harm - document the identified risks and how many staff are required in the
evaluation sheet.
Staff applying physical interventions should be made aware of physical and emotional risks to
the person being restrained, in particular including risk of positional asphyxia – document how
this has happened in the evaluation sheet.
The effectiveness of the practice in meeting its aims should be continually reviewed and the
practice should continue only for as long as it remains both effective and necessary - document
the review and outcome in the evaluation sheet.
ACTIONS
Offer the person support and reassurance – document how this has happened in the evaluation
sheet.
Promote privacy and dignity at all times – document how this has happened in the evaluation
sheet.
Ensure all staff are aware of any risks and how to call for help when required – document how
this has happened in the evaluation sheet.
All incidents must be reported on DATIX and documented in the medical notes, including:
A Mental Capacity assessment where appropriate
Steps that were taken to de-escalate the situation prior to the use of restraint
The duration of the restraint
How many staff were involved
The outcome of the situation
Ongoing assessment and management of the patient with regards to violence, aggression and
restraint
Sign,
Designation
Date and Time
Other Individual Interventions
Care Plan
Activated By
Sign
Print
Designation
Care Plan Shared
with Patient
Sign
Print
Designation
THE ASSAULT CYCLE
CRISIS
PHASE
RECOVERY PHASE
ESCALATION
PHASE
TRIGGER PHASE
POST-CRISIS
DEPRESSION
THE ASSAULT CYCLE
CRISIS
PHASE
RECOVERY PHASE
ESCALATION
PHASE
TRIGGER PHASE
POST-CRISIS
DEPRESSION
Click here to view De-escalation Scenario 1
Click here to view De-escalation Scenario 2
DE-ESCALATION: NON-VERBAL SKILLS / TECHNIQUES.
Over 55% of our communication is non verbal
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Mood match.
Mirror, ‘subtly’.
Maintain ‘normal’ eye contact.
Sit when appropriate. have relaxed and open
posture.
Allow personal space, avoiding assault arc
Use open and calming gestures
Diversity awareness.
Be aware of any tension or anxiety creeping in to
the way in which you are communicating.
Appear relaxed and calm
THE LEAPS
COMMUNICATION
MODEL
L - listen
E - empathise
A - ask
P - paraphrase
S - summarise
(G Thompson - verbal judo)
The Danger of Assumption
Click here to view Scenario 3
• Ian Davies-Specialist Trainer MAV-01872 258177
• [email protected]
• Jon Wiggans – MAV Lead - 01872 258177
• [email protected]
• Training Dept – 01872 255148
• [email protected]