Risk Management/Therapeutic co mmunication with the angry patient

Risk Management/Therapeutic co mmunication with the angry patient”

Order Description

Under assignment question, there is a video

Click on the video below (4min.17sec)

Video: “Therapeutic co mmunication with the angry patient”

This video demonstrates the interaction between a nurse and a client (Carla) who is currently distressed.

Please answer the following questions:
Reflect on the video scenario (link below), observing the interactions between the two individuals. Then answer following three (3) questions:

1. Using your knowledge and skills from previous weeks, analyse the questions asked (verbally, para-verbally) and non-verbal behaviours used in order to assess the client’s level of risk as well as assist the client regain focus, take control of their emotions and ultimately calm down.

a. From your observations of the situation, what did the nurse do well?
b. From your analysis of the situation, what changes would you suggest for Carla’s risk management?
2. What approaches can you use within the assessment process to enhance collaboration and participation when clients are at risk?
3. Reflect on what you think may be the underlying cause for Carla’s behaviour.

CriticalThinkingQuestions
http://relationalcontextofteaching.edublogs.org/2011/06/23/why-did-i-choose-to-show-and-not-tell/

Pleaseanswerthefollowing for professional portfolio

Reflectonthe videoscenario(linkbelow),observing theinteractionsbetweenthe twoindividuals.Thenanswerfollowing three(3)questions:

1.    Using yourknowledgeandskillsfrompreviousweeks,analysethe questionsasked(verbally,para-verbally)and non-verbalbehavioursused in ordertoassessthe client’slevelofrisk aswell as assisttheclient regainfocus,takecontroloftheiremotionsandultimatelycalmdown.

a.    Fromyourobservationsofthe situation,what did thenursedo well?
b.    Fromyouranalysisof thesituation,whatchangeswould you suggestforCarla’sriskmanagement?
2.    What approachescan youusewithinthe assessmentprocesstoenhancecollaborationand participationwhen clientsare atrisk?
3.    Reflect onwhatyou thinkmaybetheunderlying causeforCarla’sbehaviour.

Video:

Clickon thevideobelow(4min.17sec)

Video: “Therapeuticcommunicationwith theangrypatient”

Thisvideodemonstratestheinteractionbetween anurseand a client (Carla)whois currentlydistressed.Fromthisvideo considerthe following:

Readings

Read the followingpagesofthistext.

Hungerford,C.,Hodgson,D.,Clancy,R.,Monisse-Redman,M.,Bostwick,R.&Jones,T.(2015).Mental Health Care –AnIntroduction for HealthProfessionals in Australia(2nded). Milton,QLD:JohnWiley&SonsAustralia,Ltd.

Chapter 6:Caringforpeople displayingchallengingbehavioursp.238-273

Skillsandbehaviours–whatdo I need todo?
http://www.improvizations.com/Portals/42614/images/skills.jpg

Youwill needto completea risk assessment
Within your riskassessmentyou willneed toassessfor riskof:
o    aggression/violence (harmto others)
o    suicide ( harmtoself)
o    self-harm( harmtoself)
o    general vulnerability( exploitation)
o    past/current trauma( incl. sexual/physicalabuse)
o    drugs/alcohol(including withdrawal)
o    absconding ( leaving a place ofsafety)
o    neglect(including physicalneglect of self)
o    relatedtodependents
o    impulsive/reckless/provocativebehavioursYouwill needto:
Identifysignsof predictorsof risk[actual/potential],including static anddynamicfactors.Beableto describeriskand theriskfactors,forexample,low,medium,high levelsof risk.Chronic/ongoing oracuterisk.
Identifyprotectivefactors.

Beabletodemonstrateyourtherapeuticskillsthatwillsupporttheindividualwhois“atrisk”.
Formulate arisk summaryand riskmanagement planand clearlydocumentthiswithintherisk assessment formandtheclinical/electronichealth record. In doing thisyoualso needtoconsiderthemanagementplanswheresomerestrictionsof autonomy andfreedommaycausetheindividualtofeela lossoftheirhuman rights. Youwill needtosupportthisbalanceto ensureindividualrightsaremaintained aswellas theindividual’swellbeing.
Hand overto otherclinicalstaff,thelevelof riskfortheconsumersyou areworking withandthe action plan tosupportthe riskmanagement.
Youmayalsoneedtoconsider:
Themental illnessesthathaveriskimplications andwhy?

Theevidenceisto supportmypractice?

www.thewordworks.co.uk

RiskAssessment

It is importanttounderstand riskassessment and riskmanagement. Riskassessmentsshould alwaysincludesimilarinformationaboutthe typesof riskforthe person andthismaybemorethan one riskdependenton theindividual.Forexample,theindividualmaybeatriskofsuicidalbehaviourandalso riskofabsconding fromthe healthservice.
Risk assessmentsarebasedonstaticand dynamicfactorsandon acuteandchronic risk.Thelevelofriskcan fluctuatedepending on theindividualand theirindividualcircumstances.

RiskManagement

Riskmanagementshould alwaysfollowrisk principlesof need, responsiveness,and least restrictivepractices.
Zero Tolerance: Itis important to notethathealthservicesin Australia,haveadopted a zerotoleranceapproach toaggression,violence,assault,bullying andotheractsofviolencein theworkplace(Hungerford etal,2015).
Thereare a numberofways in whichserviceswillmanage risk, forexamplethemanagement ofclinical aggression (MOCA)is oneway in whichclinicians aretrainedtorespond torisksof aggressionand violence.
Managementofclinical risk is an approach to ensuresafety andquality ofcarewithinthehealthservices. Identifying consumerswhomaybe atriskofharmisvitaltothecareprovision andassisthealth professionalstoprevent,reduceorcontroltheserisks.

Pleaseclickhere onRiskwatch – Volume10,May2013thisbulletinhelpstoprovidesupporttheprocessofreviewofhigh risk incidentswithin healthservices. Itisanopen andtransparent waytoensure thatall casesthat involve adverseeventsormedical errorarereviewedthoroughly
Pleaseclickon workingwith a suicidalpatient/consumerthis is quickguidefortriagestaffwhenworkingwith aperson who maybeatrisk ofsuicide. Theassessment and thenmanagement ofasuicidal personisvitalto ensureappropriateand timelycareand treatment.

TheConsumerand CarerPerspective

Happell etal(2008)discusstheconsumerperspective onriskassessment andmanagement, as aneed toensure thatit iscarried outin anappropriateand timelymanner. It is importantto includeconsumersandcarer/family in all aspectsoftreatmentand planning andthis is nodifferent withinthe riskassessment andmanagement.Supporting theconsumerand carer/familytoidentifyearlywarning signs andtriggerswill assistin themanagement and earlyintervention.Risk assessmentshouldbefocusedonthestrengths and thepositivesnot juston potential riskfactors.
Allconsumers,carers,familiesand friendsalsohavetherighttoreceivehealth care orvisit a healthcare setting that is freefromriskstotheirpersonalsafety(Hungerford et al,2015).
Slade, M(2009)talks aboutwaysin whichservicescanassistpeopleto managetheir risk-takingbehaviours,bypromotinga recoveryoriented frameworktocare.Supporting individuals to haveresponsibilityfortheirownlivesandown riskis an importantintervention formental healthservicesto worktowards.Balancingrisk and riskfactors isvitaltothe careand treatmentweoffer.
Compulsorytreatment during a crisismayneedto beconsidered,our goal istoensure thatwhenthis arisesthatconsumersare treatedwiththe respectand dignity andtoaimforminimallossofpersonalresponsibilityduring thecrisis.

Self-Awareness

Understanding yourself and howyou respond toacute risksituations is important.Peoplereactdifferentlyto situations. Inthe practiceclasswewill exploreresponsesinmoredepth.Thereareanumberof emotionalresponses thatwe allexperience, asthe healthprofessional or as a consumer.
Somepeopleuse of theirdefencemechanisms(howpeopleunconsciously respondtothreats).For
e.g. the useofprojection,howoneperson mayprojecttheiruncomfortablethoughtsand feelingsonto another(Hungerford et al,2015)?
Ina situation somepeoplereporta sense of power,controland calmness;othersreportfeelingshakyandtearfulon theverge ofcollapse; othersdescribe a physicalsensationofnauseaandvomiting.
It is important thatwegainan understanding ofourselvesand howwerespond,sothatwe canprovidean effectivewayto managerisk situations,which causefewertraumastoall individualsinvolved.

Websites:

Thereare a numberofwebsitesthatprovidefactsheetsand information to supportunderstandingof riskandriskfactors inmental health.Risk isinclusive ofa numberof riskfactors andpertainstoarange of risks,belowareexamplesofsomeareasof risk(noterisk is notrestrictedtoriskofaggression/violenceandorsuicide).
Pleasereviewthefollowingwebsites:

When workingwithyouthpeople andadolescents consider the followingwebsite–Reachout.Thissiteprovides generalinformation aboutangerand angermanagement.

http://au.reachout.com/find/articles/anger

http://au.reachout.com/find/articles/being-violent

http://au.reachout.com/find/articles/anger-is-something-that-is-hard-to-deal-with

When workingwith peoplewho are expressing thoughtsofsuicideconsidertheSanewebsite.Thesefactsheetshelp tosupportpeoplewhoareincrisis.

http://www.sane.org/images/stories/information/factsheets/1007_info_25sanesteps.pdf

http://www.sane.org/images/stories/information/factsheets/1110_info_26suicidehelp.pdf

Lifeline isa crisissupportand suicideprevention 24hourservicethatyou can accessvia thetelephone.http://www.lifeline.org.au/

Watch thisbriefvideobyGrahameGould aLifelinemanager–clickhere

Additionalreading

Chapter10:Anger,HostilityandAggression
Evans,J.,&Brown,P.(2012).Videbeck’sMentalHealthNursing.(pp.169-182).Sydney,NSW:LippincottWilliams&Wilkins.

PleasenoteVidebeck’sreferencetosafetyrelatingtopatient/consumerwhomaybeinpossessionofaweapon(pp.174-175),isinrelationtoskilledstaffwhohavebeenproperlytrainedtoassistinmanagementofaconsumer/patientwithaweapon.Thepracticesofremovalofaweaponandorthrowingwateronthepatient/consumerarenotarecommendedpracticewithintheACUundergraduatecourse,SchoolofNursing,MidwiferyandParamedicine.

Chapter11:AssessmentandDiagnosis–Essentialnursingskills
Elder.R.,Evans,K.,Nizette,D.(2013).Psychiatricandmentalhealthnursing(3rded.).Chatswood,NSW:ElsevierAustralia.p203-204

Chapter12:AssessmentEssentialSkills–HoNOS;(p370)
Chapter13:SpecialisedAssessment-RiskAssessment(405&413);

Chapter21Substancerelateddisorders-Assessingrisk(p.469)
Chapter25Schizophrenia-SpecificriskassessmentissuesinSchizophrenia(p.768–770)

Meadows,G.,Singh,B.,&Grigg,M.(2012).MentalhealthinAustralia.Collaborativecommunitypractice(3rded.).SouthMelbourne,Vic:OxfordUniversityPress.
Chapter5:MentalHealthandIllnessAssessment (p.118–119)
Happell,B.,Cowin,L.,Roper,C.,Foster,K.,&McMaster,R.(Eds.).(2008).Introducingmentalhealthnursing:aconsumer-orientedapproach.Sydney:Allen&Unwin.

Pleasenotetherearealsospecificareaswithineachofthedisordersthatdiscusstheriskmanagementspecifictotheillness.

Foryourinterest

AustralianNursingFederation.(2012).ANFPolicy:Zerotoleranceofviolenceandaggressionintheworkplace.Retrievedfrom   http://anmf.org.au/documents/policies/P_Zero_tolerance_violence_aggression.pdf

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2007.04169.x/full

http://bjp.rcpsych.org/content/189/6/520.full

http://www.aenj.org.au/article/S1574-6267%2806%2900076-0/abstract

http://www.health.vic.gov.au/mentalhealth/triage/scale0510.pdf