Work Place Aggression: Managing Challenging Behaviors
Liesel Delamater, MSN, RN, ACNS-BS Jessi Green, MSN, RN-BC, AGCNS-BC, CVRN Jayme Melton, BSN, RN, CCRN Anne Mary Montero, Ph.D., HSPP Katie Saunders, BSN, RN-BC Debra F. Smith, MSW, LCSW, CCM
ACMA, April 14-17, 2019
Introduction
Methods
In 2017, IUH North Hospital frontline staff reported an increase in verbal and physical aggression from patients and family members. Staff reported feeling overwhelmed, unsupported by leadership, and unprepared to deal with the verbally and physically aggressive behaviors they encountered. The team perceived this to be unique to IUH North Hospital, not a national phenomena.
Boxes 2,3: Attributes
Box 5: Solutions
Purpose In researching the literature, OSHA, CDC, and TJC all noted that this is a national phenomena. In April, 2018 TJC sent out a Sentinel Event Alert that discussed the physical and verbal violence and aggression against healthcare workers. The goal was to develop a program and process that would support the patients, families, and staff. © Copyright Indiana University Health
S T A N D A R D W O R K
Escalation Process
Implications
Survey
LEAN Methodology: Developed A3
Background The Clinical Psychologist, Nurse Educator, and Social Work Manager developed a team approach to address these issues. Approval was received by IU North Hospital Clinical Leadership Council to proceed in bringing the team together and use LEAN as the process improvement method.
Data/Results Box 4: Gaps
Box 6: Experiments
Survey Question 1
Survey Question 2
Within the past 30 days, did a patient safety event cause you to experience anxiety, depression, or wondering if you were able to continue to do your job: Yes or No
Did you receive support from anyone with IU Health: Yes or No
Conclusions 1.
2.
3. 4.
Front line staff has been surveyed on a regular basis and feedback has been incorporated into the standard work. Training, such as Verbal Judo and Dementia education, has been provided throughout to increase compassionate interactions with patient and family members. To provide staff support: Incident Debrief, Code Lavender, and EAP’s services have been implemented. Survey results and management of incidents are to be incorporated into MDI board and discussed at huddle with goal of sustainment. Early survey results highlight an opportunity for increasing team awareness of new methods to activate support.
When the workplace becomes a battlefield, it causes harm to the patients, their families, and the employees. The environment no longer supports healing and becomes a place where patients don’t want to come and staff want to leave. In order to create a holistic environment, an interdisciplinary team must collaborate to incorporate feedback into the standard work. Our team is comprised of nursing, chaplains, social workers, IU Health police officers, physicians, clinical psychologists, and hospital leadership. With the goal of sustainment, the team continues to meet and evaluate the current process and need for changes.
Contact info Jessi L. Green: JGreen6@iuhealth.org Liesel J. Delamater: Ldelamat@iuhealth.org Jayme N. Melton: JMelton6@iuhealth.org Anne Mary Montero: Amontero@iuhealth.org Katie M. Saunders: CSaunders1@iuhealth.org Debra F. Smith: Debsmith@iuhealth.org