Conflict Management & Safety Flashcards
What is Conflict?
- Occurs between two separate parties when they experience negative emotions to perceived disagreements
- Has a meaning or underlying cause
- Can occur between the nursing team, the interprofessional team, or between a client and the healthcare professional
Conflict in the workplace results in..
- A stressful work environment
- Job dissatisfaction or burnout
- Low commitment to organization/ profession
- Low team morale
- Poor co-worker relationships
- Diminished sense of well-being
- Emotional exhaustion
- Lack of trust
What is Escalation?
- Occurs when the individual feels there is a threat to theirsafety or their own control over a situation
- Occurs as a response tofear or a threat
- Clients are at their most vulnerable (with little to no control)
- Fight or flight can be activated, thinking turns off, act on instincts
- They want to regain control over the situation
7 Stages of Escalation
- Calm
- Clients baseline
- Trigger
- Occurs because of unmet needs
- Triggers can be a situation they have no control over - illness, accident, or even hunger
- How the nurse deals with the patient during this stage determines whether client will proceed to next phases or go back to calm phase
- Agitation
- Patients are using maladaptive coping mechanisms (ineffective)
- The nurse does not actively work with the client to prevent acceleration
- Acceleration
- This is where you determine if you are still able to use nonverbal behaviours, or if you have to move toward physically restraining them
- Peak
- At risk of harm to themselves or others
- De-escalation
- Help the client regain control of their emotions
- Recovery
- Able to start engaging with the client again
-Ask : What happened? What can we do to prevent this?
- Able to start engaging with the client again
Risk Factors for Client Escalation: If the client is…
- Under the influence of a substance or experiencing withdrawal
- Being constrained (Eg.not permitted to smoke on the unit) or restrained (using physical or chemical restraints)
- Fatigued
- Overstimulated
- Anxious/worried/confused/
disoriented/scared
Risk Factors for Client Escalation: If the client HAS…
- History of violent or aggressive behaviour
- A medical and/or psychiatric condition that impairs cognition/judgment
- A current substance use disorder or alcohol dependency
- Difficulty communicating needs (for ex. language barrier, aphagia)
- Ineffective coping skills
- Lack of social support
- Each individual has their own triggers that can lead to escalation
Risk Factors for Client Escalation: If If a nurse or other professional….
- Judges, labels or misunderstands the client
- Uses a threatening tone or body language
- Makes assumptions
- Does not listen to, understand or respect a client’s values, beliefs,opinions, and/or needs
- Does not listen to the family’s concerns
- Does not provide sufficient health information or teaching
- Does not reflect on the impacts of their behaviour on the client
Signs of Agitation
Non-Verbal
- Fidgeting
- Erratic movements
- Pacing
- Aggressive posturestanding over the person, raising an arm at you, puffed up chest)
- Balled up fists
- Shaking
- Entering another individual’s personal space
Verbal
- Raised voice
- Rapid speech
- High-pitched voice
- Cursing/swearing
- Speech content
Ways nurses prevent escalation?
1) Establish a THERAPEUTIC RELATIONSHIP
2) Provide client-centered care!
3) Attempt to understand clients’ needs and perspectives
- use open-ended questions
4) Acknowledge theclient’s feelings that are leading to the behaviour
5) Engage in ACTIVE LISTENING
6) Anticipate conflict
7) Create a plan of care to prevent escalation for clients who have had a history of conflict/escalation
8) Reflect on your own values and behaviours that could possibly affect the client in a negative way
9) Using risk assessment tools to identify clients that may be at risk for escalation
Safety Precautions for Nurses
- Always know where your exits are
- Always stand between the door and your client
- Never stand with your back to a door
- No hoodies, sweaters with strings, scarfs, lanyards, necklacesor anything around your neck!
- Know your unit or organization’s protocols forsafety
What is De-escalation?
- 1 of the most important conflict resolution strategies
- An approach using a set of interventions and techniques that have been adopted to reduce or eliminate violence and aggression during a period of escalation
Benefits of De-escalation
- Prevents violence
- Avoids use of restraints
- Reduces patient anger/frustration
- Maintains safety of both patients and staff
- Improves the therapeutic relationship
- Enables patient to improve coping strategies
What is Self-Awareness?
- Process of understanding your own beliefs, thoughts, motivations, biases, and limitations
- How you react determines whether the situation further escalates or de-escalates
Involves Reflect on the following:
- What are your personal triggers?
- How do you know you are at your limit?
- How do you react to these triggers?
- How will you manage these reactions?
DO’S Of Non-Verbal Communication
- Appear calm
- Maintain appropriate eye contact
- Maintain a neutral facial expression
- Relaxed and alert posture
- Minimize excessive body movements
- Respect personal space
- Use therapeutic touch with caution
- Use open body language
- Remain calm and respectful
- Consider environmental considerations (ie. Minimizing lighting, noise, and loud conversations)
- Keep weight evenly balanced (so you cam be agile and move quickly when situations escalate)
- Keep hands always visible (To show that you are not hiding anything)
- If client does not want to speak with you
○ The nurse can go back in 10-30 minutes once they have calmed down
○ The nurse can invite the into their personal space - “you can grab a chair and join me over here”
DONT’S Of Non-Verbal Communication
- Intense or minimal eye
contact - Frown
- Smile inappropriately
- Look “closed off”
- Inappropriategesturing
- Appear inattentive
