CHCCCS020

Respond effectively to behaviours of concern This unit describes the skills and knowledge required to respond effectively to behaviours of concern of people. Skills are associated with handling difficult incidents rather than managing ongoing behaviour difficulties. The unit applies to workers in any context exposed to difficult and challenging behaviour. The skills in this unit must be applied in accordance with Commonwealth and State/Territory legislation, Australian/New Zealand standards and industry codes of practice.

STUDENT RESOURCE ivet.edu.au

1300 00 IVET

IVET Institute: RTO ID: 40548

CONTENTS

Elements and performance criteria.........................................................................................................................................3 Introduction........................................................................................................................................................................................5 Identify behaviour and plan response...................................................................................................................................6 Influences on behaviour.......................................................................................................................................................................................................... 6 Behaviours of concern...............................................................................................................................................................................................................7 Respond appropriately to behaviours of concern.................................................................................................................................... 20 Organisational policies and procedures..............................................................................................................................................................22 Staff support......................................................................................................................................................................................................................................23 Prioritise your safety.................................................................................................................................................................................................................. 24 Applying a response.................................................................................................................................................................... 26 Legal and ethical considerations................................................................................................................................................................................ 26 Seeking assistance.................................................................................................................................................................................................................... 30 Deal with behaviours of concern.................................................................................................................................................................................32 Communication............................................................................................................................................................................................................................ 35 Adopt a strategy............................................................................................................................................................................................................................41 Report and review incidents....................................................................................................................................................44 Reviewing an incident.............................................................................................................................................................................................................46 Debriefing............................................................................................................................................................................................................................................ 48

Suites 210 – 212 189E South Centre Road Tullamarine VIC 3043 © IVET Created: 13/9/22 Version: 1.0

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Elements and performance criteria

CHCCCS020 Respond effectively to behaviours of concern ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element. 1.1 Identify behaviours of concern in line with work role and organisation policies and procedures

1. Identify behaviour and plan response

1.2 Identify appropriate response to potential instances of behaviours of concern 1.3 Ensure planned responses to behaviours of concern maximise the availability of other appropriate staff and resources

1.4 Give priority to safety of self and others in responding to behaviours of concern 2.1 Ensure response to instances of behaviours of concern reflect organisation policies and procedures 2.2 Seek assistance as required 2. Apply response

2.3 Deal with behaviours of concern promptly, firmly and diplomatically in accordance with organisation policy and procedure 2.4 Use communication effectively to achieve the desired outcomes in responding to behaviours of concern 2.5 Select appropriate strategies to suit particular instances of behaviours of concern 3.1 Report incidents according to organisation policies and procedures

3. Report and review incidents

3.2 Review incidents with appropriate staff and offer suggestions appropriate to area of responsibility 3.3 Access and participate in available debriefing mechanisms and associated support and/or development activities 3.4 Seek advice and assistance from legitimate sources as and when appropriate

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Performance evidence The candidate must show evidence of the ability to complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the job role. There must be evidence that the candidate has: y

effectively dealt with at least 5 different behaviours of concern.

Knowledge evidence The candidate must be able to demonstrate essential knowledge required to effectively complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the work role. This includes knowledge of: y

different behaviours of concern: y

aggression

y

confusion or other cognitive impairment

y

intoxication

y

intrusive behaviour

y

manipulation

y

noisiness

y

self-destructive behaviour

y

verbal offensiveness

y

wandering

y

strategies for dealing with behaviours of concern

y

issues needing to be referred to an appropriate professional

y

legal and ethical consideration relevant to recognising and responding to behaviours of concern, including:

y

y

duty of care

y

human rights

y

work health and safety

organisation reporting processes

For more information on this unit of competency visit: https://training.gov.au/Training/Details/CHCCCS020

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Introduction Working in the health services industry, your main priority should be to help others. Sometimes, this is made difficult by the behaviour of patients, their family, or friends. There are times when their behaviour is not within their own control, or they may or may not know that what they are doing is inappropriate and wrong. Often, these behaviours are influenced by events they have just experienced, such as a significant trauma or loss. They may also be under the influence of drugs and alcohol, which is impairing their judgement and causing them to act in ways that are not normal.

Your initial concern should always fall to the potential danger of a situation, and you should protect yourself as a priority. You must learn how to respond appropriately to behaviours of concern and handle these types of difficult incidents to protect yourself, defuse the situation and, ideally, find a way to help the patient without causing harm to others. Through this unit, you will develop the skills and knowledge required to respond effectively to selected behaviours of concern. You will learn the skills to identify difficult incidents, apply a response in line with organisational policies and procedures, report, and review incidents, and how to debrief. You will also demonstrate your ability to effectively deal with a range of behaviours of concern using appropriate strategies and taking into consideration any legal and ethical requirements. Developing skills to manage behaviours of concern is imperative for anyone preparing to work in the health services industry. Unfortunately, occupational violence in this industry is quite common, with the World Health Organisation (WHO) reporting that up to 38% of health workers will suffer some kind of physical violence in their careers. As such, health workers need to know how to defuse these situations when they’re recognised and how to manage them when this is not possible. Health workers most at risk are those directly involved with patient care. This includes, but is far from limited to nurses, emergency room staff and ambulance officers.

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CHCCCS020 - Respond effectively to behaviours of concern

Identify behaviour and plan response Behaviour of concern can be defined as behaviour where a person or persons act in a manner that threatens the physical safety of themselves and those around them, including carers, staff, family members and friends. Behaviours of concern not only cause potential harm while posing a risk to Work Health and Safety, they also stop patients from receiving the best quality of care, thus affecting their health outcomes.

Influences on behaviour According to the NSW Health website, behaviour is affected by factors relating to the person, including: y

physical factors – age, health, illness, pain, influence of a substance or medication

y

personal and emotional factors – personality, beliefs, expectations, emotions, mental health

y

life experiences – family, culture, friends, life events

y

what the person needs and wants.

Behaviour is also affected by the context, including: y

what is happening at the time

y

the environment – heat, light, noise, privacy

y

the response of other people, which is affected by their own physical factors, personal and emotional factors, life experiences, wants and needs.

The first step to responding effectively to behaviours of concern is being able to identify the initial signs of them. It is important that you are aware of the types of behaviours of concern that are common to your role, and when they are most likely to occur. For example:

Ü O ccupational

violence inflicted on ambulance workers is most often caused by young males affected by drugs or alcohol.

Ü The

most common occupational violence inflicted on medical officers such as doctors occurs in emergency departments when treating patients affected by drugs and alcohol, or when dealing with people in highstress situations such as in delivery suites, intensive care (ICU) or critical care units (CCU).

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Ü Nurses

are most at risk of occupational violence. They are at the greatest risk when working in emergency departments, drug and alcohol services and mental health and dementia wards. Highstress situations which cause the greatest number of incidents include ICU, maternity and delivery suites and child and paediatric wards when parents of sick children are distressed.

Ü Allied

health professionals such as occupational therapists, social workers and psychologists reported the lowest levels of occupational violence. Allied health professionals are most at risk when working alone, when working drug and alcohol services and when dealing with high-stress situations such as domestic violence and child protection. These incidents occur in hospital and communitybased settings.

Ü Ancillary staff, which includes administrators, cleaners, and ward staff also experience occupational

violence. Most often, it is the admission and complaints staff that are most at risk, as well as security officers, with many reporting verbal abuse occurring daily.

To find out which behaviours of concern are most common to your role, you should conduct research, review data, speak to governing bodies, the organisation you work for, your supervisor and those working in the industry. You should also review your position description, any orientation information, as well as all relevant organisational policies and procedures to know how best to respond. If behaviours of concern have the potential to occur in the health service you work for, the organisation will have policies and procedures in place for responding to these behaviours. All staff have a responsibility to know what their role is and what to do if an incident arises.

Behaviours of concern

Reflection Before we study different behaviours of concern, let’s reflect on and discuss the following situation. Imagine you are in a very deep sleep. You are suddenly woken up by someone entering your room. You have no idea where you are, everything looks blurry and unfamiliar. The person then proceeds to coax

you out of bed to get dressed because you need to get some tests done. None of this makes sense. They then start to undress you and put different clothes on you and place you on something which suddenly starts moving giving you a jolt! All this makes you angry and fearful and a wave of emotions wells up and you start crying and hit the person.

Reflect on: y

What emotions could result in the above scenario?

y

What could be the causes of behaviours of concern in both scenario?

y

What could the staff have done differently to reduce the risk of behaviour in this scenario?

To respond to behaviours of concern effectively, it is imperative that you know what to look for. This will enable you to act quickly, manage the incident and prevent it from escalating. Behaviours of concern that you may identify in line with your work roles and organisational policies and procedures are outlined below.

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CHCCCS020 - Respond effectively to behaviours of concern

Aggression Aggression is where a person behaves in an angry or violent manner which can cause physical or emotional harm to others. A person who is aggressive will most often verbally abuse others; however, in some instances, this turns to physical abuse and violence. Physical aggression may include shoving, pushing, hitting, kicking, or biting. It is important that incidents of aggression are dealt with and defused quickly to prevent escalation. Most often, a person expresses aggression because they are frustrated, confused, angry and/or upset about the situation they find themselves in. They may also be living with health conditions that trigger an outburst. Such conditions may include, but are not limited to: y

Attention deficit hyperactivity disorder (ADHD)

y

Post traumatic stress disorder (PTSD)

y

Schizophrenia

y

Autism spectrum disorder (ASD)

y

Bipolar disorder

Also, anyone who has suffered damage to the brain may have an inability to control their behaviour. This may be the case if they have suffered a head injury, Acquired Brain Injury (ABI), stroke or an infection or illness which has affected their brain. People who are affected by alcohol and other drugs can also experience unwanted effects in the form of aggression. Alcohol and stimulant drugs such as cocaine, amphetamines, and methamphetamines, in particular, alter a person’s brain chemistry making them more likely to act without inhibitions and struggle to stay in control. When stimulant drugs are taken heavily or binged, they can cause hallucinations and

paranoia, and this can entice a person to feel the need to protect themselves as they may start to believe people are trying to harm them. This behaviour will more often than not end in them trying to inflict physical violence; often on those who are trying to help them. As a worker in health services, your workplace will have policies and procedures in place for responding to persons expressing anger. How to deal with aggressive behaviour will vary depending on the type of patient or community member you are dealing with, and the reason for their aggression. For example, if you work at a drug rehabilitation facility, the organisation will have specific procedures for supporting affected patients that will be suitable for those under the influence of drugs. While you are required to follow any organisational policies and procedures mandated for your work role, what works for one patient may not work for another, so it is important to be aware of your options and act appropriately.

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Patients and consumers of health care services have the right to: y

have access to the right treatment and services that meet their needs

y

receive high quality, safe healthcare that meets their needs

y

be treated with respect, dignity and have their culture, identity, beliefs, and choices recognised and respected

y

ask questions, make decisions with the health provider, and choose the people they want to be involved in planning and decision making

y

receive information about their own health and the services available

y

have their privacy respected

y

give feedback about services received.

Your response to behaviours of concern should take into consideration a patient’s rights and ensure their needs are met. In a situation where it becomes challenging for you to work with a patient, your own safety must be considered, even if this means removing yourself from the situation completely. If you feel able and qualified to support the person, you should ensure that you maintain a safe distance from the aggressor. It is best to approach the situation by first attempting to calm the person. You can do this by speaking in a low, slow, and calm voice, asking questions, getting the person to talk, using positive body language, and trying to make a connection with them by showing empathy for them and their situation. Telling them that all you want to do is help them can also placate them. Remember that a person who does not identify with their diagnosis will find it difficult to moderate their behaviour, therefore it is important that you respond calmly without causing undue escalation. Ask questions and clarify something with them before you proceed. For example, if the patient is bleeding you might ask them in a low, slow, and calm voice if they would like to sit down and whether it is okay for you to have a look at the cut on their arm. Remember that it is all about taking small steps and checking with them along the way so that they know what is happening, and they can decide (if they are capable). It’s also important that they are not taken by surprise, as this may worsen the triggers. Where the situation cannot be defused, you should protect yourself by withdrawing from it and calling for assistance.

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CHCCCS020 - Respond effectively to behaviours of concern

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Reflection - behaviour expressed as aggression

Think back to when you had to deal with a patient who has lived experience of mental health challenges and sometimes expresses aggression. If you haven’t had experience working with someone with mental health challenges, you may choose a co-worker or fellow student. 1.

Briefly describe the situation in which the behaviour occurred.

2. Did you feel able and qualified to deal with the situation? Why or why not? 3. Describe your response to the situation. 4. What was the outcome of the situation?

Confusion or other cognitive impairment Confusion and cognitive impairment are where a person is unable to think clearly and may feel disorientated, making it difficult for them to make even the simplest decisions. Cognitive impairment can cause a person to have memory problems, difficulty thinking and problems communicating. A person who is confused because of this may be unclear and unsure of what is happening. They may also not know where or who they are. Cognitive impairment and confusion may be short or long-term, and it may develop quickly or slowly over time. A state of confusion may be permanent, or it may be a condition that comes and goes. Confusion may cause a person to act irrationally, strangely, and potentially aggressively. As a health worker, you can identify if a person is confused by asking them a series of simple questions that they should know the answer to, such as their name, age, and the day of the week. It is important that you ask these questions in a clear, calm, and supportive way and not in a way that may be perceived as confronting, which could make a person feel stupid and subsequently upset and anger them.

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Causes of confusion are varied. Short-term confusion can occur if a person is suffering from: y

intoxication

y

certain medications, such as antidepressants and sedatives

y

head trauma or concussion

y

high fever

y

seizures

y

electrolyte and fluid imbalance, including dehydration

y

hypothermia

y

nutritional deficiencies, such as vitamin B12

y

low blood sugar

y

emotional trauma

y

lack of sleep

y

urinary tract infections in an older person

y

infections

y

unmet needs.

Long-term confusion can be caused by brain tumours, neurological diseases such as Parkinson’s, PTSD, and cognitive impairments such as dementia. How you can best assist a person who is confused will depend on the cause of their confusion. For example, a person who is confused because of intoxication will require a different strategy to someone who is confused because they have dementia. Consider the follow when dealing with someone who is confused: y

Treating them with courtesy and respect.

y

Speaking in a calm, low and reassuring tone.

y

Approaching them from the front, so they can see you coming.

y

Asking them for their name and introducing yourself by name and advising them of your area of employment. For example, “My name is Glenda, and I am a nurse here at St Andrews hospital.”

y

Asking questions that are simple and straight to the point. Only ask one question at a time. If the patient doesn’t respond, ask them again using the exact same wording.

y

Taking them to a private area, free of distractions. Be clear with them about where you are taking them.

y

Using simple distractions to assist you to get them to a private area, such as asking them if they want to get a drink, sit-down and relax or get a bite to eat. Help orient them to the area.

Feeding the patient or getting them something to drink is nurturing and a great way to get them to trust you and answer your questions so that you can work out who they are, where they came from and how to best assist them.

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CHCCCS020 - Respond effectively to behaviours of concern

Disinhibited behaviours Disinhibition generally occurs in dementia and includes those associated with decreased capacity of judgement and reduced awareness of how the behaviour impacts on others. Sexual disinhibition is particularly common. These behaviours can include: y

simulating sexual acts

y

sexual remarks

y

requesting unnecessary genital care

y

masturbation in public

y

attempts at intercourse, rape

y

exhibitionism

y

sexual aggression

y

fondling

y

propositioning others

y

chasing others for sexual purposes.

y

grabbing, groping

Responses to these behaviours include: y

modifying environmental aspects, such as closing the door or pulling the curtains to provide privacy

y

moving the person to a more private area

y

modified clothing

y

changing staff roles

y

providing distraction, redirection, and modified learning techniques

y

activities to occupy the person’s hands

y

increased, positive contact with family and friends

y

avoiding overreaction or knee-jerk responses that induce shame or humiliation.

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Intoxication Intoxication is the result of high levels of alcohol or drugs. Intoxication dramatically affects a person’s normal capacity to act or reason. Supporting an intoxicated person can be difficult and, sometimes, put you in danger. The situation can escalate quickly and without warning. A person who is drug and/or alcohol affected may not be their usual self and may not be thinking clearly or rationally. It is important that you put your own safety first when you are trying to help them. Drug and/or alcohol abuse causes the most episodes of occupational violence in the health services industry. You should never put yourself into a situation where you may be physically harmed by someone experiencing unwanted responses from drugs or alcohol. Symptoms such as speaking loudly, clenched fists, flaring nostrils, rapid breathing and a sudden change in demeanour can indicate escalation and may pose a risk to physical safety of people around them. Identifying these signs early will assist you in avoiding danger. Helping a person who is intoxicated can be challenging and sometimes dangerous, especially if they have taken drugs that cause hallucinations and paranoia. Your safety is paramount and should be your number one priority. If you feel it is safe to assist a person who is intoxicated, these tips may be of benefit: y

Stay calm and speak to them in a low tone.

y

Don’t be judgemental, don’t issue blame, make fun of them, or act annoyed or angry. This is likely to cause conflict.

y

Do not try to sober them up. The only thing that will sober a person up is time.

y

Make the person comfortable and, if they lie down, ensure that they lie on their side and not their back or stomach. If they fall asleep, regularly check on them to ensure that they are still breathing.

y

Do not leave them on their own if they are vomiting. Comfort and assist them by holding their hair back.

y

Offer and encourage them to drink water.

y

Protect them from injury. It has been estimated that 2 in every 10 intoxicated people experience some form of injury while under the influence.

y

Call for emergency assistance if the person becomes unconscious and is not breathing, if they appear confused, cold, clammy and they are vomiting; these are all signs of alcohol poisoning. Where you suspect that a person may be overdosing on drugs (i.e., they are seizing, experiencing breathing difficulties/not breathing, turning blue or there are signs of internal bleeding) you need to get emergency assistance immediately.

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CHCCCS020 - Respond effectively to behaviours of concern

Manipulation Manipulation is where a person uses persuasion, deception, coaxing and misdirection to get what they want, while ignoring and potentially harming the needs of others. A person who manipulates others often feels that this is the only way to get what they want. They lie, use bribery and blackmail, undermine, and blame others and try to make others feel guilty to get their own way. They may also fake concern and apologise to gain sympathy. People who suffer from anti-social and narcissistic personality disorders often manipulate others. Those suffering from addictive behaviours such as alcohol, drug use and gambling often manipulate others to gain access to money and to convince others that they are not addicted or that they have overcome their problem. Manipulative behaviour can be difficult to identify; you often need to observe someone over a period of time to determine what is happening and why. People who regularly manipulate others will have a preferred method of doing so, whether it is lying, distorting the truth, or spreading false information to get a rise out of people. Manipulative behaviour is unacceptable and should be dealt with immediately. You need to be firm and clearly identify the inappropriate behaviour and outline why it is unacceptable. It is important that you make them understand how their behaviour is affecting others, for example, the way manipulation: y

hurts people, causes stress and anxiety, and may affect the ability of others to trust them in the future

y

causes emotional damage

y

makes people less likely to believe them and label them as a liar and someone not to be trusted; others may stop listening to them or providing support and assistance

y

over time, causes a person to believe their own lies and make them unable to tell the difference between right and wrong, or true and false.

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Intrusive behaviour Intrusive behaviour is where a person invades your personal space and does so to intimidate you or make you feel uncomfortable. A person who is being intrusive may get too close to you, get in your face, touch, or poke you, hover around you, act overly familiar with you or ask questions that may be perceived as personal or nosey. Intrusive behaviour shows a lack of respect for a person’s privacy and includes snooping through a person’s belongings, reading text messages and emails, or entering a person’s house or room without being invited. Intrusive behaviour can make people feel scared and uneasy. It is unacceptable behaviour and should be identified and dealt with to ensure that it stops. Intrusive behaviour cannot always be controlled. Those who have conditions that affect their spatial awareness, such as autism spectrum disorder, can lack an understanding of personal space and what type of touching is considered appropriate. They may hug someone for too long or open the bathroom door without knocking first. They often need help and support to learn about selfawareness and how to maintain an appropriate social distance. When dealing with a person who exhibits intrusive behaviour, you should: y

identify the behaviour immediately and guide them away from it; implementing a diversional tactic can be an excellent way to so this, such as asking them if they would like to come and see the hospital aquarium or games room

y

change the topic to something less personal, such as the weather, local sporting teams or holiday destinations if the person is asking too many personal questions.

Speak to them about their intrusive behaviour and why it is inappropriate in a private space away from others. Offer them an alternative or solution so that next time they are in the same situation they will be more aware of their actions and how they can affect others. Speaking to them privately is important; you do not want to embarrass them or make them feel bad for something that they may not have even been aware that they were doing. Noisiness Noisiness is where a person makes loud and excessive sounds to intimidate others, bully them, get their point across, to be argumentative or to dominate the conversation. Noisiness can include yelling, shouting, stomping, banging, or kicking walls and furniture. It is a loud and constant noise that can be distressing and upsetting to others. Repeated noisiness on a regular basis can be harmful, especially to children; it can affect their self-confidence, create concentration problems, and cause them to be fearful or aggressive in the future. Incidents of noisiness should be dealt with to prevent escalation. When dealing with noisy people, it is important to be clear and calm. No one wants to be told they are being too loud and to lower their voice, especially if they are angry. Often, people who feel that they have an audience will further exaggerate their noisiness to gain attention, and even recruit others to be part of their argument. In this type of situation, it may be best to ask them to accompany you to a meeting room or private location so that you can discuss the issue with them. When people are away from others, they are more likely to relax, lower their voice and be reasonable and accepting of a solution. When speaking with them you should talk in a quiet and calm tone. 15

CHCCCS020 - Respond effectively to behaviours of concern

Self-destructive behaviour Self-destructive behaviours are actions that are deliberate and impulsive; they can harm a person physically, socially and/or emotionally. Self-destructive behaviour can be sub-conscious or intentional. It is dysfunctional and can have serious, long-lasting consequences if not addressed and dealt with effectively. Self-destructive behaviour can include:

People often engage in self-destructive behaviour due to unmet needs, including:

y

drinking alcohol and taking drugs

y

over or undereating, fasting, or purging after eating

y

gambling

y

engaging in dangerous sexual practices

y

making extreme physical changes that would be seen as out of character, such as cutting off all your hair, getting a tattoo or plastic surgery

y

becoming violent

y

avoiding others and/or isolating yourself

y

using sleep as a way to escape

y

stealing from others or shoplifting

y

cheating on a partner

y

making sudden and serious life changes, such as taking up smoking or quitting your job or school

y

getting in trouble with the law

y

a sudden decrease in work performance or a drop in school results

y

a person cutting themselves.

Ü As a coping mechanism when

a person is overwhelmed or has experienced loss

Ü Self-hatred, shame or to punish

themselves for something that they have done

Ü To drive other people away Ü For attention because they are lonely Ü Anger and bitterness at their situation Ü Alack of self-confidence.

A person who exhibits self-destructive behaviour most often suffers from anxiety, low self-esteem, and feelings of worthlessness. They may engage in dangerous behaviours and make attempts to end their life. In some cases, self-destructive behaviour may turn into self-harm where a person physically hurts themselves as a form of punishment. Self-destructive behaviour can be treated if the underlying problems and risk factors can be identified and appropriately dealt with, using a range of behavioural therapies such as counselling, coping skills and positive thinking techniques. Early intervention is extremely important to prevent further escalation of the destructive behaviour. A person who is self-destructive should be monitored closely. You should be supportive, encouraging and reassuring. Speak to them about their situation in a private room and involve their support network including family and friends. Where a person is suicidal or at risk of serious injury or self-harm, you may need to seek medical or emergency assistance.

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Wandering Wandering behaviour is where a person roams or walks off, losing their way. Wandering occurs when patients suffer conditions with significant memory loss and are mobile, i.e., able to walk or transport themselves. Wandering is associated with many conditions, including: y

autism spectrum disorder

y

Down syndrome

y

dementia resulting from Alzheimer’s disease

y

stroke

y

head injuries

y

Parkinson’s disease.

It is, however, most common in dementia patients, with 6 in every 10 people with dementia wandering off at some point. Wandering is dangerous as the person most often becomes disoriented and doesn’t know where they are, who they are or how to get help. Wandering is preventable with the right policies and procedures in place. Patients with conditions which may cause them to wander should be in a secure environment, and when they do leave, they should be appropriately supervised. Patients should have appropriate identification with them at all times in the event that they do wander. Some aged care facilities allow patients to wander if they have created a safe environment for them to do so. Below is a list of approaches to dealing with wandering patients: y

Approach them and speak to them calmly.

y

Gently guide them back to where they should be. Diversional tactics can be a great way to do this. Ask them if they would like to get something to eat, if they would like to go outside with you to get some fresh air, or tell them that there is an activity running in the games room.

y

Don’t tell them off for wandering even though you may be angry that they made you so worried. Remember that they too may have been worried, confused, and scared.

y

Try to determine the reason for their wandering, e.g., were they looking for someone or something, or are they bored and went looking for something to do?

y

Monitor them to ensure that they don’t wander off again, and make any alterations to the environment needed to stop them from wandering again.

In a situation where a person is missing and you don’t know where they have wandered to you should: y

Stay calm and thoroughly search the premises. Walk around the streets that the premises are situated in. Speak to people on the street and ask them if they have seen the person you are looking for. If possible, take a photo with you and recall what they were wearing to assist in identifying them.

y

Contact the local police. Explain the situation, the person’s condition and that you are concerned for their safety. Give the police as much information as you can to be able to identify them. It can also be helpful to make a list of places that the person enjoys or likes to visit so they can check these areas as part of their search. 17

CHCCCS020 - Respond effectively to behaviours of concern

Verbal offensiveness Verbal offensiveness is any spoken expression that is perceived as rude, offensive, and vulgar. It can include swearing, insults, put-downs and name calling. Verbal offensives that are directed at a person in an aggressive manner is classified as verbal abuse. Verbal abuse is often used to control someone through their thoughts, feelings, actions, and behaviours. It can be used to intimidate someone and manipulate them into doing what you want. Someone who is verbally offensive will: y

often make fun of people their actions, ideas, and beliefs

y

make negative comments about people and places

y

dismiss their rudeness or hurtful comments by saying that it was “just a joke”

y

answer questions in a derogatory way, making you feel stupid for having asked the question in the first place

y

make you feel scared, uncomfortable, and nervous when speaking to them, especially about certain topics that you know they feel strongly about or that could anger them

y

yell, swear and be offensive on a regular basis, often using put-downs and insults to get what they want.

No one has the right to be verbally offensive and make others feel unsafe in their environment. Verbal offensiveness is the most common act of occupational violence in the health services industry. This is often because people think that words don’t matter and that they are not affecting the person that they are directing them at. There is also the thought that there are no consequences for being verbally offensive and that a person can say whatever they want without penalty.

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In fact, Victoria has a law to regulate offensive language with the penalty, if convicted, being up to six months imprisonment (third offense). Under the Summary Offences Act 1966 section 17, offensive language is considered to be any language that is disorderly, threatening, offensive, indecent, and violent. For example, a person in a public place singing an obscene song or ballad could be charged under the Act. Where a person is being verbally offensive you should: Getting angry will only cause the situation to escalate and cause them to potentially become more aggressive and even violent.

Be clear, firm and polite

Be clear and firm in your instructions and ask them politely to follow you to another location that is quieter and away from others (if they continue to be offensive, tell them that you will only speak to them once they calm down and accompany you to the location).

Use diversional tactics

For example, you might say, “Sir, if you could please follow me, I’m sure that I will be able to address all of your concerns.”

Seek assistance

Seek the assistance of security or the police where you cannot calm the patient or other party, and they continue to be offensive.

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Stay calm

2

Watch - wandering in dementia

It is important to know to assist someone who wanders due to dementia. You are to watch the video at the link below: https://www.youtube.com/watch?v=5d2cMSgNh2U Mrs Warrick is the patient who wanders in the video, and Leah and Sarah are the healthcare professionals. In the video, Leah is starting to look visibly distressed that she cannot locate the patient, and at this point she runs into Sarah, one of the nurses. y

What information does Sarah have about Mrs Warrick that helps them eventually locate her?

y

What are the first things that they say to her when they find her?

y

Was this appropriate? Why do you think this?

y

What is the benefit of talking to other colleagues when dealing with behaviours of concern and how does this video highlight this?

19

CHCCCS020 - Respond effectively to behaviours of concern

Respond appropriately to behaviours of concern When you identify a behaviour of concern, you will need to act quickly, calming the client and responding

appropriately to the situation in line with your organisation’s policies and procedures. In the previous section, we explored several ways to deal with behaviours of concern. It is important to remember that how you respond to a behaviour of concern will not always be the same, as aspects of the incident will be different, requiring you to be flexible and select an appropriate response for each situation you are in. How best to respond will depend on several factors, including: è the organisation you work for and their policies and procedures for handling this type of incident è the environment: y

Is it safe if the response does not go as planned, e.g., are there any objects in sight that could be used as weapons?

y

Is it noisy? Will it be difficult to speak with the patient in a calm and non-confronting way?

y

Are you likely to be interrupted or distracted?

y

Are there too many people around?

y

Is the environment comfortable or is it likely to cause a person to be unsettled and anxious? For example, is it too hot, are there too many bright lights or is the room too cluttered?

è the behaviour of concern that has occurred; some are more serious and pose a greater risk which requires the response to be greater è  who is exhibiting the behaviour? Do they have any medical conditions that may explain their behaviour? This might apply to a person with dementia wandering off. è your personal safety and whether you feel comfortable enough with the situation to respond (you should always give priority to the safety of yourself and others in responding to behaviour of concern) è the resources available to assist with the incident, including staff and any required equipment.

20

As a general guideline when responding to any behaviour of concern you should:

1

2

3

4

5

6

7

Identify y

What is the behaviour of concern?

y

What has caused it? This is important as it may assist you to determine how to respond and rectify the issue. For example, if a patient is aggressive because they have been waiting to see a doctor for over 4 hours, you could solve the problem and potentially defuse their aggression by getting a doctor to see them straight away.

Ensure safety y

Is it safe for you to act?

y

Ensure safety of yourself and others.

y

Look for any dangers that exist.

Act y

In accordance with organisational policies and procedures and any legal obligations to manage the situation and prevent escalation.

y

Aim to stop the behaviour or minimise it.

y

Use nearby staff and resources to assist, where required.

y

Determine the most appropriate response for the situation. In some situations, this may require you to be calm and empathetic and, in others, firm and diplomatic.

Communicate clearly y

No matter what approach you use to respond to a client, it is important that you communicate clearly and in an appropriate tone.

y

Listen actively when the client speaks.

Seek assistance y

Where you identify that the situation is dangerous and/or outside of your job role, you should seek the assistance of supervisors, security staff and the police.

y

Where you require access to duress and/or personal alarm systems to alert the appropriate persons.

Report and record y

Report and record the incident according to organisational policies and procedures.

y

Review the incident and identify if it could have been handled differently.

Debrief Participate in debriefing to support self and others.

21

CHCCCS020 - Respond effectively to behaviours of concern

Organisational policies and procedures Organisational policies and procedures within health services environments will have planned responses for common behaviours of concern. All staff should be well versed in these planned responses so that they know how to handle situations when and if an incident arises. Staff should be made aware of planned responses on several occasions, including: y

when undertaking orientation or induction to the organisation.

y

at regular intervals as part of staff meetings and training opportunities.

y

as part of the organisation’s staff handbook.

There should also be pictorial displays in common areas such as staff rooms so all staff can review and update their knowledge on a regular basis.

What is a policy? A policy is made up of clear, simple statements of how an organisation intends to carry out its services, actions, or business. They provide a set of strict guidelines that must be followed by all members of staff when making decisions. For example A policy may state: This policy is for dealing with anger and aggression committed in the workplace by any patient, visitor or person working in the facility.

What is a procedure? A procedure describes how each policy will be put into action in an organisation. The procedures should outline who will do what, the steps they will need to take and what documentation or forms to use. Procedures usually include more detail than policies. For example 1. Remain calm and respectful. 2. Assess the situation to ensure that you or anyone else is not in danger. 3. Use a low and calm tone when speaking to the aggressive person or persons. 4. Listen to them; don’t intervene too quickly. Allow them an opportunity to voice their grievance, and listen actively. 5. Acknowledge their feelings without agreeing or disagreeing with them. Stay neutral.

22

Staff support When dealing with behaviours of concern it is important that staff are supported. Dealing with patients or others in the workplace who are acting inappropriately can be quite distressing. Working with people in these instances should be a team approach with employees feeling supported by their colleagues and the organisation as a whole. When responding to a behaviour of concern, the communication lines between colleagues, supervisors, health professionals, a patient’s family, and emergency personnel, when required, should be as open as possible. For example, if a patient is acting out of the ordinary, or if they’re disoriented and verbally abusive, one staff member may need to work on calming the patient down, while their colleague contacts the patient’s family or health professional to gather any information that may be useful in finding out why the patient is acting this way. Perhaps there’s been a sudden loss in the family, bad news or a change in medication or dosage. To ensure that incidents are appropriately supported, and staff feel safe, planned responses to behaviours of concern should maximise the availability of appropriate staff and resources. If an organisation’s procedure requires you to access a particular staff member or health professional when a behaviour of concern arises, you must do so. You should also utilise staff with specific expertise in handling particular behaviours; this will assist you, as these staff may have a rapport or relationship with a particular patient and know how best to speak to them to defuse the situation. Staff are valuable assets when dealing with behaviours of concern. Therefore, if you feel that someone is better equipped than yourself to handle a situation, you should not hesitate to use them, especially if it means a calmer, more effective and productive approach. Resources that could be utilised when responding to behaviours of concern will depend on the issue you are facing, who the person is that is exhibiting the behaviour, and what their condition is. Resources that would be helpful when dealing with a range of behaviours of concern, include: y

a quiet room that is always available for use, if you need to take a person to an area away from others

y

basic essentials such as bottles of water, tea, coffee, and light snacks – these can be used as diversion tactics to calm a person down, get them talking and allow them to feel comfortable

y

medical supplies in the event that a person is injured and needs assistance

y

games, toys, pack of cards and other items that may interest clients and distract them from the situation

y

cleaning equipment such as a dustpan, broom, wipes, and sponges in the event that you need to clean up after an incident

y

contact details of health professionals, family, and friends

y

duress and personal alarm devices if you require emergency assistance

y

phone for a person to use if they need to contact a family or friend immediately, or speak to their counsellor, sponsor, or other support person in their lives.

23

CHCCCS020 - Respond effectively to behaviours of concern

Prioritise your safety As mentioned earlier, when responding to behaviours of concern you must give priority to your personal safety and the safety of others. This is required by law under the Occupational Health and Safety Act 2004 in Victoria. This Act ensures that those employed in an organisation, as well as those being treated or visiting the facility, remain safe. Employers have a responsibility to ensure the safety of their employees. Part of this is ensuring that they are provided with adequate training to be able to respond appropriately to behaviours of concern and that the required organisational policies and procedures are followed and regularly communicated with staff. To keep yourself safe when responding to behaviours of concern you should: Be prepared Know how to handle the situation and what your role is in managing it. Familiarise yourself regularly with the organisation’s policies and procedures for handling behaviours of concern. If you are visiting a particular patient that you have not met with before, it is a good idea to familiarise yourself with their condition and check their history for any instances of behaviours of concern. Be alert Concentrate on the person who is exhibiting the behaviour of concern. Avoid looking around the room, taking your focus off the person who could potentially try to hurt you or those around you. Know your patients and/or clients Behaviours of concern will most commonly come from patients and clients that an employee may be familiar with. If you know them and are familiar with their condition you can be more effective in handling an incident and protecting yourself from potential harm. Stay calm and in control When facing a person who is abusive or aggressive it is important to maintain your composure. If you get angry back at them this will likely escalate the issue, making it worse and potentially causing the person to become violent risking your physical safety and the safety of others. Don’t stand directly in front of someone This can be seen as confrontational. Also, ensure that you are standing far enough away that you are unlikely to be harmed if the person decides to lunge at you or try to hit you. Survey the area and make sure it is safe If you can see that a person has a weapon, remove yourself immediately from the situation, find a safe place and available security staff and police if necessary.

24

Have an exit strategy Leave yourself a safe passage in case you need to remove yourself from the situation immediately. For example, if you are in a quiet meeting room with a patient, always position yourself closest to the door in case you need to leave. Ask staff for assistance If you feel that you may be in danger, consider getting a member of the security team or a police officer to attend to the patient with you. Avoid attending to a patient without notifying someone of your whereabouts Always tell someone else how long you expect to be gone for. This safeguards you if something happens. Defend yourself Under law you are permitted to defend yourself and do what is deemed to be “reasonably necessary” in the event of a physical attack on your safety. Self-defence in the form of restraint and force should only be used as a last resort where there is no other option.

Learning Checkpoint 1 1.

Define the term’ behaviour of concern’.

2. What are the 10 behaviours of concern? 3. Aside from clients and patients, who else might you need to deal with who might display some of the behaviours of concern that we have covered? List 3 that you think might be most displayed in those other than patients. 4. List 10 ways you can protect your safety when responding to areas of concern.

25

CHCCCS020 - Respond effectively to behaviours of concern

Applying a response When selecting and applying a response to an identified behaviour of concern, you should ensure that your response reflects organisational policies and procedures. As part of this you are obligated to consider and uphold any legal and ethical requirements of your job role. This ensures that behaviours of concern are responded to in an effective, consistent, and appropriate way. When dealing with a behaviour of concern, it is important that you follow the appropriate organisational policies and procedures, communicate effectively, seek assistance when required and select an appropriate strategy to suit the behaviour of concern.

Legal and ethical considerations Ethical standards There are many ethical standards you need to be aware of in the health services industry. Peak bodies set many of these ethical standards through their Code of Conduct and Code of Ethics. These include the Aged and Community Services Australia, Australian Nursing Federation, and the Australian Council of Social Service. These ethical considerations mostly relate to the treatment and care of patients and include statements that relate to: y

respect for patients

y

valuing diversity

y

behaving in a non-judgmental way

y

showing empathy

y

providing support.

The major difference between ethical and legal standards is that ethical standards are set by society; they are seen as the “right thing to do”, whereas legal standards are backed by legislation and failure to comply with these may result in legal action. We have already explored the importance of Work Health and Safety legislation to protect the safety of yourself and others in the workplace. When responding to behaviours of concern in the health services industry, it is also important that you understand your duty of care obligations, your responsibilities relating to confidentiality and privacy, and how to ensure that a person’s human rights are not violated by your actions.

26

Your duty of care obligations Duty of care is a legal requirement. As a health services worker, you have a responsibility to your clients and patients to reduce or limit the amount of harm or risk they are exposed to. You have a responsibility to foresee any possible dangers that may harm or injure a person in your care. Upholding your duty of care obligations is about doing all that is considered to be reasonable to foresee any potential dangers or sources of harm and act accordingly. Reasonable is considered to be actions that are acceptable, average, equitable, fair, fit, honest, proper, right, tolerable or within reason. Failure to do so could be seen as negligent and in breach of your duty of care obligations. When responding to a behaviour of concern, you have a duty of care to that person; however, this obligation does not supersede your own safety or the safety of others. To ensure your duty of care when responding to behaviours of concern you should: y

follow organisational policies and procedures as well as any planned responses

y

ensure your personal safety and the safety of others around you

y

take any steps that are reasonable to prevent harm, such as moving away potential objects that

y

seek help when you identify a situation where a person is being abused, is self-harming or is potentially suicidal

y

report any behaviours of concern immediately so that the situation can be managed and controlled, preventing escalation and further risk

y

report the situation and record all required information for your employer, regulatory body and/or government authority.

could be used as weapons

27

CHCCCS020 - Respond effectively to behaviours of concern

Confidentiality and privacy Workers in the health services industry have an ethical and legal responsibility to ensure client and patient confidentiality and privacy. The terms privacy and confidentiality differ. Confidentiality is an ethical duty that a person upholds, such as doctors, therapists, and attorneys. Upholding client confidentiality is best practice for any activity or organisation. Privacy is law through the Commonwealth Privacy Act 1988. Privacy legislation protects an individual’s personal information. It ensures that any information regarding client status, wellbeing or their personal details cannot be used for anything other than what they were obtained for, nor can their information be passed on to a third party without their permission. Ways to uphold privacy and confidentiality include:

ü ü ü ü

Not talking about clients outside of the work environment. Only discussing clients with those who need the information. Conducting interviews in a private place. Seek client and patient permission to share their information.

Staff members that work in health services organisations are generally required to sign a Confidentiality Agreement when they start employment. Any breach of privacy and confidentiality policies usually results in disciplinary action being taken. There are several Acts that mandate that the confidentiality of client information is upheld, some of which include: Health Administration Act 1982 (NSW)

Any information that is provided or recorded within the health system cannot be disclosed without consent from the client/patient.

Health Records and Information Privacy Act 2002 (NSW)

This Act protects the health information of individuals. It also allows individuals to access their health information when requested.

Health Services Act 1988 (Vic)

This Act ensures that anyone involved in health services, including any persons engaged or employed in a service or performing work for it, are prohibited from disclosing information that could directly or indirectly identify a patient. Penalties for such breaches may include a fine of up to 50 penalty units, which equates to $7,380.50.

Those working in the health services industry are ethically responsible to ensure client confidentiality.

28

This ethical responsibility is often written into their relevant code of conduct, practice, and oaths. The Hippocratic Oath, in particular, includes the statement:

The Australian Medical Association’s Code of Ethics also states:

“

Maintain your patient’s confidentiality. Exceptions to this must be taken very seriously. They may include where there is a serious risk to the patient or another person, where required by law, where part of approved research, or where there are overwhelming societal issues.

“

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know.

“

“

This means that a doctor may breach confidentiality to protect a third party, such as warning a wife that her husband is HIV positive. In this instance, a doctor may choose to breach confidentiality; however, they are not obligated to do so.

Human rights Every person has rights. Our human rights are the basic rights and freedoms that every person is entitled to. Human rights are upheld all over the world through the United Nations Universal Declaration of Human Rights. There are thirty articles (sections) of the declaration; each article outlines a different aspect of human rights. These articles include things like: y

everyone has the right to life

y

everyone has the right to freedom of opinion and expression

y

everyone has the right to rest and leisure

y

everyone has the right to education.

These basic human rights are further supported by a range of international treaties which Australia supports, including The Convention on the Rights of Persons with Disabilities and the Convention on The Elimination of All Forms of Racial Discrimination. Each country, including Australia uses these treaties and the declaration of human rights as the basis for their laws and the ethical obligations of industries and job roles. When responding to a person with a behaviour of concern, you must consider their human rights. To uphold a person’s human rights, we must be fair, equitable and respectful in everything that we do no matter what the situation is and how the person is behaving.

29

CHCCCS020 - Respond effectively to behaviours of concern

Seeking assistance When you identify a behaviour of concern, you may need to seek assistance or refer the situation to someone else. Seeking the assistance of others where required can provide support and advice to assist you in working through the situation in the most appropriate and safe way. They can provide guidance and assist you to select an appropriate response suitable for the patient. They can also provide you with feedback and suggest alternative strategies that could be more appropriate or that may be worth trying when your own approach has failed or is not working as effectively as you had hoped. You should only seek advice and assistance from legitimate sources as and when appropriate. A legitimate source is one that is recognised as expert in the field and someone in a position of authority who can provide you with further guidance. In seeking the assistance of others, it is important to note that you are not to seek advice from anyone who is not privy to the patient’s personal information, as this could be seen as a breach in patient confidentiality. People you could seek assistance from include: y

supervisors, managers, and senior staff

y

co-workers

y

the police and security staff

y

work health and safety officers and representatives

y

ambulance or other medical staff on hand

y

experts or specialists in the management of specific behaviours of concern such as those who specialise in working with children with autism or those with dementia

y

counsellors

y

the patient’s family and friends.

You might seek assistance for a variety of reasons, including when: y

the expertise to handle the situation is beyond your capabilities and you need help

y

you are unsure of how to handle the situation and need to seek the advice of someone who may have dealt with a similar situation in the past

y

you feel that someone may be better equipped to handle the situation more effectively because of the skills they possess and/or the relationship that they share with the client who is exhibiting the behaviour of concern

y

the situation is dangerous and there is a threat of physical violence

y

someone has been seriously injured and requires medical attention

y

the organisation’s policies and procedures dictate that a particular person is to be contacted in the event of an incident, such as the shift supervisor or facility manager

You could seek assistance from any of the above people by contacting them through a direct call out/ directly talking to them, calling them on the phone, sending them an email, through activating a personal or duress alarm, or through alerting them via security or CCTV systems. The method you use to make contact will depend on the urgency of the assistance required and whether you can leave the situation. 30

LEAR

ITY IV

NG ACT NI

3

Quiz - protecting your safety

Let’s do a little quiz on protecting your safety. Once you have done this, discuss the answers as a class. Situation

True

If you are visiting a particular patient that you have not met with before, it is a good idea to familiarise yourself with their condition and check their history for any instances of behaviours of concern. If you can see that a person has a weapon, remove yourself immediately from the situation, find a safe place and available security staff and police if necessary. Concentrate on the person who is exhibiting the behaviour of concern, but shift your focus off them to decrease the potential of them hurting you. Behaviours of concern will most commonly come from patients and clients that an employee may be familiar with. When facing a person who is abusive or aggressive, the best way to approach them is by matching their tone and getting angry at them. Standing directly in front of someone who is displaying behaviours of concern will help to defuse the situation. If you are in a quiet meeting room with a patient, always position yourself closest to the door in case you need to leave. If you feel that you may be in danger, consider getting a member of the security team or a police officer to attend to the patient with you. You only need to advise someone else how long you expect to be gone for when visiting a patient with a history of substance abuse. Under law, you are permitted to defend yourself and do what is deemed to be “reasonably necessary” in the event of a physical attack on your safety.

31

False

CHCCCS020 - Respond effectively to behaviours of concern

Deal with behaviours of concern Dealing with behaviours of concern should always be done promptly, firmly, and diplomatically, whilst taking into account any relevant organisational policies and procedures. When a situation is dealt with immediately, it limits the chances of escalation. To deal with a situation promptly, it can be useful to implement a suitable de-escalation tactic. For example, distraction can be a great option if suitable for the client and situation, such as offering a child who is throwing a tantrum a snack or asking them if they want to play a game. As we have mentioned previously, it is important to remain calm and in control when dealing with behaviours of concern. This is an important de-escalation tactic as it is more difficult for someone to continue to be angry and aggressive towards you if you are acting calm and speaking in a low tone. It is always important not to show any signs that you are upset, confused or fearful as this will most likely reinforce the person’s behaviour and continue to escalate it. To deal with a situation promptly it can be useful to ask the person exhibiting the behaviour to accompany you to a quiet area or meeting room away from others. If a person doesn’t have an audience to their behaviour, they are more likely to calm down, be reasonable and discuss the issue, allowing you to respond and address the problem. In some instances, you will need to respond firmly to deal with the behaviour of concern. In dangerous situations, and where your personal safety and the safety of others is of concern, you may need to be assertive and definitive to immediately stop the behaviour and defuse the situation. Being firm when dealing with behaviour of concern is most often used where you are not able to cooperate with the client, where there is only one option and where the behaviour is completely inappropriate, such as the person being physically abusive, controlling and manipulative.

32

It is important when being firm that you are not seen as rude, nasty, or aggressive. Being firm is about being clear, decisive, and assertive. Being firm is about setting boundaries and identifying what behaviour is unacceptable and won’t be tolerated. To be firm you should: Keep it short Don’t launch into a long, detailed explanation of why the person’s behaviour is inappropriate. Just clearly identify it as inappropriate behaviour that will not be tolerated. Providing too much of an explanation can be seen as you are apologising or trying to justify why you need to act. Don’t repeat yourself Say something once in a clear and firm tone. Be confident in what you are asking them to do, ensuring that they see your request as what needs to be done and not as a plea or choice. Use controlled and confident body language Your body language can harm your ability to appear firm. Ensure that you give direct eye contact, have your feet firmly planted on the floor in a slightly wider stance which can make you appear larger and more confident. Stand up straight, don’t lean or hold onto anything. If you say something, make sure you stick to it If you say “no” to something, don’t make allowances or allow yourself to be manipulated. Don’t allow someone to argue with you, make excuses or objections. No means no. Stick to your guns and stand your ground Don’t allow yourself to be interrupted. If a person tries to interject while you are speaking confidently and firmly, hold up your hand to signal to them to stop talking and simply say something like, “Let me finish first and then you can talk”. As well as being prompt and firm when dealing with behaviours of concern, you also need to be diplomatic. Being diplomatic is about being sensitive and facilitating a discussion to find a peaceful resolution. You avoid fighting, raising your voice, or telling the patient what to do, and instead try to work with them to achieve the best outcome. A diplomatic approach is where you work with the patient to create a solution. You may offer something in return, for example, you might say to a patient, “If you stop using offensive language right now, we can go grab a coffee together, my treat!” Then, when they are calm and comfortable, you might ask them why they use offensive language and speak to them about how it is inappropriate and that there are other ways to voice their concerns and opinions without being offensive and disrespectful to others.

33

CHCCCS020 - Respond effectively to behaviours of concern

To be diplomatic when dealing with behaviours of concern you should: Always think about your actions Take your time, even if it’s ten seconds. Take a deep breath and think about what you are going to say. When confronted by a situation, people often respond quickly, doing or saying something that they regret later. To avoid this, take the time to consider the situation and how best to respond. Stick to the facts, be clear and decisive Avoid bringing your emotions or personal feelings into a situation. Don’t waver; be clear about the situation and how to respond. Remember, however, to be diplomatic; it is important to not be confrontational, aggressive, or rude. Diplomacy is about working with someone and cooperating with them to find a solution. Use positive language For example, instead of saying “that is a terrible idea” you might say “I don’t think that’s the best idea, how about we look at it again”. Use neutral and open body language Provide eye contact and relax your shoulders and arms. Avoid making jokes, laughing, or smiling too much as this makes you appear more friendly than diplomatic. Remember that you are not making friends; you are simply using this approach to defuse a situation in the quickest and least confronting way. Listen and be understanding Get your point across, but be clear that you don’t agree with them. For example, you might say, “I can see where you are coming from, but your behaviour and how you have approached the situation is unacceptable”.

34

LIS TE

NG NI ATIO N

NIC MU

T

NI

OM

IO

ES

Verbal communication

N TIO ICA N MU

EFFECTIVE COMMUNICATION

QU

When responding to behaviours of concern, it is important that you use communication effectively to achieve the desired outcome. Good communication skills are key to resolving most behaviours of concern and defusing a situation quickly and effectively. Both verbal and nonverbal communication should be utilised appropriately in a calm, empathetic and non-threatening manner. Positive communication is imperative to achieving a successful outcome for everyone.

VER BA LC OM

Communication

NG

NON

R -VE

BA

LC

Verbal communication is defined as what you say and how you say it. When dealing with behaviours of concern, it means saying the right thing, in the right way and at the right time. When speaking, you should do so in a calm, slow and low tone. It is important to be friendly, open, and assertive while adapting your communication style to meet the needs of your client. Consider and choose your words carefully so that you don’t agitate the patient by saying something that they may not agree with. It is also imperative that you don’t lie to them or promise them things that you will not be able to deliver. To de-escalate a situation, the patient needs to feel that they trust you and that you understand them. You should use simple language that the patient will be able to easily understand. Use short sentences and be careful not to make the patient feel as though you are talking down to them. As we discussed in the previous section you should respond to behaviours of concern promptly, firmly, and diplomatically. Be clear with the patient and provide them with all the information they require if it is within your role to do so. Being clear is especially important when working with those who are confused or who may have cognitive impairments. It is important that you provide them with clear information about what is happening and outline how you intend to help them. No matter what the situation is, you should never try to action a solution without communicating it clearly with the patient. Where you are having difficulty communicating with a patient because of culture or linguistic skills, you should seek the assistance of an interpreter and/or try to communicate using visuals and physical demonstrations.

35

CHCCCS020 - Respond effectively to behaviours of concern

Non-verbal communication When we communicate, we not only use verbal communication, but we also use non-verbal signals, wordless communication, and body language. Non-verbal communication may include: Facial expressions Body movements and gestures Eye contact Posture Muscle tension Breathing The way you look, listen, move, and react to another person tells them more about how you’re feeling than words alone. Developing the ability to understand and use non-verbal communication can help you connect with others, navigate challenging situations, build better working relationships and respond more effectively to behaviours of concern. When dealing with behaviours of concern you will need to adapt your non-verbal communication depending on the situation and the patient that you are responding to. You should avoid the use of body language which could be misinterpreted and seen as aggressive or confrontational, such as crossing your arms across your chest or pointing your finger at them. It is also important to be aware of your facial expression. Avoid frowning and pursing your lips. Your facial expression should be neutral, and you should provide a good amount of eye contact. Depending on the situation it may be appropriate to touch someone. For example, where an elderly person is found wandering and is in a scared and confused state, touching them lightly on the back and guiding them to a safe area can be perceived as warm and trusting. However, it is important to note that touching someone in the wrong situation can be seen as inappropriate and threatening which could escalate the situation. It is important that you observe the non-verbal communication signals of the client, as this can indicate several different things. For example, a person who is clenching their fists and moving closer to you may be preparing to attack you. It is important to read these signs early and remove yourself from the situation.

36

Listening Listening is one of the most important aspects of communicating effectively when responding to behaviours of concern. Effective listening is just as important as what you say. When responding to behaviours of concern and providing care to patients it is important to listen to their wants, needs, questions and concerns. Most often, patients who are behaving in a concerning way are doing so because they need to vent, need help or they want someone to acknowledge them and their situation. To be a successful communicator you need to listen actively not passively. Active listening means that you are engaged and involved in the listening process. To be an active listener you should:

Pay attention

Look directly at the speaker. Concentrate on what they are saying; don’t silently prepare for what you will say next. Avoid being distracted by side conversations or environmental factors.

Show that you are listening

Smile and nod occasionally. Use positive body language and posture.

Provide feedback and respond appropriately

Ask questions to clarify information; use open questions to gain additional information. Be honest in your answers/feedback.

It is also important to consider that successful listening means not just understanding the words or the information being communicated, but also understanding how the speaker feels about what they’re communicating. While you often may not agree with a patient, it is important to listen, empathise and acknowledge their feelings. Listening can also allow you to gain a good understanding of the situation and allow you to communicate with the patient at the right time.

37

CHCCCS020 - Respond effectively to behaviours of concern

Questioning

Ü Probing questions

Effective questioning is a key way to find out information about a person’s behaviour of concern. It can help you to identify the cause and, therefore, defuse the situation. Questioning allows you to find out more about the patient and their condition and potentially build rapport with them. It is crucial that you choose the most suitable questioning technique to gather information; this should be based on the patient’s ability and the amount of detail you require to respond effectively to the behaviour of concern.

You can ask probing question if you want to find out more detail about something that was said. This effective questioning technique is also useful for clarifying something that someone has said. An example of a probing question would be “What made you react in such an aggressive way?” If you do not get the answer you are looking for, and require more detail, you can ask the question again and insert the word exactly, i.e., “What exactly made you act in such an aggressive way?”

Some effective questioning techniques include the use of the following:

Ü Leading questions A leading question attempts to lead the respondent in a certain direction of thinking, generally in line with your way of thinking. A leading question can be approached in a few different ways including:

Ü Open and closed questions Open-ended questions are questions without a fixed end. They encourage continued conversation that will help you gain more information. To use the open-ended questioning technique, you should begin each question with who, what, where, why, when, or how.

y

Giving two options Giving the respondent two options to choose from, both of which you are satisfied with. For example, “Should we go and sit in the conference room or outside to have a chat?”

Closed-ended questions are questions with a fixed end point. The answer to a closed question is either yes or no. To phrase a closed question, you should use words such as did, will, can, do, is and would. Closed-ended questions are excellent for seeking immediate information, confirming facts, and generally focussing on one point or topic. Depending on the setting, this approach may be more effective with children, and those with special, cultural, and linguistic needs.

y

Giving one option Only give the respondent one option, the option that you want, by making it appear to be the easiest option with the least hassle. For example, “Shall we go and sit in the conference room for a chat?”

y

Making an assumption Instead of asking someone what they want for dinner just say, “Let’s go to the conference room for a chat”.

y

Make your question direct Making your question direct makes it easy to agree with and just say ‘yes’. For example, “The conference room is so nice, let’s go ahead and sit down in the conference room for a chat”.

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As well as using the right questioning technique to gather information, it is just as important that you are direct and ask the right questions. Don’t ask too many questions as this can be quite confrontational for a person and make them feel uneasy which could escalate the situation. Ask one question at a time and prioritise them based on their importance.

Paraphrasing Paraphrasing is about putting things that someone else has said into your own words. It can be a useful communication technique to clarify the meaning of something that a patient has said or to help a patient to unlock and find the reason behind why they are feeling or acting in a certain way. When a patient speaks to you it can be helpful to paraphrase what they have said. This enables you to re-word and build on what has been said to clearly identify its meaning and the feelings or real issue behind what they are saying. Patients who are exhibiting a behaviour of concern may often be upset, angry, confused, and unable to think clearly. Because of this, they may have difficulty expressing or clearly identifying what the issue is, or why they are acting in a certain way. To make sure that you clearly understand the patient, it can be useful to paraphrase what they have said by using different words to convey the same idea or meaning. Paraphrasing can help both the health services worker and patient gain a better understanding of the situation and get to the root of the issue. Paraphrasing, if done correctly, can also assist a patient to discover what their problem is and why their behaviour may be inappropriate, without you directly telling them what their problem is. Instead, it appears to the patient that you are simply repeating what they have told you, allowing them to have the breakthrough moment when they suddenly realise why they feel or act in a certain way. While this technique can be useful it may not work for every patient, and some may express that they feel you are putting words into their mouth and that your paraphrasing is not accurate. As with all communication, when responding to behaviours of concern it is important to contextualise what you say to ensure that it is specific and appropriate for the patient.

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Reflection - The Johari Window Model

The Johari Window Model is a tool to enhance an individual’s perception of others. This model is based on two principles: 1.

Trust can be acquired by revealing information about you to others

2. Learning about yourself from others feedback. Each person is represented by the Johari model through four quadrants or windowpanes. Each four windowpanes signify personal information, feelings, motivation and whether that information is known or unknown to oneself or others in four viewpoints. 1.

Visit the website below and read about the Johari Window Model. The website also offers an explanation of the four quadrants. https://www.communicationtheory.org/the-johari-window-model/

2. Complete the ‘Open arena and Hidden area’ for yourself. 3. Then in pairs complete the ‘Blind spot’ for each other. 4. Following that discuss the ‘Unknown’ for each other. 5. Reflect on your behaviours associated with the hidden and unknown areas and how they affect others. 6. What points from hidden area would you move to open area, so people understand you better? 7. How will you seek feedback about your blind spots from colleagues so you can increase your open area?

Known to Others

8. As a staff member attending to behaviours of concern, what changes or adjustments will you incorporate in yourself based on your findings of your blind spot and unknown areas so you can respond to behaviours effectively?

Not Known to Others

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CHCCCS020 - Respond effectively to behaviours of concern

Known to Self

Not Known to Self

Open area or arena

Blind spot

Hidden area or facade

Unknown

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Adopt a strategy To deal with behaviours of concern, it is important to choose the right approach. To do so, you must follow any organisational policies and procedures and select a strategy to suit the particular instance. Every situation is different and, therefore, how you act in each situation will also be different. You will need to be ready to adapt and adjust your approach to achieve the best outcome. Whatever strategy you choose, it is important that you maintain your personal safety and the safety of those around you. It is also important that you are calm, show empathy and ensure that your actions are seen as being reasonable, fair, and equitable, taking into consideration a person’s human rights, your duty of care obligations and ethical responsibilities. Some common strategies that can be used could include: Diversion tactics A diversion tactic is used to draw a person’s attention away from the behaviour of concern, calm them, get them talking and resolve the issue. Diversion tactics may include offering food or drink, asking the person if they would like to play a game, go for a walk, or come and see something of interest. For example, if a child is unwell, you might ask them if they want to come and see the hospital’s meerkat display in an effort to get them to focus on something other than their pain, or the fact that they are upset. Diversion tactics are about changing a person’s focus, distracting them, and interrupting their current thinking. They can be very effective in defusing a situation quickly and building trust with the patient so that you can address the behaviour of concern and why it has occurred. Diversion tactics can be very effective when dealing with people who are aggressive, verbally offensive, intoxicated, or for those who are confused or have been found wandering. These tactics also work well with those who have displayed intrusive behaviour and noisiness. However, while diversional tactics can be effective, it is important to offer them carefully and only where you feel they would be appropriate. For example, offering food or a drink to someone who is aggressive at the wrong time could further escalate the situation.

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CHCCCS020 - Respond effectively to behaviours of concern

De-escalation When you identify that a situation may be or has the potential to escalate, it is important to act quickly to defuse the situation. De-escalation is about reducing the intensity or magnitude of the conflict, not necessarily avoiding it altogether. When people become angry, their bodies often react by releasing adrenaline. When this happens, a person will have a sudden surge of energy, and they may not be able to control their emotions. This may make it difficult for them to calm down or see reason. You may need to wait a few minutes, let the person react and then intervene to de-escalate the situation. The key to de-escalating a situation is effective communication. You should: y

be calm, empathetic and adopt a non-confrontational approach. It is important to not show fear and be confident when speaking with the patient.

y

ensure that your body language is neutral and that you avoid giving too much eye contact, as this can be misinterpreted as confrontational.

y

give the patient your undivided attention, listen and acknowledge that you are listening to them without agreeing with them or giving your opinion.

y

ensure that you are an appropriate distance from the patient so that you cannot be touched or reached if the situation suddenly changes.

y

make use of diversional tactics if appropriate.

y

seek assistance from others that could be helpful in calming the patient such as the patient’s family, friends, and regular caregivers. Engage in conversation

Often when a person is exhibiting a behaviour of concern they just want to be heard. Their behaviour may also be a cry for help. Engaging a person in conversation can allow them to calm down, focus on your questions and what they want to say, which in turn can defuse the situation. Engaging a person in conversation also allows you to assess why the person is exhibiting the behaviour of concern. For example, an elderly person who just wandered off may tell you that she was looking for her friend. To engage a patient in conversation, you should: y

use their name if you know it or ask them for their name and clarify that it is ok that you call them by it

y

use positive body language and give eye contact, if culturally appropriate

y

avoid the use of negative language

y

ask the patient for their opinion and listen actively

y

don’t argue with the patient or point out that they are wrong; the goal of engaging them in conversation is to allow them to vent their issue and potential frustrations that has led to their behaviour of concern

y

avoid personalising the situation; don’t tell the patient that you know how they feel or what they are going through, as this may anger them. Simply tell them that you understand why they might be feeling that way

y

where appropriate, engage the patient in conversation by using diversional tactics and changing the subject. However, it is important that you only do so if you feel that the patient will be receptive, as changing the subject when someone is upset and wants to vent can be infuriating and could escalate the situation further. 42

Use a quiet space A great strategy for responding to a behaviour of concern is to take the patient to a quiet space free from noise and distraction. By reducing stimulation and removing them from the prying eyes of others, it can help to calm them and get them talking in a controlled manner about their issues and/or frustrations. In a safe environment, they may also be more likely to disclose personal information and be honest. When utilising a quiet space, it is important that you take the appropriate safety and security precautions in case the patient becomes violent. To ensure your personal safety in this type of situation you should: y

notify co-workers and/or your supervisor that you are taking the patient to a quiet space and let them know exactly what room you are using

y

notify the appropriate security staff and even have them stationed nearby in case you need them. Where possible, don’t allow the patient to see the security staff as it could make them more agitated

y

ensure that you have access to a phone, or duress or personal alarm in case you need to call for help

y

position yourself in the room to ensure that you have an appropriate amount of personal space so that you cannot be touched or reached; position yourself close to the door and where possible, arrange furniture so that there is something positioned between you and the patient, such as a table.

Learning Checkpoint 2 1. Ethical considerations mostly relate to the treatment and care of patients and include statements that relate to: y

Respect for patients

y

Valuing diversity

y

Behaving in a non-judgmental way

y

Showing empathy

y

Providing support

For each of these topics, explain a situation that might be applicable in a healthcare environment. 2. When responding to behaviours of concern, communication amongst relevant parties is critical. Name 4 parties that might be involved in the patient’s care. 3. When dealing with clients or patients, you may need to seek assistance from other people,

as long as they are legitimate sources. What does this mean? Who might be considered a legitimate source?

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CHCCCS020 - Respond effectively to behaviours of concern

Report and review incidents When an incident occurs, a health facility is required by law to document the incident through an incident report. An incident report is a formal document detailing the behaviour of concern that occurred and its result, whether it was an injury, loss, damage, or a near miss. A near miss can be defined as a narrowly avoided incident that could have resulted in a serious consequence. When working in a health facility, you may deal with behaviours of concern daily, whether it is a person wandering off who is found 10 minutes later, or a person who is being manipulative because they don’t want to shower today. These behaviours do not always

require an incident report to be generated. If this was the case, health services workers would spend all their time writing reports instead of caring for patients. A behaviour of concern only requires an incident report to be generated when the behaviour causes injury, loss or damage of property, death or where a near miss has occurred. In saying this, if you have a patient who has a tendency to display these behaviours, even without it fully escalating, it’s worth discussing it with your colleagues. An incident report should be completed both internally and externally through the Victorian Health Incident Management System (VHIMS). The VHIMS is a standardised process for the collection, classification and notification of clinical incidents, occupational health and safety incidents and consumer feedback. Through every incident being reported through the VHIMS system, it provides an opportunity to make the healthcare system better by preventing incidents from re-occurring by being proactive, identifying hazards and controlling them before they pose a risk to patients and others in the facility. Who is responsible for incident reporting within an organisation will depend on the type of organisation and the policies and procedures outlining the reporting of incidents. When working in the health services industry, it is important that you report incidents strictly according to organisational policies and procedures. Good and effective incident reporting should gather evidence of who, what, when, where and how the incident occurred. An organisation’s policies and procedures should guide the level of detail required when documenting an incident. Most organisations will provide employees with a template that is easy to use and asks the right questions to ensure that all the information about the incident is documented clearly and accurately. This report should then be given to someone in a more senior position, or someone involved in hazard identification and risk in the workplace, such as a Work Health and Safety Officer, to review and fill in any gaps or elements that have not been recorded accurately or in enough detail.

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A good and effective incident report should include the following information:

ü ü ü ü ü ü

Who is reporting the incident? Printed name  and signature of the person making the report.

ü

Who was affected?

ü

What happened? A description of the incident that occurred.

ü

What injuries were sustained, if any? Where did the incident occur?

What actions were taken immediately after the incident occurred? Why did the incident occur? Were there any factors that contributed? The incident should be rated using the  VHIMS ISR rating system, i.e., severe/death, moderate, mild, no harm/near miss.

When did the incident occur, including the date and time?

When documenting the above information, it is important that you:

ü

Complete all sections of the incident report

Don’t leave anything blank.

ü

Ensure that the report is concise

Avoid providing a long-winded story, keep it short while ensuring that you provide all necessary details.

ü

Be as specific as you can

For example, instead of saying the patient had drugs in his possession you would stay the patient had three ecstasy tablets in his possession.

ü

Ensure that all information is factual

Avoid giving your opinion or thoughts on the situation.

ü

Complete the incident report in a timely manner

Where possible, an incident report should be completed immediately after the event has occurred. This ensures that the information is fresh in your mind and that you don’t miss any details or leave out any important information.

ü

Proofread the report

Look for errors in detail, information that you have left out as well as spelling mistakes that could lead someone to misinterpret the meaning of the report.

ü

Don’t just submit the report

Take the time to hand it in person to your supervisor or manager so that you can also provide them with a verbal description of the incident. This ensures that they are made aware of the incident immediately instead of at the end of the day or when they get around to reading your report.

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CHCCCS020 - Respond effectively to behaviours of concern

Any incidents that are considered serious in nature are deemed to be a Notifiable Incident, meaning that the incident must be reported to WorkSafe in Victoria. An incident is deemed to be a Notifiable Incident if it resulted in: y

the death of a person

y

a person requiring medical treatment within 48 hours of exposure to a substance

y

a person requiring immediate treatment as an in-patient or a person requiring immediate treatment for: x the amputation of any body part

x a spinal injury

x a serious head or eye injury

x the loss of a bodily function

x de-gloving or scalping

x serious lacerations.

x electric shock

Reviewing an incident Incident reports are important for several reasons. They allow you to review incidents or near misses to determine and identify any gaps, vulnerabilities and changes that can be made in the workplace to make it safer and prevent further incidents from the same source occurring in the future. They can identify areas where greater resources are needed, more staff training is required and where changes to risk management plans need to be made. Incident reporting also ensures that there is an accurate record of what occurred in case of litigation or further investigation by WorkSafe. Once an incident report has been generated it should be reviewed with appropriate staff and suggestions offered appropriate to a person’s area of responsibility. Where you are unsure about what is required to report and/or review an incident, you should seek assistance. By accessing assistance, you are ensuring that the information and advice that you receive is accurate and reliable. WorkSafe Victoria advises that where there is no one in the workplace who can advise on issues impacting the health and safety of employees, the workplace should engage the external services of a professional consultant. A professional consultant can be found by contacting a work health and safety (WHS) peak body such as the Safety Institute of Australia or the Australian Institute of Occupational Hygienists. WorkSafe also advises that other ways of gaining WHS advice could include contacting the appropriate unions and trade or industry associations as well as calling them directly.

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As part of reviewing an incident, it is important to determine how a similar situation could be avoided or handled more effectively. Part of this review should be to establish the potential causes or triggers of the incident. What occurred just before the behaviour? Were there any contributing factors, such as the environment or actions by workers? Did something happen just before the behaviour occurred, such as a person being told they can’t go outside or that they can’t have an extra piece of toast for breakfast? To gather this information, it is important to talk to others who are in contact with the patient, including the patient’s attending health professionals, family and anyone who witnessed the behaviour and may be able to provide further evidence or reasoning for what caused the behaviour.

A review should also look at how the worker responded to the incident, the steps taken by the employee to deal with the behaviour of concern and whether they followed the organisational policies and procedures, if they were followed correctly, and if they were effective. Reviewing an incident should not be about finding the mistakes and judging the employee for how they reacted and handled the situation. It should be viewed as an opportunity to identify areas for improvement, educate the employee and support them to deal with a similar situation more effectively in the future. Based on this review, the organisation should look at implementing a series of changes to prevent similar incidents in the future or handle them more effectively. Improvements that could come from reviewing an incident in the health services industry could include: y

additional training or more in-depth training for staff

y

increasing the availability of resources, for example, if a patient became aggressive because of the lack of availability of packs of cards, the organisation could look at the viability of purchasing more

y

increases in security

y

changes to organisational policies and procedures

y

better monitoring of patients and their behaviour

y

mentoring for staff or adopting a team-treating approach, where two staff work together with a patient providing support and additional assistance in case of an emergency

y

better communication between staff and health professionals to allow patients’ individual needs to be met, and for responses to behaviours of concern to be specific to the individual

y

creating more opportunities for patient enjoyment; for example, if a patient wandered off maybe it was because they were bored (by providing them with entertainment such as games and other resources, would they be less likely to wander off?)

y

provide patients with opportunities to socialise; if patients are happy in their environment, they are less likely to exhibit aggression, anger, verbal offensiveness or wander off.

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CHCCCS020 - Respond effectively to behaviours of concern

Debriefing Behaviours of concern resulting in incidents of injury, loss, damage, or a near miss with potentially serious consequences can be stressful and can really scare a person. This can have a serious effect on their mental health and wellbeing. Dealing with behaviours of concern can be traumatic for staff and they may be left feeling anxious and fearful, which can cause them to suffer from headaches and fatigue. This can be debilitating and can affect not only their work but also their personal lives. When an incident occurs, it is important that staff are supported and offered an opportunity to debrief. This is usually carried out between 3 to 7 days after the incident. In some organisations, debriefing is strongly encouraged after an incident; however, it should be voluntary. A debrief is a conversational opportunity for workers to speak about and discuss their experience, whether it be positive or negative. It provides an opportunity to reflect on the incident that occurred and how it made the worker feel. It is important that, through this reflection, a worker understands that what they had to deal with was abnormal and that their reaction was a normal psychological response. The organisation can then provide the appropriate response to support the worker to recover from the incident and return to their normal duties. It should be the priority of any organisation to ensure that workers have access to and participate in available debriefing mechanisms and associated support and/or development activities after an incident.

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In a situation where debriefing is not adequate, an organisation may provide further support through the offer of short-term counselling. Where required, an organisation may also offer the staff member time off to reflect and process the incident and to re-group, collect their thoughts and then return to work positive with a healthy mind set.

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Watch - best practice

It is important to carefully handle situations where patients are showing aggression. You are to watch the video at the link below: https://www.youtube.com/watch?v=qDQissx0wH0 Victor has been brought to the hospital as he was found screaming on a street corner. In the first part of the video, Victor is sitting on the bed not saying anything. When the doctor walks in and starts talking, Victor gets visibly distressed and is screaming he wants to go home. 1.

How does the doctor approach this; what does he do well, and what does he do poorly?

2. How does he change his approach in the second video? Is this more effective? Why/why not?

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Roleplay - Jenny’s experience

The situation: Jenny has presented to her local hospital emergency department with severe pain in her lower back. Jenny is well known to the staff here, as she is a regular visitor, especially when she is not taking her medication. Jenny has been waiting 2 hours to see someone, as it is a weekend, and the department is being overrun with emergency cases which are seen as a higher priority than hers. Jenny approaches the triage desk and starts yelling expletives at the staff, asking, “Why the f*&k haven’t I been seen to yet? Why are these other f*&kers more important than me? I was here first and surely I’m more important than some old person who looks like they’re about to die anyway!” Instructions: 1.

With your partner, roleplay the scene. You should both take a turn of being the healthcare worker.

2. After you have done this, work with your partner to write a list of what each of you did well, and perhaps what you could change next time. 3. As a class, discuss the roleplays and the situation, and see if you all took the same approach.

Learning Checkpoint 3 1.

What are 4 changes that may be made after the review of an incident?

2. In many instances of dealing with behaviours of concern, you will need to be firm with the other person. Name 4 ways that you can do this. 3. A great strategy for responding to a behaviour of concern is to take the patient to a quiet space free from noise and distraction. What are 3 things that you should do to ensure your personal safety in this type of situation?

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