A randomised experiment. What we call challenging is highly subjective, but what holds true for all of... Management strategies. Based on her body language I was able to tell that this mother was already getting agitated just by being the hospital. People behave in ways that make sense to them. These cookies do not store any personal information. Managing Challenging Patient & Family Behaviors: 101 Strategies for Healthcare Professionals. I believe this model will be incredibly useful and helpful for nurses and providers alike. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. Your irritated response to Ms. Smith is multiplied by the frustration you felt about your partner’s impatience. Managing Challenging Behaviors Alzheimer's Care A person who has dementia may exhibit challenging behaviors for many reasons. This event is not currently available for purchase. In Ms. Smith’s case, the clinic could commit to ensuring that her intake is complete and that she sees the provider within 30 minutes of her appointment time as long as Ms. Smith commits to calling before coming to the office. (See Take a look at yourself.) Ask the Right Questions; Understand Patient’s Motivation; Motivational Interviewing: Asking, Listen, Inform; Engage Patients in Focused Communication; Listen with Empathy; Empower the Patient; Interpersonal Effectiveness Skills The plan should include goals and a plan of care that takes into consideration individual patients’ cognitive levels, emotional abilities, and skill deficits. De-escalation should be the first-line response to challenging behaviour, and healthcare staff should use a range of techniques – maintaining safety, self-regulation, effective communication, and assessment and actions – to reduce the incidence of challenging behaviour. You’re too important not to get vaccinated. 2. In recent years the trends for birth have become much like planning a wedding. Behavioral problems 2. BMJ Qual Saf. Successfully managing challenging patient encounters Components of challenging encounters. Educate physicians about effective approaches to manage a challenging patient using learned skills and building upon one’s own self-awareness and emotional intelligence. 5. But opting out of some of these cookies may affect your browsing experience. Staff should explain the reasoning behind patient seclusion in depth to the patient and later in documentation. To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Challenging patient encounters like this take a toll on everyone. Please contact our Customer Service at 1-800-844-8260 for more details. She complains of flulike symptoms and states she needs to see a provider today. Leadless pacemakers: A new technology in cardiac pacing, Emergent nurse cross-training in response to COVID-19, Ceiling lifts and safe patient handling and mobility programs, How transformational leaders address fear amid COVID-19, Cross-training: Preparing for disasters beyond the pandemic, 2020 American Heart Association Basic Life Support for the inpatient setting. Managing Challenging Patient & Family Behaviors: 101 Strategies for Healthcare Professionals. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. After Ms. Smith returns to the patient room, the nurse calmly explains the situation to the provider: Ms. Smith had discovered a lump in her breast this morning. Behavioral symptoms 9. By clicking “Accept”, you consent to the use of ALL the cookies. We’ve all had challenging patient encounters, many of which stemmed from factors outside of our control. Providers who are angry, defensive, fatigued, distressed, dogmatic, or arrogant may inadvertently cause or exacerbate a challenging interaction. In this way, we not only physically quiet ourselves, but also model the appropriate tone of the appointment for the patient. Pharmacological Intervention: As each drug comes with specific risks and has different properties, any medication used to sedate a patient displaying challenging behaviour should be carefully taken into consideration beforehand. Reduced staffing and (at times, the seemingly unrealistic) increased demands from patients, family members and other visitors can all contribute to burnout. 2017;26(1):19-23. Elderly persons with dementia may present with challenging behaviors over the course of the illness. The difficulty inherent in managing a particular disease can make the interaction with the affected patient feel more challenging than consulting with a patient who has a more straightforward condition. When we control our reactions, we may help diminish the severity of a challenging patient encounter or even avoid it altogether. A 60-year-old lawyer is admitted to the hospital for evaluation of abdominal pain. Necessary cookies are absolutely essential for the website to function properly. Connecting Knowledge With Need Since 1979! In the end I was able to have a very good relationship with my patient and her husband simply by applying the model mentioned in the article “Successfully Managing Challenging Patient Encounters”. We were able to strategize and make a plan for how she wanted her labor to go in spite of the need for various induction methods. Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. For example, you might be excessively frustrated with Ms. Smith’s impatience because it reminds you of the frustration you felt the night before when your partner told you to hurry up and finish cooking dinner. Who Should Attend? Also evaluate the physical environment. This course uses a question and answer format to apply the theoretical and practical content from preceding courses… At times these behaviors may be unpredictable and include anger and aggression. What role do we play in mitigating or exacerbating difficult situations? A visit in which a worried patient is receiving bad news might understandably elicit different emotions than a routine visit. We must acknowledge the role we play in a challenging patient interaction. Categorize approaches to various high-risk patient profiles. Although we’ve all felt that hot flash of frustration or anger in response to a patient or situation, one of the best ways to prevent these emotions from interfering with our care is to consciously set the tone of the interaction. I always do my best to remind myself that what I see everyday at my job is often very scary for all my patients. These behaviors can begin abruptly or build from a patient's frustration. In the future I plan to continue to use the strategies I’ve learned to enhance my quality of care, therefore enhancing my patients’ experiences. Behavior changes 5. Every week, you’ll get breaking news features, exclusive investigative stories, short news summaries, and more — delivered to your inbox. Health Aff. Managing Challenging Patient Behaviors: 101 Strategies for Healthcare Professionals. We may even give them the gift of some much-needed light. Using words like “we” and “us” can help foster mutual respect and responsibility as you and the patient decide on the best plan of action. Other terms used to describe them include:1 1. Save time and $10 off the price of other submission methods – purchase & take the CE test online for $19.99 USD per participant. Managing Emotions under Pressure, Managing Conflict and Confrontation, Behavior Management for Dementia Related Behaviors, and Aggressive Behavior in … His wife, a former nurse practitioner, insists that a nasogastric tube would be too dangerous and demands that he be allowed to eat instead. What we call challenging is highly subjective, but what holds true for all of these encounters is that they threa ten the quality of life of those involved and are likely to lead to responses that negatively impact patient care. Managing Emotions under Pressure, Managing Conflict and Confrontation, Behavior Management for Dementia Related Behaviors, and Aggressive Behavior in … Patient surges during the COVID-19 pandemic require nurses who are cross-trained to work in units other... You have entered an incorrect email address! Inappropriate behavi… Reassure them and acknowledge their grievances. Behavior concerns 4. When the nurse hands a tearful Ms. Smith the referral form, Ms. Smith apologizes for the outburst. You also have the option to opt-out of these cookies. Alternatively, the behaviors may be part of the patient’s regular behavior and disposition, which may determine how your organization continues to care for this patient in the future. After 35 minutes in the waiting room, a patient room becomes available. I want to tell you about an encounter I had with a mother who came in to be induced with her first child. Provide them with an opportunity to explain what has angered them. I have been working as a labor and delivery nurse for nearly 3 years now. I sat down with my patient and spoke calmly with her about her fears and reservations with an induction and hospital birth. Agitation and Aggression Agitation, restlessness, and anxiety are common in people with dementia, but even more worrisome is aggression. Managing Challenging Patient & Family Behaviors: 101 Strategies for Healthcare Professionals - Latasha Ellis - Full Day In today’s healthcare environment, professionals are challenged to do more with less. 2017;19(4):364-8. A person with Alzheimer’s disease may overreact to minor stressors. Analyze effective strategies to de-escalate dangerous behavior. Schmidt HG, van Gog T, Schuit SC, et al. When my patient and her husband got frustrated about continuing interventions I helped to calm their nerves by identifying with them. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. Assess for the symptoms of major illness that interfere with treatment. Does a higher frequency of difficult patient encounters lead to lower quality care? Identifying your triggers is a crucial step toward managing your reactions when these situations arise in the future. Takeaways: This website uses cookies to improve your experience while you navigate through the website. 4. As nurses, we can impact our patients' and their caregivers' quality of life by providing innovative options for dementia care. Managing Challenging Patient Behaviors 101 De-escalation Strategies for Healthcare Professionals In today’s healthcare environment, professionals are challenged to do more with less. An PG, Manwell LB, Williams ES, et al. Strategies to Deal with the Angry Patient; Taking Care of Yourself: Safety as a Priority! Pay attention to the language you use—does it help create a collaborative environment? “What is wrong with you?” she snaps. Reduced staffing and (at times, the seemingly unrealistic) increased demands from patients, family members and other visitors can all contribute to burnout. Coping with changes in your loved one’s behavior is one of the most challenging aspects of care giving. Author(s): Kaitlyn Breiten, RN; Eleanor Condie, RN; Sarah Vaillancourt, RN; Jean Walker, RNC-OB; Ginny Moore, DNP, WHNP-BC, MS. SMITH arrives at the clinic without an appointment. From the get-go my patient let me know that she was not happy that she was having to be induced. Managing Challenging Patient & Family Behaviors 101 Strategies for Healthcare Professionals 45448 Can’t Miss Topics! Interviewing the Patient; Asking the Right Questions; Self-Awareness; What Type of Communicator Are You? Apply interpersonal effectiveness skills to patient evaluation. These cookies will be stored in your browser only with your consent. Kaitlyn Breiten, Eleanor Condie, Sarah Vaillancourt, and Jean Walker are graduate students in the women’s health nurse practitioner specialty. I remained calm and listened to their thoughts and concerns. Induction was never part of her plan, she had hoped to have a natural labor and birth with no interventions. This course provides a framework for understanding common challenging patient behaviors and engaging them with a balance of empathy and respectful limit setting. 3. J Fam Pract. 1. Although certain situations and patient attitudes may be out of our control, we must do our best not to contribute to the situation. Keep an adequate distance from the patient, but keep away from corners. In this interactive seminar, expert clinician, Latasha Ellis, will provide you with practical tips and tools that you can use immediately when faced with challenging patient and family behaviors. Understanding the source of their frustration may help you find a solution. We must learn how to recognize when a patient’s behavior is the result of ineffective coping. Even a routine visit can turn into a challenge if the patient is expressing difficult-to-manage emotions or behaviors. And consider the nature of the encounter. It is mandatory to procure user consent prior to running these cookies on your website. She’s quite concerned given her additional flulike symptoms. Miscommunication can easily lead to frustration and a perceived power imbalance between the patient and healthcare provider. In today’s healthcare environment, professionals are challenged to do more with less. Challenging patient encounters boil down to three main components: the situation, the patient, and the provider. Quizlet flashcards, activities and … In this article, we’ll identify the components of challenging patient encounters and discuss management tools to maximize clinical experiences and outcomes for both patients and ourselves. Maintain eye contact, but not prolonged. The staff do their best to work her in as quickly as possible. “I’ve been waiting over an hour and I’m sick and this clinic is so far behind because of people like you who are lazy and slow!”. We can use several strategies to help us understand and mitigate our contribution to potentially challenging situations and decrease their frequency, which will result in better health for both patients and ourselves. Ms. Smith’s intake is completed and another 20 minutes pass. Managing Challenging Behaviors in People With Alzheimer's. Being sensitive to the emotion behind the behavior can help to manage stress and frustration. The key to managing them lies in examining the source of behaviors to understand the feelings leading to the actions. When we take steps to set a calm and collaborative stage from the beginning of each patient interaction, extend empathy, identify skill deficits, construct strategic management plans, and continue ongoing self-reflection, we can walk with even the most challenging patients through their darkest moments. You can accomplish this by sitting still and speaking in a low, calm voice. Managing Challenging Patient Behaviors Recognize and effectively respond to patients with challenging behaviors. Disruptive behaviors 8. Where: CHERRY HILL, NJ When: Wednesday, February 7, 2018 at 8:00 AM - 4:00 PM. Training programs for a group home’s staff should focus on identifying and addressing challenging behaviors to limit potential injuries to staff and other clients. This is best achieved through self-reflection. • High-Risk Patient Situations • eTOH & Substance Abuse • managing the Family dynamics • Anger & Aggression • manipulative Behavior • Violent Patients • dementia Related Behaviors • Suicidal Ideation Billings, MT Dealing with an aggressive patient takes care, judgement and self-control. Multiple people in an exam room, a restless child, or a controlling spouse can adversely affect the patient encounter. Recognize and effectively respond to patients with challenging behaviors. A variety of factors can influence the situation of a patient encounter. The program will be filled with opportunities to apply many of these strategies through real patient situations, case studies and recorded interactive discussions. Ellis provides an example of working with family of a dementia patient who was discharged to a long-term care facility with a negative reputation. For example, Ms. Smith may be struggling with intense negative emotions at the prospect of an illness because she was recently diagnosed with diabetes and worries her body is failing her as she ages. Download Citation | On Sep 1, 2008, Diane Twedell published Managing Challenging Patient Behaviors | Find, read and cite all the research you need on ResearchGate This category only includes cookies that ensures basic functionalities and security features of the website. 2013;62(1):24-9. Box 1000, Eau Claire, WI 54702-1000, USA   •   Phone: Copyright © 2021 PESI, Inc. All Rights Reserved. Do patients’ disruptive behaviours influence the accuracy of a doctor’s diagnosis? The authors are at Vanderbilt University School of Nursing in Nashville, Tennessee. This hands-on training includes learning better relationship-building skills, de-escalation techniques, and recognition of preceding events leading to undesired behaviors. Managing Challenging Patient Behaviors UCSF Learning & Organization Development . Ginny Moore is an associate professor of nursing and director of women’s health nurse practitioner specialty. Acting out 6. Adding to the complicating factors, you are continually expected to achieve optimal patient outcomes, ensure safety and quality goals, and strive for even higher levels on satisfaction scores. Have a plan in place for strategically managing patients after a challenging encounter. Expectant mothers write out long birth plans and romanticize the act of bringing a child into the world. mail, fax, etc.). PESI HealthCare, P.O. Treatment Focused; Do No Harm; Clear Boundaries; Evaluating the Patient. For more information: Call (800) 844-8260 Many patients have never faced health challenges that may threaten their personal identity or even their mortality. These emotions and behaviors may be elicited by the clinical situation, such as in the case of a patient who’s frightened by his or her disease process or angry that insurance won’t cover a certain treatment. In this recording, expert clinician, Valerie R. Vestal, MSN, PMHNP-BC, will provide you with practical tips and tools that you can use immediately when faced with challenging patient and family behaviors. When we recognize patients’ skill deficits, we can increase our empathy and more successfully navigate challenging encounters. Dudzinski DM, Alvarez C. Repairing “difficult” patient-clinician relationships. Remind yourself that patients may feel helpless or as if they’ve exhausted all plausible options. (See Keep it collaborative.). It is help… Ask the person’s GP to check for any physical causes and treatments. Despite having knowledge in behavior theory and skill in intervention approaches, therapists can have difficulty managing challenging behaviors in the context of pediatric therapy sessions. As an RN I found this article to be incredibly helpful in the clinical setting. For example, consider the patient’s literacy and language proficiency. We must work to decrease the burden of these encounters to prevent negative patient outcomes and to protect our own mental health. I want to share an experience with you that provides evidence that many of the strategies mentioned in the article are truly beneficial. Employ three patient relation strategies to mitigate challenging patient behaviors. Successfully managing challenging patient encounters. Sign up today to start your free subscription to NurseLine! Reduced staffing and increased (at times the seemingly unrealistic) demands from patients, family members and other visitors can all contribute to burnout.