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Personal Class Design Part II:

Crisis Prevention Training for Patient Care Techs and Observation Assistants

Claudette D. Johnson

Grand Canyon University

NUR 469 E: Seminar II

May 16, 2013

Crisis Prevention Training for Patient Care Techs and Observation Assistants

Everyday patients are treated and cared for without incidents in hospital settings. The complicated issues involving our economy, everyday life challenges, and diverse health diseases such as dementia, and alcohol abuse has compounded an individual’s stress level. These factors increase the likelihood of an outburst, thus, placing patients and healthcare workers at risk. The article, To err is Human: Building a Safer Health System (Kohn, Corrigan & Donaldson, 1999), reported an increased number of incidences jeopardizing the safety of patients and healthcare workers. Longo (2010) reports that unsafe incidences has led to patient and staff injury, prolonged hospital stays, claims of disability and even loss of life. Factors influence patient safety.

In certain circumstances, the tendency is to blame patients for risky behavior and healthcare workers for errors in decision-making (Nath & Marcus, 2006). However, certain diseases are difficult to control (Alzheimer, Dementia, Brain injury), human behavior is unpredictable (Mentally ill and intoxicated patients) and healthcare workers still need to care for all patient population. The focus on strategies targeting education for the workforce group with the least training yet the most interaction with potentially disruptive patients is necessary. The inclusion of attention in understanding how factors contribute to safety incidences and creation of education focused on practical application of techniques in healthcare settings can reduce risk of injury (CPI, 2013). Empowerment of healthcare providers impacts the rate of disruptive incidences in inpatient settings (Druss, 2007).

Institution Philosophy

The program is designed to address identified issues in clinical care to promote patient safety. The purpose of the program is to heighten awareness and provide skills to prevent and minimize injury for the observation assistants (OA) and patient care tech (PCT). The program complies with the legislative mandates and regulatory and accreditation standards set by the Joint Commission (Longo, 2010). The program minimizes the institution’s exposure to liability. Furthermore, the training promotes the NCH vision of providing safety and security of the staff and patients (NCH, 2013).

Program Goal

The crisis intervention training is designed to teach best practice and evidence based principles in managing disruptive behaviors and difficult situations in the workplace (Crisis Prevention Intervention, 2013). OAs and PCT’s will learn how to identify at-risk individuals and families and utilize verbal and non-verbal techniques to diffuse hostile or belligerent behavior in the workplace. The participants will self-examine reaction to a crisis situation and learn skills to control fears and anxiety and avoid injury when dealing with difficult situations. The program is created to address workplace safety, positive communication skills and early intervention through recognition of signs of escalation.

Needs Assessment

Lack of appropriate training and poor communication between patient, healthcare providers and families is a contributing factor is linked to safety incidences (Health Canada, 2007). In general, improvement in communication is associated with improvement in safety (Druss, 2007). The Northwest Community Hospital’s (NCH) Safety Committee and Employee Health Department (2013) reports a 3% increase of injuries from Mr. Strong events with forty percent (40%) of the injuries involve Patient Care Techs (PCT) and ten percent (10%) are Observation Assistants (OA). NCH has a Mr. Strong policy, used to summon security to support staff in managing escalating patients and difficult incidents that threatens the safety of staff, patients and visitors. Mr. Strong request are up by 5% compared to 1-2 % in previous years. Mr. Strong post-vention survey reveals an increasing dementia population. The two highest patient populations in Mr. Strong incidents are the elderly (50%), mental health diagnosis (18%), alcohol related (12%) and the rest are related to disgruntled families and other issues.

Crisis Prevention Intervention Programs for nurses, security, mental health staff and Emergency Department personnel are offered at NCH. The Safety Committee & Violence in the Workplace Committees recommends a program targeting education for the PCT and OA groups. In addition, survey of PCT and OA reveal that 60 % value their safety as a priority in their practice (NCH, 2013).

Student Learning Objectives

Learning objectives should be specific, measurable and attainable (Billings & Halstead, 2012). Objectives are distinguished between the elements of knowledge, attitudes and skills. The interaction between the skill, knowledge and attitude is necessary and just as equally valuable (Govaerts, 2008).

• After Day 1 lecture and PowerPoint presentations, the OAs and PCTs will identify and list three signs of stress, identify and list 3 ways of addressing crisis by completing a quiz at the end of Day 1.

• After Day 1 lecture on defusing Do’s and Don’ts and discussion of case studies in the training session, OA & PCTs will list 2 Do’s and Don’ts of defusing escalation, identify potentials for injury and list two (2) ways to prevent injury by completing a quiz at the end of Day 1 (Cognitive and Affective).

• After identification of resources lecture, OAs and PCTs will list the three (3) steps of reporting and list two (2) resources by completing a quiz at the end of day 2, and demonstrate the accessing computer reporting and locate employee injury report form (Cognitive, Psychomotor, Affective)

• After the lecture on techniques of safe distance, viewing video and role playing, the OAs and PCTs will demonstrate techniques of safe distance, perform how to escape certain holds, participate in constructive feedback for staff performance during application (Cognitive, Psychomotor, Affective) and demonstrate safety precaution (Cognitive & Psychomotor) and demonstrate safety precaution (Cognitive & Psychomotor).

Lesson Plan

|Learner Objective |Timeframe |Teaching Strategy & Rationale |Evaluation Method & Rationale |

|After Day 1 lecture and |Day 1 Hour 1 | | |

|PowerPoint presentations, the | | | |

|OAs and PCTs will: |15 min |Overview (PowerPoint, handout, |Observation- allows for assessment of |

|identify and list three signs | |Questioning) |behavior and responses to assess value and |

|of stress | |Injury statistics |comfort in the topics covered. This allows |

|identify and list 3 ways of | |Course content |for formative feedback and opportunity to |

|addressing crisis | |Objectives |correct information that is not clear to |

|by completing a quiz at the end| |Strategies |the learner. |

|of Day 1 Hour 1 | |Outcome | |

| | | |Question with verbal responses allows for |

| | | |clarification of misconceptions or |

| | | |misunderstood concepts. |

| | | | |

| | | |Observation- allows for assessment of |

| | | |behavior and responses to assess value and |

| | | |comfort in the topics covered. This allows |

| |15 min |Understanding People in Crisis (Video, |for formative feedback and opportunity to |

| | |Handout, Discussion) |correct information that is not clear to |

| | |Video of patient in crisis |the learner. |

| | |Situations, reasons why crisis occurs | |

| | | | |

| | | | |

| | |Stages of a Crisis (handout, discussion)| |

| | | | |

| |5 minutes | | |

| | | |Questions allows for clarification and |

| | |The Stress Cycle (Handout of cycle & |discussion of attitude and feelings. |

| | |coping , 5 minute scenario vignette) | |

| | |Discussion on |Observation evaluates attitudes and comfort|

| |20 minutes |Identify signs of stress |in discussing stress situations |

| | |Ways to address stress | |

| | |How to handle stress |Formative evaluation of responses to |

| | | |questions and recognition of attitudes and |

| | | |feelings |

| | | | |

| | | | |

| | | | |

|Learner Objective |Timeframe |Teaching Strategy |Evaluation Method |

|After Day 1 lecture on defusing|Day 1 Hour 2 | | |

|Do’s and Don’ts and discussion | | | |

|of case studies in the training|10 minutes |Intervention Tools: |Verbal Questioning- allows for critical |

|session, OA & PCTs will: | |Handout and discussion (All cognitive |thinking assessment, evidence of the why |

|List 2 Do’s and Don’ts of | |domain, affective) |questions and shows mastery of the content |

|defusing escalation | |Defusing Do’s and Don’ts |information and evidence presented |

|Identify potentials for injury | | | |

|and list two (2) ways to | | | |

|prevent injury | | | |

|By completing a quiz at the end| | | |

|of Day 1 | | | |

|(Cognitive and Affective) | | |Both formative and summative feedback on |

| | |Case study Review (Discussion, Question,|acknowledgement of feelings and attitudes |

| | |Role play) |through anecdotal notes |

| |30 minutes | | |

| | | |Questionnaire |

| | | |Summative feedback of Day 1 progress- |

| | | |Allows for evaluation of knowledge gained |

| | |Quiz of Day 1 content |to be quantified and allows for remediation|

| | | |of information not absorbed by learners |

| | | |before the end of class. |

| |20 minutes | | |

|Learner Objective |Timeframe |Teaching Strategy |Evaluation Method |

|After identification of resources |Day 2 Hour 1 |Identification of resources: | |

|lecture, OAs and PCTs will: | | | |

|list the three (3) steps of | |List of hospital resources and map | |

|reporting and list two (2) resources|15 minutes |algorithm (Cognitive, Affective ) |Concept map- allows students to express |

|by completing a quiz at the end of | |Unit: Charge nurse, Manager, Director |relationships of escalation of issue, |

|day 2 | |Members of VIWP |identify resources and demonstrate their |

|demonstrate the accessing computer | |Employee health |critical thinking skills. Allows for |

|reporting and locate employee injury| |Human Resource |formative summation of performance |

|report form | | |feedback |

|(Cognitive, Psychomotor, Affective) | |Reporting process- Lecture, Computer | |

| | |validation, Return Demonstration |Observation- validates their cognitive |

| | |(Psychomotor, Cognitive) |knowledge on occurrence reporting and |

| |20 minutes |Occurrence report online |demonstrate understanding of the |

| | |Employee Injury report |(computer) technical skill of reporting – |

| | | |both occurrence and injury |

| | | | |

| | |Review and location of policy- Handout,| |

| | |Lecture (Cognitive, Affective) |Same as above |

| | |Violence in the workplace | |

| | |Employee Health Policy | |

| | | | |

| |15 minutes | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

|Learner Objective |Timeframe |Teaching Strategy |Evaluation Method |

|After the lecture on techniques of |Day 2 Hour 2 | | |

|safe distance, viewing video and role| | | |

|playing, the OAs and PCTs will: | |Role Playing: Video, Actual |Formative – verbal feedback of |

|demonstrate techniques of safe | |Demonstration- Role playing, |psychomotor skills including observation |

|distance |20 minutes |Discussion |evaluation of communication and problem |

|perform how to escape certain holds, | |( All Cognitive Domain, Affective) |solving skills |

|participate in constructive feedback| |Situational Application | |

|for staff performance during | |Physical Stance | |

|application | |Review of scripting | |

|Demonstrate safety precaution | |Practice Verbal responses | |

|(Cognitive & Psychomotor). | |Critique of role playing | |

| | | | |

| | | | |

| | |Return demonstration (Psychomotor, | |

| | |Affective) | |

| |20 minutes | |Observation- allows for direct |

| | | |observation of performance |

| | | | |

| | | |Checklist verifies behavioral and |

| | | |clinical competence meeting expectations |

| | | | |

| | | |Summation at the end of return |

| | | |demonstration on performance during |

| | | |demonstration |

| | | | |

| | | | |

| | |Quiz on day 2 information |Quiz Questionnaire |

| | | |Summative feedback of Day 2 progress- |

| | | |Allows for evaluation of knowledge gained|

| |15 minutes | |to be quantified and allows for |

| | | |remediation of information not absorbed |

| | | |by learners before the end of class. |

| | | | |

| | | |Questionnaire |

| | | | |

| | |Completion of program evaluation | |

| | | | |

| | | | |

| | | | |

| |5 minutes | | |

Method of Instruction & Rationale

Keeping in mind the diversity of the audience not only in experience but also in age and ethnicity, a variety of media and learning style strategies will be used. Awareness of the needs of visual, tactile and auditory learner needs is important in ensuring the content, learning strategies and learning domain matches to be effective (Billings & Halstead, 2012). A video and vignette on patient in a stressful situations and demonstration of crisis prevention techniques on de-escalation and physical safety from CPI will attract visual learners. The use of PowerPoint presentation which includes the purpose, needs assessment and the agenda of the class and presented in an organize fashion the major points of the class gives audiences an overview of the content. The use of visual aids and bullets of the content can allow the main points of the class highlighted for easy recollection. Handouts on the Stages of Crisis and Stress cycle along with NCH Violence in the Workplace Policy, employee health Policy and tutorial on online occurrence reporting can provide resource for tactile staff for future reference. Content of de-escalation techniques and communication can be delivered in two forms: the handout and demonstration of role playing in the classroom of techniques of safe stance and how to release out of a hold when grabbed by a distressed individual. Role playing is a vehicle to explore emotions, gain insight into one’s values, develop problem solving skill, and explore new outlook into the situation (Billings & Halstead, 2012). According to Amerson (2006), an intrapersonal learner works well observing the actions of others, is usually self-reflective as used in return demonstrations. Physical demonstration assesses the application of the understood concepts. Finally, case study presentations allow the participants to connect the theory to actual situations for easy assimilation to their practice (Billings & Halstead, 2012). Adult social learners can analyze and solve performance-based questions and improve their abilities unlike newer staff that would prefer structures content (Noble, Miller & Heckman, 2008). To conclude, a recap of take-away points is helpful to close the session. Creating a positive learning environment comes from understanding what is presented and also respecting and valuing everyone's contribution to the environment (Billings & Halstead, 2012).

Evaluation

Evaluation process is instrumental in assessing success of an educational program. An evaluation model is representative of ways that data or variables can be observed or clarified. A model’s advantage is the fact that it makes variables clear by clarifying priorities on which variables should be evaluated (Billings & Halstead, 2012). Selection of the model is dependent on the evaluation questions asked, the stakeholder’s needs and the course context (Billings & Halstead, 2013).

This project even though theory driven fits more a decision-oriented model. CIPP model (context, input, process, and product) provides information for judging decision choices (Stufflebeam & Webster, 1994). The context assesses the need of the target population; input assess abilities of systems for program implementation; process detects implementation issues, and product evaluation (assess program outcomes). The CIPP process provides information useful for decision-makers (Billings & Halstead, 2012). In this particular class, the tool evaluates the abilities of participants to make decisions in maintaining safety of self and patients through this program.

Selection of Evaluation Tool and Rationale

Selection of tool to evaluate the progress of learner or of the program is critical in maintaining the quality of a program and assessing effectiveness in communicating context of the material presented. Selection of the tool is dependent on the question asked and the evaluation method (Billings & Halstead, 2012). Use of evaluation instruments for each learning objective and rationale for its use are outlined within the lesson plan outline.

Program Evaluation

Assessment of educational program strategies reflects on the effectiveness of program outcomes. The overall view of the learner’s perception on how the program meets the learner’s need is vital in maintaining the effectiveness of the program. The use of a reliable, proven tool such as a Lickert scale assessment of the participants view is used to assess the value and effectiveness of the whole program (Billings & Halstead, 2012). The use of open-ended comment section is valuable in pinpointing specific effective areas of value to the learner and identifies areas to improve. In the case of a new program, these feedbacks are instrumental in measuring the outcome of a new program and refine its effectiveness for future presentations.

Conclusion

A disruptive behavior in an atmosphere that requires individual’s attention to maintain safety is dangerous and should be addressed. Injury caused by disruptive behaviors can be prevented (Peteet, Meyer, & Miovic, 2011). Addressing this issue requires a collaborative effort and accountability from healthcare workers (Wachter & Pronovost, 2009). Empowering staff with education to heighten awareness of interventions and techniques available to prevent injury is valuable in an organization.

Designing an education curriculum requires awareness of the needs of the intended audience. Knowing the needs of the audience can ensure that the learning styles and learning strategies matches the resources provided. Clearly defined objectives are the key to ensuring clarity in the program’s expectations. The use of creative teaching techniques to maximize interest and learning is the role of educators (Saxton, 2012). Use of strategies and appropriate evaluation tools to assess effectiveness of the learner and the program will strengthen the value of the program to meet intended learner needs.

References

Amerson, R. (2006). Energizing the nursing lecture: application of the theory of multiple intelligence learning. Nursing Education Perspectives, 27(4), 194-196.

Billings, D., & Halstead, J. (2012). Teaching in nursing: a guide for faculty (4th ed.). St. Louis, Missouri: Elsevier.

CPI Institute (2013). Non-violent Crisis intervention. Retrieved from

Druss, B. (2007). EMB and Quality Improvement research. Psychiatric Services. 58(10). doi: 10.1176/appi.ps.58.10.125

Govaerts, M.J. (2008). Educational competencies or education for professional competence? Medical Education, 42 (3):234–6. doi: 10.1111/j.1365-2923.2007.03001.x

Health Canada. (2007).The working conditions of nurses: Confronting the challenges. Strengthening the Policy-Research Connection, 13. 1-46. Retrieved from

Kohn, L. T., Corrigan, J. M. & Donaldson, M. S. (1999). To Err is Human: Building a safer health system. Institute of Medicine. National Academy Press. Retrieved from

Longo, J. (2010). Combating disruptive behaviors: Strategies to promote a healthy work environment. Online Journal of Issues in Nursing, 15(1), 3.

Nath, S.B., & Marcus, S.C. (2006). Medical errors in psychiatry. Harvard Review of Psychiatry, 14(4).204-11.

Noble, K., Miller, S., & Heckman, J. (2008). The cognitive style of nursing students: educational implications for teaching and learning. Journal of Nursing Education, 47(6), 245-253. doi:

Northwest Community Hospital (NCH). (2013). Safety Committee Report January 2013. Retrieved from .

Peteet, J. R., Meyer, F. L., & Miovic, M. K. (2011). Possibly Impossible Patients: Management of Difficult Behavior in Oncology Outpatients. Journal of Oncology Practice, 7(4), 242-246. doi:10.1200/JOP.2010.000122

Saxton, R. (2012). Communication skills training to address disruptive physician behavior. AORN Journal, 95(5), 602-611.

Stufflebeam, D.L. & Webster, W.J. (1994). An analysis of alternative approaches to evaluation. Assessment and Program Evaluation. Needham Heights, MA: Simon & Shuster.

Wachter, R.M. & Pronovost, P.J. (2009). Balancing ‘‘no blame’’ with accountability in patient safety. New England Journal of Medicine, 361(14). 1401–1406.

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