Clinical Excellence in Nursing: SCENS Simulations for Disruptive Behavior Management

 
Simulations for Clinical Excellence
in Nursing Services
 
SCENS
 
Disruptive Patient (1):
De-Escalation
 
SCENS
 
Disclaimer
 
The sensitivity of the content discussed during this
scenario may trigger emotional or physiological
responses
Please inform the faculty if this is uncomfortable for
you
 
SCENS
 
Learning Objectives
 
1.
Demonstrate the utilization of Prevention and Management of Disruptive
Behavior (PMDB) de-escalation principles to establish safety
2.
Implement facility specific protocol for the patient exhibiting escalating
disruptive behavior
3.
Utilize effective communication when caring for the disruptive patient
 
SCENS
 
Why?
Statistics for nurses
Joint Commission National Patient Safety Goals
Prevention and Management of Disruptive Behavior
2017 Mandatory Training
National Database of Nursing Quality Indicators (NDNQI)
 
SCENS
 
PMDB 2017 Mandatory Training
 
Prevent workplace violence
Evolved since the late 1970s
Facility level courses
Only workplace violence prevention program in the world known to
undertake rigorous physical skills evaluation
Identify disruptive situations
Recognize the signs of an escalating situation
Techniques on how to intervene to reduce risk
The key is prevention of injuries to self and others
 
SCENS
 
GAINS
 Mnemonic
G
estures
A
cting
I
ncongruent
N
oticeable
S
ystematically
 
Early signs of escalating behavior
 
SCENS
 
Normal Level of Stress
Signs and symptoms
Normal heart rate
Keeps perceptual field
Thinks clearly
Interventions
Be professional
Communicate plan of care or any delays
Offer assistance
Provide good customer service with respect and in a timely
manner
 
SCENS
 
Moderate Level of Stress
 
Signs and symptoms:
High normal heart rate
Narrowing perceptual field
Altered thinking
Interventions:
Redirect and indicate that the behavior is not
acceptable
 
 
SCENS
 
Severe Level of Stress
Signs and symptoms:
Heart rate near 100
Difficulty processing information
Tunnel vision
Complex motor skills decrease
Limited perceptual field
Interventions
:
Set limits with simply stated directions since problems
processing information are evident at this stage.
 
SCENS
 
Panic Level of Stress
Signs and symptoms:
Heart rate over 100
Unable to process information
Irrational
Gross motor skills (strength-based) are at high performance
Interventions:
Gain coworkers’ attention
Call for assistance
Avoid becoming isolated with the person
Locate the exit and maintain proximity
 
SCENS
 
Don’t
Argue
Raise your voice
Remain alone in the
room with the patient
Don’t multi-task
 
Interventions
 
4
SCENS
 
Do
Call for assistance
Code word
Remove yourself
Excess furniture
Neutral party
Remove unnecessary patients, staff and visitors
Locate the exit
Distract the patient
Give the patient your full attention
Noise level
“Gut feeling”
 
Survey the environment…
 
Locate the exit
Potential weapons
Cane
Flashlights
Cell phones
Other potentially dangerous
items
 
Know your facility policy
Check personal possessions
upon admission/entry into
facility
Be suspicious if items are
heavier than normal or that
appear altered
 
SCENS
 
Facility-Specific
 
Policies and procedures
Protocols
Equipment
Resources
State licensure; scope of practice; certifications; job description
Accountability
Documentation
Disruptive Behavior Reporting System (DBRS)
 
SCENS
 
Priorities
Get help
Establish and maintain safety
Identify the problem
Priority interventions
Recognize escalating behavior
Anticipate the need for equipment and medications
Consider restraints only as a last resort
 
SCENS
 
Potential Issues
 
Psychosocial
Equipment
Medication
Delays
Transfer to another unit/facility
Need for restraints
 
SCENS
 
Summary
1.
Discussed the use of Prevention and Management of Disruptive Behavior
(PMDB) de-escalation principles to establish safety
2.
Reviewed facility specific protocol for the patient exhibiting escalating
disruptive behavior
3.
Provided effective communication techniques to utilize when caring for the
disruptive patient
 
SCENS
 
SCENS
 
Past Medical History:
Post Traumatic Stress Disorder (PTSD), type
2 diabetes, chronic obstructive pulmonary
disease (COPD), arthritis, diabetic
neuropathy, 30 year one pack per day
smoking history,  and  he drinks “a few
beers a day”
Past Surgical History:
Appendectomy
Bilateral lower extremity shrapnel removal
 
Medications:
Metformin 500 mg three times daily with meals
Lorazepam 2 mg every 8 hours
Albuterol/Ipratropium inhaler 2 puffs four times
a day
Gabapentin 300 mg three times a day
Allergies:
Dairy products
 
Rolando Jones
49 year old male presents for an appointment for an unknown reason after
traveling two hours.  He is accompanied by his significant other.
 
Disruptive Patient: De-escalation
 
SCENS
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SCENS provides simulations focusing on Prevention and Management of Disruptive Behavior (PMDB) in nursing services, emphasizing safety protocols and effective communication. The training covers early signs of escalating behavior, stress levels recognition, and interventions to handle disruptive situations proactively. With a focus on prevention and workplace violence, SCENS aims to enhance nurses' skills in de-escalation and risk reduction.

  • Nursing
  • Clinical Excellence
  • Disruptive Behavior Management
  • Training
  • Workplace Violence

Uploaded on Jul 16, 2024 | 0 Views


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  1. Simulations for Clinical Excellence in Nursing Services SCENS Welcome To

  2. SCENS

  3. Disclaimer SCENS The sensitivity of the content discussed during this scenario may trigger emotional or physiological responses Please inform the faculty if this is uncomfortable for you

  4. Learning Objectives SCENS 1. Demonstrate the utilization of Prevention and Management of Disruptive Behavior (PMDB) de-escalation principles to establish safety Implement facility specific protocol for the patient exhibiting escalating disruptive behavior Utilize effective communication when caring for the disruptive patient 2. 3.

  5. Why? SCENS Statistics for nurses Joint Commission National Patient Safety Goals Prevention and Management of Disruptive Behavior 2017 Mandatory Training National Database of Nursing Quality Indicators (NDNQI)

  6. PMDB 2017 Mandatory Training SCENS Prevent workplace violence Evolved since the late 1970s Facility level courses Only workplace violence prevention program in the world known to undertake rigorous physical skills evaluation Identify disruptive situations Recognize the signs of an escalating situation Techniques on how to intervene to reduce risk The key is prevention of injuries to self and others

  7. Early signs of escalating behavior SCENS GAINS Mnemonic Gestures Acting Incongruent Noticeable Systematically

  8. Normal Level of Stress SCENS Signs and symptoms Normal heart rate Keeps perceptual field Thinks clearly Interventions Be professional Communicate plan of care or any delays Offer assistance Provide good customer service with respect and in a timely manner

  9. Moderate Level of Stress SCENS Signs and symptoms: High normal heart rate Narrowing perceptual field Altered thinking Interventions: Redirect and indicate that the behavior is not acceptable

  10. Severe Level of Stress SCENS Signs and symptoms: Heart rate near 100 Difficulty processing information Tunnel vision Complex motor skills decrease Limited perceptual field Interventions: Set limits with simply stated directions since problems processing information are evident at this stage.

  11. Panic Level of Stress SCENS Signs and symptoms: Heart rate over 100 Unable to process information Irrational Gross motor skills (strength-based) are at high performance Interventions: Gain coworkers attention Call for assistance Avoid becoming isolated with the person Locate the exit and maintain proximity

  12. Interventions SCENS Do Don t Argue Raise your voice Remain alone in the room with the patient Don t multi-task Call for assistance Code word Remove yourself Excess furniture Neutral party Remove unnecessary patients, staff and visitors Locate the exit Distract the patient Give the patient your full attention Noise level Gut feeling 4

  13. SCENS Survey the environment Know your facility policy Check personal possessions upon admission/entry into facility Be suspicious if items are heavier than normal or that appear altered Locate the exit Potential weapons Cane Flashlights Cell phones Other potentially dangerous items

  14. Facility-Specific SCENS Policies and procedures Protocols Equipment Resources State licensure; scope of practice; certifications; job description Accountability Documentation Disruptive Behavior Reporting System (DBRS)

  15. Priorities SCENS Get help Establish and maintain safety Identify the problem Priority interventions Recognize escalating behavior Anticipate the need for equipment and medications Consider restraints only as a last resort

  16. Potential Issues SCENS Psychosocial Equipment Medication Delays Transfer to another unit/facility Need for restraints

  17. Summary SCENS 1. Discussed the use of Prevention and Management of Disruptive Behavior (PMDB) de-escalation principles to establish safety Reviewed facility specific protocol for the patient exhibiting escalating disruptive behavior Provided effective communication techniques to utilize when caring for the disruptive patient 2. 3.

  18. SCENS

  19. Disruptive Patient: De-escalation SCENS Rolando Jones 49 year old male presents for an appointment for an unknown reason after traveling two hours. He is accompanied by his significant other. Past Medical History: Post Traumatic Stress Disorder (PTSD), type 2 diabetes, chronic obstructive pulmonary disease (COPD), arthritis, diabetic neuropathy, 30 year one pack per day smoking history, and he drinks a few beers a day Past Surgical History: Appendectomy Bilateral lower extremity shrapnel removal Medications: Metformin 500 mg three times daily with meals Lorazepam 2 mg every 8 hours Albuterol/Ipratropium inhaler 2 puffs four times a day Gabapentin 300 mg three times a day Allergies: Dairy products

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