What approaches can you use within the assessment process to enhance collaboration and participation when clients are at risk?

Risk Management/Therapeutic co mmunication with the angry patient Order Description Under assignment question there is a video Click on the video below (4min.17sec) Video: Therapeutic co mmunication with the angry patient This video demonstrates the interaction between a nurse and a client (Carla) who is currently distressed. Please answer the following questions: Reflect on the video scenario (link below) observing the interactions between the two individuals. Then answer following three (3) questions: 1. Using your knowledge and skills from previous weeks analyse the questions asked (verbally para-verbally) and non-verbal behaviours used in order to assess the clients level of risk as well as assist the client regain focus take control of their emotions and ultimately calm down. a. From your observations of the situation what did the nurse do well? b. From your analysis of the situation what changes would you suggest for Carlas risk management? 2. What approaches can you use within the assessment process to enhance collaboration and participation when clients are at risk? 3. Reflect on what you think may be the underlying cause for Carlas behaviour. CriticalThinkingQuestions http://relationalcontextofteaching.edublogs.org/2011/06/23/why-did-i-choose-to-show-and-not-tell/ Pleaseanswerthefollowing for professional portfolio Reflectonthe videoscenario(linkbelow)observing theinteractionsbetweenthe twoindividuals.Thenanswerfollowing three(3)questions: 1. Using yourknowledgeandskillsfrompreviousweeksanalysethe questionsasked(verballypara-verbally)and non-verbalbehavioursused in ordertoassessthe clientslevelofrisk aswell as assisttheclient regainfocustakecontroloftheiremotionsandultimatelycalmdown. a. Fromyourobservationsofthe situationwhat did thenursedo well? b. Fromyouranalysisof thesituationwhatchangeswould you suggestforCarlasriskmanagement? 2. What approachescan youusewithinthe assessmentprocesstoenhancecollaborationand participationwhen clientsare atrisk? 3. Reflect onwhatyou thinkmaybetheunderlying causeforCarlasbehaviour. Video: Clickon thevideobelow(4min.17sec) Video: Therapeuticcommunicationwith theangrypatient Thisvideodemonstratestheinteractionbetween anurseand a client (Carla)whois currentlydistressed.Fromthisvideo considerthe following: Readings Read the followingpagesofthistext. HungerfordC.HodgsonD.ClancyR.Monisse-RedmanM.BostwickR.&JonesT.(2015).Mental Health Care AnIntroduction for HealthProfessionals in Australia(2nded). MiltonQLD:JohnWiley&SonsAustraliaLtd. Chapter 6:Caringforpeople displayingchallengingbehavioursp.238-273 Skillsandbehaviourswhatdo I need todo? http://www.improvizations.com/Portals/42614/images/skills.jpg Youwill needto completea risk assessment Within your riskassessmentyou willneed toassessfor riskof: o aggression/violence (harmto others) o suicide ( harmtoself) o self-harm( harmtoself) o general vulnerability( exploitation) o past/current trauma( incl. sexual/physicalabuse) o drugs/alcohol(including withdrawal) o absconding ( leaving a place ofsafety) o neglect(including physicalneglect of self) o relatedtodependents o impulsive/reckless/provocativebehavioursYouwill needto: Identifysignsof predictorsof risk[actual/potential]including static anddynamicfactors.Beableto describeriskand theriskfactorsforexamplelowmediumhigh levelsof risk.Chronic/ongoing oracuterisk. Identifyprotectivefactors. Beabletodemonstrateyourtherapeuticskillsthatwillsupporttheindividualwhoisatrisk. Formulate arisk summaryand riskmanagement planand clearlydocumentthiswithintherisk assessment formandtheclinical/electronichealth record. In doing thisyoualso needtoconsiderthemanagementplanswheresomerestrictionsof autonomy andfreedommaycausetheindividualtofeela lossoftheirhuman rights. Youwill needtosupportthisbalanceto ensureindividualrightsaremaintained aswellas theindividualswellbeing. Hand overto otherclinicalstaffthelevelof riskfortheconsumersyou areworking withandthe action plan tosupportthe riskmanagement. Youmayalsoneedtoconsider: Themental illnessesthathaveriskimplications andwhy? Theevidenceisto supportmypractice? www.thewordworks.co.uk RiskAssessment It is importanttounderstand riskassessment and riskmanagement. Riskassessmentsshould alwaysincludesimilarinformationaboutthe typesof riskforthe person andthismaybemorethan one riskdependenton theindividual.Forexampletheindividualmaybeatriskofsuicidalbehaviourandalso riskofabsconding fromthe healthservice. Risk assessmentsarebasedonstaticand dynamicfactorsandon acuteandchronic risk.Thelevelofriskcan fluctuatedepending on theindividualand theirindividualcircumstances. RiskManagement Riskmanagementshould alwaysfollowrisk principlesof need responsivenessand least restrictivepractices. Zero Tolerance: Itis important to notethathealthservicesin Australiahaveadopted a zerotoleranceapproach toaggressionviolenceassaultbullying andotheractsofviolencein theworkplace(Hungerford etal2015). Thereare a numberofways in whichserviceswillmanage risk forexamplethemanagement ofclinical aggression (MOCA)is oneway in whichclinicians aretrainedtorespond torisksof aggressionand violence. Managementofclinical risk is an approach to ensuresafety andquality ofcarewithinthehealthservices. Identifying consumerswhomaybe atriskofharmisvitaltothecareprovision andassisthealth professionalstopreventreduceorcontroltheserisks. Pleaseclickhere onRiskwatch Volume10May2013thisbulletinhelpstoprovidesupporttheprocessofreviewofhigh risk incidentswithin healthservices. Itisanopen andtransparent waytoensure thatall casesthat involve adverseeventsormedical errorarereviewedthoroughly Pleaseclickon workingwith a suicidalpatient/consumerthis is quickguidefortriagestaffwhenworkingwith aperson who maybeatrisk ofsuicide. Theassessment and thenmanagement ofasuicidal personisvitalto ensureappropriateand timelycareand treatment. TheConsumerand CarerPerspective Happell etal(2008)discusstheconsumerperspective onriskassessment andmanagement as aneed toensure thatit iscarried outin anappropriateand timelymanner. It is importantto includeconsumersandcarer/family in all aspectsoftreatmentand planning andthis is nodifferent withinthe riskassessment andmanagement.Supporting theconsumerand carer/familytoidentifyearlywarning signs andtriggerswill assistin themanagement and earlyintervention.Risk assessmentshouldbefocusedonthestrengths and thepositivesnot juston potential riskfactors. Allconsumerscarersfamiliesand friendsalsohavetherighttoreceivehealth care orvisit a healthcare setting that is freefromriskstotheirpersonalsafety(Hungerford et al2015). Slade M(2009)talks aboutwaysin whichservicescanassistpeopleto managetheir risk-takingbehavioursbypromotinga recoveryoriented frameworktocare.Supporting individuals to haveresponsibilityfortheirownlivesandown riskis an importantintervention formental healthservicesto worktowards.Balancingrisk and riskfactors isvitaltothe careand treatmentweoffer. Compulsorytreatment during a crisismayneedto beconsideredour goal istoensure thatwhenthis arisesthatconsumersare treatedwiththe respectand dignity andtoaimforminimallossofpersonalresponsibilityduring thecrisis. Self-Awareness Understanding yourself and howyou respond toacute risksituations is important.Peoplereactdifferentlyto situations. Inthe practiceclasswewill exploreresponsesinmoredepth.Thereareanumberof emotionalresponses thatwe allexperience asthe healthprofessional or as a consumer. Somepeopleuse of theirdefencemechanisms(howpeopleunconsciously respondtothreats).For e.g. the useofprojectionhowoneperson mayprojecttheiruncomfortablethoughtsand feelingsonto another(Hungerford et al2015)? Ina situation somepeoplereporta sense of powercontroland calmness;othersreportfeelingshakyandtearfulon theverge ofcollapse; othersdescribe a physicalsensationofnauseaandvomiting. It is important thatwegainan understanding ofourselvesand howwerespondsothatwe canprovidean effectivewayto managerisk situationswhich causefewertraumastoall individualsinvolved. Websites: Thereare a numberofwebsitesthatprovidefactsheetsand information to supportunderstandingof riskandriskfactors inmental health.Risk isinclusive ofa numberof riskfactors andpertainstoarange of risksbelowareexamplesofsomeareasof risk(noterisk is notrestrictedtoriskofaggression/violenceandorsuicide). Pleasereviewthefollowingwebsites: When workingwithyouthpeople andadolescents consider the followingwebsiteReachout.Thissiteprovides generalinformation aboutangerand angermanagement. http://au.reachout.com/find/articles/anger http://au.reachout.com/find/articles/being-violent http://au.reachout.com/find/articles/anger-is-something-that-is-hard-to-deal-with When workingwith peoplewho are expressing thoughtsofsuicideconsidertheSanewebsite.Thesefactsheetshelp tosupportpeoplewhoareincrisis. http://www.sane.org/images/stories/information/factsheets/1007_info_25sanesteps.pdf http://www.sane.org/images/stories/information/factsheets/1110_info_26suicidehelp.pdf Lifeline isa crisissupportand suicideprevention 24hourservicethatyou can accessvia thetelephone.http://www.lifeline.org.au/ Watch thisbriefvideobyGrahameGould aLifelinemanagerclickhere Additionalreading Chapter10:AngerHostilityandAggression EvansJ.&BrownP.(2012).VidebecksMentalHealthNursing.(pp.169-182).SydneyNSW:LippincottWilliams&Wilkins. PleasenoteVidebecksreferencetosafetyrelatingtopatient/consumerwhomaybeinpossessionofaweapon(pp.174-175)isinrelationtoskilledstaffwhohavebeenproperlytrainedtoassistinmanagementofaconsumer/patientwithaweapon.Thepracticesofremovalofaweaponandorthrowingwateronthepatient/consumerarenotarecommendedpracticewithintheACUundergraduatecourseSchoolofNursingMidwiferyandParamedicine. Chapter11:AssessmentandDiagnosisEssentialnursingskills Elder.R.EvansK.NizetteD.(2013).Psychiatricandmentalhealthnursing(3rded.).ChatswoodNSW:ElsevierAustralia.p203-204 Chapter12:AssessmentEssentialSkillsHoNOS;(p370) Chapter13:SpecialisedAssessment-RiskAssessment(405&413); Chapter21Substancerelateddisorders-Assessingrisk(p.469) Chapter25Schizophrenia-SpecificriskassessmentissuesinSchizophrenia(p.768770) MeadowsG.SinghB.&GriggM.(2012).MentalhealthinAustralia.Collaborativecommunitypractice(3rded.).SouthMelbourneVic:OxfordUniversityPress. Chapter5:MentalHealthandIllnessAssessment (p.118119) HappellB.CowinL.RoperC.FosterK.&McMasterR.(Eds.).(2008).Introducingmentalhealthnursing:aconsumer-orientedapproach.Sydney:Allen&Unwin. Pleasenotetherearealsospecificareaswithineachofthedisordersthatdiscusstheriskmanagementspecifictotheillness. Foryourinterest AustralianNursingFederation.(2012).ANFPolicy:Zerotoleranceofviolenceandaggressionintheworkplace.Retrievedfrom http://anmf.org.au/documents/policies/P_Zero_tolerance_violence_aggression.pdf http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2007.04169.x/full http://bjp.rcpsych.org/content/189/6/520.full http://www.aenj.org.au/article/S1574-6267%2806%2900076-0/abstract http://www.health.vic.gov.au/mentalhealth/triage/scale0510.pdf