103 Educating Patients: Creating Teaching Moments in Practice
healthcare professionals need to deesca- late the situation. Escalation of behaviors can lead to as- sault, so earlier interventions are more effective. It is important for healthcare professionals to recognize behaviors and then provide interventions. Violence oc- curs in a cycle, starting with the activation of the behavior, which may have an iden- tifiable trigger. In the first phase, restless behaviors such as pacing can be noted. Escalation then occurs, with examples of agitation, shouting, cursing, and relat- ed behaviors. The crisis phase is when violence occurs. Following a crisis, the phases of recovery, postcrisis depres- sion, and stabilization happen (McKnight, 2020). There are common de-escalation tech- niques that can be used when someone
begins to escalate. If it is safe, moving to a private area away from the public is rec- ommended. There should be an aware- ness of personal space, giving around two feet distance, which may also provide some safety. Exits should not be blocked, and if the person wants to leave, they can. The healthcare professional should show empathy and not be judgmental, focusing on trying to understand the per- son’s emotions. Nonverbal expressions are important, such as a calming tone and relaxed body language. Healthcare pro- fessionals should avoid overreacting and remain rational. Using silence and giving time for decisions are also effective tech- niques. Boundaries must be respectfully set by providing clear and enforceable limits if behaviors are disruptive or bel- ligerent, (Hallett & Dickens, 2017; McK - night, 2020).
CASE STUDY: MR. FRANK
Mr. Frank is a 74-year-old African American male who presents to the clinic three days after discharge from the hospital following an observational stay. He was brought into the hospital with dizziness and loss of conscious- ness and was newly diagnosed with type II diabetes. Mr. Frank now takes metformin and says he’s been taking “a water pill” for many years but doesn’t know what it is or why he takes it. He is a retired contractor, and states he has avoided “anyone related to hospitals” for most of his life. At discharge, he was given multiple patient education sheets, which he has brought in with him for his appointment. Upon review, the topics he was given include a full booklet (45 pages) on diabetes, a page about type I diabetes, one on type II diabetes, one on gestational diabetes, one on testing blood glucose, and one on taking insulin.
Question 1 : What are considerations for developing rapport with Mr. Frank? Commentary on question 1 : First impressions and building trust are important. This may be especially true with Mr. Frank, as it seems he may have some distrust of healthcare professionals. Acknowledgment and introductions should be done, including asking him how he would like to be addressed. Being aware of nonverbal behaviors during communication, using open-ended questions, and involving Mr. Frank in the conversation are all needed. Demonstrate empathy during the discussion.
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