APNA 27th Annual Conference Session 3014: October 11, 2013

Transcription

1 APNA 27th Annual Conference Session 3014: ctober 11, 2013 Crisis Intervention Training with a Twist: National Staff Training to Develop Self-Care Skills & Integrate Chaos Theory for Safer Work Environments Angela C. Schmidt, BS, BSN, RN-BC angschmidtmsn@gmail.com APNA 27 th Annual Conference ctober 11, 2013 The Speaker has no conflicts of interest to disclose Learning bjectives As a result of participating in this session, the participant will be able to cite examples of the gaps in knowledge and practice that identify PTSD as a vocational hazard for nurses. 1. Identification of the myth that verbal, physical or emotional abuse towards nurses in the workplace is just part of the job. 2. Discuss & review studies/research literature regarding types of violence nurses experience on the job. 3. Develop creative educational strategies to provide staff development on Watson s theory of caring, selfcare skills for nurses, PTSD assessments and chaos theory Schmidt 1

2 APNA 27th Annual Conference Session 3014: ctober 11, 2013 Stability is a vision from nursing s past. Chaos theory is the new Normal Increased workload & Complexity of care Short hospital stays Staffing shortages Post traumatic stress Compassion fatigue (Beck, 2011) Barriers to Critical Thinking Technology/Security issues with Electronic Medical Record Staffing issues float/traveler RN s High, risk acutely ill or aggressive patients Physical/verbal abuse directed toward staff (from patient or peer) (Aiken et al, 2010) National Policy Educational bjectives I. Self-Care Skills based in Watson s Caring Theory II. Benner s Novice to Expert Nurse theory/application III. Crisis Management Skills IV. Chaos Theory as the new standard in healthcare V. Mandated national staff development programs The Joint Commission's National Institute of ccupational Environmental Health Joint Commission highlights horizontal violence in hospital settings All Healthcare workers, especially emergency and psychiatric care experience work-related assaults. Nurses have the highest rate of victimization in the healthcare industry (McEwen & Dumpel, 2012, p.20). Schmidt 2

3 APNA 27th Annual Conference Session 3014: ctober 11, 2013 Registered Nurse Safe Staffing Act of 2013: H.R (3) Health care worker fatigue has been ID ed as a major pt safety hazard, and appropriate staffing policies and practices are indicated as an effective strategy to reduce health care worker fatigue and to protect pts. A national survey of RN s found that 74 % experience acute or chronic effects of stress and overwork. (8) A 2012 study of Penn. hospitals shows that by reducing RN burnout, which is attributed in part to poor nurse staffing, those hospitals could prevent an estimated 4,160 infections with savings of $41,000,000. (9) When hospitals employ insufficient numbers of nursing staff, RN; s are being required to perform professional services under conditions that do not support quality health care or a healthful work environment for RN s. Preparation of curriculum design and development Tipping the Legislative Balance Towards RN Care Legislative Action is driven by finances as basic national incentives Utilization of Worker s Compensation Data Relationship of staff burnout to patient safety and quality of care Collective action of ANA/APNA lobbyist approach with proposed solution Proposed grant/research partnership with SAMSHA or NIMH Schmidt 3

4 APNA 27th Annual Conference Session 3014: ctober 11, 2013 Personal Self Care and rganizational Strategies for Resiliency Adaptability Sense of Humor De-Briefing after Critical events Pairing staff for mentoring/coaching Cognitive Reframing to enhance optimistic rather than negative self-talk Use resilience and PTSD assessment scale tools Shirley, M.R.(2012 p.553) Magnet Hospitals Improving utcomes (it s not enough to get our ducks in a row) Better work environments Improved nurse job satisfaction Less nurse burnout Shared governance structure Transformational leadership concepts (Kelly, L. A., McHugh, M. D., & Aiken, L. H. (2012). Nursing Practice Application for Crisis Management and Self Care Differing views among co-workers Relationship with one s manager Physical and physiological reactions to work Patient relationships Health-work environments Cultural diversity (Pipe, 2008) Schmidt 4

5 APNA 27th Annual Conference Session 3014: ctober 11, 2013 Creative Educational Strategies Integrate chaos theory as the new norm of healthcare Dialogue in the community Ideal Mandated Crisis Training in members Bridge Integrate Watson s caring leadership models into healthcare organizations Integrate crisis management skills in healthcare systems Design innovative nursing practices using Benner s model for clinical wisdom Translate evidence into practice via nursing and transformational leadership models l8 References Aiken, L. H., Hanlon, A. L., Hanrahan, N. P., & McClaine, L. (2010). Relationship between psychiatric nurse work environments and nurse burnout in acute general hospitals. Issues in Mental Health Nursing, 31, Becher, J., & Visovsky, C. (2012). Horizontal Violence in Nursing. MEDSURG Nursing, 21(4), Beck, C. T. (2011). Secondary Traumatic Stress in Nurses: A systematic review. Archives of Psychiatric Nursing, 25(1), Benner, P., Chesla, C., & Tanner, C. (2009). Expertise in nursing practice: caring, clinical judgment and ethics (2nd ed.). New York: Springer. Haigh, C.A. (2008). Using simplified chaos theory to manage nursing services. Journal of Nursing Management. 16, DI: /j x Kelly, L. A., McHugh, M. D., & Aiken, L. H. (2012). Nurse utcomes in Magnet and Non-Magnet Hospitals. Journal f Nursing Administration, 42(10), S44-9. doi: 0b013e31822eddbc References House of Representatives bill H.R1821 Registered Nurse Safe Staffing Act of Images are from ClipArt on Microsoft powerpoint, except slide 3, RN image is Julia Dwan Mendenhall Schmidt, presentor s mother. Malloch, K., & Porter- Grady, T. (2011). Quantum leadership: innovation, transforming health care. (3rd ed.). Jones & Bartlett Learning. advancing Sudbury: McEwan, D. & Dumpel, H. (2012). Workplace violence assessing occupational hazards and identifying strategies for prevention, part 1. National Nurse McEwan, D. & Dumpel, H. (2012). Workplace violence assessing occupational hazards and identifying strategies for prevention, part 2. National Nurse Mealer, M., Burnham, E., Goode, C., Rothbaum, B., & Moss, M. (2009). The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses. Depression & Anxiety ( ), 26(12), doi: Schmidt 5

6 Slide 14 l8 Somehow the hanging indents did not show up. Check to see the parts of book references that should be in italics. Titles of books should not have all words capitalized. The rest of the references look good. lois, 10/24/2012

7 APNA 27th Annual Conference Session 3014: ctober 11, 2013 References Papa, A. & Venella, J. (2013). Workplace violence in healthcare: strategies for advocacy. The nline Journal of Issues in Nursing. 18(1).DI:10.391/JIN.Vol18No01Man05,Retrieedfhttp://nursingworld. org/mainmenucategories/anamarketplace/anaperiodic l ls/jin/tableofcontents/vol /no1-jan-2013/workplace- Violence-Strategies-for -Advocay.html Pipe, T. B. (2008). Illuminating the inner leadership journey by engaging intention and mindfulness as guided by caring theory. Nursing Administration Quarterly, 32(2), Russell, K.A. (2012). Nurse Practice Acts Guide and Govern Nursing Practice. Journal of Nursing Regulation, 3(3), Shirley, M.R.(2012). How resilient are your team members? Journal of Nursing Administration 42(12), DI:10.109/NNa.0b013e318274b4d6 Watson, J. (2008). Nursing: the philosophy and Science of Caring (revised ed.). : University Press of Colorado. RATINAL: Quantum leadership embraces the idea of vulnerability as being an asset in the new leadership paradigm. This is counterintuitive to most nurses. The concept of resilience which entails a dynamic process with vulnerability at one end and the ability to bounce back (resiliency) at the other end is more approachable. Studies have shown resilience can add protective factors of selfefficacy, adaptability and a sense of humor which can assist a nurse to recover and thrive in spite of adversity (Shirley, 2012, p.551). penness to change and personal reliance enhance individual employees readiness for organizational change. Persons with high resiliency are more able to change without experiencing trauma. In order to develop personal resilience it is necessary to have educational programs for nurses to learn and enhance their personal resilience. rganizational strategies to assist in the development of resiliency could include: 1. De-briefing after critical events to create learning from past difficult experiences 2. Cognitive reframing coaching to assist nurses to enhance optimistic self-talk rather than negative self-talk 3. Pairing of nurses with high personal resilience with others whom need to build upon this skill(shirley, 2012, p.553). Schmidt 6