DESC Script What is it? A structured, assertive, communication approach for managing and resolving conflict. D Describ e the specific situation ti E Express your concerns about the action S Suggest other alternatives C Consequences should be stated When to use it? Whenever you have a personal conflict with another health team member that threatens your ability to perform your job well. Key Points Have timely discussion Use I statements Avoid blaming statements Focus on what is right, not who is right If you don t know what to say under for C-consequences, Don t let that stop you!! You would still have made a good assertive statement if you used D,E,S ES.
How to use DESC? Case scenario: As a first year resident you are asked by an attending physician to prepare to admit a patient with a stage 3 decubitus ulcer with possible sepsis. You find that the patient is being admitted to the geriatric floor and you go meet the patient and complete the work-up. The attending greets you with, I wanted him admitt itted to the surgical ward, not the senior center, in front of coworkers at the nursing station. You never think about what will make our job easier. This is not the first time the attending has been verbally abusive. DESC script example: You decide to use the DESC script to respond to the attending as follows: D I know you re busy but you did not indicate that you wanted the patient on the surgical ward. Admitting decides where to place the patient not me, based upon your instructions. ti It is not fair to yell at me when you don t like what is happening. E When you yell at me you make me uncomfortable and I feel diminish my authority and possibly the respect I will receive from the staff because you appear to be blaming me for a situation that I am not responsible for. S It would be more effective for you to discuss with admitting where you want your patients or give me a full briefing on what you want done for the patient and where you want them admitted. C If you continue to treat me with disrespect when you only give me partial information I will file a complaint with the Chief medical officer. I will also post an adverse event into our reporting system.
DESC DESC: A case scenario for role play You are the charge nurse for a 34 bed obstetrical unit. It s busy in labor and delivery and you just noticed that one of the fetal monitors is revealing a sustained low heart rate. You confront the nurse who tells you the resident said to monitor the situation, but you feel the patient should be prepped for a c-section. You find the obstetrical resident and he tells you that you re interfering and he has everything under control. Meanwhile the fetal monitor shows evidence of fetal distress. The attending comes in and says to prep the patient for c-section. The resident says that is just what I was about to do! What would you do? Use the DESC script to share any concerns with the resident.
ALEEN What is it? A conflict resolution approach to reduce the tension in a confrontation, clarify the problem, and reach a solution. A Anticipate L Listen E Empathize E Explain N Negotiate Pause, think of problem, then approach person Listen without interrupting Summarize and show empathy Explain your behavior or action Reach a mutually agreeable solution When to use it? In conflict situations where a patient, family member, or colleague is upset and approaches you with a complaint or concern that you can address. Key Points - Listening to full story of other person without interruption is important to reduce escalati ting tension and help the upset person realize that they are being heard. - Show genuine empathy - Reaching a mutually agreeable plan would require some flexibility from your end on matters that are within your control.
Using ALEEN Case scenario: Mr. Doe is an 80-year-old gentleman with Diabetes type 2 who is under your care in the ICU recovering from a splenectomy. His surgery was complicated by bleeding requiring a reoperation. Patient is stable in ICU and insulin is being used to control his blood glucose per a standard ICU protocol. His home medications include oral hypoglycemic agents but no insulin. One morning you hear the patient s daughter yelling at the nurses rses. She is extremel tremely upset that her father is being given insulin for high blood glucose. She is concerned because her dad only needs pills to treat diabetes. She does not want him to receive insulin for rest of his life. Could using ALEEN format help you handle this situation? A You overhear daughter yelling at the nurses and instead of rushing to explain and defend your treatment plan you pause for a few moments to consider the situation then approach her saying: It seems like you are upset, can you help me understand why? L You listen without interrupting to daughter's concerns about her father being treated with insulin not the pill. She tells you that she does not think insulin is good for him and she does not want her dad to be on insulin for rest of his life. E You show empathy by saying : I can understand why that would be upsetting to you. Certainly we would not want to give him medicine that would cause risk to him or make the problem worse. E You ask for permission to explain. Is it ok if I explained why we are giving your father insulin?. Then you explain why controlling blood glucose after surgery is important to prevent surgical site infections and why insulin is a better treatment option for him in the ICU given that he is not eating yet. You also explain that giving him insulin now does not mean that he will need insulin for rest of his life. N You assure the daughter that you will closely monitor her father s blood sugar aiming to keep it below 180 to prevent risk of infection and will plan to take him off the insulin as soon as possible as he recovers from the surgery. You finish by asking if that was a plan that the two of you could agree on. She approves and conversation ends on a fi friendly note.
ALEEN ALEEN: A case scenario for role play You are called to the surgery prep area by one of the nurses to calm down an upset patient and family. The patient is a 78-year-old woman from out of state on her second trip with her 3 children back to Hopkins for a Whipp le procedure. She was sent home the first time because of a fever and was again canceled by the surgeon today. They were frustrated most because this is the second time they are cancelled with no real answers and delaying surgery further when their mother may have cancer. You review the case and find out that the patient has 103 degree fever which makes it unsafe to undergo surgery and anesthesia due to increased risk of developing infection, septic shock, and death. You plan to go over, talk to the patient and family, and conduct a fever work up for this patient. What would you do? Use the ALEEN framework to resolve the conflict with patient and family member.
The Two Attempt Rule What is it? A communication process that seeks to ensure patient safety by empowering providers to bring any safety concerns that go unheard or aren t addressed satisfactorily up the chain of command till consensus is achieved. Escalate if Need be Rechallenge Agree on Course of Action Get A tt ention NAMES First State the issue Make eye contact Verbalize your Feelings ( CUS) Clear & Concise Propose Action When to use it? Whenever you voice a patient safety concern that goes unheard or is not been addressed satisfactorily by other team members. Key Points - The two attempt rule directs team members to attempt to make themselves heard twice. If that is unsuccessful this rule directs them to escalate or go up the chain of command till their concern is addressed. - Using an assertive communication style, as in above diagram, will help other team members listen to you more. -Using the CUS words ( I m concerned ; I m uncomfortable;thisisa safety ft issue ) can be hl helpful li in communicating your feelings/ view of the situation and can help get the other person s attention.