Safe Management Techniques

Introduction:Patient and Caregver smiling
In this module, you will learn about “safe management techniques.” What this means is that when you work with residents who behave in potentially dangerous ways, there are some effective things you can do to ensure their safety as well as your own. In this module you will learn some of these techniques.

It is common for a resident to become frustrated, depressed, angry or resentful about physical or mental losses he/she may be experiencing. Medications the resident takes may also contribute to difficult behaviors. Residents may express these behaviors towards you directly, or indirectly, by not being cooperative in the care you provide. These behaviors may be distressing, simply annoying or time-consuming, but they could have the potential to become unsafe if not managed correctly. In this module you will identify behaviors that are potentially dangerous and what to do when they occur. You will learn about positive management techniques that protect the resident’s health, safety and well-being. The techniques in this module can be useful during difficult situations.

 

How do you recognize signs of abuse and neglect?

Unfortunately, we occasionally read about or hear news reports of abuse and neglect occurring in personal care homes. Residents may abuse one another, staff may abuse residents or residents may abuse staff. By law, signs of abuse and neglect are to be reported. Therefore, you must become knowledgeable about this topic. Abuse can be physical or emotional. Some examples of abuse are:

  • Pushing, hitting or shaking.
  • Pulling hair or ear.
  • Tying a resident to a bed or chair.
  • Locking a resident in a room.
  • A staff person engaging in any sexual contact with a resident.
  • Giving too much medicine on purpose.
  • Yelling at or threatening with words.
  • Harassing a person.
  • Using ethnic slurs.
  • Sexual harassment.
  • Rape.
  • Attempted rape.
  • Sexual assault.
  • Threatening to make a person leave the home.

Another form of abuse is “financial abuse.” This involves taking property or money from a resident or encouraging a resident to hand over his/her assets. Residents have the right to protection of their money and property.

Neglect is the failure to provide necessary care that results in harm to the resident.

Examples of neglect include:

  • Leaving a group of aggressive residents unsupervised.
  • A direct care staff person falling asleep while on duty.
  • Delaying the normal scheduling of routine medical or dental visits for health maintenance.
  • Isolating a resident in their room.
  • Leaving a resident unattended by staff for long periods of time.
  • Failing to seek medical help when a resident shows symptoms of injury or illness, or if a resident complains of pain.
  • Delaying assistance with activities of daily living, such as failure to help a resident with toileting and causing the resident to soil himself/herself.

 

What should you do if you see abuse or neglect?

You should ask your supervisor what the home’s procedures are to report suspected abuse or neglect. It is not your responsibility to investigate or confirm the suspected abuse or neglect—only to report what you see. When reporting to your supervisor, it is important to be “objective.” State only what you see or hear, not your interpretation of what you see or what you assume is happening, which is “subjective” information. In other words, just state the facts.

You may also report suspected abuse or neglect to any of the following:

  1. DHS regional office. Location and contact information for each of the regional offices can be found online.

    Click Here
  2. DHS complaint hotline. Each personal care home is required to post the Personal Care Home Complaint Hotline number (1-877-401-8835).
  3. Area Agency on Aging (AAA) office. The phone number is in the blue pages of the phone book and should be posted in a conspicuous place in each licensed facility. A trained professional will either help resolve the issue or contact the proper authority, if necessary.

 

Improving communication:

This section describes ways to build positive relationships with residents. The first step in trying to understand how a resident behaves is to try to identify the reason behind the behavior. Ask yourself, “What does the resident need?” Is it to be heard? Is it to feel in control? For example,

  • A resident who is hostile and uncooperative while you try to assist with dressing or toileting may be feeling a loss of personal privacy or independence.
  • An angry resident may refuse to eat his food and throws his food on the floor because no one involved him in making his food choices and he feels a loss of control over his daily life.
  • A resident who becomes agitated because others are talking about her when she sees them looking at her and smiling as they talk may be experiencing a sensory loss of hearing.
  • A resident who used to be outgoing and friendly but is now quiet, may be having a bad reaction to a change in medications.

The next step is to follow basic principles of effective communication.

Face the resident, lean forward slightly, get to the resident’s level and make eye contact. Eye contact is when one looks directly at an individual’s eyes. When you do this, you send a message that you are interested in what the resident is saying. Gently touching the resident’s hand or arm, when appropriate, may also help you get the resident’s attention.

Listen carefully to the resident, limiting your own comments. You can show interest by nodding and saying things like “I see,” “Oh,” “Mm,” “how about that” and “Uh-huh.” Check for understanding by repeating back what you have heard her say. This will help you learn how she seems to feel about the situation at the moment.

Ask open-ended questions rather than “yes/no” questions. For example, say, “How is your day going?” rather than “Are you having a good day?” Ways to start open-ended questions are using: “How” “What” “Could” and “Would.”

Use “I” rather than “you.” For example, when Sheila starts screaming when someone turns on the TV, you can begin by saying to Sheila “I see that the TV upsets you.” “I” messages have a gentle tone and calming effect. They are especially important when working with residents with dementia who are sensitive to the “feeling tone” of the environment. When you use “I” messages, you show consideration for other people’s wants or needs. “You” messages sound like the person is being blamed or shamed for their behavior and can cause people to become agitated and angry. An example of a “you” statement with Sheila is “You shouldn’t be sitting next to the TV if you don’t like it.” Notice how the “I” statement suggests concern for Sheila and the “you” statement suggests that Sheila has caused the problem.

We all like to be acknowledged and appreciated. Look for what a resident does well and let them know you appreciate it. Give attention to good behaviors and ignore bad behaviors. Being consistent in how you respond is important for getting the bad behavior to stop.

Acknowledging a resident’s good behavior will help you build a positive relationship with that resident. For example, when Mary uses polite language in the dining room rather than swearing, praise her and tell her how much you enjoy talking with her. Words of praise help the resident feel capable and cared for.

A good technique to use when you are caring for a resident who is not always in touch with reality is to direct the resident from a bad behavior to a good behavior. You do this by distracting the resident from his/her bad behavior. For example, if a resident becomes upset while waiting for a family member to visit, you can acknowledge his/her feelings about the visitor not coming, and then try to get the resident involved in an activity with other residents. Or you might ask him/her to help you with something you are doing while waiting.

The techniques noted above can be effective tools for helping to prevent violence. It is impossible, however, to always avoid conflict whenever a group of people is living together. Anne and Frank might fight over who gets to sit in the lounge chair. Tom might accuse Harry of using his shaving lotion. A group of residents might be unhappy about the activity schedule. A safe management technique that you can use to try to create a “win-win” situation and help residents feel heard, valued and respected is the process that gives each person the chance to be heard and understood. Here are the steps:

  • Separate residents when it can be done safely. Ask everyone to sit down to discuss the problem.
  • Use “I” statements rather than statements beginning with “you.”
  • Allow each person to express his/her opinion or feelings while others listen.
  • Offer ideas to satisfy each resident’s needs or concerns.

 

What do you do when a resident’s behavior becomes violent?

When a resident is in a crisis and out of control, your primary concern is safety. Your employer will provide you with specific techniques for handling violent behavior. These principles about violent behavior are important for you to remember:

  • Violent behavior is usually not planned and not under the resident’s control. To help ensure everyone’s safety, you should:
    • Quickly remove other residents and staff from the area.
    • Call for extra help when needed.
    • Get something such as a table between you and the aggressive resident.
    • Try to get any potential weapons out of reach.
  • Once you begin interacting with an out-of-control resident, you become part of the action. Act calmly and composed, even if you don’t feel that way. Never shout or yell or try to grab or hold the resident. This will only escalate the situation.
  • The time to learn how to handle violent behaviors is before anything happens, not while in the middle of it. If you work with residents who go into crisis, ask your employer to teach you specific techniques for handling violent situations.
  • Resist the urge to control the situation. Trying to control an aggressive resident will only lead to more anger and danger.

 

Prohibited techniques:

In addition to needing to know the positive ways to reduce bad behavior that endangers the resident or others, you need to be aware of activities that are not allowed:

  • Locking a resident in a room.
  • Using loud noises to scare a resident.
  • Pushing or grabbing a resident.
  • Giving a resident medicine to make him/her quiet or sleepy.
  • Using something like a pillow or tie to keep a resident from moving.
  • Holding a resident with your hands so that he/she can’t move.

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