Conflict Resolution Refresher Training

• This e-learning session is a CRT 3 yearly refresher

• If you have not undertaken CRT within the last 3 years, you must attend an initial face to face session

• CRT is mandatory for frontline staff only. – NHS Protect describes frontline staff as ‘those who have

direct public contact’

• CRT must be undertaken every 3 years

Conflict Resolution Training

Aim

• To recognise different aspects of conflict that staff encounter and to understand different methods of resolving or de-escalating such conflicts

• Understand how your attitude and behaviour affects the way people react to you and how the attitude and behaviours of others can influence the quality of patient care

• To refresh and consolidate prior learning

By the end of session, you will have knowledge of :

1. Common causes of conflict

2. 2 forms of communication

3. Examples of communication breakdown

4. Examples of communication models

5. Patterns of behaviour

6. Different warning and danger signs

7. Impact factors

8. Distance when dealing with conflict

9. Use of ‘reasonable’ force

10. Methods for dealing with conflict

Objectives

What is Conflict?

• Disagreement or argument

• Struggle or fight

• Incompatibility

Assaults

• Non Physical and Physical Assaults are criminal offences, which can be dealt with in a criminal court of law

• During 2014/2015 there were:

– 67864 physical assaults reported in the NHS in

England

– 1,679 criminal sanctions obtained

Non Physical Assault ‘The use of inappropriate words or behaviour causing distress

and/or constituting harassment’ Examples

• Offensive language / gestures • Unwanted abusive remarks • Loud and obtrusive conversation • Invasion of personal space • Brandishing weapons • Threats or risks of serious injury • Stalking/ harassment / bullying

Physical Assault

‘The intentional application of force to the person of another without lawful justification, resulting in physical injury or

personal discomfort’

Examples

• Spitting • Pulling hair

• Pinching • Biting

• Scratching • Punching

• Grabbing • Slapping

• Kicking • Use of weapons eg pens, bottles, food, cutlery

Reasons for Aggressive Behaviour

Patients behave aggressively for various reasons e.g.:

Do you have to hold a patient regularly to prevent them harming themselves or others or to administer treatment?

Clinical Holding Training is provided by the Trust and teaches you how to intervene safely. Your Line Manager is required to risk assess your training needs.

Head Injury Fear

Infection Drug Regime

Dementia Substance Abuse

Anaesthetic

Common Reasons for not Reporting Assaults

• Used to it/part of the job

• ‘I am the person it would have been reported to’

• Patient was under the influence of alcohol/drugs

• Didn’t think any action would be taken

• Incident was a result of the patient’s clinical condition

• Sympathy for patient or a relative –patient was anxious/upset

• Didn’t want to pursue for another reason e.g. repercussions

• Time required to file a report

• Situation was resolved/not serious enough

Effects of Abuse

• Prevents staff from doing their job

• Less job satisfaction

• Time off work / stress

• Short / long term physical injuries

• Low morale

• Feel unsafe in workplace

• Employee turnover

• Complaints

Effects of Abuse

Sanctions that can be considered:

• Verbal warnings

• Acknowledgement of Responsibilities Agreements

• Written warnings

• Withholding treatment

• Use of secure places

• Civil injunctions and Anti-Social Behaviour Orders

• Criminal prosecution.

How do We Communicate?

Verbal (Spoken and Written)

Non Verbal (Body Language)

• How did it make you feel?

• What impressions did it leave on you?

• What impressions do you think it left with the other person?

• How did it affect your work?

• Did you have time off work?

• Were you prepared for what happened?

Think of an Example of Verbal Assault

Verbal Communication

2 types of verbal communication

Spoken

• Actual words spoken or written - language used

• And also the way in which the words are spoken or written

Written

• Words can be threatening and aggressive

• e.g. Texting / emails capital letters, red, underlined, bold

Verbal Communication Which are you?

Critical – displays disciplinarian behaviour, make statements that are critical of others, condescending

• Don’t do that again

• I don’t want you to do it that way, do it this way

• Sit up straight and look at me when I’m talking to you

Nurturing – display caring, supportive, loving, praising behaviour

• Don’t worry, we’ll sort it out.

• Let me help you with that

• Sit down, lets have a cup of tea

Child – will comply with what’s asked of them even if they don’t agree, they don’t complain at the time but afterwards, can be manipulative, play on other persons emotions

• Why me, its always me, never anyone else

• I am throwing this away, you obviously don’t like it

• If you loved me, you would do it for me

Verbal Communication Which are you?

Free Child – behaviour is instinctive, spontaneous, carefree, not aware of boundaries and effect on others

• Lets party • That’s fantastic, I can’t wait • Lets do it differently, I’m bored of it this way

Adult – mature, factual, logical, rational. Treat people with respect, are approachable, reasonable, adaptable, non judgemental.

• You were right to point that mistake out, thank • I think this could help, what do you thin • Can we try an avoid any misunderstanding

The ADULT state offers the least conflict

If you have been subjected to aggressive behaviour could you have modified your attitude

and behaviour? Could it have resolved the situation better?

Non Verbal Communication Facial Expressions

Angry Happy Sad Surprised

Disapproving Afraid Worried Shocked

Non Verbal Communication Signs

• Arms folded – defence posture

• Pointing – aggressive

• Raised eyebrows – surprise or disbelief

• Nodding – listening

• Yawning or stretching – bored

• Palms facing upwards – open & honest

• Foot tapping / biting nails / drumming fingers– impatient, nervous

• Rubbing hands together – anticipation

• Putting a hand or finger to cheek - thinking deeply

Attitude and Behavioural Cycle

The Betari Box

When we're stuck in a negative cycle, then it's up to us to

stop that cycle by changing our attitude. This will positively

impact those around us – and therefore break the cycle.

Breakdown of Communication

Language Differences / Jargon Cultural Differences

Fear Physical Disabilities (eg deaf)

Weather Conditions Mental Health

Alcohol / Drugs-Misuse/Regime Anger

Educational Background Noise/Distraction

Stress / Anxiety Stereotyping

Confused Distance

Time taken Too quiet / too loud

Learning Difficulties

What can cause a breakdown in communication….

Patterns of Behaviour

• Compliance - most likely to happen, will do as asked

• Verbal Resistance / gestures - tuts, swears, threats

• Passive Resistance - stand or sit and do nothing, protest by holding on

• Active Resistance - persons draws back to resist, throws something as a distraction

• Aggressive Resistance – bite, spit, use head,

elbows, arms, hands, scratch, leg, knee, feet (stamp, kick, scrape)

• Serious or Aggravated Resistance - using any weapons, knives, chairs, pens, walking sticks,

Warning Signs of Aggressive Behaviour

• Direct prolonged eye contact

• Facial colour darkens

• Head back

• Subject stands tall

• Kicks the ground

• Large movements up close

• Increased breathing rate

• Behaviour stops / starts abruptly

Danger Signs of Aggressive Behaviour

• Fist clenching & unclenching

• Facial colour pales

• Lips tighten over teeth

• Head drops to protect throat

• Eyebrows droop to protect eyes

• Hands rise above waist

• Shoulders tense

• Stance moves from square to sideways

• Stare at intended target on body

• Lowering of body to launch forward

What will have an impact on the way the person reacts and how you react:

Impact Factors

Gender Alcohol

Age Injury

Size Weapons

Skills – Physical Imminent Danger

Mental Health Numbers Present

Environment (Light, Heat, Seats) Drug Regime

Distances

Intimate < 18” Close family / partners

Personal 18” – 4’ People we know and don’t feel threatened by

Social 4’-12’ Most other people entering or remaining within this area cause no anxiety

Reactionary Gap The extremity of your arms and your opponents reach plus any weapons they have. Absolute minimum distance to enable escape

• Distance can give us time to think and then react. We naturally allow certain people closer and give others a wide berth!

• At work we often don’t have a choice; caring for someone can mean an invasion of personal space which can make the person feel uncomfortable and anxious.

Distances

Communication Model 5 Steps Appeal

Ethical Appeal

• ‘Please leave, please sit over there’ - make a reasonable request to someone

Reasoned Appeal

• Re-enforce rules and explain why you are making the request

Personal Appeal

• Appeal to their better nature, consider options, why do YOU want them to do it

Practical Appeal

• Last chance to get the person to stop what they are doing, offer alternatives/options. ‘Is there anything I can do to help?’ Explain consequences if they don’t comply

Action

• Reasonable action – make sure you carry out what you said you would do, don’t issue empty threats

Fight or Flight Our brains have an in-built system for preparing the body when threatened, to run away or to fight!

• Increase in Heart rate / Adrenaline surges

• Increase in Respiration rate

• Increase in the ability of senses

• Increase in body heat resulting in perspiration

• Reduction in the ability to make decisions

So if the communication model is not an option and you feel sufficiently under threat that you don’t want to hang around and have a chat, the FLIGHT is the best option.

Flight

• Flight is natural reaction to a potentially dangerous situation.

• Don’t panic. Shout – ‘HELP’ ‘FIRE’

• Assess the situation and decide on a course of action – you could: – Dial ext 75999 (Royal Stoke Security Control) – Dial ext 2222 (County Switchboard) – Dial (9)999 (Police) – Go to a well lit public place – shop, library, police station – Create a physical barrier – chair, desk – Activate panic alarm / shriek alarm – Get in car and lock the doors, sound horn – Make excuses and escape – collect something from elsewhere

Fight and The Law

Fight is absolutely the final option but if it is the only option:-

The Law considers:-

• Minimum use of force

• Proportionality of force used

• Seriousness of evil to be prevented

• Right of self defence

REMEMBER: Property is not worth physical intervention

Reasonable Force

• Anyone can use reasonable force to protect themselves or others, or to

carry out an arrest or to prevent crime.

• So long as you use force that you honestly and instinctively believe is necessary in the heat of the moment, that would be the strongest evidence of you acting lawfully and in self defence.

• This is still the case if you use something to hand as a weapon.

• As a general rule, the more extreme the circumstances and the fear felt, the more force you can lawfully use in self-defence.

• If you are in your own home and in fear for yourself or others, the law

does not require you to wait to be attacked before using defensive force yourself.

Policies and Procedures

Policies

• EF01 – Security

• EF15 - Management of Violence and Aggressions at Work

• Therapeutic Intervention

Procedures

• Requesting Security Assistance in the Management of Violent Patients.

These can be found on the UHNM Intranet site

Reporting Incidents

It is important to report any incident of non physical or physical abuse as soon as possible using your own words to explain the incident.

• Please report using the Trust incident reporting system – Datix

• Incident reports assist investigations and highlight trends e.g. an area has high levels of aggressive incidents or the same individual is aggressive regularly or a specific member of staff are being targeted

• If you report the incident to the Police, please obtain the following details to include on your Datix:

• Time incident reported to Police

• Who reported incident to Police

• Police Crime Number

• Surname & Collar Number of Police Officer/s in attendance

• Police response/instructions

• Plan your consultations, know the risks – case history, risk markers, liaise with colleagues

• Avoid lone working

• Know where your Staff Panic alarms are located

• Test them • Ensure you know how to activate them • Know what they sound like • Know how to respond • Know who will respond

• Inform Security of any concerns and request support

• Wear a quick release ID card lanyard

Never Assume It Won’t Happen To You

Be ‘Security’ Aware

Be ‘Security’ Aware

If you are a lone worker and you visit patients at home: • Keep your phone / screech alarm in pocket • Programme emergency fast dial numbers on your mobile

phone • Adhere to ‘Buddy’ system • Park in well lit area • Park facing the way you will drive away • Walk in a self-confident way, with purpose • Don’t use a mobile phone / I Pod whilst walking • Enter the property last, check the locking mechanism as you

enter • Lock car doors when driving • Withdraw from the property if threatened

Summary

• Understand the common causes of conflict

• 2 forms of communication – Verbal

– Non-verbal

• Examples of communication breakdown

• Examples of communication models

• Patterns of behaviour

• Different warning and danger signs

• Impact factors

• Distance when dealing with conflict

• Use of ‘reasonable’ force

• Methods for dealing with conflict

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Contact Details

• Please refer to the Trust Intranet / Services / Security for details of how to get in touch with the LSMSs, Operational Security Teams, LCFS, the Police and other useful contacts

• Contact the Local Security Management Specialist directly if you require any further information or support on 75999(Stoke) or 2645 (County)