PACS 3700/COMM 3700 Communication & Conflict Management Jan 22, 2014 Conflict Communication.
Conflict Resolution Training. Aims and Objectives »Describe common causes of conflict »Describe...
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Transcript of Conflict Resolution Training. Aims and Objectives »Describe common causes of conflict »Describe...
Aims and Objectives
» Describe common causes of conflict» Describe two forms of communication» Give examples of communication breakdown» Explain 3 examples of communication models that can assist in
conflict resolution» Describe patterns of behaviour they may encounter during
different interactions» Explain the different warning and danger signs» Give examples of impact factors» Describe the use of distance when dealing with conflict» Explain the use of “reasonable force”» Describe different methods for dealing with possible conflict
situations
Background to the training
» Violence in mental health/learning disability settings is not new. » Reliable data problematic, but there are concerns that problem is
getting worse in some areas.» Increasing demands from staff, unions and service users for safe
and therapeutic services.
Although the focus of this initiative is on violence by people with mental disorders directed towards staff, service users can also be
victims.
Violence by staff towards staff is also a serious problem.
Policy background
» NHS Security Management Service measures (2003)» Zero Tolerance (1999)» National Audit Office report (2003) » Blofeld inquiry into the death of David Bennett (2004) » Delivering race equality in mental health care: An action plan for reform
inside and outside services and the Government's response to the Independent inquiry into the death of David Bennett (2005)
» National Institute of Mental Health England (2004) » National Institute of Clinical Excellence (2005)» MHAC 11th Biennial report “In place of fear” (2003-2005)
http://www.nhsbsa.nhs.uk/Protect.aspx
Government body which has policy and operational responsibility for tackling violence across the NHS.
Within SHFTSecurity Management Director – Huw Stone
Non-exec SMD – Pam CharlwoodSecurity Management Specialist – Dave White (Risk Team)
Legal Protection Unit (LPU)
Memorandum of understandingSupporting staff in pursuing sanctions for those service users who
police can’t or won’t prosecute
NHS Protect (Security Management Service)
What is Conflict & What Causes it?
In Groups discuss and write down what conflict means to you?
What different types of conflict are there? What does it look like sound like etc?
Communication Breakdown
• Below is a simple communication model. What things could stop the correct message getting across
Transmitter Receiver
Message
Message
COMMUNICATION
NON-VERBAL VERBAL
Tone…..% of meaning is in the way the words are
said
Words…..% of meaning is the words that are spoken
Body Language…..% of meaning is
facial expression and body language
How do we communicate?
Cultural awareness
• People have different expectations of the services we provide.
• There are many factors that affect these expectations – language barriers, differing gestures, body language, modesty, religion, fear, anxiety and a lack of knowledge and understanding.
• Not all cultures have the same body language. Some people will not make eye contact when talking and some people will not shake hands as touching is not accepted. Invading personal space is accepted and common practice is some cultures. Some females may not even communicate without a chaperone or a husband present…
Transactional Analysis
In the 1950,s a Psychoanalyst, Eric Berne developed a theory which claimed we all have 3 basic ego states, which make up our personality.
The model is useful for explaining why and how
• People think like they do• People act like they do• People interact / communicate with others.
Transactional Analysis
3 EGO STATES
PARENT
ADULT:You are right, I was
wrongI think it might work what
do you think?
CHILD
Nurturing:Don’t worry we can work
it outLet me help you with thatCome with me let's have
a cup of tea
Critical:Don’t do that again
How many times do I have to tell you?Don’t slouch…
Adapted:Why me? It’s not fair!If you loved me you
would do itI’ll throw it away if you
don’t want it
Free:Yahoo! I’ve won
BRILLIANT Just what I wanted
Let’s Party
• Critical Parents display disciplinarian behaviour and make statements that are critical of others, “How many more times do I have to tell you”, “Sit up straight and look at me when I speak”
• Nurturing Parents display teaching, caring, supportive, loving and praising behaviour. “Don’t worry, we will sort it out” “Let me help you with that” “Come on, let’s go and have a cup of tea”
The adult ego state
is characterised by mature, factual, logical and rational behaviour. It is
the state that offers the least, or no conflict. Adults treat people with
respect, the are approachable, reasonable, adaptable, rational and
non-judgemental. “You were right to point the incorrect figure in my
report, thank you” “ I think this could help us, what do you think?” “Can
we try and avoid any misunderstanding?”
The adapted child
may display behaviours that they have learned and can be manipulative and play on a persons emotions. “why me, its always me, never anyone else” If you loved me, you would do it for me”
The Free child
is characterised by behaviour that is instinctive, spontaneous, carefree and without boundaries. “Oh Brilliant! That’s fantastic, I can’t wait” “Let’s do it differently now, I’m a bit bored of this way!”
Transactional analysis.STATEMENT EGO STATE
Look, I’ve shown you this over and over again. Now you go and do it!
How do you think the first presentation went?
I love it when the boss is on holiday, work is so much more fun, I’m going shopping!
Do you realise that I called you over an hour ago? Where have you been all this time?
I know I made a mess of that report. Please give me a chance to do it again- I know I can do it better. Please! Please!
I’m not sure I understand. Would you explain it to me again, please?
Don’t worry, never mind. It wasn’t really that bad.
Why aren’t you working? It looks bad if you’re just sitting around. Haven’t you got anything better to do?
You’re right. I have written it down incorrectly. Thanks for pointing it out
Critical parent
Adult
Free child
Critical parent
Adapted child
Adult
Nurturing parent
Critical parent
Adult
Communication Models
The C.U.D.S.A. Model
• C – Confront the situation• U – Understand each others situation• D – Define the problems• S – Search for and evaluate solutions• A – Agree upon and implement the best solution
Communication ModelsThe LEAPS Model:
• L – Listen; Listen actively• E – Empathise; Show understanding• A – Ask; If you need more information• P – Paraphrase; Put the facts into your
own words• S – Sum up; Condense the facts
• Useful in interviews and crisis resolution
This 5 STEP APPEAL model is used to de-escalate conflict. It is useful when resolving a difficult situation or where a person refuses to comply with a request.
1. SIMPLE APPEAL.
To make a reasonable request of somebody.
2. REASONED APPEAL.
The reason / understanding as to why you are making the request.
1. PERSONAL APPEAL.
Appeal to their better nature, why do YOU want them to do it?
1. FINAL APPEAL.
The last chance to get the person to stop what they are doing. Offer alternatives / options / consequences.
1. ACTION.
Make sure you do what you said you are going to do, don’t make threats!
Communication Models
Attitude and Behavioural CycleSometimes known as Betaris Box
My Behaviour
Your Behaviour
My attitude
Your attitude
Attitude and behaviour cycles
“ The way you see them is the way you treat them and the way you treat them is the way they often become”
Zig Ziglar
Patterns of Behaviour
Serious or aggravated resistance
Aggressive resistance
Active resistance
Passive resistance
Verbal Resistance
Compliance
Patterns of behaviour.
Trigger Phase
• An event or situation triggers an aggressive response within the individual
• Early warning signs can be easily missed• The trigger may not be obvious and the persons
response may seem to ‘come from nowhere’.
The Escalation Phase
• Anger and aggression begins to escalate.• Stress and frustration increases.• Person becomes overly focussed on the issue and less
likely to respond to any rational intervention.
The persons feelings need to be acknowledged
The Crisis Phase.
• As the person becomes increasingly physically, emotionally and psychologically aroused, control over aggressive impulses lessen and direct violence becomes likely.
• It is important to focus on the safety of yourself, the aggressor and anyone else who may be affected.
The Recovery Phase.
• Agitation decreases, anxiety lessens, communication becomes possible.
BEWARE! IT IS AT THIS POINT THAT MOST INTERVENTION ERRORSOCCUR.
• Adrenalin can remain effective for up to 90 minutes, causing heightened states of physical and emotional arousal, you may be at risk if you expect the person to be able to discuss the incident at this time.
Post Crisis Depression Phase.
• The persons behaviour will usually regress below their baseline behaviour.
• Mental and physical exhaustion is common and the persons behaviour will ‘dip’ below their normal base line behaviour. They may become tearful and withdrawn or ashamed.
Warning and Danger SignsWarning signsDirect, prolonged eye contactFacial colour may darkenHead is backSubject stands tallSubject kicks the groundLarge movements close to peopleBreathing rate acceleratesBehaviour may stop/start abruptly
Danger SignsFists may clench and unclenchFacial colour may become palerLips tighten over teethHead drops to protect throatEyebrows droop to protect the
eyesHands raise above the waistShoulders tenseStance moves from square to
sideways Stare is now at intended targetLowering of body to launch
forward
Impact factors
People Objects Places
Sex-Age-Size-BuildAlcohol Excessive Noise
Specialist Knowledge Drugs Safe exits/Layout
Skill-Boxing/Martial Arts Potential weapons (that could be used to cause injury)
Public or private premises
Mental State Offensive WeaponsDeliberately made to cause injury
Being in a position of disadvantage
Numbers Present Items of value Slip/Trip Hazards
Tiredness or exhaustion(Physical or Mental)
Time of day Imminent danger
90º The “Fighting Arc” is thearea in which peoplecan fight successfully.
It covers a 90º degree anglein front of the body.
By positioningyourself in the“offside position”you will make it more difficult forhim / her toattack you
The Fighting Arc
Offside Positioning
What is Assault?
Physical assault» The intentional application of force by one person to
another, without lawful justification, resulting in physical injury or personal discomfort
Eisener v. Maxwell 1951, Kaye v. Robinson 1991
Non-Physical Assault» The use of inappropriate words or behaviour causing
distress and/or constituting harassment
Physical and non-physical assaults should be documentedin the service users notes and on an incident form and
physical assaults referred to the police.
What to do when it doesn’t work?
Flight
This is always your preferred option, and it is safer. Never stay in a situation in which you feel uncomfortable; remember, even if your job role means that you work with a duty of care that duty starts with you!
Unfortunately fight may be you only option. If it is, you should be aware of the limitations and legal requirements; the following laws are relevant if you have to protect yourself legally
Reasonable force
The Criminal Justice and Immigration Act 2008 provides a statutory defence:
‘A person may use such force as is reasonable in the circumstances in the prevention of a crime…
Any force must be absolutely necessary and
proportionate to that which it seeks to prevent.
The law states that any use of force must be :» Necessary
» Was there any need to use force at all?
» In proportion to that which it seeks to prevent»Was the level of harm suffered reasonable compared to what would have happened if no forcible intervention had been made?
» Carried out because of an “honestly held belief”»‘The test to be applied for self defence is that a person may use such force as is reasonable in the circumstances as he honestly believed them to be in the defence of himself or another.’
» Reasonable»Discussed on next slide
Using Reasonable Force
Assessing reasonablenessIn all cases, surrounding circumstances will aid the decision with regardto pursuit of criminal proceedings.
The assailant’s height, build, gender, level of threat, use of weapon, intent to harm.
The victim’s height, build, gender, alternative courses of action available, location circumstances,
e.g. action deemed suitable in response to a threat in a pub may not be considered appropriate in a care home.
Additionally, the interpretation of reasonable force depends on several further factors which are decided upon in the courts –
»The gravity of the crime you were trying to prevent »whether it was possible to prevent it by non-violent means»whether you were ready to try those means first
A note about weapons
• If anyone is armed with a weapon DO NOT approach them
• Instead secure the area, removing any other service users and staff members and call the police
• only staff with proper training and protective equipment should approach armed assailant
Assessing reasonableness
» A member of the public strikes a man who attempts to steal her bag.
» The thief tells the police that he was assaulted….Was the action taken “reasonable”?
» A CPN who has recently been appointed is alone with a male service user in his home. He threatens to kill her but as he is between her and the door she cannot escape. He grabs her hair and attempts to force her to the floor. She strikes him in his ribs and kicks his shins while shouting for him to stop.
» Are her actions acceptable?
Any thoughts?
P.L.A.N.
P = Proportionate – am I using the right level of force? (don’t use a sledgehammer to crack a nut)
L = Legal – Am I covered by law?
A = Accountable – Am I accountable for my actions? Yes you are!
N = Necessary – Was the action taken necessary?
Empowering
Sharing
Key messages: how would you rather manage violence and aggression?
With this?Think people…
• Or this?• Think problems…
Patience
Listening
TalkingHearing
Helping
Understanding
Empathy
Restrain
SecludeMedicate
Prosecute
Inject
Section
Contain
Paterson and Miller 2005
Compassion
Caring
Challenge the language…
• Change the culture…
He kicked off
She went crazy
She is acting up
He is playing up
She is a typical P.D.
He is badnot mad
It is justattention-seeking
It is justbehavioural Distressed
Agitated
Unwell
Angry
Frightened
Tormented
Upset