To Be or Not To Be?

1. To Be or Not To Be? Professionalism at its Best!

2. Née-Née’s No-No’s • No booing,hissing, spitting, or visual display of middle-digits • No snoring • No throwing of sharp pointy objects

3. PROFESSIONALISM

4. Merriam-Webster dictionary: Professionalism is a way of exhibiting a courteous, conscientious and generally businesslike manner in the workplace.

5. Objectives • 1. Understand the impact Chronic Kidney Disease has on the patient both physically and mentally. • 2. Understand what is needed from staff in order to work with difficult patients. • 3. Look at the trends for Involuntary Discharge as a means of prevention. • 4. Introduce Decreasing Patient Provider Conflict and Caring Communications as tools to assist with working with difficult patients.

6. Our Patients “Patients with renal disease are challenged by many stressors, including loss of biochemical and physiologic kidney functions, development of digestive and neurological disorders, bone disease and anemia, inability to function in the family and to maintain one’s occupation, decreased mobility, decreased physical and cognitive competence, and loss of sexual function” Kimmel, MD & Peterson, MD Seminars in Dialysis, 2005

7. From CMS…. • “we believe that every dialysis facility has the resources and responsibility to work with every patient, including patients perceived to be disruptive or challenging” -Conditions of Coverage

8. ETHICS MAIN GUIDING PRINCIPLE FOR ALL PROFESSIONAL ETHICS IS? DO NO HARM!

9. Relationships: Personal vs Professional • Purpose • Balance of Power • Focus

10. Challenging situations are often the delayed result of professional boundary violations.

11. Common Problems: Boundaries Crossed • Becoming personally involved • Gifts • Showing favoritism • Dual relationships

12. Becoming Personally Involved • Sharing that shifts FOCUS from pt to professional • Lose ability to respond objectively • React emotionally

13. Gifts • Unit policy against giving/receiving of gifts • Federal regulations against giving to patients • Protects pts from feeling that they need to pay extra for quality • Protects staff from feeling they need to give extra attention

14. Showing Favoritism • Show that you favor one pt over another, or facilitate a pt favoring you over other staff • Creates expectation that it will be done again • Expectation that other staff will do the same • Distrust of other staff

15. Dual Relationships • Exchange of goods or services

16. SEXUAL MISCONDUCT • Demeaning to the patient • It is usually intentional • It is a breach of TRUST • Long-term effects can be devastating but may not be readily apparent • THE BREACH OF TRUST IS USUALLY FAR MORE SERIOUS THAN THE ACTUALSEXUAL CONTACT

17. What are Boundaries? • Boundaries: • Limits that must be set to assist professional • to be helpful to the patient • to remaining appropriately detached from the patient and his/her problems. • Remember: • The professional sets the boundaries and standards. • Once a patient, always a patient.

18. Personal Vs Professional

19. Crossing The Line • Do you share personal problems or aspects of your intimate life with patients? • Have you ever traded assignments to care for a specific patient? • Have you ever spent off-duty time with a patient? • Do you keep secrets with patients? • Do you become defensive when someone questions your interaction with a patient? SOURCE: "Crossing the Line: When Professional Boundaries are Violated," National Council of State Boards of Nursing Inc., 1998.

20. Crossing The Line • Have you ever given gifts to or received them from a patient? • Have you felt possessive of a patient, thinking that only you could provide the care the patient needs? • Have you ever flirted with a patient? • Have you chosen sides with a patient against his or her family and other staff? • Have you ever been verbally disrespectful to a patient for example cursed, raised your voice, intentionally ignored, disregarding what a patient was explaining to you? SOURCE: "Crossing the Line: When Professional Boundaries are Violated," National Council of State Boards of Nursing Inc., 1998.

21. YOU HAVE CROSSED THE LINE WHEN

22. You’ve Crossed The Line When • You talk to patients about your personal life (husband, children, siblings, and other family members) in depth. • You tell patients where you live and give them your phone number or visit patients in their homes as a friend, not in your professional capacity. • You plan activities with patients outside of the unit.

23. You’ve Crossed The Line When • You complainto patients about: • other patients • your own aches, pains, and illnesses. • about other staff members. • You accept gifts from patients. • You feel compelled to “fix”a patient’s problem morethan thepatient does. • You buy or sell items from or to patients.

24. Reasons for Conflict • Non-adherence • Mental Health & Substance Abuse Issues • Cultural & Racial Issues • Complex Environment • Communication Difficulties

25. Communication Conflicts

26. Patients want from staff • Kindness • Recognition • Comfort • Emotional support This requires Caring Communications

27. Heart-Head-Heart Communication:Two Sides to a Satisfying Service Experience Heart Head Feelings, personal attention, caring We’re so busy the heart messages get lost. Information, tasks Dialysis is so full of tasks

28. Caring Communication Hints • Acknowledge patients likely feeling. • Share your good intentions: How are your actions for the customer’s sake? • Ask open-ended, not yes-no questions. • Use the words “for you.” • Express appreciation to the person.

29. Messages Key to Patient Satisfaction • You are not a number. • YOU, uniquely YOU matter to me. • I respect your thoughts and feelings. • I want you to feel my support. • Yes, I’m here to care for you. And, I also care ABOUT you.

30. DPC “CONFLICT” Resolution Model 9 step program

31. “CONFLICT” Resolution Model C-Create a Calm Environment O-Open Yourself to Understanding N-Need A Nonjudgmental Approach F-Focus on the Issue L-Look for Solutions I-Implement Change C-Continue to Communicate T-Take Another Look

32. Create A Calm Environment “In order to effectively address a conflict, you need to be aware of the physical surroundings, as well as the thoughts and feelings you are experiencing because of the conflict”

33. Open Yourself to Understanding Others “When addressing a conflict, it is important to acknowledge the perspective and feelings of the other individual(s) involved”

34. Need A Nonjudgmental Approach “As a dialysis professional, it is important for you to maintain an objective and professional approach as you address the conflict. Keep in mind that words exchanged in the heat of an argument are often not intended as personal attacks.”

35. FocusOn The Issue “When conflict occurs, there is a tendency to lose sight of the issue that started the disagreement. What starts out as a concern about starting dialysis on time can quickly become a disagreement about the facility staff, the clinic operations, or the physician care.”

36. Look For Solutions “Not all conflicts can be resolved nor are all conflicts based on valid complaints. But working in collaboration with the patient will improve the likelihood of a positive outcome.”

37. ImplementAgreement “If you take the time to work through the conflict, it is likely that you will reach a stage of agreement when changes will need to be put into action.”

38. Continue To Communicate “Effective resolution of a conflict requires follow up communication. This allows you to monitor the progress being made. And demonstrates to the patient your commitment to resolving the conflict.” How's it working out?

39. Take Another Look “Handling a conflict, like successfully performing dialysis related tasks, requires practice, understanding, education, and monitoring. Regardless of whether a conflict is minor or major, reviewing the steps used in addressing the conflict will be beneficial.”

40. Benefits of Professionalism Staff • Professionalism makes us feel good. • It makes us feel that our job is valued. • It gives us a code of conduct so we know what is expected of us. • It promotes mutual respect—staff to patient, patient to staff, and staff to staff. • It makes us feel in control. • It promotes independence. • It builds confidence in us.

41. Benefits of Professionalism • Patients • Itmakes our patients feel safe. • It makes our patients have confidence in us. • It helps with patient satisfaction. • It makes the patient feel respected. • It supports the delivery of good care to the patient. • It supports the patient’s independence rather than dependence.

42. Assessing Professional Behavior • Ask yourself these questions: • Can this be documented in the medical record? • Are you willing to do this for all patients/staff? • Would this be allowed in another setting? • How does this activity relate to care needs?

43. How Do We Respond When Others Are UN-Professional?

44. Step 1: Determine Your Involvement • Determine if you are truly involved in this situation, and if so, to what level you are affected. • Often, we find we are annoyed by behaviors that are not directed at us. In those situations, change your perception and reaction to the behavior, and let it go.

45. Step 2: Understand The Other • Resist the temptation to moralize. • Instead, try to understand where they are coming from. • Take a deep breath, and really listen.

46. Step 3: Influence His/Her Attitude • State specifically, in a non-confrontational way, how/why the behavior has breached a professional code of conduct. • Do not try to place blame or find fault; rather, focus on preventing the problem from recurring in the future.

47. Step 4: Recover And Move On • Once the problem is addressed, let the incident go and move on. • Dwelling on it will only increase your levels of stress and frustration.

48. Reflection & Action Planning • What do I want to do to improve my professional style? • Notice your own actions that exhibit a lack of professionalism. • Carefully evaluate your behavior in light of beliefs and assumptions . • Challenge whether the belief or assumption is valid. • Create an action plan to work on bringing more coherence between actions and beliefs, creating greater integrity and authenticity.

49. WOW: Way Of Work

50. Presented by: Treneva A. Butler, LCSW, NSW-C Patient Services Coordinator ESRD Network 14 Borrowed from Mid-Atlantic Renal Coalition