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Professionalism & Working with Difficult Patients

Professionalism & Working with Difficult Patients. The ESRD Network of Texas, Inc. Our Patients.

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Professionalism & Working with Difficult Patients

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  1. Professionalism&Working with Difficult Patients The ESRD Network of Texas, Inc.

  2. 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

  3. It’s not an easy life Sometimes this causes denial, anger and behavior issues

  4. What Do We Know? • That facilities are desperately seeking ways to work with challenging patients. • That resources are few • That there are no concrete answers • That each individual patient represents a new challenge

  5. 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

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

  7. What is needed? • More compassion • More understanding • More staff education • How to work with mentally challenged individuals • In many cases PCT’s have limited training on working with difficult patients • More support for staff and patients

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

  9. Compassion (Advocacy) Balance (Tension) Excellence (Quality) Efficiency (Stewardship) Jim Rohack, MD, Medical Director SWHP

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

  11. Role of Network in grievances • Be objective • Hear all sides • Gather information • Facilitate resolution • Make a determination

  12. What do we see at the Networks?

  13. Growing Number of Involuntary Dismissals nationally • Tantamount to DEATH SENTENCE? • “We have no other choice” • “Our back is against the wall on this” • “We have tried everything else” Some Will Die…

  14. Beneficiary/Representative Contacts Category by Quarter for 2013

  15. Trending Involuntary Discharge 2008 to 2013 Maintaining a steady number is not good enough!

  16. January-April, 2013 Number of all Involuntary Discharges by Type Number = 19 IVD must be decreased by 1 or 5% per quarter

  17. How does Professionalism & Working with Difficult Patients fit together?

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

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

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

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

  22. 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

  23. 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

  24. Dual Relationships • Exchange of goods or services

  25. 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

  26. TOOLS TO HELP • Decreasing Dialysis Patient- Provider Conflict Toolkit • Caring Communications Tips

  27. IG-”At the time of publication of these rules, each facility had received a copy of an interactive program developed by the ESRD Networks on Decreasing Dialysis Patient Provider Conflict (DPC) that addresses proactive techniques to resolve such issues before progression to involuntary discharge.” DPC Toolbox

  28. Toolbox Contents • Ethical, Legal, Regulatory Statement • Poster • Brochure • Pocket Card • Bibliography • Taxonomy & Glossary • Tip Sheets • “Top Ten” Responses • Interactive Web-Based Training • Training Modules • QI Tracking Tool

  29. Toolbox Contents cont. • Critical thinking algorithms and video • Clips of “real life” situations • Use of Taxonomy & Glossary • Use of conflict resolution techniques • Sent to each facility in US • Interactive educational software

  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. OpenYourself 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 How's it working out? “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.”

  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. Tools to help you use the Conflict Resolution Model • DPC Brochure: “Decreasing Conflict & Building Bridges” • DPC CONFLICT Poster • DPC CONFLICT Pocket Guide

  41. 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

  42. 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.

  43. 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.

  44. When the team is struggling with a patient… • Educate their staff about caring communications tips • Contact the Network as soon as possible • Suggestions, tips, ideas • Objective party

  45. Additional ideas to consider • Patient Care Conference (PCC) • Behavior Agreements • Patient Advocacy Meetings • Professionalism Trainings

  46. How to handle a situation… • If the patient is an actual and immediate danger to others • Weapons • Striking others • CALL 911 • Immediate Discharge • IG- An "immediate severe threat" is a threat of physical harm. For example, if a patient has a gun or a knife or is making credible threats of physical harm, this would be considered an "immediate severe threat."

  47. The Renal Professional YouMake A Difference

  48. ESRD Network of Texas, Inc. • Thank you for your participation • For assistance contact the Patient Services Department : Treneva Butler 469-916-3808 Ron Davis 469-916-3810 Maria Bustamante 972-503-3215 ex 344

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