"The Respect-Worthy Supervisor: Receiving and Giving Respect in Home Health Care Supervision.“ Rita A. Jablonski,

1. "The Respect-Worthy Supervisor:  Receiving and Giving Respect in Home Health Care Supervision.“Rita A. Jablonski, Ph.D., RN, ANPAnthony J. DeLellis, Ed.D.

2. Respectful Supervision • Begins with respectful communication

3. Give respect to get respect? ? • Usually get respect if you give respect, but no guarantee • Get no respect if you give no respect, guaranteed

4. Giving respect - names are important • Call people what they want to be called: If her name is Mary Jones, do you call her Mary, Ms. Mary, Miss Mary, Mrs. Mary, Ms. Jones, Miss Jones, Mrs. Jones?

5. Giving respect - names Ask people what you should call them, and then just do it

6. Respect is listening • Listen actively • Look, stop, wait - let them finish • Don’t interrupt • Turn off radio, TV - completely off • Let them know you heard and understood • Paraphrase

7. Respectful communication - • Respect is something we feel, even if we don’t show it. • So show it!

8. Tone and choice of words matter • Use respectful tones. • Use courteous language, always.

9. Clothes matter • How we dress sends a message to the people around us about how we feel about them.

10. Assertive vs Aggressive Communication Assertive - say what is on your mind, but keep in mind the feelings of others. Aggressive - say what is on your mind, but don’t care about the feelings of others or deliberate try to hurt or offend them.

11. Politeness and Power • Powerful people can afford to be polite. • Politeness isn’t weakness. • Politeness isn’t being somebody you’re not. • Politeness to rich and poor alike is - powerful.

12. Addressing Unsatisfactory Performance Opportunity to help the NA to concretely understand workplace obligations Cultural differences regarding “on time” Differences in work ethic among members of various age cohorts, e.g. “entitlement” in workers under the age of 30 versus “work until you drop dead” ethic of workers in their 60s

13. Addressing Unsatisfactory Performance May be the first time a worker has had to problem solve Instead of telling the worker, “Late again, you are fired,” try asking the worker a series of questions to help him or her figure out options “Coaching” type of management

14. Be assertive when coaching • Speak assertively, not aggressively. • Stick to the point. • Describe the behavior, don’t characterize the employee as a loser. • Don’t be afraid to praise someone who is not perfect - when praise is due. • Don’t use praise to avoid conflict.

15. Coaching is shared risk • Coaches rise or fall when their teams rise or fall. • Coaches find inner motivation of team members. • Team members eventually have to go it alone.

16. Disagreement • Disagreement with an employee is never an excuse to switch from assertive communication to aggressive communication. • Respect, assertiveness, listening, and politeness are especially important during disagreement.

17. Compassionate Creative Decisive Empathetic Fair Flexible Humble Objective Problem-solver Respectful Self-directed Self-evaluative Understanding Visionary System-thinker (able to see big picture) Hewlett, et al., “Minnesota Frontline Supervisor Competencies & Performance Indicators,” U. of Minn., 1998. Effective Supervisors

18. Internal motivation. External motivation. Recognition. Importance of staff development & training. 2 important questions: What motivates you? How do you want to be recognized? LaLiberte, Hewitt and Larson, “Staff Motivation and Recognition.” Some Guiding Principles for Supervisors

19. Challenging Issues in Home Care

20. Legal and Ethical Situations that Accompany Supervision

21. Legal Definitions • Assault (criminal act)An attempt to inflict physical injury on a person; the unwanted touching of one individual by another • Battery (criminal act)The actual infliction of physical injury on a person. Includes “every willful, angry, and violent or negligent touching of another’s person or clothes or anything attached to his person or held by him” (Creighton, 1986).

22. Legal Definitions • Unlawful use of restraintCould be considered assault and battery • Care must be taken to use only with a physician’s order; to monitor the client frequently (minimum, every hour); to remove the restraints and exercise the limbs (minimum, every 2 hours)

23. Legal Definitions • TortA legal wrong, not a crime (a crime must have evil intent and involve a criminal act). • A legal right of a person is somehow violated, and the violation is called a “tort.” • A legal case involving torts is heard in civil, not criminal, court. • Example: two drivers are involved in an automobile accident. No criminal charges are filed. One driver sues the other.

24. Legal Definitions • Negligence“The omission to do something that a reasonable person, guided by those considerations that ordinarily regulate human affairs, would do, or as doing something that a reasonable and prudent person would not do” (Creighton, 1986, p. 141)

25. Legal Definitions • Malpractice“any professional misconduct, unreasonable lack of skill or fidelity in professional or judiciary duties, evil practice or illegal or immoral conduct” (Creighton, 1986, p. 141)

26. Legal Definitions • DefamationThe ruining of a person’s reputation by verbal or printed statements; any verbal or printed statements that could be considered detrimental to a person’s personal or professional reputation • SlanderOral defamation • LibelWritten/published defamation

27. Legal Definitions • Neither slander nor libel refers to a conversation or written communication between 2 persons, unless overheard or witnessed by a third person.

28. Legal Definitions • Defamation is not an issue when there is a legal duty to speak. • Confidentiality • Be aware of potential HIPAA violations, especially when carrying client records and information in your car. • Be aware of your surroundings when using your cell phone in the field. Password protect laptops, Palm devices

29. Types Of Legal Issues

30. Types Of Legal Issues • Living Wills • Also known as Natural Death Acts, Patient Self-determination Acts • These documents state which specific treatments may be rendered if a client is unable to make medical decisions for him or herself.

31. Types Of Legal Issues • Patient-specific treatment instructions • Designation of a proxy to make these decisions • Do Not Resuscitate Orders • Medicaid regs do not require that DNR orders be kept in the client file in the agency, and as a practice, agencies do not obtain a copy. • The DNR notice is to be posted in the room or on the client’s door.

32. Types Of Legal Issues • The RN’s responsibility is to discuss this with the family and instruct the aide as to the family’s wishes regarding who to call should the client become unresponsive. • That may be the rescue squad, hospice, or a family member. • If the family wants the rescue squad called, it is important that the nurse instruct the family to have DNR orders posted in an obvious place. • The RN would insure that the aide understands what DNR orders are and what the aide’s responsibilities are as a result. • Usually, DNRs stipulate that no “heroic” efforts be made in the event of severe illness or cardiovascular arrest. • Can be modified, e.g., may not administer CPR and intubation but may use medications

33. Ethical Issues

34. Ethical Issues • Ethics • A body of knowledge concerned with the rightness or wrongness of an act. In the professional arena, ethics refers to the rightness or wrongness of professional conduct. • Something may be legally “right” but ethically “wrong,” depending on a person’s own code of ethics: e.g., abortion

35. Ethical Issues • Types of ethical views • “Do no wrong” • “The end justifies the means” • “The individual’s choice takes precedence over society’s views” • “I know what is best for you”

36. Ethical Issues • Clients should be active participants in decisions about matters that involve themselves or their lifestyles

37. Ethical Issues • Decision-making is problematic with cognitively impaired individuals

38. Ethical Issues • Supervisors must be able to help PCAs realize that individuals with cognitive impairment may be unable to make decisions is some areas, but may be able to make decisions in other areas • Mental capacity fluctuates, resulting in periods of lucidity and confusion • Respect for others as one useful guiding principle in remaining ethical

39. Violence in the Client’s Home

40. Violence in the Client’s Home • National Institute of Occupational Health and Safety • “Physical assault, threatening behavior, or verbal abuse occurring in the workplace” • Usually client-caregiver; also caregiver-client, , caregiver-caregiver, family-caregiver

41. Violence in the Client’s Home • Violence is not often recognized as a problem in the home.

42. Violence in the Client’s Home • Many administrators and licensed nurses have been acculturated to view violence as “part of the job” • Many administrators think that physical abuse upsets PCAs more than verbal abuse; actually, PCAs can be just as upset with verbal assaults such as racial slurs, cursing, and demeaning remarks

43. Impact of verbal and physical abuse on PCAs • Feelings of hurt, anger, frustration, resentment, sadness, disrespect, being violated, shock, and fear • Less willing to spend time with offending clients, less willing to care for them • Absenteeism, negative behavior toward supervisors, quitting job

44. Making a difference • Put a mechanism in place for PCAs to report violent behavior by clients • Ask about the existence of physical or verbal abuse during supervisory visits, and be prepared for more information than you expected; make sure you document interactions and interventions in your notes

45. Making a difference • Recognize that the violent or abusive behavior may be triggered by a specific event (e.g., bathing) or may be due to feelings that cannot be expressed by a cognitively impaired individual.

46. Making a difference • Once PCAs alert the nurse supervisor about this behavior, the nurse needs to do the following: speak to the family regarding what they have done to successfully handle the abusive and violent behavior; advise the PCA as to the best approach.

47. Making a difference • If the family is also grappling with the same issues unsuccessfully, the RN should urge the family to discuss possible solutions with the health care provider (MD, NP).

48. Making a difference • The nurse should advise the family that solutions to violent and aggressive behavior must be sought if the client is to remain in the home with the NA. In fact, this is a common reason for NH placement.

49. Making a difference • Need to stress that UNDER NO CIRCUMSTANCES IS IT ACCEPTABLE FOR CAREGIVERS TO “HIT BACK” OR RESPOND IN KIND TO A CLIENT’S ABUSIVE BEHAVIOR.

50. Making a difference • Virginia has a mandatory reporting statute and it is the nurse’s obligation to make an APS referral for all cases of suspected or actual abuse and neglect.