It's a dangerous world out there sometimes
It’s a dangerous world out there sometimes
Teach employees how to play it safe
(Look for a story on teaching patients about home safety in a new patient-teaching supplement in the January issue of Homecare Education Management.)
A Chicago agency’s social worker visited one patient’s home for the first time and found the door locked behind her. She didn’t feel comfortable asking the family to unlock the door, so she proceeded to help the patient.
Then suddenly the patient and his son started a heated argument. "A gun was pulled out by the patient, and the social worker felt she couldn’t get out of the home," recalls Margaret Carpenter, director of human resources for CareMed Chicago, which serves the entire urban and suburban areas of Chicago and parts of Indiana.
Guns are not just in violent neighborhoods
This story illustrates how important it is for agencies to educate their staff about safety measures. Patients who have guns in their homes can be found anywhere in the United States, and this type of potential violence is not limited to urban areas like Chicago.
So education managers can be on the front lines of protecting staff by teaching them how to protect themselves from dangerous neighborhoods, violent family members, and abusive patients.
The CareMed social worker came out of her situation all right. She verbally defused the potentially explosive argument. "She basically told them that she would leave and not administer the care until the gun was locked away, and they complied with that," Carpenter says.
The social worker returned to the agency and filled out an incident report. Her manager contacted the patient and let him know that until the agency was assured that nothing like that would ever happen again, no one would make anymore visits.
"We put that in writing and contacted an attorney," Carpenter says. It turned out that the gun was registered. So the agency required the patient to keep it in a locked container in a room away from where the staff was giving care. "The social worker did go back and didn’t have any problems after that," she adds.
CareMed has since held an extensive program on staff safety, requiring employees to attend several 21¼2 to 31¼2-hour sessions on staff and patient safety and disaster planning.
The agency gave employees three different pre-tests so that results could be compared with the post tests. "We found out the staff was really uninformed on safety issues," Carpenter says.
"But the post test showed a 90% improvement on their competency in those areas, and the sessions were met with a lot of positive feedback from the employees," she adds.
If an employee did not pass the post test, he or she would have to repeat the session.
The agency jazzed up the sessions by showing safety videos, inviting representatives of the local police and fire departments to speak, and by giving out raffle prizes. Everyone who completed the 51¼2 hours of training entered the raffle drawing. Winners received safety items, like smoke alarms, carbon monoxide indicators, and some other items donated by the local fire and police departments. Some prizes were purchased.
Carpenter and other experts have these suggestions for keeping safe:
1. Recognize potential danger.
Nurses and other home care employees routinely enter strange neighborhoods and homes, so they need to know how to watch for signs of trouble. These could include guns in the home, poorly lit streets in the evening, and people hanging around buildings and street corners.
"They need to be able to assess their environment," says Margo Beaudry, RN, clinical director of Optimum Home Health in Orleans, MA. The company has seven offices that cover the mostly rural Cape Cod, eastern Massachusetts, and parts of Rhode Island and Connecticut.
"They should know where the exits are, and if they feel uncomfortable they should place themselves near the exits," Beaudry says. "If they feel at all threatened, they should leave the home and go to the office to allow an administrator to deal with the situation."
Carpenter says her agency encourages staff to ask the patient to leave the door unlocked while the home care employee is present.
"We go into neighborhoods where people have dead bolts and six different locks on their doors because they’re trying to keep out the gangs or whatever," Carpenter explains. "And the nurse has to insist that the door not be locked or she won’t be able to work there."
Home care employees should look for both danger signs and potential ways to escape danger as they enter a new territory, suggests Tammy L. Burton, an officer and self-defense instructor with Baptist Health Police Force of Montgomery, AL.
Burton helped conduct a safety inservice for Baptist Home Services of Montgomery. The hospital with which the home care agency is affiliated has incorporated its own police force.
"Look for people that might be watching you, and park in a well-lit area if you’re going out at night," Burton says. "Look for a library, fire department, or other places you could go if you need to leave your car, and become familiar with the areas you’re visiting." (See tips on self-defense, p. 193.)
2. Verbally disarm a hostile person.
Sometimes it’s easy for an argument between a patient and family members or between family members and a home care aide to escalate.
Perhaps a family doesn’t like the way the aide washes the patient, but this is how the aide is instructed to do it on the care plan. An argument could ensue.
Beaudry tells her aides to handle this situation in a way that is non-threatening. Here’s what she suggests:
• Never criticize the individual, only criticize the act.
• Don’t argue.
• If a patient becomes argumentative, leave the home.
• If the caregiver becomes argumentative, answer his or her questions quietly.
• Refer to the plan of care that the nurse has set up.
• Keep repeating yourself in calm tones.
• If the caregiver continues to interfere, say you need to call your office, and do so.
If either the patient or caregiver uses foul language and calls the home care worker names, then the aide should reply: "You don’t need to speak with me that way. I’m doing my best to follow this plan of care. I know what I’m doing and will try to go on with my work," Beaudry suggests.
If the patient or caregiver continues to agitate the home care worker, then it’s time to call the office, Beaudry advises.
"Don’t ignore verbal abuse because it could escalate into something physical, and I don’t expect employees to subject themselves to that," she adds.
3. Leave threatening situations.
"A lot of times aides feel they need to stay in the house for the safety of the patient, and I find they get into trouble on their own that way," Beaudry says.
Instead, Optimum Home Health teaches aides to first protect themselves by leaving threatening situations and report these incidents to their managers.
The agency once had a female patient whose husband had been abusive to her for decades. "He was very abusive verbally to the aide also, but the aide would take it because she thought he would hurt his little wife," Beaudry recalls.
"Then he pushed the aide one time, and sometime in the same week he pushed his wife down also, and she ended up in the hospital."
The aide ended the visit after she was pushed and reported the incident. Beaudry then learned that the patient also had a gun in the house, and she had the police remove it.
CareMed has devised a code red emergency system that warns staff when they need to stay out of certain areas of the city because of gang violence eruptions, Carpenter says.
"We have a policy at CareMed that we don’t refuse visits based on the area, so we go into some of the most dangerous parts of the city and suburbs," she adds.
But if employees ask for an escort, they are given one. And a special emergency plan was set up to give staff early warning of danger.
The way it works is the city’s housing authority will notify the agency in the event of a gang fight. The agency’s supervisors then will find out if any nurses, aides, or other staff are visiting or are planning to visit that area.
"If they’re already there, then we would put a code, a certain number on their pager, and it means Code red: Get out of the area immediately,’" Carpenter explains.
The employees are told to first leave the area and then contact the agency to let their supervisors know they are safe.
So far the agency hasn’t implemented its code red, but drills are scheduled.
Carpenter says she tells employees to trust their guts. "We had to really emphasize the fact that if something doesn’t look right or feel right, it usually isn’t right, and you need to look out for yourself number one."
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