Conflict Resolution Level 1
Date issued: August 2019
For review: August 2021
Ref: E-19/occupational health/SK/Conflict resolution v2
PDF: conflict resolution final July 2019.pdf [pdf] 330KB
Key Roles
UHPNT Security Management Director (SMD) is and must be a voting member of the board, and ensure that adequate security management provision is made for the Trust. Our SMD is Nick Thomas.
Role of UHPNT Local Security Management Specialist (LSMS). The LSMS has a vital role in ensuring that we comply with Secretary of State Directions and any further necessary guidance.
Our LSMS is Andrew Davies, and he is also a member of the Health and Safety Committee.
University Hospitals Plymouth NHS Trust Physical Interventions Lead
Sophie King is Trust PI Lead Sophie delivers training for Physical Interventions, and will advise on specific queries or concerns regarding PI (restraint) of patients. Contact: sophieking@nhs.net
Kate Galloghly is responsible for all bookings for level 1, level 2 and level 3 Conflict Resolution training. Contact: kate.galloghly@nhs.net or plh-tr.conflictresolutiontrainingenquiries@nhs.net
Conflict Resolution Explained
Level 1 Conflict Resolution Training: (once every 3 years)
This is Mandatory for all front line staff (staff working with patients or meeting patients/visitors (receptionists). This training meets the UK Core Skills Training Framework Statutory/Mandatory Subject Guide Version 1.5 (subject 4) which UHPNT has agreed to work within the framework of, and this is also a commissioning requirement.
Level 1 Conflict Resolution is a 3 hour (approximate) face to face theory session, and deals with the general concepts of de-escalating violence and aggression. This at request and by agreement can be more tailored to specific areas/staff groups as part of their mandatory training programme (block week training /CME). Please note that Preceptee Nurses and Operating Department Practitioners receive this training as part of their Preceptee Orientation.
Level 2 Conflict Resolution Training: (once every 12 months)
Level 2 Conflict Resolution is a practical session covering Breakaway/self- protection skills for staff in case they are grabbed physically /assaulted by patients/visitors. General sessions run throughout the year, but also this can be tailored to specific areas as part of their mandatory training programme (block week training/CME). Please note that Preceptee Nurses and Operating Department Practitioners receive this training as part of their Preceptee Orientation.
Level 3 Conflict Resolution Training: (once every 12 months)
This is restraint training, and is tailored to match clinical area needs, via training needs analysis, and through discussion with the UHPNT Physical Interventions Lead. Any area where staff may be required use restraint should engage with this training.
To book any of the above training, please email: kate.galloghly@nhs.net or
plh-tr.conflictresolutiontrainingenquiries@nhs.net
Useful Information
Local Security Management Specialist
Andrew Davies: andrew.davies12@nhs.net (01752 439738)
Joanne Woolley: jwoolley@nhs.net (01752 437004)
Physical Interventions Team
Sophie King (PI Lead) – sophieking@nhs.net (01752 430181)
Kate Galloghly (PI Administrator) – kate.galloghly@nhs.net (01752 430180)
Generic Mailbox – plh-tr.conflictresolutiontrainingenquiries@nhs.net
Safeguarding
Contacts to Access the Following:
Mental Capacity Act (MCA) + Deprivation of Liberty Safeguards (DoLS) Training – Angela Hill – angela.hill10@nhs.net
Freedom to Speak Up Guardians – plh-tr.f2sguardians@nhs.net
Staff Health and Wellbeing (Occupational Health) –
plh-tr.OccupationalHealth-Derriford@nhs.net
Useful Policies
To locate the following go to:
- Groups
- Document Library
- Trust Documents
Security:
- Red/Yellow Card application form (word document procedure for individuals who are violent and aggressive)
- Procedure for Individuals who are Violent or Aggressive
Safeguarding Adults & Children:
- Child 16-17 Years Admitted (or Pending Admission to Adult or Paediatric Ward) Following Deliberate Self-Harm
- Management of Non-Physical and Physical Intervention (Restraint) for Adults in an Acute Hospital Setting policy
- Managing the Care Needs of People with a Learning Disability in the Acute Hospital Setting
- Mental Capacity Act (MCA 2005) including Deprivations of Liberty (DoLS 2007)
Acute Paediatrics: Physical Interventions:
- Trust Paediatric Physical Intervention policy
- Risk Assessment for Planned Restrictive Physical Intervention
- Record of Supportive Holding Episode
- Positive Behaviour Plan
- Flow Chart for Decision Making Before Using Planned Restrictive Intervention on a Child or Young Person
- Best Interest Decision Tool (aged 16 & 17)
- Debriefing Family & Carers form
- Debriefing Staff Involved in a Physical Intervention form
- Discharge Against Medical Advice Proforma
Common Causes of Conflict
Staff working in the Trust may encounter different kinds of internal and external challenges every day. Conflict is inevitable, but the key is effective conflict resolution (management). Causes of conflict with patients may occur because of:
- Unrealistic demands and expectations by patients, colleagues, managers and family/carers.
- A perceived poor level of service or difficulty in accessing services.
- Long waiting times and delays in service provision.
- In health care environments emotions are often high because patients have a heightened sense of vulnerability of anxiety.
- Delayed or cancelled appointments.
- Patients may be under the influence of alcohol, drugs, which can influence their behaviour and can quickly lead to an escalation of conflict.
- Mental Illness.
- Reaction to medications.
- Brain injury, medical condition, may cause or increase challenging behaviours.
Causes for conflict are multi-faceted and are not always about the individual. Our actions can make matters worse. Systems that may seem logical to staff may be unfamiliar and confusing to patients and carers. Similarly building design and signage can be very confusing and frustrating to users and visitors.
Most people engage with the Trust when they are vulnerable. Fear and anxiety can manifest itself in aggression.
What is assault?
Physical assault is defined as the intentional application of force to the person of another, without lawful justification, resulting in physical injury or discomfort.
Non-Physical assault is the use of inappropriate words or behaviour causing distress, and or constituting harassment. Like physical assault it can be very debilitating.
Violence is incidents where staff are abused, threatened or assaulted in circumstances relating to their work, involving an explicit challenge to their safety, wellbeing or health.
Aggression is any behaviour that is perceived by the victim as being deliberately harmful or damaging either psychologically or physically.
The assault cycle
Stage 1: Trigger Phase is the event that sets off the anger reaction. The event is seen as threatening to the individual and starts off a chain of angry responses. The person may show changes in their baseline behaviour or mood, and appear upset, angry, withdrawn or demanding. At this stage it is possible to intervene to deescalate the person or for the person to calm themselves down.
Stage 2: Escalation Phase is where the individual progresses to a point where they show signs of clear agitation. Adrenaline is building up in the body, which interferes with the ability to think and react rationally. Once this stage is reached there is less chance of calming the person down. This is the phase where the body prepares for flight or fight.
Stage 3: Crisis Phase is when the individual is definitely out of control or physically threatening. At this point the safety of others is at risk. They are unlikely or unable to respond to calming techniques and may find it difficult or respond to others once this phase has been reached.
Stage 4: Recovery Phase is where an individual returns to baseline behaviour or mood. Heightened adrenaline remains in the body for at least 90 minutes and can last for up to 3 days, causing an individual to react more forcefully if provoked or if demands are placed upon them. The crisis phase can be re-ignited during this phase.
Stage 5: Full recovery phase is where an individual’s ability to think clearly begins to return, and the person may feel guilty about what has happened.
Three main forms of communication
Verbal Communication: the spoken word.
Para-verbal: which builds on verbal communication, underlines the message we are sending using vocal emphasis through tone, pitch and volume.
Nonverbal: by which messages are sent using more physical means, for example facial expression, eye movement and physical gestures including crossed or uncrossed arms or legs, and posture.
Tips for body language to avoid conflict
- Keep your body relaxed and open.
- Open hand gestures.
- Breathe deeply and calmly.
- Respect other person?s personal space.
- Be aware of your own facial expressions.
- Do not make sudden movements.
- Do not stare.
Be aware of the Impact of your tone of voice, body language and words on communication, especially in a conflict situation.
Patterns of behaviour
The ways in which people typically react in line with how situations might escalate is outlined below. It is usual for individuals to progress through these as distinct stages, so recognising each stage may alert you to potential danger. Please note though that with patients, due to the nature of their injury, illness or medication some of these stages may not occur.
Compliance: this is the most usual state where a person acts in accordance with your request.
Verbal resistance and gestures: when people become noncompliant they often initially manifest this through words or body language.
Passive resistance: may signal the initiation of a physical confrontation, here for example the person may refuse to acknowledge you.
Active resistance: points to an escalation of the above, indicators may be a person shrugging off a touch, pulling away or pushes.
Aggressive resistance: this is when the person physically attacks.
Serious or aggravated resistance: this is the final and most dangerous stage - it may relate to the use of weapons or actions that can lead to serious injury.
Communication Models that may help de-escalate conflict
Five Step Appeal
Step 1: Ethical appeal, ask the person to carry out the task you require of them e.g. “please could you stop using such offensive language, the nursing staff and other patients are finding it upsetting”
Step 2: Reasoned appeal, reinforce the rules, explain why you have made the request (i.e. Trust Policy, not conducive to a healing safe environment).
Step 3: Personal appeal, e.g. “How would you feel if it was your mother/children listening to you swear”?
Step 4: Practical appeal, the final appeal e.g. you may be asked to leave/I may need to call security etc.
Step 5: Action, this depends on the threat as you see it, examples may be calling security, calling police, requesting a red card etc.
LEAPS: is a communication model that may help if you are confronted with aggressive behaviour:
- Listen to what the individual has to say Empathise with what is being said
- Ask questions to find out more
- Paraphrase the facts into your own words
- Summarise a course of agreed action
- Proxemics: Stance / posture / space
- Eye contact
- Respect touch boundaries
- Facial expression
- Environment
- Consider the influence of your appearance
- Think about your hand movements
Warning Signs: as a general rule an attacker may display nonverbal signs that they are preparing for an attack (some patients due to the nature of their illness, injury or medication may not). Recognising these signs may give you time to consider calling for help or removing yourself from the situation.
- Prolonged eye contact.
- Increased breathing rate.
- Stamping the ground.
- Standing tall.
- Head held back.
- Large, exaggerated movements.
- Erratic behaviour.
Danger Signs: these suggest a much higher probability of something happening in comparison to the warning signs.
- Fist clenching.
- Lips tightened over teeth.
- Chin drops.
- Hands above waist height.
- Shoulders tensed.
- Staring at intended target.
Communication Breakdown
Culture: cross cultural communication may be hampered by a lack of understanding between the participants and even when both parties want the same outcome these differences may lead to conflict. Social etiquette rules for men and women can vary between countries. Cultural groups may display different body language.
Cultural differences may include:
- Gender.
- Eye contact.
- Clothing.
- Personal space.
- Chaperoned communication.
- Shaking hands.
Physiological barriers: may be an outcome of a personal distress or discomfort, caused for example by ill health, poor eye sight or hearing difficulties. This may also be an outcome of the misuse of alcohol or other non-prescription drugs.
Physical barriers: these may be distractions, for example background noise, poor lighting, or uncomfortable heating, environmental layout, uncomfortable seating.
System errors: refers to poorly designed structures and the lack of role clarity with staff being uncertain about what is expected of them.
