Critical Analysis of Crisis Prevention Intervention (CPI) PDF

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1 Running head: CRITICAL ANALYSIS

Critical Analysis of Crisis Prevention Intervention

Critical Analysis of Crisis Prevention Intervention

2 CRITICAL ANALYSIS Reflective practice is the process of examining one’s own experiences, thoughts, emotions and feelings (Bulman & Schutz, 2013). By engaging in reflection, it allows the nurse to understand strengths, weaknesses and limitations in order to improve the quality of care to patients (Koshy, Limb, Gundogan, Whitehurst, & Jafree, 2017). This assignment explores communication and physical techniques learned in the crisis intervention training to establish therapeutic interventions in the healthcare setting. In the nonviolent crisis intervention program, the training is focused on recognizing and responding to an individual in crisis before they escalate towards aggressive behaviours. The training focused on 3 key topics including; nonverbal techniques, verbal de-escalation strategies, last resort physical intervention. Through nonverbal communication, awareness was raised on position, posture and proximity (CPI, 2019). Through verbal communication, teaching was focused on tone, volume, cadence and exploring the verbal escalation continuum. In learning about the verbal escalation continuum, insight was gathered on responding to patients who are uncooperative by setting limits, seeking help and re-establishing communication (CPI, 2019). A particular relational difficulty in which this training could have been useful was in a scenario that took place at clinical, in which the patient was demonstrating anger when they learnt they weren’t able to burn cedar in their room. When a patient is experiencing anger, the need for personal space and proper support is vital (Yamamoto-Mitani, Noguchi-Watanabe, & Fukahori, 2016). CPI training would have been beneficial knowing the CPI techniques of how to calm the patient down through verbal and nonverbal communication. Empathetic listening could have been implemented by listening to what the patient was saying and by focusing on their feelings (CPI, 2019). By incorporating empathetic listening, it ensures that all viewpoints are heard and creates a less vulnerable atmosphere for both the nurse and the patient (CPI, 2019).

3 CRITICAL ANALYSIS Through verbal communication, the nurse would use a calm tone with the patient. Staying calm and using paraverbal communication helps patients feel cared for and respected, which in turn, supports their feelings and helps decrease anxiety (Kieft, de Brouwer, Francke, & Delnoij, 2014). A relational difficulty where this training could have been used, was when a patient raised their voice while trying to explain the historical context of smudging. It was apparent that the nurse failed to show empathy towards the patient’s traditions nor addressed his needs. The nurse used an unproductive response by responding inappropriately and saying, “That’s against the facility’s policy, no can do.”, ignoring the patients concerns (CPI, 2019). A useful approach the nurse could have adapted from the CPI training would include empathetic listening. Empathetic listening helps the patients to express their concerns and encourages the nurse to respond to the patient’s needs (Dingley, Daugherty, Derieg, & Persing, 2008). As the nurse failed to address the patient’s concerns, the patient began to shout. According to CPI (2019), the patient escalated into the next level of the crisis development behavior, known as defensive behaviour, by rejecting what the nurse was saying and by challenging the nurse by stating “You’re useless” (CPI, 2019). A healthcare issue stemming from this situation was how the nurse ineffectively applied any of the components of a nurse-client relationship (CNO, 2006). Nurses are accountable in providing safe, compassionate, competent and ethical care (CNA, 2017). The nurse displayed moral disengagement by being apathetic towards her patient and displaying non-compassion towards the patient’s concerns (CNA, 2017). Another salient issue regarding this scenario was failing to provide client-centred care. The nurse ineffectively met the standard of client-centred care by failing to recognize that the outcome of the patient reactions is influenced by the ability of the nurse to sustain a therapeutic relationship (CNO, 2006). In this situation, it would have been salient to implement the technique of self-

4 CRITICAL ANALYSIS reflection as the nurse seemed to be neglectful towards providing culturally competent care (CNA, 2017). While the CPI training provides theoretical and conceptual strategies to deal with patients in crisis such as empathetic listening, limit setting and paraverbal communication, the nurse could have implemented the conceptual approach of using therapeutic rapport by using nonjudgemental empathic listening to increase the quality of the therapeutic relationship. Empathic listening is a therapeutic intervention that recognizes what a person is saying (CPI, 2019). By listening and exploring the needs of the patient, the nurse could have looked for ways to honour the client’s request. By doing so, it would help increase the patient’s trust and would further establish a therapeutic relationship (CNO, 2002). A theoretical approach the nurse could have used from CPI could have been limit setting through the if and then pattern. For example, “If you can speak calmly, we can look for an alternative way to honour your request” This pattern positively influences the client’s behavior and the quality of the therapeutic relationship by expressing concern and awareness towards the patient’s cultural beliefs (CNO, 2018). Based on this reflection, I would have incorporated more emphasis towards knowing how to set limits in a respectful manner. By respectfully setting limits, it decreases aggressive behavior, reduces anxiety and encourages the development of a therapeutic relationship (El Azzab, Mohamed, & el-nady, 2019). Another objective I would have applied more emphasis on would be towards re-establishing the therapeutic rapport, specifically after the crisis incident. Reestablishing therapeutic rapport following an incident not only helps the patient reflect on their actions, it enables the patient to create a plan of action with the nurse to address alternative coping mechanism in the event of a future crisis situation (CNO, 2006). References

5 CRITICAL ANALYSIS Bulman, C., & Schutz, S. (2013). Reflective practice in nursing (5th ed.). Hoboken, NJ: Wiley Blackwell Canadian Nurses Association (CNA). (2017). Code of ethics for registered nurses. Retrieved from http://www.cna-aiic.ca College of Nurses of Ontario. (2018). Entry-to-practice competencies for registered nurses. Toronto, Canada: Author. Retrieved from https://www.cno.org/globalassets/docs/reg/41037-entry-to-practice-competencies 2020.pdf College of Nurses of Ontario. (2002). Professional standards. Toronto, Canada: Author. Retrieved from https://www.cno.org/globalassets/docs/prac/41006_profstds.pdf College of Nurses of Ontario. (2006). Therapeutic nurse-client relationship. Toronto, Canada: Author. Retrieved from https://www.cno.org/globalassets/docs/prac/41033_therapeutic.pdf Crisis Prevention Intervention. (2019). Nonviolent crisis intervention foundation course. United States: CPI Dingley, C., Daugherty, K., Derieg, M. K., & Persing, R. (2008). Improving patient safety through provider communication strategy enhancements. In K. Henriksen, J. B. Battles, M. A. Keyes, & M. L. Grady (Eds.), Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools). Rockville (MD): Agency for Healthcare Research and Quality (US). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK43663/

6 CRITICAL ANALYSIS El Azzab, S., Mohamed, S., & el-nady, M. (2019). Using of limit setting strategies at psychiatric hospital: Patients and nurses perspectives. International Journal of Nursing, 6. https://doi.org/10.15640/ijn.v6n1a13 Kieft, R. A., de Brouwer, B. B., Francke, A. L., & Delnoij, D. M. (2014). How nurses and their work environment affect patient experiences of the quality of care: A qualitative study. BMC Health Services Research, 14, 249. https://doi.org/10.1186/1472-6963-14-249 Koshy, K., Limb, C., Gundogan, B., Whitehurst, K., & Jafree, D. J. (2017). Reflective practice in health care and how to reflect effectively. International Journal of Surgery. Oncology, 2(6), e20. https://doi.org/10.1097/IJ9.0000000000000020 Yamamoto-Mitani, N., Noguchi-Watanabe, M., & Fukahori, H. (2016). Caring for clients and families with anxiety. Global Qualitative Nursing Research, 3. https://doi.org/10.1177/2333393616665503...