MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 89 7 8 A. SEBELUM TERJADINYA KEKERASAN SUBMISSIVE PENCEGAHAN DAN KAWALAN HAZAD PENILAIAN RISIKO SEBELUM TERJADINYA KEKERASAN Staring and eye contact • Melihat dengan renungan atau pandangan mata yang tajam Tone & volume of voice • Meninggikan suara atau bercakap dengan nada memerli, menghina & sebagainya • Menuntut perhatian Tone & volume of voice • Berjalan mundar-mandir • Tidak dapat duduk dengan tenang di tempat yang disediakan (kerusi pelawat, katil, kerusi roda) Anxiety • Kelihatan cemas, tidak selesa, terburu-buru dan risau Mumbling • Mengatakan sesuatu yang tidak jelas, terburu-buru sehingga sukar difahami oleh orang yang mendengar Reference: STAMP: component of observable behavior that indicate potential for patient violence in emergency departments. Luck L, Jackson D and Usher K. Journal of Advanced Nursing. 59.1 pp 11-19. yr 2007
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 90 9 10 B. JIKA TERJADINYA KEKERASAN (ASSERTIVE) • Melayan dengan baik • Mendengar dengan baik tanpa mengambil hati • Tenangkan pelanggan • Cuba memahami masalah : “I feel you” • Teknik traffic light: Merah : STOP- jika pesakit sedang marah Kuning : bersedia- ANALISA kata-kata pesakit Hijau : JALAN- analisa & paraphrase kembali kata-kata setelah pesakit tenang/ pause VERBAL
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 91 11 12 • Mendekati dan cuba berinteraksi (jika boleh) • Bertanyakan soalan • Tegur dan bertanya masalah/ kenalpasti kerisauan (address worry) ANXIETY APA PERLU DILAKUKAN? • Jika mumbling terhadap anda, cuba untuk dekati • Jika mumbling bukan terhadap anda, tidak perlu untuk didekati MUMBLING APA YANG PERLU DILAKUKAN?
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 92 13 14 • Memaklumkan rakan sekerja anda yang anda akan mendekati individu tersebut • Secara lisan: Bertanya dan menunjukkan keprihatinan secara bersesuaian - submissive (body posture) • Bersedia untuk melarikan diri jika individu tersebut menunjukkan sikap agresif. MUNDAR MANDIR (PACING ROOM) • KAWALAN SECARA KEJURUTERAAN: - Menyediakan ‘panic button’ di setiap kawasan yang berisiko - Menyediakan bilik selamat (safe room) bagi anggota kesihatan - Menyediakan akses sekurang-kurangnya 2 pintu keluar bagi tempat yang berisiko terjadinya kekerasan - Susun atur perabot - Pemasangan CCTV di tempat yang strategik - Safety barrier - Ruang menunggu pesakit - Pencahayaan LANGKAH KAWALAN DAN PENCEGAHAN HAZAD
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 93 15 16 SENARIO 1 Jam 5:30 pagi, seorang ibu datang untuk bersalin bersama suaminya. Ibu dimasukkan ke bilik bersalin setelah didapati pembukaan pintu rahim 9 cm. Suaminya berada di ruang menunggu. Setelah hampir 2 jam, si suami datang ke kaunter untuk menanyakan tentang isterinya. Jururawat di kaunter memberitahu isteri telah dimasukkan ke wad. Suami memarahi kakitangan kerana tidak memberitahu beliau. Sebenarnya, semasa dipanggil, beliau telah ke kafeteria untuk minum pagi. CONTOH SENARIO • KAWALAN SECARA PENTADBIRAN : - Pemasangan notis papan tanda peringatan kepada pelanggan - Menerapkan dan menyemai Budaya Korporat KKM sebagai salah satu budaya kerja (Penyayang, Profesionalisme dan Kerja Berpasukan) - Mengikuti latihan kemahiran Soft Skills - Mengikuti aktiviti kerohanian - Mewujudkan kumpulan sokongan menangani tekanan di tempat kerja di setiap jabatan - Mengamalkan budaya nilai-nilai murni dan bersikap lebih profesional dalam menjalankan tugas
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 94 17 18 SENARIO 2 Seorang suami datang ke wad Kenanga 2C – mahu masuk untuk melawat isterinya yang dimasukkan setelah bersalin. Pengawal Keselamatan menghalang beliau dari masuk kerana doktor sedang melakukan rondaan. Pengawal cuba menerangkan kepada suami tersebut tetapi tidak berjaya. Pengawal memanggil staff untuk menangani masalah tersebut kerana suami masih marah dan tetap hendak masuk. Suami melemparkan kata-kata kesat kepada pengawal. CONTOH SENARIO SENARIO 3 En. Zawawi datang ke klinik membawa ibunya untuk temujanji pada jam 8:00 pagi. Masalah parking menyebabkan beliau sampai lewat ke kaunter. Beliau tidak berpuas hati apabila beliau diberi nombor giliran yang lambat sedangkan beliau perlu pergi ke tempat kerja dengan segera untuk mesyuarat. CONTOH SENARIO
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 95 19 CONTOH LAKONAN DARIPADA SENARIO 20 03- 88831215 / 1243 / 1188 03-88831176 [email protected] fb.me/oshmedicaldev http://medicaldev.moh.gov.my/ckpp/ Sebarang pertanyaan, sila hubungi:
21 22 PENGHARGAAN DR. SHAHABUDDIN BIN IBRAHIM DR. PRIMUS JOHN DR. AUJI AZHANI BINTI MOHD ZAHIR DR. MUHAMMAD SHAUQI BIN ABDUL KADIR DR. AZRI ARIFF BIN ABDUL ZAWAWI DR. THANARAJ DORAISAMY SEKIAN TERIMA KASIH UNIT KESELAMATAN & KESIHATAN PEKERJAAN CAWANGAN KUALITI PENJAGAAN PERUBATAN BAHAGIAN PERKEMBANGAN PERUBATAN KEMENTERIAN KESIHATAN MALAYSIA HAK CIPTA TERPELIHARA © KEMENTERIAN KESIHATAN MALAYSIA MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 96
MODUL 5 CODE GREY
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 98 1 2 MODULE 5 Part I CODE GREY: INTRODUCTION OCCUPATIONAL SAFETY & HEALTH UNIT MEDICAL CARE QUALITY SECTION MEDICAL DEVELOPMENT DIVISION MINISTRY OF HEALTH MALAYSIA COPYRIGHT (C) MINISTRY OF HEALTH MALAYSIA
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 99 3 4
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 100 5 6
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 101 7 8 Our colleagues felt … • ALONE • PUNCHING BAG • AFRAID OF REPERCUSSIONS • DON’T KNOW WHAT TO DO/ SAY • ACCEPT FATE
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 102 9 10
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 103 11 12 CODE GREY An emergency code that activates a well trained and professional team to respond and handle any harmful incident or potential harmful incident to ensure the safety and well being of healthcare staff as well as others. CODE BLUE RESPONSE • Team • Trained • Appropriate place
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 104 13 14 THE CODE GREY CORE 3P VALUES WHAT’S NEXT?
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 105 15 16 CARTA ALIR TINDAKAN CODE GREY SOP: 3D METHOD IN CODE GREY
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 106 17 18 NOTES …. 1. Physical restrain (patients) - health team 2. Physical restrain (public) - security officers/ police 3. Code black = suspect armed & life threatening conditions 4. Code black is best manage by the police, code grey team, highest management representative & psychiatrist/ clinical psychologist 5. Always tackle at the local level team first before initiating code grey team 6. DASS can be repeated TEAM MEMBERS Cultural Dimension Theory of High power-distance It describes the effects of a society's culture on the values of its members, and how these values relate to behaviour, using a structure derived from factor analysis “that less powerful members of the society accept their place and realize the existence of formal hierarchical positions” Geert Hofstede (1984, 2001)
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 107 19 20 ROOM FOR DISCUSSION WITH SUSPECT 1. Ideally each site/ location (fixed) 2. Easy access 3. Away from public/ crowd 4. Minimal things, tidy, no dangerous objects 5. Keep mineral water & offer drink to the suspect TEAM MEMBERS MAIN 1. Senior doctors (department) 2. Senior Assistant Medical Officer 3. Senior Matron 4. Sisters 5. Doctor (OSH) 6. Higher rank security officers 7. Public Relations Officer (PRO) OPTIONAL 1. Psychiatrists 2. Clinical psychologists
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 108 21 22 TRAINING 1. COMMUNICATION • De-escalation techniques • Addressing people and empathy to issues • Giving assurance 2. EVALUATE SITUATION • Psychotic signs • Identifying hazards • Life threatening • Body language 3. SOP • Number (operator) • Info (code grey, location) • Team members & schedule • Critical Incident Stress Debriefing (CISD) • Offer staff help & recognize symptoms • Notification EXAMPLE STEP BY STEP SCRIPT 1. You look very upset 2. Tell me about it 3. I’m sorry this is happening 4. What would like me to do to help you 5. Here’s what I’d like us to do next 6. Thank you for sharing your feelings with us
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 109 23 24 Where is our direction…….game over or become a GAME CHANGER ? Henry Ford quotes…“Whether you think you can or you can’t, you are right...” GOVERNANCE, PARTNERSHIP & ANALYSIS 1. MINISTRY OF HEALTH MALAYSIA 2. HOSPITAL - management meeting - HOD meeting - department level meeting 3. Jawatankuasa Keselamatan & Kesihatan Pekerja (JKKP) 4. STATE - management meeting - KPAS
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 110 25 26 ACKNOWLEDGEMENT DR. SHAHABUDDIN BIN IBRAHIM MSc. IHSHM (LSBU) Deputy Director, Tengku Ampuan Rahimah Hospital, Klang, Selangor [email protected] 03- 88831215 / 1243 / 1188 03-88831176 [email protected] fb.me/oshmedicaldev http://medicaldev.moh.gov.my/ckpp/ Any questions please contact:
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 111 27 THANK YOU OCCUPATIONAL SAFETY & HEALTH UNIT MEDICAL CARE QUALITY SECTION MEDICAL DEVELOPMENT DIVISION MINISTRY OF HEALTH MALAYSIA COPYRIGHT (C) MINISTRY OF HEALTH MALAYSIA 1 DE-ESCALATION OCCUPATIONAL SAFETY & HEALTH UNIT MEDICAL CARE QUALITY SECTION MEDICAL DEVELOPMENT DIVISION MINISTRY OF HEALTH MALAYSIA COPYRIGHT (C) MINISTRY OF HEALTH MALAYSIA MODULE 5 Part II
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 112 2 VERBAL DE-ESCALATION • Use of techniques that have the potential to ease an escalating situation • Verbal de-escalation is used in an attempt to prevent a person from causing harm to us, themselves or others • Consists of tactics to help limit the number of staff who might be injured on the job • Timing is crucial - used at the EARLIEST in any escalating situation 3 PHYSICAL FORCE • NEVER recommended • LAST resort
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 113 4 TACTICS FOUR MAIN CATEGORIES Evade/ Escape Personal Safety Prevent De-escalate 5 WHO NEEDS TRAINING? • Everyone • NOT a self defence course • Focus here is ONLY on personal safety
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 114 6 VERBAL SKILLS • To de-escalate effectively one must be able to communicate effectively • Open as many clear lines of communication as possible- no barriers • Show empathy • Apologise and express regret • Negotiate with the person if the problem/ conflict has a solution 7 VOICE • Tone • Volume • Rate • Inflection of voice • Avoid humour • Be respectful • Calm • Validate • Relocate • Be aware/ alert for non verbal cues/ threats • Get assistance
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 115 8 LISTENING • Choice • Concentration • Three main components: - Attending - Following - Reflecting 9 NON-VERBAL SKILLS • Space (respect personal space) • Posture (opened and relaxed) • Eye contact (don’t stare) • Stance (stay on same level) • Touch (use with caution)
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 116 10 • 80-90% • Need to identify what we are communicating to others non verbally • Important to recognize non verbal cues from the other person NON-VERBAL COMMUNICATION 11 BODY LANGUAGE • Finger pointing • Shoulder shrugging • Jaw set • Clenched teeth • Eyes! - eyebrow raised, eyes opened wide, hard stare, closing eyes longer than normal
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 117 12 CHALLENGING POSTURE • Face to face • Nose to nose • Touching • Finger pointing • When there are weapons - Person should be relocated to a safer environment • Ask person to be placed in a neutral location • DON’T demand for it to be handed over 13 PERSONAL SPACE • Usually 1.5 to 3 feet - far enough so you cannot be hit or kicked • Encroachment of personal space can escalate anxiety • Do NOT touch a hostile person • Keep your hands visible at all times
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 118 14 One staff member should be assigned to assume control of a potentially disturbed or violent situation DE-ESCALATION TECHNIQUES 15 THE STAFF MEMBER WHO HAS TAKEN CONTROL SHOULD : • Consider an appropriate de-escalation technique for that situation • Manage others in the environment:- - Removing other patients from the area - Enlisting the help of colleagues and - Creating space • Clearly explain to the person and others in the immediate vicinity what you intend to do • Instructions should be delivered in an assertive manner. Be clear and brief. • Move towards a safe place and avoid being trapped in a corner
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 119 16 • Obtain facts about the problem • Encourage reasoning without appearing to be condescending • Attempt to establish rapport • Emphasize on cooperation • Offer realistic options • Use open ended questions to get information • Be aware of own verbal and non verbal signals • Employ effective listening skills 17 DO NOT : • Be patronizing or over bearing • Minimize the person’s concerns • Threaten
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 120 18 VERBAL DE-ESCALATION TECHNIQUES • Effective listening • Distracting the other person by :- - Getting the other person to focus on something positive - Changing the subject - Use humor (sparingly) to lighten the mood (be very careful with this! 19 VERBAL DE-ESCALATION TACTICS • Motivating the other person (especially useful with students) • Empathizing with the other person • Giving choices • Setting limits
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 121 20 VERBAL DE-ESCALATION TECHNIQUES • Minimize communication barriers • Barriers to communication prevent effective communication • It may be an environment that is not conducive or an individual’s attitude, perception or beliefs 21 DE-ESCALATING TECHNIQUES Barriers to Communication: • The use of jargon • Judgmental, critical, differences in perception and viewpoint • Minimizing, dismissive, condescending, argumentative • Lack of attention, interest, distractions, or irrelevance to the receiver • Physical disabilities such as hearing problems or speech difficulties • Physical barriers to non-verbal communication • Language differences and the difficulty in understanding unfamiliar accents. • Expectations and prejudices which may lead to false assumptions or stereotyping • Cultural difference • Noisy environmental
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 122 22 Use positive and helpful statements such as: • “I would like to help you!” • “I know someone who would be able to help you with this…” • “Ms. X handles this for our district, let’s ask her what she thinks about this situation …!” 23 CALL FOR HELP! • DON’T be a HERO • Alert someone else as soon as possible • Two heads are always better than one • There is safety in numbers • It will be beneficial to have a witness, if the situation deteriorates and someone is injured
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 123 24 NOTIFICATION AND FOLLOW-UP • Always report minor situations • Minor situations can be a “cry for help” and/ or “warning signs” of bigger things to come! • Minor situations can lead to major situations • After any confrontation, advise or direct the person for counseling, if possible • ALWAYS document every threatening event 25 THINGS NOT TO DO! • Avoid becoming emotionally involved - control your emotions at all times • Avoid engaging in power struggles • Avoid being rigid in the process • Avoid telling the other person that you “know how he or she feels” • Avoid raising your voice, cussing, making threats, and giving ultimatums or demands • Avoid aggressive language, including body language • Do not attempt to intimidate a hostile person
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 124 26 REMEMBER • Remain calm at ALL times • Validate! “I understand why you might be upset” (This does not mean that you agree with them) • Remove onlookers - or relocate the person to a safer place. (Onlookers can become either “cheerleaders” or additional victims) • Send for help • Watch out for non-verbal clues or threats • Bring in another trained person to assist whenever possible 27 TIPS 1. If you find yourself in a threatening situation, remember what we discussed today: • Be emphatic and non-judgmental - do not discount their feelings • Respect personal space - decreases anxiety and prevents acting out behavior • Use non threatening non verbals • Avoid over reacting • Focus on feelings- watch and listen carefully for the real message
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 125 28 2. If you find yourself in a threatening situation, remember what we discussed today: • Ignore challenging questions- redirect attention to issue at hand • Set limits- give clear simple and enforceable limits • Choose wisely what you insist upon- think carefully what is negotiable and what is not • Allow silence for reflection • Allow time for decisions 29 STEPS TO BE TAKEN 1. The two main concerns are: a) to keep him from attacking and b) to keep you in control of the situation - even if it does go violent. 2. Intervention must occur to end the situation. 3. Interventions may be accomplished by supervisors, security or police, depending on the circumstances. 4. Make sure your appropriate chain of command has all of the facts 5. You should receive medical treatment for any physical injuries. 6. Counseling for post-traumatic stress and fear resulting from the incident may be appropriate. 7. Trained staff can conduct a de-briefing session with involved staff. 8. Look at steps to be taken to prevent other similar situations from occurring in the future.
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 126 30 A critical component of de-escalation is both the willingness to use force if necessary and the ability to do it effectively. Your ability to respond tactically is not only a deterrent, but an assisting element in de-escalation. 31 03- 88831215 / 1243 / 1188 03-88831176 [email protected] fb.me/oshmedicaldev http://medicaldev.moh.gov.my/ckpp/ Any questions please contact:
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 127 32 ACKNOWLEDGEMENT DR. GAYATHRI K. KUMARASURIAR (MRCPsych ,U.K) Psychiatrist, Tengku Ampuan Rahimah Hospital, Klang, Selangor [email protected] 33 THANK YOU OCCUPATIONAL SAFETY & HEALTH UNIT MEDICAL CARE QUALITY SECTION MEDICAL DEVELOPMENT DIVISION MINISTRY OF HEALTH MALAYSIA COPYRIGHT (C) MINISTRY OF HEALTH MALAYSIA
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 128 2 1 PERSONAL SAFETY OCCUPATIONAL SAFETY & HEALTH UNIT MEDICAL CARE QUALITY SECTION MEDICAL DEVELOPMENT DIVISION MINISTRY OF HEALTH MALAYSIA COPYRIGHT (C) MINISTRY OF HEALTH MALAYSIA MODULE 5 Part III INTRODUCTION • Self-awareness • Non-verbal communication • Personal space and zone • Working position
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 129 3 SELF AWARENESS 1. Ask yourself: Can I reduce avoidable risks by physically and mentally preparing to work with potentially dangerous people? 2. History/ Background Information: What do I need to know about the presenting or inherent problems of the clients that will influence my response to their dangerous behaviour? 3. Self-Control: Do I have an effective plan for self-control? 4 4. Background Info: medical aspects • All staff members must have rapidly acquire knowledge of people whom they work with. - Some aspects are directly related to risks in responding to assaultive behaviour - Impact of exertion on their general medical condition - Lack of oxygen to brain increasing potential for agitation & fighting - Asthma, COPD, etc. - Seizure - Pregnancy - Medications decreasing self- awareness including perception of pain - Medical/ neurological conditions that decrease self-awareness - Heart condition or arrhythmia
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 130 5 6 5. Self Control: Can you make it? • Fight or flight: - Normal, involuntary reaction to threat of physical injury - May feel physically strong - Yet temporarily incapable of making sound judgment • Maintaining self-control in difficult circumstances is the hallmarks of professional behaviour. • Only solution: develop a series of pre-planned interventions for maintaining/ regaining control. • Stress caused by repeated experiences of “Fight or flight” is cumulative. NON-VERBAL COMMUNICATION Definition :Includes all unspoken messages both intentionally or not.
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 131 7 PERSONAL SPACE A personal space, or the physical space surrounding us that encompasses the area that we feel safe, and where any threat to that personal space would make us feel uncomfortable. Some may call personal space their personal bubbles. The size of our personal bubbles depends very largely on our cultural background. 8
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 132 9 10 WORKING POSITIONS 1. Access to exits 2. Open stance 3. Avoid cornering: When patient is cornered, he feels there’s only one way out – by fighting a. Contact cornering b. Angulated cornering
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 133 11 c. Psychological cornering d. Exit cornering YOU 12 1. Face-to-face, hands above waist, palm open, balanced on feet 2. Person A will stand with their shoulders at right angles to the shoulders of Person B. 3. L-Shaped Stance demonstrates respect and decreases confrontation WORK POSITIONS - STANDING PERSON A PERSON B
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 134 13 WORK POSITIONS-SITTING 45º angle to person, lock wheels, you touching the wrist/ ankle, feet flat on floor-no crossed legs 14 03- 88831215 / 1243 / 1188 03-88831176 [email protected] fb.me/oshmedicaldev http://medicaldev.moh.gov.my/ckpp/ Any questions please contact:
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 135 15 ACKNOWLEDGEMENT DR. NORNI BT. ABDULLAH Consultant Psychiatry, Hospital Tengku Ampuan Rahimah, Klang, Selangor [email protected] DR. SALINA AKHTAR BT. MD. YUSOF Consultant Psychiatry, Hospital Tengku Ampuan Rahimah, Klang, Selangor [email protected] 16 THANK YOU OCCUPATIONAL SAFETY & HEALTH UNIT MEDICAL CARE QUALITY SECTION MEDICAL DEVELOPMENT DIVISION MINISTRY OF HEALTH MALAYSIA COPYRIGHT (C) MINISTRY OF HEALTH MALAYSIA
1 2 POST-INCIDENT RESPONSE COUNSELLING TO BE DONE BY COUNSELLOR CRITICAL INCIDENT STRESS DEBREIFING (CISD) TO BE DONE BY SUPERVISOR (S) MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 136 MODULE 5 Part IV POST INCIDENCE RESPONSE OCCUPATIONAL SAFETY & HEALTH UNIT MEDICAL CARE QUALITY SECTION MEDICAL DEVELOPMENT DIVISION MINISTRY OF HEALTH MALAYSIA COPYRIGHT (C) MINISTRY OF HEALTH MALAYSIA
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 137 3 CRITICAL INCIDENT STRESS DEBREIFING (CISD) OBJECTIVE • The mitigation of the impact of a traumatic incident • To facilitate normal recovery process • To identify members who might need extra professional care 4 CRITICAL INCIDENT STRESS DEBREIFING (CISD) INTRODUCTION • It’s not psychoterapy or counselling session • It’s simply a supportive, crisis-focused discussion of traumatic event • It aims at reduction of distress and a restoration of group cohesion and unit performance
MODUL LATIHAN Mencegah & Menangani Kekerasan Terhadap Anggota di Fasiliti Kementerian Kesihatan Malaysia 138 5 6 CRITICAL INCIDENT STRESS DEBREIFING (CISD) YOUR ROLE • As facilitators - similar profession backround • Typical formula: One facilitator for every 5 to 7 group members. Can have 2 facilitators for a bigger group size. • Do debriefing 10 to 15 minutes CRITICAL INCIDENT STRESS DEBREIFING (CISD) 7 PHASES 1. INTRODUCTION 7. RE-ENTRY 2. FACTS 6. TEACHING 3. THOUGHTS 5. SYMPTOMS 4. REACTIONS