Hospitals generally use a set of colour coded indicators in order to alert the care professionals within a healthcare setting about an emergency. The colour codes also present a set of unique criteria that signifies the manner in which care professionals are expected to respond during the emergency situation. It should be mentioned here that the emergency situation can range from an incident of incivility, violence or a disaster such as fire breakout. The most widely used colour codes include the codes red, yellow, white, orange, green, pink, grey, black and brown. This essay would revolve around the central theme of the code white emergencies within the healthcare facilities and throw light on the fact that whether effective communication could help care professionals to deescalate problems related to incivility caused by patients within a care unit.
Incivility can be defined as a behavioural trait of making an impolite or an offensive remark. As stated by Oyeleye et al. (2013), incivility has been mentioned to be synonymous to unsociable behaviour. Incidences of incivility are on the rise in care units, with patients putting up a violent behaviour against the care providers. According to a study conducted by Cheung, Lee and Yip (2017), it has been stated that the prevalence of violence and threats from the patients and their family members are on the increase despite employing serious efforts worldwide to control the scenario. The researchers in this case adapted a multiple logistic regression model and collected data over five months from August till December to estimate the prevalence of code white emergencies. The sample size comprised of 107 physicians and 613 nursing professionals. The findings revealed that 53.4% of the participants has experienced verbal abuse. Further, it was also found that 16.1% of the participants had experienced harassment with 14.2% having experienced sexual harassment and 2.5% having experienced racial harassment. The results critically revealed that violence and aggression was majorly perpetrated by the family members of the patient. Another study conducted by Campana and Hammound (2013), suggested that nursing care professionals frequently experience incivility from the patients and their relatives which results in burnout. The study clearly indicated that aggression and violence perpetuated a poor workplace environment which led to increased burnout.
According to CNO, conflict arises during circumstances where the client and the care professional differ in their perspective of effective care. The primary reasons where a conflict could possibly rise between a client and a nurse includes situations where the client is either intoxicated or withdrawing from substance abuse, is being constrained or restrained from a habit such as smoking or drinking, is fatigued or is tensed. In addition to this, factors such as previous medical history of violent behaviour, or being diagnosed with a psychiatric condition, experiencing language barrier issue or not getting adequate support can also lead to a condition of conflict (Cno.org, 2019). It is important to understand here that certain behaviour on the part of the care professional could also lead to a conflict. These incidences include, misunderstanding or judging a client, holding incorrect perception about the cultural background of the client, misbehaves with the client or fails to adapt a family centred approach for recovery and does not appropriately address the concern of the family members. (Cno.org, 2019) Another important aspect that has been attributed to cause client-professional conflict can be mentioned as the inability of the care professional to reflect upon their behaviour and endeavour to improve the scope of practice (Cno.org, 2019).
In this regard, I would like to mention one incident from my practicum where I could correctly identify a situation and take appropriate measures to avoid the possibility of a conflict. Shahzin, a 19 year old Muslim female had been accompanied by her father to the outpatient department. She complained of excessive abdominal pain and weakness. One of my colleagues, RN Mark was documenting the patient history and when the patient’s father enquired about what had mentioned. RN Mark causally mentioned we would be able to find that out after taking the vitals and performing the abdominal assessment. Shahzin’s father seemed offended and stated in a loud voice, ‘are you going to assess her?’ I was casually talking to a GN at that time but I could sense that something was wrong. I asked RN Mark and he mentioned that, ‘He is not letting me take her vitals’. Considering the conservative religious and social background of Shahzin it was clear to me that her father would definitely like a male RN to touch his daughter even for the purpose of vital assessment.
I spoke to Shahzin’s father and assured him that the assessment would be performed by a female RN and she would ensure that Shahzin is comfortable. I offered him a glass of water and asked him if he would like a RN who belonged to the similar religious and cultural background as his to perform the assessment. Her father relented and thanked me. I apologized on behalf of RN Mark.
Therefore, from the above scenario, it is clear that effective communication can help in avoiding the case of a conflict. In order to devise strategies to deescalate the problems related to violence and incivility, it is extremely important to identify the instances that seem problematic to patients and their family members and enrage them. Provision of client-centred care can be explained as the best practice that could help in effectively dealing with instances of violence and incivility. As mentioned by Blevins (2015), involving the family members in the care process and decision making process can positively help in avoiding instances of aggression and violence.
Therefore, to conclude, it can be said that establishing a patient-centred therapeutic relationship with the client along with the inclusion of a family-centred practice can help in avoiding conflicts. Also, reporting to supervisors in adverse situations or collaborative planning with another colleague can help in avoiding conflict scenarios. Certain adverse events could also be addressed by withdrawing services or leaving the patient for a while to allow him gain composure. Overall, introspecting upon self-behaviour and effective communication can help in deescalating problems related to patient incivility.
Blevins, S. (2015). Impact of incivility in nursing. MedSurg Nursing, 24(6), 379-381.
Campana, K. L., & Hammoud, S. (2015). Incivility from patients and their families: can organisational justice protect nurses from burnout?. Journal of nursing management, 23(6), 716-725.
Cheung, T., Lee, P., & Yip, P. (2017). Workplace violence toward physicians and nurses: prevalence and correlates in Macau. International journal of environmental research and public health, 14(8), 879.
Cno.org (2019). [online] Cno.org. Available at: https://www.cno.org/globalassets/docs/prac/47004_conflict_prev.pdf [Accessed 19 Feb. 2019].
Oyeleye, O., Hanson, P., O’connor, N., & Dunn, D. (2013). Relationship of workplace incivility, stress, and burnout on nurses’ turnover intentions and psychological empowerment. Journal of Nursing Administration, 43(10), 536-542.