HealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
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View All ProductsAs a premier provider of healthcare education, we are committed to promoting safer, more successful surgical and sedation outcomes for each and every patient.
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Learn MoreEvery coach with a clinical background has a patient who has made a significant impact on his or her life--one who, while in the role of patient, has been the teacher. Ray* was that patient for me. While I had been a practicing nurse and psychotherapist for many years, I was relatively new to the world of nursing on a locked psychiatric ward. Ray was sent to our locked unit because he had become behaviorally unmanageable; his mother, acting as his primary caregiver, was no longer able to reason with him. Ray was an Hispanic man in his early 30’s. He was significantly developmentally delayed and dealt with anger, frustration, and fear by banging his head on any available hard surface. As a result, he had cut himself over one eye, suffered intracranial swelling, and had developed a disfigured “cauliflower” ear. When Ray arrived on the unit, he had been heavily sedated by EMS workers; he was placed in soft restraints for his safety and the safety of those taking care of him.
Patient-Centered Communication
I met Ray on his first day on the unit, and we began to communicate. Communicating with Ray meant helping him to understand that I was not there to hurt him. He was able to speak and expressed his fear of needles (he had been sedated using intramuscular injections). We established some ground rules with each other. If he could control his head-banging, injections would not be needed. But, Ray’s developmental disability meant that our agreements were sometimes short-lived and quickly forgotten in what he perceived to be threatening circumstances. At the end of each encounter, regardless of outcome, other staff and I thanked Ray and expressed belief in his ability for improvement. Medications Ray routinely took to control seizure episodes gradually began to assist in his behavioral control, but Ray’s “go to” method of expressing fear, anger, or frustration continued to be head-banging.
Staff were baffled as to how to deal with this continued behavior; we had tried behavioral reinforcement of all kinds, including using food as a reward and bargaining by offering privileges in exchange for not banging his head. We worked together as a team, so that one person’s efforts would not be unwittingly undermined by those of another. Although well-meaning, professionals will often “undo” each other’s hard work by failing to adequately communicate what is being done and why.
While these behavioral efforts were important in teaching Ray new ways of coping, under stress they failed to work. One day, one of the male clinicians suggested that perhaps a wrestling helmet, one with holes cut out over the ears and designed for impact, would be useful. We presented Ray with his helmet, telling him it would help to keep him safe, and he loved it. He did not want to remove it for any reason. And, interestingly, once Ray began wearing his helmet, we were able to tie positive behaviors with it, and his incidence of head-banging diminished dramatically. While in Ray’s case, we required a helmet to jump start our effectiveness in consistent communication, it was the model for communication, based on the HealthStream principles of RELATE™, which made the difference in the long term.
* name changed to protect the identity of the patient.
Making a Difference, Long-Term
After a time, Ray’s behavior had improved to the point of allowing him to be discharged. His mother, an elderly woman, felt she was no longer able to take care of him, and she continued to be afraid of his potential for head-banging. Ray was placed in a small group home with other developmentally-delayed males. He did well. Several of us continued to think about and inquire about Ray. We learned that the interior of his wrestling helmet had become worn to the point of rubbing his head. We bought a new helmet, and two of us took it to him in the group home. Imagine my surprise when, on greeting Ray, he addressed us pleasantly and was not wearing a helmet. In fact, when we presented him with his new helmet, he placed it in a corner. He told us he did not want to wear it, didn’t need it, and no longer wanted it as it reminded him of his old behaviors. What I learned that day is that all interactions mean different things to different people, and while Ray’s helmet and our staff were important for a time in his life, Ray had moved on.
HealthStream’s learning management system and healthcare training solutions support medical training initiatives and allow for the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceBe confident in your staff’s ability to reduce risk by providing compliance training that changes behavior.
View All ProductsDevelop next-level people for next-level care by prioritizing quality and safety improvements.
View All ProductsEstablish a culture of belonging with education supporting DEI, wellness, engagement, and leadership development.
View All ProductsUtilize patient access solutions and advanced reimbursement solutions to manage clinical denials and improve your organization’s reimbursement strategy.
View All ReimbursementExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ProductsOur competency development solutions personalize learning for clinicians to bridge the gap between theory and practice for your nurse residents.
View All ProductsEnhance maternal & child nursing care with solutions focused on improving the quality of care for mothers, infants, and children.
View All ProductsAddress staffing orientation challenges to easily achieve and maintain certification with our emergency and acute care training solutions.
View All ProductsAs a premier provider of healthcare education, we are committed to promoting safer, more successful surgical and sedation outcomes for each and every patient.
View All ProductsOur solutions are designed to cater to the needs of patients, healthcare professionals, and organizations dealing with illnesses or chronic conditions.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare workforce management is essential. We provide advanced scheduling solutions for organizations to solve issues such as nurse retention
View All ProductsComprehensive, industry-leading provider onboarding and credentialing software that validate health outcomes and support provider assessment.
View All CredentialingOur affordable CVO credentialing services establish patient safety by enabling primary source verification for your healthcare organization.
View All ProductsIntegrate with Epic to validate and add new providers directly to your provider master file.
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