Written exam

Zero Tolerance harassment

Does not tolerate any form of harassment whether its towards race, color, religion, gender, national origin, age, sexual orientation and/or disability.

Acts of Harassment…

will result in automatic dismissal

Harassment covers any form of…

intimidating or inappropriate behavior (verbal, written, or behavioral) that creates an uncomfortable environment.

Assault

Intentionally putting another person in apprehension of a harmful or offensive contact.

• Physical injury is not required

Harassment

Any conduct that creates significant anguish to another person such that it may bother, scare, or emotionally abuse them.

Consent

-affirmative, conscious, voluntary, and revocable

-the responsibility of each person to ensure they have affirmative consent of the other to engage in a activity

-Lack of protest, lack of resistance, or silence does not result or constitute to consent

-Affirmative consent can be revoked at any time

-existence of a dating relationship or past relationship/sexual relationship will never by itself be assumed to be an indicator of consent

• asking for and giving consent isnt only about intimate relationships, It is to be asked about in the day-to-day life when you make decisions or set boundaries and respect for other people’s choices all the time.

Stalking

• Cyber___ involves annoying or harassing someone with repeated calls or electronic communications that are obscene or threatening

• It is a crime to use an electronic device to distribute personal information about or digital images of someone with the intent to harass or harm that person

• Scheduling shirts with the intent to see another scholar may ultimately be considered ___ if the scholar feels uncomfortable or has made it clear they do not want to be visited by that particular individual.

Prohibited behaviors

• Threatening: swinging fists, destroying property, or throwing objects

Prohibited behaviors

Verbal or written: any expression of an intent to inflict harm

Prohibited behaviors

Verbal abuse: swearing, insults, or condescending language

Prohibited behaviors

• Physical attacks: hitting, shoving, pushing, or kicking

Prohibited behaviors

Retaliation: adverse action against a person based on their participation in a harassment investigation

Prohibited behaviors

Inappropriate behaviors with a person under the age of 18

Prohibited behaviors

Failing to comply with the terms of a no-contact order

Quid Pro Quo (H1)

Decisions based on a request for a intimate favor or expected return for something

Hostile Environment

Unwelcome conduct that results in the following:

• interfere with an individual’s ability to work

• creates an intimidating, hostile, or offensive work environment

Examples of Harassment (Seual)

• unwelcomed seual propositions

• unwanted seual innuendoes or behavior, repeated or not

• Unwelcomed seual comments or jokes

• Unwanted touching or leering

• Sending someone unwanted seual materials

Examples of Harassment (non-seual)

• slurs

• negative stereotyping

• Threatening or hostile acts related to above

Non-Harrassment

• mutual consent like consensual hugging between friends and a compliment between colleagues are not considered (H)

• Giving and receiving constructive feedback should be evidence based and delivered in an appropriate manner

• initiating conversations where you ask how someone’s weekend was, avoid asking them for detailed personal/private info

• Complimenting a colleague (“nice work” or “nice haircut”)

Responding to Harasser

Harassment is unlikely to stop until confronted. Inform the harasser that their actions are offensive and unwelcome. There is no best way to respond to harassment in every circumstance.

• Project confidence, even if you do not feel that way

• Do not apologize, make an excuse, or ask a question. You do not need to say sorry for your feelings

• Name the behavior and state that it is wrong

Reporting and Incident

Incident arises —> Report to supervisor —> investigation —→ Resolution

Mandatory Reporting

• Health care providers are legally obligated to report suspicious behavior or events to the correct authorities

• Scholars are not mandatory reporters legally but should none the less be required under program policy to report anything suspicious to a program facility and/or cope health solutions staff member

Incident Reporting

An unexpected or unanticipated event that needs to be reported to the program facility and COPE health solutions, this includes harassment.

Reporting:

1. Program manager

2. Regional Manager

3. Director

Open Door Policy

• Cope encourages open communication

• if you have a problem or issue that you want to discuss, you should feel free to talk to your supervisor or another point of contact

Considered Workplace Violence

• physical assault

• threats

• harassment

• domestic violence can spillover into the workplace

• intimidation

• bullying

• stalking

Zero Tolerance Policy

• all threats or acts of violence occurring on program site property, regardless of the relationship between employee and individual involved in the incident

• all threats or acts of violence not occurring on program site property, but involving someone who is acting in the capacity of a representative of the organization

• all threats or acts of violence not occuring on program site property, but involving an employee of the organization if the threats or acts of violence affect the legitimate interests of employees or the org.

Workplace violence

any action that threatens the saftey of an employee and negatively impacting an employee’s physical and or psychological well-being, or causes damage to an organization’s property.

Behaviors of Concern (BoC)

• disruptive, aggressive, hostile, or emotionally abusive behaviors that generate anxiety or creare a climate of distrust, and which adversely affects productivity and morale.

• exp: expressed frustration, prolonged anger, holding grudges, hypersensitivity to criticism, blaming others, extreme anxiety, visible distress and isolation

Possible factors for BoC

• pain

• personal stress

• fear of unknown

• psychological causes

• anger at hospital system (long awaited times or cramped spaces)

• Physiological causes

BoC communication indicators (verbal)

• raised voice, aggressive statements (demanding attention), Confrontational statements

BoC communication indicators (paraverbal)

• voice quality

• rate of speech

• inflection

BoC communication indicators (Non-verbal)

• sitting at the edge of the bed

• gripping arm rails

• tense posture

• eye movement

• leaning in

• breathing changes

• clenched fists

• pacing

Areas more susceptible to violence

• emergency department

• Geriatric units

• behavioral health units and clinics (outpatient)

• psychiatric wards

• waiting rooms and exam rooms

• pain management department

Common misconceptions

Violence is not sudden or sporadic, it is evolutionary

• “They just snapped” or “They are a loner”

Cycle of Assault

Trigger —> Escalation —> Crisis —> recovery —> post-crisis Depression

Trigger

• The event that initiates the escalation of behavior.

• Can lead to a violent or an assaultive episode.

• Comes from a perceived loss or threat of loss from the individual.

• Predisposing factors are usually unknown to health care providers.

Escalation of behavior

Anxiety —> Aggressive behavior —> physical violence

De-escalating the Situation

• Active (empathic) listening

• Remain non-judgmental

• Leave silence for reflection

• Be patient

• Maintain attitudes of respect and acceptance

• Avoid conflicts over power and control

• Rational detachment

Restraints

1. physical restraints

2. Behavioral restraints (Form of restraint used for the management of violent or self destructive behavior that jeopardizes the immediate physical safety of the patient, staff, or others

3. Seclusion (involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving

DO NOT ENTER ROOM IF PATIENT HAS RESTRAINTS (HS)

Recovery and Post-crisis Depression

• Being quiet, lack of energy, crying, moving to a protected area

• Emotional status below average state

• Individual may become tired and not remember the incident

Intervention

• Give person space and time

• Look at what caused the behavior

Code Gray

Combative or disruptive person

Code Silver

Person who is armed with weapon or hostage situation

Code Pink

Infant abduction

Code Purple

Child abduction

Mandatory Reporting responsibilities

Report to the Division required shall be made within 24 hours after the employer knows of the injury

1) Report —> charge nurse —> seek treatment —> Call emergency pager

2) After a violent incident, it is important that all personnel involved in the incident, meet immediately following to discuss.

What should always be reported

• aggressive and hostile behaviors

• physical violence

• threats and threatening behavior

Open door policy

includes scratching, spitting, bitten, choked, sexually assaults, verbally threatened, grabbed etc etc.

Don’t think it is someone else’s responsibility, you have responsibility to help maintain a safe enviorment.

Extreme danger Gap (Active shooter)

Period of time between extreme violence and the arrival of law enforcement

• anywhere that there’s human congregation and activity there can be violence

Accept, Assess, Act and alert

• accept the situation

• assess the situation (what is going on/where is the danger coming from)

• Act (avoid, barricade, fight)

• Alert (emergency response)

Law enforcement

• be prepared to calmly and quickly tell them what they need to know

• follow orders

• do not attempt to re-enter the scene until they give you the all clear

• their first priority will bot be the wounded

Anatomical Position

• Patient’s body is erect

• Head, eyes, toes, and palms are directed forward with limbs at sides of body

Medial and Lateral

• towards the midline of the body

• away from the midline of the body

Anterior and Posterior

• face or front side (ventral)

• Backside (dorsal)

Proximal

Close to the middle of the body, toward torso

Distal

Away from the middle of the body, away from torso

Cranial

Towards the top of the head

Caudal

Away from the top of the head, toward the hind parts

Superior

Above or over something, based on a reference point

Inferior

• Below or under something, based on a reference point

Flexion

Closing of a joint

Extension

Opening of a joint

Supination

Palm of hand faces fowards vertically

Pronation

Palm of hand faces backward/dorsal

Supine

Lying down facing ceiling (on back)

Prone

Lying down facing the floor (on stomach)

Eversion

Sole of foot faces outward

Inversion

Sole of foot faces inward

Adduction

Move toward the midline

Abduction

move away from midline

Trendelenburg Position

Patient’s head is low and legs are elevated

used as a first measure for hypotension or change of blood flow

Reverse Trendelenburg Position

Patients head is elevated

used for head trauma victims (anyone with an open/bleeding wound)

Fowler’s Position

Semi-sitting position with hip at an angel of 45-60 degrees

• used after abdominal operations

Semi-Fowler’s position

• semi-sitting position with hip ar an angle of approx. 30 degrees (knees can be flexed and supported by a pillow after additional support)

• helps reduce pressure on a patients back

Orthopedics

Branch of surgery concerned with injuries and disorders of the musculoskeletal system.

Total Hip Replacement

• Common orthopedic procedure

• Arthroplasty: replacement of arthritic dysfunctional joint surface

• Patient placed in Fowler’s position after total hip replacement surgery.

important precautions (orthopedic patients)

• Do not change patient position unless directed by nursing staff

• Do not flex the hip past 45 degrees

• Do not adduct the hip past 

X-rays

• Used to determine the structural status of bones and other high density tissues

• Must wear lead apron and thyroid shield to protect from ionizing radiation.

CT

• Computerized Axial Tomography

• Specialized x-ray used to examine soft tissues like the liver, brain or pancreas

MRI

• Magnetic Resonance Imaging

• Uses magnetic field and radio waves to create cross-sectional images of head and body

• High image quality, but time consuming and expensive

Ultrasound

• High-frequency sound waves are used to produce real-time pictures of internal organs

• Used during pregnancy to observe development of fetus

C-Arm

• X-Ray machine used in surgery to take pictures of spine without moving patient.

Catheter

• Small tube inserted into a body cavity, duct or vessel.

• Allows drainage, injection of fluids or access by surgical instruments

Chest Tube

• Flexible plastic tube inserted through the side of the chest into the pleural space.

• Used to remove air (pneumothorax), fluid or pus

EKG/ECG

• Electrocardiogram

• Records electrical activity of heart

Intubation

• Usually refers to endotracheal intubation

• Placement of flexible plastic tube into trachea to protect the patient’s airway and allow mechanical ventilation.

IV

• Intravenous

• Insertion of flexible catheter into a vein using a needle for guidance and to puncture skin.

NG Tube

• Nasogastric Tube

• Inserted through nose, past pharynx and esophagus, into stomach; used for feeding and/or administering drugs, or emptying the stomach

Ventilator

• Machine breathes for patients who are unable to do so on their own.

• Can be adjusted to set respiratory rate, air pressure, etc.

ACU (ambulatory Care unit)

• Patients are able to walk, either assisted or unassisted.

ICU (intensive care Unit)

• Where unstable medical patients go for constant care.NIC

NICU (Neonatal Intensive Care Unit)

• Where premature and/or seriously ill or unstable babies are treated.

PACU (Post-Anesthesia Care Unit)

Provide care for patients recovering from anesthesia after undergoing surgery

BM

Bowel Movement

CBC

Complete blood count

• Percent of each cell type (RBCs, WBCs, platelets, etc.).

TKO

To keep open