The opportunity to address challenging family behaviours in paediatric care – The impact of shifting from ‘zero tolerance’ to ‘graded response’
Anne Preisz1, Sydney Children’s Hospital Network 1Sydney Children’s Hospital Network
Abstract
This presentation aims to identify and clarify the impact of challenging behaviours between parents, carers and healthcare staff in complex paediatric care and suggest new mechanisms to manage those behaviours. I propose the existing ‘zero-tolerance’ approach to aggression in healthcare is not consistently applied, and is clinically unfeasible and ethically inadvisable. This approach has failed to distinguish the degree of harm to others; including heath care staff, other families and especially the child. Evidence suggests entrenched conflict compromises safe care and leads to medical error, and therefore a change in approach is imperative. I will propose and outline an interdisciplinary, contextual and graded approach that acknowledges the impact of emotion and high-stakes decisions in paediatric care, yet has embedded opportunity and expectation to reset and re-establish trustful relationships with parents to reduce unintended harm to all parties. Drawing on clinical ethics principles, illustrative challenges and experiences in our hospitals and stakeholder input, a quality improvement science approach was used to collaboratively develop a graded response matrix (GRM) tool to address this issue transparently. The novel GRM resource supports staff to identify levels and signs of ‘anticipated’, ‘challenging’ and ‘aggressive’ behaviour and respond early and appropriately. This organisationally endorsed model has shown sustainable success in containing challenging behaviours in paediatric care and setting early compassionate boundaries to allow clinicians and carers to continue to work in partnership for the interests of the sick child.
Biography
Bio to come