Resolute and consistent responses to family members’ problematic behaviors

Advise family members to stop the problematic behavior immediately

Flatly say, “Please stop that right now”, regarding family members’ troublesome behaviors.

Advise family members who exhibit difficult behaviors, such as abusive language in a loud voice, by saying, “It scares the other patients, so if you don’t stop that right now, there will be trouble”.

Clearly warn the family members that if they don’t stop the troublesome behavior, the police will come.

The entire team will maintain a resolute attitude of not condoning or forgiving problematic behaviors

Training and role-playing exercises have been conducted so that the nurses and the entire team can share and practice the resolute attitude of not condoning or forgiving conduct that violates hospital rules.

Depending on the nurse, the husband took a rebellious stance, such as ignoring her or yelling, but by consistently demonstrating a resolute attitude as a team, the husband gradually began to listen to what the medical staff said.

Attempted enforcement measures taken toward family members who exhibit problematic behaviors

Take action that corresponds to the problematic behaviors of the family members and the patient

If a family member’s problematic conduct causes terrible inconvenience to other patients, take steps such as having the patient (along with the family member) move to a private room, or, if the patient is perspirant, have her leave the hospital early.

Visiting restrictions and prohibition will be used as the final trump card.

Even if measures are taken toward a family member due to problematic conduct, the patient will not be affected

The police requested that the patient be discharged because the husband’s troublesome behavior adversely affected the other patients, but since the patient was a pregnant woman who had been hospitalized for a month, hospitalization continued, and the husband was refused visitation rights instead.

Although the nurses were tired of dealing with the family member’s problematic conduct, they treated the ill patient with the care she needed, and no one agreed with her forced discharge.

Involvement with consideration given to avoiding conflict with family members

Be very careful so as not to anger family members

When warning family members who have displayed troublesome behaviors, since they will only get back at you when you state it one-sidedly in a commanding tone, say “Can you please stop”? through a polite request instead.

Depending on your treatment of them, this can keep family members calm to some extent, so try not to rile them up.

Observe the facial color and expressions of family members, and respond accordingly so as not to arouse more antipathy than necessary.

Be very careful to not get emotional

Even if a family member says something that makes no sense, respond calmly so as not to incite agitation and get emotional.

Be very careful so you do not embarrass family members

When explaining the medical condition of the pregnant woman or the baby to family members who do not have a high educational background, we should use simple and easy-to-understand words.

Even with family members who engage in troublesome behaviors, if the atmosphere is settled, be careful so as not to embarrass them.

Interact with family members with consideration of their characteristics and predicting their actions

Since the husband seemed to have a developmental disability, we held a study session on “developmental disabilities in adults” in the ward, and shared a common policy within the team on how to deal with the husband.

For family members who are easily angered or panicked, the team made an effort to share information in order to avoid situations where they are forced to make decisions immediately after giving an explanation; the prognosis of the pregnant woman and the baby must be explained at an early stage.

When the newborn was transferred to another hospital, it was expected that the husband would oppose this and go on a rampage, so we had a pre-meeting with all the professions in the hospital about how to explain it all to the husband and how to get through the ordeal in case of an emergency.

Preparation that anticipates the occurrence of problematic conduct

Multiple people must respond accordingly to family member(s) who exhibit problematic behaviors

Just before the husband hit the doctor, multiple people—including the guards—stopped the raging husband and soothed his anger while rubbing his back until he calmed down.

Since medical staff who have suffered violent abuse cannot manage the situation, three or more people go to the room where the family member is, with two or more present to stop the family member, just in case.

When problematic conduct occurs, if a man comes in to stop the husband, controlling the situation is easier.

In important situations with family members who are expected to display problematic behaviors, make careful preparations that go beyond the ward

Since all nurses in the perinatal ward are women, security guards and male staff at the critical care center are hired when multiple family members who exhibit problematic behaviors are present.

In cases where the husband might not understand the doctor’s explanation and is unsatisfied with the extension of the child’s hospital stay, and his reaction is expected to develop into violence, we prepare for careful and rapid intervention, such as having a male paramedic wait outside the door of the interview room.

CCooperation with the medical team

Share information about the family members within the team, and be consistent with the response

Obstetrics and pediatric doctors, as well as ward nurses (hereinafter referred to as the medical team), regularly share information on family members.

The manager called on the medical team to treat family members as naturally as possible without preparation.

The medical team tried to treat the husband normally.

When an event where the husband was difficult to deal with occurred, it was shared with the whole team on an electronic medical record.

The importance of the initial response was shared with the whole team.

When the family members took a defiant stance, the whole team shared a unified policy to respond calmly without backing down.

Share feelings mutually among the team’s members

Having colleagues who understand your pain and difficulties will ease your feelings a little.

As the administrator, I set up a place with the idea that it is a venue where everyone can share their feelings so that each individual staff member will not have a hard time alone.

Cooperation with the hospital organization

Report on family members and seek the cooperation of the entire hospital

We report monthly on family members’ current status at the ward manager meetings.

We requested the cooperation of the director of the nursing department, as well as the hospital director, to increase the number of security guards at night.

At the manager meeting, a request was made to inform all hospital staff about the white code call when problematic conduct occurs.

To protect the team from the resentment of family members who are refused visitation rights, we begged the hospital director for special measures such as using the nearby parking lot, but the director did not listen.

We immediately informed the entire hospital about family members’ verbal abuse and violence, and constantly thought of a system to protect the nurses in the ward and made preparations for it.

Cooperation with social resources outside the hospital

Emphasize cooperation with health centers when interacting with the patient and family members

The community health center, which is responsible for supporting patients during pregnancy, provides pre-hospitalization information about patients (who could possibly be hospitalized) with problems and their families during the course of pregnancy.

We meet with the health center every two months to provide them with information on high-risk families who leave the hospital and return to the community, including details of problematic behaviors caused by family members in the hospital.

Since we have cultivated a face-to-face relationship with public health nurses through regular meetings, discharged patients and their family members can be entrusted to them and left in their care.

Feel secure working with police

To deter family members from engaging in violence and verbal abuse, the hospital association requested that the police dispatch a police car in the event of an emergency.

The police told us to keep a record of the words and actions of family members in the event of an emergency, so we are complying and have been submitting records.

We are relieved that the police call from time to time to ask, “How is the situation in the ward”? They say, “If something happens, a police car will be dispatched immediately”.

Patient protection

Act in consideration of the patient

When the family member who was the perpetrator of DV was absent, the patient talked about what happened to the couple in the past up to the present in an intimate conversation.

In view of the traumatic burden on the patient, only the nurse-in-charge became the listening ear for the patient so that the story would not spread too much among different nurses, and no further investigation would happen.

The team gently watched over the patient and tried to convey the message that “You and your unborn child are very important” on a daily basis.

Teach the patients knowledge and resource information as an administrator

As the administrator, I told the patient that her husband’s actions toward her were DV.

As the administrator, I told the patient about the telephone consultation center and shelter.