No Hit Zone
Reinforcing a Culture of Safety through Awareness and Education
Objectives
• History: What prompted “No Hit

Zone” policy?
• Elements of the “No Hit Zone”
Project
• Educate on how to int...
No Hit Zone Dilemmas
• Many healthcare workers have
encountered situations where parents
or adults become angry, raise the...
“No Hit Zone” Beginning
• In 2005 Rainbow Babies introduced a
“ No Hit Zone” policy for their hospital

• Since then the p...
Goals
• Assist in lowering the frequency of disruptive
behaviors in our hospitals and clinics
• Assist in maintaining a sa...
• Hitting and disruptive behaviors puts
healthcare providers in a difficult situation;
therefore, no type of hitting is al...
“No Hit Zone” Elements
• Poster
– Widespread

• Brochures-Parent Resources
– Available throughout clinic facilities
focusi...
No Hit Zone Policy
PURPOSE
The purpose of this policy is to create and reinforce an
environment of comfort and safety for ...
No Hit Zone Policy
POLICY STATEMENTS
When hitting is observed, it is everyone's responsibility to
interrupt the behavior a...
General Guidelines
• Be nonjudgmental

• Model effective interventions (such as distraction), when
appropriate
• Try to ha...
Interruption
Can be used to “de-escalate” a situation in
which caregivers begin to raise their
voices, curse, or show othe...
Your calm, sympathetic, physical
presence is probably the most
effective response. You will
need to have a variety of lead...
• Scripting Examples
• “Can I help you with something?”
• “Would you like me to take your child to get a
book or sticker”
...
Scenario #1
You are a nurse working in a pediatric clinic.
You observe a caregiver yelling at her 2 year
and 3 year old ch...
Discussion

LOUISVILLE.EDU
• Calmly ask if the caregiver needs any assistance.
• Acknowledge how frustrating it is to wait a long
time with two young...
• Let the physician seeing the patient know
the family is stressed and starting to get
disruptive.
• Doctors and nurses sh...
• Situations may occur when a child/adult
is hit or physically disciplined and you
may need to relay that the clinic is a ...
• “For the safety and protection of
everyone in our clinic we participate
in a “No Hit Zone”. I am obligated
to say someth...
Scenario #2
• You are walking down the clinic hallway, a
mother yells at her child, yanks him by the
arm and hits him seve...
Discussion

LOUISVILLE.EDU
• Intervene and notify the mother that the clinic is
a “No Hit Zone”.
• Offer assistance.
• Let the team taking care of th...
• What if the mother states “it is
my right to discipline my child” ?
• What do you do?
LOUISVILLE.EDU
Discussion

LOUISVILLE.EDU
Response
“I am not trying to step into your role as a
parent but this facility is a “No Hit Zone”. We
do not allow hitting...
Sympathize with the frustrations and
stresses the parents may be
experiencing. Acknowledge that you
respect their role as ...
Scenario #3
• You are sitting in your office and hear crying
coming from the bathroom two doors
down. You continue to list...
Discussion

LOUISVILLE.EDU
• You look around your office and find a new toy. You go to
the bathroom and knock. You ask the caregiver if
everything is...
• After reporting the incident to the medical team,
you returned to check on the welfare on the child.
You observe the car...
Discussion

LOUISVILLE.EDU
• Intervene with the caregiver and child again
and explain that this clinic is a “No Hit
Zone”. Make a Social Worker refer...
• If a person becomes angry consider
calling security. Don’t make threats.
If indicated by the situation, notify
Child/Adu...
LOUISVILLE.EDU
LOUISVILLE.EDU
Roll Out

LOUISVILLE.EDU
Continuation of Program
• Refill of brochures, repair of
signage
• Education of new staff
• Other languages

LOUISVILLE.ED...
Acknowledgements

Erin Frazier
Kosair Children’s Hospital
Deonya Muhammad
University of Louisville Department of
Jamie Iss...
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No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education

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Presented by University of Louisville pediatrician Kelly Dauk. This program was created in collaboration with Dr. Erin Frazier and the Kosair Children's Hospital Child Abuse Task Force. This teaches healthcare workers how to intervene when they witness an adult or parent become angry or hit a child or another adult.

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  • Has anyone here every been in a situation where parent or adult becomes angry, raise their voices, or hit a child or another adult in your presence during a hospital stay or clinic visit??? Everyone tends to look at each other on who will react. It makes families in other rooms very uncomfortable. There has not been education or training on how to deal with this situation.
  • Many other hospitals have seen this situation and hence Rainbow started this program.
  • It is similar to taking finger nail clippers on an airplane—at security they can’t decide if the clippers are for use on the nails or if it is a weapon.
  • This is the best way to keep a situation under control before children get hit.
  • I have begun using the scripts frequently in my clinic for de-escalation. The more frequently I use them- the more comfortable I become doing this. I have frequently taken kids out of a room to take a walk with me, to get stickers, or to color while I write notes to give the parents a few minutes to settle down. Many time parents have thanked me for taking the child for a few minutes.
  • It may be helpful to have an area where you keep crayons, books, movies etc for children if needed. Families usually get frustrated or upset when other stressors are present. Always remember there may be much more going on in the family. This is a good time to offer help and resources.
  • The sooner you get involved with a disruptive patient/family member the easier it is to de-escalate the situation and help the family with the situation that is causing stress.
  • We acknowledge the parents right to discipline their child but this does not include spanking while in our facilities.
  • If people steal the poster—let them take the poster and get more.
  • No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education

    1. 1. No Hit Zone Reinforcing a Culture of Safety through Awareness and Education
    2. 2. Objectives • History: What prompted “No Hit Zone” policy? • Elements of the “No Hit Zone” Project • Educate on how to intervene when necessary LOUISVILLE.EDU
    3. 3. No Hit Zone Dilemmas • Many healthcare workers have encountered situations where parents or adults become angry, raise their voices, or hit a child or another adult in your presence without clear guidelines of what to do. • Our goal is to help equip healthcare workers with some tools to use during these encounters. LOUISVILLE.EDU
    4. 4. “No Hit Zone” Beginning • In 2005 Rainbow Babies introduced a “ No Hit Zone” policy for their hospital • Since then the program has been spread to over 30 hospitals across the country LOUISVILLE.EDU
    5. 5. Goals • Assist in lowering the frequency of disruptive behaviors in our hospitals and clinics • Assist in maintaining a safe and caring atmosphere for patients, families, and staff • Elevate the standard of care in all places where children interface with health care workers LOUISVILLE.EDU
    6. 6. • Hitting and disruptive behaviors puts healthcare providers in a difficult situation; therefore, no type of hitting is allowed in our facilities • Disruptive behaviors, such as, physical discipline yelling, jerking of body parts, etc. can lead to more physical and aggressive behaviors LOUISVILLE.EDU
    7. 7. “No Hit Zone” Elements • Poster – Widespread • Brochures-Parent Resources – Available throughout clinic facilities focusing on alternative types of discipline LOUISVILLE.EDU
    8. 8. No Hit Zone Policy PURPOSE The purpose of this policy is to create and reinforce an environment of comfort and safety for patients, families, and staff working in our facility. DEFINITION No Hit Zone: an environment in which no adult shall hit another adult, no adult shall hit a child, no child shall hit an adult, and no child shall hit another child. LOUISVILLE.EDU
    9. 9. No Hit Zone Policy POLICY STATEMENTS When hitting is observed, it is everyone's responsibility to interrupt the behavior as well as communicate hospital policy. PROCEDURE All staff will be made aware of the clinic policy that is in place to ensure and reinforce an environment of comfort and safety. Staff will identify and respond to situations that compromise the safe environment utilizing the education they are provided. If appropriate, additional intervention will be provided by appropriate staff dependent on the level of severity. LOUISVILLE.EDU
    10. 10. General Guidelines • Be nonjudgmental • Model effective interventions (such as distraction), when appropriate • Try to have conversations with caregivers out of earshot of others (including the children) so caregivers aren’t embarrassed into being confrontational • Thank parents for respecting our policies LOUISVILLE.EDU
    11. 11. Interruption Can be used to “de-escalate” a situation in which caregivers begin to raise their voices, curse, or show other signs of stress and inappropriate behaviors that occur prior to physical discipline LOUISVILLE.EDU
    12. 12. Your calm, sympathetic, physical presence is probably the most effective response. You will need to have a variety of lead-ins that you can comfortably use, depending on the situation specifics. (use your own language to convey one or more of the example messages) LOUISVILLE.EDU
    13. 13. • Scripting Examples • “Can I help you with something?” • “Would you like me to take your child to get a book or sticker” • “You’ve been waiting for awhile. Let me see when you can expect a doctor to see you” • “Most 2-year-olds can’t sit still/behave for long periods. Would it help if I found something for him to play with?” • “Do you have family here supporting you?” LOUISVILLE.EDU
    14. 14. Scenario #1 You are a nurse working in a pediatric clinic. You observe a caregiver yelling at her 2 year and 3 year old children while in the patient’s room. •What do you do? LOUISVILLE.EDU
    15. 15. Discussion LOUISVILLE.EDU
    16. 16. • Calmly ask if the caregiver needs any assistance. • Acknowledge how frustrating it is to wait a long time with two young children. • Offer to see how long until the patient will be seen. • Offer something for the children to do to keep them busy—books, movies, count stickers, snacks. • Always consider stresses the family may be underneed to get kids off bus, need to get to another appointment (court), other family members may be ill etc. LOUISVILLE.EDU
    17. 17. • Let the physician seeing the patient know the family is stressed and starting to get disruptive. • Doctors and nurses should respond immediately to disruptive behavior to help de-escalate situations. • It may take a few times before you are comfortable with this. • Consult a social worker if available and appropriate LOUISVILLE.EDU
    18. 18. • Situations may occur when a child/adult is hit or physically disciplined and you may need to relay that the clinic is a “No Hit Zone”. LOUISVILLE.EDU
    19. 19. • “For the safety and protection of everyone in our clinic we participate in a “No Hit Zone”. I am obligated to say something. What can I do to help you or your family?” • “You may have seen our posters in your room/waiting room. This clinic is a “No Hit Zone”. We ask that you refrain from hitting and keep conversations quiet/private out of courtesy to the other patients and families.” LOUISVILLE.EDU
    20. 20. Scenario #2 • You are walking down the clinic hallway, a mother yells at her child, yanks him by the arm and hits him several times. He is a patient waiting to be seen. • What do you do? LOUISVILLE.EDU
    21. 21. Discussion LOUISVILLE.EDU
    22. 22. • Intervene and notify the mother that the clinic is a “No Hit Zone”. • Offer assistance. • Let the team taking care of the patient (physician and nurses) know about the incident. • Provide documentation of the incident in the patient’s chart. LOUISVILLE.EDU
    23. 23. • What if the mother states “it is my right to discipline my child” ? • What do you do? LOUISVILLE.EDU
    24. 24. Discussion LOUISVILLE.EDU
    25. 25. Response “I am not trying to step into your role as a parent but this facility is a “No Hit Zone”. We do not allow hitting of any kind. This is for the safety of everyone in our facility.” LOUISVILLE.EDU
    26. 26. Sympathize with the frustrations and stresses the parents may be experiencing. Acknowledge that you respect their role as a parent/caregiver. LOUISVILLE.EDU
    27. 27. Scenario #3 • You are sitting in your office and hear crying coming from the bathroom two doors down. You continue to listen and identify that it is a child and their caregiver in the bathroom. The child is crying and you hear what sounds to be the caregiver hitting the child and verbally scolding them for misbehaving. • What do you do? LOUISVILLE.EDU
    28. 28. Discussion LOUISVILLE.EDU
    29. 29. • You look around your office and find a new toy. You go to the bathroom and knock. You ask the caregiver if everything is ok. The caregiver opens the door. You observe that the child is around 3 years old. The caregiver appears to be angry and worked up. The child is still crying. You bend down to the child and ask if she would like a toy. You then tell the caregiver that the facility is a “No Hit Zone”. You ask if there is anything you can get the caregiver. You then report the incident to the nurse and the medical team that will be seeing the child. • If you get no response from your knock, request that the caregiver open the door. LOUISVILLE.EDU
    30. 30. • After reporting the incident to the medical team, you returned to check on the welfare on the child. You observe the caregiver hitting the child repeatedly as she pulls her toward the bathroom. You observe the child crying and screaming. • What do you do? LOUISVILLE.EDU
    31. 31. Discussion LOUISVILLE.EDU
    32. 32. • Intervene with the caregiver and child again and explain that this clinic is a “No Hit Zone”. Make a Social Worker referral and again notify the medical team who will be seeing the child. • Depending on how you feel about the first intervention and the severity of the current situation you may want to contact security and child protective services. LOUISVILLE.EDU
    33. 33. • If a person becomes angry consider calling security. Don’t make threats. If indicated by the situation, notify Child/Adult Protective Service • Be aware of adults that go to private places to spank their children. • Do not put yourself in a dangerous situation. Contact security when appropriate. LOUISVILLE.EDU
    34. 34. LOUISVILLE.EDU
    35. 35. LOUISVILLE.EDU
    36. 36. Roll Out LOUISVILLE.EDU
    37. 37. Continuation of Program • Refill of brochures, repair of signage • Education of new staff • Other languages LOUISVILLE.EDU
    38. 38. Acknowledgements Erin Frazier Kosair Children’s Hospital Deonya Muhammad University of Louisville Department of Jamie Issis Pediatrics Tara Cockerel Rainbow Babies and Children’s Hospital Therese Sirles Riley Children’s Hospital Melissa Currie Anne Eldridge Steve Wright Michelle Robey Steve Menaugh Members of the Kosair Children’s Hospital Child Abuse Task Force LOUISVILLE.EDU

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