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GENERAL PURPOSE: To describe one unit's experience with imbedding MHWs in medical unit staffing to address the impacts of patient behavioral challenges. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing-education activity, you should be able to: 1. Examine the impact of poor patient behavior on other patients, staff, and the institution. 2. Recall the implemented changes and their associated outcomes in the hospital described.


1. Which statement about current conditions within healthcare is accurate?


a. There's a long history of concern with worker safety over patient safety.


b. There's an underlying culture of acceptance of poor patient behavior.


c. Workplace violence and its impact on employees is a major focus.


2. Staff members caring for behavioral health patients on medical units


a. are confident in their skills to care for disruptive patients.


b. are often fearful for their own safety.


c. receive higher than average patient satisfaction scores.


3. Which statement about integrating medical and psychiatric service models isn't accurate?


a. Consultative services provide only intermittent support.


b. Infrastructure and space needs limit operational efficiency of combined units.


c. Combined units have a significant positive financial impact.


4. Which factor has significantly contributed to reports of violence against healthcare workers?


a. There's been a dramatic increase in hospital patients with addiction disorders.


b. Inpatient units are no longer permitted to isolate patients with behavioral health problems.


c. Reporting of violent assaults is mandatory.


5. Because of violent behavioral incidents, staff members


a. are required to report assaults.


b. have infrequent contact with these patients.


c. report increased job dissatisfaction and burnout.


6. Traditional worker safety interventions when caring for patients exhibiting violent behaviors


a. are reactive, short-term solutions.


b. decrease staff turnover by reducing injuries.


c. function to de-escalate patients' behavioral patterns.


7. Which of these factors is directly linked to financial impact on the institution?


a. private rooms and blocked beds


b. loud and disruptive patients


c. staff not confident in their skills


8. Through focus groups, staff members on the unit recommended


a. increased pay and paid time off.


b. additional education and resources.


c. more 1:1 observation personnel.


9. The training provided by the psychiatric nurse educator focused on


a. providing emotional support for affected staff members.


b. collaborating with nursing leadership.


c. threat recognition and proactive de-escalation techniques.


10. What was the primary purpose of security conducting hourly rounds?


a. to grow stronger relationships with the nursing staff


b. to check in with the charge nurse on duty


c. to provide a better sense of safety


11. Which approach did hospital senior leadership support?


a. hiring additional MHWs for 1:1 observations as needed


b. imbedding MHW positions on the unit most affected


c. having MHWs attend only to behavioral health patients


12. Which candidate for the MHW position was viewed as ideal?


a. a trained and experienced mental health technician


b. a creative UAP who's motivated to learn new skills


c. an effective, motivated communicator with MHW and UAP experience


13. Integrating the MHW into the medical unit


a. required reeducating staff members.


b. was welcomed by nursing staff.


c. was a smooth transition to the new care model.


14. MHWs functioned collaboratively with the medical and nursing teams by


a. making suggestions for patients' behavioral care plans.


b. limiting their focus to behavioral health issues.


c. covering patient care needs while the nurses attended interdisciplinary rounds.


15. Clinical 1:1 observation hours over 3 years


a. increased due to the availability of more staff.


b. were reduced, allowing UAPs to be utilized to their full capacity.


c. evidenced a decline only after the final MHW was hired.


16. Which statement about staff engagement metrics on the unit is accurate?


a. The scores on the unit surpassed the organization's average.


b. Nursing quality indicators showed a slight decrease from 2015 to 2017.


c. Gallup staff engagement scores rose steadily over 3 years.


17. Which element of the program was key to its success?


a. recruiting and retaining the right staff members


b. training and orientation of the MHWs


c. communicating the program goals to unit staff


18. Incidents of staff harm


a. were reduced as a result of the program.


b. demonstrated no significant change in reporting.


c. couldn't be accurately quantified.