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.
2. Objectives
• History: What prompted “No Hit
Zone” policy?
• Elements of the “No Hit Zone”
Project
• Educate on how to intervene when
necessary
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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.
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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
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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
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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
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7. “No Hit Zone” Elements
• Poster
– Widespread
• Brochures-Parent Resources
– Available throughout clinic facilities
focusing on alternative types of
discipline
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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.
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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.
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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
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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
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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)
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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?”
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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?
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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.
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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
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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”.
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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.”
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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?
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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.
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23. • What if the mother states “it is
my right to discipline my child” ?
• What do you do?
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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.”
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26. Sympathize with the frustrations and
stresses the parents may be
experiencing. Acknowledge that you
respect their role as a parent/caregiver.
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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?
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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.
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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?
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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.
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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.
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37. Continuation of Program
• Refill of brochures, repair of
signage
• Education of new staff
• Other languages
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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
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Notas do Editor
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.
