Management Of Disruptive Behavior Research Articles

Attribution to Classroom Disruptive Behavior: Insights from Secondary Teachers

Disruptive behavior in the classroom is a significant concern for teachers in schools across the globe. Extensive research has conclusively shown that effectively managing disruptive behavior in the classroom is a crucial factor that enhances the quality of instruction. The successful management of disruptive behavior in the classroom is influenced by various factors, including the causal attribution that a teacher assigns to the behavior. This study explored teachers’ perspectives on the factors contributing to disruptive behavior in the classroom. The study employed an interpretive paradigm and a qualitative approach with a case study research design. Data was generated via semi-structured interviews with six members of the School Management Team and a focus group interview with seven teachers from four purposively chosen Quintiles Three secondary schools. The findings showed that teachers attribute classroom disruptions to the characteristics and attributes of learners, contextual elements within schools, and external factors. The study concludes that these factors should be considered when developing classroom behavior strategies.

Physician Disruptive Behavior Compromising Safe Care Delivery.

The negative impact and management of disruptive behavior are discussed in the article by Monika Kumar, et al.

The impact of ASPECTSS-based design intervention in autism school design: a case study

PurposeThe objective of this paper is to study the efficacy of the ASPECTSS Design Index's concepts as drivers of design intervention for educational environments for students on the autism spectrum. Based on the seven principles of acoustics, spatial sequencing, escape spaces, compartmentalization, transitions, sensory zoning and safety, ASPECTSS formed the basis for a preliminary post-occupancy evaluation (POE) and survey of an existing school environment.Design/methodology/approachConcepts drawn from the review of other strategies for autism spectrum disorder (ASD) friendly design were integrated with the seven ASPECTSS principles to create a design framework and consequent design retro-fit for a Pre-K-12th grade public school for students on the autism spectrum. The following design interventions were proposed: colour-coding based navigation; acoustical treatments in key circulation spaces; introduction of transition alcoves; classroom reorganisation using compartmentalization principles and the introduction of escape spaces for de-escalation. Specifically, a classroom template of modules of ASPECTSS-compliant layouts was provided to all staff. The efficacy and impact of these interventions were assessed using a whole campus online staff survey with further probing using classroom observations and subsequent interviews.FindingsThe results show alignment between the implementation of the ASPECTSS informed design interventions and responses to nine of the Likert scale items were all significantly lower than the middle response, indicating a high degree of satisfaction from survey respondents. These questions and responses related to the colour scheme facilitating ease of navigation for visitors of the school, the acoustics of the building successfully mitigating sound magnification and subsequently student distractibility, the organisation of the classrooms enhancing learning and the de-escalation zones allowing improved management of disruptive behaviours in the classroom.Research limitations/implicationsThis study focuses primarily on the Autism ASPECTSS Design Index as a framework for assessing classroom efficacy. Other tools and frameworks may produce different insights. A single school site was studied. Validation of these findings in other school environments is necessary before generalising these strategies at scale. The use of qualitative tools, primarily teacher and staff surveys, provides one lens into the efficacy of these design strategies. Further research using measurable biometric indicators such as heart-rate and stress levels measured through wearable technology could provide a first step towards the triangulation of these findings.Practical implicationsThese findings could help provide more standardised best practices for designing learning environments for autism, potentially providing supportive strategies with real impact on learning quality, skill development and knowledge acquisition in school environments. This could potentially have economic implications by supporting more efficient progress for autistic students through their school curriculum.Social implicationsSimilar to economic impact, if validated and generalised, these findings could help with sense of accomplishment, general mental health improvement, alleviation of family stress and potential reduction of stigma in the autism community.Originality/valueThere is a slowly emerging field of design guidance for autism schools, but very little empirical evidence on the measurable efficacy of these strategies. This research provides one type of such evidence, as measured by the perceived impact from the point of view of staff and teachers at the school.

Assisting physicians who exhibit disruptive behavior: Understanding the costs, contributors, and corrections.

The aim of this article is to discuss the etiology, prevalence, impact, and management of disruptive behavior in physicians. These various aspects will be examined at both the individual and system level, to provide appropriate perspective and detail effective approaches to address these behaviors. Clinical experience and review of the authors' and other researchers' findings provide consensus on numerous key aspects of physician disruptive behavior. Physicians demonstrating disruptive behavior are often distressed. The behavior should be understood as arising from biopsychosocial contributors, knowledge gaps, insight, and systems factors. These contributors are inclusive and may interact with each other. A comprehensive approach is required which can include assessment/reassessment tools, individualized programming (therapy, coaching, instruction), deliberate practice, medical follow-up, and system intervention. Complications include the diversity of disruptive behaviors, the many contributory factors therein, disagreement about methodology/measurement, and the role of the system.

An Analysis of the Studies Examining Classroom Management in Education Faculty Journals in Turkey: A Meta-Synthesis Study

In this study, it was aimed a systematic re-examination of qualitative studies related to the classroom management. For this purpose, it was examined ten journals published by education faculties. In conclusion, 14 qualitative studies, which exactly met the criteria were examined. These studies were analyzed by using thematic synthesis method. As a result of thematic synthesis, four main themes emerged. These themes were the context of classroom management, factors affecting classroom management, disruptive behaviors, and coping with disruptive behaviors. The sub-themes related to classroom management main theme were strategies, approaches, dimensions, and competencies. The factors affecting classroom management were students, teachers, parents, school management, physical insufficiency, and socio-economic structure. The sub-themes related to the disruptive behaviors main theme were breaking the rules, disrupting the flow of the lesson, rudeness and disrespectfulness, emotional instability, verbal violence, indifference, and physical violence. In addition, the sub-themes related to the coping with disruptive behaviors main theme are tolerance, guidance, communication, cooperation, verbal warning, enforcement of sanctions, giving responsibility, and reaction. According to the meta-synthesis results, it may be said that synthesized qualitative studies mostly emphasize on the scope of classroom management, the factors affecting classroom management, and management of disruptive behaviors in classroom.

CLINICAL PERSPECTIVES: OUTPATIENT MANAGEMENT OF IMPULSIVITY, HYPERACTIVITY, AND AGGRESSION IN YOUNG CHILDREN (AGES 2-7)

Young children often have limited coping abilities and tolerance for change, especially when faced with life stressors. Maladaptive behaviors resulting in impulsivity, hyperactivity, and aggression can impair daily functioning, cause caregiver stress, and occasionally necessitate emergency mental health interventions. This presentation is designed to enhance clinicians’ skills in the evaluation and management of young children presenting with disruptive behaviors, with whom ADHD is a possibility. Presenters will use a combination of reviewing current research literature and clinical best practices. In addition, some of the presenters have active research studies that examine elements of the topics outlined and will include relevant materials and new research when available. When applicable, AACAP Practice Parameters and Policy Statements will be reviewed and distributed to members who attend the session. The agenda is as follows: 1) assessment of young children with disruptive behaviors (Diane Misch, MD, Infant and Preschool Committee); 2) treatment guidelines for pharmacological management of disruptive behaviors and ADHD (Magdalena Romanowicz, MD, Infant and Preschool Committee); 3) long-term outcomes of Parent-Child Interaction Therapy on ADHD symptoms, including new research findings (Regina Bussing, MD, MSHS); 4) how mindful parenting can support caregivers in managing young children with ADHD, and a case presentation (Elizabeth Reichert, PhD, and Mari Kurahashi, MD, MPH); and 5) summary and discussion (Matthew Young, PhD). Participants will learn to identify childhood disorders presenting as disruptive behaviors and enhance their assessment and treatment planning skills. They will gain an appreciation for treatment strategies and acquire knowledge of de-escalation techniques and mindful parenting. Temper tantrums, hyperactivity, and impulsive aggression are common in the young child population with presumed ADHD. Early intervention can positively impact a child’s developmental trajectory. Clinicians working with preschoolers need to understand current evidence-based practice to ensure that their clinical needs are adequately met.

Overcoming barriers in cognitive-behavioral therapy for youth anxiety and obsessive-compulsive disorder: Addressing parent behaviors.

Exposure-based cognitive-behavioral therapy (CBT) is a well-established treatment for anxiety disorders and obsessive-compulsive disorder (OCD) in youth. Although a majority of youth respond to CBT, a substantial portion remain symptomatic and/or experience a return of symptoms after completing a course of treatment. This highlights the need for further improvements to this evidence-based treatment. Given that parent behaviors can negatively influence treatment, addressing parental behaviors in CBT serves as a novel and promising treatment target to improve youth's therapeutic outcomes. The authors review three common parent behaviors that influence anxiety and treatment outcomes: family accommodation, parent anxious behaviors, and management of disruptive behaviors. The authors then discuss each behavior, its effect on anxiety/OCD and treatment, and how to address the behavior within the context of CBT. In doing so, therapeutic learning can be optimized to improve CBT outcomes for youth with anxiety disorders and/or OCD.

Experience of mental health nurses regarding mechanical restraint in patients with psychomotor agitation: A qualitative study.

To explore mental health nurses' experiences whilst managing a patient with psychomotor agitation, and the factors that influence the decision to use mechanical restraints. Psychomotor agitation is considered a potentially violent psychiatric emergency. The management of disruptive behaviours includes mechanical restraints as the last resort although its use has consequences for patients, professionals and the therapeutic relationship. A qualitative study design with a hermeneutical approach was developed. A total of 31 nurses were purposively sampled from six short- and medium-stay mental health inpatient units. Data were obtained from semi-structured interviews. A thematic content analysis following the seven steps of Colaizzi's method was performed. Three researchers independently conducted an inductive analysis within a perspective of a hermeneutic paradigm. The COREQ checklist was followed in carrying out this research. Four themes emerged from the analysis: 1) Nurses' perceptions of restraint methods, 2) Factors influencing decision-making, 3) Consequences for professionals of the use of mechanical restraint and 4) Alternatives to mechanical restraint. Aspects such as the importance of teamwork, the issue of cognitive dissonance, ethical conflict and barriers to effecting the withdrawal of these measures affect the mental health nurse's decision-making process. The understanding of these aspects is crucial to further reducing its incidence and negative consequences and achieving the elimination of mechanical restraints. Knowing how nurses feel during the patient's episode of psychomotor agitation and which factors influence the decision on whether to apply coercive methods can guide us on the quality of care offered.

Patients’ Experiences of Seclusion during Admission in Psychiatric Settings in KwaZulu-Natal: A Qualitative Study

Background
 In South Africa, seclusion is one of the practices used in the management of disruptive behaviors in psychiatric settings. Despite its continued use, seclusion is always subject to controversial debates, and patients who undergo it express a range of negative experiences.
 Objective
 To explore the experiences of patients regarding seclusion during their admission in a psychiatric hospital. Methods
 A qualitative descriptive design was used. In-depth interviews were conducted with ten patients attending a community psychiatric clinic in KwaZulu-Natal. Interviews were analyzed using content analysis.
 Results
 Two themes emerged from the findings: controversial views of seclusion and negative experiences of seclusion. Seclusion was considered more as a punishment measure which was often used abusively, than a therapeutic intervention. Participants expressed loneliness, humiliation, and powerlessness following their seclusion experience. Limited patient-staff interaction and communication worsened patients’ negativity towards seclusion. Conclusion
 Findings from this study underscore the need to review practices, policies and procedures regarding the use of seclusion. Seclusion should be only used when the need is absolute and as the last treatment option. Open communication between the care providers and the patients should be emphasized during the time of seclusion.
 Rwanda J Med Health Sci 2020;3(3):342-361

The Disruptive bEhavior manageMEnt ANd prevention in hospitalized patients using a behaviORal intervention team (DEMEANOR) study protocol: a pragmatic, cluster, crossover trial

BackgroundDisruptive behavior in hospitalized patients has become a priority area of safety concern for clinical staff, and also has consequences for patient management and hospital course. Proactive screening and intervention of patients with behavioral comorbidities has been reported to reduce disruptive behavior in some settings, but it has not been studied in a rigorous way.MethodsThe Disruptive bEhavior manageMEnt ANd prevention in hospitalized patients using a behaviORal intervention team (DEMEANOR) study is a pragmatic, cluster, crossover trial that is being conducted. Each month, the behavioral intervention team, comprising a psychiatric-mental health advanced practice nurse and a clinical social worker, with psychiatrist consultation as needed, rotates between an adult medicine unit and a mixed cardiac unit at Vanderbilt University Medical Center in Nashville, TN, USA. The team proactively screens patients upon admission, utilizing a protocol which includes a comprehensive chart review and, if indicated, a brief interview, seeking to identify those patients who possess risk factors indicative of either a potential psychological barrier to their own clinical progress or a potential risk for exhibiting disruptive, aggressive, or self-injurious behavior during their hospitalization. Once identified, the team provides interventions aimed at mitigating these risks, educates and supports the patient care teams (nurses, physicians, and others), and assists non-psychiatric staff in the management of patients who require behavioral healthcare. Patients who are both admitted to and discharged from either unit are included in the study. Anticipated enrollment is approximately 1790 patients. The two primary outcomes are (1) a composite of objective measures related to the patients’ disruptive, threatening, or acting out behaviors, and (2) staff self-reported comfort with and confidence in their ability to manage patients exhibiting disruptive, threatening, or acting out behavior. Secondary outcomes include patient length of stay, patient attendant (sitter) use, and the unit nursing staff retention.DiscussionThis ongoing trial will provide evidence on the real-world effectiveness of a proactive behavioral intervention to prevent disruptive, threatening, or acting out events in adult hospitalized patients.Trial registrationClinicalTrials.gov: NCT03777241. Registered on 14 December 2018.

The importance of non-technical performance for teams managing postpartum haemorrhage: video review of 99 obstetric teams.

Little is known about how teams' non-technical performance influences clinical performance in obstetric emergencies such as postpartum haemorrhage. Video review - observational study. A university hospital (5000 deliveries) and a regional hospital (2000 deliveries) in Denmark. Obstetric teams managing real-life postpartum haemorrhage. We systematically assessed 99 video recordings of obstetric teams managing real-life major postpartum haemorrhage. Exposure was the non-technical score (AOTP); outcomes were the clinical performance score (TeamOBS) and the delayed transfer to the operating theatre (defined as blood loss>1500ml in the delivery room). Teams with an excellent non-technical score performed significantly better than teams with a poor non-technical score: 83.7 versus 0.3% chance of a high clinical performance score (P<0.001), 0.2 versus 80% risk of a low clinical performance score (P<0.001), and 3.5 versus 31.7% risk of delayed transfer to the operating theatre (P=0.008). The results remained robust when adjusting for potential confounders such as bleeding velocity, aetiology, time of day, team size, and hospital. The specific non-technical skills associated with high clinical performance were vigilance, role assignment, problem-solving, management of disruptive behavior, and leadership. Communication with the patient and closing the loop were of minor importance. All performance assessments showed good reliability: the intraclass correlation was 0.97 (95% CI 0.96-0.98) for the non-technical score and 0.84 (95% CI 0.76-0.89) for the clinical performance score. Video review offers a new method and new perspectives for research in obstetric teams to identify how teams become effective and safe; the skills identified in this study can be included in future obstetric training programmes. Non-technical performance is important for teams managing postpartum haemorrhage; video review of 99 obstetric teams.

Bad Boys and Mean Girls: Callous-Unemotional Traits, Management of Disruptive Behavior in School, the Teacher-Student Relationship and Academic Motivation

Callous-unemotional (CU) traits comprise a temperament dimension characterised by low empathy, interpersonal callousness, restricted affect and a lack of concern for performance. CU traits are the hallmark feature of psychopathy in youth and are associated with more varied, severe and stable antisocial behaviour. However, little is known about the presentation, impact and correlates of CU traits in schools. We conducted a mixed methods study investigating the relationships between CU traits, student disruptive behaviour, responses to classroom management strategies, teacher-student relationship quality and academic motivation. Participants comprised 437 children aged 11 to 14 years (M = 12.5 years, 51% female) and 12 teachers recruited from a state school in England. Teacher participants consisted of 8 women and 4 men aged 23 to 51 (M = 35.27 years, SD = 10.43). Children completed the Inventory of Callous-Unemotional Traits (ICU; Frick, 2004). Teachers then completed an interview and questionnaires for a randomly selected subsample of students who i) scored in the top 25% on student report of CU traits (n = 24), and ii) scored below the median (n = 23). Thematic analysis of teacher interviews revealed that high CU children display more frequent, severe antisocial behaviour in school. Teachers reported that high CU students were resistant to teacher discipline strategies, often showing intense displays of anger in response to their attempts to set limits. High CU students appeared to be less responsive to social rewards (e.g., praise). Encouragingly, some teachers reported a good relationship with a child identified as high in CU traits, despite recognizing that this student’s behaviour made it difficult for other teachers to maintain a harmonious classroom environment. Teachers attributed the poor academic performance of children high in CU traits to a lack of motivation, reporting the need for intense monitoring and feedback to ensure that these students completed schoolwork. Findings suggest that risk pathways for poor school outcomes may differ for antisocial children high and low in CU traits, and emphasize the need to modify existing school-based interventions to promote academic engagement and prosocial behaviour in this high-risk subgroup of antisocial children.

Optimizing Performance by Preventing Disruptive Behavior in Radiology.

Disruptive behaviors impede delivery of high-value health care by negatively impacting patient outcomes and increasing costs. Health care is brimming with potential triggers of disruptive behavior. Given omnipresent environmental and cultural factors such as constrained resources, stressful environments, commercialization, fatigue, unrealistic expectation of perfectionism, and burdensome documentation, a burnout epidemic is raging, and medical providers are understandably at tremendous risk to succumb and manifest these unprofessional behaviors. Each medical specialty has its own unique challenges. Radiology is not exempt; these issues do not respect specialty or professional boundaries. Unfortunately, preventive measures are too frequently overlooked, provider support programs rarely exist, and often organizations either tolerate or ineffectively manage the downstream disruptive behaviors. This review summarizes the background, key definitions, contributing factors, impact, prevention, and management of disruptive behavior. Every member of the health care team can gain from an improved understanding and awareness of the contributing factors and preventive measures. Application of these principles can foster a just culture of understanding, trust, support, respect, and teamwork balanced with accountability. The authors discuss these general topics along with specific issues for radiologists in the current medical environment. Patients, providers, health care organizations, and society all stand to benefit from better prevention of these behaviors. There is a strong moral, ethical, and business case to address this issue head-on. ©RSNA, 2018.

Disruptive behavior in the operating room: prevalence, consequences, prevention, and management.

Disruptive workplace behavior can have serious consequences to clinicians, institutions, and patients. There is a range of disruptive behaviors, and the consequences are often underappreciated. The purpose of this manuscript is to review the definition, prevalence, consequences, prevention, and management of disruptive behavior in the operating room. Although a small minority of operating room clinicians act disruptively, 98% of clinicians report having recently been exposed to disruptive behavior, with the average being 64 events per clinician per year. The causes include intrapersonal factors, workplace relationships, workplace logistics, and broader contextual factors. Disruptive behavior undermines patient care by decreasing individual and team clinical performance. It decreases clinician well being, sets a poor example for medical students who are susceptible to negative role models, and decreases hospital efficiency. The way that clinicians respond to disruptive behavior may either exacerbate or reduce the consequences of the behavior. In order to prevent disruptive behavior, the causes must be addressed. Institutions must have robust policies to deal with disruptive behavior and have preventive measures that include regular staff education. Whenever disruptive behavior does occur, it must be expeditiously addressed, which may include graded discipline. Disruptive intraoperative behavior is prevalent and harms multiple parties in the operating room. Institutions require comprehensive measures to prevent the behavior and to mitigate consequences.

FREEDOM OF MOVEMENT: A MULTILEVEL INTERVENTION TO REDUCE PHYSICAL RESTRAINTS USE IN ACUTE CARE

Physical restraints are frequently used in elderly care and justified to prevent falls, control disruptive behavior and allow interventions. Physical restraints do not bring benefit, being associated with poor outcomes like direct injuries, reduced mobility and mortality. We have implemented an intervention multilevel program involving all the health care team of an acute care Alzheimer unit (SOMADEM) to reduce the use of physical restraints and to promote methods for achieving safety. SOMADEM (SOMAtic and DEMentia) is an 18-bed unit in a geriatric hospital. Patients admitted in this unit have dementia and at the same time behavioral and psychological symptoms of dementia (BPSD) due to a concomitant acute somatic disease. The intervention model has a longitudinal design in 3 phases: education, specialized consultation and physical restraints alternatives. The educational part consists in a 4-hour training of all unit staff taught by a specialized interdisciplinary team. The content covers risk of falls, management of disruptive behavior, legal issues regarding physical restraints prescription, alternatives to its use and discussion of clinical vignettes. A weekly specialized consultation by the same team proposes alternative ways. Prevalence of physical restraints after the intervention program is the primary outcome; evaluation of types of physical restraints, falls and fall-related injuries, psychoactive drugs prescription, disruptive behavior, functional independence status and destination after discharge are secondary outcomes. Data during the 12 months after the start of intervention will be compared to a 15-month period before the intervention used as baseline. Encouraging results will be discussed.

Procedures and compliance of a video modeling applied behavior analysis intervention for Brazilian parents of children with autism spectrum disorders.

Video modeling using applied behavior analysis techniques is one of the most promising and cost-effective ways to improve social skills for parents with autism spectrum disorder children. The main objectives were: (1) To elaborate/describe videos to improve eye contact and joint attention, and to decrease disruptive behaviors of autism spectrum disorder children, (2) to describe a low-cost parental training intervention, and (3) to assess participant's compliance. This is a descriptive study of a clinical trial for autism spectrum disorder children. The parental training intervention was delivered over 22 weeks based on video modeling. Parents with at least 8 years of schooling with an autism spectrum disorder child between 3 and 6 years old with an IQ lower than 70 were invited to participate. A total of 67 parents fulfilled the study criteria and were randomized into two groups: 34 as the intervention and 33 as controls. In all, 14 videos were recorded covering management of disruptive behaviors, prompting hierarchy, preference assessment, and acquisition of better eye contact and joint attention. Compliance varied as follows: good 32.4%, reasonable 38.2%, low 5.9%, and 23.5% with no compliance. Video modeling parental training seems a promising, feasible, and low-cost way to deliver care for children with autism spectrum disorder, particularly for populations with scarce treatment resources.

Clinical and social outcome of children and adolescents presenting in the emergency room for disruptive behavior in Lyon and the Rhône-Alpes region: A multidisciplinary approach

Over the last decade, the frequency of emergency room (ER) visits for pediatric psychiatric disorders has increased in the most western countries. Although data available in France is scarce, a similar trend was observed concerning violent or runaway youth. There is no medical consensus on the status and care management of disruptive behavior (DB) in children and adolescents in ER. Seclusion and physical restraint are often requested to treat violence. With a blur lawful framework for minors, such coercive measures raise ethical issues while contradicting the idea of the patients’ autonomy and well-being. Moreover, consulting in the ER for such situations could lead to an inappropriate use of the healthcare system, a poor assessment of associated psychiatric disorders or comorbidities and an underestimation of suicide risk. Thus, the ER visit for a disruptive child or adolescent is characterized by its uncertainty. It represents a situation of heterogeneity in care management as well as a stake of social exclusion and of dangerous behavior.The study aims to:.– analyze these uncertainties by presenting a multidisciplinary and integrative research methodology through combining clinical evidence and social sciences comprehension;– to implement a cohort to describe children and adolescents admitted to the ER for DB (aggressiveness, violence, fugue or theft), their care management and their social and clinical outcome;– to pool these clinical data with an ethnographic fieldwork focused on DB as a “trouble” experienced by various professionals in the ER.We will focus our presentation on these methodological considerations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Disruptive behaviour in the perioperative setting: a contemporary review

PurposeDisruptive behaviour, which we define as behaviour that does not show others an adequate level of respect and causes victims or witnesses to feel threatened, is a concern in the operating room. This review summarizes the current literature on disruptive behaviour as it applies to the perioperative domain.SourceSearches of MEDLINE®, Scopus™, and Google books identified articles and monographs of interest, with backreferencing used as a supplemental strategy.Principal findingsMuch of the data comes from studies outside the operating room and has significant methodological limitations. Disruptive behaviour has intrapersonal, interpersonal, and organizational causes. While fewer than 10% of clinicians display disruptive behaviour, up to 98% of clinicians report witnessing disruptive behaviour in the last year, 70% report being treated with incivility, and 36% report being bullied. This type of conduct can have many negative ramifications for clinicians, students, and institutions. Although the evidence regarding patient outcomes is primarily based on clinician perceptions, anecdotes, and expert opinion, this evidence supports the contention of an increase in morbidity and mortality. The plausible mechanism for this increase is social undermining of teamwork, communication, clinical decision-making, and technical performance. The behavioural responses of those who are exposed to such conduct can positively or adversely moderate the consequences of disruptive behaviour. All operating room professions are involved, with the rank order (from high to low) being surgeons, nurses, anesthesiologists, and “others”. The optimal approaches to the prevention and management of disruptive behaviour are uncertain, but they include preventative and professional development courses, training in soft skills and teamwork, institutional efforts to optimize the workplace, clinician contracts outlining the clinician’s (and institution’s) responsibilities, institutional policies that are monitored and enforced, regular performance feedback, and clinician coaching/remediation as required.ConclusionsDisruptive behaviour remains a part of operating room culture, with many associated deleterious effects. There is a widely accepted view that disruptive behaviour can lead to increased patient morbidity and mortality. This is mechanistically plausible, but more rigorous studies are required to confirm the effects and estimate their magnitude. An important measure that individual clinicians can take is to monitor and control their own behaviour, including their responses to disruptive behaviour.

Dos and Don’ts of Dealing With Disruptive Physician Behavior

Dos and Don’ts of Dealing With Disruptive Physician Behavior

Improving the management of disruptive behavior and reducing antipsychotic medications in nursing facility residents.

The objective of this work is to improve the management of disruptive behavior in the nursing facility setting through an interdisciplinary team (IDT) approach to reduce the use of antipsychotic medications in accordance with the Centers for Medicare & Medicaid Services initiative. The process began with a search and review of more than 100 peer-reviewed articles, government, and association resources that focused on the management of disruptive behavior in older adults. While data were limited to the past 10 years, the vast majority of data reviewed were within the past 5 years. This information was reviewed and discussed by all of the coauthors who meet in person at the American Society of Consultant Pharmacists as a work group. This group was tasked with identifying strategies through an IDT to improve the management of disruptive behavior and reduce the use of antipsychotic medications in nursing facility residents. In addition, significant follow-up work was accomplished following the live working session. Through an IDT, strategies can be implemented for long-term care residents to prevent and better manage disruptive behavior. These strategies can result in the reduction of the use of antipsychotic medications. The field of long-term care would benefit from further research to identify additional nonpharmacologic and pharmacologic treatments for managing disruptive behavior.