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Ep. 33: Situational Awareness
5 Plays2 months ago
Situational awareness may sound simple, but in healthcare it can mean the difference between safety and crisis. In this episode of Confidence in Conflict, Marcus (former healthcare security director) and Natalie (nurse practitioner and clinical team leader) break down how “relaxed but alert” awareness helps providers stay safe, protect colleagues, and deliver better care. Drawing on Vistelar’s training and real-world experience, they explore the 10-5-2 proxemics principle, the STAMP warning signs of escalation, and the critical role of teamwork in preventing violence before it starts.
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Transcript
Introduction to Healthcare Situational Awareness
00:00:04
Speaker
Welcome back to Confidence in Conflict, where healthcare professionals learn to navigate challenging moments with skill, empathy, and unwavering confidence.
00:00:12
Speaker
I'm Marcus, here with my co-host, Natalie.
00:00:15
Speaker
Today, we're diving deep into something that could literally be the difference between a routine patient interaction and a crisis, situational awareness.
00:00:23
Speaker
Thanks,
Balancing Clinical Focus and Environmental Awareness
00:00:24
Speaker
Marcus.
00:00:24
Speaker
I have to say this topic hits close to home for anyone working in healthcare.
00:00:29
Speaker
You know, we spend so much time focused on clinical protocols and patient care, which is absolutely crucial.
00:00:35
Speaker
But we often overlook one of our most fundamental safety skills, simply being aware of what's happening around us.
00:00:42
Speaker
Exactly.
00:00:43
Speaker
And before we dive in, let me just say this up front.
00:00:46
Speaker
Situational awareness isn't about being paranoid or suspicious of every patient who walks through the door.
00:00:52
Speaker
It's about developing a relaxed but alert mindset that allows us to provide better care while keeping ourselves and our colleagues safe.
00:00:59
Speaker
That's such an important distinction, Marcus.
00:01:01
Speaker
We're not talking about fear-based practice here.
00:01:05
Speaker
We're talking about professional awareness, the same kind of scanning and assessment mindset we use when we evaluate a patient's condition, just applied to our broader environment.
Key Elements of Situational Awareness
00:01:15
Speaker
So let's start with the basics, Natalie.
00:01:18
Speaker
When we talk about situational awareness in health care, what exactly are we talking about?
00:01:23
Speaker
Great question.
00:01:24
Speaker
Situational awareness is really about three key components.
00:01:28
Speaker
First, it's perceiving what's happening around you.
00:01:32
Speaker
The people, the environment, and the dynamics at play.
00:01:35
Speaker
Second, it's comprehending what those observations mean in context.
00:01:40
Speaker
And third, it's projecting what might happen next based on what you're seeing and understanding.
00:01:47
Speaker
That sounds almost like the nursing process.
00:01:49
Speaker
Assess, analyze, and anticipate.
00:01:52
Speaker
Exactly.
00:01:53
Speaker
It's the same systematic thinking we already use, just expanded beyond the immediate patient care scenario to include the broader context of our work environment, just like we do already with infection control, wound care, and other concerns.
Addressing Tunnel Vision in Healthcare
00:02:07
Speaker
Now, I know from my security background that one of the biggest challenges with situational awareness is that healthcare providers often get so focused on their immediate tasks, which, again, is understandable and necessary, that they can develop what we might call tunnel vision.
00:02:25
Speaker
How do you see this playing out in clinical settings?
00:02:28
Speaker
Oh, absolutely.
00:02:29
Speaker
And it makes perfect sense why this happens.
00:02:32
Speaker
When you're dealing with a medical emergency or trying to manage multiple patients, your attention naturally narrows to the most critical clinical needs.
00:02:41
Speaker
But here's what I've observed.
00:02:43
Speaker
The most experienced healthcare professionals, the ones who seem to have this almost supernatural ability to prevent problems before they occur, they've learned to maintain that broader awareness even while focusing on specific tasks.
00:02:58
Speaker
So how do they do it?
00:02:59
Speaker
How do you develop that skill?
Professional Awareness Techniques
00:03:01
Speaker
Well, it starts with what Vistellar teaches about being relaxed but alert when you're in your professional role.
00:03:08
Speaker
In healthcare, that means whenever you're wearing scrubs or your hospital ID, you're essentially in a professional awareness mode.
00:03:17
Speaker
Not paranoid, not hypervigilant, just present and attentive to your environment.
00:03:23
Speaker
Let's get practical here.
00:03:25
Speaker
Picture this scenario.
00:03:27
Speaker
You're a nurse walking onto a medical floor at the start of your shift.
00:03:31
Speaker
What does good situational awareness look like in those first few minutes?
00:03:34
Speaker
Perfect example, so as I'm walking onto the unit, I'm not just thinking about which patients I need to check on first.
00:03:41
Speaker
I'm also scanning the overall atmosphere.
00:03:44
Speaker
Are family members clustered together having intense conversations?
00:03:49
Speaker
Is there unusual activity around the nurses' station?
00:03:52
Speaker
Do I see any patients who appear agitated or restless?
00:03:56
Speaker
Are there any unfamiliar faces, visitors who seem out of place or potentially disruptive?
Strategic Use of Distance for Safety
00:04:02
Speaker
And you're doing this while also transitioning into your clinical responsibilities.
00:04:06
Speaker
Exactly.
00:04:07
Speaker
It becomes second nature with practice.
00:04:10
Speaker
I'm listening to the report, but I'm also picking up on the energy of the handoff.
00:04:14
Speaker
Is the night nurse stressed about a particular patient situation?
00:04:18
Speaker
Are there any safety concerns that didn't make it into the formal report but might be evident in body language or tone?
00:04:25
Speaker
This actually ties into something fundamental in Vistalar's approach, the importance of environmental scanning.
00:04:31
Speaker
And one of the tools they emphasize is what they call Proxymix, specifically the 10-5-2 principle.
00:04:37
Speaker
Can you walk us through how this applies in healthcare settings?
00:04:41
Speaker
Oh, this is so practical for healthcare workers.
00:04:44
Speaker
The 10-5-2 principle is about using distance strategically for both safety and respect.
00:04:50
Speaker
At 10 feet, you're in what Vistelar calls the evaluate or exit zone.
00:04:56
Speaker
You're far enough away to assess the situation and decide whether to approach or whether you need to get help first.
00:05:03
Speaker
And in healthcare, this might mean pausing before entering a patient room to assess what you're seeing and hearing.
00:05:08
Speaker
Exactly.
00:05:10
Speaker
Maybe I hear raised voices, or I see through the doorway that a patient appears agitated.
00:05:15
Speaker
At 10 feet, I have options.
00:05:17
Speaker
I can choose not to enter alone, I can call for backup, or I can modify my approach based on what I'm observing.
00:05:23
Speaker
What about the five-foot distance?
00:05:26
Speaker
At five feet, what Vestalar calls communicate or evade, you're close enough to initiate verbal contact, but you still have room to back away if needed.
00:05:36
Speaker
In health care, this might be where you pause to make initial contact with a patient or family member, gauge their response, and then decide how to proceed.
00:05:45
Speaker
And the two-foot distance?
00:05:47
Speaker
That's operate or escape.
00:05:49
Speaker
You're at greatest risk at this distance, so you need to be most cautious.
00:05:54
Speaker
In health care, we often need to be this close for patient care.
00:05:58
Speaker
But the key is being prepared to move away quickly if the situation changes.
00:06:03
Speaker
And here's something interesting.
00:06:05
Speaker
Health care providers often rush through these distance zones too quickly, getting too close too fast before they've really assessed what they're walking into.
00:06:14
Speaker
That's fascinating, because it sounds like healthcare workers might actually be putting themselves at risk by being too eager to help.
00:06:21
Speaker
That's exactly right, Marcus.
00:06:23
Speaker
Our instinct to provide immediate care can sometimes override our safety awareness.
00:06:28
Speaker
But the reality is, if we become victims of violence or aggression, we can't help anyone.
00:06:34
Speaker
There's nothing heroic about getting hurt because we failed to properly assess a situation first.
00:06:40
Speaker
Let's talk about what healthcare workers should actually be looking for as they develop their situational awareness skills.
00:06:46
Speaker
What are the key indicators that something might be escalating?
Recognizing and Intervening on Behavioral Signs
00:06:49
Speaker
This is where Vistalar's research on behavioral indicators becomes invaluable.
00:06:54
Speaker
There's actually a really important study that's directly relevant to health care.
00:06:59
Speaker
It's called the STAMP study, and it was conducted specifically in emergency departments in Australia to identify behavioral patterns that predict potential violence.
00:07:10
Speaker
Stamp, can you break that down for our listeners?
00:07:14
Speaker
STAMP stands for the five categories of observable behaviors that can signal escalating risk.
00:07:22
Speaker
Staring and eye contact patterns, tone and volume of voice, anxiety indicators, mumbling and pacing.
00:07:30
Speaker
These aren't necessarily signs that someone is definitely going to become violent, but they are reliable predictors that tension is building and the situation requires more careful attention.
00:07:43
Speaker
Let's go through these one by one, starting with staring and eye contact.
00:07:48
Speaker
So this can range from very obvious threatening stares to more subtle signs like the complete avoidance of eye contact.
00:07:55
Speaker
Someone who's giving you that thousand yard stare, you know, that blank, unfocused look, can actually be just as concerning as someone who's glaring at you aggressively.
00:08:05
Speaker
Both can indicate that someone is emotionally escalating in ways that might lead to unpredictable behavior.
00:08:11
Speaker
What about tone and volume?
00:08:13
Speaker
This is probably the most obvious one.
00:08:16
Speaker
When someone's voice gets louder or their tone becomes more aggressive, we naturally recognize that as a warning sign.
00:08:23
Speaker
But we also need to pay attention to the opposite.
00:08:26
Speaker
Someone who suddenly becomes very quiet, starts muttering under their breath, or begins speaking in a way that seems disconnected from the situation.
00:08:35
Speaker
The anxiety indicators, what does that look like?
00:08:38
Speaker
Physical restlessness, inability to sit still, rapid breathing, fidgeting, repeatedly asking the same questions, or seeming unable to process information that would normally be straightforward.
00:08:52
Speaker
In healthcare settings, we expect some level of anxiety.
00:08:56
Speaker
People are often worried about their health or their loved ones.
00:08:59
Speaker
But when anxiety seems disproportionate or is escalating despite attempts to provide reassurance, that's when we need to pay closer attention.
00:09:09
Speaker
And mumbling?
00:09:10
Speaker
This can be particularly subtle.
00:09:13
Speaker
Someone might be having what appears to be a normal conversation, but they're also making comments under their breath, or their speech pattern changes in ways that suggest
00:09:24
Speaker
internal agitation.
00:09:27
Speaker
Sometimes people will start talking to themselves or making comments that don't quite fit the context of what's happening.
00:09:33
Speaker
Finally, pacing.
00:09:35
Speaker
This is about restless movement.
00:09:37
Speaker
Someone who can't seem to stay in one place keeps getting up and sitting down, paces back and forth in a waiting area, or shows other signs of physical agitation.
00:09:48
Speaker
But it's important to note that in healthcare settings, some pacing might be normal.
00:09:53
Speaker
People are worried.
00:09:54
Speaker
They're in unfamiliar environments.
00:09:57
Speaker
The key is recognizing when the movement pattern seems to be escalating or when it's paired with other concerning behaviors.
00:10:04
Speaker
Now one thing I want to emphasize is that just because someone is showing these behaviors doesn't mean they're definitely going to become violent.
00:10:11
Speaker
These are what Vistalar calls gateway behaviors.
00:10:14
Speaker
They might lead to more serious problems, but there are also opportunities for intervention.
00:10:18
Speaker
That's such a crucial point, Marcus.
00:10:20
Speaker
These indicators aren't meant to make us suspicious of our patients and families.
00:10:25
Speaker
They're meant to help us recognize when someone needs additional support or when we need to modify our approach to prevent escalation.
00:10:34
Speaker
So when a healthcare worker recognizes these warning signs, what should they do?
00:10:38
Speaker
The first thing is not to ignore your instincts.
00:10:41
Speaker
If something feels off, it probably is.
00:10:44
Speaker
Vistalar teaches that our intuitive sense, built on natural instincts and experience, is incredibly reliable.
00:10:52
Speaker
If something seems out of the ordinary or threatening, take the most conservative approach.
00:10:57
Speaker
Which might mean what?
00:10:59
Speaker
Practically speaking?
00:11:00
Speaker
It could mean getting additional staff support before proceeding or simply taking more time to assess the situation before acting.
00:11:08
Speaker
Also, using VISTA-LARS crisis management strategies, such as reducing environmental stimulation, adapting your communication, and addressing urgent needs first.
00:11:19
Speaker
Let's talk about positioning and spatial awareness a bit more.
00:11:23
Speaker
How should healthcare workers think about their physical positioning when they're interacting with patients or families?
00:11:29
Speaker
This goes back to the proxemics principles we discussed earlier.
00:11:32
Speaker
When you're near someone who might be escalating, you want to position yourself at an angle rather than directly in front of them.
00:11:40
Speaker
This is less threatening to them and gives you better options for moving away if needed.
00:11:45
Speaker
And what about hand placement?
00:11:47
Speaker
Keep your hands visible and in non-threatening positions.
00:11:50
Speaker
Avoid pointing, which can be perceived as aggressive.
00:11:54
Speaker
Instead, use open palm gestures when you need to gesture, and be mindful of crossing your arms, which can appear defensive or dismissive.
00:12:03
Speaker
What about the broader environmental awareness, beyond just the immediate interaction with a patient?
00:12:08
Speaker
Great question.
00:12:09
Speaker
This is about scanning for what Vistelar calls risk assessment and threat assessment.
00:12:15
Speaker
Risk assessment is identifying objects or conditions that could cause harm.
00:12:20
Speaker
Maybe there's medical equipment that could be used as a weapon, or there are trip hazards that could be problematic if you need to move quickly.
00:12:28
Speaker
And threat assessment?
00:12:29
Speaker
That's focusing on behavioral indicators that could be precursors to violence.
00:12:34
Speaker
Essentially what we've been discussing with the stamp behaviors and other warning signs.
00:12:39
Speaker
The key is doing both types of assessment simultaneously and continuously, updating your awareness as situations evolve.
00:12:48
Speaker
Let me ask you about something that I think is really challenging in healthcare settings.
00:12:52
Speaker
Unlike many other work environments, healthcare workers often can't just walk away from a difficult situation.
00:12:58
Speaker
You have professional and ethical obligations to provide care.
00:13:01
Speaker
How do you balance situational awareness with those care responsibilities?
Enhancing Patient Care through Awareness
00:13:05
Speaker
That's probably the most important question you could ask, Marcus, because you're absolutely right.
00:13:10
Speaker
We can't just abandon our patients when things get challenging.
00:13:14
Speaker
But here's the thing.
00:13:15
Speaker
Good situational awareness actually enhances our ability to provide care rather than interfering with it.
00:13:22
Speaker
How so?
00:13:23
Speaker
When we recognize early warning signs of escalation, we can intervene before a situation becomes dangerous.
00:13:30
Speaker
We can modify our communication approach, get additional support, or address underlying concerns before they spiral into crisis situations.
00:13:39
Speaker
The goal isn't to avoid difficult patients.
00:13:41
Speaker
It's to manage difficult situations more effectively.
00:13:45
Speaker
Can you give me an example of how this might work in practice?
00:13:48
Speaker
Sure.
00:13:50
Speaker
Let's say I'm working with a patient who's been waiting for several hours in the emergency department for test results.
00:13:56
Speaker
I notice he's started pacing, his tone is becoming more irritated when he asks questions, and he's making increasingly frustrated comments under his breath.
00:14:05
Speaker
Classic stamp behaviors.
00:14:08
Speaker
So what do you do differently because you've recognized these signs?
00:14:11
Speaker
When I first acknowledge what I'm observing, I might say something like, I can see you're getting pretty frustrated with all this waiting.
00:14:19
Speaker
Let me see what I can find out about your test results.
00:14:21
Speaker
I'm addressing the underlying concern while also demonstrating that I'm paying attention to his emotional state.
00:14:27
Speaker
That seems like it would be de-escalating.
00:14:30
Speaker
Exactly.
00:14:31
Speaker
By recognizing and responding to the early signs of escalation, I can often prevent the situation from reaching a crisis point.
00:14:39
Speaker
but I'm also positioning myself strategically, making sure I have a clear path to exit if needed.
00:14:45
Speaker
And I might alert my colleagues that this patient is showing signs of frustration so they can be prepared to provide support if necessary.
00:14:53
Speaker
This connects to something Vistalar emphasizes about having a showtime mindset when you're in your professional role.
00:15:00
Speaker
Can you talk about how that applies to maintaining situational awareness?
00:15:04
Speaker
The Showtime mindset is about being consciously present and engaged whenever you're in your professional capacity.
00:15:10
Speaker
In healthcare, that means whenever you're in scrubs or wearing your hospital ID, you're on in terms of both patient care and professional awareness.
00:15:20
Speaker
So it's not something you turn on and off depending on how you're feeling that day?
00:15:24
Speaker
Exactly.
00:15:25
Speaker
It's a professional discipline.
00:15:27
Speaker
Just like we maintain clinical standards, regardless of our personal mood or energy level, we maintain awareness standards.
00:15:35
Speaker
It becomes part of your professional identity.
00:15:38
Speaker
Let's talk about some common mistakes or blind spots that health care workers might have when it comes to situational awareness.
00:15:44
Speaker
One of the biggest ones is what we might call familiarity bias.
00:15:49
Speaker
Healthcare workers often become so accustomed to their work environment that they stop really seeing it.
00:15:55
Speaker
They assume that because they work there every day, they know everything they need to know about potential risks or warning signs.
00:16:02
Speaker
But environments and people are constantly changing.
00:16:05
Speaker
Exactly.
00:16:07
Speaker
Every shift brings different patients, different family dynamics, different stress levels, and different staff.
00:16:14
Speaker
What was true yesterday might not be true today, and what's true at the beginning of your shift might not be true at the end.
00:16:21
Speaker
What other blind spots do you see?
00:16:23
Speaker
Another big one is assuming that clinical expertise automatically translates to safety awareness.
00:16:29
Speaker
Just because someone is excellent at managing medical emergencies doesn't mean they're naturally good at recognizing behavioral warning signs or managing interpersonal conflicts.
00:16:40
Speaker
Those are different skill sets.
00:16:42
Speaker
Completely different.
00:16:43
Speaker
And healthcare education traditionally focuses heavily on clinical skills while giving much less attention to conflict management or personal safety skills.
00:16:54
Speaker
It's not that healthcare workers aren't smart or capable.
00:16:58
Speaker
It's that they haven't been trained to think systematically about these situations.
00:17:03
Speaker
Let's talk about team-based situational awareness.
00:17:06
Speaker
How can healthcare teams work together to maintain better overall awareness of what's happening in their work environment?
Sharing Observations for Team Safety
00:17:11
Speaker
This is really where situational awareness becomes powerful.
00:17:17
Speaker
When an entire team is observant and communicating about what they're seeing, you create what's almost like a collective early warning system.
00:17:25
Speaker
What does that look like in practice?
00:17:27
Speaker
It might mean including behavioral observations in your shift reports.
00:17:31
Speaker
Instead of just reporting clinical information, you might also mention, the patient in room 12 seemed pretty agitated during my last interaction.
00:17:40
Speaker
Or the family in room 8 is asking a lot of questions about discharge planning and seems frustrated with the pace of care.
00:17:48
Speaker
So you're sharing situational intelligence, not just clinical information.
00:17:52
Speaker
Exactly.
00:17:53
Speaker
And it means creating a team culture where it's not only acceptable but expected to ask for backup or support when you're dealing with a potentially challenging situation.
00:18:05
Speaker
Nobody should feel like they have to handle a difficult interaction alone just because they're the assigned caregiver.
00:18:11
Speaker
This actually connects to something important about situational awareness.
00:18:15
Speaker
It's not just about recognizing problems, it's also about recognizing when you need help or resources.
00:18:20
Speaker
That's such an important point, Marcus.
00:18:22
Speaker
Good situational awareness includes honest self-assessment.
00:18:27
Speaker
Am I the right person to handle T encountered some technical issues with it?
00:18:32
Speaker
I am almost done should be sending in the next 10 to 15 minutes should have it over to you in the next 10 minutes.
00:18:38
Speaker
His situation.
00:18:39
Speaker
Do I have the skills, the energy, the emotional bandwidth to manage this interaction safely and effectively?
00:18:46
Speaker
Sometimes the most situationally aware thing you can do is recognize that someone else would be better equipped to handle a particular situation.
00:18:54
Speaker
Let's talk about technology and situational awareness.
00:18:58
Speaker
Healthcare environments are increasingly filled with monitors, alarms, electronic devices.
00:19:03
Speaker
How does this impact our ability to maintain awareness of the human dynamics around
Managing Technology Distractions
00:19:07
Speaker
us?
00:19:07
Speaker
This is such a relevant question.
00:19:10
Speaker
All of that technology can actually create what we might call alert fatigue.
00:19:15
Speaker
When you're constantly responding to beeps and alarms, you can start to tune out your broader environment.
00:19:22
Speaker
Plus, when we're focused on screens and devices, we're naturally less aware of what's happening with people around us.
00:19:29
Speaker
So how do we balance the need to monitor clinical technology with the need to monitor human behavior?
00:19:35
Speaker
I think it requires conscious intention.
00:19:38
Speaker
We need to periodically lift our heads up from the monitors and screens and do deliberate environmental scans.
00:19:45
Speaker
It's about developing rhythms and habits that ensure you're regularly checking in with the human elements of your work environment, not just the technological ones.
00:19:54
Speaker
Can you give me an example of what those rhythms might look like?
00:19:58
Speaker
Sure.
00:19:59
Speaker
Maybe every time you complete a documentation task, you take a moment to visually scan your work area and check in with nearby patients or families.
00:20:08
Speaker
Or maybe you use transition moments, like when you're walking between patient rooms, as opportunities to observe what's happening in the broader unit environment.
00:20:18
Speaker
That sounds like it would become automatic with practice.
00:20:21
Speaker
Exactly.
00:20:22
Speaker
Just like clinical assessments become second nature, environmental awareness can become an integrated part of how you move through your workday.
00:20:31
Speaker
Let's discuss some specific health care settings and how situational awareness might look different in each.
00:20:37
Speaker
Starting with emergency departments.
00:20:39
Speaker
Emergency departments are probably the most challenging environments for situational awareness because everything is constantly changing, stress levels are high, and you're dealing with people in crisis situations.
00:20:51
Speaker
The STAMP study we discussed earlier was actually conducted specifically in emergency departments, which tells you how important these skills are in that setting.
00:21:01
Speaker
What makes EDS unique from a situational awareness perspective?
00:21:05
Speaker
Several things.
00:21:06
Speaker
First, you're dealing with people who are often in pain, frightened, or intoxicated, all states that can lead to unpredictable behavior.
00:21:14
Speaker
Second, there are long wait times that can build frustration.
00:21:18
Speaker
Third, you have a constant flow of new people, so you can't rely on familiarity to guide your assessments.
00:21:25
Speaker
And fourth, the environment itself is chaotic, which can make it harder to distinguish normal chaos from concerning developments.
00:21:33
Speaker
So ED staff need to be especially skilled at rapid assessment and continuous reassessment.
00:21:39
Speaker
Absolutely.
00:21:40
Speaker
And they need to be comfortable with what Vistelar calls tactical proxemics, using distance, positioning, and movement strategically.
00:21:49
Speaker
In an ED, you might need to approach an unknown patient who's potentially agitated, and you want to do that in a way that maximizes both safety and your ability to provide care.
00:22:01
Speaker
What about medical surgical units?
00:22:03
Speaker
These environments present different challenges.
00:22:06
Speaker
You typically have longer relationships with patients, so you might think you know them well.
00:22:11
Speaker
But pain medications, illness progression, or family stress can change someone's behavior patterns quickly.
00:22:19
Speaker
The key is not to assume that because someone was calm yesterday, they'll be calm today.
00:22:24
Speaker
And in these settings, family dynamics might be more complex because there's more time for tensions to build.
00:22:29
Speaker
Exactly.
00:22:30
Speaker
You might have family members who've been at the bedside for days, dealing with their own stress, fear, and exhaustion.
00:22:38
Speaker
Sometimes the patient isn't the primary concern from a behavioral standpoint.
00:22:43
Speaker
It's the family members who are struggling to cope.
00:22:46
Speaker
What about intensive care units?
00:22:48
Speaker
ICUS present unique challenges because patients are often sedated or unconscious, so your primary behavioral concerns are usually with family members.
00:22:58
Speaker
But the stress levels in ICUs are incredibly high.
00:23:02
Speaker
Families are dealing with life and death situations.
00:23:05
Speaker
They're often sleep deprived, and they may be struggling with difficult care decisions.
00:23:10
Speaker
So situational awareness in ICUS might be more about family dynamics and less about patient behavior.
00:23:16
Speaker
Often yes, though we can't forget that patients who are semi-conscious or coming out of sedation can also exhibit unpredictable behaviors, especially if they're confused or disoriented.
00:23:30
Speaker
Let's talk about psychiatric units, where behavioral awareness is obviously central to the work.
00:23:35
Speaker
Psychiatric units are interesting because staff are typically very well trained in recognizing behavioral warning signs and managing difficult situations.
00:23:45
Speaker
But there can be a tendency to become so focused on psychiatric symptoms that you miss other types of situational concerns, like family members who are struggling with their loved one's condition or environmental factors that might be contributing to patient agitation.
00:24:01
Speaker
So even in settings where behavioral awareness is part of the core mission, there can still be blind spots.
00:24:07
Speaker
Absolutely.
00:24:08
Speaker
And one thing that's important in psychiatric settings is recognizing that situational awareness isn't just about preventing violence.
00:24:17
Speaker
It's also about creating therapeutic environments and recognizing opportunities for positive intervention.
00:24:24
Speaker
That's a great point.
00:24:25
Speaker
Let's talk about how situational awareness can actually enhance patient care, not just prevent problems.
00:24:31
Speaker
When you're really tuned in to what's happening with your patients and their families, you pick up on needs and concerns that might not be explicitly stated.
00:24:40
Speaker
Maybe you notice that a patient seems more anxious after certain visitors leave, or that they're more cooperative with care in the morning versus the evening.
00:24:49
Speaker
These observations can help you tailor your approach to be more effective.
00:24:54
Speaker
So it's not just about safety, it's about providing better, more personalized care.
00:24:59
Speaker
Exactly.
00:25:00
Speaker
When you understand the human dynamics at play, you can work with them rather than against them.
00:25:06
Speaker
You can time difficult conversations when people are most receptive.
00:25:10
Speaker
You can identify family members who might be helpful allies in care.
00:25:15
Speaker
And you can recognize when environmental factors are impacting patient well-being.
00:25:20
Speaker
Let's address something that might be on our listeners' minds.
Empathy and Responsive Care
00:25:23
Speaker
Some healthcare workers might worry that focusing on situational awareness will make them seem less caring or more distant from their patients.
00:25:30
Speaker
How would you respond to that concern?
00:25:31
Speaker
I think it's actually the opposite.
00:25:34
Speaker
When you're more aware of what's happening with your patients emotionally and behaviorally, you're better able to respond to their actual needs.
00:25:42
Speaker
You're not just providing generic care.
00:25:45
Speaker
You're providing care that's responsive to the whole person in their specific situation.
00:25:50
Speaker
So awareness enhances empathy rather than replacing it.
00:25:53
Speaker
Exactly.
00:25:55
Speaker
And when patients and families sense that you're really paying attention, that you see them as individuals rather than just medical cases, they often respond with greater trust and cooperation.
00:26:06
Speaker
Let's talk about training and skill development.
00:26:08
Speaker
How can healthcare workers improve their situational awareness skills?
00:26:12
Speaker
First, it's about making it conscious and intentional.
00:26:15
Speaker
Most of us have better observational skills than we realize, but we're not applying them systematically.
00:26:21
Speaker
Start by deliberately practicing environmental scanning.
00:26:26
Speaker
When you enter a new space, take a moment to really look around and notice what's happening.
00:26:32
Speaker
What about practicing behavioral observation?
00:26:35
Speaker
You can practice this anywhere, not just at work.
00:26:39
Speaker
When you're in public spaces, practice noticing people's body language, tone of voice, and interaction patterns.
00:26:46
Speaker
Obviously, you're not making clinical judgments about strangers, but you're exercising your observational muscles.
00:26:53
Speaker
Are there specific training programs that healthcare organizations should consider?
00:26:57
Speaker
Vistalar's conflict management training is specifically designed for healthcare environments and includes extensive work on situational awareness and behavioral recognition.
00:27:08
Speaker
But even basic training in these concepts can make a huge difference.
00:27:13
Speaker
The key is making it relevant to healthcare contexts and giving people opportunities to practice in realistic scenarios.
00:27:21
Speaker
What about ongoing skill maintenance?
00:27:23
Speaker
Like any professional skill, situational awareness requires regular practice and refinement.
00:27:29
Speaker
Healthcare organizations can integrate awareness discussions into staff meetings, include behavioral observations and case reviews, and create cultures where these skills are valued and developed.
00:27:40
Speaker
Let's talk about leadership and situational awareness.
00:27:43
Speaker
How can healthcare leaders model and promote these skills?
00:27:46
Speaker
Leaders set the tone for whether situational awareness is seen as an important professional skill or just an add-on.
00:27:53
Speaker
When leaders consistently demonstrate awareness of staff well-being, patient satisfaction, and environmental factors, it signals that these things matter.
00:28:03
Speaker
What does that look like practically?
00:28:05
Speaker
It might mean leaders doing their own environmental rounds, asking staff about challenging situations they've encountered, and providing resources and support when potentially difficult situations are identified.
00:28:18
Speaker
It's about creating systems and cultures that support proactive awareness rather than just reactive crisis management.
00:28:25
Speaker
We should also talk about the psychological aspects of maintaining situational awareness.
Maintaining Awareness without Stress
00:28:30
Speaker
It can be emotionally challenging to be constantly alert to potential problems.
00:28:34
Speaker
That's a really important point, Marcus.
00:28:36
Speaker
There's a difference between productive awareness and anxious hypervigilance.
00:28:41
Speaker
The goal is what Vestiler calls being relaxed but alert, aware and ready, but not stressed or fearful.
00:28:49
Speaker
How do you maintain that balance?
00:28:51
Speaker
Part of it is trust in your skills and training.
00:28:54
Speaker
When you know you have tools for managing difficult situations, you can maintain awareness without anxiety.
00:29:00
Speaker
It's also about perspective, recognizing that most patient interactions go smoothly and that awareness is about being prepared for the exceptions, not expecting problems constantly.
00:29:12
Speaker
And it's important to have support systems and debriefing processes when challenging situations do occur.
00:29:17
Speaker
Absolutely.
00:29:18
Speaker
Situational awareness shouldn't be a solitary burden.
00:29:22
Speaker
It works best when it's a team-based approach where people support each other and share both observations and coping strategies.
00:29:30
Speaker
Let's talk about measuring and evaluating situational awareness.
00:29:33
Speaker
How can healthcare organizations know whether their staff are developing these skills effectively?
00:29:38
Speaker
This is challenging because situational awareness is often about preventing problems that might have occurred, which is hard to measure where am I directly.
00:29:49
Speaker
But you can look at indicators like staff confidence in handling difficult situations, reduction in workplace violence incidents, improved patient satisfaction scores, and decreased need for security interventions.
00:30:02
Speaker
What about individual assessment?
00:30:04
Speaker
You can use scenario-based training and assessment where staff demonstrate their ability to recognize warning signs and describe appropriate responses.
00:30:14
Speaker
You can also incorporate situational awareness into performance evaluations and professional development planning.
00:30:21
Speaker
I want to make sure we address something important, the connection between situational awareness and cultural competency.
00:30:26
Speaker
How do cultural differences impact our ability to accurately read situations and behaviors?
00:30:31
Speaker
This is crucial, Marcus.
00:30:33
Speaker
Many of the behavioral indicators we've discussed can be influenced by cultural background, personal trauma history, language barriers, or unfamiliarity with healthcare environments.
00:30:44
Speaker
What looks like agitation might actually be cultural expressions of concern or language barriers creating frustration.
00:30:54
Speaker
So how do we maintain awareness while avoiding cultural bias?
00:30:57
Speaker
It's about recognizing the difference between unusual behavior and concerning behavior.
00:31:03
Speaker
Something might be unusual for you, but completely normal for the patient or family.
00:31:08
Speaker
The key is looking for changes in behavior patterns rather than just behaviors that seem different from what you're used to.
00:31:15
Speaker
And probably checking your assumptions and seeking to understand before jumping to conclusions.
00:31:20
Speaker
Exactly.
00:31:21
Speaker
Good situational awareness includes awareness of your own potential biases and limitations.
00:31:28
Speaker
When you notice something that seems concerning, ask yourself whether it might have explanations you haven't considered.
00:31:35
Speaker
As we start to wrap up, let's talk about the future of situational awareness in health care.
00:31:40
Speaker
How do you see these skills evolving as health care continues to change?
00:31:44
Speaker
I think we're going to see increasing recognition that these skills are fundamental to healthcare safety and quality, not optional extras.
00:31:53
Speaker
As healthcare becomes more complex and stressful, the ability to manage human dynamics becomes even more important.
00:32:00
Speaker
What about technology's role?
00:32:02
Speaker
Technology will probably provide better tools for monitoring and assessing situations, but it will never replace the need for human judgment and interpersonal skills.
Practical Tips for Enhancing Awareness
00:32:13
Speaker
If anything, as technology handles more routine tasks, the uniquely human skills of observation, empathy, and conflict management become more valuable.
00:32:24
Speaker
Before we close, let's give our listeners some concrete action steps they can take to start improving their situational awareness skills immediately.
00:32:32
Speaker
Great idea.
00:32:34
Speaker
First, start with intentional environmental scanning.
00:32:37
Speaker
When you begin each shift, take two minutes to deliberately observe your work environment.
00:32:43
Speaker
What's the overall energy level?
00:32:45
Speaker
Are there any situations that seem to need extra attention?
00:32:49
Speaker
Who are the key players, patients, families, colleagues, that might impact your shift?
00:32:54
Speaker
What's second?
00:32:56
Speaker
Practice the 10-5-2 ProxyMix principles.
00:32:59
Speaker
Start paying attention to distance and positioning in your patient interactions.
00:33:04
Speaker
Take that extra moment at 10 feet to assess before approaching.
00:33:08
Speaker
Use the 5-foot distance to establish initial contact and gauge response.
00:33:14
Speaker
And be conscious of your safety and positioning when you need to be in close contact.
00:33:19
Speaker
Third, learn to recognize stamped behaviors—staring, tone changes, anxiety, mumbling, and pacing.
00:33:27
Speaker
But remember, these are early warning signs, not definitive predictions.
00:33:33
Speaker
Use them as cues to modify your approach or seek additional support, not as reasons to avoid providing care.
00:33:40
Speaker
Fourth, trust your instincts.
00:33:42
Speaker
If something feels off, it probably is.
00:33:45
Speaker
Take the conservative approach, get help, and don't ignore your gut feelings.
00:33:50
Speaker
Your intuitive sense, combined with your professional experience, is a valuable assessment tool.
00:33:56
Speaker
And finally?
00:33:58
Speaker
Make it a team effort.
00:33:59
Speaker
Share relevant observations with your colleagues, ask for support when you need it, and create a work culture where situational awareness is seen as a shared responsibility, not an individual burden.
00:34:12
Speaker
Those are excellent practical steps that any healthcare worker can start implementing immediately.
00:34:17
Speaker
And remember, the goal isn't to become suspicious or fearful of your patients and families.
00:34:23
Speaker
The goal is to become more skilled at recognizing when people need different types of support, when situations require different approaches, and when you need additional resources to provide the best possible care safely.
00:34:37
Speaker
Exactly.
00:34:39
Speaker
Situational awareness ultimately serves both safety and quality of care.
00:34:43
Speaker
When we're more aware of what's happening around us, we're better equipped to respond appropriately to whatever situations arise.
00:34:49
Speaker
And in healthcare, that can literally be the difference between a routine interaction and a crisis, between a satisfied family and a formal complaint, between a safe shift and a dangerous incident.
00:35:03
Speaker
Before we go, I want to remind our listeners that if you're finding value in these conversations, please take a moment to follow, rate, and review Confidence in Conflict wherever you get your podcasts.
00:35:13
Speaker
Your reviews help other healthcare professionals find these resources, and we truly appreciate your support.
00:35:19
Speaker
And remember, developing situational awareness is like developing any professional skill.
00:35:25
Speaker
It takes practice, patience, and commitment.
00:35:28
Speaker
Don't expect to master it overnight, but do start practicing these principles consistently.
00:35:35
Speaker
The investment in your own professional development will pay dividends in both your safety and your ability to provide excellent patient care.
00:35:44
Speaker
Natalie, thank you for another insightful discussion.
00:35:47
Speaker
For our listeners, remember that conflict isn't just possible in healthcare.
00:35:51
Speaker
It's inevitable.
00:35:53
Speaker
But with the right skills, awareness, and mindset, you can navigate these challenging moments with confidence and competence.
00:35:59
Speaker
Thanks, Marcus.
00:36:01
Speaker
Until next time, stay aware, stay safe, and remember that your commitment to professional excellence extends beyond clinical damage skills to include the human dynamics that shape every healthcare interaction.
00:36:16
Speaker
That's a wrap on this episode of Confidence in Conflict.
00:36:19
Speaker
We'll see you next time.
00:36:20
Speaker
This podcast uses synthetic voices to share Vistalar's training and communication strategies.
00:36:25
Speaker
Music