Preventing Violence in the Healthcare Workplace

Alabama Nurse,  Mar-May 2004  by Carroll, Vicki

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Mike Napier is one of the experts at the Academy Group (listed in the Resource section) who can deliver listening and calming training, which includes the following: "I" messages are useful in calming techniques, often helping to relieve tension and calm things down. They illustrate how you feel, and how the other person's actions impact you: "I became concerned when you say..." "I can hear the distress in your voice." "I can see that you are angry."

Paraphrasing is a calming technique wherein you state, in your own words, what the other person has stated. It demonstrates that you are listening, that you care. Paraphrasing can clear up misunderstandings. It is difficult to reason with someone who is under the influence of emotions. You must address the emotions before you can address the problem.

In their article, "Managing the Violent Patient," Doctors Rice and Moore offer several suggestions that can be applied to visitors, patients, and co-workers as well. They suggest the best approach is honest, straightforward, and frank. Eye contact and close positioning should be avoided as they can provoke stress and anxiety. The healthcare provider should act as an advocate, not an adversary. Never lie, as they may take out their anger on you and others when they find out they have been deceived. Arguing and machismo are improper responses to a potentially violent person according to Rice and Moore. Commanding someone to calm down invites escalation as the person must protect his ego. Ignoring the patient can also lead to escalation. These psychiatrists suggest that the most dangerous reactions are denial and absence of concern.

Over and over again, experts tell us to take threats seriously. Threats must be taken seriously, and communicated to security and other staff members. When a patient declared he was going to kill the next person who tried to get him out of bed, that information was not passed on to the next shift. A healthcare worker was stabbed in the abdomen the next day while trying to coax the patient into a chair.

OSHA guidelines suggest that violence prevention training should involve all employees at facilities and cover topics such as:

* The workplace violence prevention policy.

* Early recognition of escalating behavior.

* Ways of diffusing volatile situations, managing anger, and appropriately using medications.

* The location and operation of safety devises such as alarms.

* Policies and procedures for obtaining medical care, counseling, workers' compensation, or legal assistance after a violent episode.

Training in the management of aggressive behavior is a necessary tool for today's healthcare worker. Utilizing the training will promote your safety and that of your clients and co-workers.

Resources:

Crisis Prevention Institute

3315-K North 124th Street

Brookfield, WI 53005 USA

www.crisisprevention.com

800-558-8976

The Academy Group

7542 Diplmat Drive

Manassas, VA

703-330-0697

*Occupational Safety and Health Administration (OSHA)

"Guidelines for Preventing Workplace Violence for Healthcare & Social Service Workers"