Work Place Conflict and Violence; Strategies on Awareness & De-escalation

The following techniques and strategies can be found from the following document: “Workplace violence can happen anywhere especially predominant in behavioral health, emergency medicine, nursing homes, long term care and home care.” (Patient and Visitor Violence; What Do We Know? What Can We Do? By Jonathan Rossen, The Online Journal of Issues in Nursing).

Troubles addressing the problem of workplace violence is the assumption that it’s normal or part of the job, and that it’s unpredictable making is nearly impossible to prevent. I’m going to help other nurses including yourselves become more aware of your surroundings regarding possible violent situations and strategies allowing for the safest most peaceful outcomes possible.

According to Ian Miller with thenursepath.com the most effective de-escalators have been found to have the following skills. Honesty, Confidence, Non-judgemental, A permissive non-authoritarian manner and Ability to empathize.

The following 7 strategies will help in de-escalating workplace violence for everyone involved.

1)     Call for help:

a.      Never attempt de-escalation of a patient alone.

b.      Having that 3^rd person available to “take over” if/when needed will be beneficial.

2)     Switch ON your skills:

a.      Take a deep breath and try to remain calm.

b.      Assess your physical environment, remove people not directly involved in the de-escalation situation.

c.      Physical objects: Are the physical objects that could turn into potential weapons such as pens, medical equipment or furniture.

d.      Physical space: Be aware of the layout of the room. Always have a clear pathway to the exit of the room.

3)     Body Skills:

a.      While managing an agitated patient remember to physically step back.

b.      Never attempt to single-handedly block or restrain the patient.

                                                    i.     Assume a relaxed, open stance

                                                   ii.     Keep your hands open, visible and unclenched.

                                                  iii.     Face your body at an angle, this appears less confrontational.

                                                  iv.     Relax your face, make frequent eye contact but do NOT stare.

4)     Verbal Skills:

a.      There should only be one primary person communicating with the person being de-escalated.

b.      Be authentic, concise (no rambling), simple, repeat as necessary and be prepared to listen twice as much as you talk.

                                                    i.     Begin by introducing yourself, ask what the patient prefers to be called when addressing them.

                                                   ii.     Your voice should be clear with a soft tone.

                                                  iii.     When requesting information from the patient you may need to repeat yourself several times allowing for the information to be processed by the patient.

                                                  iv.     Encourage the patient to communicate their wants and feelings.

                                                   v.     Allow them to vent their anger.

                                                  vi.     Usage of humor may be helpful, but be careful the patient may think you’re coming off condescending or belittling to them.

5)     Listening skills:

a.      It’s important to understand what the patient is truly saying without putting your own interpretation or agendas into the mix.

b.      Even if the patient is delusional, everyone has their own sense of truth.

6)     Set clear careful boundaries:

a.      Setting clear and defined boundaries should happen early on in the situation but not used as a threat or show of power.

b.      The most important boundary to set is that of physical violence being unacceptable.

c.      Present each boundary with care, repeat as necessary respecting the other person’s dignity.

d.      Aggression sometimes happens as a response to feelings of lost dignity, disrespect and being frightened.

7)     RED ZONE:

a.      If the situation continues to escalate consider your options:

                                                    i.     Give the person options other than violence. Suggest offering the person something you can realistically deliver on that may help them calm down.

b.      If all of the above options fail, withdraw from any further attempts of de-escalation.

                                                    i.     At this point communication move from discussing the person’s feelings or actively listening to more of an authoritative approach.

                                                   ii.     The focus is now on ensuring everyone’s safety.

                                                  iii.     Escorting a team of individuals like police or security to help remove or place the person in a safer environment may be necessary.

                                                  iv.     Moving to the authoritative approach should be anticipated by staff. For example, reminding everyone that if things don’t work out peacefully this is the next step.

Ultimately this is a very stressful situation for everyone involved. This can be the cause of nursing burn out for some nurses, questioning whether they want to continue bedside nursing.

Make sure you sit down for a debriefing on the events that happened and be prepared to vent to a co-worker and get off your chest what happened to you so you don’t bottle up the experience which can be very stressful. Sometimes replaying and saying out loud what just happened to you can be very therapeutic. Allow others to acknowledge your feelings and discuss how you handled the situation. It’s okay to cry.

Do your best to leave work and these situations at work, so you can come home and not take it out on your family.

Thank you for watching, and I’ll see you next time.