Personal Safety in the Healthcare Environment

Objectives Upon completion of this module the learner will be able to: understand signs of escalation identify the stages of a crisis developing discuss the proper ways to respond identify resources at the NCH workplace

Why is this important? Because human behavior is unpredictable, you can never be 100 % protected from violence in the workplace Knowing how to recognize and respond to threatening behavior will help you protect yourself and others.

What should I look for? While everyone experiences mood swings, you should be aware of signals that a problem may be more serious: unwarranted anger verbal threats agitation clenched fists yelling staring talking fast increased loudness swearing pacing restlessness

How should I respond? Recognize the warning signs Position yourself safely Stay calm and speak politely Remove yourself from the threat Call for help from team members &/or Security

How does a crisis escalate? Violent acts usually occur when people feel threatened in some way, which may or may not have anything to do with reality. Aggressive behavior generally follows a pattern of escalation. You need to know how to handle each of these levels in order to control the situation and protect yourself and those around you.

The Pattern of Escalation… Anxiety > Defensiveness > Loss of Control

Level 1 Anxiety is characterized Anxiety by a noticeable change in behavior In this case, you should try to be supportive to the individual.

Level 2 Defensiveness The person starts acting out his or her anger, usually with abusive language and/or verbal threats. At this point, people generally become less rational and cannot be calmed down easily. Staff should: - Remain calm, rational and professional - Listen to the person’s concerns - Stand at least 1 ½ to 3 feet away - Stand at a slight angle to the person - Call Security if needed

Level 3 Loss of Control The most dangerous level of aggression occurs when a person resorts to yelling, screaming or actual physical violence. This person may be capable of using any object as a weapon. Personal Safety Try to position yourself near an exit if possible. Keep your distance! Your priority is to get out of harm’s way and find help.

Body Language Keep Room Safe Adopt a non-threatening pose - arms relaxed and hanging down at the side, palms open below your waist and facing the person, legs relaxed. Keep your hands visible - perceived as less threatening, if hands can be easily seen Don’t look directly into the person’s eyes - this is threatening to many people, focus your eyes on the chin. Remove sharp objects - pens, pencils, letter openers, heavy decorative items may be used as weapons Remove large decorative jewelry Do not wear a stethoscope around your neck Do not wear ID badge on a cord around your neck

Stay Calm Position Yourself Speak slowly and politely Do not show anger yourself. This is difficult to do, but showing anger only makes the situation worse. Do not take it personally. Do not argue or agree with the person if they have any bizarre ideas Allow the person to ‘vent’ and just listen, without becoming judgmental – often the person may calm down within minutes Set limits while offering the person choices and consequences. Stand 1½ to 3 ft in front of the person but a little off to the side Do not face the person directly. This is close enough to allow you to talk, but far enough not to threaten their personal space Do not turn your back on the person Always approach from the front slowly Position yourself closer to an exit

Action Steps If you are feeling threatened, remove yourself from potential harm ! Seek help in your immediate area Have someone call Security – pg 4141 – ‘Show of Force’. Sometimes just the presence of officers is enough to de-escalate the situation. - 3333 – Mr. Strong or Contact 911 if that is your first level of response Notify your Department Director/Manager/Charge RN & the Administrative Supervisor

After the Episode Once a person’s tension is spent, he or she may start to calm down. Don’t let your guard down. Continue to treat the person with caution, as further aggressive behavior may easily be triggered. When the opportunity exists, discuss what happened with the person and what might be done to avoid a repeat occurrence. Take a few minutes to meet with all staff that were involved to assure that everyone is unharmed, to review what happened, and what could be done differently in the future. Remember we must always maintain the person’s dignity!

NCH Resources NCH has zero tolerance for workplace violence (Admin # 118) NCH is committed to a harassment-free workplace (HR #308) Violence in the Workplace Committee (Chair x 5103) Mental Health Liaison (Inpatient x 4165) Critical Incident Stress Management Team (x 7933 – Admin Supervisor) Crisis Prevention Intervention Training ( CPI Classes - Learning Center ) Security (pg. 4141, x 7550)