1. Personal Safety in the Healthcare Environment

2. 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

3. 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.

4. 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

5. 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

6. 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.

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

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

9. 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

10. 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.

11. 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

12. 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

13. 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 – Mr. Strong or
Contact 911 if that is your first level of response
Notify your Department Director/Manager/Charge RN & the
Administrative Supervisor

14. 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!

15. 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)