The Essentials of Aggression Management in the Community Health Clinic

The Essentials of Aggression

Management in the Community Health

Clinic

Presented By:

Steve Wilder, BA, CHSP, STSSorensen, Wilder & Associates

Bourbonnais, IL

An employee enters the facility carrying a

brown paper bag. The employee doesn’t say anything to anyone, and is wearing camouflaged clothing. The employee has been acting strange the past few weeks, making threats to his supervisor and fellow employees, and making comments about “getting even”

What Would You Do If…

An employee comes into work, and tells you

that he/she is going to commit suicide

A co-worker comes into the employee lounge while you are in there, stating “I’ve had it with that )#&*% and if she doesn’t watch out, she’s gonna be one sorry SOB”


An employee starts crying once or twice every

shift, for no apparent reason, and without provocation

A female co-worker, going through a divorce, gets a call from her estranged spouse, and hangs up the phone and tells you “he says he’s coming here to kill me”


A co-worker can’t seem to stay awake, and

keeps complaining that her paycheck isn’t enough to make ends meet.

A co-worker returns from lunch daily with a detectable odor of alcohol on his breath


Like every other catastrophic event that

we have faced (mass casualties, staffing shortages, lack of supplies, fires, loss of utilities, etc.) episodes of Workplace Violence tax our resources, place our people at risk, and jeopardize our ability to care for those who need us most.

Each Of These Scenarios Are Indicative Of A Potential Incident Of

Workplace Violence.

Incidents of Workplace Violence are equally catastrophic in

nature, but can be avoided, if we understand the issues, and

know what to look for.

Nearly 1/3 of all Americans are victims of

crime each year

3 people die of violent acts in the workplace everyday

90% - 95% of acts of violence are against women

Workplace violence is the leading cause of female deaths in the workplace

The Impact of Violence in the Workplace

43% of healthcare managers have reported a

violent incident in their workplace in the last 3 years.

25% of healthcare workers have experienced acts of Workplace Violence against them.

Violence in the workplace is the #1 security threat.

Approximately 900 deaths and 1.7 million non fatal assaults occur in the work place a year.

15% of all work-related fatalities that occurred in the US in 2007 were due to violent acts.

Facts

Always Remember

Incidents of Workplace Violence can be avoided, if we understand the issues and know what to look for.

What Constitutes Workplace Violence?

In simplest terms:Any incident in which an employer or employee is threatened, intimidated, physically or verbally

attacked, harassed, injured or killed

THE GOLDEN RULE:

IN EVERY HEALTHCARE FACILITY, THE RISK OF VIOLENCE SHOULD ALWAYS BE RECOGNIZED, BUT CAN ALWAYS BE AVOIDED OR MITIGATED THROUGH

PREPARATION

PREVENTING WORKPLACE VIOLENCE

To increase safety and lessen your chances of being injured, follow some simple guidelines:

Limit physical interventions Use adequate number of staff Develop and train Emergency Response Teams Provide training to all employees Train using role playing, situations, and mock

drills

Responding To A Violent Situation

Male• 80%Probabilit

y

Caucasian• 75%

Probability

Working Age• 90%

Probability

Characteristics of the Potentially Violent Person

90% Will Display One Or More Of The Following


Pathological Blaming Depression

Personality Disorder

History of Violence



Erotomania Interest in weapons

Chemical Dependence

Alcohol dependence



Elevated Frustration Levels

Impaired Neuro Functions

Evidence of Psychosis

Recognizing and Avoiding Potentially

Violent BehaviorThe Aggression Continuum:

Six Steps from Calm to Violent

The Aggression Continuum

The continuum can best be thought of as a six foot step ladder. The closer the aggressor gets to the top rung, the more likely the risk of violent behavior.


Remember what the sticker on the

top step says:DANGER

Do Not Stand Here


STEP 1:

the Person is

Calm• Calm

Step 1: Calm and Non-Threatening

Persons Action: Presents In A Calm Manner Not Agitated Presence Is Not Threatening Is Just “Another Person Functioning In Society”


Step 1: Calm and Non-Threatening

Your Response: Respect Person Dignity Listen to Person Concerns Be Compassionate and Caring Focus on Persons Needs



STEP 2:

the Person is

VerballyAgitated• Verbally Agitated

• Calm

Step 2: Verbally Agitated

Persons Actions: person expresses verbal anger the anger is not directed at any specific person or

object the person is no threat to you


Step 2: Verbally Agitated

Your Response: Listen To The Person Respect The Person Save The Person’s Self Esteem DO NOT Give Orders



STEP 3:

the Person is

VerballyHostile

• Verbally Hostile

• Verbally Agitated

• Calm

Step 3: Verbally Hostile

Persons Actions: behaviors very similar to being

“verbally agitated” person is oblivious to efforts to calm him


Step 3: Verbally Hostile

Your Response: Maintain non-threatening body posture Respect the “personal zone” Allow the person to vent anger Keep your instructions minimal



STEP 4:

the Person is

VerballyThreatening

• Verbally Threatening



• Calm

Step 4: Verbally Threatening

Persons Actions: Begins to focus anger on specific person(s) Makes demands for action Makes threats of consequences if demands are

not met


Step 4: Verbally Threatening

Your Response: Maintain eye contact Avoid cornering the person Give person options ANTICIPATE VIOLENCE


To corner the person means to trap the person. To remember the dangerous methods of cornering, remember the acronym C-A-P-E:

C - Contact CorneringA - Angular CorneringP - Psychological CorneringE - Exit Cornering

CORNERING


STEP 5:

the Person is

PhysicallyThreatening

• Physically Threatening




• Calm

Step 5: Physically Threatening

Persons Actions: Takes stance that suggests violence May scan area for potential weapons May make aggressive moves against you


Step 5: Physically Threatening

Your Response: Must recognize this is the critical point Maintain defensive posture Look for strong side/weak side indicators Be prepared for physical attack



• Physically Violent

• Physically Threatening




• Calm

STEP 6:

the Person is

PhysicallyViolent

Step 6: Physically Violent

Persons Actions: Physically attacks you in some form


Step 6: Physically Violent

Your Response: Change to self defense/survival mode


Watch for non-verbal clues :

Sudden Movements Toward You Tightening Of Small And Large Muscle Groups Twitching Of Facial Muscles Darting Eye Movements Fixed Staring

Additional Key Points

Watch for non-verbal clues :

Glancing For Weapons Shifting Balance Raised Voice Pitch And Increased Volume Changing Stances Increased Breathing Rate

Additional Key Points

DON’T Give Orders Instead Of Choices DON’T Project A “Don’t Give A Damn” Attitude DON’T Over Stare DON’T Make Threats Or Lie To The Individual DON’T Argue DON’T Turn Your Back Or Walk Away DON’T Become Emotional DON’T Corner The Individual, Or Invade His Space

The DON’T List of Aggression Management

DO Monitor Your Own Status DO Demonstrate Self Confidence DO Stay Calm And Relaxed DO Keep Voice Pitch/Volume Down DO Offer Honest Options DO Allow Individual To Make Choices DO Allow Individual To Save Self Esteem DO Maintain Safe Personal Distance DO Position Yourself On Individuals Weak Side Do Take Your Time

The DO List of Aggression Management

Most Men Carry Pens/Pencils/Cigarettes on Weak Side

Most Men Carry Their Wallets On The Strong Side

The Tip Of The Belt Usually Points To The Weak Side

Most Women Carry Purse Over Strong Side Shoulder

Most Men Part Their Hair On The Weak Side

Strong Side / Weak Side Indicators

Most People Wear Their Watch On The Weak Side

Most People Stand With Strong Side Shoulder Dipped Lower

Most People Will Stand With Weak Side Foot Forward

Most People Carry Pagers, Phones, Etc. On Strong Side

Strong Side / Weak Side Indicators

1. Commitment To Outcome

2. Pay Attention

3. Know The Aggression Continuum

4. Assessing The Cause

5. Avoid Ego Battles

Ten De-Escalants To Apply

6. Monitor Status

7. Monitor The Environment

8. Offer Options / Choices

9. Avoid Cornering – I.E. C.A.P.E

10. Establish Leadership (Who’s In Charge)

Ten De-Escalants To Apply

THE BUDDY SYSTEM:

When responding to a situation that you know may become violent or involve aggressive behavior, always use a buddy system. A minimum of two

people, but 3 or more is even safer.

Responding to Potentially Violent Incidents

Triangle Approach

Back Up #1

Back Up #2

In ChargeAggressor

First, obtain any necessary medical attention you may

need.

Report the incident to your supervisor

Complete a Violent Incident Report Form and turn it in to your supervisor

If You Are Involved In A Violent Situation

Talk about it! Watch for signs of Post Traumatic Stress Disorder Utilize CISD Teams Utilize EAP programs Utilize Crisis Intervention Teams Critique each session from Quality Improvement

perspective

If You Have An Incident…

QUESTIONS / COMMENTS

Steve WilderSorensen, Wilder & Associates

Bourbonnais, IL 60914815-482-2989 (cell)

[email protected]

mailto:[email protected]

The Essentials of Aggression Management in the Community Health Clinic

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