A comprehensive training program is the most effective means of preparing staff to address disruptive behavior or assaults. There are, however, some basic steps that all staff members can take to improve their interventions in potential crisis situations. The points below are not intended to replace training, but rather to provide an overview of some of the techniques and strategies that should be explored in training programs, which emphasize prevention of workplace violence.
For purposes of this article, crisis moments refer to those points in time when individuals lose physical and rational control of their behavior. Almost always, there are warning signs a person’s behavior is moving toward a crisis. The following tips can aid in early interventions and increase the likelihood of staff de-escalating an incident before it becomes dangerous.
1. Respect All Individuals’ Personal Space
Personal space is the area around us that we consider an extension of ourselves. How much space each of us requires to feel comfortable varies considerably. What is almost universally true, however, is that anxiety rises when personal space is invaded. This heightened anxiety makes it more likely a person will act out in a more serious way.
To avoid such a response, maintain at least an arm’s-length distance from a person whose behavior is escalating. In this way, you will be less likely to increase the person’s anxiety. You will also reduce danger to yourself by maintaining a margin of safety that allows you time to react.
If you must touch an anxious person to provide medical care, explain what you are about to do before you begin. If the person objects, decide if: 1) the procedure can wait until the person is less anxious; 2) someone else might be better suited to provide the care, e.g. someone who has established stronger rapport with the person; or 3) the procedure must be done by you at this very moment. This third alternative should be a last resort, chosen only due to medical necessity. If this is your decision, be prepared for the possibility of the patient reacting negatively.
2. Be Aware of Your Own Body Position
In addition to maintaining adequate space between you and an anxious person, avoid eye-to-eye, toe-to-toe positions, as they might be interpreted as challenging. Positions perceived as challenging can evoke a “fight or flight” response from the other person, and neither of those reactions is likely to be helpful. Standing at an angle to the person and off to the side is much less likely to escalate an agitated person’s behavior.
3. Be Empathic to Others’ Feelings
Try not to judge or discount the feelings of others. Whether or not you think their feelings are justified, those feelings are real to the other person. Pay attention to them, and don’t be afraid of silence. Your supportive presence is often more important than what you say.
4. Keep Nonverbal Cues Nonthreatening
As a person begins to lose control of rational thought, the person becomes more tuned into your body language and less tuned into your words. Nonverbal communication — including gestures, facial expressions, movements and tone of voice — becomes paramount in conveying a calm, respectful attitude.
5. Ignore Challenging Questions
When a person challenges your authority or an organizational policy, redirect the individual’s attention to the issue at hand. For example, suppose a female visitor is smoking in a waiting area. You remind her that there is no smoking allowed in your facility and ask her to put out her cigarette. She responds by saying, “Who are you to tell me what to do?” Answering this type of question only leads to a nonproductive power struggle, and it also sidesteps the issue at hand — the woman’s smoking. It’s better to ignore the challenge and restate your request.
6. Set and Enforce Reasonable Limits
If patients or family members become belligerent, defensive or disruptive, establish limits and directives clearly and concisely. When setting limits, offer simple, clear choices and consequences to the acting-out individual. Be sure the consequences are reasonable and enforceable.
For example, you might tell a family member who is insistent about entering an emergency treatment room, “Please come back to the waiting area with me, and I’ll be sure the doctor speaks with you about your husband as soon as possible. If you try to enter the treatment room again, I’ll have to call security, and then it will be even longer before you can talk to the doctor.”