Responding to Abusive Patient Behavior (Part I of III): 3 Pitfalls to Avoid When Training Staff

Healthcare workers, police and security personnel greatly benefit from training that shows them how to appropriately deal with patients, visitors and even other employees who may become disruptive or violent. But if that training isn’t delivered properly andto the right people, problems can result. This first part of our serieson managing abusive patients discusses how hospitals can avoid themistakes often made when developing their education programs.

Earlier this year, a 19-year-old man was brought into a hospital in the Louisville, Ky., area suffering from apparent cardiac arrest. When emergency room staff members were unable to revive him, several members of the man’s family began throwing furniture and attacking ospital staff. In all, seven people were injured, including a security guard who had to be admitted to the intensive care unit.

The Bureau of Labor Statistics (BLS) reported in 2000 that nearly one-half of all nonfatal injuries from occupational assaults and violent acts occurred in healthcare and social services settings. Whether working in an emergency room, a psychiatric ward, a nursing home or any other healthcare facility, staff members face patients and others who exhibit disruptive, assaultive and violent behavior. Healthcare facilities are often places of great anxiety, stress, grief and anger. Patients, their family members, and even co-workers can lose control of their emotions and become verbally or physically aggressive.

Administrators often choose an educational approach as a logical starting point for examining issues relating to workplace safety and minimizing risk. Proper training can provide employees with a consistent framework for identifying warning signs of violence, as well as techniques they can use to respond appropriately to differing levels of disruptive behavior. Training will also teach them how their own behavior significantly affects the behavior of others.

If training is to be successful in achieving the goals of minimizing risk and creating a safer workplace, however, it must be implemented in a way that gives it the highest possible chance of success. There are three key pitfalls that administrators can avoid in order to increase training effectiveness.

Pitfall No. 1 — Training Only Your Security Staff
One of the strategies often used in human service organizations is to train security personnel or a crisis response team to respond to potentially violent incidents. This strategy allows a relatively small group of workers to specialize and become experts in responding to threatening situations. While this is a good strategy, it is an incomplete one.

Staff members who are not part of the crisis response team are often interacting with an individual before the response team is called and until they arrive. Their responses and attitudes can be critical in diffusing the stress and anxiety of irrational individuals. In fact, if they respond appropriately, the crisis response team might not be needed at all.

When untrained staff members are confronted with potentially dangerous behavior, it is more likely they will respond instinctually with a “fight or flight” response. Neither fighting nor fleeing is consistent with one’s duty of care. The body’s fight response will usually cause a disruptive person’s behavior to escalate further. A flight response from staff — admittedly the best option in some situations — may create an even less safe situation as the disruptive individual is left alone. Training helps to transform those instinctive responses into more appropriate interventions.

By training all staff, every employee gains the skills and confidence to intervene safely. Staff who are closest to a given patient or situation are often in the best position to diffuse escalating behavior and eliminate the need for a crisis response team call. Therefore, it is best if all employees have a foundation in the same training, even if a crisis response team or security staff has more specialized training in responding to violence.

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