The right tools—and support from your organization—will protect you and your patients.
- Nurses and other healthcare workers are harmed by violent patients and family members and need to be safe in practice.
- Many nurses believe workplace violence is part of the job.
- Learning and practicing de-escalation techniques can help protect nurses and patients.
VIOLENCE continues to be a problem in healthcare settings. (See Workplace violence stats.) Too many nurses continue to believe that workplace violence is part of the job, so they don’t ask for help when they’re in a combative situation with a patient or family member, and they don’t notify their supervisors of an injury. However, the American Nurses Association (ANA) position statement on Incivility, Bullying, and Workplace Violence states that “all registered nurses and employers in all settings, including practice, academia, and research must collaborate to create a culture of respect, free of incivility, bullying, and workplace violence.” In other words, violence should never be an accepted part of practice.
But when you do encounter combative patients or family members, what should you do? First, remember that they’re in a stressful situation and may act out for many reasons, including a medical diagnosis, drug misuse withdrawal, medication effects, mental health issues, or financial anxiety. Quickly building rapport with the patient and using proven verbal de-escalation tools can help you prevent a tense situation from becoming violent.
Verbal de-escalation tools
Verbal de-escalation involves communicating effectively, offering clear explanations for protocols and procedures, checking your own behavior to make sure you’re not contributing to the tension, and offering the patient realistic options. However, if you’re ever in a situation where you’re not sure what to do, ask for help from fellow staff members or your organization’s safety and security staff. (See Verbal de-escalation tips.)
Listen carefully to what the patient or family member is saying. They might not be able to express their actual needs, so look for a theme while assessing the situation, listen to what is and isn’t being expressed, and determine what their body language is telling you.Don’t raise your voice, which may only anger the patient and cause him or her to speak even more loudly. Statements such as “I’m here to keep you safe” can be beneficial. Remind the patient (and yourself) that you’re on the same team and should be working together. Don’t get caught up in an “us versus them” dynamic. Treat the patient as an important member of the healthcare team.
Many patients and family members won’t understand what staff members are doing or why. When you’re questioned by a patient or family member, don’t just state that “it’s policy”; provide a clear rationale. When you’re sure they understand, you can talk about options to meet the patient’s needs that are in line with your organization’s policies.
When offering the patient choices and suggestions to resolve a situation, be realistic. Determine what the patient has control over, what feasible choices are available, and how immediate his or her needs are. Offering an unrealistic option simply to appease the patient may backfire and result in lost trust. If possible, walk with the patient while discussing options. Moving may release stress and help calm the patient.
You can make a situation better or worse, so pay attention to your own behavior. Avoid anger, closed body language, and aggression. Instead, stay calm, keep a relaxed posture, and make eye contact. Keep your hands visible so that the patient doesn’t think you’re hiding something. Remember that having too many people in the room may overwhelm the patient; however, for safety, you may want at least one other staff member with you.
Combative patients and family members can be intimidating, but with the right tools and support from your colleagues and safety and security personnel, you can keep yourself and others safe. And remember that violence at work is not part of the job. Collaborate with your organization to develop and implement de-escalation protocols that protect everyone.
Julia Mason Jubb is an associate professor in the RN to BSN Online Option at Chamberlain College of Nursing, Chamberlain University. Cathryn J. Baack is an assistant professor and program director for the DNP program family nurse practitioner track at Leighton School of Nursing, Marian University, in Indianapolis, Indiana.
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