PROtect Yourself! Empowering Tips & Techniques for Personal Safety: A Practical Violence Prevention Manual for Healthcare Workers. Rae Stonehouse
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•Frequent heavy use of medications, restrictions, seclusion and restraints — intrusive and most restrictive approaches
•Strict structure negating a positive milieu
•Expectations of violence as “part of the job” or common occurrence
•Lack of recognition of the possibility of risk, preventing care provider from identifying and intervening at the earliest stage
•Dislike of client
•Projected animosity
•Authoritarian attitude
•Overcontrolling behavior
•Lack of socializing with client (little persontoperson contact)
•Burnout
Triggers for Aggression:
The literature suggests that just as many patients with pre-assaultive behaviours (verbal aggression, high activity level and invasion of personal space) never go on to assault staff as those that do. So what is it that drives the 50% of violent prone clients to assault staff?
It is generally felt that there is a “trigger” that sets off the physical aggression. It is important that you have an awareness of potential “triggers” in your working environment.
One of the strongest triggers is activated when the client perceives that they are being treated with disrespect or unfairly. When healthcare workers are tired or overworked they may become insensitive to their client’s needs. Staff interaction with their clients can thus become argumentative, authoritarian, and in some cases threatening. To maintain our personal safety we must be able to conduct a self-assessment and identify when we are displaying verbally aggressive behaviour and are becoming part of the problem, rather than part of the solution.
Triggers can include:
•Intoxication
•Loss of a central love relationship
•Acute emotional crisis
•Loss of personal power
•Loss of face
•Fear
•Pain
•Physiological states e.g. hunger, thirst, lack of sleep, boredom and unstructured activity
•Staff rejections
•Rejection
•Disrespect
•Crowding
•Irritating patients and staff
•Tasks a patient may not want to perform
These personal attitudes have been effective when working with disturbed individuals:
•Alertness
•Sensitiveness
•Self-Awareness
•Confidence
•Respectfulness
•Belief in Equality
•Genuineness
Violence in the Workplace Self-Assessment
Here are some selfassessment questions to help you to become more aware of your own feelings regarding violence and the violent client.
1)Do I have a constant sense of fear around this client?
2)Do I feel comfortable turning my back on this client?
3)Do I avoid this client?
4)Do I take sides with either the client or the family?
5)Do I feel capable of handling violent, assaultive behavior if it occurs?
6)Do I feel judgmental about the client’s behavior?
7)Do I want to punish the client because of their behavior?
8)Have I become so uptight and anxious about the client that I am distorting his/her behavior in my mind?
9)Am I so angry with the client and with my fellow staff that we can no longer deal therapeutically with the client?
10)How am I coping with the feelings that I have about the client?
Proactive Tip: If you have answered “Yes” to any of these questions it might be a good idea to talk to one of your fellow workers about your feelings. Odds are that others feel similarly. Perhaps it would be a good topic to discuss at a staff meeting. That would allow you the opportunity for you and your fellow workers to acknowledge your feelings about the client and to develop strategies to be able to continue to work therapeutically with them.
Communication with a Disturbed Individual
General Attitude and Approaches:
A.Attitude or feeling state
•Control your own behaviour. Remain calm (“mirror calm”).
•Be non-judgmental.
•Avoid threatening words or actions.
•Don’t take insults personally.
•Do not enter a power struggle.
•Use “soft focus” eye contact and an expression that says “I’m your friend, not your enemy”.
•Show concern without anger.
•Be in firm but kindly control.
•Be empathetic. (Remember “Hurt People, Hurt People”). Show that you have listened and understood how the individual feels. “I heard you say ...”; “As I understand it ...” ; “I know it is difficult for you, how can I make it easier?”
•Show respect, if only because he/she is a human being and all human beings are entitled to respect. Show the person that you are for him/her, not neutral and not against him/her.
•Be genuine. Don’t respond in an institutionalized or stereotyped professional manner. Try to affect an open, spontaneous interaction style. Use your own language and avoid buzz words that might anger the person e.g. “It is our policy ...”
•Be concrete. Deal with the individual in and with specific, concrete feelings, behaviours and directions. Do not be vague. Do not lie.
•Recognize and reinforce steps to regain control. Use positive gestures and language.
•Trust your intuition and feelings. Ask the person if you are correct. For example, “I have the feeling you are upset because your daughter couldn’t visit today. Am I right or wrong about that?”
•Be aware of personal responses to aggressive behaviour. Caregivers who project their own feelings of rage and fear onto the impaired will overestimate the potential for violence and resort to excessive use of restraints, physical or chemical.
•Heed inner dialogue (awareness of counter-transference reactions).
•Avoid the “saviors” or “macho” attitude in an effort to live up to expectations of on-lookers or to compensate for personal fears.
B.Speech
•Use simple, concrete, positive statements. Say what you want them to do not what you don’t want them to do. For example, “Please sit over here” instead of “Don’t pace in the dining room.”
•State instructions or questions one at a time. When they can respond appropriately, they are regaining control.
•Keep