De-escalation & Evasion Techniquesin Healthcare

Hillery Phillips, MSN, CCRN-K, RN-BC

• There is no conflict of interest, sponsorship, commercial support, or endorsement of any product to disclose.

DISCLOSURE STATEMENT

Objectives

• The Healthcare worker will be able to return demonstrate therapeutic patient handling techniques when dealing with a violent patient

• The Registered Nurse will be able to recognize the rise in aggression in violent patients,and be able to implement effective de-escalation techniques into practice.

What is work place violence?

• The National Institute for Occupational Safety and Health defines workplace violence as “violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty.”

• 4 times more common in healthcare than in private industry

Unique Challenges in

Healthcare

• Healthcare culture

• Ethical Duty

• “Part of the job”

• Unintentional

• Fear of stigmatizing perpetrators

• Reduced funding for mental health services

Prevalence of WPV in

Healthcare

• 21 percent of registered nurses and nursing students reported being physically assaulted—and over 50 percent verbally abused—in a 12-month period

(2014 American Nurses Association’s Health Risk Appraisal survey of 3,765 registered nurses and nursing students)

Work Place Violence is

Costly & Preventable

• Medical treatment

• Missed work

• Worker’s compensation

• Caregiver fatigue

• Injury

• Stress

What can we do about it??

• Implement an effective Work Place Violence prevention program

• 5 Key Components

• Management commitment and worker participation

• Worksite analysis and hazard identification

• Hazard prevention and control

• Safety and health training

• Recordkeeping and program evaluation

Recognizing Aggression

• Calm

• Verbally Agitated

• Verbally Hostile

• Verbally Threatening

• Physically Threatening

• Physically Violent

So how do we keep people from escalating?

5 Universal Truths of Human Interaction

All people want to be treated with dignity & respect

All people want to be asked rather than told to do something

All people want to be informed as to why they are being asked to do something

All people want to be given options rather than threats

All people want a second chance when they make a mistake

RESPECT• The global message promoting respect,

understanding, and forgiveness can connect all people everywhere

Tactical Civility• The more different we are from others,

the more “tactically” we must speak in order to gain compliance, develop cooperation, or work in collaboration

Motivating the Disagreeable

• Know your audience

• See your audience the same way they see themselves

• True essence of empathy

• Use the language of your audience

• Communicate simply

Taking crap with dignity & style

• “Never use words that rise readily to your lips, or you’ll make the greatest speech you’ll ever live to regret”

• The valuable art of remaining calm

Sucker punches of life

• Taking taunts or criticism effectively

• “To win 100 victories in 100 battles is not the highest skill. To subdue the enemy without fighting is the highest skill”

• Confucian philosopher Sun-tzu

Dealing with verbal attacks

• First step is to acknowledge that crap is being flung

• Second, admit is is being flung at you

• Third, congratulate yourself

• It’s ok to be questioned, heckled, or even attacked

Secret is simple

•Laugh it off

Take the Giant LEAPS

LISTEN

Look like you are listening

EMPATHIZE

What does empathy look

like?

Seeing through the eyes of another

ASK

Types of Questions

General

• “What really happened today?”

Opinion Seeking

• “Is there some way we can solve this problem? What’s your view on how we ought to go about this?”

Direct

• “Did you pull your IV out?”

Leading

• “Isn’t it true that…?”

PARAPHRASE

SUMMARIZE

Buddy System

Sexually Inappropriate

Self Defense VS Patient Control

• Involves any an all means of self protection

• Force used must be reasonable and necessary

• Used only in emergency situations to protect the provider from harm or injury

Self Defense

• Tactics to maximize patient management while minimizing injury to patients and other providers

• Professional responsibility to protect and defend

Patient Control

Reasonable Person Standard

SELF-DEFENSE FOR NINJA NURSES

Hillery Phillips, MSN, CCRN-K, RN-BC

HILL-KWON-DO

Safety Precautions when dealing with a violent person• Remove stethoscope from around your neck

• Clip your badge lanyard to your pocket

• Utilize the buddy system

• Be mindful of things that can be used for weapons

• Monitor your surroundings

• Don’t turn your back to the patient

• Avoid being cornered if possible

Safely restraining limbs during restraint

application

Surf Board

References

• Texas Center for Nursing Workforce Studies (TCNWS). Retrieved from https://www.dshs.texas.gov/chs/cnws/

• Thompson, G. & Jenkins, J. (2013). Verbal Judo: The Gentle Art of Persuasion. New York: William Morrow.

• Workplace Violence in Healthcare: Understanding the Challenge. Retrieved from https://www.osha.gov/Publications/OSHA3826.pdf