The Essentials of Aggression
Management in the Community Health
Clinic
Presented By:
Steve Wilder, BA, CHSP, STSSorensen, Wilder & Associates
Bourbonnais, IL
An employee enters the facility carrying a
brown paper bag. The employee doesn’t say anything to anyone, and is wearing camouflaged clothing. The employee has been acting strange the past few weeks, making threats to his supervisor and fellow employees, and making comments about “getting even”
What Would You Do If…
An employee comes into work, and tells you
that he/she is going to commit suicide
A co-worker comes into the employee lounge while you are in there, stating “I’ve had it with that )#&*% and if she doesn’t watch out, she’s gonna be one sorry SOB”
What Would You Do If…
An employee starts crying once or twice every
shift, for no apparent reason, and without provocation
A female co-worker, going through a divorce, gets a call from her estranged spouse, and hangs up the phone and tells you “he says he’s coming here to kill me”
What Would You Do If…
A co-worker can’t seem to stay awake, and
keeps complaining that her paycheck isn’t enough to make ends meet.
A co-worker returns from lunch daily with a detectable odor of alcohol on his breath
What Would You Do If…
Like every other catastrophic event that
we have faced (mass casualties, staffing shortages, lack of supplies, fires, loss of utilities, etc.) episodes of Workplace Violence tax our resources, place our people at risk, and jeopardize our ability to care for those who need us most.
Each Of These Scenarios Are Indicative Of A Potential Incident Of
Workplace Violence.
Incidents of Workplace Violence are equally catastrophic in
nature, but can be avoided, if we understand the issues, and
know what to look for.
Nearly 1/3 of all Americans are victims of
crime each year
3 people die of violent acts in the workplace everyday
90% - 95% of acts of violence are against women
Workplace violence is the leading cause of female deaths in the workplace
The Impact of Violence in the Workplace
43% of healthcare managers have reported a
violent incident in their workplace in the last 3 years.
25% of healthcare workers have experienced acts of Workplace Violence against them.
Violence in the workplace is the #1 security threat.
Approximately 900 deaths and 1.7 million non fatal assaults occur in the work place a year.
15% of all work-related fatalities that occurred in the US in 2007 were due to violent acts.
Facts
Always Remember
Incidents of Workplace Violence can be avoided, if we understand the issues and know what to look for.
What Constitutes Workplace Violence?
In simplest terms:Any incident in which an employer or employee is threatened, intimidated, physically or verbally
attacked, harassed, injured or killed
THE GOLDEN RULE:
IN EVERY HEALTHCARE FACILITY, THE RISK OF VIOLENCE SHOULD ALWAYS BE RECOGNIZED, BUT CAN ALWAYS BE AVOIDED OR MITIGATED THROUGH
PREPARATION
PREVENTING WORKPLACE VIOLENCE
To increase safety and lessen your chances of being injured, follow some simple guidelines:
Limit physical interventions Use adequate number of staff Develop and train Emergency Response Teams Provide training to all employees Train using role playing, situations, and mock
drills
Responding To A Violent Situation
Male• 80%Probabilit
y
Caucasian• 75%
Probability
Working Age• 90%
Probability
Characteristics of the Potentially Violent Person
90% Will Display One Or More Of The Following
Characteristics of the Potentially Violent Person
Pathological Blaming Depression
Personality Disorder
History of Violence
90% Will Display One Or More Of The Following
Characteristics of the Potentially Violent Person
Erotomania Interest in weapons
Chemical Dependence
Alcohol dependence
90% Will Display One Or More Of The Following
Characteristics of the Potentially Violent Person
Elevated Frustration Levels
Impaired Neuro Functions
Evidence of Psychosis
Recognizing and Avoiding Potentially
Violent BehaviorThe Aggression Continuum:
Six Steps from Calm to Violent
The Aggression Continuum
The continuum can best be thought of as a six foot step ladder. The closer the aggressor gets to the top rung, the more likely the risk of violent behavior.
The Aggression Continuum
Remember what the sticker on the
top step says:DANGER
Do Not Stand Here
The Aggression Continuum
STEP 1:
the Person is
Calm• Calm
Step 1: Calm and Non-Threatening
Persons Action: Presents In A Calm Manner Not Agitated Presence Is Not Threatening Is Just “Another Person Functioning In Society”
The Aggression Continuum
Step 1: Calm and Non-Threatening
Your Response: Respect Person Dignity Listen to Person Concerns Be Compassionate and Caring Focus on Persons Needs
The Aggression Continuum
The Aggression Continuum
STEP 2:
the Person is
VerballyAgitated• Verbally Agitated
• Calm
Step 2: Verbally Agitated
Persons Actions: person expresses verbal anger the anger is not directed at any specific person or
object the person is no threat to you
The Aggression Continuum
Step 2: Verbally Agitated
Your Response: Listen To The Person Respect The Person Save The Person’s Self Esteem DO NOT Give Orders
The Aggression Continuum
The Aggression Continuum
STEP 3:
the Person is
VerballyHostile
• Verbally Hostile
• Verbally Agitated
• Calm
Step 3: Verbally Hostile
Persons Actions: behaviors very similar to being
“verbally agitated” person is oblivious to efforts to calm him
The Aggression Continuum
Step 3: Verbally Hostile
Your Response: Maintain non-threatening body posture Respect the “personal zone” Allow the person to vent anger Keep your instructions minimal
The Aggression Continuum
The Aggression Continuum
STEP 4:
the Person is
VerballyThreatening
• Verbally Threatening
• Verbally Hostile
• Verbally Agitated
• Calm
Step 4: Verbally Threatening
Persons Actions: Begins to focus anger on specific person(s) Makes demands for action Makes threats of consequences if demands are
not met
The Aggression Continuum
Step 4: Verbally Threatening
Your Response: Maintain eye contact Avoid cornering the person Give person options ANTICIPATE VIOLENCE
The Aggression Continuum
To corner the person means to trap the person. To remember the dangerous methods of cornering, remember the acronym C-A-P-E:
C - Contact CorneringA - Angular CorneringP - Psychological CorneringE - Exit Cornering
CORNERING
The Aggression Continuum
STEP 5:
the Person is
PhysicallyThreatening
• Physically Threatening
• Verbally Threatening
• Verbally Hostile
• Verbally Agitated
• Calm
Step 5: Physically Threatening
Persons Actions: Takes stance that suggests violence May scan area for potential weapons May make aggressive moves against you
The Aggression Continuum
Step 5: Physically Threatening
Your Response: Must recognize this is the critical point Maintain defensive posture Look for strong side/weak side indicators Be prepared for physical attack
The Aggression Continuum
The Aggression Continuum
• Physically Violent
• Physically Threatening
• Verbally Threatening
• Verbally Hostile
• Verbally Agitated
• Calm
STEP 6:
the Person is
PhysicallyViolent
Step 6: Physically Violent
Persons Actions: Physically attacks you in some form
The Aggression Continuum
Step 6: Physically Violent
Your Response: Change to self defense/survival mode
The Aggression Continuum
Watch for non-verbal clues :
Sudden Movements Toward You Tightening Of Small And Large Muscle Groups Twitching Of Facial Muscles Darting Eye Movements Fixed Staring
Additional Key Points
Watch for non-verbal clues :
Glancing For Weapons Shifting Balance Raised Voice Pitch And Increased Volume Changing Stances Increased Breathing Rate
Additional Key Points
DON’T Give Orders Instead Of Choices DON’T Project A “Don’t Give A Damn” Attitude DON’T Over Stare DON’T Make Threats Or Lie To The Individual DON’T Argue DON’T Turn Your Back Or Walk Away DON’T Become Emotional DON’T Corner The Individual, Or Invade His Space
The DON’T List of Aggression Management
DO Monitor Your Own Status DO Demonstrate Self Confidence DO Stay Calm And Relaxed DO Keep Voice Pitch/Volume Down DO Offer Honest Options DO Allow Individual To Make Choices DO Allow Individual To Save Self Esteem DO Maintain Safe Personal Distance DO Position Yourself On Individuals Weak Side Do Take Your Time
The DO List of Aggression Management
Most Men Carry Pens/Pencils/Cigarettes on Weak Side
Most Men Carry Their Wallets On The Strong Side
The Tip Of The Belt Usually Points To The Weak Side
Most Women Carry Purse Over Strong Side Shoulder
Most Men Part Their Hair On The Weak Side
Strong Side / Weak Side Indicators
Most People Wear Their Watch On The Weak Side
Most People Stand With Strong Side Shoulder Dipped Lower
Most People Will Stand With Weak Side Foot Forward
Most People Carry Pagers, Phones, Etc. On Strong Side
Strong Side / Weak Side Indicators
1. Commitment To Outcome
2. Pay Attention
3. Know The Aggression Continuum
4. Assessing The Cause
5. Avoid Ego Battles
Ten De-Escalants To Apply
6. Monitor Status
7. Monitor The Environment
8. Offer Options / Choices
9. Avoid Cornering – I.E. C.A.P.E
10. Establish Leadership (Who’s In Charge)
Ten De-Escalants To Apply
THE BUDDY SYSTEM:
When responding to a situation that you know may become violent or involve aggressive behavior, always use a buddy system. A minimum of two
people, but 3 or more is even safer.
Responding to Potentially Violent Incidents
Triangle Approach
Back Up #1
Back Up #2
In ChargeAggressor
Triangle Approach
Back Up #1
Back Up #2
In ChargeAggressor
First, obtain any necessary medical attention you may
need.
Report the incident to your supervisor
Complete a Violent Incident Report Form and turn it in to your supervisor
If You Are Involved In A Violent Situation
Talk about it! Watch for signs of Post Traumatic Stress Disorder Utilize CISD Teams Utilize EAP programs Utilize Crisis Intervention Teams Critique each session from Quality Improvement
perspective
If You Have An Incident…
QUESTIONS / COMMENTS
Steve WilderSorensen, Wilder & Associates
Bourbonnais, IL 60914815-482-2989 (cell)
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