To manage aggression, give staff right skills
To manage aggression, give staff right skills
Most aggressive behavior in a health care setting can be controlled before it turns violent if you know the right strategies to use, says Steve Wilder, CHSP, EMT-P, a security consultant with Sorenson, Wilder & Associates, a security consulting firm in Bradley, IL.
Wilder teaches health care safety with a continuum that trains the health care professional to recognize the six behavioral changes a person goes through between "calm and "physically violent," as well as ways to defuse the aggressive behavior at each level. In addition, the program covers basic do's and don'ts for dealing with aggressive behavior, as well as steps the health care professional can take to lessen the chances of injury. He presented an overview of his recommended strategies at the most recent meeting of the American Society for Healthcare Risk Management (ASHRM).
Workplace violence is common in many industries, but the health care workplace poses special risks, Wilder notes. In addition to the catalysts that can prompt violence in any workplace — disgruntled employees, domestic disputes, unhappy customers — the health care facility also has to deal with people who may be mentally unstable, on illegal drugs, or emotional overwrought over health issues. The good news, he says, is that many violent incidents can be avoided if staff members know how to respond when people show the first signs of aggression.
"The risk manager's role is to assess the training that has been done in various departments and to provide more training whenever necessary," Wilder says. "This is not something that comes naturally to people."
He also cautions against providing training only in the most obvious departments such as the emergency department and the mental health department. While those staff certainly need training, so do employees in many other areas. Obstetrics and pediatrics are good candidates, for instance, because people become involved in custody disputes that can turn violent.
"And sadly, we see violence in oncology departments," Wilder says. The stress level is high, and often it is the family members who are involved in violent incidents in the waiting room, he says. "You're dealing with death and dying, and the stress can lead to domestic problems in your facility," he explains.
He recommends training staff to limit physical interventions, and he says all employees should be trained using role playing, sample situations, and mock drills. Much of the training should consist of teaching people how to recognize when someone may become violent.
"We hear a lot of people say they didn't see it coming," Wilder says. "They say the person was calm one minute and then he just started swinging and caught them off guard."
That shouldn't happen if staff members are trained properly, he says. Few people actually go from totally calm to violent that quickly. The signs of impending trouble are there if you know what to look for.
Wilder teaches health care staff that they can profile people to spot potential trouble. Eighty percent of people who get violent in a health care setting are male, 75% are white, and 90% are of working age, he says. There also is a 90% chance that the person will have at least one of the these characteristics: history of violence, evidence of erotomania (a rare disorder in which a person holds a delusional belief that another person, usually of a higher social status, is in love with him or her), alcohol dependence, history of pathological blaming, elevated frustration levels, history of personality disorder, evidence of psychosis, chemical dependence, history of depression, impaired neurological function, or an interest in weapons.
Training on how to avoid and handle violence is a necessity for health care workers, says Robert Chicarello, CPP, acting director of security and parking at Brigham and Women's Hospital in Boston. The hospital offers a variety of training programs, including classes on managing aggression in the workplace and rape and aggression defense for women. He makes a point of ensuring that all the emergency department nurses are well trained because they are the most at risk, but he also encourages training for all nurses and other staff.
"We offer two classes, a three-hour course and a six-hour course that comes with certification from the particular course materials we use," Chicarello reports. Brigham and Women's uses the Management of Aggressive Behavior (MOAB) program, provided by MOAB Training International in Kulpsville, PA.
Chicarello and Wilder emphasize that training in aggression management is no substitute for having an adequate and properly training security staff. The goal is to have the front line staff trained well enough that they can see the potential for violent behavior and possibly de-escalate the situation. The training also should enable them to protect themselves better once violence breaks out.
Once the security staff are on scene, they are responsible for controlling the situation, Chicarello says. "We don't want people thinking that they can wrestle someone to the ground because we trained them in aggression management, but so much of the benefit comes from being able to recognize the situation you're in and talk to the person appropriately," he says. "Sometimes the right words can prevent the violence from ever happening."
Sources/Resource
For more information on controlling aggressive behavior, contact:
- Robert Chicarello, Acting Director, Security and Parking, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115. Telephone: (617) 732-5500.
- Steve Wilder, Sorensen, Wilder & Associates, 111 N. Michigan Ave., Bradley, IL 60915. Telephone: (800) 568-2931.
For more information on the Management of Aggressive Behavior (MOAB) program, contact:
- MOAB Training International, P.O. Box 460, Kulpsville, PA 19443. Telephone: (215) 723-2533. Web: www.moabtraining.com. The company offers a varied pricing structure depending on the length of training and the number of students. A three-hour introductory program, for instance, costs $1,695 for up to 24 attendees, and then an additional $50 for each additional attendee. The company also offers "train the trainer" programs in which one person can be trained to provide MOAB instruction to others in your organization. Other options also are available.
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