Ten ways to defuse incidents

A comprehensive training programme is the most effective means of preparing staff to address disruptive behaviour or assaults. There are, however, some basic steps that all staff members can take to improve their interventions in potential crisis situations.

The points mentioned here are not intended to replace training, but rather to provide an overview of some of the techniques and strategies that should be explored in training programmes that emphasise prevention of workplace violence.

For the purposes of this article, crisis moments refer to those points in time when individuals lose physical and rational control of their behaviour. There are almost always warning signs a person’s behaviour is moving toward a crisis. The following tips can aid in early interventions and increase the likelihood of staff defusing an incident before it becomes dangerous.

1. Respect all individuals’ personal space
Personal space is the area around us that we consider an extension of ourselves. How much space each of us requires to feel comfortable varies considerably. What is almost universally true, however, is that anxiety rises when personal space is invaded. This heightened anxiety makes it more likely a person will act out in a more serious way.

To avoid such a response, maintain at least an arm’s length distance from a person whose behaviour is escalating. In this way, you will be less likely to increase the person’s anxiety. You will also reduce danger to yourself by maintaining a margin of safety that allows you time to react.

If you must touch an anxious person to provide medical care, explain what you are about to do before you begin. If the person objects, decide if: 1) the procedure can wait until the person is less anxious; 2) someone else might be better suited to provide the care, e.g. someone who has established stronger rapport with the person; or 3) the procedure must be done by you at this very moment. This third option should be a last resort, chosen only due to medical necessity. If this is your decision, be prepared for the possibility of the patient reacting negatively.

2. Be aware of your own body position
In addition to maintaining adequate space between you and an anxious person, avoid eye-to-eye, toe-to-toe positions, as they might be interpreted as challenging. Positions perceived as challenging can evoke a ‘fight or flight’ response from the other person, and neither of those reactions is likely to be helpful. Standing at an angle to the person and off to the side is much less likely to escalate an agitated person’s behaviour.

3. Be empathic to others’ feelings
Try not to judge or discount the feelings of others. Whether or not you think their feelings are justified, those feelings are real to the other person. Pay attention to them, and don’t be afraid of silence. Your supportive presence is often more important than what you say.

4. Keep non-verbal cues non-threatening
As a person begins to lose control of rational thought, he or she becomes more tuned into your body language and less tuned into your words. Non-verbal communication – including gestures, facial expressions, movements and tone of voice – becomes paramount in conveying a calm, respectful attitude.

5. Ignore challenging questions
When a person challenges your authority or an organisational policy, redirect the individual’s attention to the issue at hand. For example, suppose a female visitor is smoking in a waiting area. You remind her that there is no smoking allowed in your facility and ask her to put out her cigarette. She responds by saying, ‘Who are you to tell me what to do?’ Answering this type of question only leads to a non-productive power struggle, and it also sidesteps the issue at hand – the woman’s smoking. It is better to ignore the challenge and restate your request.

6. Set and enforce reasonable limits
If patients or family members become belligerent, defensive or disruptive, establish limits and directives clearly and concisely. When setting limits, offer simple, clear choices and consequences to the acting-out individual. Be sure the consequences are reasonable and enforceable.

7. Permit verbal venting when possible
It is often the safest and best alternative to let a person shout, removing others from the area when feasible. Allow the person to release as much energy as possible by venting verbally. When a person is venting, there will be peaks and troughs in the outburst as the person’s energy expenditure rises and falls. If you cannot allow the person to continue venting, state your directives and reasonable limits during the ‘troughs’ in the venting process.

8. Identify the real reason for the behaviour
Even in the midst of an angry tirade, there is useful information to be gained about what a person is thinking and feeling. The real reason for a person’s outburst is often not what it seems to be. Anxious patients and family members can be highly critical of clinic staff for reasons that are much more related to the fear and helplessness they are experiencing than to the ways staff members are performing their duties. Try to listen for the real message – the feelings behind the facts. Restate the message you think you have received in order to determine if you have correctly understood the person’s intent.

9. Stay composed, avoid overreacting
It is hard not to take things personally, especially since angry people often say very personal things. But it is essential to do your best to remain calm and professional – at least on the outside. Your composed, rational response can go a long way towards influencing the person’s behaviour in a positive way.

10. Use physical techniques only as a last resort
Physical restraint should be used only when people’s behaviours are dangerous to themselves or others. Physical intervention itself always carries some risk of injury to staff or to the person being restrained. Such interventions should be used, therefore, only when it is more dangerous NOT to intervene.

Furthermore, physical interventions should be used only by competent staff members who are trained to use the safest, least restrictive methods of intervention possible and who are well-versed in any applicable regulations or laws pertaining to restraint use in their facilities.

Prevention promotes a culture of caring
Not every crisis situation can be successfully diminished, but trained staff members who know these 10 key principles are much more likely to influence behaviour in a positive way, defusing potential crisis situations before they become dangerous. Prevention is the best way to promote a culture of caring and a safe and respectful workplace for everyone.

The information above was adapted from 10 Tips for Crisis Prevention by CPI and is provided with permission. Article courtesy of Campus Safety Magazine

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