Community Health Clinic Presented By Steve Wilder BA CHSP STS Sorensen Wilder amp Associates ID: 249417
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Slide1
The Essentials of Aggression Management in the Community Health Clinic
Presented By:
Steve Wilder, BA, CHSP, STS
Sorensen, Wilder & Associates
Bourbonnais, ILSlide2
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…Slide3
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…Slide4
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…Slide5
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…Slide6
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
. Slide7
Incidents of Workplace Violence are equally catastrophic in nature, but can be avoided, if we understand the issues, and know what to look for.Slide8
Nearly 1/3 of all Americans are victims of crime each year3 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 workplaceThe Impact of Violence in the WorkplaceSlide9
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. FactsSlide10
Always Remember
Incidents
of
Workplace Violence
can be avoided, if we understand the issues and know what to look for.Slide11
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 killedSlide12
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 Slide13
To increase safety and lessen your chances of being injured, follow some simple guidelines:
Limit physical interventions
Use adequate number of staffDevelop and train Emergency Response Teams
Provide training to all employees
Train using role playing, situations, and mock drillsResponding To A
Violent SituationSlide14
Male
80%Probability
Caucasian
75% Probability
Working Age
90% Probability
Characteristics of the Potentially Violent PersonSlide15
90% Will Display One Or More Of The Following
Characteristics of the Potentially Violent Person
Pathological Blaming
Depression
Personality Disorder
History of ViolenceSlide16
90% Will Display One Or More Of The Following
Characteristics of the Potentially Violent Person
Erotomania
Interest in weapons
Chemical Dependence
Alcohol dependenceSlide17
90% Will Display One Or More Of The Following
Characteristics of the Potentially Violent Person
Elevated Frustration Levels
Impaired Neuro Functions
Evidence of PsychosisSlide18
Recognizing and Avoiding Potentially Violent Behavior
The Aggression Continuum:
Six
Steps from Calm to ViolentSlide19
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.Slide20
The Aggression Continuum
Remember what the sticker on the top step says:
DANGER
Do Not Stand HereSlide21
The Aggression Continuum
STEP 1:
the Person is
Calm
CalmSlide22
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 ContinuumSlide23
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 ContinuumSlide24
The Aggression Continuum
STEP 2:
the Person is
Verbally
Agitated
Verbally Agitated
CalmSlide25
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 youThe Aggression ContinuumSlide26
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 ContinuumSlide27
The Aggression Continuum
STEP 3:
the Person is
Verbally
Hostile
Verbally Hostile
Verbally Agitated
CalmSlide28
Step 3: Verbally Hostile
Persons Actions:
behaviors very similar to being
“
verbally
agitated”
person is oblivious to efforts to calm him
The Aggression ContinuumSlide29
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 ContinuumSlide30
The Aggression Continuum
STEP 4:
the Person is
Verbally
Threatening
Verbally Threatening
Verbally Hostile
Verbally Agitated
CalmSlide31
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 ContinuumSlide32
Step
4:
Verbally Threatening
Your Response:
Maintain eye contact
Avoid
cornering
the person
Give person options
ANTICIPATE VIOLENCE
The Aggression ContinuumSlide33
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 Cornering
A
- Angular Cornering
P
- Psychological Cornering
E
- Exit Cornering
CORNERINGSlide34
The Aggression Continuum
STEP 5:
the Person is
Physically
Threatening
Physically Threatening
Verbally Threatening
Verbally Hostile
Verbally Agitated
CalmSlide35
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 ContinuumSlide36
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 ContinuumSlide37
The Aggression Continuum
Physically Violent
Physically Threatening
Verbally Threatening
Verbally Hostile
Verbally Agitated
Calm
STEP 6:
the Person is
Physically
ViolentSlide38
Step
6: Physically Violent
Persons Actions:
Physically attacks you in some form
The Aggression ContinuumSlide39
Step
6: Physically Violent
Your Response:
Change to self defense/survival mode
The Aggression ContinuumSlide40
Watch for non-verbal clues :
Sudden Movements Toward You
Tightening Of Small And Large Muscle GroupsTwitching Of Facial Muscles
Darting Eye Movements
Fixed StaringAdditional Key PointsSlide41
Watch for non-verbal clues :
Glancing For Weapons
Shifting BalanceRaised Voice Pitch And Increased Volume
Changing Stances
Increased Breathing RateAdditional Key PointsSlide42
DON’T Give Orders Instead Of Choices
DON’T
Project A “Don’t Give A Damn” Attitude
DON’T
Over StareDON’T Make Threats Or Lie To The IndividualDON’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 ManagementSlide43
DO Monitor Your Own Status
DO
Demonstrate Self Confidence
DO
Stay Calm And RelaxedDO Keep Voice Pitch/Volume DownDO
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 ManagementSlide44
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 IndicatorsSlide45
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 IndicatorsSlide46
1. Commitment To Outcome
2. Pay Attention
3. Know The Aggression Continuum
4. Assessing The Cause
5. Avoid Ego Battles
Ten De-
Escalants
To ApplySlide47
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 ApplySlide48
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 IncidentsSlide49
Triangle Approach
Back Up #1
Back Up #2
In Charge
AggressorSlide50
Triangle Approach
Back Up #1
Back Up #2
In Charge
AggressorSlide51
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 supervisorIf You Are Involved In A Violent SituationSlide52
Talk about it!Watch for signs of Post Traumatic Stress Disorder
Utilize
CISD Teams Utilize
EAP programs
Utilize Crisis Intervention TeamsCritique each session from Quality Improvement
perspective
If You Have An Incident…Slide53
QUESTIONS / COMMENTS
Steve Wilder
Sorensen, Wilder & Associates
Bourbonnais, IL 60914
815-482-2989 (cell)
swilder@swa4safety.com
www.swa4safety.com