Prevention and Management of Violence and Aggression Training

Prevention and Management of Violence and Aggression Training STEPHEN WHEELER

Are we at risk?

Prevention & Management of Violence & Aggression in the WorkplaceAims • To enable an understanding of aggression and violence that may be encountered during the course of your employment. • To offer a framework to be used when faced with an angry person. • To recognise and respect the diversity within our environment, while promoting and delivering good practice in the safe prevention and management of violence and aggression.

Prevention & Management of Violence & Aggression in the WorkplaceObjectives • to recognise and defuse potentially violent episodes. • to avoid overreaction to episodes of violence. • to maximise staff and client safety. • to enable the confidence. • to recognise what can be dealt with safety and what cannot.

Organisational Expectation • NHS Lanarkshire does not expect any of its staff to put themselves at undue risk from violence and aggression. • Prevention of violence and aggression is the safest and preferred option. • It is acceptable to acknowledge instinct and to explore alternative strategies. • Not all risk comes from clients.

Your Responsibilities. Familiarise yourself and comply with: • Organisational policies and procedures • Local policies and procedures • Health & Safety Control Book Complete accident reports for all incidents and near misses. Attend and participate in training

What Increases Risk?

What Increases Risk? • Working alone • Working outside normal working hours • Working within a community • Handling valuables and medication • Providing or withholding a service • Exercising authority • Working with people who are emotionally or mentally unstable • Working with people who are under the influence of drugs and/or alcohol • Working with people under stress • Working with people who have to wait while in pain or discomfort.

What is Violence? The Health and Safety Executive (HSE) 2004 define violence as, “Any incident in which a person working in the healthcare sector is verbally abused, threatened or assaulted by a patient or member of the public in circumstances relating to his or her employment.”

What makes YOU Angry?

Perception • What makes one person afraid or uncomfortable may be perfectly acceptable to someone else. It is necessary to take this ‘personal perspective’ into account. • It is important to recognise that individuals will view incidents differently.

Obvious warning signs Group Exercise

EYES Pupils dilate. Staring Crying FACE Sweat Skin Color changes Grimacing Sneering Clenched teeth POSTURE Upright stance Invading personal space Neck and shoulder muscles tense VOICE Tone and pitch changes Volume and speed of speech increases. Speech content changes, obscenities, threats, insults, dismissive remarks and silences. Replies to questions abruptly often with aggressive Spitting out words Lost for words [can’t think straight] May become quieter. Uncommunicative BREATHING Breathing becomes faster and more shallow, HANDS White knuckles Clenched fists Obscene/gestures Throwing things Thumping fist on objects Slamming doors Pointing fingers Shaking fists Hidden hands [possible concealed weapon] BEHAVIOUR Appear oblivious to surroundings Signs of confusion Signs of withdrawal Signs of delusions and/or hallucinations FEET Pacing Very still Kicking the ground

What causes Violence and Aggression? A combination of factors: • Anger • Frustration • Medical or Psychological conditions • Influence of drugs and/or alcohol • Power or control issues

The Typical Assault Cycle Excitable Transfer [possible additional assaults] ( based on Kaplan and Wheeler (1983) Escalation Phase Crisis Phase Summit Post Crisis Depression Phase Escalation shift Trigger phase Plateau or Recovery Phase Decent Emotional Transfer Emotional Transfer Baseline Behaviour

Self Defense • You can act in self defence of another inScots Law and you can come to the assistance of a person under threat of imminent physical violence.

Use of Force • A person may use force as is reasonable in the circumstances for the purpose of • Self Defence • Defence of another • Defence of Property • Prevention of a Crime • The use of force must be both necessary in the circumstances and should be proportional to the threat

Understanding Fear & Anger The Adrenaline Flows • Glucose is released by the liver • Breathing gets faster • The heart beats faster • Skin changes occur • The pupils of the eyes open wider • Blood is diverted from the digestive system • The muscles tense for action And so the body is prepared for Fight or Flight.

Points to note • Being angry can be normal • An angry person will be looking for reasons to justify the way they feel and therefore, their behaviour. • An audience may inflame the situation. • Being grateful can minimise feelings of anger.

De-escalation • De-escalation is based on core values and skills. • We communicate a great deal about ourselves by our non-verbal behaviour, which seems more important than what we say. • Although most non verbal behaviour is unconscious and automatic we can take control.

De-fusion & De-escalation • When faced with a potential violent incident, de-fusion and de-escalation should be attempted as a first option where possible. • De-fusion & De-escalation are influenced by the attackers ability to understand what is being said. Where this ability to understand is absent defusing and de-escalation is affected.

GROUP WORK

Assessing Risks Assessing RisksSpectrum of Dangerousness No problem A bit iffy [could go either way] Difficult [all your skills] Dangerous [all your skills plus luck] “aaaargh”! [the wrong place at the wrong time]

Prevention and Management of Violence and Aggression Waiting for the GP.

Actions • Safety takes precedence • Give obvious assistance. • Make friendly gesture • Make a Concession

Receptionist Scene one • The receptionist is really busy, especially as his colleague has had to slip out for an hour.He also has been given typing to do which is urgent. • The clinic didn’t start on time and is now running late . • A queue has built up.

Actions • Apologise • Talking and/or listening should be tried in the first instance. Hear • Communicate clearly Use words appropriate to the violent person’s level of understanding. • Demonstrate an interest in what the person is saying.

Receptionist Scene 2 • The next patient is obviously annoyed at having to wait for attention. • Swaying slightly, he says aggressively: “I’ve been waiting ten minutes in this queue. Its’ just not good enough

Actions • De-personalise issues. Divert the focus • Personalise yourself. Turn you into a “real” person. • Empower the client. • Acknowledge that if you work together you can both find a solution.

Receptionist Scene Three The telephone beside the receptionist rings: “Excuse me”, he says to the patient, and answers the telephone,he then has to go and find some information. He completes the telephone conversation and then turns his attention again to the patient: “ • Where were we? • What was it again?”

Actions: Voice • Tone Avoid being provocative or patronising, • Pitch • Volume • Accent Can cause an escalation.

Receptionist Scene Four • But the patient retorts: “ If that phone rings again before you’ve dealt with me, I’m going to teach you a lesson you’ll never forget.”

Actions • Convey a desire to reduce distress • Acknowledge concerns and feelings. “I can appreciate how worried you must be…………..” “I can see the difficulty you have…….” • Check understanding. Recap

Receptionist SceneFive • The phone rings again and the patient immediately thrusts his hand across the desk. “ Right, you’ve been warned. I’m going to have you.”

Actions Give the person time and space. • Safety strategies • Safe environment • Alerts

Receptionist SceneSix • WRONG PLACE • WRONG TIME

Actions • Facial Expression • Gestures • Posture • Proximity and angle to the other person • Body Buffer Zone Personal space

Actions: Eye Contact • Staring • Squaring up • Confrontational Taking notes can promote natural limited joint eye contact.

De-escalation TechniquesNon-verbal Mirroring is a subtle, non-verbal interaction, which encourages mimicry by others Can be calming in some situations.

Remember • We have no control over what people say or the way they act, but we do have control over the way we behave and respond to their behaviour. • The angry person may have been justified.

Prevention and Management of Violence and Aggression Training