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Response teams help diffuse volatile situations


Hospitals and care centers are places of healing, but they’re also places of high emotion.


Many facilities have workplace-


violence plans in place for times when patients, family members, visitors or even co-workers lose control. Indiana University Health and


St. Vincent Health both include workplace-violence training in the core competencies employees must review yearly. Web-based trainings teach employees how to identify potentially violent situations and then provide scenarios to help them practice the skills. “We give them tips


Everett


and ideas and strategies for how to diffuse the situation, how to calm whoever is being aggressive, and get the situation under control,” said Linda Q. Everett,


PhD, RN, NEA-BC, FAAN, executive vice president and chief nursing executive for IU Health.


Additional support | At the beginning of 2011, IU Health formed an aggression prevention team comprised of social workers, chaplains, safety and security officers, behavioral care clinicians and administrative supervisors who have been trained to diffuse potentially violent situations. Most of the time, Everett said, employees on the unit are able to circumvent a problem before it spirals out of control. When they can’t, it’s reassuring to know that the APT is only a call away. “The trained health care professionals


on staff at IU Health — nurses, physicians and others who may be interacting with patients and families — are pretty skilled at knowing when something is getting out of hand. When they begin to feel threatened or uncomfortable, they call the team.” Kimble Richardson, MS, LMHC,


LCSW, LMFT, LCAC, is a licensed mental health counselor with the St. Vincent Stress Center of Indianapolis. He said St. Vincent’s critical incidence stress management team assists with extreme situations. “If a visitor or family member can’t


Kimble Richardson, a licensed mental health counselor with the St. Vincent Stress Center of Indianapolis, addresses the issue of stressed-out patients and family members.


seem to get calmed down, we could eventually get called in for that,” he said. “We try to use other means first. We try to have an understanding of why people are upset and what we can do to help them.”


Clear expectations | Richardson and Everett said the safety of employees and patients is tantamount, and visitors who become violent are asked to leave. Both hospitals permit supervisors to form an agreement with a potentially volatile individual before a situation escalates. The agreement spells out acceptable behavior and the consequences of breaking those rules. Everett said the approach has been successful since its implementation this year. “If it looks like there’s going to be


a social issue [or] a difficult family or patient situation, we devise a care contract with that patient or visitor that really holds them to a certain level of behavior,” Everett said. “I think it’s helped. We’re trying to introduce strategies that will calm people and remind them that certain behaviors are expected of them even if they are a patient or a visitor.” ●


MARC LEBRYK / Custom Publications


Recognize the signs According to Kimble Richardson, MS,


LMHC, LCSW, LMFT, LCAC, a licensed mental health counselor with St. Vincent Stress Center of Indianapolis, people tend to exhibit certain behaviors when they’re about to lose their temper or become violent. “You don’t have to be a mental health professional to notice those things, but it takes a little bit of sophistication to be attuned to other people’s social cues,” he said.


Signs of escalating aggression include:


■ Clenched jaw ■ Faster breathing ■ Pressured or louder speech ■ Wringing hands or clenching fists ■ Cursing ■ Pacing


Recognizing the signs is the first step, but


nurses must know what to do in these tense situations. Richardson said it’s possible to stop an episode before it really begins just by listening and offering to help. “Many times, that helps calm people


down pretty quickly,” he said. “In many cases when people are getting upset like this, they just want information. They want to know that you’re attending to them.”


Indiana Nursing Quarterly • indystar.com/nursing • Fall 2011 9


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