How to calm a tense situation before it turns violent

Last week’s code silver and rising anger over continued masking mandates in health care facilities serve as reminders that working in health care may carry a risk to our health and safety.

Fortunately, the man who called in threats of harm to the ATRMC Emergency Department was unarmed when he arrived at the hospital and was quickly apprehended. But Asante employees are now facing growing hostility among visitors who do not want to wear a mask. Oregon recently lifted its Oregon’s COVID-19 restrictions, but health care facilities as well as public transportation are exempt from that order.

Asante’s Workplace Violence Prevention Program, established in early 2020, is designed in part to educate the workforce on crisis intervention techniques and other methods to defuse tense encounters before they escalate into violence.

“When one experiences a crisis they generally go through a crisis cycle, or a typical progression of six phases,” says Jennifer Nidalmia, a clinical practice adviser for Behavioral Health Services. “In the early phases, responding with safety and de-escalation can prevent the emergency or crisis peak and even stop the crisis cycle. However, once the person reaches the crisis peak, the person must be safely guided through the response to complete the phases of recovery and stabilization.”

De-escalation involves a complex range of verbal and nonverbal communication skills that can calm an agitated person to help them regain self-control. Nidalmia and her team have developed the following “quick tips” to help staff members defuse a tense encounter.

Facial expression and body language

Be aware of your body position and posture to avoid escalating an already tense situation.

• Be calm (or at least act calm). Maintain non-threatening eye contact, smile and keep your hands open and visible.
• Listen. Nod your head to show that you are paying attention.
• Respect personal space. Maintain an arm’s length distance from the person. Avoid touching the upset person or their belongings because it may be misinterpreted.
• Approach the patient from an angle or from the side.
• Convey confidence in your ability to resolve the situation.
• Use supportive body language. Avoid threatening gestures, such as finger-pointing or crossed arms.
• Avoid laughing or smiling inappropriately.

Tone of voice

Use a reassuring, non-confrontational tone.

• Talk slowly and calmly. Use a firm, confident voice.
• Convey control and confidence in your ability to resolve the situation.

What to say

Express a desire to help.

• Allow the person to express concern. “Please tell me what’s bothering you.”
• Use a shared problem-solving approach. “How can we correct this problem?”
• Be empathetic. “I understand how frustrating this must be for you.”
• Avoid being defensive or contradictory. This only exacerbates a tense situation.
• Apologize if appropriate. “I’m sorry this happened. Let’s find a way to fix it.”
• Follow through with their problem. “I’m going to bring this to my supervisor immediately.”
• Avoid blaming others or giving the “It’s not my job” message. Instead say, “Let me get someone who can help you with this problem.”
• Be alert to early signs of a patient’s rising anxiety; perhaps offer an empathic inquiry such as, “You seem to be upset. Can you tell me what’s troubling you?”

If you are under imminent threat, call 911 or Security. If you have been subject to verbal or physical abuse, call Asante Compliance’s confidential hotline, (800) 296-7173. For questions related to the Workplace Violence Prevention Program, email Wo********************************@as****.org.

Use RELATE communication

Reassure and Empathize

• “My name is Shea and I am here to make sure you’re safe.”
• “Being here can feel scary and overwhelming.”
• “You’re in a safe place.”
• “It makes sense why you feel uncomfortable.”
• “I am here with you. You are safe.”

Listen

• “I can hear that you’re frustrated.”
• “Tell me what concerns you right now.”
• “Tell me how I can make this experience better for you.”
• “Help me understand what will help you feel safe/better.”

Answer, take Action

• “Here’s what I can do to make this experience easier for you.”
• “My goal is to keep you safe and secure. Help me do that by …”
• “Would you like me to come back in a few minutes to talk more?”
• “It’s difficult for me to listen when you’re yelling.”
• “Can we try to communicate in a different way?”
• “I know this is uncomfortable; I’m sorry.”
• “Can I do …? It will help you …”

Express appreciation

• “Thank you for trusting me.”
• “Thank you for working with me to make this better.”
• “Thank you for listening.”
• “Thank you for communicating your needs with me.”

— Shea Quinn and Bruce Budmayr, Asante Patient Experience