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Effective de-escalation training in healthcare is crucial for navigating volatile patient interactions, especially amid the increasing prevalence of violence against healthcare workers. These de-escalation techniques are vital for maintaining trust with patients while ensuring healthcare worker safety. In this blog post, you’ll learn about the state of workplace violence in healthcare, why de-escalation training is essential, and core techniques healthcare workers can use to safely de-escalate tense situations.
The Need for De-escalation Training in Healthcare
As defined by the National Institute for Health and Care Excellence (NICE), de-escalation in healthcare refers to “the use of techniques (including verbal and non-verbal communication skills) aimed at defusing anger and averting aggression.” The goal of these techniques is to ensure both healthcare worker safety and patient safety by addressing and soothing tensions before they escalate into more serious—or even dangerous—incidents.
While violence can occur in any workplace or institution, it is important to note that it is four times more likely to occur in healthcare settings, according to the U.S. Occupational Safety and Health Administration.
Even more alarming, according to the American Hospital Association, 44% of healthcare workers reported experiencing physical violence at work, and 68% reported being verbally abused. This underscores the need for effective de-escalation training in healthcare to improve the well-being of patients and healthcare worker safety.
The impact of workplace violence in healthcare extends beyond immediate physical harm. The mental and emotional toll of experiencing violence cannot be understated, as 6 in 10 healthcare workers have considered leaving their jobs or changing their profession entirely due to workplace violence in healthcare. Such violent patient interactions can significantly contribute to healthcare worker burnout and add to nurse turnover within a healthcare organization.
Healthcare workers subjected to aggression and violence in the workplace are also at a higher risk of experiencing severe mental health issues.
According to a study by “Healthcare (Basel),” healthcare workers that were exposed to violence were two to four times more likely to report high levels of post-traumatic stress disorder (PTSD), anxiety, depression and burnout compared to their counterparts with no exposure. This only exacerbates the already high levels of stress healthcare workers experience daily.
Workplace violence also comes with substantial costs for healthcare organizations. According to a report by the American Hospital Association, around $4.7 billion of hospital expenses are allocated for security measures. Additionally, healthcare workers that were affected by workplace violence were more frequently on leave, costing hospitals approximately $53.7 million annually in absenteeism.
Overall, the repercussions of workplace violence ripple throughout healthcare organizations, from the administrative level all the way down to healthcare worker safety. These issues lead to:
- Increased absenteeism
- Reduced job satisfaction
- Mental health issues among staff
- A decline in the quality of patient care
Therefore, workplace violence prevention efforts through effective de-escalation training in healthcare is not just about addressing immediate safety issues, but about sustaining the health and safety of the healthcare workforce and organization as a whole.
De-escalation in Healthcare: Techniques That Work
The Joint Commission strongly advocates for de-escalation training techniques as the primary method for managing agitated or aggressive behavior in healthcare environments. They recommend using restraints and seclusion only as a last resort, citing significant risks including humiliation, trauma, and even death for the patient.
Supporting this stance, data from the Cochrane Library reveals that 40% of restraint-related deaths in the United States were caused by unintended asphyxiation during restraint.
By effectively preventing violence through effective de-escalation, healthcare workers can reduce the likelihood of situations escalating to the point where restraints are considered necessary, thereby safeguarding both patient and healthcare worker safety.
Effective techniques for de-escalation training in healthcare involve a combination of both verbal and non-verbal communication skills, empathy, and situational awareness.
Incorporate Training and Education
De-escalation training in healthcare is necessary to equip healthcare workers with the skills and tools they need to manage tense situations effectively. Given that healthcare workers cannot predict or control patient reactions, training in de-escalation techniques is essential for maintaining safety and ensuring staff are prepared to handle challenges calmly and competently.
At Penn Presbyterian Medical Center (PPMC), healthcare workers undergo rigorous de-escalation training as part of a system-wide commitment to protecting staff from violence. This training not only teaches valuable de-escalation tactics but also equips staff with the knowledge to recognize early signs of potential violent outbursts, allowing for timely intervention before situations escalate.
Feedback from participants post-training indicates its effectiveness: approximately 54% of those who completed the PPMC de-escalation training agreed or strongly agreed that it made them feel more equipped to safely de-escalate a situation.
By investing in continuous training, healthcare organizations can ensure that their staff are always prepared and able to handle conflicts safely.
Reduce Noise and Distractions
There are several preventative measures healthcare organizations can take to de-escalate stress before it can cause conflict. One such measure, as explored by Forbes, supports the idea that reduction of noise in the healthcare setting can greatly reduce stress in both staff and patients.
For example, Massachusetts General Hospital’s Lunder Building is a prime example of how noise reduction can benefit healthcare organizations. After they implemented an innovative design to cut down on average noise levels, interviews revealed that patients were sleeping better, and staff were able to work more effectively with fewer interruptions from noise. This approach helps healthcare organizations proactively reduce stress and tension, preventing agitation and potential violence among patients right from the start.
Use the “STAMP” Method
The STAMP method is a method used by healthcare staff to assess observable behaviors that indicate potential for violence in patients. By making note of these behaviors, healthcare workers can be prepared for the early signs of agitation and intervene to de-escalate the patient before the behavior can become violent.
The acronym STAMP consists of five distinctive behaviors:
- Staring and eye contact: Excessive staring is an early indicator of agitation and is often used as a cue to prompt providers into action or to pay more attention to the patient. Similarly, while a lack of eye contact can sometimes be interpreted as anger or passive resistance, it's crucial to consider cultural factors. In many cultures, avoiding eye contact is a sign of respect rather than defiance, so these instances should be distinguished from behaviors motivated by negative emotions.
- Tone and volume of voice: Tone and volume of voice was associated with 13 of the 16 violent episodes involved in a study on violence assessment within an emergency department. This behavior can manifest as yelling and raised voices, or as sarcastic and caustic remarks intended to cause discomfort or hurt.
- Anxiety: While it is perfectly normal for patients to be anxious within the clinical setting, it becomes concerning when this anxiety is excessive and compounded by mental health issues, head injuries, substance misuse, or other disorienting factors, which can potentially lead to violent behavior.
- Mumbling: Mumbling is a precursor to more violent behavior because it is perceived to be a sign of mounting frustration. Mumbling, incoherent speech, and slurring of words can also indicate the presence of disorientating substances that might make the patient more volatile.
- Pacing: Similar to mumbling, pacing is an indicator of mounting agitation, which may also manifest as fidgeting, staggering, waving arms, or pulling away from providers. Not only does pacing signal potentially disruptive behavior, but it can also create unease and anxiety among other patients.
Utilize Active Listening and Empathy
When it comes to de-escalating a situation without resorting to physical restraints or medication, active listening and empathy go a long way in soothing a patient.
Active listening involves fully focusing on the patient, not just hearing them but also engaging with active body language like eye contact, open and visible hands, and even sitting down to signal attentiveness. It also involves asking clarifying questions and reflecting statements back to the patient, which helps ensure they feel truly understood.
Alongside active listening, showing empathy—recognizing and validating someone’s emotions—can significantly soothe and reassure a patient. Phrases such as, “I understand this is difficult for you” or “I can see that you are very upset, and I want to help,” can humanize the interaction and diffuse tensions.
Together, active listening and empathy not only reduce anxiety and tension in agitated patients but also foster trust between the patient and provider, enhancing relationships and improving overall care outcomes.
Empowering Healing & Safety Through Compassionate De-escalation
De-escalation in healthcare offers numerous benefits, not only in terms of healthcare worker safety, but also in improving the overall quality of care within a healthcare organization. By effectively addressing and calming potentially violent situations, the risk of harm toward healthcare workers is significantly reduced. This allows for a top-down approach to care, as staff that feel safe and comfortable in their positions can better help patients achieve positive health outcomes.
A notable success story demonstrating the power of proper de-escalation techniques involves Dr. Lynn Roppolo, MD, and her empathetic approach to handling agitated patients. Recalling a particular incident, Dr. Roppolo described entering a tense situation where a severely agitated patient was being restrained by five officers. “I walked in the door and said to him, 'I’m Dr. Roppolo, sir. I’m here to help you, and you are safe,’” she explained.
Over the next several minutes, Dr. Roppolo actively listened to the patient, gradually persuaded the officers to leave the room—keeping one as a precaution—and maintained a safe distance by positioning herself near the door. Through this careful and respectful engagement, she uncovered the root cause of the patient’s frustration, enabling her to successfully de-escalate the situation.
Dr. Roppolo’s approach emphasizes a soothing and empathetic demeanor over immediate physical restraints or medication. By prioritizing the safety of both the patient and herself, maintaining situational awareness, and ensuring a protective barrier by staying close to the exit, she exemplified effective crisis intervention techniques.
“De-escalation requires empathy, compassion, kindness, partnering, understanding, and a sincere willingness to help,” Dr. Roppolo said. “Try to understand why the patient in front of you is agitated and treat them like you would want to be treated if you were in their shoes.”
Final Thoughts
As healthcare becomes increasingly more complex and demanding, the need for proper techniques for de-escalation in healthcare is critical for effective conflict management within the care setting.
By equipping healthcare workers with the skills and strategies needed to effectively de-escalate potentially dangerous situations, organizations prioritize creating a safe and supportive environment for both staff and patients. This approach goes beyond merely preventing violence; it proactively cultivates a culture of safety, empathy, and respect. Such an environment not only ensures the safety of healthcare workers but also enhances their ability to provide compassionate care to the patients they serve.