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De-escalation. Prevention of violent or aggressive incidents. What can you do?

De-escalation. Prevention of violent or aggressive incidents. What can you do?. Understand how aggressive situations develop Understand how to minimise such situations Understand strategies that may reduce the risk of violence. Some myths 1.

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De-escalation. Prevention of violent or aggressive incidents. What can you do?

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  1. De-escalation. Prevention of violent or aggressive incidents. What can you do? • Understand how aggressive situations develop • Understand how to minimise such situations • Understand strategies that may reduce the risk of violence

  2. Some myths 1 • despite what you read in the papers the UK is generally a very safe country, the rate of violent crime is lower than most other western countries. .

  3. Some myths 2 • The British crime survey http://www.homeoffice.gov.uk/rds/pdfs06/hosb1206.pdf reports • a reduction in violent crime by 43% in last 10 years to 2006. • 16-24 year old men are most at risk of being victims of violent crime • Most violent crime does not result in injury to the person. It is ‘low level’ such as pushing and shoving

  4. Aggression and health professionals • violence to health care professionals may be becoming more frequent but is still uncommon. • Like the general public we must also consider the risk of violence • the stress to health care professionals who have to deal with distressed or disturbed individuals is considerable

  5. The influence of emotion • Events that involve emotions can influence the way we and our clients, think, feel andbehave. • Strong emotions bias the way we think and reduce self awareness and problems solving. • People become more impulsive and consider consequences less

  6. SOME EMOTIONS DEFINED: • FEAR: (anxiety) a response to a threat. • RESENTMENT: Where we feel others are getting things we want or feel we deserve. • FRUSTRATION: When we don’t like what we get, events cause us displeasure. • REPROACH: We feel someone is to blame for events, we attribute purpose and malice. • ANGER: Frustration + blame

  7. Aggression and behaviour • Aggression is a set of behaviours that indicate an act of violence may occur • it may or may not be associated with anger/fear • the expression of emotions is an interaction, and engages the emotions and behaviours of the other person. • Look at one of the models of escalation and see if it makes sense.

  8. The role of anger • If someone is exposed to certain unpleasant stimuli a set of automatic systems make anger more likely; • Pain • Discomfort • Feeling under attack e.g. unfair treatment, malice, self esteem. • Being afraid e.g. not understanding, being in danger. • Mood state e.g. don’t care • Stimuli that are: • Sudden • Intense • Unpredictable • Uncontrollable • Add to this effect; • Exposure to scenes of violence • Presence of weapons • Use of hostile words • Arguments • Other forms of arousal e.g.. heat.

  9. Cumulative effect • These make us more likely to attribute malicious intent to the behavior of others, we look for someone to blame. • We then consider actions – and consider consequences. • Things which interfere with rational thinking interfere with this element of self control e.g.; alcohol

  10. Reducing riskControlling the environment • Reception areas are well planned they look clean and friendly • Natural daylight and fresh air • Crowding is avoided so there is a perception of space • Noise levels are controlled • Staff belongings are in a safe area • Good visibility for staff • Clear guidelines/policies about violence and substance misuse • Clear lines of communication and able to discuss risk with managers • Layout of furniture as barriers • Access to exit for escape • Access to alarm • Are other staff aware of who is being seen? • Movable objects as potential weapons • Is everyone aware of procedures? • Collective risk awareness/management and team responses • Training in recognising risk, negotiation skills, Escape skills

  11. Reducing RiskCONTROLLING OUR BEHAVIOUR: • Be approachable • Be aware of warning signals and NV cues • Be aware that anger and agitation is often based on fear. • Be aware of and control your own anger / anxiety. • Consider your own beliefs and prejudices • Avoid becoming defensive and responding to insults • Consider your own body language • Take a relaxed defensive stance, hands open and available, avoid sudden movements

  12. Preventing escalationDo’s • Allow the person time and space to describe the situation. • ‘Tell me exactly what is bothering you’. • ‘Lets sit down and talk about this’ • Show concern and understanding for their feelings. • ‘I can see your upset’ • ‘If that happened to me I would be put out too’ • ‘I want to make sure I’ve got this right’ • Communicate clearly give information clearly check understanding. Repeat if needed and try not to be condescending. • Convey you desire to help sort out the problem. • ‘I am sure we should be able to sort something out’ • ‘At least we can make a start’

  13. Preventing escalationDon’t Say or imply • ‘I am in the right’ • ‘How dare you say that’ • ‘I can’t let them get away with that’ • ‘Don’t be silly’ • ‘Other people have much worse problems’ • ‘Yes but that’s your fault’

  14. Preventing escalationDo’s • focus on the problem not the person • ‘I am afraid we are not allowed to do that, can you think of another way around it’ • Personalize yourself • ‘That just what my husband says to me’ • ‘When my mother went in hospital I was really worried’ Make a concession • ‘You have a point there’ • ‘I can see something’s gone wrong somewhere’ • Make a deliberately friendly gesture • ‘Would you like me to phone the housing people for you’? • ‘I can give you some leaflets that might help’ Get people to consider consequences • ‘If your were in my position what would you do’ • ‘If you did that what would happen’

  15. Final thoughts: • Remember that some people may behave in ways that appear strange and antisocial. These behaviours can influence ours; we could avoid people, become paternalistic or become afraid and increase the risk of anger. • Don’t feel you have to be brave. • Take threats seriously, if you feel at risk leave the situation and get help. Or; • Tell the client to leave. • Run away • Raise the alarm – shout scream. • Lock yourself in a safe area. • Consider a physical response.

  16. Student nurses role • if you feel at risk do not stay in a situation • leave quietly and calmly if possible. • avoid turning your back on someone who is very angry, • don’t touch the person • keep your distance. • Learning from adverse incidents; • Debriefing • Serious incident review • Clinical supervision/reflective practice

  17. Resources and guidance • http://www.rcpsych.ac.uk/PDF/NICE%20Guideline%202005.pdf. http://guidance.nice.org.uk/CG25/guidance/pdf/English/download.dspx • for the NICE guideline on Clinical Practice Guidelines for Violence: The Short-term Management of Disturbed/ Violent Behaviour in Psychiatric In-patient Settings and Emergency Departments 2005 • Health development agency violence and aggression in General practice

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