Ten strategies to extinguish potentially explosive behavior
Donna K. Leckey BSN, RN, EMT-Paramedic

August 2011 
Volume 41  Number 8
Pages 55 - 59
  PDF Version Available!

ACCORDING TO A SURVEY by the Emergency Nurses Association, between 8% and 13% of ED nurses reported that they were victims of violence at work every week. When violence was reported, 15% of nurses said they sustained physical injury. In 97% of incidents of physical violence and 91% of verbal abuse, the attackers were patients or their relatives.1Although violence can occur in any area of a healthcare facility, the most volatile areas are the ED and psychiatric unit. Besides treating victims of violence, staff on these units care for many patients who are under the influence of alcohol or drugs. In addition, fewer inpatient psychiatric beds and the lack of mental health services in some communities mean that many unstable psychiatric patients end up in acute care hospitals.2This article will review how to protect your patients and yourself from potentially violent behavior by taking a look at early signs of patient agitation and potential causes of anger. It will also discuss 10 practical strategies to help you defuse violent situations.Violence prevention policies and security protocols vary from facility to facility, so check and follow the policies and procedures where you work. All facilities are expected to have a safety plan to protect employees. According to The Joint Commission's Environment of Care Standard, the plan should include a statement of commitment to the health and safety of staff, patients, visitors, and the community, as well as to the protection of the environment.3 Your facility should take a zero-tolerance approach to these types of situations.Become familiar with the safety plan at your facility and know when to call for backup. Know the location of panic buttons in your units and when to use them.Violence toward nurses manifests in various ways. Being struck, perhaps with the patient's hand or an object lying near the patient, is an example of physical violence. Violence can also take the form of verbal threats, which can vary from the patient

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