What to Do When Patients Start Screaming At You

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You’re at work, busy with not enough hours in the day and too many all at the same time. You’re exhausted, but if you don’t stay focused, more lives than your own will be affected.

Except right now, you’re being screamed at by someone you’re trying to help.
For health care and hospitalist workers, patients acting distressed or agitated comes with the job. Unfortunately, that could lead to verbally volatile behavior. That doesn’t mean it’s a good thing, or that it should be accepted; just that it’s all too common.
While blowing off steam can allow the person the chance to calm down on their own, what do you do when instead of getting calmer, the person only gets angrier—and becomes physically aggressive or violent?
It starts with you.
First, “[h]ospitalists should focus on what they can control,” says Judith Schubert, president of CPI, in a recent The Hospitalist article. This includes monitoring and moderating your own behavior, from the tone in your voice to your stance, being aware of the environmental factors around you, and continually assessing the risk involved. 

Add in empathy.
Empathy is also an integral part of decreasing fear and anxiety. As taught during CPI’s de-escalation training, a unit in the Nonviolent Crisis Intervention® program, “challenging or oppositional questions and emotional release or intimidating comments often mark the beginning stages of loss of rationality,” says Schubert. “These are behaviors that warrant specific, directive intervention aimed at stimulating a rational response and diffusing tension. Before it even gets to that point, empathy, demonstrated with the patient and family members, can reduce contagion of emotional displays that are likely rooted in fear and anxiety.”
It’s also important to remember that there is always an underlying cause for the agitation, and that it’s not necessarily linked to persons with mental illnesses. Many temporary medical conditions can cause agitation, as can intoxication.
Get training.
As mentioned above, de-escalation training will help you help someone regain control while keeping everyone, including yourself and bystanders, safe. Verbal de-escalation is, in fact, an essential part of helping avoid the need for a takedown or restraints, says Dr. Scott Zeller, MD, chief of psychiatric emergency services at Alameda Health System in Oakland, CA. “Knowing how to safely help a patient calm down will result in better outcomes for the patient, the physicians, and everyone nearby.”
The Joint Commission has mandated that healthcare facilities address workplace violence risk, and that “staff are trained in the use of nonphysical intervention skills” to prevent the use of restraints and seclusion, and, if this last resort is reached, that staff are trained in nonviolent methods.
So what can you control?
At the first signs of agitation, you need to stay calm yourself, says Dr. Aaron Gottesman, MD, SFHM, director of hospitalist services at Staten Island University Hospital in NY.
Make sure you and your team are trained to react in productive, safe ways when a crisis emerges, and keep communicating.
“Training will help staff to take steps to ensure that their behavior and attitudes don’t become part of the problem,” says Schubert. “Coordination, communication, and continuity among all members of a hospital team are crucial to minimize conflict, avoid chaos, and reduce risks.”
Want to see de-escalation methods in action? Click on the video below. For more information on the training CPI has to offer, here’s an overview of Nonviolent Crisis Intervention®. 

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About the Author

“I truly value how much CPI’s philosophy revolves around treating every person with dignity and respect at all times—even during their most difficult, vulnerable moments. This philosophy helps workplaces expand their culture of care and operate with compassion as a guiding framework. The more that compassion can drive us, the more we can create positive change.”

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