Photo: kieferpix / Thinkstock

What to Do When Patients Start Screaming At You

You’re at work, with not enough hours in the day to do everything you need to. You’re exhausted, but if you don’t stay focused, many lives could be affected. 

For healthcare and hospitalist workers, patients acting distressed or agitated comes with the job. Far too often this distress and agitation lead to verbally volatile behavior. 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, “hospitalists should focus on what they can control,” says CPI’s Judith Schubert in an article for The Hospitalist. 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.  
 
Empathy is key. 
  
Empathy is an integral part of decreasing fear and anxiety. As taught during CPI’s Nonviolent Crisis Intervention® training 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 important to remember that there is always an underlying cause for the agitation. Many temporary medical conditions can cause agitation, as can intoxication, or even just the stress of being at a hospital. CPI refers to these as precipitating factors. These factors are out of our control and play a major role in your, and your patients’, behavior. 
  
Get training. 
  
De-escalation training teaches you to 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.” 
  
Fortunately, organizations are recognizing the necessity for staff training. 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 to maintain safety.  

See how CPI training thoroughly aligns with the Join Commission’s mandates.
  
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.” 
  
For more information on the training CPI has to offer to defusing disruptive behavior, here’s an overview of our Nonviolent Crisis Intervention and Verbal InterventionTM training. 


Image Credit: Lightfield Studios/Shutterstock
Find Our Podcast
Feedback