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September 30, 2015

Hospital Violence Reduction and SCARF Triggers

Hospital Violence Triggers

Hospital Violence Triggers for Conflict or Crisis

In a recent MORI opinion poll patients indicated that they want to feel a close presence of clinical staff and to receive better communication from staff.  

“Information is crucial – lack of information contributes to anxiety and discomfort of patients and carers who are waiting”.

Staff generally circulate well within Emergency Departments, however this is usually the case at particularly ‘easy’ times within the ED – if the ED gets busy then less staff are circulating and therefore there are less staff for the visitor to the ED to stop and ask questions of!  Information from staff becomes critical during busier times.

We often notice that the information screens (the queuing system in the Triage area and the message screen in ambulance triage and in Majors and Minors areas) sometimes are not displaying any (or any useful) information from the patient or visitors point of view.   This increases their need for personal comfort from a member of staff.

We recommend that the provision of clear and timely information to patients and visitors about what is happening regarding their care should always be a priority in the ER as it will reduce Hospital Violence Triggers.

Approach, Attention and Awareness for reducing the risks of Hospital Violence Triggers

Our team noticed one interaction between an attending client who presented at an Ambulant Triage area.

She spoke for her friend and directly said to the nurse at the desk:  “My friend has redness and swelling to her face and arms – can she see someone?”.

I noted particularly the response of the nurse:    “You must register” [pointing around the corner].    The nurse:

  • had not smiled
  • had not offered any kind of welcome or greeting
  • had not introduced herself
  • had issued a three-word command, not a request
  • had not expressed any empathy toward the afflicted person
  • gave no other clarity or certainty about “how” things work

Simply, clear opportunities to reduce or halt the onset of stress in the presenting client and her visitor friend had been missed, all at the first interaction.   It can be assumed that many more interactions followed during that patient’s journey through the ER.  If all of them followed the same pattern as described above, then we believe that a basic reminder of customer-service skills may in fact go a long way towards reducing the incidence of Hospital Violence Triggers – or status-induced – aggression.

Simply, our staff approach should offer where possible:

Status Welcome, Hospitality, Respect, Privacy

Certainty Timely Information and Clarity,

Autonomy Options, Alternatives, Choice

Relatedness Genuine Warmth, Understanding of Cultural Issues, Empathy

Fairness Consistent Rules, Promises Kept, Give-and-Take when necessary

Of course this is not always possible, but for the majority of frustrated clients, we believe that these five focusses lie on the pathway to a more peaceful ER and the avoidance of the main triggers in Hospital Violence.

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Gerard O’Dea is a conflict management, personal safety and physical interventions training consultant.  He is the training director for Dynamis, a specialist provider of personal safety and violence management programmes and the European Adviser for ‘Verbal Defense and Influence’, a global programme which addresses the spectrum of human conflict.  www.dynamis.training



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Gerard O'Dea

Gerard O'Dea is the Director of Training for Dynamis. Training Advisor, Speaker, Author and Expert Witness on Personal Safety, Conflict Management and Physical Interventions, he is the European Advisor for Vistelar Conflict Management, a global programme focussing on the spectrum of human conflict.

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