blowing out the fuse

8/14/2019 Blowing Out the Fuse

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University Community Hospital

The Department of Spiritual Care

Bishop Bruce Wright Ph.D. - Manager.

Rev. 07/09

Blowing Out the Fuse!Understanding The Angry Patient

andDefusing Explosive Situations



The Angry Patient



Understanding The Ingredients of an Explosive

Situation



Inside the Patient

Anxiety Fear

Nausea Pain Loss of Control

Why me?



On the Surface of the Patient

Aggression Blame PlacingConfrontational Intimidation Frustration Demanding

Profanity Seizing Control Anger



The FuseMatches Courtesy of Hospital Staff

(Remember...Perception IS Reality!)

Non-Caring DefensivenessConfrontational Condescension

Evasiveness Inattention



The Equation for Disaster A (Patient’s Internal Emotional State) +

B (Patient’s Aggressiveness) +

C (Staff Defensiveness)

equals….



Understanding Emotions

“If you know howemotions emerge and change, you can make

patients feel better about their lives, their

health care experienceand your health careorganization.”

Paul Alexander Clark



Emotions1) Are chemical and neural

reactions in the brain.2) Are a constant experience.3) Are formed from a

combination of:

a) An external stimulus b) Our subjective

experience of thatstimulus

c) And any behaviors thatresult and our internalphysiological response.

Treating the Patient's Emotions By Paul Alexander Clark



We are “hardwired” to detectemotions in others.

•Facial expressions.•Body language.

•Tone of voice.•Implicit as well as explicit behaviors



We have the emotional need to have our

emotions acknowledged and validated by others.

When we do not feel that

emotional validation,happiness subsides, despairintensifies, depressiondeepens, anger grows and

internal emotional needsare unfulfilled.

Treating the Patient's Emotions By Paul Alexander Clark



And because emotions are biochemical in

nature, they can and do influence physical,mental and psychosocial health.



ACE (Adverse Childhood Experience) Study

• A major research study 17,421 participants.• Compared current adult health status to childhoodexperiences.• Results: subjects with ACE experience: 4-50 times morelikely to have adverse health or disease as an adult• Adverse emotional experience was the biggest single factor in predicting adult health

.Foege WH. Adverse childhood experiences: A public health perspective. Am J Prev Med 1998 May;14(4):354-5.

. 60% to 90% of physician visits are stress related

. Stress is linked to the six leading causes of death, whichinclude heart disease, cancer and suicide.

American Psychological Association, 2008, Heart Pangs?



Every patient arrivescarrying emotional

baggage.

Anxiety Fear Nausea Pain Loss of Control Why me?

We must always remember…



Therefore we must make sure we’reaware of what emotions we are

eliciting in our patients.

And every experience, every staff interaction, every sight, sound, taste and

smell stimulates and accentuates emotions in the patient.



We must continually ask ourselves…

What are my words, my posture, andmy attitude saying to my patient?

Concern or disinterest?

Empathy or

irritation?

I care and you matter,or I don’t really care because you don’t

really matter.



Am I showing empathy?

Am I demonstrating that I care?



For a few minutes, put on the patient'sgown. How it would feel…

“Think about what it feels like towake up for a blood draw at 3a.m.

How does it feel to hear youcan't spend the night withyour child, spouse or loved one?



For a few minutes, put on the patient'sgown. How it would feel…

How does it feel to cryand have no one notice?

How does it feel to hear nurses laughing at the

nursing station as you liein your own vomit and

continue to press the call button?”

Paul Alexander Clark, Press Ganey Associates



Nursing Behavior that Triggers Anger

Non-verbal triggersTone of voice: sarcastic, condescending, disbelieving

Other trigger actions: Long wait times, not promptly addressing needs, passing the buck, inattentiveness

Body language: Armsfolded across chest, lookingaway, looking at your watch,smirking, scoffing, rolling your eyes, drumming fingers



Verbal TriggersYou’re wrong.

It doesn’t help to tell customers that they’re wrong, even when they are. Just courteously state the facts, as supported

by evidence. Let the facts speak for themselves.

Nursing Behavior that Triggers Anger

I’m sorry you feel that way.People can see through this old trick.

Say sorry only when you’re sorry.Even when the customer is not

completely right, identify what couldhave been done better, and apologize

for those mistakes.



That’s the policy … I can’t do that Instead…"That’s contrary to our policy,

but I know what you mean. Let me see what I can do."

No way ... Not gonna happen ...

That's impossibleInstead…"I tried to do that for anothercustomer, but I really couldn't get it

approved."

As I’d already said … As I’d said beforeJust repeat or paraphrase what you had said, without

saying you’d already said it.



That’s not my job.It is your job. Take ownership of the problem.

I assume or I guessGet the facts. Don’t

assume, don’t guess.

I’m going to have toend this

conversation … Youmust leave the

buildingUsed only as the lastresort. Used only when

customers are truly dysfunctional.

Calm downThese words oftenhave the oppositeeffect.

You should have Instead…"In casethis happens again,

it might help you to”

You have to . . .Instead…"Would you please …"



Instead of lighting the

fuses, let’slearn how toblow out the

matches!



Non-verbal De-escalation Techniques

The most important aspect of de-escalation with angry patients.

¥

65% of communication - nonverbalcommunication & vocal qualities of speech.

¥

35% of human communication through thespoken word.

Using Body Position toDefuse Angry Peopl, Loo, http://www.hodu.com/defuse.shtmlTristan Loo



During a hostile confrontation between two people, both parties will naturally, and often unthinkingly, assume

either defensive or aggressive nonverbal behavior.• Finger pointing(very aggressive)

• Glaring Invasionof personal or evenintimate space (4”and closer)

• Arms crossed Widening of stance

• Hands on hips• Fingers clenchedinto a fist

• Increase in the volume of voice

Using Body Position toDefuse Angry People, Loo,

http://www.hodu.com/defuse.shtmlTristan Loo



Instead of further igniting the situation through our body language, we can also train ourselves to promote peace through

nonverbal cues that express peacefulness.

Using Body Position t oDefuse Angry People, Loo, http://www.hodu.com/defuse.shtmlTristan Loo

De-Fusing Through Non-Verbal Cues



The single biggest nonverbal gesturethat conveys peace is by placing yourpalms up so that they are facingupwards.

This feels entirely unnatural when weare confronted with a hostile person,so it requires practice, but you canpractice this during any conversation.

Open palms not only convey submissiveness, but also honesty.


Palms Up!



When someone becomes angry at us, it iscommon for them to turn their body sothat it is directly facing our own.

Instead, orient your body position angled

in such a way that if you were to draw aline in the direction that both of you arefacing, it would intersect at an imaginary third point.

Provides a feeling of openness during theconversation.

Creates that imaginary third point whichacts like an escape route.


Triangle Body Pointing



When angry people speak louder.

Our response is to raise ourown voice.

Vocal competition fostersconflict.

Instead speak in a gentle,

calm, and soothing tone. … just a few notches higherthan barely audible.

Lower Your Voice!

Eliminates competition

They can’t respond to

something that they can’t hearso they lower their voice inresponse.




Most animals, including humans, areprogrammed to minimize exposure to

their necks because this is a vital area

that can be attacked.

Head tilting is a peaceful gesture

because by tilting your head, you

expose your neck.

Has the psychological effect of disarming the other person by making

you seem less threatening.

Head Tilting




Respect Their Personal Space.

Entering an upset person's personal space can intensify his orher emotions.

3 - 6 feet

Healthcare Training Weekly, October 25, 2007

www.hcpro.com/NRS-78059-975/Use-nonverbal-cues-to-ease-angry-patients.html

Three feet is adequatefor most situations,

however allow up to 6feet for aggressive and

confrontationalpeople.



An Open StanceCaregivers should assume a stance in which they slightly

turn their body at an angle to the patient while keeping theirhands open and in plain view. Angry patients will perceive this stance as less threatening.





Appropriate Eye Contact and FacialExpressions.

Your face and eyes convey a direct message to thepatient.

You should maintain general eye contact, but not stare atthe other person.





The goal is to establish or reestablisha collaborative relationship.”

(Simms, C. (1995). How to unmask the angry patient. American Journal of Nursing, 95(4),36-40.).

Rather than focusing on the stressfulemotion of anger alone, nurses must

focus on the patient and the fears heis facing

Therapeutic Responses to Anger

Focus on interacting with the patient rather than reacting tothe anger.

Dodaro, D.C. (1988). Beyond the wall. Nursing, 18(4), 96.



Be calm and reassuring.

Seek to understand any underlying problems.

Acknowledge their feelings of anger .

Focuses on empowering the

patient , and redirecting the energy once used for anger for more

productive means.

Murdach, A.D. (1993). Working with potentially assaultive clients. Health and Social

Work, 18(4) 307-312.



Take an active role in this situation by addressing the patient's actions

Provide a safe and supportive environment forthe patient to express his feelings

Refuse to be disagreeable.



Most Importantly…..

When you have an angry patient,remember...



A - Apologize•No matter who's to blame; apologize anyway.• You are not accepting blame, you are simply saying, "I'm sorry about the

problem."•Be completely sincerity. Be sure that tone of voice matches words.

S - Sympathize•Identify with his feelings. Validates his feelings

A - Accept Responsibility• Let him know that you intend to make things right.

• You can't help what has already happened, but you will come up with a

solution to the problem or you will find someone who can. P - Prepare to Take Action•Decide what to do•Do it

•Report back to the patient



Blowing Out The Fuse!

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