Episode 230: Violence in Health Care

“A lot of healthcare workers that I talk to say that they are kind of brought up with the culture that violence is part of the job. It’s not your job to take abuse,” Chris Snyder, University of Utah Health security manager for the University of Utah Department of Public Safety in Salt Lake City, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS. Snyder gave an overview of violence in health care, educational resources for de-escalation strategies, and violence prevention tips. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by October 21, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.

Episode Notes

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Highlights From Today’s Episode

“If I have a patient who maybe comes in two or three times a month for an appointment, or maybe they’re inpatient, I do want to focus on their baseline behavior. Because any deviation from that gives me the opportunity to practice situational awareness and know that something is happening.” Timestamp (TS) 07:36

“The number-one rule is you have to give your undivided attention. All too often we are multitasking and doing different things, and we’re in a hurry, or it’s the end of our shift, or we’re working overtime. But when you just stop and drop everything and give that undivided attention and show that individual that you’re there to support them and that you’re listening to them and that you’re there to help them, it makes a huge difference in setting the path for the rest of their journey.” TS 12:45

“Another reason why we don’t see things reported is because a lot of our employees feel like, ‘Hey, it has to be an actual physical act of violence for me to report it. Someone has to actually hit me or grab me or throw something at me.’ But workplace violence is defined by the Occupational Safety and Health Administration and other groups as all forms that include verbal aggression, verbal abuse, name calling, intimidation, workplace bullying, sexual harassment, sexual inuendo, in addition to those physical acts of violence.” TS 13:22

“Taking the time to ask questions, explain procedures, even talk about wait times—and in the meantime, tending to a physiological need. . . . Anything like that is a huge step in keeping that person closer to their baseline behavior.” TS 18:50

“We need to trust our intuition because if something doesn’t feel right, it most likely isn’t right. Sometimes our mind does not connect the dots there, but if the hair on the back of your neck stands up, listen to that.” TS 24:03

“[Another important factor is] training and education. You need some kind of training on de-escalation and it dovetails with personal safety. And the reason I say that is because when we talk about personal safety, we talk a lot about how we communicate, and a big piece of that is nonverbal communication. So, safety, communication, de-escalation, all of those things are important.” TS 29:48

“Know before you go. Have you reviewed a patient’s chart? Is there a history? Say we have disruptive behavior—maybe we have a patient who is sexually inappropriate with female staff members. Do all staff members know? Is there a plan in place? . . . Check that patient’s chart information. Are there behavioral indicators that we’re concerned about or any red flags that we want to be aware of?” TS 31:07

“One major rule of de-escalation is that you cannot control somebody else’s behavior. It’s not possible. We can only control our own behavior. And by mastering that, we can influence another person’s behavior. And hopefully, if they’re at the top of that roller coaster, we’re not riding up to meet them. We’re staying down at the bottom. We want them to come down and meet us because that’s when we’re going to actually communicate and have a conversation. . . . And also know what our own boundaries are. We’re human beings. I could be the best at de-escalation and always maintain my composure, but I have a tipping point as well.” TS 32:42

“Another thing that we don’t often discuss is the importance of debriefing. We talk about, ‘Let’s debrief as a team,’ what went right, what went wrong, what were the triggers, what happened, is everybody okay? That includes physical injury and emotional injury, as well. But we are in the habit of only debriefing bad things. How about we debrief a good thing every once in a while?” TS 37:30

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