6 steps from calm to violent behavior
Risk managers should encourage health care staff to think of a six-step aggression continuum, suggests Steve Wilder, CHSP, EMT-P, a security consultant with Sorenson, Wilder & Associates in Bradley, IL. The closer the person gets to Step 6, the more likely he or she will turn violent.
In Step 1, the person is calm and nonthreatening, though he or she may be unhappy about an issue.
In Step 2, the person is verbally agitated but the anger is not directed any specific person or object. At this step, the health care staff should listen to the person and try to save his or her self-esteem. Do not give orders.
In Step 3, the person is verbally hostile, ramping up his or her comments and agitated, oblivious to efforts to calm him or her. At this stage, the staff should maintain a nonthreatening body posture and respect the person's personal space. Allow him or her to vent his or her anger, and keep your instructions to a minimum.
As the person moves to Step 4, he or she becomes verbally threatening, focusing his or her anger on specific people and making demands for action. He or she may threaten consequences if his demands are not met. Staff should maintain eye contact but avoid cornering this person. Give him or her options and anticipate that violence could erupt at any moment.
Step 5 is when the person becomes physically threatening. He or she takes a stance that suggests violence and may scan the area for potential weapons. He or she may make aggressive moves against particular people. Staff must know that this is the critical point when violence may be prevented or its effects mitigated. They should assume a defensive posture at this point and be prepared for a physical attack.
Step 6 is when the person becomes physically violent.
"Knowing those steps can help people gauge where they are with this person and adjust their behavior accordingly," Wilder says. "If you don't have some reference points, you're just waiting to see what happens."
Risk managers should encourage health care staff to think of a six-step aggression continuum, suggests Steve Wilder, CHSP, EMT-P, a security consultant with Sorenson, Wilder & Associates in Bradley, ILYou have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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