By Michael Oreskovich

Violent behaviour needs to be carefully managed in a healthcare setting. It poses a danger to patients, families and staff and interferes with care delivery. Runnymede Healthcare Centre has addressed this issue with hospital-wide violence de-escalation training. By recognizing when people are at risk of aggressive behaviour and understanding its root causes, the hospital’s staff are empowered with strategies to safely resolve potentially dangerous situations.

During a hospital stay, stress, anxiety and certain medical conditions may trigger some patients and visitors to use physical force or make threats against others. In 2005, more than one-third of Ontario’s nurses reported being physically assaulted by a patient over the year, according to the Workplace Safety and Insurance Board. Healthcare workers have the second-highest rate of lost time due to injury from workplace violence among all labour sectors in the province.

“A safe and respectful environment is fundamental to the delivery of quality healthcare, and we have zero tolerance for violence at Runnymede,” says Catherine Fitzpatrick, Runnymede’s Director of Flow, Quality, Pharmacy and Privacy. “Although measures were already in place to protect patients, families and staff, our hospital was committed to identifying proactive approaches to workplace violence prevention.”

Hospital-wide violence de-escalation training was launched at Runnymede in May, 2019. The aim was to provide staff with knowledge and techniques to safely resolve potential conflicts before they escalate. The training also helps staff recognize and address warning signs from people who are at risk of violent behaviour. These include non-verbal cues like pacing, and verbal cues like changes in tone of voice.

A key de-escalation technique taught to staff is rational detachment. “This helps staff control how they react to others’ aggressive behaviour and stay calm,” said Halima Arush, health & safety specialist at Runnymede. Key to the practice of rational detachment is understanding that hostility from others should not be taken personally. According to Arush, “this keeps staff members’ response to an aggressive person measured, and helps them focus on resolving the situation in a rational way.”

Staff are also trained to raise their awareness to what are known as precipitating factors, stressors in a person’s life that can trigger violent behavior. Recognizing these factors and being empathetic are key to improve communication with a patient or visitor before they become aggressive. “It helps the person feel understood and that their concerns are validated, so they’ll be more likely to cooperate with staff in a productive way,” Arush says.

Runnymede’s training consisted of an online learning module followed by an in-person workshop. Facilitated by a violence de-escalation expert, the in-person workshops provided staff with an opportunity to role-play their responses to potentially violent scenarios. This includes using a collaborative, team-based approach to resolving tense situations.

According to Raj Sewda, Runnymede’s VP, Clinical Operations & Quality, Chief Nursing Executive & Chief Privacy Officer, there are many benefits to rolling out violence de-escalation training. “It ensures our hospital continues to provide safe, high-quality care by proactively reducing the risk of harm to patients, family members or our staff,” he said. “The training also refines our staff’s ability to be empathetic to their needs – another example of how Runnymede puts patients and families at the centre of their care experience.”

Michael Oreskovich is a communications specialist at Runnymede Healthcare Centre.