Trauma-Informed Care: Preventing Workplace Violence through De-escalation

In today's healthcare settings, particularly hospitals, the prevalence of workplace violence is alarming. According to a 2022 Hennepin Healthcare Survey, 97% of nurses have witnessed some form of workplace violence over the past two years, including acts of verbal abuse, intimidation, harassment, and physical assaults. By implementing trauma-informed care practices and focusing on de-escalation techniques, healthcare professionals can create safer environments for both staff and patients. 

Understanding Trauma-Informed Care

Trauma-informed care is an approach that recognizes and responds to the signs, symptoms, and risks of trauma to better support the health needs of patients who have experienced adverse events. It shifts the focus from "What's wrong with you?" to "What happened to you?”, acknowledging that a patient's life experiences, both past and present, significantly impact their health and behavior.

The core principles of trauma-informed care include:

1. Understanding the prevalence of trauma
2. Recognizing its effects on health and behavior
3. Integrating knowledge about trauma into policies and practices
4. Actively avoiding re-traumatization

Implementing TIC in healthcare settings is crucial because trauma is surprisingly common. Approximately 70% of adults in the U.S. have experienced at least one traumatic event in their lifetime. By adopting a trauma-informed approach, healthcare providers can create an environment that promotes safety, trust, and empowerment for all patients.

De-escalation: A Key Component of TIC

De-escalation refers to strategies and techniques used to prevent, defuse, or resolve conflicts before they escalate into aggression or violence. In a hospital setting, where stress levels can run high, effective de-escalation is essential for maintaining a safe environment for both patients and staff.

Key de-escalation strategies include:

1. Staying calm and reassuring: Speaking softly and slowly, maintaining a relaxed posture, and using gentle eye contact can help reduce emotional intensity.
2. Active listening: Nodding, acknowledging concerns, and paraphrasing the patient's words show that you're genuinely listening and understanding their perspective.
3. Validating emotions: Empathize with the patient's feelings, even if you can't immediately resolve the issue. For example, saying "I see why this is frustrating" can make a significant difference.
4. Setting clear, respectful boundaries: Establish limits for acceptable behavior while maintaining a supportive attitude.
5. Offering choices: When possible, give patients options to help them feel more in control of their situation.

Both TIC and the de-escalation techniques discussed above rely on the healthcare worker’s ability to be empathetic to the patient and their situation. No one wants to find themselves in a hospital seeking care, especially when they are unsure why their or their family member is suddenly unwell. Showing empathy, the ability to understand and share the feelings of another and a cornerstone of trauma-informed care, can help. In a healthcare setting, demonstrating empathy can significantly reduce tension and prevent potential conflicts.

Empathy in healthcare involves:

1. Recognizing the patient's perspective: Try to see the situation from their point of view, considering their fears, anxieties, and past experiences.
2. Acknowledging emotions: Validate the patient's feelings without judgment.
3. Responding with compassion: Show genuine concern for the patient's well-being and a willingness to help.
4. Practicing cultural sensitivity: Be aware of and respectful towards the patient's cultural background and beliefs.

Let's explore how trauma-informed care, de-escalation techniques, and empathy can be applied in common high-stress scenarios in a hospital setting:

Scenario 1: Family Members Awaiting Results

A family has been waiting for hours to hear about their loved one's condition after surgery. They're becoming increasingly agitated and demanding answers from the nursing staff.

First, recognize that the family's behavior stems from fear and anxiety. Approach them with empathy, acknowledging their concerns. Use a calm, reassuring tone. Explain the situation clearly, avoiding medical jargon. Offer to find out more information, if possible, and provide a realistic timeframe for updates.

Scenario 2: Patient in Mental Health Crisis
A patient in the emergency department is experiencing a severe anxiety attack, becoming loud and potentially aggressive.

First, remember that the patient's behavior is likely rooted in past trauma or current distress. Avoid actions that might be perceived as threatening like sudden movements. When working with the patient, speak calmly and clearly. Offer the patient choices to help them feel more in control. Minimize environmental stimuli, especially bright lights and loud noises, if possible.

When TIC Doesn’t Work: Technology to Prevent Workplace Violence

Even the most skilled professionals can find themselves in precarious situations in healthcare settings. In these moments, having robust safety measures becomes crucial. Two technologies that have proven particularly effective in protecting against workplace violence are discreet duress buttons and real-time location systems.

Canopy has integrated discreet duress buttons and real-time location systems in its wearable safety technologies. 

The Canopy Wear-1 Button can serve as a lifeline for healthcare workers facing threats. These lightweight devices, which are worn on healthcare workers’ badge reels, allow workers to quickly press their button and discreetly alert security personnel and nearby colleagues when they feel endangered. By summoning help quickly, others are able to help de-escalate a situation. 

When individuals press their buttons, which include their personal identifying information, the security team and nearby colleagues will, thanks to real-time location systems (RTLS), know where the individual is and who to look for. By highlighting the location of the healthcare worker within the facility, RTLS ensures quicker response times. This technology is particularly valuable in large facilities where every second counts. 

Unlike other technologies, Canopy also provides alert-tracking and audit reports that highlight when and where individuals alert for help as well as the response actions that are taken after the alarm sounds. Thanks to this, victims of workplace violence are no longer required to remember every aspect of the incident for reporting purposes. Instead, they may only need to verify what happened or how they felt in the moments before pressing the button. This takes the onus of reporting off those individuals most impacted by the event and ensures that security teams are made aware of every incident in a timely manner.