Katie Young (l) and Cherise Debousse demonstrate
how to correctly counter an aggressive move by a patient.
Preventing workplace violence is part of HUP’s wide-ranging efforts to keep patients, families and staff safe. Changing the hospital’s visitation policy and forging an environment of civility and mutual respect are both making an impact on decreasing the potential for these incidents. Now, HUP has rolled out a third component: violence prevention training from the Crisis Prevention Institute (CPI).
The training, which is available to all levels of HUP staff from any department, focuses on “giving people tools to prevent a situation from increasing in severity,” said Molly Moore, MSN, Nursing Professional Development specialist, who heads the initiative. “It teaches ways to recognize a difficult situation and then how to modify your behavior to de-escalate that situation. In the majority of cases, people are not mad at the actual staff member, but at something else going on in their lives.”
Some believe this kind of hospital violence occurs primarily in the ED, but nothing could be further from the truth. “There’s not a specific patient population,” said Katie Young, RT, one of the course instructors. “It occurs in a low percentage of patients [and visitors] but it’s widespread. It can happen anywhere.”
Three Levels of Training
The training is available in three class levels: Prevention First, Foundation, and Advanced Skills. The first level, Prevention First — an online only course — lays the foundation for de-escalating difficult situations. It demonstrates how verbal, nonverbal (e.g., body language, facial expressions, proximity) and paraverbal (how you say what you say) communication “can all affect how someone responds to you,” Moore said.
The second level, Foundation — an online course and an in-person training class — allows participants to practice the de-escalation skills and language learned in the online course, in a variety of situations found in the health care setting. “All of our scenarios are ones you may encounter in a hospital,” Moore said, such as a patient getting frustrated while waiting for an appointment or coming into the ED already feeling angry. (Prevention First, the online only component, is always available. In-classroom trainings have been cancelled until further notice.)
Young and Cherise Debouse, RN, both of whom work on patient care units at HUP, recently led the Foundation session. At the training, Debouse described a personal experience that led her to not only get the training but also go on to be trained as a CPI instructor. An elderly patient, who initially seemed calm and pleasant, kept saying throughout the day that she wanted to go home. Debouse tried to talk and distract her but, that evening, Debouse saw the patient walking down the hall to leave the unit, pocketbook in hand. The patient – who at 5’2” did not seem intimidating – would not go back to her room; she was intent on leaving, no matter how Debouse tried to gently dissuade her. Finally, as they got near the door to exit the unit, the patient whacked Debouse with her handbag.
While Debouse was taken aback, she also learned an important lesson: Don’t assume a patient isn’t capable of becoming aggressive.
Young agreed. “To prevent a situation, you need to see its potential to become aggressive.”
The third level of CPI training, Advanced Skills, incorporates physical skills, such as disengagement techniques and holds, along with the verbal de-escalation concepts. This level will only be offered to members of HUP Security.
Moore said that the goal of the training is to have a standardized hospital-wide approach to de-escalate situations before they reach a violent level. But, she stressed, “it is not a replacement for calling Security if you feel unsafe.” HUP Security can be reached by calling 2677 from any HUP phone.
To enroll in the CPI training, employees need to complete the attestation for the level of training they plan to complete. To enroll in the Prevention First (online only) Program, search “CPI: Prevention First Attestation” on Knowledge Link. Once the attestation is signed, the CPI Program will automatically populate an employee’s Knowledge Link Learning Plan.
If you would like more information or have any questions, please reach out to Molly Moore (Margaret.moore@pennmedicine.upenn.edu).