Hospitals in general, and emergency departments in particular, are feeling the effects of increased demand coupled with shrinking budgets. Personnel are stretched to the limits providing effective care in an environment that is increasingly dangerous due to gang violence, availability of addictive substances, lack of access to primary care physicians, lack of appropriate in-patient psychiatric placements, overcrowding and general chaos. Add to that the limited training many emergency room personnel have in de-escalation techniques and we clearly have a recipe for (potential) disaster.
So, aside from extensive training, what is a person to do?
Take it back to the basics…the very basics.
Try to understand what it might be like from the viewpoint of a visitor to your emergency room. The hustle and bustle; the waiting; the number of people; the waiting; the noises; the waiting; the smells; the waiting; the lack of communication; and, let’s not forget the waiting. If you spend your working hours in the ER you likely have become very accustomed to all of the environmental stimulation. Many of your patients are not so accustomed to everything that is happening around them. Combine that with the fear many people have about being in a hospital and the distrust of medical professionals – it’s no wonder we have people who are agitated in the emergency departments across the country. They simply don’t feel safe.
These might be routine tests to you, but to a new mom or dad sitting with their baby in the emergency department for the first time there is nothing routine about those tests. People who are ill or injured are already under stress. When they are kept waiting for hours before having access to a physician that stress is multiplied. Information is powerful, so simply keeping patients and their family members informed as to the length of wait, or reasons for delays might lessen the feelings of helplessness and minimize violent outbursts.
Nurses, technicians and other personnel involved in triage are a vital tool in helping detect when situations are starting to escalate. How do people’s voices sound? What type of body language are they demonstrating? Do you feel a general sense of unease? Good communication amongst the emergency department team is critical in reducing the occurrences of violent outbursts that threaten the safety of other patients and staff.
Obviously with health care professionals stretched as thin as they are it’s a challenge to spend significant time with each patient in an emergency room, but does that mean the quality of your time spent isn’t significant? Even in brief interactions with patients and their loved ones ER personnel can make sure to treat the families with dignity and respect and show a little empathy. Those small tokens can go far in helping families feel they have an ally instead of an adversary.
Nikki Wince – Mandt System Faculty