OHP 1

1
In pairs introduce yourself covering

• Name, place of work and job title.
• What experience have you of abusive and
  aggressive behaviour in the workplace?
• What do you hope to get from the course?

2
General Definitions of Abuse

• Abuse misuse, make bad use of, deceive,
  maltreat, revile,an established unjust or
  corrupt practice Fowlers Dictionary
• Abusean act of misuse, exploitation, deceit,
  wrong or improper use or action so as to injure,
  damage, maltreat or corrupt Stuart
  Sindeen

3

Defining Abuse

• Abuse can be categorised as
• Physical
• Emotional
• Sexual
• Psychological
• Financial
• Neglect
• Actual
• Potential
• Short term
• Long term

4
class
race
position
gender
Power
status
strength
knowledge
age
relationship
5
Aggression

• Any form of behaviour intended to harm or injure
  someone against his/her wishes
• Includes any form of injury, including
  psychological or emotional injuries

6
Aggression

• Instrumental - a means towards some other end
• Emotional - angry aggression/deliberately
  conflicts injury

7
Violence

• Deliberate attempts to inflict physical harm

8
Channels for abusive/aggressive behaviour

• From client to worker
• From client to client
• From worker to client
• From worker to worker
• From person onto self

9
Why People Become Aggressive/Abusive

• There are many reasons why people become
• abusive/aggressive
• These are some examples
• Alcohol/drugs
• Lack of communication/information
• Believing its the only option
• Feeling cornered
• Fear
• Psychological (eg negative thoughts)
• Emotional (eg turmoil)

10
Why People Become Aggressive/Abusive (cont.)

• Frustration
• Being kept waiting
• Too hot/too cold
• Boredom
• Overcrowding
• Resentment
• Anger
• Triggers prior to your involvement
• Your behaviour
• Stress
• Too many demands

11

• Triggers can be
• Internal (thoughts, feelings, beliefs)
• External (situation, behaviour, people)

12
Verbal Communication

• 7 Verbal
• What we say,
• Words, phrases and content
• 38 Vocal
• How we say it,
• Tone, intonation, pitch and pace
• Sarcasm comes into this category
• Bluck/Bennett

13
Non-verbal Communication

• 55
• Body movement
• Body language
• Gestures
• Facial expressions
• Eye contact
• Bluck/Bennett

14
Personal Space

• Everyone has their own personal territorial
  needs. They may vary from time to time depending
  on several factors.
• Culture Sex
• Familiarity Emotion
• Environment
• This zone/territory can increase 3 fold when we
  are angry.
• Bluck/Bennett

15
Personal Space (Proxemics)

• Rules of Distance
• Public distance-
• Public gatherings.(eg the choice of distance on
  a beach)
• Used for unknown people.
• Touch not possible without moving.
• A distance of 10 to 18 feet.

It must be remembered that when someone is
seated, to lean over them is to enter their
intimate space in a most threatening
manner. Bluck/Bennett
16
Personal Space (Proxemics)

• Social Distance
• From 18 inches to two arms length or more.
• Shaking hands distance.
• Touch not possible without moving.
• Used when parties have limited choice about
  relating to each other or when the person is
  relatively unknown.
• Bluck/Bennett

17
Personal Space (Proxemics)

• Personal Distance
• One arms length.
• Touch requires consent.
• For private conversation used only when sure of
  the boundaries of the relationship.
• If the rule is broken it is likely to produce a
  backward movement, eye contact is avoided and
  attempts at distance are made.
• Bluck/Bennett

18
Personal Space (Proxemics)

• Intimate Distance
• Less than one arms length.
• Either the person can choose to touch the other
  without having a chance to avoid the touch.
• Belongs to a very close relationship.
• When rules are necessarily broken, (ie on a bus)
  the impact is reduced by avoiding eye contact.
• Bluck/Bennett

19
The Reactionary Gap

• The Relationship Between Time and Distance
• The time it would take to cover
• 6 feet Less than half a second
• 12 feet Less than a second
• 21 feet Less than one and a half seconds
• Bluck/Bennett

20

• Risk of violence greater if the person
• Is a member of a group which condones violence
• Has history of violence
• Is aroused by some aversive stimuli
• Is disinhibited
• Expects violence to be rewarded
• Believes no other action possible
• Breakwell 1997

21

• Other risk factors
• The person has been threatening violence
• Cues to violence eg weapons
• Display of high arousal signs
• Person is being verbally abusive
• Peer group pressure being exerted
• Non-verbal signs
• Breakwell 1997

22
Trigger Factors

• These increase the risk from potential to actual
  violence within therapeutic relationship
• Intensification of aversive stimulation
• Onset of disinhibition
• Sudden absence of alternative options
• Arrival of cues
• Increase in reward
• Use of words/phrases (barbs)
• Sudden major life changes/new stressors
• Misinterpretation of persons behaviour
• Breakwell 1997

23
Communicating Effectively

• To communicate effectively you should avoid
• Making assumptions about people, their appearance
  or accent
• Sounding disinterested, not using tone or rhythm
  - you will sound bored or boring
• Letting tension get the better of you - your
  voice becomes higher pitched
• Bluck/Bennett

24
Communication

• Keep people informed
• Stay calm and communicate clearly
• Use every day language and not jargon
• Deal as calmly as possible with questions and
  queries even if you think they are trivial
• Look out for signs things are escalating
• Bluck/Bennett

25
The Assault Cycle

• This is a tool to look at process which occurs
  during an episode of violent/aggressive behaviour
• There are 5 phases
• The trigger phase
• The escalation phase
• The crisis phase
• The recovery phase
• To past crisis depression phase

26
The Trigger Phase

• Movement away from their normal baseline
  behaviour
• Use different language
• Increase in anxiety/suspicions
• Goal is to decrease above feelings
• Non-threatening
• Listening skills
• Concern
• Defusion skills
• Dont overreact - instil confidence

27
The Escalation Phase

• Behaviour deviates from their normal at fast rate
• Decrease in logic and reasoning
• If defusion hasnt worked, think of own safety
• This phase leads to violent behaviour
• Intervene as early as possible
• Compromise, offer concessions if they stop their
  behaviour
• Assailants who accede to small concessions are
  more likely to agree to larger ones
• You may call in a colleague for back up/support
  or leave the area

28
The Crisis Phase

• Due to heightened physical, emotional and
  psychological states of arousal the control over
  violent behaviours dramatically lessens.
• It is dangerous to attempt any defusion
  techniques. The safety of yourself and others in
  the area is now paramount.
• GET OUT.

29
The Recovery Phase

• Gradual return to their normal behaviours. Can
  take up to 90 minutes to come down.
• Dangerous time as intervals errors most made
  during this phase.
• Person very susceptible to triggering off again.
• Do not try to analyse the problem.
• Give clear instructions about what you expect
  from them.

30
The Post Crisis Depression Phase

• The person may drop below their normal baseline
  behaviours and become tearful, guilty and
  ashamed.
• The person may now be amenable to interventions
  to look at the incident.
• Our aims should be to relieve the persons guilt
  and look at ways of preventing the incident
  happening again.
• This phase is not inevitable for some people
  there will be no guilt, shame or remorse.

31
Reducing the Risks

• Risk assessments should be undertaken in
• environmental problems and hazards
• working patterns and routines
• behaviour

32
Tactics for Defusion

• Maintain adequate distance
• Avoid corners, move toward a safe place
• Explain intentions to the person and others
• Appear calm, self-controlled and
  confidentBluck/Bennett

33
Tactics for Defusion

• Acknowledge the persons anger, feelings and
  concerns.
• Ensure your own non-verbal communication is
  non-threatening.
• Ask for facts, encourage reasoning.
• Be aware of how to call for help.
• Leave the area. Bluck/Bennett

34
Defusion Techniques

• Look and behave non-aggressively
• Appear calm, self controlled, think of the
  message you are giving out with your body
  language.
• Check your own posture - sit down but only if you
  are in no immediate physical danger. Bluck/Benne
  tt

35
Defusion Techniques

• Do not lose your temper
• Keep to a normal tone of voice, be assertive.
  The aggressor may raise their voice or start
  shouting, be sure you do not mirror this
  behaviour. Bluck/Bennett

36
Defusion Techniques

• Show concern
• Show concern for the aggressor and their problem.
  If it is appropriate then apologise. Be
  honest, if you would be upset under the same
  circumstances, then say so. Bluck/Bennett

37
Defusion Techniques

• Choices
• When they start to calm down offer a menu of
  possible solutions. Be honest, realistic and
  open.
• Do not make promises that cant be kept just to
  rid you of the immediate problem - unless your
  physical safety is in danger.
• Offer allegiance, by an ally. Bluck/Bennett

38
Defusion Techniques

• Location
• Change location if thought helpful - move away
  from an audience but remember not to put yourself
  at further risk.
• If at all possible try to separate a group or a
  pair. Bluck/Bennett

39
Defusion Techniques

• Offensive behaviour/language
• Do not allow this behaviour to go without
  comment. Recognise their behaviour and ask for
  it to stop. Address the aggressive behaviour
  first before delivering a service or
  information.
• Responses such asIf you stop threatening me
  then I will be able to help you to look at
  Bluck/Bennett

40
Defusion Techniques

• The cost
• Make it clear about the cost of behaving
  aggressively.
• Inform the aggressor that if their behaviour
  continues you will not be able or prepared to
  help look for solutions.
• An intervention you may consider is to inform the
  aggressor that if the behaviour doesnt stop you
  will call the police. Bluck/Bennett

41
Defusion Techniques

• Repeat verbal responses
• Broken record techniques or memorise verbal
  responses in advance.
• Acknowledge their anger
• Make it clear you have heard how angry or upset
  they are. Acknowledge their feelings and rights
  - but dont necessarily agree. Never be
  dismissive or over-bearing.
• Bluck/Bennett

42
Defusion Techniques

• Express your need
• What I would like in this situation, what is
  bothering me Use this if you feel it may help
  the other person be responsive but no t if it is
  going to be judgmental or blaming.
  Bluck/Bennett

43
Defusion Techniques

• Appeal to past good behaviour
• Say things likeWe never had this trouble
  before
• Try to help the aggressor save face and not look
  foolish for their when they have settled down.
  Bluck/Bennett

44
Defusion Techniques

• Diversion
• Change the subject or move the topic on.
• Be careful if you offer a cup of tea and perhaps
  a cigarette.
• Bluck/Bennett

45
Defusion Techniques

• Lightening the mood
• a well timed joke may help but not in the heat of
  the encounter. This is a difficult technique as
  judgment on the right time to joke in a
  potentially dangerous situation has to be spot
  on. Bluck/Bennett

46
Defusion Techniques

• Get information
• Ask the aggressor what the problem is, what the
  aggressor needs, what is causing concern, what is
  it that is bothering them.
• Acknowledge the information
• Check that you have fully understood the problem.
  Repeat back what you have heard. Bluck/Bennett

47
Defusion Techniques

• Imminent Physical Assault
• If you feel concerned for your physical safety
  then leave. Use any method at your disposal to
  ensure your safety, for example deception etc.
• It didnt work
• With the best will in the world there will be
  occasions where it is just not possible to defuse
  the violent incident/individual.
• Bluck/Bennett

48
Legislation

• Employment Rights Act 1966 - Section 44
• Prevents an employer from taking action such as
  dismissing or disciplining an employee who leaves
  their place of work because of danger which they
  believe to be Serious and Imminent and which
  they could not be reasonably expected to prevent.
• This includes taking any appropriate steps to
  protect themselves or others from danger.

49
Legislation

• Health Safety at Work Act 1974 -
• Section 2 (1)
• It shall be the duty of every employer to ensure,
  so far as is reasonably practicable, the health,
  safety and welfare of all his employees.

50
Legislation

• Health and Safety at Work Act 1974
• Section 2 (2)
• It is the employers responsibility to ensure
  that employees receive such information,
  instruction, training and supervision, as is
  necessary, to ensure the health, safety and
  welfare of staff by ensuring staff are competent.

51
Legislation

• Health and Safety at Work Act 1974
• Section 7
• It shall be the duty of every employee while at
  work to take reasonable care for the health and
  safety of himself and of other persons who may be
  affected by his acts or omissions at work.

52
Legislation

• Management of Health Safety at Work Regulations
  1992
• This imposes a new requirement for employees to
  bring to the attention of employers any situation
  or condition which the employees consider to be a
  serious danger and any shortcomings in the
  employers health and safety arrangements.

53
Legislation

• Criminal Law Act 1967
• Section 3
• Any person may use reasonable force in self
  defence.
• Whilst the law imposes a duty on a potential
  victim to retreat and escape it may not always be
  possible.
• In this case the use of force and/or restriction
  of liberty in self defence is likely to be
  considered legitimate.

54
Legislation

• Terms used in both civil and criminal law
• Assault and Battery
• Criminal assault occurs when one person, either
  by a physical action or possibly a verbal
  utterance, causes another to believe that they
  are about to be subjected to any form of physical
  violence (apprehension).

55
Legislation

• Assault and Battery
• Battery occurs only if actual violence is
  inflicted. However under civil law, assault and
  battery include the simple act of touching.
• A nurse touching or making as if to touch a
  patient without lawful authority or the patients
  consent could, under civil law, be accused of
  committing assault and or battery.
• (Gajos 1998)

56
Legislation

• How do we define reasonableness?
• Reasonableness is
• a) No more than necessary to accomplish the
  object for which it is allowed (not for
  punishment, retaliation etc).
• b) In proportion to the harm which is threatened
  - the greater the danger the greater the force is
  considered reasonable.
• The law in some circumstances takes into
  consideration
• that the defender may only have a brief moment
  to
• decide their actions.

57
Legislation

• Any use of force must be
• proportionate
• legal
• accountable
• necessary