Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Preparing for a Meeting with a Potentially Violent Client (OSACH, 2006):

Proper preparation can greatly decrease the risk of a violent incident with a potentially violent client. Consider these strategies before meeting with such a client:

  • Gather information about the individual and his or her characteristics. If possible, find out what triggers violent behaviour in this person. Review previous reports and client files or consult with internal or external resources. Respect client confidentiality.
  • Meet in as safe an area or room as possible. Consider these factors:
      1. Natural surveillance opportunities
      2. Secured furniture and absence of sharp objects or items that could be thrown or used as weapons
      3.  Access to escape routes
      4. Access to panic button or alarm mechanism and telephone
  • Treat or interview potentially aggressive or upset clients in a relatively open area, while observing client confidentiality and privacy.
  • If you cannot choose the meeting location, bring a co-worker.
  • Let security and other staff know when and where you are meeting.
  • Ask a co-worker to telephone you at a predetermined time during the meeting. Give “yes” or “no” answers to pre-planned questions such as:
      1. Are you okay?
      2. Do you need me to join you?
      3. Do you want me to call security or the police?
  • Give the client copies of documents so that you can keep your distance.
  • Be on time; waiting can trigger anger.

Body Language

Employees must pay close attention to the body language of a potentially violent client. A hostile stance increases tension and interferes with verbal communication. When approaching an angry person:

  • Stand about one metre (three feet) away (that is, outside the individual’s personal space), on an angle (as opposed to . directly in front of the person) and on the person’s non-dominant side (people usually wear watches and part hair on the non-dominant side)
  • Place yourself so that you have a clear exit
  • Position yourself on the same physical level; avoid standing over the person
  • Use calm body language: hands open, attentive facial expression, relaxed posture
  • Avoid pointing or gesturing; make no sudden movements
  • Avoid touching the person
  • Avoid staring eye contact

Verbal Communication

Talking can defuse anger. Here are some strategies to use when speaking with someone who is angry:

  • Make your first contact neutral or non-directive: for example, ask how you can help. This inquiry communicates a sense of normal interaction.
  • Always be courteous to clients despite their behaviour. Introduce yourself and call them by name.
  • Use active listening skills. Do not interrupt.
  • Confirm your understanding of the issue or problem by repeating what the client has told you.
  • Acknowledge the client’s feelings and concerns.
  • Use simple language; avoid jargon or technical language.
  • Speak slowly, quietly and confidently.
  • Remain open-minded and objective.
  • Always be honest. Do not make promises that you cannot keep.
  • Keep the client’s attention focused on the current issue.
  • Use silence as a calming tool.
  • Always attempt to explain delays or long waiting periods. Not doing so can be construed as discourtesy.
  • Be prepared to apologize as necessary and accept criticism positively.
  • Avoid giving commands.
  • Look for ways to the help the person save face.
  • In a calm and non-threatening way, explain that violence is unacceptable and is not tolerated.
  • If you feel threatened, politely and calmly terminate the interaction.

Terminating an Interaction with an Angry Client

If you feel threatened, or if the interaction is increasing a client’s anger, terminate the interaction immediately.

  • Calmly but politely interrupt the conversation.
  • Tell the person that the conversation is over.
  • Either leave or ask the person to leave.
  • If the person does not leave, inform a manager or supervisor immediately.
  • Notify other staff in the immediate area.
  • If required, call the emergency response team. Consider using a silent alarm or code word if your organization uses these.
  • Call the police.
  • If you threaten to call the police, be prepared to call them.

Complete an incident report after the employee has received treatment.

 

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