Violence and Aggression in the Health Care Sector
Main causes of violence in the health care sector, prevention of violence, verbal and non-verbal de-escalation.
5. De-escalation
5.2. Self-defence communication techniques
- Lack of interest (often connected with a halo effect) = in such a case stay objective and state your opinion clearly.
- Missing competence (assessor doesn´t understand the concrete thing) = again stay objective, if this is in respect to your superior, you need to be very tactful.
- Hidden motive (assessor uses the task for another purpose than supposed) = it is necessary to prepare enough documents that support your other view
- Different view of thing (assessor uses different criteria for evaluation) = point out that you view it another way.
The technique: “the view from the other side”
This technique is not very elegant but is the most effective. Your answers include two parts – in the first, you refuse the statement and in the second, you explain all.
Practical example
The head nurse notes to her colleague: “You made it really easy.”
The colleague answers: “I didn´t make anything easy, I only worked more effectively that the others”.
An older physician says to a younger one: “You want to go home earlier, so you hurried up. “ In addition, he gets the following answer: “I didn't hurry up, I only did not lag behind.”
After a meeting, one colleague gossips about another: “Have you seen Eliška, she sat down next to the chief again”.Eliška said: “I didn’t sit down next to the chief, he sat down next to me.”
In this technique, you can use the first part to gain time for the second part in which you explain the situation. You will face very stupid points in many cases. You can easily decline them. Sentences can begin as in the examples below:
“It is your opinion. The truth is ...”
“When you think.” The truth is that...”
“If it helps you.”
“You say it, I don´t care.”
“It is your bad luck.”
“It is not your business”
Technique Questions
This is a very easy technique, that is softer
than the previous technique and it is possible to use it during the
communication with the superior.
Questions are suitable if somebody is not objective. You put the
opponent onto a general level where he has to explain his statements or on the
level where he doesn't have enough arguments.
Practical
example
Colleagues are talking in the changing room. “Your clothes are terrible,” says the first one. “What do you mean?” asks the other. “I would not wear it” - the first. The other:
“Does it mean it doesn´t suit me or you?”
The first one is a little bit confused and adds: “It is tasteless.” She gets the following answer: “So it is terrible or tasteless? Do you know the difference?”
Next questions to be used in the frame of this technique:
“What do you mean by that?”
“What is the aim of it?”
“What should I understand by it?
“How did it come to you?”
“Why do you think it?”
“What doesn't suit you about it?”
Technique Interpreting
This technique is one of the most effective techniques of verbal self-confidence. You behave like an interpreter and translate harmful attacks into a friendly language or you can even conjure up compliments about yourself. You can be cheeky, aggressive, clever or stupid. You make only one statement but first you repeat statements of your partner with other words.
Examples
“You are a rowdy! “ = “Yes, but I am as straight as a row. “
“You are an ox!” =”Yes, but you hitch me to a cart and I’ll go!” (I work here most of all)
"You leave first” = “Yes, I work so effectively that
I can go."
This Interpreting Technique can be used with
humour. However, there are situations when diplomacy is needed or even a little
bit of sarcasm from us. In certain situations,
we face tactless behaviour and we can use the method interpreting for
translating some biting remarks.
Examples
You tell your colleagues about an interesting movie. In that moment, a colleague comes and interrupts you: “I don't watch TV at all. I have more important things to do.”
A diplomatic answer = “You want to say, watching TV is not right.”
A biting answer = “Do you want to say that I am a slacker, who hangs around in front of the TV? “
You are invited to a party and are the first to arrive. The host welcomes you with the following words: “I invited so many people and you have arrived first!”
A diplomatic answer = “You want to say, that you are not pleased that I have arrived.”
A biting answer = “That is what I call a nice Welcome” Thank you very much!”
From the point of view of interpreting techniques, in particular if we speak with our superiors it is better to use a diplomatic answer. Statements that are more positive help you to communicate with irritated bosses. It is better to use sentences like this:
“Your tactless behaviour shows that….”…“You want to say that …”“
“I think you are irritated.”
“Do you think that …?”
“Your words show…”
“Your question shows that…”
Reaction to anger
If somebody is shouting or raising his/her voice, it can throw us off balance. We are not able to speak or to react, and then, a double reaction normally comes: we start raising our voice and shouting or we let the aggressor shout himself/herself hoarse and feel humiliated.
Practical example
The hospital manager scolded the senior consultant of a ward over the telephone, because, he/she exceeded the allowed financial limit for the ward. Then, the senior consultant scolded the chief physician of the ward over the telephone. Then, the chief physician scolded the senior nursing officer, and finally, he argued with her. The senior nursing officer went to the ward sister, who was scolded too. The nurse who waited for the ward sister because she needed her help became the victim of a verbal attack: “Why are you standing here? Don't you have any work?” Therefore, the nurse suffered the outburst even though; she had nothing to do with it.
In situations, when the attacker shows a very high level of rage and aggression, it is not good to start heroic performance and in particular with regard to your superior. As we can see, aggression chaining doesn't pay and it is not pleasant to be the scapegoat. So what do you do to leave the rage carousel confidently? For communication with furious people, there is one rule:
There is no need to let somebody prey on you, even if you have been a failure!
There are two recommendations for communication with a furious person:
1) If you have failure, admit your failure,
2) Never discuss offences (don't listen to it or you can warn your opponent to apologise; if verbal offences occur, you have to point out these offences – “You have just offended me, I am expecting your apology.” – Or leave the room – You can also let rageful children in their room and tell them to come when they become calm.
The majority of upset people can be calmed by a de-escalating attitude (with arms akimbo, sloped to one side and with an interested expression). You do not need to explain anything, apologise, do anything,, only be there and wait until the volcano of upset to gush out. Because you are silent and do not verbally react, you start to take control of the situation. Zdeněk Jirotka wrote shrewdly: “It is nothing to talk about and it so nice to say nothing about it.” You put in substance so the attacker is silent and it depends on you when you start speaking. The right amount of silence will help you to unsettle the other side. As soon as you counterpart (at least a bit) calms down, you can start speaking with them quietly. In this communication, it is better to use words like “I supposed, I assumed, I believed” than the expression “I thought”.
In addition, the situation may arise when a rage starts deepening and there is a danger that it gets out of control. In such situations, you can hold up a mirror to your counterpart and say quietly but firmly:
“You are upset”
“You are shouting”
“You are raising your voice”.
“You are speaking in a threatening tone with me”.
When you point out this improper behaviour, you are no longer a victim. You are an observer, who evaluates the behaviour of a furious counterpart. Diplomacy may help in these situations in a similar way. It is said that a diplomat is somebody who carefully considers something before he/she does not say anything. In situations, when you do not know exactly why somebody is shouting at you (and becomes even more furious) or it is not possible to use silence, then it is suitable to react.
I offer here three key points, as to how you can stop speedily a shower of offences. It is important to stay calm and concentrated. Try sentences that hold up a mirror to your counterpart:
“You have just called me an idiot”.
“You have just offended me”.
If this calming way does not help, here are some recommended variations:
1) Try to submit a peace contract. “I can see I have made you upset, it will not happen anymore. And now please stop offending me.”
2) “I expect you to apologise” “I am not going to suffer your insults any more, apologise to me.“
3) If the first soft variations do not help, interrupt the conversation immediately.
“I am not ready to continue under these circumstances.”
Then just turn and leave. You should already have an exit route decided upon. Be aware of slamming the door, as you do not know when you will want to come back through this door. You can also try to have the last word when you make a clear statement of what is expected of the aggressor.
“You can contact me any time when you are ready to speak calmly.”
Then you leave decisively. If the counterpart is shouting some threats (“Never come back”), make little of it as these are mostly empty words. Of course, you can counter with blow:
“So do you want to talk in peace at last?”
You win respect if you behave self-confidently. Fear of harmful consequences are often unreasonable. Those who emphatically and decently asked for an apology and did not let the behaviour disarm them has acted assertively. Nobody has a right to shout at you or to insult you even, if you made a mistake. The failure is not to make a failure, but to repeat it. In addition, he who shouts and cannot solve situations calmly runs down only himself, as he is not able to control his emotions. Don't be afraid of being assertive and protect your own sovereignty. Do not forget that the main condition is decency and any vulgarity or showing counterpart's foibles is the height of weakness.
[1] Techniques are inspired by the book by Matthias Nöllke: The big book of verbal self-defence. Praha: Grada, 2009. ISBN: 978-80-247-3004-2