Blowing Out the Fuse!

Understanding The Angry Patient

and
Defusing Explosive Situations

University Community Hospital

The Department of Spiritual Care
Bishop Bruce Wright Ph.D. - Manager.
Rev. 07/09
The Angry Patient
 Understanding The
Ingredients of an Explosive
Situation
Inside the Patient

Anxiety
Fear
Nausea
Pain
Loss of Control
Why me?
On the Surface of the Patient
Aggression
Blame Placing
Confrontational
Intimidation
Frustration
Demanding
Profanity
Seizing Control
Anger
 The Fuse
Matches Courtesy of Hospital Staff

(Remember...Perception IS Reality!)

Non-Caring
Defensiveness
Confrontational
Condescension
Evasiveness
Inattention
The Equation for Disaster
A (Patient’s Internal Emotional State) +
B (Patient’s Aggressiveness) +
C (Staff Defensiveness)
equals….
 Understanding Emotions
“If you know how
emotions emerge and
change, you can make
patients feel better
about their lives, their
health care experience
and your health care
organization.”
Paul Alexander Clark
 Emotions
1) Are chemical and neural
reactions in the brain.
2) Are a constant experience.
3) Are formed from a
combination of:
a) An external stimulus
b) Our subjective
experience of that
stimulus
c) And any behaviors that
result and our internal
physiological response.
Treating the Patient's Emotions By Paul Alexander Clark
We are “hardwired” to detect
emotions in others.
•Facial expressions.
•Body language.
•Tone of voice.
•Implicit as well as explicit behaviors
We have the emotional need to have our
emotions acknowledged and validated by
others.

When we do not feel that

emotional validation,
happiness subsides, despair
intensifies, depression
deepens, anger grows and
internal emotional needs
are unfulfilled.

Treating the Patient's Emotions By Paul Alexander Clark

And because emotions are biochemical in
nature, they can and do influence physical,
mental and psychosocial health.
ACE (Adverse Childhood Experience) Study

• A major research study 17,421 participants.

• Compared current adult health status to childhood
experiences.
• Results: subjects with ACE experience: 4-50 times more
likely to have adverse health or disease as an adult
• Adverse emotional experience was the biggest single
factor in predicting adult health
.Foege WH. Adverse childhood experiences: A public health perspective. Am J Prev Med 1998 May;14(4):354-5.

. 60% to 90% of physician visits are stress related

.include
Stress is linked to the six leading causes of death, which
heart disease, cancer and suicide.
American Psychological Association, 2008, Heart Pangs?
We must always remember…
Every patient arrives
carrying emotional
baggage.

 Anxiety
 Fear
 Nausea
 Pain
 Loss of Control
 Why me?
And every experience, every staff
interaction, every sight, sound, taste and
smell stimulates and
accentuates emotions in the
patient.

Therefore we must make sure we’re

aware of what emotions we are
eliciting in our patients.
We must continually ask ourselves…
What are my words, my posture, and
my attitude saying to my patient?

Concern or disinterest?
I care and you matter,
Empathy or or I don’t really care
because you don’t
irritation? really matter.
Am I showing empathy?

Am I demonstrating that I care?

For a few minutes, put on the patient's
gown. How it would feel…
“Think about what it feels like to
wake up for a blood draw at 3
a.m.

How does it feel to hear you

can't spend the night with
your child, spouse or loved
one?
 For a few minutes, put on the patient's
gown. How it would feel…

How does it feel to cry

and have no one notice?

How does it feel to hear

nurses laughing at the
nursing station as you lie
in your own vomit and
continue to press the call
button?”
Paul Alexander Clark, Press Ganey
Associates
Nursing Behavior that Triggers Anger
Non-verbal triggers
Tone of voice: sarcastic, condescending, disbelieving

Body language: Arms

folded across chest, looking
away, looking at your watch,
smirking, scoffing, rolling
your eyes, drumming fingers

Other trigger actions: Long wait times, not promptly

addressing needs, passing the buck, inattentiveness
Nursing Behavior that Triggers Anger
Verbal Triggers
You’re wrong.
It doesn’t help to tell customers that they’re wrong, even
when they are. Just courteously state the facts, as supported
by evidence. Let the facts speak for themselves.

I’m sorry you feel that way.

People can see through this old trick.
Say sorry only when you’re sorry.
Even when the customer is not
completely right, identify what could
have been done better, and apologize
for those mistakes.
 As I’d already said … As I’d said before
Just repeat or paraphrase what you had said, without
saying you’d already said it.

That’s the policy … I can’t do that

Instead…"That’s contrary to our policy,
but I know what you mean. Let me see
what I can do."

No way ... Not gonna happen ...

That's impossible
Instead…"I tried to do that for another
customer, but I really couldn't get it
approved."
 That’s not my job.
It is your job. Take ownership of the problem.

Calm down I assume or I guess

These words often Get the facts. Don’t
have the opposite assume, don’t guess.
effect.
I’m going to have to
You should have end this
Instead…"In case conversation … You
this happens again, must leave the
it might help you to” building
Used only as the last
You have to . . resort. Used only when
.Instead…"Would customers are truly
you please …" dysfunctional.
Instead of
lighting the
fuses, let’s
learn how to
blow out the
matches!
 Non-verbal De-escalation Techniques

The most important aspect of de-escalation

with angry patients.

➙ 65% of communication - nonverbal

communication & vocal qualities of speech.

➙ 35% of human communication through the

spoken word.

Using Body Position to

Defuse Angry Peopl, Loo, http://www.hodu.com/defuse.shtmlTristan Loo
During a hostile confrontation between two people, both
parties will naturally, and often unthinkingly, assume
either defensive or aggressive nonverbal behavior.
• Finger pointing
(very aggressive)
• Glaring Invasion
of personal or even
intimate space (4”
and closer)
• Arms crossed
Widening of stance
• Hands on hips
• Fingers clenched
into a fist
• Increase in the
volume of voice Using Body Position toDefuse Angry People, Loo,
http://www.hodu.com/defuse.shtmlTristan Loo
 De-Fusing Through Non-Verbal Cues

Instead of further igniting the situation through our body

language, we can also train ourselves to promote peace through
nonverbal cues that express peacefulness.

Using Body Position t oDefuse Angry People, Loo, http://www.hodu.com/defuse.shtmlTristan Loo

 Palms Up!
The single biggest nonverbal gesture
that conveys peace is by placing your
palms up so that they are facing
upwards.
This feels entirely unnatural when we
are confronted with a hostile person,
so it requires practice, but you can
practice this during any conversation.
Open palms not only convey
submissiveness, but also honesty.

Using Body Position t oDefuse Angry People, Loo, http://www.hodu.com/defuse.shtmlTristan Loo

 Triangle Body Pointing
When someone becomes angry at us, it is
common for them to turn their body so
that it is directly facing our own.
Instead, orient your body position angled
in such a way that if you were to draw a
line in the direction that both of you are
facing, it would intersect at an imaginary
third point.
Provides a feeling of openness during the
conversation.
Creates that imaginary third point which
acts like an escape route.
Using Body Position t oDefuse Angry People, Loo, http://www.hodu.com/defuse.shtmlTristan Loo
Lower Your Voice!
When angry people speak
louder.
Our response is to raise our
own voice.
Vocal competition fosters
conflict.
Eliminates competition
Instead speak in a gentle,
They can’t respond to
calm, and soothing tone. …
something that they can’t hear
just a few notches higher
so they lower their voice in
than barely audible.
response.

Using Body Position t oDefuse Angry People, Loo, http://www.hodu.com/defuse.shtmlTristan Loo

 Head Tilting
Most animals, including humans, are
programmed to minimize exposure to
their necks because this is a vital area
that can be attacked.
Head tilting is a peaceful gesture
because by tilting your head, you
expose your neck.
Has the psychological effect of
disarming the other person by making
you seem less threatening.

Using Body Position t oDefuse Angry People, Loo, http://www.hodu.com/defuse.shtmlTristan Loo

 Respect Their Personal Space.
Entering an upset person's personal space can intensify his or
her emotions.

Three feet is adequate

for most situations,
however allow up to 6
feet for aggressive and
confrontational
people.
3 - 6 feet

Healthcare Training Weekly, October 25, 2007

www.hcpro.com/NRS-78059-975/Use-nonverbal-cues-to-ease-angry-patients.html
 An Open Stance
Caregivers should assume a stance in which they slightly
turn their body at an angle to the patient while keeping their
hands open and in plain view.
Angry patients will perceive this stance as less threatening.

Healthcare Training Weekly, October 25, 2007

www.hcpro.com/NRS-78059-975/Use-nonverbal-cues-to-ease-angry-patients.html
Appropriate Eye Contact and Facial
Expressions.
Your face and eyes convey a direct message to the
patient.
You should maintain general eye contact, but not stare at
the other person.

Healthcare Training Weekly, October 25, 2007

www.hcpro.com/NRS-78059-975/Use-nonverbal-cues-to-ease-angry-patients.html
 Therapeutic Responses to Anger
The goal is to establish or reestablish
a collaborative relationship.”
(Simms, C. (1995). How to unmask the angry patient. American Journal of Nursing, 95(4),
36-40.).

Rather than focusing on the stressful

emotion of anger alone, nurses must
focus on the patient and the fears he
is facing

Focus on interacting with the patient rather than reacting to

the anger.
Dodaro, D.C. (1988). Beyond the wall. Nursing, 18(4), 96.
 Be calm and reassuring.
Seek to understand any underlying
problems.

Acknowledge their feelings of

anger.
Focuses on empowering the
patient, and redirecting the energy
once used for anger for more
productive means.
Murdach, A.D. (1993). Working with potentially assaultive clients. Health and Social
Work, 18(4) 307-312.
 Take an active role in this situation by
addressing the patient's actions

Provide a safe and supportive environment for

the patient to express his feelings

Refuse to be disagreeable.
Most Importantly…..
When you have an angry patient,
remember...
A - Apologize
•No matter who's to blame; apologize anyway.
•You are not accepting blame, you are simply saying, "I'm sorry about the
problem."
•Be completely sincerity. Be sure that tone of voice matches words.

S - Sympathize
•Identify with his feelings. Validates his feelings

A - Accept Responsibility
• Let him know that you intend to make things right.
•You can't help what has already happened, but you will come up with a
solution to the problem or you will find someone who can.

P - Prepare to Take Action

•Decide what to do
•Do it
•Report back to the patient
Blowing Out The Fuse!

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