PRACTICE PARTNER
Look Through the Patient’s Eyes
First, consider what the environment is like
for the patient. Henrietta Van Hulle, VP
Client Outreach at the Public Services Health
and Safety Association, reminds that health-
care professionals navigate their settings and
system every day. It makes sense to them.
They’re comfortable there. But that is not
necessarily so for patients.
Patients can be anxious. They’re often deal-
ing with the unknown. At the best of times,
that can get the pot boiling. Now, add in
whatever else is going on in the patient’s life.
Or maybe they’ve had previous undesirable
experiences with health care.
All of this, even without aggression and vio-
lence present, is reason enough for the health
care team to pacify. In practice, that can mean
providing enough information, speaking
slowly and giving patients enough time to
process what you’re saying, and making eye
contact. “Keep a calm outer demeanour,” Ms.
Van Hulle says.
Sound too simplistic? Not really, says
Dr. Brittany Poynter. She’s clinical head
of the ED at the Centre for Addiction and
Mental Health (CAMH) in Toronto, and
an assistant professor in the Department
of Psychiatry at the University of Toronto’s
Faculty of Medicine. When patients are in a
heightened state, some basic steps to build
rapport and show understanding can go a
long way.
At CAMH, Dr. Poynter is part of a team
working to de-escalate patients who are
exhibiting a variety of psychiatric symptoms.
Her advice, however, applies to a large swath
of patients. Many individuals, in certain cases
and at certain times, could potentially turn
aggressive or violent.
Consider, she says, some common patient
experiences: wait times, absence of privacy,
negative attitudes of staff, lack of respect or
courtesy, not feeling heard, insufficient com-
munication. These and other realities of being
a patient can set people on edge.
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DIALOGUE ISSUE 4, 2018
Dr. Poynter says it’s vital to be preventa-
tive, i.e., act at the first signs of agitation.
Even before it gets to that point, some
de-escalation strategies are really just good
proactive care interventions.
For instance, introduce yourself, provide
reassurance that you’re there to help, be clear
and concise (short sentences, simple vocabu-
lary), and identify the patient’s wants and
feelings. Listen closely to what patients say,
and acknowledge that you’re listening.
Repeat information as necessary to ensure
clarity. Set limits for safety, like acceptable
behaviours, and do it in a respectful man-
ner. Offer choices, even something as simple
as where to sit. And perform little acts of
kindness, like meeting a basic request or just
providing hope.
“It’s important to put yourself in the other
person’s shoes and offer empathy,” says Dr.
Poynter.
These strategies can work, not all the time
and not for everybody but even in quite
challenging cases. In an article for the Toronto
Star, Dr. Poynter wrote specifically about
patients who are experiencing a mental health
crisis. They’re probably scared, she said, and
their actions are likely driven more by fear
than a desire to harm. Some people can’t tell
what’s real from what’s not.
Look for something about the patient’s
position to agree with – you could agree with
their truth (even a bit of it), agree with the
principle, or agree to disagree. Finding com-
mon ground fosters trust, she said.
What if someone is brandishing a knife?
Dr. Poynter explained that rather than
saying “No weapons allowed, give it to us
or we’ll call the police”, she might try this
approach: “I’m glad you’re at the hospital.
You’re in a safe place now. We’re going to
hold on to the knife for you, so that we can
all be safe. Let’s sit down and talk.”
It won’t always work and it’s not the only
answer. Still, some of these communication
fundamentals are the go-to protocols.