PHYSICAL HEALTH ISSUES
• Prior to the use of planned
intervention individuals should have
a health assessment to identify any of
the following physical difficulties.
• Any difficulties should be identified in
the individuals care plan and staff
must be made aware of any signs/
symptoms to look for during physical
intervention.
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PRIOR TO THE USE OF
PHYSICAL INTERVENTION
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Asthma/ breathing difficulties
Hemiplegia/ skeletal abnormalities
Recent fractures
Recent dislocations (fingers, elbows,etc)
Epilepsy
Vomiting
Arthritis/oesteo- arthritis
Pregnancy
Heart conditions
2
During the use of physical
intervention
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Breathing difficulties/rapid breathing
Seizures
Fractures
Dislocations
Cyanosis/ mottling of skin
During the use of physical intervention
staff must observe for signs of medical
emergencies if these occur medical advice
must be sought
3
COMMUNICATION DIFFICULTIES
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Deafness
Blindness
Poor verbal speech
Poor comprehension skills
Long hair
Ensure you take into consideration
communication difficulties when restraint is
used, use alternative support systems
such as signing pictures or modelling
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The Effects of violence
• Physical assault can cause staff physical
effects. But psychological effects can be
equally disabling. Delayed manifestations
can include:
• Sleep disturbance
• Tearfulness
• Irritability
• Loss of concentration
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POST INCIDENT MANAGEMENT
• Following an incident of physical intervention,
staff & service users should be given separate
time to talk about what happened in a safe
environment.
• Post incident interviews should be designed to
find out what happened & the effects on the
participants, not to apportion blame.
•
(Department of Health 2002)
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Rules To Debriefing
• It should not be time limited
• What you say should be valued
• Its not about what you did wrong its about
feelings
• It should be confidential
• It should be conducted in a safe environment
• Managers need to debrief too!!!
O'Neill (unpublished)
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De-escalation: definitions
• De-escalation refers to a set of verbal and
non-verbal responses which, if used
selectively and appropriately, reduce the level
of a person’s hostility by reducing anger and
the predisposition to assaultative behaviour.
(Turnbull et al,1990)
• The concept of de-escalation should be
applied in a broader sense to encompass the
role of the organisation, including its culture
organisation policies and procedures
(Leadbetter & Patterson, 1995)
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NON-VERBAL CUES AND EARLY WARNING SIGNS
•Invasion of ‘personal space’ - coming too close
•Increased volume of speech
•Replicating earlier violent episodes
•Prolonged eye contact
•Verbal threats or gestures
•Increased or prolonged restlessness body tension
•Facial expressions tense and angry
•Blocking of escape routes
•Reporting violent feelings
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Stages in a Violent Episode; an Affective Model
Phase 3
Crisis
Phase 2
Escalation
Phase 1
Triggering
Phase 4
Recovery
Stable Base Line
Phase 5
Depression
TIME
• Observe
•De-escalate
• Inform
•Contain
• Remove
•Anticipate
• Wait
• Reassure
• Plan
Prevent
and
Support
Trigger
Kaplan & Wheeler, 1983
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Instrumental Model of Aggression
Choice of
violence
Choice
of victim
Choice of
Violence type
Choice of timing
NB Opportunistic
behaviour
Choice of
Location
Stable Base Line
Stable Base Line
TIME
Patterson & Miller 2005
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Managing your own emotions
Before you can control a situation you need to be
able to control yourself
• Recognise and acknowledge signs of anxiety
– E.g. fight/flight/freeze, adrenaline responses
• Recognise danger signals of your own & others anger
– E.g. raising voice, clenching fist, bracing shoulders
• Take one deeper than normal breath / exhale slowly
• Use positive self statements e.g. ‘I can cope’ if you feel your
anxiety levels are increasing
• Perhaps withdraw temporarily ‘time out’ ! !
• Count to ten !
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De-escalation: Non Verbal Aspects
Stance
Posture
Space
Eye contact
Touch
Facial expression
Pitch/tone/volume
Environment
Hand gestures
Escape/withdraw
Active listening
Stay calm
Control breathing
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De-escalation: Verbal Skills
Steady, calm, even tone
Don’t react with agitation
Empathy
Avoid jargon
Don’t make promises
Be honest
Be yourself
Personalise
Concise language
Don’t argue/challenge
Positive words/phrases
Reflect/paraphrase
Clarify the problem
Avoid terms of intimacy
Avoid boundary words
Ask open questions
Be assertive
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Interpersonal strategies
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Strategies of Engagement
Competing
Collaborating
Compromising
Avoiding
Accommodating
Co-operation
Thomas (1975)
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Interpersonal strategies
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Depersonalise the issue
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Personalise yourself
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Empower the person
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Make a token concession
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Make a deliberate friendly gesture
•
Using “we”
•
Using diversions
(Davies & Frude, 2002)
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