The hospital, despite being a place for "caring", has become the scene of aggression towards carers. What hospital carer has never had to deal with an aggressive patient in the course of their work? Understanding the causes and manifestations of this violence is crucial to dealing with it effectively. So how can hospital carers prevent and better manage patients' aggression towards them? What communication techniques can help defuse such situations? Sandrine Massoc, a nurse specialising in methods of communication between carers and patients, explains.
Doctors, nurses, midwives, care assistants... Twice as many hospital care staff are subjected to aggressive behaviour in the course of their work as other working people (according to the Mutuelle nationale des hospitaliers survey conducted by Odoxa in May 2022). 64 % of nurses and healthcare assistants have already suffered at least one attack, and almost all of them are confronted with insults and threats on a daily basis.
Furthermore, according to a survey carried out by the French National Order of Nurses in May 2023, the sectors most affected by aggression are emergency departments and psychiatry. In addition, 75 % of nurses who responded to the questionnaire stated that they had been the victims of or witnessed insults in the course of their professional practice (over all their years in the profession).
What is aggression?
Aggression is difficult to define, since it varies according to different schools of thought: psychology, philosophy, biology. In biology, it is a behaviour that serves life and self-assertion, with the aim of satisfying one's needs.
According to the World Health Organisation (WHO), "aggression is a premeditated or impulsive psychophysiological reaction characterised by hostile behaviour (attack or defence) directed against a target perceived as a threat".
It can be directed at others, at oneself or at objects. Aggression can be physical (hitting, spitting, use of weapons) or psychological (insults, humiliation, threats, racist or sexist comments).
Aggression can take several forms:
- active: people show their aggression
- passive: people do not show their aggression but may say things that make them feel guilty or humiliate them
For example, a patient who doesn't look at you or respond to you when you enter the room.
Understanding the causes of aggressive behaviour
Aggressive behaviour on the part of patients or their families is due to a number of factors. Incomprehension about waiting too long, medical language that is sometimes too complex, language barriers, ongoing pain. But there are also multiple fears: fear of the hospital, fear of the announcement of a serious diagnosis, fear of death.
Because of the lack of time and staff, carers are themselves under stress, sometimes unavailable to listen to patients, which can create anxiety and frustration for them. As a reminder, the word "patient" does not mean "one who waits" but "one who suffers".
How to manage aggression better
"Violence is the tragic expression of unsatisfied needs", according to the founder of the Non-Violent CommunicationMarshall Rosenberg. If someone feels angry, it's because they have unmet needs. For example: the need for understanding, consideration, security, attention, etc. It is important to identify these needs in order to better manage an aggressive situation.
When faced with an angry person, you can practise two techniques of the helping relationship: empathy and reformulation.
[Training]
Carers faced with aggression and violence
What carer has never had to deal with aggression in the course of their duties? How should you respond? What actions should be taken? An analysis of situations from the perspective of the individual, the department, the teams and the institution.
Empathy
Listening attentively and without judgement to what the patient is saying allows you to show them that you are trying to understand them and find a solution. Psychologist Isabelle Filliozat reminds us that "it is because our frustrated side has not been received that it is violent". This first stage is crucial: by seeing that someone is listening and trying to help, the person can calm down.
Be careful, though, because understanding does not mean agreeing: just because you try to understand someone does not mean you agree with what they say or how they behave.
Reformulation
Once you have listened to what the person has said, rephrase it to let them know that you have understood their expectations. There are several rephrasing techniques: echo, synthesis, mirror, etc. Rephrasing requires a great deal of tact and attention.
Finally, propose solutions and argue your decisions, always with respect and openness.
To sum up, what are the stages?
Active listening
Listen carefully to what the person is saying. Stay calm and cool. The first thing to do is to make sure you are safe. Express your limits, pass the hand, call for help if the situation is too difficult for you. If you are in the corridor, suggest that the person goes into a separate, quiet room and remember to tell your colleagues where you are. Let them express themselves. If they feel heard, they'll listen to you in return.
Reformulation
Rephrase what she has just said to clarify her needs and show that you are trying to understand her. Use simple words and short sentences. Regularly use the person's name to make listening more personal.
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Solutions and arguments
Suggest solutions, argue the case once the person has had a chance to speak, and explain the possibility that you may have made a mistake.
Think of yourself
After the event, if you feel the need, talk about what you have experienced with a colleague or someone you trust to relieve yourself of the emotional burden and stress. Don't forget to record the event verbally and in writing.
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Verbal and non-verbal communication: what posture/attitude should you adopt when faced with an angry person?
To do | It also means |
Keep a distance of two metres between you if possible. | Don't touch an angry person. |
Stay calm. | Don't shout louder than the person, don't respond by being aggressive yourself. |
Let her express herself. | Don't tell her she's wrong, don't cut her off. |
Give it your undivided attention. | Don't do anything else while listening to it (typing on the computer, being on the phone...). |
Be open and willing to listen. | Don't huff and puff, don't roll your eyes, don't cross your arms. |
Managing aggressive patient behaviour is an additional workload for carers. Each situation is unique and requires its own tailored response. To avoid escalating conflicts, it is essential to master these crisis management techniques. ORSYS training courses can help you do this.
