Most everyone within the healthcare field has encountered verbal hostility from patients, the family members of patients, or other staff members. However, have healthcare professionals been trained how to handle these situations with empathy, professionalism, and tact? While the significant attention directed toward maintaining the technical or clinical skills of medical staff is necessary, the evidence suggests that not enough attention has been devoted to equipping medical personnel with the skills to handle situations involving verbal conflict.
A Need for Empathetic Verbal De-escalation Skills
Persons who provide medical care are often exposed to aggression – both verbal and physical. A national survey of almost 3,500 hospital emergency room staff revealed that 100% of these staff had witnessed both an act of violence and threats of violence at work within the last three years. Of these emergency room staff members, a quarter had witnessed more than 20 incidents of aggressive behavior in the ER in the last three years, and 20% reported dealing with verbal abuse almost daily.1 Another study that observed patient behavior within an urban hospital emergency room revealed that 16% of patients (1 in 6 patients) displayed hostility toward the medical staff.2 A third emergency room study, involving 1,572 patients at one hospital, revealed 1 in 30 patients committed a violent act against the medical staff, and roughly 50% of patients were verbally hostile at some point.3
In addition to the emergency room setting, nursing staff working in geriatric care and psychiatric units have also reported that dealing with verbal and physical hostility is common.4 Paramedics and other rescue personnel encounter aggression and a lack of patient cooperation on an almost daily basis.5 Medical staff providing palliative care regularly encounter anger and hostility from patients and those grieving with the patients.6 Even clerical staff working in intake and records within hospitals and clinics often report having to deal with hostility and threats from waiting patients, or the family and friends of patients.7
Unfortunately, research has also revealed significant deficits in empathetic verbal de-escalation skills within the healthcare field. While the healthcare profession attracts individuals with high levels of empathy for their fellow humans, only individuals who are driven and have strong leadership skills usually complete the training necessary to earn their positions as doctors, nurses, therapists, technicians, or paramedics. As a result, more than one study has suggested that the focus on leadership skills and technical proficiency has been at the expense of empathetic listening and verbal de-escalation skills.8
In survey after survey, healthcare staff report feeling ill-equipped to handle situations involving patient (or even coworker) hostility and aggression. Studies of doctors, nurses, paramedics, and intake staff have revealed that most feel unprepared and untrained to handle patient verbal hostility in an effective and professional manner.9 Even within psychiatric care units, where staff are more likely to have received training for the management of aggressive behavior, treatment staff have complained that their training often emphasizes policies and theoretical concepts rather than providing practical skills people need for calming individuals who are angry or upset.10
The Results of Empathetic Verbal De-escalation Skills Training
Even without having had specific training in verbal de-escalation skills, some healthcare staff naturally have outstanding communication skills that involve deflecting verbal abuse, empathetic listening, paraphrasing back statements, and offering options that guide individuals to a peaceful resolution of the conflict. Doctors and nurses who utilize these communication skills are rated as more professional by their patients and coworkers, receive fewer complaints about their demeanor, and experience fewer violent acts.11 Unfortunately, these verbal de-escalation skills do not come naturally to most people.
Realizing the need for verbal de-escalation skills training, some healthcare organizations have recently begun providing this sort of training to their staff – with very positive results. One study involved providing first-year nursing students with a course in patient communication skills and verbal de-escalation. A pretest / posttest survey before and after the course revealed that after completing the course the majority of the nursing students felt much more confident about their ability to handle stressful patient interactions.12 In another example, advanced nursing students completed a verbal de-escalation training course just before beginning their clinical placements. Surveyed 3 months into their clinical placements, the nursing students reported that they felt much better prepared to handle their clinical placement experiences because they had completed the verbal de-escalation course.13
In a third study, a group of 110 palliative care nurses received communication and verbal de-escalation training. Then they were surveyed six months later to determine the effects of the training. These nurses reported being calmer, and experiencing less stress, when communicating with patients, and patients’ families after having completed the training. They also reported feeling more confident about handling all difficult communication situations, such as making death notifications. Many of these nurses emphasized that the role-play portion of the training that allowed them to practice their new skills in a safe environment was one of the most beneficial parts of the course.14
Another study involved providing verbal de-escalation training to a group 78 nurses. A comparison of patient violence before and after the training revealed that after the nurses had received the training, acts of patient aggression fell by about 25% over the 28 months after the training.15 Finally, a review of nine additional studies involving verbal de-escalation training within medical settings revealed that all nine studies saw increased staff confidence and improved skills in handling hostile patient behavior.16
Clearly, verbal de-escalation training offers many benefits for those working in the medical field. When healthcare professionals develop verbal de-escalation skills, they feel more confident when handling hostile patients, hostile members of patients’ families, and confused patients in emotional crisis. Healthcare professionals with strong verbal de-escalation skills also better manage conflict situations with their coworkers. They are perceived of as more professional by patients and coworkers and experience fewer aggressive acts or demeanor complaints from patients. Regrettably, these skills do not come naturally to most people, including many within the healthcare field. While highly competent in their clinical skills, many medical professionals tend to be lacking the skills to professionally handle verbal conflict in a safe and tactful manner. As a result, healthcare field personnel should all receive patient communication and empathetic verbal de-escalation training on a routine basis in order to improve staff safety and patient care.