Occupational Health and Safety Department: Spring 2025 Update (Violence Prevention)

Shared on behalf of Occupational Health and Safety

In 2024 there were 871 incidents reported through the Incident Learning System. Of the 871 incidents, 283 were related to violence/harassment. This means that nearly 32% of all reported incidents involved violence or harassment towards our staff. Violence, in particular, is the single most reported incident type at Thunder Bay Regional Health Sciences Centre.

1. Scan Your Environment Continuously

  • Observe patient behavior: Pay attention to patients’ non-verbal cues, such as tense body language, clenched fists, or agitated movements. These could signal that the person is becoming agitated or may escalate into aggression.
  • Look for changes in tone or behavior: Watch for sudden shifts in a patient’s mood, like rapid speech, loud talking, or disoriented behavior, which may indicate distress or a potential violent outburst.

2. Know Your Patients’ Risk Factors

  • Review patient history: Before interacting with a patient, check their records for any previous instances of violence, mental health issues, or substance abuse. These are risk factors for aggressive behavior.
  • Watch for triggers: Certain triggers, like pain, frustration with treatment, or a history of mental health crises, can cause patients to act out. Stay informed about specific patient needs or risks.

3. Recognize Early Warning Signs of Aggression

  • Behavioral signs: Increased agitation, pacing, clenched jaws or fists, and erratic movements often precede violence.
  • Verbal cues: If a patient starts to use threatening language, shout, or make demands in an aggressive manner, this could indicate the situation is escalating.
  • Tension in the room: A sudden shift in mood or atmosphere, like a calm environment becoming tense or quiet, should trigger heightened awareness of potential risk.

4. Position Yourself for Safety

  • Exit routes: Always be aware of your nearest exit and the layout of the space. Position yourself near an exit when possible, so you have an escape route if needed.
  • Personal Alarms: Ensure you are wearing your personal alarm on every shift and that it is in good working order.
  • Keep a safe distance: Stay at least an arm’s length away from patients who may seem agitated. This reduces the risk of physical confrontation and gives you more time to react.
  • Avoid being cornered: Try not to be placed in a position where you cannot quickly leave the area, especially when working with agitated patients.

5. Maintain Calm and Non-Threatening Body Language

  • Avoid aggression in posture: Stand with an open posture and avoid crossing your arms or taking defensive stances. Keep your hands visible to show you are not a threat.
  • Use a calm, soothing voice: Speak slowly and in a non-confrontational tone. Stay neutral and avoid raising your voice, which may escalate the situation.
  • Eye contact: While maintaining eye contact can show that you are engaged, avoid staring, as this can be perceived as a challenge or threat.

6. Listen Actively

  • Empathy: If a patient is upset, let them express themselves without interruption. Listen to their concerns and show empathy. Sometimes, simply feeling heard can de- escalate tension.
  • Acknowledge their feelings: Use statements like, “I understand that you’re frustrated,” or “I can see that you’re in pain.” This can help calm the patient and open a line of communication.

7. Set Boundaries Early

  • Assertive communication: If a patient starts to cross a line (e.g., using threatening language or becoming physically close in an aggressive manner), calmly and clearly set boundaries.
  • Non-verbal cues: In addition to verbal boundaries, your body language should reflect calm authority and assertiveness. Keep your posture open but firm.

8. Stay Calm and Don’t Take It Personally

  • Keep your emotions in check: If a patient becomes angry or hostile, stay calm and don’t let emotions drive your reactions. It’s important to separate the patient’s behavior from who you are as a person.
  • Avoid reacting emotionally: If a patient is yelling or being verbally abusive, avoid responding with anger or frustration, as this can escalate the situation.

9. Work as a Team

  • Alert colleagues early: If you notice a situation beginning to escalate, quietly notify a colleague or call for backup before things get out of control. Use the Hospital’s emergency codes to call for help if necessary.
  • Team coordination: If you’re working with a team, ensure you’re all aware of the situation and prepared to act in unison if needed. Have a plan for managing a violent situation, including how to exit or contain it.

10. Know the Warning Signs of a Violent Outburst

  • Physical cues: Look for clenched fists, rapid breathing, or a fixed gaze—these can indicate that someone is about to lash out.
  • Verbal threats: Words like, “You better do what I say,” or “I’m going to hurt someone” are red flags. Take threats seriously, even if they seem like a bluff.

11. Use De-Escalation Techniques

  • CPI (Crisis Prevention Intervention).
  • Gentle Persuasive Approach.

12. Know Your Facility’s Protocols

13. Report Incidents and Concerns

  • Document threats or violence: Always report any incidents of violence, threats, or suspicious behavior to your supervisor, so the situation can be addressed and preventive measures put in place.
  • Follow up: If you’ve observed a concerning situation, check in later to ensure it’s being properly addressed, and keep open communication with your team about ongoing risks. By staying aware of the environment, anticipating potential risks, and responding to aggression appropriately, you can help prevent violence before it escalates.