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Deescalating aggression

by ERguru ERguru (New) New

I am looking for information on programs to train staff of ER, psych, etch on how to prevent & manage aggressive & violent behavior. Do you have a program that you use? Did you purchase a program or did you develop it yourself. If you purchased, what of the continueing costs with each training session? Any information would be great. Thank You

The hospital I used to work at used a model called P.I.P. Pre-intervention, Intervention, and Post-intervention. Sorry, I don't know how the program was developed or anything about training costs. Maybe someone else knows more about it.???

You may want to check with your Security dept. They will usually get mailings from companies that do "healthcare related" education on this subject. I have also helped with putting on classes in the past where we used our internal experts such as clinical RNs/specialist in psych, EAP, Employee Health and we even got one of the local police experts in to teach us how to deescalate patients.

Our Level I Trauma center presented a program called "Preventing Violence in the Workplace" that the police department sponsors. They sent two very seasoned detectives to teach us how to recognize potential signs of violence in patients as well as recommendations on how to handle ourselves when patients become aggressive (which is daily). It was required for all employees, including clerks and financial counselors. I thought it was a very beneficial program.

I am a geripsych nurse and we had a program called C.P.I. -Crisis Prevention and Intervention -that one of our staff had to become certified in to train the rest of us- a two day training for us.

One of the "moves" is one staff on each side of the aggressive patient holding one arm each. The patient's palm is to be facing out with a staff member holding the arm at the wrist and midway up the upper arm (the staff holds the wrist in a way which prevents the patient from yanking away but I forget how to describe it) and hold the arm straight by pushing forward on upper arm and backward on wrist (enough to control -not hurt, obviously). Then each staff member puts their leg (one closest to patient) between the patients feet (the staff will then have their feet apart a little for a wider base of balance and support) and gently pull the patient slightly forward, using their hip (staff's) to help balance the patients mid-body -the patient is now on the balls of his feet but his weight is supported by the staff. With practice amongst the team members it worked great! Try it and you will see that if it is done right, it is not painful and totally prevents you from being able to fight- we practiced it on each other so we knew. There were a lot of other components and basic principles as well. One of those was a method that a single staff member could use as self defense which used the patients attempt to hit (momentum) against him so it put him off balance, without hurting anyone and allowed the staff to get away/get help. This was about three years ago and our hospital has since dropped the course as the one person trained in it quit. The one problem was when little nurses like me tried it on 6 foot 250 pound farmers, that was more difficult but it has been my experience that the little old ladies who weigh 75 pounds soaking wet are the hardest to subdue anyway and this worked well on them (and on the kids)! The security guys were resistant at first because one of the principles is that one staff is calling the shots to decrease confusion and facilitate quickly getting the situation under control and the security guys were used to coming in and taking over and doing it their way. Once the training expired and the trainer left we have since returned to the old chaotic method and it doesn't work as well although those of us who can do it try to coach others but it is hard to find the time and to teach it properly when not a trained trainer...Good luck and hope this helps!


I was also trained in CPI. I found it to be extremely effective in the Psych/Recovery setting. This method involves verbal de-escalation and uses physical restraint as a last resort. It teaches evasion techniques and a team approach to managing 'out of control' patients. Since policemen deal with this type of problem on a daily basis, I would think they would be a valuable resource for additional information. Most psych and alcohol rehab hospitals usually have a pretty effective program in place and may also be a good source of information. Good luck in your search.

Ours is called SAMA (Satori Alternatives to Manage Aggression). Satori stands for "clear understanding". It is a four day program that has been condensed into one 8 hour session. It involves all aspects of aggression, including recognizing, de-escalating, and defensive techniques. It was developed by Larry Hampton and it copyrighted by Satori Learning Designs, Inc. I quess you could find out about them on the net, but I'm not sure. We had employees from our district go to a conference on it, then they taught us. Hope it helps


Specializes in ER, PACU, OR.

our system makes us take a class called non-violent crisis intervention. it's ok i guess? lol! :p not!

really........when it comes down to the them or you, they emphasize moves and defenses to help you, but insist the priority is not to hurt them. :eek: excuse me......if i feel threatened or like i am gonna get hurt.........whatever i have to do i will do, to protect myself. that's not a male attitude, or an i'm bad attitude, because i'm not.

it's a safety or survival of the fitest, and i really will not be physically assulted at any cost.

just my two cents :)

me :)

teeituptom, BSN, RN

Specializes in ER, ICU, L&D, OR.

Howdy Yall

From deep in the heart of Texas

I dont know cen 35, that sounded at least like a quarters worth to me. My hospital offers no training in this area, our security force is still strictly hands off in policy. They can call for help while watching you get beat up. Handling aggression here is learned by the school of watching people who have dealt with it before, and feel comfortable with it. And just learning how to do it.

We do have a code rush policy where every male in the hospital is supposed to respond, hopeing that a show of numbers will deter a crisis from developing, or does it just give the violent person more people to beat up on. Does it sound like I have a special feeling for this issue. Yes I do, Thats too long to go on here in this column

keep it in the short grass yalll


ps speak softly and carry a 4 iron,,,,,,,,,FORE

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