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Verbal threats and reporting angry feelings.

The ideal outcome for an encounter with an angry, aggressive or threatening person is that safety is not compromised and the healthcare professional is able to talk the person down, helping them to express the reason why they are angry. Follow-up support should be offered to help stop the person repeating the same behaviour. However, people should also be made aware of potential sanctions if they are unable to comply, for example withdrawal of treatment, involvement of the police and so on.

Legal and professional issues

Nurses may be inclined to accept aggressive behaviour as part of the job (Mclaughlin et al. 2009) due to being encouraged to be caring, compassionate and accepting of others. Despite this, nurses have the right to work without feeling intimidated or threatened and should not tolerate verbal or physical abuse, threats or assault. Personal comments, sarcasm and innuendo are all unacceptable.

Employers have a responsibility to adhere to Management of Health and Safety at Work Regulations (HM Government 2000). This involves providing a safe environment for people to work in and one that is free from threats and abuse. With any physical assault, the police should be involved.

Preprocedural considerations

Pharmacological support

Short-term use of a benzodiazepine, for example diazepam or lorazepam, may be indicated. Assess this carefully, that is, do not assume that it is necessary. Once a situation is more under control, you can ask if the person feels less angry and whether they feel that they need further support. Suggesting this at the wrong time or insensitively may inflame the situation.

A psychiatrist may prescribe an antipsychotic medication for short-term use, for example Risperidone.

See also Box 5.11 for phrases that might help when talking with an angry person.

Box 5.11 Phrases that might help when talking with an angry person

I can see that you are angry about this …

I would like to help you try to sort this out, how can I do that?

In order for me to help you, I need you to stop shouting.

You are shouting at me and I can’t help you until you stop.

Please stop (unacceptable behaviour), you are making me and these other people quite frightened.

Can you tell me what is making you so angry so that I might be able to help you sort it out?

Try to agree with the patient where possible (this can be a good way to diffuse tensions):

I can see how that would annoy you … let’s see what we can do about it.

What might I/we do, for you to … (comply with the rules/request)?

Principles table 5.8 Communicating with a patient who is angry

Principle Rationale

Remain calm.

Verbally acknowledge the person’s distress/anger and suggest you wish to help. The person may respond positively and accept help. E

Acknowledge issues that may be contributing, for example being kept waiting. This helps the person feel that their concerns are understood. E

Consider what causes there may be, for example medication or disease (consider diabetes – hypo/hyperglycaemia), medical, circumstantial and so on. Several factors might be influencing the behaviour. E

Consider safety – try to move to another area (ideally where you can sit down). If others might be intimidated or in danger, be clear about moving one of the parties away where practical, but do not endanger yourself in the process. Maintain safety for all. E

If a person’s behaviour is hostile and intimidating, tell them you are finding their behaviour threatening and state clearly you wish them to stop/desist (see Box 5.11 for suggested phrases). Some people may not be aware of the impact of their behaviour and will change it when it is pointed out that it is unacceptable. E

Assess individual situations and make use of relatives or friends if they are present and can be of assistance in diffusing the situation. Sometimes people will listen more to a person who is close to them. E

Create some physical distance or summon assistance if the patient does not concur and