People behave badly because they are sick and under stress?
Joel Lashley from Vistelar:
Another myth that gets us in a lot of trouble in healthcare is the myth that people behave badly when they’re sick. Is that true? I’ve spent over 20 years working in healthcare but also as a healthcare consumer. I once spent a month myself in the hospital recovering from a painful orthopedic surgery. I was married to a woman for 20 years who had a serious and chronic health care condition that was very painful before she died. I spent a lot of time sleeping on hospital floors and in chairs. Also, I have a son who had several surgeries when he was young, has lifelong healthcare challenges and so I’ve spent a lot of time in hospitals as a consumer. But in all those years, and all those trying circumstances I never threatened or yelled at or spit on or shoved a nurse. Does that make me special?
In reality most of the people that come to our hospital are cooperative and grateful to be there. Yeah, they’re sick and under stress but they know where they need to be and they know how to behave in that environment. It’s only a small number of people who behave badly so we have to remind ourselves of that. And we have to learn to focus, not just on the people who are behaving badly but all of our patients and to set limits on bad behaviour.
When people are in crisis they are in pain, they have just learned some bad news, they’re going to exhibit crisis behaviour. My husband has cancer, I can’t believe this. These are crisis behaviours. You’re going to see people aren’t going to curse, they’re going to melt down. Now everybody is behaved that way. Some people are going to become depressed, they’re going to cry. Some people are going to be very reserved and internalize everything. When we see people in genuine crisis we do have to learn to deescalate. Non-escalation is the basis for everything that we do. But when people aren’t managing people in crisis we have to learn specific skills to deescalate.
We have to learn to reduce all that stimulation. To manage the environment that they’re in. All these people, all this light, all this sound. We have to adapt our communication for their needs. We have to use one voice. We have to reverse yell. We have to exhibit the behavior for them that we need to see from them because all behaviour equalizes.
And finally, we have to learn to manage their urgent unmet need because people act out for a reason not because of a diagnosis. Tired, cold, hungry, thirsty, in fear, in pain, lonely, right? They have an unmet need. We learn to deescalate well. We learn to non-escalate well. We manage these four levels of crisis and bring people back out of crisis and into recovery.