Combative or Confrontational Situations

What are the Risk Factors?

  • Working directly with individuals who have a history of behavioral issues, violence, drug or alcohol abuse.
  • Poor design of work environment including room layouts which may block an employee’s vision or interfere with easy exit and poorly lit corridors, rooms or parking lots.
  • Lack of means of emergency communication.
  • Inadequate security and unrestricted access to facilities, clinics and hospitals.
  • Lack of comprehensive staff training regarding how to de-escalate situations and how to interact with individuals who have dementia or who may exhibit violent behaviors.

Injury Prevention Strategies for Combative or Confrontational Situations

  1. Design areas for safety. Provide sufficient lighting, install curved mirrors, arrange furniture for easy exit, and, when possible, ensure that rooms have two exits.
  2. Determine the behavioral history of patients, residents or clients to learn about any past behavioral concerns and identify possible triggers, such as certain dates, visitors or staff.
  3. Communicate any concerns regarding the potential for aggressive behaviors using chart tags/flags, log books and reports, particularly during hand off at change of shift. Work collaboratively to develop the best approach for managing an individual’s behavior.
  4. Install panic buttons at workstations and make sure they are regularly maintained.
  5. Ensure that the public does not have unlimited access to patient, resident or client areas.
  6. Provide staff with comprehensive training in de-escalation and self-protection as well as specialized training in how to interact with individuals suffering from dementia, if applicable.

Resources and Training Guides

Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers-OSHA https://www.osha.gov/Publications/osha3148.pdf

Management of Aggressive Behavior Training http://www.moabtraining.com/main.php

National Council of Certified Dementia Practitioners http://www.nccdp.org/