A crisis can be defined as a moment in time when an individual in your charge loses rational, and at times even physical, control over his or her own behavior. This can be very challenging and anxiety producing for those responsible for intervening. Due to the chaotic, unpredictable nature of a crisis, it is vital that staff stay calm and proceed with a plan. These crisis moments do not sprout into being without roots; there are almost always warning signs that let you know an individual’s behavior is escalating.
When the CODE D buzzer sounds – everyone in the building pauses to hear the instructions and location of the crisis. All available staff start running to the area to assist, as you turn the corner you go into a high alertness to see what is going on and what needs to be done to help.
Staff arrive in groups, usually way more people than would ever be needed to handle a crisis. The client or persons who are having the crisis begin to change levels of behavior by just seeing people arrive. They do not always calm down and regain control just because they are outnumbered – some see it as more of a challenge.
Attempting to use CPI (Nonviolent Crisis Intervention) training skills that more than 6 million professionals—spanning from facility administrators to front-line mental health providers to school teacher—have participated in to learn how to resolve conflict at the earliest possible stage.
Sometimes it works perfectly and the situation is taken care of within minutes and then there are times when it seems like the aggressive act is never going to end.
I have seen nurses get scratches, bruised, punched, kicked, and of course called ever name in the book and more. For the seasoned nurse or staff members – the behavior is just a crisis. For the new nurse or new staff member who has never see such a violent act in the work place can become extremely stressful.
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I see no reason to consider CPI an authentic prevention curriculum. Most of the text of its workbook reviews self-defense techniques, which of course presume that the prior material on prvention has failed, It’s an accurate assumption.
In addition, CPI advocates initiation of rapport building only AFTER violence has been violently suppressed. That advice, is clearly dangerous nonsense that is the exact opposite of evidence-based practice. When you build rapport early, BEFORE a crisis arises, and you learn how to manage patients effectively instead of memorizing a simplistic cookie-cutter approach like CPI, violence occurs far more rarely. CPI will get you and your institution credit for trying, but it offers little more than that. It’s a recipe for excusing failure, not a recipe for success. Unless your insitution seek only excuses for failure, it’s money poorly spent.
It depends on the environment you work in. There were many more times good rapport was used and succeed than the use of CPI – however when someone comes to the hospital locked in ankle shackles and cuffs they are not happy people and have no desire to listen to use. There are violent situations that CPI doesn’t work in at all and the staff has time for self protection only.
Thankfully, I worked in the UK where we don’t see ankle shackles and cuffs! However, some patients (or would be patients) arrive in handcuffs in police vans with (often) a dozen officers in tow. More often than not, the patient would be known to us and when they see a kind face they recognise they tend to calm down quickly. We always asked for the cuffs to be removed once inside the hospital doors although we were sometimes met with resistance from the officers – the patient had earlier fought with the officers, generally because they were in crisis (perhaps delusional or hearing voices). However, when the patient was calm, we insisted the cuffs were removed. C&R (Control and Restraint) was our penultimate resort (medication by injection being the last) and sometimes it could take an hour or more working with the patient to relieve their anxiety and stress through talking, asking how we could help.
Yes it is always nice when they see the staffs faces and calm down because they feel safe. The shackles and cuffs were normal for the arrivals at our facility. Sad but true.