Workplace Violence Awareness Month: Situational awareness and proxemics

Internal data at Michigan Medicine and research both tell us that most physical workplace violence injuries are the result of dangerous behavior from individuals experiencing delirium, dementia or developmental delay.

Knowing what is happening in the environment – or having situational awareness – is pivotal to maintaining safety. As health care workers, we can protect ourselves and others by being aware of our surroundings and performing 360-degree scans of the environment and individuals around us, at work, and while traveling to and from work.

Part of being aware and prepared includes safe body positioning, or proxemics, when working with patients, family, and visitors. 

A video released by Michigan Medicine Security last year offers important tips on maintaining safety through proxemics.

Safety story #1:

An adult, female patient was admitted to general medicine with acute altered mental status and a previous diagnosis of dementia. The staff caring for the patient reported that she was initially withdrawn and quiet, with a poor appetite and limited eye contact. The patient was oriented only to herself. 

Over the course of the first two days of hospitalization, the patient became more irritable, visibly frustrated and had episodes of verbal escalation. Nursing documented that the patient had not slept or eaten well, was unsteady during ambulation and did not have any in-person family visits.

Due to the patient’s confusion and continued risk factors for delirium superimposed on dementia, nursing was caring yet cautious when approaching the patient for assessment and medical tasks. Staff remained at arm’s length or greater distance from the patient whenever safely possible.

When the patient then began trying to bite staff during each interaction, team members were able to avoid injury because they were aware of the patient’s situation and adjusted safety measures and care accordingly.   

Safety story #2:

A staff member was walking down the hall between the University Hospital cafeteria and Einstein Bagel when they observed a plain black duffle bag, unattended on the floor in the hallway. The staff member called Security to report the bag.

Security asked for the description and location of the bag. As it turned out, the bag belonged to another staff member who had been performing work in the hallway and accidentally left the bag behind. Within a few minutes, the staff member returned to retrieve the bag.

The employee reporting the bag did the right thing. It is always important to report things that seem out of the ordinary.

Important safety tips

When providing patient care:

• Be aware of how and where you are positioning yourself in the care space and in relation to the patient, family and visitor. When possible, maintain an arm’s length plus 6 inches.
  • If unable to maintain safe distance related to work:
    • Understand the potential for violence: Does the patient have a history of aggression? Have they become aggressive during their stay?
    • If the patient has a risk of aggression, pre-plan care when safe proxemics cannot be maintained. A team approach is best.

• Position yourself on the door side of the patient bed or exam table whenever possible, particularly if you are caring for an individual with known physical violence.
•  Do not reach over a patient who is lying in bed. Doing so puts you at risk for being bitten, hit or grabbed.
• Be aware of subtle changes in a patient’s thought process, mood and orientation.
  • Adjust care accordingly, such as when to approach or not approach the patient, when to take another staff member with you into the care space, and when to give the patient a few minutes to calm down.
• Use caution when wearing a lanyard, clothing with ties or strings, dangling earrings or stethoscopes during care. Wearing long hair down can also create risk.

General best practices:

• When walking, remember the three A’s of Situational Awareness: Aware, Anticipate and Avoid.
  • Aware: When walking, keep your head up, eyes and ears open (do a continuous 360-degree scan using all your senses)
  • Anticipate: Look for anything that seems out of the ordinary or concerning
  • Avoid: Avoid the area of concern; change your walking pattern or route

•  If you see something in the environment that doesn’t look or feel safe, please notify Security. It’s okay to be overly cautious.

For more information on behavioral escalation, situational awareness and what to do in a workplace violence situation, please refer to UMHS Policy & Procedures to Mitigate Violent and Unsafe Behavior and Support a Therapeutic Care Environment for Patients, Families, Visitors and Staff.