MEDICAL SERVICES
PROVIDED ON BEHALF OF THE DEPARTMENT FOR WORK AND PENSIONS
Training & Development
Dealing with Aggressive and
Potentially Violent Behaviour
Self-Directed Learning
MED-CMEP-DWAPVB~0062(a)
Version: 2 Final
25th January 2008
Medical Services
Foreword
This training has been produced as part of a Continuing Medical Education
programme for Health Care Professionals approved by the Department for Work
and Pensions Chief Medical Adviser to carry out assessments.
All Health Care Professionals undertaking medical assessments must be Registered
Nurses or Registered Medical Practitioners who in addition, have undergone training
in disability assessment medicine. The training includes theory training in a
classroom setting, supervised practical training, and a demonstration of
understanding as assessed by quality audit.
This training must be read with the understanding that, as experienced Health Care
Professionals and disability analysts, the Health Care Professionals will have
detailed knowledge of the principles and practice of relevant diagnostic techniques,
and therefore such information is not contained in this training module.
In addition, the training module is not a stand-alone document, and forms only a part
of the training and written documentation that a Health Care Professional receives.
As disability assessment is a practical occupation, much of the guidance also
involves verbal information and coaching.
Thus, although the training module may be of interest to non-medical readers, it
must be remembered that some of the information may not be readily understood
without background medical knowledge and an awareness of the other training
given to Health Care Professionals.
Office of the Chief Medical Adviser
25th January 2008
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Document
control
Superseded documents
Version history
Version Date
Comments
2 Final
25 January 2008
Signed off by MSCMT
2a (draft)
11 December 2007
Updated by Dr Peter Ellis
1 Final
12 July 2004
Signed off by MP&CT
1d (draft)
9 July 2004
Updates following MP&CT QA
1c (draft)
11 May 2004
Following internal QA
1b (draft)
21 April 2004
Following internal T&D QA
1a (draft)
10 March 2004
First draft
Changes since last version
Foreword added
Atos Origin changed to Atos Healthcare
Minor style changes
Outstanding issues and omissions
Updates to Standards incorporated
Issue control
Author:
Elizabeth Timms
Owner and approver: Dr Jennifer Wintle
Signature: Date:
Distribution:
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Contents
Introduction 5
1.
Section One – Policy and Procedures
7
2.
Section Two – Behaviour Types
11
3.
Section Three - Techniques and Strategies for Dealing with
Aggressive Behaviour
21
4.
Section Four – Self Assessment Exercise Answers
31
5.
Section Five – MCQ Final Assessment Exercise
36
MCQ Dealing with Aggressive and Potentially Violent Behaviour
37
Observation form
39
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Introduction
An Introduction to your Learning Path
Welcome to the learning pack on Dealing with Aggressive and Potentially
Violent Behaviour.
The Learning Pack will take you approximately three hours to complete
which can be done in one go or at smaller separate 'sittings'. It is important
that you complete learning activities in the order they are given; by doing so
you will reflect, consolidate and build on your learning throughout.
A Guide to using this Pack
The following symbols are used to assist you in completing the learning
activities included in this pack:
Indicates a time for reading
Indicates you should record / write your reviews and comments
Advises you of the materials that are provided and/or needed.
Suggests the approximate time needed to complete any particular learning
activity
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Learning Pack Objectives
Through completion of this learning pack you should:
Understand the organisation's procedures for recognising
potentially violent persons
Understand the procedures to follow in the event of an
aggressive/violent incident, including reporting procedures
Recognise types of behaviour and the triggers for aggressive
behaviour
Be aware of techniques / strategies for effectively handling
aggressive/violent behaviour
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1. Section One – Policy and Procedures
Welcome to the first section of your Learning Pack which concentrates on
the Policy and Procedures for dealing with aggressive and violent behaviour.
Objectives
By the end of this section you will:
Understand the organisation's procedures for recognising
potentially violent persons
Understand the procedures to follow in the event of an
aggressive/violent incident, including reporting procedures
Materials
You will need to obtain the following materials to assist your learning:
'Potentially Violent Persons Procedure' (MED-PVPP01)
Duration
The learning activities during this section should take approximately 90
minutes to complete.
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Policy and Procedures
Medical Services has a responsibility to provide information and training to
ensure the health and safety of its employees. Medical Services takes this
responsibility very seriously and has ensured that a robust procedure aimed
at reducing the risk of aggressive and/or violent behaviour has been
adopted.
We also work closely with our customers (Department for Work and
Pensions, DWP) exchanging information on potentially violent (PV) clients in
order to minimise the risks to both you and DWP staff.
Dealing effectively with aggressive and/or potentially violent people is also
an important element of achieving customer satisfaction and avoiding
complaints.
You should have obtained a copy of the organisation's policy and
procedures document 'Potentially Violent Persons Procedure (MED-
PVPP01).
You should take time now to review this document and complete the self-
assessment exercise on pages 8 and 9 of this pack. It is important that you
give sufficient time to reading and understanding the content of the
procedures document prior to attempting the questions.
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Policy and Procedure Self Assessment Exercise
Having reviewed the document 'Potentially Violent Persons Procedure'
(MED-PVPP01) you should now answer the following questions. If possible
do this without referring to the text.
Q1 Who is a Potentially Violent Person?
A1
Q2 Who is responsible for making sure that all individuals who have
contact with the public are aware of the dangers in dealing with Potentially
Violent Persons?
A2
Q3 If an incident occurs, the initial responsibility for dealing with the
Potentially Violent Person rests with whom?
A3
Q4 What form should you complete to inform about an incident involving a
Potentially Violent Person?
A4
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Q5 What form will the Site Manager use to report an incident to the
customer business unit?
A5
Q6 If you communicate with a known Potentially Violent Person, either
face to face, by telephone or letter, what form should you complete and
why?
A6
Q7 There are five key actions / considerations that you should complete if
you are going to visit a potentially violent person - what are they?
A7
The answers to the above questions can be found in section four. You
should check your own answers against these; if you have any wrong
answers please revisit the relevant part(s) of the procedure document to
clarify your understanding.
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2. Section Two – Behaviour Types
The second section of your learning pack focuses on types of behaviour and triggers
for aggressive behaviour.
Objectives
By the end of this section you will:
Recognise types of behaviour and the triggers for aggressive behaviour
Materials
The following material is included in this pack to assist your learning:
o Information on 'Types of Behaviour'
Duration
The learning activities during this section should take approximately 40 minutes to
complete.
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Types of Behaviour
There is a wealth of information available on types of behaviour; learning about
them not only gives us information on which to base our views of others but should
also increase our own self-awareness. It is not simply a matter of how do we feel
when others behave in a certain way but it is also important to recognise that others
will be affected by the way in which we behave.
Defining Behaviour
Non Assertive (Passive) Behaviour
1. Behaviour that includes:
2. Failing to stand up for your rights or doing so in such a way that people can
disregard them
3. Expressing your needs, wants, opinions, feelings or beliefs in apologetic, diffident
or self-effacing ways
4. Failing to express your needs, wants, opinions, feelings or beliefs
Aggressive Behaviour
Behaviour that involves:
1. Standing up for your own rights, but doing so in such a way that you violate the
rights of others
2. Ignoring or dismissing the needs, wants, opinions, feelings or beliefs of others
3. Expressing your own needs, wants, etc inappropriately, e.g., 'What! I'm up to my
eyes in it already. I can't do that as well'
Assertive Behaviour
Behaviour that includes:
1. Standing up for your own rights without violating the rights of others
2. Expressing your needs, wants, opinions, feelings and beliefs in a direct, honest
and appropriate way
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The Effects of Behaviour
The Effects of Non-Assertion - Initial
Initially, non-assertive behaviour can have a positive effect. We have avoided an
argument or upsetting the other person and are relieved at the outcome.
Other people may feel sorry for us and we may feel a little sorry for ourselves (which
we actually like doing!). All this helps to reinforce the non-assertive behaviour.
The Effects of Non-Assertion - Long-term
However, long-term non-assertive behaviour will inevitably lead to a loss of self-
esteem.
We may feel angry or hurt and wallow in self-pity; there may be outbursts of
aggression followed by remorse, and there will be increased stress and possible
health problems. The loss of self esteem will also mean that it is more difficult for us
to act in an assertive way as we begin to feel that others are better than us and have
more rights than we do.
The long term effects on others are also negative; colleagues eventually stop feeling
sorry for us and begin to feel annoyed and irritated. This will lead to them not
respecting us and they may avoid us altogether rather than be faced with the self-
pity. Some people may use the non-assertive behaviour as a signal than we can be
taken advantage of.
The Effects of Aggression - Initial
Initially aggressive behaviour can also have a positive effect. We have had our say
and cleared the air; we may have won or got what we wanted and this may give us a
good feeling. We may feel a sense of power and other people may admire our
outspokenness and say so.
The Effects of Aggression - Long-term
However, in the longer term aggression is negative; we may feel guilt or shame and
become very apologetic and over-helpful. This will lead to us behaving in a non-
assertive manner in order to 'make up' for our aggression in the past.
On the other hand, we may stay in the aggressive stance and become drained of
energy, as we have to maintain a constant state of alert in case someone tries to get
his or her own back. Very long term this can lead to mistrust and even hatred and
we will isolate ourselves more and more.
Long term effects on others are also negative. People may feel angry or hurt and
retaliate openly; worse still there may be covert retaliation such as withholding vital
information, not passing on messages, passing misinformation etc. People will often
take fewer risks and decisions around an aggressive person, as they fear the
consequences of mistakes.
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The Effects of Assertion - Initial
Initially assertive behaviour can have a positive effect. Both parties have aired their
feelings without hurting or upsetting each other.
The Effects of Assertion - Long-term
In the longer term assertion is also positive, as we will be able to maintain a sense
of self-esteem and control. Others will begin to recognise the benefits for
themselves of dealing with an assertive person and will start to mirror your assertive
behaviour.
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How You Come To Be Non-Assertive or Aggressive
Positive Reinforcement
Often non-assertive behaviour is positively reinforced since it has resulted in your
avoiding conflict or upsetting others. In the case of aggressive behaviour, you may
have got your way and feel a sense of power.
Others around you may also praise you for standing up for yourself.
Organisational Culture
Some organisations encourage non-assertive or aggressive behaviour through a
climate that discourages questioning or trying out new ideas or by promoting
aggressive managers.
Fear of Unpleasant Consequences for Assertion
Fear of what might happen if you behave in an assertive way, e.g. anxiety about
causing an argument or upsetting a friend, may cause you to be non-assertive. This
is a common reason for people behaving non-assertively, and anxiety will diminish
only after you start behaving assertively and have not experienced unpleasant
consequences.
Perceiving Situations or Other People as Threatening
If you are unsure of your ability you may wish to avoid drawing attention to yourself.
You will then keep a low profile and avoid certain situations or certain people, or if
you cannot avoid them totally, side step them as much as possible.
Often when we feel threatened we react in an aggressive way, in order to protect
ourselves. Sometimes the threat is real, but often it is our perception of what will
happen that makes us brace ourselves and get into an aggressive mode.
Failing to Accept Your Assertive Rights
If you do not realise or fully accept that you have certain rights, you will not stand up
for these rights and become non-assertive.
Failing to Think Rationally about Yourself
This often comes about when you start to compare yourself unfavourably to other
people, e.g. 'I'll never be as good as Tony at getting my ideas across.' This may or
may not be true, but it will lead to you putting ideas across tentatively and to
withdraw them at the first sign of resistance. This type of thinking can eventually
lead to a negative self-image and will maintain your non-assertion.
Sometimes, the comparison with others will lead you to feel jealousy or resentment
against others, which in turn can lead to aggressive behaviour. At other times the
comparisons you make will be exaggerated in your favour, leading you to boast to
other people.
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Confusing Assertion with Aggression
If you are used to an environment where non-assertion is common, you will be likely
to see any firm statement of assertion from others as aggression. Because you do
not want to be seen as aggressive, you bend over backwards to make sure that this
does not happen.
Your Beliefs about Aggression
If you believe that the only way to get results is to be aggressive and you want to get
results, then you will behave aggressively. Such a belief stems from seeing the
world as a hostile place, in which the only way to survive is to 'get them before they
get you.'
It is a self-fulfilling prophecy that if you treat people aggressively, then they are likely
to be aggressive in return. In addition, you may see non-assertion as the only
alternative to aggression and so ignore the option of behaving assertively.
Failing to Develop Assertive Skills
If you have been encouraged or rewarded from early days for behaving non-
assertively or aggressively, then this is the behaviour you become skilled in using.
As you only use assertive behaviour in 'safe' situations, you do not become skilled at
such things as stating your own point of view when it is different from other peoples'.
The result is that your behaviour pattern will contain a lot of non-assertion and there
maybe bursts of aggression when the tension resulting from this non-assertion
becomes too much.
When you have been non-assertive about something for a period of time, frustration,
hurt, or anger can build up until you are not prepared to stand it any longer. It is
often the straw that breaks the camel's back, and other people can be quite taken
aback by your sudden outburst.
Equating Non-Assertion with Politeness
You have probably been brought up to be polite and considerate to others. The
mistake many people make is to believe that in order to be polite you need to be
non-assertive. It is both polite and assertive to thank people or to apologise for
something. It is however non-assertive to apologise profusely for your own opinion
or for needing someone to help with some work.
Confusing Non-Assertion with Helpfulness
You may believe that when you are non-assertive you are actually being helpful to
the other person. In fact, the reverse may well be true. For example, if during an
examination/interview you ask questions in a non-assertive way the purpose of them
may be vague and unclear to the claimant. You may believe that you are being
helpful by not asking an assertive/direct question or probing answers but this can
lead to vague and less valuable information being given by the claimant. He/she
may interpret your non-assertive approach as a lack of interest and may eventually
become irritated.
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Summary of Verbal Aspects of Behaviour
NON-ASSERTIVE
ASSERTIVE
AGGRESSIVE
Long rambling
Statements that are clear and to Excess of "I" statements
the point
Fill in words "maybe"
"I" statements, "I'd like"
Boastfulness "My"
Apologetic and permission
Suggestions not weighted with
Threatening questions
seeking "I should", "I ought" advice
Few "I" statements (often
No 'shoulds' or 'oughts'
Requests as instructions or
qualified)
threats
Phrases that dismiss own
Constructive criticism without
Heavily weighted advice in
needs, "not important really" blame or assumptions
the form of "should" and
"ought"
Self put downs, "I'm
Questions to find out the
Blame put on others
hopeless"
thoughts, opinions and wants of
others
Ways for getting round problems Assumptions, sarcasm and
other put downs
Sometimes wobbly
Steady and firm
Very firm
Tone may be sing-song
Tone is middle range
Tone is sarcastic, sometimes
cold
Often dull and monotone
Sincere and clear
Hard and sharp
Quiet, often drops away at
Not over-loud or quiet
Often shouting, rises at the
the end
end
Hesitant and filled with
Fluent, few hesitations
Fluent, few hesitations
pauses
Sometimes jerks from fast to Emphasises key words
Often abrupt
slow
Throat clearing frequently
Steady, even pace
Blames others
Whilst not all the criteria outlined above under the heading 'assertive' will be present
in every case, it is important to ensure that your manner and tone are based on
these criteria. This helps you present a confident approach to the examination and
interview. A non-assertive or aggressive approach can give the impression of
uncertainty and a lack of experience and/or knowledge.
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Summary of Non-Verbal Aspects of Behaviour
NON-ASSERTIVE
ASSERTIVE
AGGRESSIVE
FACIAL
"Ghost" smiles when
Smiles when pleased,
Smile may become "wry"
EXPRESSION
expressing anger and
frowns when angry
being criticised
otherwise "open"
Scowls when angry
Eyebrows raised in
Features steady
Eyebrows raised in
anticipation
amazement or disbelief
Quick changing features Jaw relaxed but not loose Jaw set firm
Chin thrust forward
EYE CONTACT Evasive
Firm but not a stare
Tries to stare down and
dominate
Looking down
BODY
Hand wringing
Open hand movements
Finger pointing
MOVEMENTS
Hunched shoulders
Sits upright and relaxed
Fist thumping
Nervous movements
Stands with head held up Stands upright, head in
which detract
the air
Arms crossed for
Strides around
protection
Arms crossed -
unapproachable
Whilst not all the criteria outlined above under the heading 'assertive' will be present
in every case, it is important to ensure that your non-verbal communication is based
on these criteria. This helps you present a confident approach to the examination
and interview.
A non-assertive or aggressive approach can give the impression of uncertainty and
a lack of experience and/or knowledge.
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Triggers for Aggressive Behaviour
Earlier you will have read about the generic reasons why people behave in an
aggressive way. Obviously you are meeting claimants in what may be a stressful
situation for them and the following outlines some of the specific factors that could
affect how they behave:
They feel their benefits are under threat or that the incapacity / disability is
under question or not believed i.e. they think their integrity or honesty is
in question
They are fearful of what the examination entails or are suspicious of
Medical Services and our role
They are ill, tired, under stress or frustrated
They feel like victims; powerless in their situation
They have not had their expectations met
They were already upset with someone else or about something else
They do not feel listened to - or that no-one will listen unless they shout or
make a scene
They are out to prove they are right, whether they are or not
They have had conflicting stories/versions of events from different
members of staff/Health Care Professionals
They have acted on things they were told by members of staff and these
were wrong
They have already experienced an unpleasant attitude or indifferent, rude
or discourteous behaviour from someone in Medical Services
They believe someone in Medical Services promised something that was
not delivered
They feel they can manipulate you to get what they want if they make a
fuss
They made a wrong assumption about what Medical Services could do for
them
They are embarrassed about doing something incorrectly
They are under the influence of drink or drugs
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Types of Behaviour Self Assessment Exercise
Having read the information on 'Types of Behaviour' you should now answer the
following questions. If possible do this without referring to the text.
Q1 Is standing up for your own rights, but doing so in such a way that you violate
the rights of others, aggressive or assertive behaviour?
A1
Q2 Fill in the missing words:
A2
Assertive behaviour includes expressing your needs, wants, _ _ _ _ _ _ _ _,
feelings and _ _ _ _ _ _ _ in a direct, _ _ _ _ _ _ and appropriate way.
Q3 Can non-assertive behaviour have a positive effect?
A3
Q4 Which type of behaviour can have a positive effect both in the short and long
term?
A4
The answers to the above questions can be found in section four. You should check
your own answers against these; if you have any wrong answers please revisit the
relevant part(s) of section two of this learning pack to clarify your understanding.
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3. Section Three - Techniques and Strategies for
Dealing with Aggressive Behaviour
The third section of your learning pack looks at the techniques and strategies for
dealing with aggressive behaviour
Objectives
By the end of this section you will:
Be aware of techniques / strategies for effectively handling aggressive /
violent behaviour
Materials
The following material is included in this folder to assist your learning:
Information on the techniques for handling aggressive behaviour
Duration
The learning activities during this section should take approximately 30 minutes to
complete.
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Effectively Handling Aggressive Behaviour
Types of Assertion
We identified earlier that assertive behaviour involves:
Standing up for your own rights without violating the rights of others
Expressing you needs, wants, opinions, feelings and beliefs in a direct, honest and
appropriate way. This includes offering an apology where appropriate, which can be
very valuable in maintaining an assertive interaction.
We also established that this in turn means we will be able to maintain a sense of
self-esteem and control; it is therefore key in effectively handling the aggressive
behaviour of others.
We all find that we can be assertive in some situations whilst in others this is less
easy. This is because our repertoire of assertive behaviour is very often limited.
There are different types of assertion, and the ability to use all types will give far
more scope to deal with a wider range of situations.
There are 6 main types of assertion
BASIC
EMPATHETIC
DISCREPANCY
NEGATIVE FEELINGS
CONSEQUENCE
RESPONSIVE
Basic Assertion
This is a straightforward statement where you stand up for your rights. It involves
making clear your needs, wants, beliefs, opinions or feelings.
For example:
"Yes Mr… your appointment was scheduled for 10.00am"
"I need to write down the details of your medical condition because the Decision
Maker has requested this report"
Basic assertion is the most common form of assertion used every day to make your
needs, wants and opinions known. In addition, you use it to give praise,
compliments, information or facts to others. It is particularly appropriate to use it
when you are raising an issue for the first time. You can also use it to re-emphasise
your needs, when you feel your initial statement has been ignored or played down.
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Empathetic Assertion
This assertion contains an element of empathy as well as a statement of your needs
or wants. By empathy we mean the ability to put yours
lf in the other person's position and recognise their feelings, needs and wants. For
example:
"I appreciate that you are finding some of the questions difficult however it is
important that you answer them as fully as you can. I will help you by taking you
through the routine of a typical day and in that way we will provide a full report for
the Decision Maker."
Empathy is different to sympathy. Sympathy involves feeling sorry for someone and
leaves people where they are - feeling sorry for themselves.
Empathetic assertion can be used when the other person is engrossed in a situation
and you wish to indicate that you are aware of and sensitive to this situation. This
enables the other person to realise that you are not dismissing them. It is an
essential ingredient in resolving conflicts where people behave aggressively.
It is also useful in holding you back from over reacting with aggression since you
must give yourself time to imagine the other person's position, and so automatically
slow down your responses.
Discrepancy Assertion
By this we mean pointing out the discrepancy between what has previously been
agreed and what is actually happening or about to happen. It often concludes with a
statement of your needs or wants. For example:
"Originally I thought that you had agreed to a physical examination but now that we
have finished the interview you are saying you do not want to be examined is that
correct?"
Discrepancy assertion is a useful starting point when you suspect there is a
contradiction between what has been agreed and what is happening or about to
happen. It helps to establish whether there is really a contradiction or whether there
has just been a misunderstanding. It helps you and the other person to clarify and
agree the way forward without conflict.
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Negative Feelings Assertion
Here you are making a statement that draws the attention of another person to the
undesirable effect their behaviour is having on you. It can contain the following
elements, not necessarily in this order:
1.
When.................(an objective description of other's behaviour)
2.
The effects are..........(how the behaviour specifically effects you)
3.
I feel..............(a description of your feelings)
4.
I'd like................(a statement of what you want or prefer)
For example:
"WHEN you shout at me in this way, IT MEANS that I'm not able to help you. I
FEEL concerned about this, so I'D LIKE you to lower your voice and speak calmly
with me.
Negative feelings assertion can be used when a person is still ignoring your rights in
spite of your having raised the issue on previous occasions. It allows you to state
your case objectively rather than in an emotional outburst.
Consequence Assertion
This informs the other person of the future consequences for them of not changing
their behaviour. It also includes the chance to change the behaviour before the
consequence occurs.
For example:
"If you continue to shout in a threatening manner, I'll be left with no option other than
bring this appointment to an end. I'd prefer not to have to do that but I'll be left with
no alternative."
This is the strongest form of assertion and is a last resort behaviour, to be used
sparingly and only when all other types have failed. It is easy for consequence
assertion to be seen as aggressive and in order to avoid this you must ensure that
the words themselves are factual rather than emotional or personal. You should be
aware of your non-verbal behaviour and remain in an assertive stance rather than
an aggressive one.
Obviously if the unwanted behaviour continues you must take the action your
previously outlined and inform the other person that you intend to do this.
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Responsive Assertion
The emphasis with this type of assertion is upon finding out where other people
stand - their needs, wants, opinions, and feelings. This is often done by asking
questions but can also be done by statements making it clear you would like to hear
from them. For example:
"You say that you are not happy to discuss your medical condition with me, however
your carer is prepared to help you with this - is that acceptable to you?"
"What problems does that create for you?"
"I'd like you to say what activities you do during an average day."
Responsive assertion is the vehicle for checking that in standing up for your own
rights you are not violating the rights of others. It can be very useful when others
are behaving non-assertively.
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Additional Key Points
It's not always easy when feeling 'threatened' to identify and use effectively the right
sort of assertion - this comes with experience. However the more you use assertive
techniques in everyday interactions the more familiar you will become with them and
thereby the more likely you are to be able to use them in more difficult situations.
The following are additional points you should take into consideration to help you
recognise, prevent and deal effectively with aggressive behaviour:
Your Feelings
Your feeling of fear is a better indicator of something threatening than
looking for signs of anxiety in others
Fear is information for you to use. Therefore if the hair stands on end at
the back of your neck, stop and assess. It may just be a natural reaction to
change or the unknown
Your Actions
Do not respond to aggression with aggression
Stay calm; speak slowly and clearly. Do not argue or be enticed into
further argument
Do not hide behind your authority, status or jargon. Inform the customer
who you are, ask his/her name and discuss what you need / would like him
or her to do
Try to talk things through adult to adult in order to defuse the situation, but
remember your first duty is to yourself
Avoid an aggressive stance: crossed arms, hands on hips, a wagging
finger or raised arm will challenge and confront
Never put a hand on someone who is angry, they may see this as
threatening
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Safety First
Finally it is important that you maintain your safety
When you feel frightened ask yourself:
Is this person's anger/hostility directed at me, the organisation,
themselves, or is it a form of distress?
Am I in danger? If you think you are, leave and get help immediately
Am I the best person to deal with the threat? If you find particular
situations difficult, perhaps someone else could handle it more
effectively. This is a positive step / decision
Never underestimate the threat
Keep a safe distance from your aggressor
If the threat of violence is imminent, avoid potentially dangerous locations
such as the top of stairs, restricted spaces or places where there is
equipment which could be picked up and used as a weapon
Keep your eye on potential escape routes. Keep yourself between the
aggressor and the door and if possible behind a barrier such as a desk or
table
Be mindful of Health and Safety matters. Arrangement of furniture in the
examination room should leave you with a clear pathway from your desk
and seat to the door. Avoid seating the claimant in the exit path
Never turn your back. If you are leaving move gradually backwards
Never remain alone with an actively violent person. Be prepared to move
very quickly if necessary
Do not have objects that could be used as tools of aggression within
reach of an aggressive person e.g. pens, letter openers, hot drinks
Do not visit a known potentially violent person unless accompanied by
another member of staff
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Self Reflection
Having reached this part of your pack, take time now to reflect on a previous difficult
and/or threatening situation that you have faced. Record your thoughts below.
Describe the situation
What warnings did you receive that the situation was going to be or become
difficult and/or threatening?
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How did you react?
What was the outcome?
What would you do differently if you faced a similar situation?
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Effectively Handling Aggressive Behaviour Self Assessment
Exercise
Having read the information on 'Effectively Handling Aggressive Behaviour' you
should now answer the following questions. If possible do this without referring to
the text.
Q1 List the six main types of assertion
A1
Q2 True or False?
Sympathy is described as 'putting yourself in the other person's position and
recognising their feelings, needs and wants
A2
Q3 Negative Feelings assertion contains four main elements, what are they?
A3
Q4 Which type of assertion is considered the strongest?
A4
The answers to the above questions can be found in section four. You should check
your own answers against these; if you have any wrong answers please revisit the
relevant part(s) of section three of this learning pack to clarify your understanding.
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4. Section Four – Self Assessment Exercise
Answers
The fourth section of your Learning Pack provides answers to the various self-
assessment exercises you have completed in previous sections.
Objectives
By the end of this section you will:
Have compared your own self-assessment exercise answers to the ideal
Identified any areas of the Learning Pack that you should revisit for
clarification
Materials
The following material is included in this folder to assist your learning:
Self-Assessment Exercise Answers
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Policy and Procedure Self Assessment Exercise - Answers
Q1
Who is a Potentially Violent Person?
A1
Someone who threatens or conducts violence against an employee, associate
or self-employed contractor
Q2
Who is responsible for making sure that all individuals who have contact
with the public are aware of the dangers in dealing with Potentially Violent
Persons?
A2
The Director of Service Delivery DWP through the Company Security Officer
Q3 If an incident occurs, the initial responsibility for dealing with the
Potentially Violent Person rests with who?
A3
The Site Security Co-ordinator
Q4 What form should you complete to inform the Team Leader of an
incident involving a Potentially Violent Person?
A4
IF1
Q5 What form will the Site Manager use to report an incident to the
customer business unit?
A5
IF2
Q6
If you communicate with a known Potentially Violent Person, either face
to face, by telephone or letter, what form should you complete and why?
A6
Form Appendix 2(PVP)
To assist the DWP with a PVP status annual review
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Q7
There are five key actions / considerations that you should complete if
you are going to visit a potentially violent person - what are they?
A7
You must not visit a potentially violent person unless you:
Are accompanied by another individual, unless it is believed that the presence
of a third party would increase the risk of an incident
Consider carrying a personal alarm
Let your office know when and where you are going to make the visit
Have agreed with another individual, a report back time, when you expect to
have completed the visit and returned to the office, or a place of safety e.g.
home
Provide the nominated individual with a contact number to check with you, if
you do not call in
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Types of Behaviour Self Assessment Exercise - Answers
Q1
Is standing up for your own rights, but doing so in such a way that you
violate the rights of others, aggressive or assertive behaviour?
A1 Aggressive
Q2
Fill in the missing words:
A2
Assertive behaviour includes expressing your needs, wants, opinions,
feelings and beliefs in a direct, honest and appropriate way.
Q3
Can non-assertive behaviour have a positive effect?
A3
Yes, in the short term
Q4
Which type of behaviour can have a positive effect both in the short and
long term?
A4 Assertive
behaviour
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Effectively Handling Aggressive Behaviour Self Assessment
Exercise - Answers
Q1
List the six main types of assertion
A1 Basic
Empathetic
Discrepancy
Negative
Feelings
Consequence
Responsive
Q2
True or False?
Sympathy is described as 'putting yourself in the other person's position and
recognising their feelings, needs and wants
A2
False, empathy is described in this way
Q3
Negative Feelings assertion contains four main elements, what are they?
A3
An objective description of the other person's behaviour
How the behaviour specifically affects you
A description of your feelings
A statement of what you want or prefer
Q4
Which type of assertion is considered the strongest?
A4 Consequence
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5. Section Five – MCQ Final Assessment Exercise
Welcome to the fifth and final section of your Learning Pack. This section includes a
multiple choice assessment exercise which you should complete and forward to
your local Training and Support Manager at your local Medical Service Centre
(MSC)
As this exercise is 'open book' it is anticipated that you will achieve 100% correct
answers. If you should get any incorrect answers your Training and Support
Manager will advise you so that you can complete a second attempt.
Objectives
By the end of this section you will:
Have completed the multiple choice assessment exercise
Materials
The following materials are included in this folder to assist your learning:
Self-Assessment Exercise Answers
Duration
The activities in this section should take approximately 15 minutes to complete.
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MCQ Dealing with Aggressive and Potentially Violent
Behaviour
Instructions:
This is a multiple-choice questionnaire, which means you are asked a series of questions
and given a choice of possible answers for each. Only one answer is correct in each case.
You should attempt all questions, tick the answer you believe to be correct and return your
completed MCQ to your local MSC.
Name (Please Print):
Date:
Signature:
Base (MSC):
Question
Possible Answers
Tick
box
Which type of
A
Passive
behaviour includes
1
an open, relaxed
posture in its non-
B
Aggressive
verbal aspects?
C
Assertive
Who can designate a
A
The Customer Business Unit(s)
member of the public
2
as a Potentially
Violent Person?
B
Any member of Medical Services' staff
C
A Medical Services' Site Manager
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Question
Possible Answers
Tick box
Who would complete A
A Medical Services' Site Manager
form IF3 following an
3
incident?
B
A witness
C
The claimant
Which type of
assertion is useful
A
Consequence
when you suspect
4 there is a contradiction
between what has
B
Basic
been agreed and what
is happening or about
to happen?
C
Discrepancy
How does the
A
A yellow circle
customer business
5
unit indicate on a
claimant's referral
B
A red chequered square
documents if he/she is
a Potentially Violent
Person?
C
A green square
Which type of
A
Aggressive
behaviour includes
6
'shoulds' and/or
'oughts' in its verbal
B
Assertive
aspects
C
Passive
If you are asked to
visit a potentially
A
Complete the visit and report the lack of information
violent person where a
afterwards
7 full account of the
incident that led to the
person being
B
Do not complete the visit and return the file to the
classified as
Administration section
potentially violent is
not included in the file
you should:
C
Complete the visit making sure you take another
individual with you
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Observation
form
Please photocopy this page and use it for any comments and observations on this
document, its contents, or layout, or your experience of using it. If you are aware of
other standards to which this document should refer, or a better standard, you are
requested to indicate this on the form. Your comments will be taken into account at
the next scheduled review.
Name of sender:
________________________ Date:
_____________
Location and telephone number:____________________________________
Please return this form to: Angie Rhodes
Training and Development Co-ordinator
Atos Healthcare
3300
Solihull
Parkway
Birmingham
Business
Park
Birmingham
B37 7YQ
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