Transcript
Speaker: Welcome back to Confidence in Conflict, the podcast where we explore evidence-based strategies for creating safer healthcare environments.
Speaker: I'm Marcus, former Healthcare Security Director, and today we're diving into something fundamental yet often overlooked, how your voice can be your most powerful tool for staying safe.
Speaker: And I'm Natalie, nurse practitioner and clinical team leader.
Speaker: Marcus, when people think about safety in health care, they often think about alarms, security guards, or physical barriers.
Speaker: But what we're talking about today is something every single health care worker already has, their voice and their presence.
Speaker: That's exactly right, Natalie.
Speaker: Throughout my healthcare security career, I've seen countless situations where the right words, delivered the right way, completely transformed what could have been a dangerous encounter.
Speaker: Today, we're exploring how verbal strategies and presence can prevent conflict before it even starts.
Speaker: And this isn't just theory, Marcus.
Speaker: As someone who's worked in emergency departments and trauma units, I can tell you that how we use our voice, our tone, our word choice, our timing, can literally be the difference between a peaceful interaction and a violent one.
Speaker: Let's start with the foundation.
Speaker: Natalie, when we discuss using your voice for safety, what exactly are we talking about?
Speaker: What makes the difference between words that calm and words that escalate?
Speaker: It starts with understanding that what we say is not nearly as important as how we say it.
Speaker: Every word we say carries emotional weight, especially when someone is stressed, frightened, or frustrated, which describes most patients and families we encounter in healthcare settings.
Speaker: They're not just hearing our words, they're feeling them.
Speaker: They're interpreting not just our words, but our tone and body language.
Speaker: That's such an important point.
Speaker: From a security perspective, I learned that people often react more to the emotion behind words than to the actual content.
Speaker: You can say the exact same sentence in two different ways, by simply varying the tone or your facial expression and convey two completely different meanings and intentions.
Speaker: Sure, just depending on the tone you use, you can sound distracted, uncaring, dismissive, or judgmental.
Speaker: But if you use the right tone, you can sound empathetic and caring.
Speaker: That's right.
Speaker: But the words you choose also have a lot of impact on your meaning and intentions.
Speaker: Exactly.
Speaker: Let me give you a real example from last week.
Speaker: A patient had been waiting in the emergency department for six hours with chest pain.
Speaker: He was getting increasingly agitated, demanding to know when he'd be seen.
Speaker: A newer nurse approached him and said, Sir, you need to calm down.
Speaker: There are people ahead of you.
Speaker: The patient exploded.
Speaker: I can imagine.
Speaker: That response, while factually accurate, probably felt dismissive and controlling to someone who was already scared about his symptoms.
Speaker: Exactly.
Speaker: Later, I approached the same patient using what I've learned about verbal de-escalation.
Speaker: I said, I can see you're really worried about your chest pain, and six hours feels like forever when you're scared.
Speaker: Let me explain exactly what's happening with your care and what we're monitoring for.
Speaker: His entire demeanor changed instantly.
Speaker: That's a perfect example of how the same information can be delivered in completely different ways.
Speaker: Natalie, let's break down what you did differently in that second approach.
Speaker: Well, first I acknowledged his emotion, his worry and fear.
Speaker: Then I validated his experience.
Speaker: That six hours really does feel like forever, especially when you're scared.
Speaker: Only then did I move to providing information and reassurance.
Speaker: The sequence matters, Marcus.
Speaker: That sequence is crucial.
Speaker: It's what Vistalar calls emotional acknowledgement before information.
Speaker: When people feel heard and understood emotionally, they become much more receptive to factual information.
Speaker: If you try to give facts to someone who feels dismissed, they often can't even process what you're saying.
Speaker: And there's something else important in that example.
Speaker: I used what they call empathetic language.
Speaker: Instead of saying, you need to calm down, which puts the responsibility on the patient and implies they're doing something wrong, I focused on acknowledging their legitimate concerns.
Speaker: Let's talk more about tone of voice because this is something that can make or break any interaction.
Speaker: Natalie, what have you learned about how tone affects safety in clinical settings?
Speaker: Absolutely, tone is critical, Marcus.
Speaker: I've seen situations where someone said all the right words.
Speaker: but their tone was impatient or condescending, so they escalated the situation anyway.
Speaker: Your tone needs to match your intent.
Speaker: If you want to convey respect and concern, your voice needs to sound respectful and concerned.
Speaker: And tone is one of those things that people pick up on unconsciously but immediately.
Speaker: Even if someone can't articulate why, they know when someone's tone feels authentic versus when it feels fake or forced.
Speaker: That's so true.
Speaker: And it's not about being artificially sweet or overly cheerful.
Speaker: In healthcare, people want to feel like you're taking their situation seriously.
Speaker: A calm, steady, genuinely concerned tone often works much better than an overly bright customer service voice.
Speaker: Let's discuss pacing, because this is another vocal element that significantly impacts safety.
Speaker: Natalie, how does the speed and rhythm of your speech affect patient interactions?
Speaker: Pacing is huge, Marcus.
Speaker: When we're busy or stressed, we tend to speak faster, but that can make patients feel rushed or unimportant.
Speaker: I've learned to deliberately slow down my speech when I'm dealing with someone who seems agitated or confused.
Speaker: It has a calming effect.
Speaker: There's a lot of good psychological research behind that.
Speaker: When you speak slowly and calmly, it can help regulate the other person's nervous system.
Speaker: It's like your calm energy becomes contagious.
Speaker: Vistalar calls that modeling.
Speaker: It's based on the understanding that our behavior sets the tone and pace for others to naturally follow.
Speaker: Pausing is another form of pacing that models positive communication.
Speaker: When someone asks a question or expresses a concern, I've learned to pause for a moment before responding.
Speaker: It shows that I'm considering what they've said rather than just waiting for my turn to talk.
Speaker: That way, I can set the tone of the conversation and send it in a good direction.
Speaker: That pause also gives you time to choose your words more carefully.
Speaker: In high stress situations, our tendency is often to react quickly, but that quick reaction isn't always the most helpful response.
Speaker: So true.
Speaker: And let's talk about volume, because that's another vocal element that affects safety.
Speaker: Marcus, what have you observed about how loudness or softness impacts conflict situations?
Speaker: Volume is fascinating because it can either escalate or de-escalate so quickly.
Speaker: If someone is shouting and you shout back, you've just created a shouting match.
Speaker: But if someone is agitated and you deliberately lower your voice, they often unconsciously lower theirs to match you.
Speaker: I use that technique all the time.
Speaker: When a patient or family member is getting loud, I actually speak more quietly.
Speaker: Not so quietly that they can't hear me, but noticeably softer than their volume.
Speaker: It's amazing how often they adjust their volume to match mine.
Speaker: And there's something about a calm, quiet voice that suggests confidence and control.
Speaker: It communicates that you're not threatened or overwhelmed by their emotions, which can be very reassuring to someone who feels out of control themselves.
Speaker: Let's talk more about word choice.
Speaker: This is another place where we can make a major difference in preventing conflicts.
Speaker: Certain words tend to escalate situations, while others naturally de-escalate.
Speaker: Like the phrase, calm down, we mentioned before.
Speaker: What are some other words or phrases you have noticed that may escalate others?
Speaker: One of the biggest escalators I've observed is the word, no, when it's used without context or alternatives.
Speaker: No, you can't do that, immediately creates an adversarial dynamic.
Speaker: But I understand why you'd want to do that, and here's what we can do instead, provides the same boundary while maintaining partnership.
Speaker: That's such a good point.
Speaker: I've learned to replace commands with explanations and options whenever possible.
Speaker: Instead of, you have to wait, I might say, the good news is we're monitoring your condition carefully.
Speaker: While we're waiting for your test results, would you like me to explain what we're watching for?
Speaker: That approach turns waiting into active care rather than passive delay.
Speaker: You're reframing the experience entirely.
Speaker: Natalie, what about language that acknowledges uncertainty?
Speaker: Health care is full of situations where we don't have immediate answers.
Speaker: Oh, that's so important, Marcus.
Speaker: Early in my career, I felt like I had to have all the answers immediately, so I'd sometimes give vague or overly optimistic responses.
Speaker: But I've learned that honest uncertainty, expressed with confidence in the process, is much more trusted than false certainty.
Speaker: Can you give us an example of how you handle uncertainty now?
Speaker: Sure.
Speaker: If a family asks when their loved one will be discharged and I don't know yet, I might say, that's exactly the question we're working to answer right now.
Speaker: Dr. Smith is reviewing the latest test results, and I expect to have an update for you within the next hour.
Speaker: I'll come find you as soon as I know more.
Speaker: That's brilliant because you're acknowledging their question, explaining why you don't have the answer yet, showing that work is actively being done, and giving them a time frame for when they'll get information.
Speaker: It turns uncertainty into a transparent process.
Speaker: And it prevents them from feeling ignored or forgotten.
Speaker: Marcus, let's talk about something that's really important.
Speaker: How we respond when someone is upset or emotional.
Speaker: What language patterns help versus hurt in those situations?
Speaker: This is where I see the biggest differences between effective and ineffective responses.
Speaker: Phrases like, calm down, or don't be upset, rarely work because they invalidate the person's emotions.
Speaker: Instead, acknowledging the emotion first creates connection.
Speaker: Exactly.
Speaker: I've learned to use phrases like, I can see this is really frustrating, or it makes sense that you'd be worried about this.
Speaker: It's not agreeing that their response is proportionate, but it's validating that their emotion is understandable, given their perspective.
Speaker: And there's something powerful about naming emotions accurately.
Speaker: If someone is scared but expressing it as anger, gently identifying the underlying fear can shift the entire conversation.
Speaker: That's so true.
Speaker: I had a patient last month who was yelling at me about the pain medication not working.
Speaker: But when I said, it sounds like you're really scared that the pain isn't getting better, he broke down and admitted he was terrified that something was seriously wrong.
Speaker: Once we addressed the fear, we could have a much more productive conversation about pain management.
Speaker: That's a perfect example of how the right words can reveal what's really going on underneath the surface behavior.
Speaker: Let's talk about questions, Natalie.
Speaker: How we ask questions can dramatically affect both safety and outcomes.
Speaker: Questions are so powerful, Marcus.
Speaker: Open-ended questions that invite someone to share their perspective can completely change the dynamic of an interaction.
Speaker: Instead of, are you having pain?
Speaker: Which gets a yes or no answer, I might ask, tell me about how you're feeling right now or what's your biggest concern today?
Speaker: Those broader questions give people space to tell their story, which often reveals important information we wouldn't get from narrow, closed questions.
Speaker: and they make the person feel like a partner in their care rather than just a passive recipient.
Speaker: When people feel heard and involved, they're much less likely to become confrontational.
Speaker: Let's discuss something that's crucial but often overlooked, how we communicate policies and rules.
Speaker: Natalie, there's a huge difference between explaining a policy and just enforcing it.
Speaker: Absolutely.
Speaker: When I have to communicate a rule or limitation, I've learned to explain the why behind it, not just the what.
Speaker: For example, instead of, visiting hours are over, I might say, we end visiting hours at 8 p.m.
Speaker: because our patients need uninterrupted rest for healing, and it helps our night shift nurses provide the best care.
Speaker: That explanation helps people understand that the rule serves a purpose beyond just control.
Speaker: It's about patient care, not arbitrary authority.
Speaker: and when possible, I try to offer alternatives or compromises.
Speaker: Visiting hours are ending, but you're welcome to call in the morning to check on how the night went, and visiting starts again at 9 a.m.
Speaker: Speaking of alternatives, let's talk about the power of offering choices.
Speaker: Even small choices can help people feel like they have some control in an otherwise powerless situation.
Speaker: Choices are amazing for preventing conflicts, Marcus.
Speaker: Even something as simple as, would you prefer to wait in the family lounge or would you like me to update you by phone, gives people agency.
Speaker: When people feel like they have some control, they're much less likely to act out.
Speaker: And choices work even in situations where the main outcome isn't negotiable.
Speaker: You might not be able to change what needs to happen, but you can often offer choices about how it happens.
Speaker: Exactly.
Speaker: We do need to get this blood draw done, but would you prefer to sit up or lie down?
Speaker: Another example might be, would you like me to explain what I'm doing as I go, or would you prefer to talk about something else?
Speaker: Let's talk about something that's particularly relevant in health care, how we communicate bad news or difficult information.
Speaker: This is where verbal skills can literally prevent violent reactions.
Speaker: This is so critical, Marcus.
Speaker: The way we deliver difficult information can determine whether someone falls apart, gets angry, or is able to process and cope with what they're hearing.
Speaker: I've learned to use what's called the warning shot approach.
Speaker: Can you explain that for our listeners?
Speaker: Instead of just blurting out bad news, I prepare people for what they're about to hear.
Speaker: I have some test results to share with you, and I'm afraid they're not what we were hoping for.
Speaker: That gives their brain a moment to brace for impact rather than being blindsided.
Speaker: And then you follow up with support and next steps, right?
Speaker: You don't just deliver the bad news and leave them hanging.
Speaker: Exactly.
Speaker: The scan shows that the cancer has spread.
Speaker: I know this is devastating news.
Speaker: Dr. Johnson is going to come talk with you about treatment options, and I'm going to make sure you have all the support resources you need.
Speaker: That structure, warning, news, immediate support, and next steps helps people process difficult information without feeling abandoned or hopeless.
Speaker: Let's talk about something that happens frequently in healthcare.
Speaker: When we make mistakes or when things don't go as planned, how we communicate about errors or complications can prevent or trigger angry reactions.
Speaker: This is where honesty, accountability, and immediate action plans become crucial.
Speaker: People can usually handle mistakes if they feel like you're being honest about what happened and taking responsibility for fixing it.
Speaker: I've learned to use what I call the Acknowledge, Apologize, Act approach.
Speaker: I realize I told you the doctor would be in within an hour, and it's been two hours now.
Speaker: I apologize for the delay and for not updating you sooner.
Speaker: Let me go find out exactly when she'll be available and get you a realistic time frame.
Speaker: That approach prevents defensiveness and shows that you take their time and concerns seriously.
Speaker: It also demonstrates that you're actively working to solve the problem rather than just making excuses.
Speaker: Marcus, let's address something that many health care workers struggle with.
Speaker: How to set boundaries or say no while maintaining rapport and safety.
Speaker: Boundary setting is definitely an art form.
Speaker: The key is communicating the boundary clearly while showing that you understand and care about their needs, even if you can't meet their specific request.
Speaker: I use what I call empathetic limits.
Speaker: For example, I can see how much you love your mom and want to stay with her.
Speaker: Unfortunately, we can only allow one visitor overnight in the ICU, but let me see if we can arrange for you to have some extra time with her during the day.
Speaker: That acknowledges their motivation, explains the limitation, and offers an alternative.
Speaker: It shows that you're trying to work with them, not against them.
Speaker: And sometimes the boundary is about safety.
Speaker: I understand you're frustrated, but can I ask you to lower your voice while we work together to solve this problem?
Speaker: This has to be a calm and healing environment for our patients.
Speaker: That frames the boundary in terms of mutual benefit rather than just control.
Speaker: Let's talk about body language and how it interacts with verbal communication.
Speaker: Natalie, how does your physical presence support or undermine your words?
Speaker: Body language is huge, Marcus.
Speaker: You can say all the right words.
Speaker: But if your body language contradicts them, people will believe your body over your words every time.
Speaker: If I'm saying, I have time to listen, but I'm checking my watch or looking at my phone, my words become meaningless.
Speaker: And positioning matters too.
Speaker: Standing over someone who's sitting can feel intimidating, even if that's not your intention.
Speaker: Sitting down or positioning yourself at their eye level creates a more collaborative feel?
Speaker: Absolutely.
Speaker: And eye contact is crucial.
Speaker: Not staring, which can feel aggressive, but making regular, comfortable eye contact that shows you're present and engaged with what they're saying.
Speaker: What about facial expressions?
Speaker: How do they support verbal de-escalation?
Speaker: Your face needs to match your words and your intent.
Speaker: If someone is telling you about their pain or fear and you have a neutral or distracted expression, it contradicts any empathetic words you might be saying.
Speaker: Your face should reflect appropriate concern and engagement.
Speaker: Let's discuss something that's particularly challenging, dealing with people who are under the influence of substances or experiencing mental health crises.
Speaker: How do verbal strategies adapt to these situations?
Speaker: These situations require extra patience and modified communication strategies, Marcus.
Speaker: With someone who's intoxicated, I speak more slowly, use simpler sentences, and repeat important information.
Speaker: I also avoid arguing with distorted perceptions and instead focus on keeping them safe.
Speaker: And with mental health crises, it's often about entering their reality rather than trying to correct their perception, at least initially.
Speaker: Exactly.
Speaker: If someone is paranoid and thinks the staff is trying to hurt them, saying, no, we're not, doesn't help.
Speaker: But saying, that sounds really scary.
Speaker: What would help you feel safer right now?
Speaker: Acknowledges their experience and opens up problem solving.
Speaker: Let's talk about cultural considerations because health care serves incredibly diverse populations.
Speaker: How do cultural differences affect verbal safety strategies?
Speaker: Cultural awareness is so important, Marcus.
Speaker: Different cultures have different norms around eye contact, personal space, authority, family involvement in medical decisions, and emotional expression.
Speaker: What feels respectful in one culture might feel disrespectful in another.
Speaker: And when you're not sure about cultural preferences, it's often okay to ask directly.
Speaker: I want to make sure I'm communicating in a way that's comfortable for you.
Speaker: Is there anything I should know about how you prefer to receive medical information?
Speaker: That's such a good approach.
Speaker: It shows respect for their cultural background and gives them permission to guide the interaction in a way that works for them.
Speaker: Let's address something practical.
Speaker: What about when verbal strategies aren't working?
Speaker: How do you know when to try a different approach or when to call for help?
Speaker: Great question, Marcus.
Speaker: People will sometimes escalate despite my best efforts.
Speaker: And if someone's voice is getting louder, if they're making threats, if they're becoming physically agitated, or if they're not responding to redirection, that's when I might pause the conversation and get additional support.
Speaker: And there's no shame in getting help.
Speaker: Sometimes, a fresh person with a different communication style or approach can make all the difference.
Speaker: It's not a failure of your verbal skills.
Speaker: It's smart safety management.
Speaker: Exactly.
Speaker: And sometimes, you need to be direct about safety.
Speaker: I want to keep working with you on this, but I need to feel safe to do my best thinking.
Speaker: Can we agree to keep our voices calm so we can focus on solving this together?
Speaker: That's a great example of setting a safety boundary while keeping the focus on collaboration and problem solving.
Speaker: Marcus, let's talk about something that's often overlooked, how we talk to colleagues about difficult patient interactions.
Speaker: The way we discuss challenging patients can affect how the whole team approaches those interactions.
Speaker: That's such an important point.
Speaker: If the Schiff Report describes someone as difficult or non-compliant, it can create negative expectations that become self-fulfilling prophecies.
Speaker: I've started using more descriptive, non-judgmental language in handoffs.
Speaker: Instead of, Mr. Jones is difficult, I might say, Mr. Jones is really anxious about his diagnosis and tends to ask a lot of questions.
Speaker: He responds well when you take time to explain things step by step.
Speaker: That gives the next nurse useful information about how to approach the patient successfully rather than just warning them to expect problems.
Speaker: It's another way of modeling, except this time we are modeling safe and appropriate attitudes for peers.
Speaker: And it helps maintain our empathy and professionalism.
Speaker: When we label patients negatively, it becomes harder to see them as individual people with legitimate needs and concerns.
Speaker: Let's discuss something practical for our listeners.
Speaker: How do you practice and improve your verbal de-escalation skills?
Speaker: These aren't abilities you're born with.
Speaker: They're skills that can be developed.
Speaker: Practice is so important, Marcus.
Speaker: I actually practice phrases and responses at home, thinking through different scenarios I might encounter.
Speaker: It's like rehearsing for a play.
Speaker: The more you practice the words, the more natural they become under pressure.
Speaker: And role playing with colleagues can be incredibly valuable.
Speaker: You can practice difficult conversations in a safe environment and get feedback on your approach.
Speaker: I also pay attention to interactions throughout my day, and not just with patients, but with family, friends, cashiers, anyone.
Speaker: Every interaction is an opportunity to practice respectful, empathetic communication.
Speaker: Recording yourself can be eye-opening too, though obviously not with actual patience.
Speaker: But practicing responses and then listening back can help you notice things like tone, pacing, or word choice that you might not be aware of in the moment.
Speaker: and studying successful interactions is just as important as analyzing the difficult ones.
Speaker: When an interaction goes really well, take a moment to think about what you did that worked so you can replicate it in the future.
Speaker: Let's talk about self-care in relation to verbal safety strategies.
Speaker: Using these techniques effectively requires emotional and mental energy.
Speaker: How do you maintain your capacity to communicate effectively throughout long, stressful shifts?
Speaker: That's such an important question, Marcus.
Speaker: Compassionate communication is emotionally demanding.
Speaker: I've learned that I need to actively recharge between difficult interactions.
Speaker: Even if it's just taking three deep breaths or stepping outside for a minute,
Speaker: and recognizing when you're too depleted to communicate effectively is crucial.
Speaker: If you're exhausted or emotionally overwhelmed, your verbal skills are going to suffer, which can actually create safety risks.
Speaker: Absolutely.
Speaker: Sometimes the safest thing you can do is ask a colleague to take over an interaction, if you're not in the right headspace, to handle it well.
Speaker: As we start to wrap up, let's give our listeners some concrete takeaways.
Speaker: Natalie, what are the most important things someone can start implementing immediately to use their voice more effectively for safety?
Speaker: First, slow down your rate of speech, especially in tense situations.
Speaker: Second, acknowledge emotions before trying to provide information or solutions.
Speaker: Third, explain the why behind policies and procedures, rather than just enforcing them.
Speaker: I'd add, practice active listening by pausing before responding, use I statements instead of you statements when possible, and always offer choices when you can, even small ones.
Speaker: And remember that your tone matters more than your words.
Speaker: People will remember how you made them feel long after they've forgotten what you said.
Speaker: For our listeners who want to develop these skills further, what resources would you recommend?
Speaker: VistaLars training programs are excellent, of course, but also look for de-escalation training in your organization, practice with colleagues, and pay attention to health care workers who seem to handle difficult situations well.
Speaker: Learn from their approaches.
Speaker: And remember that these skills are useful for interacting with everyone, not just your patients.
Speaker: Better communication reduces stress and improves relationships across all areas of life.
Speaker: Before we close, Marcus, I wanna emphasize something important.
Speaker: Your voice and your presence are powerful tools that you already possess.
Speaker: You don't need special equipment or training to start using them more effectively.
Speaker: Small changes in how you communicate can make huge differences in safety and outcomes.
Speaker: That's exactly right.
Speaker: Every healthcare worker has the ability to create safer environments through their words and their presence.
Speaker: It's not about perfection.
Speaker: It's about intentional practice and continuous improvement.
Speaker: And remember, when you use your voice to create safety and show respect, you're not just protecting yourself and your patients.
Speaker: You're modeling these skills for your colleagues and contributing to a culture where everyone feels safer and more valued.
Speaker: For our listeners, we encourage you to start small.
Speaker: Pick one technique we've discussed today and practice it during your next shift.
Speaker: Notice what happens when you slow down your speech or when you acknowledge someone's emotions before providing information.
Speaker: That's all for today's episode of Confidence in Conflict.
Speaker: Thanks for joining us.
Speaker: If you enjoyed this episode, don't forget to follow, rate, and leave a review on your favorite podcast platform.
Speaker: Remember, your voice is one of your most powerful tools for staying safe and helping others feel safe too.
Speaker: Use it intentionally, use it with compassion, and use it with confidence.
Speaker: This podcast uses synthetic voices to share Vistalar's training and communication strategies.
