Find the 'pause button' to defuse tense situations

Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith University police officers are trained in de-escalation, and I thought it would be useful to hear about some of those techniques because it might help regular people who feel themselves starting to lose their temper in stressful situations. My guest is Erika Taylor, the chief of university police at Upstate, who has experience teaching de-escalation techniques. Welcome to "The Informed Patient," Chief Taylor.

Chief Erika Taylor: Good morning.

Host Amber Smith: Upstate leaders launched a "Respect and Heal" campaign a year or so ago with many components for reducing violence in healthcare settings. Your focus on de-escalation ties into that. And even though I know your training is designed for healthcare staff, I thought people who may be patients or family members of patients might benefit from learning about this. But before we get into details, why do you think there is an issue with workplace violence in hospitals and healthcare settings?

Chief Erika Taylor: Unfortunately I think we live in a different world than we did even five or 10 years ago. All of us just went through a pandemic where our worlds drastically changed. We started to face and focus on things that we never really had an opportunity to before. We lost the ability, if you will, to function in a public setting like we did previously. I think a lot of people had a lack of personal interaction with others, a lack of conflict resolution, a lack of the need for critical thinking. And I think as a result of that, we've now seen an increase in these issues nationwide in healthcare and out of healthcare.

Host Amber Smith: So this is kind of side effects from the pandemic that we're still dealing with, it sounds like.

Chief Erika Taylor: Yeah, absolutely.

Host Amber Smith: Well, it can be especially stressful, though, when a loved one is ill or injured -- something unexpected, something may be life threatening. Do you have advice for people to help them avoid overreacting?

Chief Erika Taylor: I do. One thing that I train my team on is finding your pause button, if you will. That's definitely easier said than done. Learning to take that deep breath, taking a couple of seconds or minutes, if you will, before you react, before you answer, to think of the questions that you need answers to.

Sometimes it's really important to write things down to take notes or to gather your thoughts later on, in preparation of that next encounter that you may have with medical staff members. And it's really the power of, I think, knowledge and understanding. Oftentimes I think we have people in our facilities that, they may not come from a healthcare background, or they may not have familiarity with these types of conflict or crises. And it's really challenging to navigate, especially when you may not get the news or the answers that you were anticipating. You may be encountering something that is with your loved one, especially when it comes to children. We love hard, and we fight hard. I think that's a natural instinct, right? So I think it's really important to make sure that we can find our pause with that.

The other side of that, I think, is finding grace. I teach my people about grace all the time, and trying to understand that we come from different backgrounds. We may deal with things differently. Bedside manner is huge, right? So it's really important to take our time as we navigate these crises to have the best result.

Host Amber Smith: I love the concept of finding the pause button. That's something to think about. Now what about nonverbal communication? Why is that part of this?

Chief Erika Taylor: Nonverbal communication is huge. I think it's something that people may not think about, right? But I use the example from COVID, of what did COVID give all of us? Whether you came from a small family or a large family, it gave you a 6-foot rule, right? And it's something that we may not have had before that.

Nonverbal communication is something that doesn't lie, if you will. Your eyes don't lie. Even though we wore masks, I think everyone could always tell what I was thinking, going through my mind. Nonverbal communication is important for de-escalation because it also gives you cues or indicators of how someone may be responding to the message that you're conveying. It may give information or cues on how they may react.

We talk about signs of balling their fists or clapping their hands or throwing an item, slapping their fists on the table, pacing back and forth. You have indicators of anxiety, which is a natural response to crisis, and it also gives you indicators if this may escalate beyond that, if you have someone that may be, they may become violent, or they may become combative, they may become aggressive, verbally or physically.

Nonverbal communication is really important to help you understand and recognize those cues before that actually escalates to that point, and it may provide an opportunity to prevent it from getting that far.

Host Amber Smith: So it doesn't sound like it's something that a person can necessarily control. I mean, it's nonverbal. Their eyes are going to be what they are, and you can read a person's face sometimes.

Chief Erika Taylor: Mm-Hmm.

Host Amber Smith: But maybe they would notice that in their companion or their friend that's with them.

Chief Erika Taylor: Yes, absolutely. I think you may know, those that are closest to you, with their verbal cues are more than anyone else.

Especially with my own team, I tell the supervisors, know your people. You should know if they look a certain way or they're acting a certain way, or they're responding in a certain way, that that may be their normal, or it may not be. It also helps us regulate our teams a little bit better. And recognizing those cues in your own people helps you recognize those cues with individuals you are not familiar with.

I think as a person. Initially, you may not be able to control that, but I do think self-reflection is also really important. If we recognize that maybe we wear our heart on our sleeve, if you will, or that we may have a nonverbal cue that may be a trigger for others, it may escalate others, I think it's really important, I think, to recognize those in ourselves so we also are better at responding to crisis.

It's very important that, crisis is a two-way street. It's a two-way communication. So those individuals delivering the message, that may be the trigger. We may be part of escalating that beyond what it could have been, and vice versa. So I do think that self-reflection is still just as important.

Host Amber Smith: Now are we still keeping the six feet of personal space?

Chief Erika Taylor: So some people do. I grew up in not a huge family, but I don't think I really ever had that six foot rule. And now I even find myself liking my distance, if you will. So I don't know as if we're really keeping it by rule, but I do think that people may be aware of their surroundings a little bit more of who's in their space. And I also find that it's helping with deescalation because if we can respect that space, in my world, it's what I call a "reactionary gap." And what it really means is it just gives people kind of that opportunity to gauge their surroundings, to recognize the crisis or the trauma that they're in and navigating that appropriately.

I think when we close the gap on people and we encroach on their space, we automatically are making them more anxious. It's just natural.

Host Amber Smith:

This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Chief Erika Taylor. She leads the University police department at Upstate, and we're talking about de-escalation techniques Now what is empathetic listening, and is this something people can practice with their health care providers?

Chief Erika Taylor: Absolutely. So empathy is something where you really listen to understand. You listen to hear what the message is. You're not just listening to check that box that you've heard a conversation. Empathy is really important because if someone doesn't feel that you care, then you may have completely lost that relationship. I compare empathy to customer service, if you will, that the population that you're serving or the population that you're encountering really needs to think that you are tuned into their message.

We may think of encounters where we've had a medical staff member come into a room on a computer on wheels, or I'm going to age myself here, but on a Blackberry, right? They're doing things on their phone. And the patient or the family member that they're dealing with may not think that they have their undivided attention. So if you don't have their undivided attention, they're not going to think that you care. And in fact, they're not going to think that you have empathy. So I would relate the two of them together. But I do think it's definitely an active listening process that people should practice, because also if you're listening to hear and you're listening to understand, you may be able to focus on the facts versus the feelings, or a better balance of.

Host Amber Smith: For a family member who is getting frustrated, they don't feel like their questions are getting answered, do you have suggestions for what they can do?

Chief Erika Taylor: I do. I oftentimes recommend taking a pause, like we had already talked about, to see if we can restart that conversation. Upstate has a term. They call it "U-turning a conversation." In the middle of crisis, if a conversation is not going as we had anticipated or it's starting to escalate for reasons we use the term, "let's U-turn this conversation." And really it's a second chance at that conversation to see if you can have a better understanding.

Being excited or emotional throughout the conversation may not lead to such a productive conversation or active listening or understanding and communication, so I also think it's important. Sometimes personalities just don't mesh and I also think that it's completely OK to take a step back and ask if there's someone else that they can speak with.

I also think it's important if we, as the staff member, are finding that maybe we aren't the best fit for that conversation or we aren't connecting with them to find someone on our team that may be able to do that for us. I think humbling ourselves a little bit and realizing it doesn't have to be me. It definitely can be somebody, maybe I have somebody that would connect with them better. So again, finding that pause. I think we often find that escalating beyond that, it doesn't really help the conversation. There's not a lot of conflict resolution, if you will, during those moments. So finding the appropriate people to have that would be important.

Host Amber Smith: Now, do university police get summoned to intervene if there's a disagreement that's escalating?

Chief Erika Taylor: We do sometimes. So we have well over 100 contract security guards that work for us under University Police. And they're often that first line of defense. They often get called to help with that de-escalation, to help be that buffer. If the conversation is escalating beyond that, or there's a concern for safety, there's a concern that someone may become violent or aggressive, then they would contact University Police to escalate it to that next level.

I say sometimes it's like parking a police car at a stop sign. Sometimes our presence alone is enough to really deescalate that and get it to stop. Other times it's not. But I would say the majority of the time those efforts are successful in one way, shape or form in reducing the conversation. So we have a chance to U-turn and start over.

Host Amber Smith: So that's when officers would use the de-escalation techniques that you've taught them.

Chief Erika Taylor: So officer presence is actually part of de-escalation. It's really, our continuum kind of starts there. But, yeah, we definitely assist medical staff in that deescalation process all the time. Sometimes we find their pause for them, and essentially we just get them to stop for a second. We have an opportunity to talk with all the parties that are involved, the medical staff members, the patients, the families, and sometimes we are able to reconvey that message, to have better understanding. And then the situation's over from there. We would use all versions of that to find a solution.

Host Amber Smith: Any advice for people who are headed to the hospital to be with a loved one who's ill or injured? Things to leave at home, things to bring with tthem?

Chief Erika Taylor: We do have weapons detection systems and screening systems that are coming into our facility, so definitely no weapons of any kind. One thing to know about SUNY Upstate Medical University is we are, technically, a SUNY school, so handguns, if they are a legal permit holding individual, they're not allowed to have them here at Upstate.

Otherwise, I would definitely recommend things that they can keep their mind busy with, Sudoku or word puzzles. Bring a phone charger if that's something that you would like to scroll. Think whatever items that you can think of that are going to help keep your mind at ease, that are going to help you de-escalate during crisis.

I was recently at the hospital with my own son, and I know that I'm trained for this, I do this every day. It's different when it's your own loved one. And finding things that are going to keep your stress level low. We all have a natural level of anxiety, which is extremely escalated when we're taking care of those that we love. So I think we need to put our needs kind of in front of that.

So I would recommend any devices that would help distract your mind, but keep you focused, if that makes sense, and help keep you calm. Cell phone charges are big ones, but definitely busy items, if you will.

Host Amber Smith: Well, that's very good advice. And I thank you so much for making time for this interview.

Chief Erika Taylor: You're very welcome.

Host Amber Smith: My guest has been Chief Erika Taylor from Upstate's University police department. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe, with sound engineering by Bill Broeckel, and graphic design by Dan Cameron. Find our archive of previous episodes at upstate.edu/informed. If you enjoyed this episode, please tell a friend to listen too. And you can rate and review "The Informed Patient" podcast on Spotify, Apple podcasts, YouTube, or wherever you tune in. This is your host, Amber Smith, thanking you for listening.