Woman's first response after car crash: 'You from Philly?'

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Nicole "Snooki" Polizzi and a fellow "Jersey Shore" cast member were involved in a minor traffic accident in Italy last summer. Read more at the San Francisco Examiner: http://www.sfexaminer.com/entertainment/2011/05/jersey-shore-star-snooki-italy-car-crash#ixzz1fbQICOrR

On Tuesday afternoon, I was driving in New Jersey with my 14-month-old son and my car was T-boned by another women's vehicle that failed to stop at the stop sign.  After the impact and coming to a screeching stop, knowing that my son and I were alright (despite my heart palpitations!), I jumped out of the car, went immediately to her driver’s side door, and said “is everyone alright?”

An appropriate question as I am thankfully observing that no airbags were deployed, damage was moderate and she was soon walking, problem free, and talking on her cell phone without any hesitation.  Her response was… “You from Philly?” 

Maybe I was overly sensitive, but I was ready to lay out this women. Not only did her careless driving put me, my son and other drivers in harm but her inconsiderate response immediately put me on the defensive.  I was about to pull up my sleeves and make her very aware that I was from Philly.  Truthfully, I couldn’t hurt a fly but this woman pissed me off.  I was inconvenienced, I am now without my car for 2 weeks, and I had nothing nice to say to her so I returned to my car and called the cops.  Whether it was maternal instinct, Philly attitude, or simply my Italian upbringing, this woman was on my “list.”

When the cops arrived, they were very professional, polite to us both, and took our information as per protocol.  Still not interacting with this woman because I wasn’t sure I would be proud of my actions, she tried to strike up a conversation with me and proceeded to tell me she did not know there was a child in the car (I had made her aware).  I was short (probably sarcastic) with her and as she walked away, the cop approached me.  He nicely said that he observed that I didn’t look as if I wanted to be in conversation with her and that he would stay near to keep her at a distance.  I guess I’ll never be a good poker player since I don’t hide my emotions well, but I appreciated that cop stepping in, stating the obvious and preventing the situation from worsening by taking control.

This experience made me think heavily about how nurses are taught to de-escalate situations to prevent aggression and emotion from becoming violence, physical or verbal.  In my situation, I certainly was not going to be physical with this woman but my verbal responses were definitely teetering toward foul language. 

De-escalation is skilled verbal and non-verbal cues through body language and listening skills that can help effectively stop the cycle of disruptive behavior. There are no dramatic statistics to show how many violent assaults may have been avoided by a nurse skillfully de-escalating a violent patient.  But emergency room nurses are very familiar with this concept as a first line of defense. I previously made the statement that violence in the Emergency Department commonly starts when a patient arrives agitated, often for issues related to drug addiction, gang retaliation alcoholism and/or psychiatric conditions. 

However, if nurses know this is a large part of our clientele, are we simply not trained well enough to de-escalate an obviously complicated situation?  Do we subconsciously add to a patient’s emotion and aggression by our comments, stereotypes and body language?  Does having a security presence at the door add to a patient’s innate defensiveness? Do nurses need to learn better de-escalation techniques? What trends in violence do you see? Is it only psychiatric or intoxicated patients causing a disruption or does aggression also come from medical patients, or their family member?  Is violence worse during the night shift or days?  Post your experiences.