Tips on De-escalation for Health Care Professionals

For health care workers, managing patient behavior can be a challenging but critical component of the job. Depending on the nature of their conditions and specific treatment needs, patients may be experiencing significant pain, confusion, stress or fear, possibly resulting in tense and emotional situations. In these cases, patients could become increasingly agitated and hostile, with some even resorting to violence and putting you in harm’s way. These incidents can leave you with serious injuries and hinder your ability to provide adequate care. Such violence is a prevalent threat in the health care sector. According to the Bureau of Labor Statistics (BLS), health care employees account for nearly half (48%) of nonfatal occupational injuries due to workplace violence, despite only making up 10% of the total workforce. Altogether, the BLS found that health care professionals are five times more likely to experience workplace violence than employees in other industries, with nurses and personal care aides being the most vulnerable.

Considering these findings, it’s imperative to understand how to handle potentially volatile situations with patients and, in turn, keep yourself safe on the job so you can continue to provide the best possible care. This typically involves the use of de-escalation, which refers to a variety of techniques intended to help defuse dangerous scenarios. This article provides more information on de-escalation, outlines when to use these techniques in health care settings and offers associated best practices.

What Is De-escalation?

De-escalation involves using communication and other strategies to stabilize or lessen the severity of a conflict without leveraging force or coercion. It centers around purposeful actions, conversations and body language to help foster a calm atmosphere and reduce the overall risk of verbal abuse and physical violence. In the context of health care, de-escalation primarily applies to managing aggressive or otherwise distraught patients before they resort to hurting themselves or others. When interacting with these patients, the main goals are to keep them and anyone else in the area safe from harm while also helping them properly work through their emotions. In addition to promoting a positive and safe environment, utilizing effective de-escalation techniques can carry a number of benefits in health care settings, including fewer occupational injuries, a reduced need for physical restraints, and better rapport between patients and staff.

When Is De-escalation Necessary?

While every patient and situation is unique, some common triggers may indicate a higher likelihood of hostility and potential for violence. Key patient triggers can include fear and anxiety regarding uncertain diagnoses or upcoming procedures, a perceived lack of control over their routines and decisions, severe pain or discomfort from a recent treatment or worsening condition, overstimulation due to mental health issues, and ongoing agitation from previous medical trauma. These triggers could cause patients to become aggressive with little to no warning, making it important to be prepared to act quickly and implement de-escalation techniques. Regardless of whether these triggers are present, it’s best to monitor all patients for early signs of anger and distress to allow for prompt intervention. Key signs include:

• Attitude changes — This may entail sudden shifts in a patient’s demeanor or communication patterns, such as a raised voice; harsh, crude or threatening verbiage; and unrealistic or inappropriate demands.
• Concerning body language — A patient may display mounting frustration with their body through clenched fists, tense shoulders, heavy breathing, a flushed face, eye rolling and pacing.
• Withdrawn behavior — This may involve a patient isolating themselves from others, speaking less than usual (or not at all) and no longer making eye contact.

De-escalation Best Practices

Upon detecting signs that a patient is becoming agitated or hostile, consider utilizing the following de-escalation tips to help defuse the situation before violence occurs:

• Maintain personal space. Keep ample space between yourself and the patient so that no one feels cornered or trapped. Establishing these boundaries can also protect you if the patient tries to instigate a physical altercation.
• Show empathy. Even if the patient is acting odd or irrational, don’t be judgmental or discredit their emotions. Give them your full attention and hear what they have to say. While you shouldn’t necessarily agree with what they are saying, you should validate their feelings and offer supportive responses (e.g., “That must be frustrating,” or “It sounds like that was really challenging for you. How can I help?”). If the patient questions your authority or tries to insult you, stay calm and remember that their words are rooted in their own distress. Try to redirect the conversation back to their own needs as swiftly as you can.
• Display a calm demeanor. Be sure to use relaxed nonverbal cues that show you don’t want to harm the patient or worsen the situation. Hold eye contact to help the patient feel seen, but avoid excessive staring or glaring. Maintain an open and approachable posture with your arms at your sides rather than crossed, and use slow and intentional movements to make it clear you aren’t a threat.
• Listen carefully. Engage in active listening by hearing the patient’s concerns and using verbal and physical indicators to show you understand what they are saying. This may include nodding your head and leaning slightly toward them as they speak, offering brief verbal affirmations (e.g., “I see,” or “Go on”) to encourage them to continue sharing, asking clarifying questions, and rephrasing or summarizing key points back to them to ensure everyone is on the same page.
• Use simple messaging. As you communicate with the patient, keep your voice steady and optimistic. Use clear and concise language that’s easy for them to comprehend. Refrain from making complex statements or asking difficult questions, as this might upset the patient further. Instead, provide realistic options and alternatives for them to consider until you can work toward a solution to the issue at hand. It may help to start with small choices, such as offering a glass of water or a blanket for the patient’s comfort, before empowering them to make larger decisions.
• Establish strict limits. Although it’s vital to remain calm and nonthreatening toward the patient, you also need to demonstrate that poor behavior comes with consequences. If the patient’s words or actions are unacceptable, be straightforward with them and outline the potential ramifications they could face (e.g., involvement of security or law enforcement) by continuing to escalate the situation. Emphasize the need for mutual respect to reach a positive outcome.
• Allow sufficient time. Never try to rush through the de-escalation process, as this may only exacerbate the situation. Give the patient enough time to work through their emotions, respond to your questions and reflect on the incident as a whole. This can allow for greater understanding of both parties’ perspectives and promote improved decision-making, thereby reducing the likelihood of similar incidents in the future.

Keep in mind that not all incidents can be de-escalated. Sometimes, patients may still resort to violence. If you feel that you or anyone else involved in the situation is in immediate danger, don’t hesitate to remove yourself and ask for help. Depending on the severity of the incident, this may entail contacting your supervisor, getting assistance from your co-workers or security personnel, or calling 911.

Conclusion

Violence brought on by agitated or hostile patients is a serious concern for health care workers like you. Knowing how to handle potentially dangerous situations and implement effective de-escalation techniques can help you protect yourself and focus on delivering quality care.