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De-Escalating Aggressive Patient Behavior: Tips and Strategies

De-Escalating Aggressive Patient Behavior: Tips and Strategies

Managing patient complaints and dissastisfaction is an unpleasant but certain reality for healthcare organizations. Despite best efforts, situations occur in which patients are unhappy and feel compelled to voice their displeasure and concerns. Unfortunately, in some cases, the patient making the complaint might become angry or aggressive.

As the media shows, violence in healthcare is all too common, and healthcare providers and staff need to be prepared to handle aggressive and potentially violent situations if they occur. Educating staff about the risks of violence and strategies to address such behavior is imperative for healthcare organizations.

First and foremost, understanding that no single response will work in every situation is crucial. Healthcare providers and staff should consider the individual patient, the circumstances, and the broader context of the situation when responding to escalating behavior. An article from the Western Journal of Emergency Medicine notes four main objectives when working with an agitated person. They include:

  • Ensuring the safety of the patient, staff, and others in the area
  • Helping the patient manage his/her emotions and distress and maintain or regain control of his/her behavior
  • Avoiding the use of restraint when possible
  • Avoiding coercive interventions that escalate agitation1

De-escalation might be one appropriate technique that healthcare providers and staff can be trained to use if confronted with violent or aggressive behavior. According to the aforementioned article, the 10 domains of de-escalation are:

  1. Respect personal space while maintaining a safe position.
  2. Do not be provocative.
  3. Establish verbal contact.
  4. Be concise; keep the message clear and simple.
  5. Identify wants and feelings.
  6. Listen closely to what the person is saying.
  7. Agree or agree to disagree.
  8. Lay down the law and set clear limits.
  9. Offer choices and optimism.
  10. Debrief the patient and staff.2

For more information about each of these domains, see Verbal De-Escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup.

In the most serious cases, patient aggression can turn harmful or deadly. A patient might attempt to physically attack, stab, or shoot a healthcare provider, worker, another patient, or bystander. The response to this sort of violent situation should be threefold:

  1. Contact law enforcement immediately; this should be done as soon as possible to allow police time to respond to the scene.
  2. Isolate the aggressor in as limited an area as possible, such as locking the waiting room door to prevent access to the patient care area.
  3. Evacuate as quickly as possible by all means of egress available.

To learn more about preventing workplace violence in healthcare, see MedPro's article titled From Verbal Insults to Death: The Reality of Workplace Violence in Healthcare.

1 Richmond, J. S., Berlin, J. S., Fishkind, A. B., Holloman, G. H., Zeller, S. L., Wilson, M. P. . . . Ng, A. T. (2012, February). Verbal de-escalation of the agitated patient: Consensus statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. Western Journal of Emergency Medicine, 13(1), 17–25.

2 ibid.

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