DeEscalation Tips for Healthcare

TIP 1 Be Empathetic and Nonjudgmental

When a patient says or does something you perceive as weird or irrational, avoid judging or discrediting their feelings. Whether or not you think those feelings are justified, they are indeed real feelings to that person. Pay attention to them.

Empathic listening is done by:

• Giving the patient your undivided attention.

• Listening carefully to the person’s feelings and the facts they’re providing.

• Using positive nonverbal messages, such as eye contact and head nodding.

• Restating and paraphrasing what the patient said; use their words and ask questions to clarify.

TIP 2 Respect Personal Space

If the space allows, stand between 1-3 feet away from the person who’s exhibiting escalated behaviors. This personal space tends to decrease anxiety and can help prevent the patient from lashing out or harming themselves or others.

If you must enter someone’s personal space to provide care, explain your actions so the person feels less confused and frightened.

TIP 3 Allow Time for Decisions

When a patient is upset, they may not be able to think clearly. Give them time to think through and process what you’ve said. Just as you don’t want to feel rushed, your patients don’t either. Avoid rising anxiety and stress for both of you by giving patients that time.

TIP 4 Use Nonthreatening Nonverbals

When behavior begins escalating, nonverbals become key communicators to diffusing the situation. Be mindful of your gestures, facial expressions, movements, and tone of voice. The more a patient escalates into distress, the less they can process your choice of words. When we speak to somebody we care about and respect, our tone and body language become relaxed, receptive, and nonthreatening. There is a special degree of patience and attention we show to those people. And those same qualities are exactly what a person in crisis needs to see so that they can safely de-escalate.

TIP 5 Set Limits

When a patient is defensive, disruptive, or belligerent they need limits that are clear, simple, and enforceable. Setting limits as a form of intervention is effective when limits are clearly stated, expectations are reasonable, and the limits given are enforceable—not punishable.

TIP 6 Focus on Feelings

As a health care professional, you understand how important facts are. When dealing with escalating behaviors, how a patient feels is often the heart of the matter. Not all individuals can accurately describe their feelings toward what is happening to them.

Offering supportive responses lets the patient knows you understand what is happening and helps them filter through their emotions in a more rational manner.

TIP 7 Ignore Challenging Questions

Engaging a patient who verbally challenges you often results in a power struggle. When a person challenges your authority, redirect their attention to the issue at hand. Managing a power struggle is critical to your mental well-being, as well as that of the individuals you’re conversing with.

TIP 8 Avoid Overreacting

While you cannot control a patient’s behavior, you can control how you respond to them. Remaining calm, rational, and professional will have a direct effect on whether the situation escalates or diffuses.

Strategies to help you remain calm include:

• Taking several deep breaths before responding.

• Remembering that distress behavior is often rooted in fear and anxiety.

• Taking a moment to calm yourself by reiterating what the patient is saying.

TIP 9 Choose What you Insist Upon Wisely

Be thoughtful in deciding which rules are negotiable and which are not. For example, if a patient doesn’t want to shower in the morning, are you able to offer them the choice to do it in the afternoon or evening?

Options and flexibility can help you avoid unnecessary confrontations.

TIP 10 Allow Silence for Reflection

It may seem counterintuitive to let moments of silence occur while working with patients, but sometimes it’s the best choice. This gives both you and the patient a chance to reflect on what’s happening, and how to best proceed.

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