De-Escalation Techniques for Long-Term Care
Prevent harm, promote peaceful conflict resolution and help stabilize individuals in crisis with these de-escalation strategies.
What is de-escalation?
Patients in long-term care often face an array of physical and behavioral health challenges. These stressors can lead to interpersonal conflicts, or they may drive patients to engage in aggressive and potentially dangerous behaviors. De-escalation involves using both verbal and non-verbal tactics to ward off these dangerous behaviors. Learn to employ these de-escalation skills to proactively reduce the intensity of conflict and bring about a peaceful resolution.
How do we define escalating behavior?
Escalating behavior can be verbal or physical. Name-calling, insults, harassment, and threats, as well as other humiliating and discriminatory speech, are verbal behaviors that can lead to escalation. Actions that cause physical harm are also escalating behaviors. Throwing objects, pushing, pinching, punching, and kicking are all examples of physically aggressive behavior.
What are signs of escalating behavior?
Acts of physical, verbal or emotional aggression are usually preceded by identifiable outward signs. Careful observation of patients who are “acting out” can help identify the emotional and environmental triggers that might escalate into unsafe behavior.
Physical signs of escalating behavior
A patient in need of de-escalation will demonstrate their aggression in their body language and posture. Look for signs of tension—clenched fists, tightening jaw, etc. If the patient appears restless for a prolonged period of time, or if they are using excessive hand gestures and fingerpointing, these are signs that de-escalation may be necessary. If a patient does not respect others’ personal space, or if they are touching or grabbing other people around them, these behaviors should be addressed proactively.
Verbal signs of escalating behavior
Also pay attention to how patients communicate. Besides obviously threatening statements or speech, other clues to impending escalation may include rapid, agitated speech and repetitive complaints or demands. If a patient’s verbal reasoning becomes unclear or excessively emotional, these are also signs of escalation.
Emotional triggers for escalation
Certain heightened situations of stress and anxiety can be triggering for patients. Be on the lookout for escalating behaviors on occasions like these:
- Patient receives bad news
- Patient is experiencing delays or long wait times
- Patient’s expectations do not align with reality
Sometimes, individuals will exhibit escalating behavior under seemingly “normal” circumstances. Often this can be attributed to unexpressed fears or nagging questions that have not been addressed. Or, the current situation mirrors prior occasions where the patient has had a negative experience. They may also feel that their caregivers are being insensitive to their needs. It is important to check in emotionally with patients and understand their mood and mindset.
For example, does the patient seem—
- Threatened or afraid?
- Ignored or invalidated?
- Overwhelmed or out of control?
- Attacked or defensive?
- Disrespected or rejected?
These can be signs that a patient may need de-escalation. Also, patients in long-term care may be experiencing paranoia or other symptoms of psychosis brought on by dementia or other neurological conditions. Careful observation will help ward off aggressive behavior before it starts.
Environmental triggers for escalation
Situations with potential for escalation can also occur due to external conditions. Crowded spaces may be a trigger for some patients. Overstimulating conditions (too loud, too bright, etc.) may also cause difficulties. Pay attention during handovers and shift changes, as these types of transitions and disruptions can be overwhelming for patients, too.
What are some de-escalation strategies?
Learn these de-escalation skills to promote peaceful resolution in various patient conflict scenarios.
- Be an active listener. Leave space for the patient to be fully heard. Reflect back what you hear to clarify and summarize their points and validate their emotions, even when you do not agree with their overall conclusion. This builds trust and shows your willingness to help.
- Practice empathy over sympathy. The key to empathy involves understanding and identifying with the other person’s feelings. This is more important to successful de-escalation than emotional expressions of sympathy or pity.
- Pay attention to body language. Keep your posture open, your tone calm, and keep yourself from blocking or invading the personal space of the other person. This helps reduce your perceived threat level. Many aggressive and unsafe situations stem from defensive behaviors brought on by the patient feeling threatened or cornered.
- Manage your emotions. Stay grounded. Regulate your own reactions and be aware of your own potential triggers. Measuring your responses creates space for the patient to mirror your attitude and behavior, lowering the emotional temperature.
- Set responsible limits. Clear, but compassionate boundaries are essential for de-escalation. Preserving a structure for acceptable interaction helps patients regulate their own behavior and gives them a framework for addressing their needs and emotions safely.
- Stay on top of the situation. Practice continuous assessment and realistically evaluate what you can to de-escalate. Patients respond differently to different individuals, so it can be useful to get help from a colleague when things are at an impasse. You cannot use your de-escalation tactics when the threat of physical violence is imminent, so know when to remove yourself from the situation safely.
De-escalation training for healthcare workers
At GuideStar Eldercare, we provide comprehensive de-escalation training for you and your staff. We walk you through the de-escalation techniques and frameworks that we have seen succeed firsthand. It is all part of our goal of providing a comprehensive, compassionate response to behavioral health challenges in long-term care facilities like yours. GuideStar Eldercare is accredited through Joint Accreditation™ Interprofessional Continuing Education to provide full-credit CE, so physicians, nurses, social workers and pharmacists on your staff can receive expert in-service training sessions on this and other topics.
GuideStar Eldercare believes in treating the whole person. This includes providing safe, patient-centered interventions for aggressive behaviors without over-reliance on dangerous psychotropic medications. Get in touch with us today to learn how you can receive the full de-escalation training session and other expert in-service topics for your facility and staff.