While assisting a resident in the washroom, Brent, a seasoned Health Care Aide, was seriously injured by a resident displaying responsive behaviours. Brent has not received any violence prevention training since his original orientation upon hire at this facility. 

Unfortunately, violence has been on a steady incline for healthcare workers across Manitoba. One survey¹ conducted on nurses in Manitoba states that 56% have been physically assaulted, 46% have been punched at work, 39% have been bitten and 9,000 have been verbally abused. These types of incidents have the potential to cause severe physical and psychological damage, which no worker in any industry should experience. 

De-escalation is the art of reducing the intensity of a conflict or potentially violent situation by assisting an individual in returning to their typical behaviour once they have become escalated or emotionally charged. There are numerous factors, which may not always be readily apparent, that may contribute to the escalation of an individual’s behaviour. Becoming familiar with recognizing the different phases of the stress cycle will provide you with the tools to appropriately intervene and successfully de-escalate the individual. 

Determining the appropriate response method to assist an individual to de-escalate will depend on which phase of the stress cycle the individual is currently experiencing. In most industries, there are physical tools to help workers navigate challenging situations; in healthcare, more often than not, workers are their only tool. Attempting to reason or problem-solve while an individual is in an escalated state will not be successful.

 There are always two kinds of problems:

• Your problem – as you define it as a professional and;

• The problem from the other person’s point of view (Jenkins, 2013).

Effective communication skills are essential when navigating responsive behaviours, some general tips for de-escalation include:

• Remain professional

• Use assertive communication

• Empathize

• Give respect

• Remain flexible

When navigating violent incidents, maintaining self-control is key. Remaining professional is an effective way to reduce the likelihood the individual will further escalate.

 Understanding your own triggers allows you to maintain self-control and respond logically to the behaviour displayed. Focusing on the individual’s behaviour rather than their attitude will ensure a positive outcome. Assertive communication is the most successful form of crisis intervention when de-escalating an emotionally charged individual. Creating win-win situations, using “I” statements, clearly communicating boundaries, and taking responsibility for your own actions are a few examples of successfully using assertive communication. 

Although you may not approve of the individuals’ actions or words, acknowledging their feelings provides them with the comfort of being heard and supported. We must always treat individuals the way we would want to be treated under similar circumstances. We must respect the individual even when we do not agree with the behaviour they display, much like we must always remain flexible and adapt to the situation as it progresses (Jenkins, 2013). Remaining flexible provides a continuous opportunity in working toward better communication. 

Always remember that every individual is unique; you want what they want; satisfaction and a happy result. Let nothing stand in the way of that (Jenkins, 2013).

To learn more about the stress cycle, appropriate intervention techniques, assertive communication and how you can use yourself as a tool to navigate challenging situations and de-escalate emotionally charged individuals, contact MASH for Professional Assault Response Training (PART). 

¹Workplace Violence | Manitoba Nurses Union

Jenkins, G. J. Thompson and Jerry B. 2013, Verbal Judo: The Gentle Art of Persuasion, Alive Communications