Aggressive behavior

Hospital staff learn how to calm patients

De-escalation trainers Veronika Wiesinger and Christian Auburger show their full commitment.

(Bild: Ordensklinikum Linz)

Many patients entering a hospital are nervous. From time to time, such situations get out of hand and aggression increases. Hospital staff at the Ordensklinikum Linz are therefore taking part in a de-escalation course to learn how to deal with aggressive people.

"We've been waiting for hours. When will it finally be our turn?" or "I don't have forever, does anyone even work here?" are typical statements that echo through the corridors of an outpatient clinic.

It's clear that many patients and their relatives are nervous when visiting a hospital. Unfortunately, however, situations occasionally get out of hand and aggression rises. In the worst cases, verbal arguments are joined by threatening physical gestures. Not a pleasant situation for anyone present. However, if you know how, agitated people can be calmed down well - employees can already learn this in several hospitals in so-called de-escalation courses.

How do dicey situations arise in the first place and what measures can be taken to defuse them? "In addition to the basic mood of the patient - as mentioned, they are usually tense - there are also factors such as waiting times, staying sober, fear of uncertainty, family issues, etc.," reports Christine Haas, Head of Nursing Intensive Care Units and Cardiac Catheterization Laboratory and one of several de-escalation trainers at the Ordensklinikum Linz, Upper Austria.

You can practise how to keep an aggressive patient at bay.

(Bild: Ordensklinikum Linz)

Confrontations occur in almost every healthcare facility, most frequently in acute hospitals. However, it has been proven that the risk of physical violence is highest in the emergency room. Back to an example: if an impatient person in the outpatient department shouts "I've been waiting for an hour, is there anyone working here?", most people would probably try to justify themselves immediately. That would be the wrong reaction!

No explanations in the "hot" phase
"Instead of explaining something or giving an account, it's better to say to the person in question: 'I can see the waiting time is already very long for you'," says Haas, demonstrating a technique that she has already introduced to many training participants. This form of conversation is called "mirroring", says the expert, "you can literally mirror what has been said, the behavior shown or the visible emotion. This technique seems very unfamiliar to all course participants at first, but once you have found your own style, it is very helpful. The waiting patient will answer 'yes' to the intervener's statement. They feel seen and recognized in their subjective distress, which is the first step towards de-escalation."

If this does not end the complaints, a second attempt at mirroring is sometimes necessary. However, the de-escalation trainer assures us that a normal basis for discussion can usually be established afterwards. "Then you can also explain the facts to the other person, e.g. that the ward is understaffed and there are therefore longer waiting times or there is a priority order."

Highly upset people cannot be calmed down with factual information.

Mag. Christine Haas, Deeskalationstrainerin, Ordensklinikum Linz

Bild: Ordensklinikum Linz

Why is it not possible to explain the situation to the angry person immediately? Mag. Haas: "Highly upset people cannot be calmed down by factual information. People in exceptional emotional situations are cognitively incapable of processing this information."

The patient's worries are often hidden behind the aggression: "Sometimes it's not the waiting time itself that's the problem, but the partner in need of help who is waiting at home. The desire for a glass of water, which he doesn't dare to get for fear of missing the appointment, can also be behind his behavior," the trainer points out.

Fend off physical assaults
If it is not possible to establish a basis for discussion and the other person becomes physically abusive, the course participants learn to gain distance, remove themselves from the situation and get help. Sometimes a loud "stop" is enough to show that personal boundaries have been crossed. If the attacker holds the hospital employee by their clothing, for example, release techniques are useful.

For moments like these, course participants learn the "ALFI technique" (defense, escape and release technique). This is about protecting the employee, but also about the safety of the attacker. "We don't train self-defense, because that would also involve injuring the angry person," says Haas. The training sessions are part of the "Mindfulness has an impact" project. Its aim is to prevent violence and successfully deal with violence and aggression at the Ordensklinikum Linz.