How to manage difficult and aggressive patients and their families

My experience working in healthcare has always reminded me of the extraordinary work that is done every day to provide care and support in the most difficult work environments. Coping with life-threatening situations and helping patients and families experiencing unexpected illnesses and health crises can expose many healthcare professionals to higher levels of stress, emotions, and aggression. It means that.

The distinction between difficult and aggressive behavior is important. Difficult behavior may address certain characteristics or emotions, while aggressive behavior can be defined as harassment, abuse, racial abuse, intimidation, or violence.

Clear steps need to be taken to manage aggression, support team members, and set clear expectations for patients and their families. All healthcare providers have a duty of care to comply with occupational health and safety obligations by identifying and mitigating potential risks to healthcare professionals and always protecting their safety and well-being.

It is essential to develop and implement a procedure that includes:

  • A clear policy outlining the management of aggressive behavior.
  • Proactively and visibly promotes zero tolerance against aggressive behavior.
  • Recommended language or language that helps reduce dispute escalation.
  • We provide training on managing difficult behaviors and aggression.
  • An escalation pass that includes a hospital emergency code, extortion alert or police.
  • Video surveillance.
  • Existence of physical security.

Managing difficult behaviors and aggression is a skill and is the most important skill in dealing with emotional upheaval and complex health problems.

ACER model

The goal of all difficult interactions is to spread action while maintaining safety as a top priority. Taking the time to understand why patients and their families are exhibiting difficult behaviors is the first step in providing an empathic response. This is very helpful in understanding where the action is coming from, rather than making excuses. Every action makes sense. The following “ACER” model is recommended for escalating difficult or abusive behavior.

A: Evaluate

Assessing the condition of the patient and family is very important. It is very important to pay attention to the signals of escalating behavior. Physiological signs may be observed, including:

  • I flushed my face.
  • shake.
  • get red.
  • Clenching of facial, fist or facial muscles.
  • Sudden or jerky movements.
  • Go to your personal space.
  • Grab your arm.
  • I scream and raise my voice.
  • I’m staring at you for a long time.
  • Throw items or hit your fist at the counter.

You need to be aware of whether the situation is getting worse and whether you or anyone else is at risk of physical harm. These signals alert you to the escalation of actions and help you determine which action you need to take. Ultimately, your judgment is important in such situations.

C: Calm down

Focusing on your breathing allows you to stay calm, focused and in control. How to be polite, respectful and non-threatening to the patient or family when appropriate and safe (when the customer shows aggressive behavior) and the consequences of continued behavior Set a clear boundary by letting us know with.

E: End or Engage

You will need to make an immediate decision regarding your personal safety — if you are in imminent danger, you may need to get out of the situation immediately. If you are in a position to engage and talk with the patient and family and are calm, try to resolve the problem. Speak in a calm and firm tone without raising your voice. Relieve frustration, listen carefully and empathize with the situation for patients and their families. View open and neutral body language and be careful not to break into your personal space. We will try to be calm and solve the problem in a professional way.

R: Report

Depending on the severity of the situation, you may need to use the appropriate hospital emergency code, call the guards, press the extortion button, or dial 000 to the police to escalate the incident immediately. A formal report must be prepared and documented for incident reporting and investigation.


Self-care is important not only immediately after the incident, but also as part of daily work. It’s hard to take care of others unless you take care of yourself. There are many approaches to self-care, but one is to find the one that works best for you. Strategies may include taking a physical break from the work environment where possible and making time for replenishment activities outside of work. Exercise, yoga and meditation may also help relieve stress.

Provide or seek additional support

In the case of aggression that may have seriously affected team members (after an incident or for some time on track), EAP (Employee Assistance Program) should be provided. It is important to be aware of the signs of psychological and emotional effects that require professional counseling for yourself and others and seek additional support as needed.

The important role of healthcare professionals in our community should never be underestimated. Patients and their families must always show respect and courtesy. In the event of difficult behavior or aggression, it is to demonstrate quality care while setting and implementing clear boundaries to ensure the protection and safety of the team.

Monique Richardson is the author of “Managing Difficult Customer Behavior — A Practical Guide to Confident Conversation” and one of Australia’s leading experts in service leadership and customer service. For more information, please visit

Image Credit: © / au / WavebreakMediaMicro

How to manage difficult and aggressive patients and their families

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