Managing the Assaultive Resident and Countering Rising Emotions
When a resident threatens harm to himself or to others, the stress can trigger strong emotional responses. You may not be able to keep a resident from losing control, but you can minimize the stress precipitated by the assaultive resident if you are prepared.
There are six suggested guidelines to follow in managing assault:
- Recognize that physical aggression represents an attempt to achieve security and control; therefore intervention should strengthen the resident’s sense of responsibility, comfort, and safety.
- Avoid taking a resident’s verbal or physical attacks personally. Staff are convenient targets for pent-up emotions.
- Physical struggle is always a time-limited event. Its intensity cannot be sustained indefinitely. The struggle will subside. Staff’s task is to minimize the risk of injury to both the resident and the staff.
- Recognize staff teamwork. Use planned sequential techniques to intervene.
- Recognize that effective management of the assault begins by accurately evaluating the situation and what needs to be done. Avoid reacting impulsively. Get help. Avoid physical struggle alone. Make a plan. When the team is assembled, clearly describe the plan.
- Use the following techniques aimed at diminishing the intensity of emotions (there are rising levels of emotion for both the resident and the staff).
Techniques to counter the effects of rising levels of emotion
- Psychologically disarm the resident. Acknowledge the resident’s distress. Establish your role as ally, not enemy. Never joke or make light of the situation.
- Direct the attention of the participants, both the staff and the resident. People have difficulty paying attention, therefore, communicate using the person’s name (hearing one’s name is an attention-getter).
- Give directions for behavior. Use specific statements to tell resident what to do. For example, “Mr. Jones, let go of my arm.”
- Communicate clearly and concisely. Use short, simple statements. Economy of language is essential in managing any emotionally charged situation.
- Communicate Expectations. Make clear to the resident what behavior is required of him. This can increase his sense of security and control. For example, “Mr. Jones, I expect you to maintain control. If you can’t we are here to prevent injury.”
- Avoid arguing or defending. Offer explanations in a matter-of-fact way.
- Modulate voice tone. Adjust your tone according to the resident’s stage of emotional intensity. A softer than normal tone can be effective in gaining the resident’s attention and in de-escalating the situation in mild to moderate levels. In emotional levels that are severe, a louder than normal tone voice and slower speech can gain attention. Do not shout, as this is stimulating. If emotions have erupted, use a normal and monotonous tone, making bland, repetitious statements.
- Avoid threatening body language, clenched fists, hands on hips, etc. Avoid tense or angry facial expressions. Avoid quick movements. Adopt a posture that communicates composure and a desire to assist the resident.
- Respect personal space. Uninvited intrusion into the personal space surrounding one’s body is perceived as threatening and may provoke physical aggression. Seek the resident’s permission to enter his personal space, if possible.
(Reprinted with permission from Eymann Publications, Inc.)