Managing difficult situations: a toolkit for healthcare professionals

Managing difficult situations: a toolkit for healthcare professionals

Working in healthcare, you will come across various forms of challenging behaviours. You may also witness these behaviours in the client’s family or their loved ones. It’s important to understand why these situations happen and how to manage them when they do occur.

Below, our Clinical Service Lead, discusses the reasons situations escalate and a useful toolkit to use to manage those difficult situations as professionally and safely as possible.

The causes of escalating situations

Many factors contribute to a client or a family member becoming agitated or even violent. It’s important to consider why this individual is acting that way and what may have caused it. This is called the ‘Precipitating factor’ – the factor that influences behaviour. The causes or precipitating factors of the individual can often be something that healthcare professionals have little or no control over. Below is a list of possible precipitating factors to consider:

• Impaired cognitive ability (e.g. as a result of intellectual disabilities, mental health illnesses, dementia)
• Fear, stress and anxiety
• Lack of self-esteem
• Loss of control
• Failure
• Trauma of similar experiences
• Physical environment (people, cleanliness, noise and temperature)
• Changing environment (this could be moving into a new room, home or even visiting a new place)

For the client’s family members and loved ones, situations can become intense due to them worrying about the client’s illness. This behaviour is completely normal and to be expected.

Understanding what these precipitating factors are can help to de-personalise the challenging situation. If you take challenging behaviour personally, it is more likely that you become a part of the problem, causing the behaviour or situation to escalate.

It is good to have a toolkit of techniques for managing difficult situations. When you’re confronted with a difficult situation or challenging behaviour, using the toolkit below will help you manage the situation professionally and confidently.

Managing difficult situations toolkit

1. Give rational responses to information-seeking questionsIf you are asked any information-seeking questions from the client or their family, such as ‘Where is my top?’. Ensure to give a rational response that provides them with an informative answer.
2. Play down challengesWhenever asked questions from the client or their family, which create conflict, or question authority. It’s important to play down the challenge and stick to the original topic at hand. For example, if you can’t locate a client’s item of clothing, focus your attention on finding their clothing and only that.
3. Allow appropriate ventingIt is okay to allow verbal and emotional outbursts from individuals as long as it doesn’t pose a threat to yourself, colleagues or the client and their family. Sometimes, letting the individual vent releases any anger or frustration rather than keeping it bottled up.
4. Remove the person or audience from the challenging situationIf you find a particular environment is the cause of the challenging situation, and you can do so, remove the individual from the environment. Alternatively, if someone is contributing to the challenging situation, kindly ask if they can remove themselves for a short period whilst the situation de-escalates. If you are struggling, ask a colleague to support you.
5. Setting boundariesSetting boundaries limits verbal intervention and allows you to have more control in the situation. By giving the individual the opportunity to interrupt or take control of the situation can result in a challenging environment. Implementing boundaries straight away allows everyone to understand what they can and can’t do. It’s important to set boundaries that are clear and simple. They should always be reasonable, enforceable and consistent.
6. Utilise empathic listeningAn empathic listening process is used to understand what an individual is communicating. It’s important to be non-judgemental and give your undivided attention to the person you are communicating with. Allow them to express their emotions and reflect on what they have said. Silence can often encourage people to talk more. 
7. Be aware of your body languageOur bodies transmit non-verbal messages to those around us. It’s important to be aware of your body language in challenging situations as it may appear defensive or closed off. Try to focus on not crossing your arms and maintaining eye contact at all times. This will show you are listening to the individual and focused on the conversation.
8. Respect personal spaceIn healthcare, we often need to be very close to our clients when delivering care. However, it’s important to consider how the client feels at all times. Sometimes the client may feel overwhelmed and may need some time to themselves. If possible, give them space but ensure their health is prioritised and stable beforehand.
9. Awareness of your paraverbal communication

Paraverbal communication is the way we communicate through tone, pitch and the pace of our voice. Always consider your paraverbal communication when on shift. For example, if you were to raise your voice to a louder volume, the individual you are speaking with will more than likely raise their voice as well. If you keep your voice at a lower volume, it may encourage the individual to lower theirs.