Conflict management and the aggression continuum

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The challenges that face healthcare professionals are numerous and constant, and conflict management and aggression continuum is one of them. Time and available resources are far too often extremely limited, adding further pressure to an already high-pressure profession.

This type of environment, where all workers are under considerable stress, can easily lead to a rise in tension and anxiety.

If these issues are not resolved swiftly and amicably then they can become a source of conflict. While the potential for conflict between colleagues is high so is it between patients are healthcare workers.

Patients all come from different backgrounds and have varied expectations, providing plenty of potential flashpoints.

The consequences of unresolved conflict can be very serious indeed. Contentious situations between colleagues can lead to a breakdown of communication.

When this happens vital information does not always reach the people it needs to.

Breakdowns in communication can also lead to resources not being allocated properly or to work being duplicated.

Conflict in the workplace can contribute to creating a toxic environment that may cause patients to become uncomfortable.

In the most serious cases of unresolved conflict, the result can be patient harm.

The good news is that healthcare professionals already possess most of the skills required for conflict management and resolution.

The key process of patient care involves; carrying out an assessment, making a diagnosis, crafting a treatment plan, followed by ongoing evaluation and modification to the treatment plan if necessary.

This exact same process can be applied to situations where conflict arises.

However, to apply these techniques, situations that can lead to conflict need to be spotted early. Two things that can allow conflict to escalate are a failure to address issues head-on and failure to notice the warning signs.

What is Aggression Continuum?

The Aggression Continuum shows how behaviour can get worse, starting from feeling anxious to becoming violent. If you’re a nurse or care worker, you may have seen how a patient’s behaviour can change quickly.

It begins with signs like restlessness, pacing, or looking tense. Then, it may move to verbal aggression, where someone might shout, use threatening words, or insult others. The next step could be intimidation, where a person might make threatening gestures, get too close, or break things.

If not stopped, it can lead to defensive aggression, where someone might push or try to escape. Finally, if things aren’t resolved, it could turn into active physical aggression, where a person may hit, kick, or use weapons to hurt others.

By understanding these steps, professionals can spot warning signs early and use strategies to calm the situation before it gets too dangerous, keeping everyone safe.

The aggression continuum

The continuum typically ranges from low-level irritability or frustration to high-level violent outbursts.

Awareness of how situations develop into conflict is a key component of managing the risk factor.

To help identify this Steven Wilder, an expert in healthcare safety and security, developed the ‘aggression continuum’.

Hardly ever do people go straight from being at peace to being physically aggressive and violent.

Conflict management and understanding the aggression continuum are important in places like hospitals and workplaces.

The aggression continuum, created by Steven Wilder, shows six stages that people go through when they get more upset:

1. Calm: People are relaxed and can talk politely.
2. Verbally agitated: People show they are frustrated but don’t direct it at you.
3. Verbally hostile: People are more upset and say angry things, but not directly at you.
4. Verbally threatening: People get really angry and start making threats.
5. Physically threatening: People use aggressive body language and might look for something to use as a weapon.
6. Physical violence: People start hurting others.

Wilder has identified these six emotional stages that people progress through and worked out the key ways to respond to each one.

The six stages of the aggression continuum

The first stage of aggression continuum is being calm.

This is most people’s default setting. In this emotional state, they are able to refrain from any aggressive behaviour and state any concerns they might have in a polite and courteous manner.

In this situation, the best response is to focus on their needs, listen to them, and show compassion.

The second stage of aggression continuum is verbally agitated.

This is when a usually calm person is having a bad day and they are feeling frustrated or agitated.

They can be verbally aggressive but they are frustrated with something else, not anything you are responsible for.

Wilder calls this “non-directed anger”.

The key to responding to this emotional state is to not take it personally or to become defensive. Instead, you should listen to them allowing them to vent and express their feelings.

The third stage of aggression continuum  is known as verbally hostile.

This is very similar to the previous stage ‘verbally agitated’, except with an added element of emotion.

The person in question will be more resistant to attempts to calm them down and will use hostile but general statements.

When responding to this emotional state it is important to be keenly aware of the person’s emotions, be vigilant for clues such as, voice cracking or eyes tearing up.

Use non-confrontational body language and respect their personal space. Avoid issuing instructions or telling them what to do.

Instead, ask them how you can help.

The fourth stage of aggression continuum  is called verbally threatening.

This manifests as ‘direct anger’ and threats are directed at a specific person. They will single you out, be demanding, and threatening if they don’t get what they want.

Maintain eye contact with them but avoid making them feel trapped or cornered, this can lead to them lashing out.

Be braced for the fact that they may become violent and call for help.

Try and limit the number of people interacting with them to three.

This is called the triangle approach, whoever is closest to the person being aggressive is in charge and should be the only one who speaks.

The fifth stage of aggression continuum  is when they become physically threatening.

Once someone has entered this stage it will become evident from his or her body language.

They will adopt an aggressive stance, ball up their fists, or start looking around for weapons, which may include everyday objects.

If you are dealing with someone in this state you should subtly go into a defensive stance and try to position yourself on their weak side.

The final stage of aggression continuum  is physical violence.

This is when they physically attack you or others nearby. Your response to this should be to defend yourself.

Bear in mind that the aim is to take control of the situation and not to fight them if at all possible.

When they start raising their voice you should lower yours to try and take the heat out of the moment.

Click here to book breakaway training.

Avoiding conflict escalation

Facing any of these later stages can be disconcerting and worrying. However, by learning to spot the signs and knowing how to react to each stage we can prevent things from escalating and reduce conflict altogether.

Sometimes a person can progress through all six stages during the course of a single conversation.

In cases such as these, we need to be highly alert and well trained so as to be able to respond in the correct manner on instinct. Other times people’s emotional state can develop over days, weeks, or even longer.

There are several things we can do in our day-to-day interactions with people to prevent this from happening.

Being present in the moment, engaging in active listening, and using problem resolution techniques, can help us to avoid situations that can give rise to conflict. When we see anger or frustration building it is optimal to tackle the situation head-on.

Talk face-to-face if at all possible, apologise if appropriate, and use a mediator where necessary.

5 Examples of conflict management in healthcare settings?

1. Effective Communication:

In a healthcare setting, a nurse listens carefully and pays attention to a patient’s worries and questions about their treatment plan. By having a conversation with the patient, the nurse helps them understand their care better, avoids misunderstandings, and prevents conflicts from happening.

2. Mediation:

Imagine a situation where a doctor and a nurse have different ideas about how to treat a patient. They ask a mediator, who is trained in helping people solve problems, to help them talk and find a solution together. The mediator’s role is to make sure both the doctor and nurse agree on the best way to take care of the patient and keep them healthy.

3. Establishing Policies and Procedures:

At a healthcare facility, they create rules that explain what to do when conflicts come up between staff members or with patients.

These rules are there to prevent conflicts from getting worse and make sure that everyone is treated fairly.

By following these rules, everyone knows what to expect and how to solve problems when they happen.

4. Training and Education:

In a healthcare organisation, they offer special classes to teach doctors, nurses, and other staff members how to handle conflicts.

These classes use fun activities, like acting out different situations, and real-life examples to teach them how to communicate well, listen actively, and deal with conflicts in a positive way.

5. Patient Advocacy:

Imagine a family member of a patient in the hospital who is worried about the care their loved one is receiving.

The hospital assigns a person called a patient advocate to listen to their concerns and investigate the situation.

The patient advocate works with the healthcare team to fix any issues and make sure the patient gets the support they need. This helps solve conflicts and make sure everyone is happy with the care provided.

How to Manage Conflict

Avoiding or diffusing confrontation is one approach on the conflict continuum. Instead of engaging in direct confrontation or escalating the conflict, individuals choose to avoid or diffuse it altogether.

This can involve minimising communication, ignoring the issue, or withdrawing from the conflict situation.

While avoiding confrontation may provide temporary relief or maintain a peaceful atmosphere, it is not always an effective long-term strategy for resolving conflicts.

Avoidance can lead to unresolved issues, misunderstandings, and potential resentment. It is important to recognise that conflicts can be an opportunity for growth, understanding, and finding mutually beneficial solutions.

In certain situations, avoiding or diffusing confrontation may be appropriate, such as when emotions are high and there is a need to cool down.

However, it is crucial to address conflicts in a constructive manner, considering open communication, active listening, and finding common ground for resolution.

The goal should be to find a balance between avoiding unnecessary confrontation and proactively addressing conflicts to achieve positive outcomes.

Is leap model used in care?

In a care environment, the LEAPS model can help healthcare professionals, caregivers, and even patients navigate conflicts or difficult situations.

By actively listening to patients’ concerns, empathising with their experiences, analysing the underlying issues, proposing potential solutions, and working together to find resolutions, the LEAPS model promotes effective communication and collaboration in care settings.

Whether it’s addressing conflicts between healthcare providers, resolving disagreements between patients and healthcare professionals, or finding solutions to complex care-related issues, applying the LEAPS model can support a more constructive and patient-centered approach to problem-solving.

It encourages understanding, open dialogue, and the pursuit of mutually beneficial outcomes, ultimately enhancing the quality of care provided.

It can help deal with conflicts and challenges in a structured way. Let’s understand it step by step:

1. Listen:

The first step is to listen carefully to the other person involved. Pay attention to what they say and how they feel. Listening is important to understand their side of the story.

2. Empathise:

Put yourself in their shoes and try to feel what they are going through. This helps you understand their emotions and concerns better.

3. Analyse:

Take some time to think about the problem. Look at it from different angles and try to figure out what’s causing the conflict. Identify the main issues and what everyone wants.

4. Propose:

Once you understand the problem, suggest possible solutions. Think about what could work for everyone involved. Be open to discussing and adjusting the suggestions.

5. Solve:

Work together with the other person to find the best solution. Talk openly, listen to their ideas, and try to reach an agreement that feels fair for both sides.

Using the LEAPS model can make problem-solving in healthcare and caregiving easier. It helps people communicate better, understand each other, and find solutions that work for everyone.

Also Read: What is breakaway training and the importance of PMVA training  (Prevention and Management of Violence and Aggression training).

Diffusing Confrontation

When faced with conflicts, avoiding or diffusing confrontation is one way to handle them. It means taking steps to prevent arguments or calming down tense situations.

While it may seem like a good idea at first, it’s important to know that avoiding confrontation doesn’t always solve problems in the long run. They are just a means to manage conflict for a short time.

Avoiding confrontation means trying to keep things peaceful by not engaging in arguments or walking away from disagreements.

It can give temporary relief and maintain a peaceful atmosphere. However, it’s essential to remember that unresolved issues can lead to misunderstandings and hurt feelings.

Conflict can provide an opportunity for growth and understanding if approached in a positive way. It’s important to find a balance between avoiding unnecessary arguments and finding ways to address conflicts constructively.

This means talking openly, listening carefully, and working together to find solutions that work for everyone involved.

Remember, conflicts can be resolved peacefully by communicating honestly and finding common ground.

It’s okay to take a break and calm down before discussing the issue. By approaching conflicts in a positive manner, we can find peaceful solutions and maintain healthier relationships with others.

Diffusing Confrontations in Healthcare (Practical Steps)

To calm down a confrontational situation in healthcare, it’s important to use kind words, honesty, and openness.

These approaches can help stop confrontations from happening and also help manage them when they do.

Here are some tips:

1. Positive Communication: Talk openly and kindly. Use “I” statements, like “I feel that…” instead of “You did…”. This helps avoid sounding rude.
2. Disarming Statements: Before giving your opinion, show you understand the other person’s side. For example, say, “It seems we have different points of view. Can I share where I’m coming from?” or “I’ve seen things differently, maybe because of my own experiences.”
3. Non-Confrontational Language: Don’t blame anyone. Focus on the problem and talk about it without making anyone feel threatened.
4. Physical Space: Keep a safe distance. Don’t stand too close to avoid making the situation worse. Leave space and never corner the person.
5. Remove Potential Weapons: If there is any risk, make sure there are no things around that could be used as weapons.
6. Ask for Help: If it seems like things are getting worse, take it seriously and call for help, like asking a supervisor or security to assist.

By using these steps, you can help calm down confrontations and make healthcare settings safer and more respectful.

How to Calm Down a Confrontation (General)

To help calm a confrontation, follow these steps:

1. Stay Calm: Keep calm and do not show anger or frustration.
2. Listen Carefully: Look at the person and nod. Repeat what they say to make sure you understand.
3. Acknowledge Feelings: Let the person know you understand how they feel. For example, say, “I can see you’re upset because…”
4. Use “I” Statements: Instead of saying “You made me feel…”, say “I feel upset when…” so they don’t feel blamed.
5. Take a Break: If it’s getting too tense, suggest taking a short break and come back to talk later.
6. Find Common Ground: Look for things you both agree on and work together to find a solution.
7. Focus on the Problem, Not the Person: Talk about the issue, not the person. Stick to the facts, not how you feel about them.
8. Stay Neutral: Use kind words and avoid sounding like you’re telling the person what to do.
9. Encourage Positive Talk: Point out the good things and encourage helpful discussion.
10. Ask for Help: If the problem is hard to solve, ask someone else, like a mediator, to help.

By following these steps, you can help calm down a confrontation and find a solution.