Mastering De-escalation in Health Care Settings: What You Need to Know

If you’re working in a care setting, you know how quickly situations can get tense. Whether it’s a resident who’s upset or a family member who’s stressed, things can escalate fast. We will cover what de-escalation in care setting is about.

But here’s the thing: knowing how to de-escalate these situations can make all the difference.

Let me walk you through how you can master this skill and create a safer, more supportive environment for everyone involved.

Why De-escalation Matters

When tensions rise, everyone feels it. Stress levels go up, and the quality of care can take a hit. S

taff might feel burned out, and residents may end up emotionally and even physically harmed.

But learning how to de-escalate effectively can prevent this, keeping both you and those you care for safe and calm.

I remember an incident involving a resident, Jane, who was anxious because she was experiencing a change in her routine due to a staff shortage.

Her anxiety escalated to the point where she began to pinch care workers and exhibited biting behaviour.

To calm the situation, I:

• Kept a calm, soft tone. Guided Jane to her favourite armchair in the quiet sunroom for safety.
• Spoke clearly and gently, saying, “Jane, it’s Mary. I’m here to help. You’re safe.”
• Gave her comfort with her cherished family photo album as a distraction.
• Dimmed the lights and turned off the TV to reduce background noise.
• Asked a colleague to bring her usual morning tea in her favourite mug, keeping things familiar.

These steps eased Jane’s anxiety, and within 20 minutes, she was much calmer, flipping through her photo album and sharing family stories.

This approach not only prevented things from getting worse but also helped her feel safe and comfortable again.

You would also notice a bit of person centered care here which is what is generally preached in care.

Also, don’t for to use your 6 Cs of care.

Understanding De-escalation

So, what is de-escalation? Simply put, it’s about bringing the emotional temperature down. It’s a way to defuse tension before things get out of hand.

By using specific techniques, you can help an agitated person feel understood and safe.

And trust me, it works!

Recognising the Stages of Escalation

Before you can de-escalate a situation, you need to understand how it escalates.

According to 9 Glasl’s model of conflict escalation, here’s how things can progress:

1. Disagreement: A mild tension or difference in viewpoints.
2. Personalisation: The conflict becomes personal.
3. Problem-solving breakdown: Communication starts failing.
4. Confrontation: Open hostility begins.
5. Loss of face: Parties start attacking each other’s reputation.
6. Strategies of threats: Increasing threats and counter-threats.
7. Limited destruction: Small-scale attacks or aggression.
8. Fragmentation: The conflict becomes chaotic.
9. Total breakdown: Complete breakdown of communication and relationships.

Understanding these stages can help you identify when and how to intervene before things get out of control.

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If you want to learn practical aspects of de-escalation techniques, write me a mail – enquiries@caringforcare.co.uk. Depending on your industry, mostly people in healthcare and mental health would choose breakaway training while people working in schools will either go for Positive behaviour training or challenging behaviour training. You can click the link to learn more about them.

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Spotting Early Warning Signs

The earlier you catch the warning signs, the better. Look out for changes in body language, tone of voice, or behaviour.

Here are some things to watch for:

• Restlessness
• Raised voice
• Tense posture
• Aggressive gestures

By recognising these signs early, you can step in before the situation escalates. I remember when a resident TB was restless because he was not served his coffee on time which led to him yelling.

One care worker asked, “Just coffee and everyone is in trouble”.

My reply was simply, ” Dude, we just ignored his needs”. He is feeling cheated and left alone because of that.”

“Let’s take a step back and address TB’s needs calmly.”

TB has just shown us that coffee was important to him at his usual time, as stated in his care plan. Watching for early signs can quickly help us prevent situations from escalating.

Understanding a resident’s care plan helps us provide better support, so it’s important to familiarise ourselves with their preferences.

The Power of Empathy and Active Listening

Here’s a tip from my years in care: empathy and active listening are your best friends in these situations.

When someone feels heard and respected, they’re much more likely to calm down. It’s all about building trust and showing that you’re there to help, not to fight.

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Also Read:

• What is breakaway training
• PMVA versus MAPA Training
• 5 Examples of Conflict Management in Healthcare
• What is Physical Intervention Training?

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De-escalation Techniques You Can Use

Now, let’s dive into some specific techniques that you can use to de-escalate situations effectively:

1. Active Listening

Active listening means really paying attention to the person speaking. Use non-verbal cues like nodding and making eye contact to show you’re engaged.

Here’s how you can phrase things to show you’re listening:

• Instead of saying, “You’re not making any sense,” try, “Let me make sure I understand. Are you saying that…?” This shows you’re trying to comprehend their perspective.
• Instead of saying, “That’s not what happened,” say, “I’d like to hear your view of the situation. Can you walk me through it?” This demonstrates that you’re open to their narrative.

Pro Tip: Use the “SOLER” technique to enhance your listening:

• Squarely face the person.
• Open your posture.
• Lean towards them (just slightly).
• Eye contact (maintained in a culturally appropriate way).
• Relax your body language.

2. Empathy and Validation

Empathy is about acknowledging the other person’s feelings without necessarily agreeing with their actions.

It’s a way to validate their emotions:

• Instead of saying, “You shouldn’t feel that way,” try, “It sounds like this situation is really frustrating for you.” This validates their feelings without judgment.
• Instead of saying, “Just relax,” say, “I can see how upset you are. Tell me more about what’s bothering you.” This shows that you recognise their distress and want to understand.

Practice Tip: Role-play these responses with a colleague. Take turns being the agitated person and the caregiver, and reflect on how different responses make you feel.

3. Clear and Concise Communication

In tense situations, clear communication is crucial. Here’s how you can be clear and concise:

• Instead of saying, “We’ll get to you when we can,” say, “I’ll check on your status in 15 minutes and update you then.” This provides a specific timeline and action.
• Instead of saying, “Don’t worry about it,” say, “I understand this is important to you. Let’s break down the issue and address it step by step.” This acknowledges their concern and offers a structured approach.

Communication Clarity Checklist:

• Use simple, jargon-free language.
• Speak at a moderate pace.
• Provide specific, actionable information.
• Check for understanding.

4. Setting Boundaries

Setting clear boundaries is essential for maintaining a safe environment. Here’s how you can do it:

• Instead of saying, “Calm down or you’ll have to leave,” say, “I want to help you, but I need you to lower your voice so we can talk effectively.” This sets a clear expectation while showing willingness to help.
• Instead of saying, “You can’t act like this here,” say, “In this facility, we have a policy of mutual respect. How can we address your concerns while following this policy?” This references established rules and invites cooperation.

Traffic Light System: Use this visual aid to help assess and respond to escalating situations:

• 🟢 Green: Calm discussion – Proceed with active listening.
• 🟡 Yellow: Rising tension – Employ empathy and clear communication.
• 🔴 Red: Potential danger – Set firm boundaries and seek additional support.

Non-verbal De-escalation Strategies

Your body language can either escalate or de-escalate a situation.

Here’s what to do—and what not to do:

Do:

• Stand at an angle to the person.
• Keep your hands visible and relaxed.

Don’t:

• Square up directly in front of them.
• Cross your arms or put hands in your pockets.

Why It Matters:

• Angling your body appears less confrontational.
• Open posture demonstrates transparency and calmness.

Practice Tip: Stand in front of a mirror and practice transitioning from a closed, confrontational posture to an open, non-threatening one. Notice how it changes your appearance and how it feels.

The Importance of Training

If you’re thinking, “This sounds like something I could use more of,” you’re absolutely right!

De-escalation is a skill that gets better with practice, and specialised training can equip you with the tools and confidence to handle even the trickiest situations.

Ongoing Learning and Teamwork

Continuous learning is key. Regular training sessions and access to resources for ongoing education ensure that you’re always at your best.

Plus, teamwork plays a big role in de-escalation—having a colleague step in if you’re struggling can make all the difference.

Final Thoughts

De-escalation is about creating a culture of calm and safety in your care setting. It’s a skill that benefits everyone—from you to the residents and their families.

So, keep learning, keep practising, and remember: you’ve got this!

If you ever feel unsure or need more guidance, there are plenty of resources out there.

Don’t hesitate to reach out for more training or support. Your efforts to master de-escalation will make a huge difference in the lives of those you care for—and in your own peace of mind.

Keep yourself and others safe. Gain the key skills to handle tough situations confidently. Book our de-escalation training courses today and make a real difference. You can also call or send us a mail: enquiries@caringforcare.co.uk or 01782 563333