Guidelines for communicating with the physically and verbally aggressive client.


WORKING WITH THE CLIENT WHO BECOMES AGGRESSIVE

        Most of us are able to sit back and assess a new situation. We can decide if we like what we see, whether or not it is safe, and if we are not comfortable, we can simply avoid it. And as we gain experience in the world, this process becomes easier because we have encountered similar situations before: the learning process has become more efficient. But for the client with cognitive impairment this is not the case. Because of their impairment, many situations – even ones they have encountered many times before – can seem new. Like everyone else, this can make them anxious, but unlike most people, they cannot draw on their past experiences to interpret what is happening now. And they cannot quickly assess what is happening because of their impairment. Not surprisingly, they feel vulnerable and afraid. And many people, in those situations, will feel they need to defend themselves and become aggressive. It can be very difficult to work with someone who is confused and aggressive. You need to keep that person safe, but you must also protect yourself and others. Fortunately, with some common sense and a little planning, you can accomplish these goals. · Do not indiscriminately use force: Using force can often backfire. Certainly, there are times when you need to physically restrain someone. But when and how to do so should be clearly outlined in the policies of the institution in which you are working. Make sure you familiarize yourself with them before these incidents happen. · Stay calm: It is natural to become excited when someone is acting aggressively. But many times, if you allow that person to express the anger, the possibility of physical violence can be avoided. Most people have a natural aversion to harming another person, so give the person who is angry the opportunity to be verbal rather than physical. · Use reason: Try and remember that the person who is acting aggressively is not doing so to harm you. That person believes that he/she is trying to protect themselves. Don’t give them another reason to feel threatened. Be quiet, rational, and calm.

DEALING WITH DIFFICULT BEHAVIOR
        Behavior may disguise a client’s need for comfort and understanding.

        How do I communicate in difficult situations? If care recipients are angry, try not to take it personally. Often, they are upset about the situation and don’t know how to handle it. Give them some space and listen to their concerns. Do not raise your voice or get defensive, this will only add to their anger. Sometimes the best thing to do is not to respond but just to listen.

        Recognizing the link between actions and needs helps build good relationships. Keep in mind that residents in long-term care are adjusting to changes in their lifestyles that affect them physically, emotionally, and socially.

        Difficult behavior may signal a need for comfort and understanding. Or it may be an attempt to be in control when a person feels powerless. For example, rather than being annoyed when a resident continua uses the call light, stop by often to offer reassurance.

        Basic psychological needs are the root of most conflict. Following are four basic needs identified by Dr. William Glasser for motivating behavior.

        Belonging:

  • Loving, sharing, and cooperating.

        Power:

  • Achieving, accomplishing, being recognized and respected.

        Freedom:

  • Making choices

        Fun:

  • Laughing and enjoying

        Difficult behavior is a symptom of a problem (e.g., anger, fear, boredom, loneliness). Look beyond the behavior for possible unmet needs. Try to recall any incidents that might have triggered an outburst in order to avoid future problems.

        In difficult situations, stay calm and reassuring. Pay particular attention to your voice (tone and volume), your posture, facial expression, and other nonverbal signals. Be willing to listen to concerns, and assure clients that you care about them.

        Coping with changes can be difficult for anyone. The elderly face significant changes that can bring a sense of loss, loneliness, frustration, fear, depression, lack of self-confidence, and many other unpleasant feelings. If a client seems upset, ask how you can help, and take time to listen.

        Consider some of the concerns that affect the elderly, and show compassion (sympathy for another’s suffering):

  • Change in lifestyle, loss of independence health problems, pain, unable to sleep;
  • Unmet physical and social needs;
  • Longing for the “good old days”;
  • Confusion;
  • Loneliness;
  • Lack of control;
  • Financial concerns;
  • Family problems;
  • Facing mortality (death).

        Individuals cope with problems and frustrations in different ways. Some people take out their anger on everyone; others may be quiet and withdrawn. Some people blame everyone else for their problems; others blame themselves for everything. Some deny there is a problem; others try to find a reason or excuse for everything.

        Sometimes residents are uncooperative, demanding, threatening, rude, stubborn, or unpleasant. Do not argue or feel hurt. Be calm and supportive. Try to look beyond the behavior to the underlying need for comfort and understanding. Identify and encourage coping ·skills that help the client (and you) deal with difficult situations.