Helping Nurses Learn to De-Escalate Patient and Family Anger

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Nurse managers today spend a lot of their time in service recovery. Sometimes, patients are very unrealistic in their expectations about their care, which drives them to become very emotional when they feel their needs are not being met. But increasingly, nurse managers tell me that their staff make volatile situations worse by either arguing with the patient or taking emotional comments personally and complaining that their boundaries are being violated. Consider the story that a manager shared that I have heard repeatedly over the past year:

I was asked to see a patient today by one of my new nurses. She told me that the patient and his wife were totally out of control and had been disrespectful to her. She wanted me to fix things and felt that she was owed an apology. I went into the room and asked them to tell me what was happening and leading to their frustration. It turns out that they had waited for 12 hours to be admitted to the unit. The wife was upset because she felt that she was not given updates in the emergency department. They had arrived by ambulance, so she did not have a car and was hesitant to leave until she was sure her husband was okay. Her dogs were at home alone, and she had been unable to reach a neighbor who could feed them and take them out.

After hearing her story, her anger and frustration were understandable. Her experience with our hospital had been challenging before she ever reached our unit. My young staff member had not taken the time to ask any questions or find out why they were upset. She was making the situation about her when it clearly was not. I helped the wife arrange to have her animals fed and walked by having our social worker call her family and friends. I gave her my business card and cell number and told her to call me if she needed help. I know our young staff don’t have a great deal of life experience but I think some of the violence and anger we see today is a direct reflection of the lack of face to face communication skills and empathy. We need to do a better job of coaching and teaching how to de-escalate patient and family who are upset.

Many health systems are now using simulation and case situations to help staff learn skills and strategies to de-escalate patient anger. These strategies frequently include doing the following:

Listen Actively: Show empathy by listening without interrupting and acknowledging their feelings.
Use a Calm Voice: Speak softly and slowly to create a calming effect.
Maintain Professional Body Language: Use open, non-threatening gestures and avoid aggressive postures.
Validate Emotions: Recognize their feelings without necessarily agreeing with the reason for anger.
Set Boundaries: Clearly communicate acceptable behaviors and limits.
Offer Solutions: Collaborate on resolving issues or providing alternatives.
Avoid Confrontation: Do not argue or escalate the conflict further.
Ensure Safety: If the situation escalates, have protocols in place to ensure everyone’s safety.
Seek Support: Involve security or additional staff if needed.

Although all these strategies are important, the truth is that there is nothing like great storytelling to convey important lessons. Last month, a 12 minute TED Talk was released by Kaitlyn Carey, RN titled The Secret to De-Escalating Angry People. Kaitlyn is an experienced Emergency Department nurse with years of experience de-escalating angry patients. She effectively uses the metaphor of a blowfish to offer tools and strategies to help angry patients and families. It is a relatable video for nurses that can easily be used to begin a class on patient de-escalation and open discussion on how to more effectively handle both our own emotions and those of patients and families.

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