What To Do When an Agitated Patient Starts Screaming at You

You’re at work, with not enough hours in the day to do everything you need to. You’re exhausted, but if you don’t stay focused, many lives could be affected. You can’t afford to have a patient’s behavior negatively impact how you perform your duties.

For health care and hospital workers, the distressed or agitated patient comes with the job. Far too often this distress and agitation lead to verbally volatile behavior. According to the 2020 IAHSS Healthcare Crime Survey, 85% of all assaults in U.S. hospitals are patient-on-staff or visitor-on-staff assaults.

In the moment it might seem appropriate to let them blow off some steam and calm down on their own. But what do you do when instead of getting calmer, an agitated patient only gets angrier, their behavior moves toward being physically aggressive or violent, and you become another assault statistic?

It Starts With You

How you respond to disruptive behavior plays a critical role in determining whether the incident will escalate into a crisis situation.

That means monitoring and moderating your own behavior, from the tone in your voice to your stance.

The more an agitated patient escalates into distress, the less they can process your choice of words. When we speak to somebody we care about and respect, our tone and body language become relaxed, receptive, and nonthreatening. There is a special degree of patience and attention we show to those people.

Patience and attention are exactly what a person in crisis needs to see so that they can safely de-escalate.

It's Important to Show Empathy

Empathy is an integral part of decreasing fear and anxiety. As taught during CPI’s Nonviolent Crisis Intervention^® training program, challenging or oppositional questions and emotional release or intimidating comments often mark the beginning stages of loss of rationality. These are behaviors that warrant specific, directive intervention aimed at stimulating a rational response and diffusing tension.

Before it even gets to that point, demonstrating empathy with both an agitated patient and their family members can reduce the kinds of emotional displays that are likely rooted in fear and anxiety.

Whether or not you think their feelings are justified, they are real feelings to that person. Pay attention to the patient and give them your undivided attention. Listening carefully not only to the person’s words, but to the feelings and facts they’re providing. Respond with positive nonverbal messages, such as eye contact and head nodding. You can also demonstrate empathic engagement by repeating or paraphrasing what the patient said, using their own words to ask clarifying questions.

Understand that All Behavior is Communication

There is always an underlying cause that manifests itself in an agitated patient. Many temporary medical conditions can cause agitation, such as intoxication, or even just the anxiety and stress of being at a hospital.

CPI refers to these as Precipitating Factors. These factors are out of our control and play a major role in your behavior, as well as that of your patients.

Remember that all behavior is communication. Whether it’s screaming and swearing, angry gestures, or kicking and hitting, behavior is an attempt to express something that’s usually rooted in fear, frustration, pain, or just an inability to make unmet needs known.

How You Respond Matters

At the first signs of agitation, you need to stay calm and not overreact. You may not be able to control the behavior of an agitated patient, but you can control how you respond to them. Remaining calm, rational, and professional will have a direct effect on whether the situation escalates or diffuses.

Remind yourself that distress behavior is often rooted in that person’s fear and anxiety.

Be cognizant of the fact that when behavior begins escalating, nonverbals—your gestures, facial expressions, movements, and tone of voice—become even more important to diffusing the situation.

If the space allows, stand between 1-3 feet away from the person who’s exhibiting escalated behaviors. This personal space tends to decrease anxiety and can help prevent an agitated patient from lashing out or harming themselves or others. If you must enter their personal space to provide care, explain your actions so they feel less confused and frightened.

It may seem counterintuitive to let moments of silence occur while working with patients, but sometimes it’s the best choice. An agitated patient may also not be capable of thinking clearly. Allow them time to think through and process what you’ve said. Just as you don’t want to feel rushed, your patients don’t either. Pausing to give patients time process can avoid rising anxiety and stress for both of you.

If the primary reason for engaging with the patient is to get them to take some action, be thoughtful in deciding which rules are negotiable and which are not. For example, if a patient doesn’t want to shower in the morning, are you able to offer them the choice to do it in the afternoon or evening? Options and flexibility can help you avoid unnecessary confrontations.

Train to Respond Safely

Finally, remember that reacting safely to an agitated patient is not instinctive. It’s critical that you and your team prepare to respond in productive, safe ways when a crisis emerges, and keep communicating consistently and appropriately.

De-escalation training teaches you to help someone regain control while keeping everyone, including yourself and bystanders, safe. Verbal de-escalation is, in fact, an essential part of helping avoid the need for the kind of physical response that may lead to a takedown or restraints. Knowing how to safely help a patient calm down will result in better outcomes for the patient, the physicians, and everyone nearby.

CPI offers a series of programs that train health care professionals to safely manage the agitated patient and defuse disruptive behavior:

Nonviolent Crisis Intervention^® focuses on verbal de-escalation and early intervention, giving staff an effective framework for decision making and problem solving. It aspires to create the safest environment for all parties involved by teaching safe disengagements and restrictive interventions that can be implemented with the least use of force.

Verbal Intervention™ Training is ideal for organizations with a hands-off policy, and staff who don’t experience the kind of higher risk situations that require restrictive interventions. The goal is to give you and your colleagues the confidence and skills to verbally de-escalate disruptive behaviors and prevent further escalation.

Being a health care professional means that every day presents you with new situations and challenges. That includes scared and agitated patients. Understanding what you can control, and training to help you control it in a safe and positive manner, can have a significant impact on the people you interact with, and the environment you work in.