Behaviors of Concern: A Brief Guide to Approaching Aggressive Patients


There is a high tendency for health professionals to easily overlook negative patient body language, but it can also just as easily be a warning of a looming act of violence. Before the start of the pandemic, acts of healthcare violence were on an upward trend; and even now, the industry is still scrambling on how to adjust.

One solution is to train and educate staff on how to recognize the early signs of conflict, triggers, and patient anxiety.


What are the common triggers of patient aggression?

Some triggers of anxiety are frustration, anger, or fear. Here are some of the typical root causes:

  • Waiting. Long lines, although less common in a physician's office, are typical in the Emergency Department.
  • Fatigue. Someone who is not feeling well is probably not sleeping very well. Fatigue becomes a big driver of anxiety when coupled with the patient’s feeling of losing control.
  • Fear of injury or pain. Patients can sometimes fear treatment more than their injury. Fear of an unknown procedure can act as a trigger.
  • Drugs. Prescriptions missed medications or illegal drugs can play a big role in a patient’s behavior.

Just like other behavioral patterns, the stages of conflict can typically be recognized. Stages of conflict also referred to as a spectrum of violence first begins with anxiety. For example, a patient is upset about an appointment starting late. Even while they sit and wait, this could quickly turn into some sort of verbal aggression that could turn physical. With close observation, the behaviors can be identified by looking for signs of patient anxiety at initial contact.


What are the signs of patient anxiety?

  • Head Down
  • Flushing of the skin
  • Rubbing of the hands
  • Shallow breathing
  • Sweaty hands and brow
  • A nervous laugh
  • Veins appear
  • Dry mouth and swallowing
  • Bouncing finger tapping
  • Touching of the nose
  • Playing with the hair

Preventing Challenging Behaviors

How you approach challenging behavior may vary based on your experience and past training. Generally, here are some agreed-upon steps to follow.

  • Pause – stand back, take a moment before approaching and assess the situation.
  • Speak slowly and clearly in a calm voice.
  • Explain your care actions.
  • Try not to rush the person, act calmly.
  • Show respect and treat people with dignity at all times.

When challenging behavior happens, communication is the key

Avoid harsh aggressive or abrupt statements. Don’t say things such as “You must….”, “Don’t…..”, “Stop…….”. Use alternatives and “I’ language like “I would like you to…” It would help me if……”, “ I feel scared when…….”. See our checklist of phrases to avoid when dealing with aggressive patients.

When challenging behavior happens:

  • Back off where possible
  • Keep calm
  • Call for help

Leave the person to calm down, if possible. Remove others from the environment. Be aware of your own body language and tone of voice used.


Management of Aggressive Behaviors Training

Sometimes all the best dialogue won’t be enough to ward off an unexpected attack. Healthcare workers can benefit from the management of aggressive behaviors training. MOAB (Management of Aggressive Behavior) focuses on principles, techniques, and skills for recognizing, reducing, and managing violent and aggressive behavior. The program also provides humane and compassionate methods of dealing with aggressive people.


Need More Resources?

Learn more here about MOAB training offered by LHA Trust Funds here.


Glenn150

About The Author

Glenn Eiserloh, CHSP -Senior Risk Consultant, LHA Trust Funds

Glenn Eiserloh has more than seventeen (17) years of loss prevention and risk management experience. Mr. Eiserloh has a Bachelor’s of Science degree from the University of New Orleans in Finance with a concentration in insurance. He provides consultation services relative to workplace loss prevention, safety training, general liability risk reduction, worksite safety inspections, and trend analysis.

Content Related to this Article

09.20.2022
Article

Workers' Compensation Tip: The Importance of Conducting JSAs to Reduce Work-Related Injuries

Many work-related injuries can be attributed to strenuous tasks, repetitive motion, and unsafe procedures. In healthcare,...

Learn More

09.12.2022
Article

Recent Developments in Healthcare Liability

Healthcare facilities are exposed to liability in a variety of ways; primarily from breaches in the appropriate standard ...

Learn More

09.07.2022
Article

Health Care Provider Obligations and Risk Considerations Under the 21st Century Cures Act

Providers are now using patient portals to offer an array of information to patients including laboratory results, surgic...

Learn More