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Establish communications
When the tensions are high, communication is easily muddled. It is more than possible that your patient does not want to talk with anyone. Before you proceed at all, it is important to make it so that they are willing to speak. You want to ask them if they are willing to talk with you. Be persistent with your request, while being as kind as possible at the same time. No matter how difficult or upset it is for them to recall the inciting incident, they must be open to the prospect before anyone can move forward. Finally, you have to recognize the potential communication barriers ahead of you. This could be cultural barriers such as language or religion, or it could just be emotions at the heat of the moment like anger or embarrassment. Be open to the prospect that you have to tailor your message and approach to these factors.
Take the time to listen
Even in high pressure scenarios, you need to make sure that you are listening to your patients. Not only does listening gives you a better understanding of the situation at hand, it helps patients open up to you and feel valued. Put yourself in their shoes: You are probably in the hospital for ailments or bodily issues that are outside of your control. All you can do is wait for the medical staff to deliver a verdict or present you with a difficult choice. That overwhelming sense of helplessness and dread is often the spark for many emotional blowups. Lending an ear while making it clear that you are invested and engaged in what they have to say returns a sense of agency and control, while establishing a relationship between you and the patient.
Ask smart questions
Being an active listener goes a long way in de-escalating situations both before and during their boiling point. You can even take it a step further by actively asking questions, regarding the patients. You can ask “how they are doing” or “how are things going” to show that you are invested in their problems. If a patient is already upset, ask them what happened before the situation escalated or whether or not they need any assistance. It is also important to ask if they hurt themselves. Patients can wind up inadvertently hurting themselves further in the middle of an episode, and this is often masked by the adrenaline in the moment. When they answer, be sure to also give ample time for patients to respond. Talking over them too much will make them feel drowned out. Give them the space to let out whatever they have on their mind.
Empathize with your patients
Hospitalization can be a mentally draining experience. The uncertainty regarding your health situation, disruption of your daily routine and prolonged isolation from your friends and loved ones are just a few of the problems that patients have to deal with. The frustration only grows when it feels like no one truly understands what they are going through. Listening is important but it is only half the battle– you need to show that you truly care about a patient’s situation. Just recognizing the weight of their situation, and the strength it takes to continue on can mean a surprising amount. By reassuring them that their experiences are valid, you make their hospital visit feel far less isolating.
Work closely with other staff
As with any hospital problem, remember that you are working within a team. Working together with your fellow HCPs can make the most terrifying meltdowns feel manageable. For example: if you feel like you are not getting through to a patient, you can reach out to a co-worker who has already built a connection with them. They can assist you with de-escalating the situation and you can learn from their experiences and approach towards connecting with others. This arrangement goes both ways of course— you have to be willing to lend a helping hand, whenever someone else is struggling with a difficult situation. If a patient is tiring a staff member, offer your services and take over for them for a short period of time. This can even be a team-wide apporach, if the rest of the staff is amenable to this arrangement.
Establish boundaries
While it is your responsibility to do what you can, everyone has their limits. Patients could very well make irrational and aggressive demands that you cannot reasonably meet, in the current circumstances. Provide non-committal answers to avoid further conflict or escalations. “I will check with my supervisors but I cannot guarantee anything” is an example of such a response. Instead of outright telling them no or making a promise you cannot keep, you are striking an ambiguous middle-ground that cannot be held against you.