Scenario

An adult son of a resident living with dementia arrived for a visit just a few minutes ago. They stomp out of their mother’s room and come up to you demanding to know why their mother is not wearing a bra when they have insisted since their mother has moved in that she should wear one every day because she has always worn a bra and feels undignified when she is seen without one. It is included in her care plan as part of their morning routine. Over the last month, any staff who have attempted to help the resident put on a bra in the morning ends up being swatted away, yelled at, and told they, “don’t want that damn thing on. It’s uncomfortable!”

Instructions

1. As a group, read the “De-escalation Strategies” section (on page two).
2. Discuss how you would respond to the scenario using the skills from the handout in pairs.
3. As a group, go through the guiding questions to debrief the huddle. If possible, hold this safety huddle in a relevant location (shower room, bathroom, etc.) to analyze the hazards in each environment.

Guiding questions

• What are the wishes of the mother who is in your care?
• What is the family member upset about?
• How could you use each of the de-escalation strategies to help the situation with the family member? • How can you empathize with the family member about the changes they see with their mom over time?
• At what point would you consider involving a supervisor in the conversation?

De-escalation strategies

Working with clients or residents and their families is not always easy. Transition can be difficult, and when people's expectations of care or routine are not met, it can lead to challenging situations. You may not be able to control how others act, but you can control how you respond.

Here are some reminders when working to de-escalate difficult situations:

• Speak respectfully, loud enough to be heard, and slower than usual.
• Use the ready posture to approach, respecting everyone’s space and belongings.
• Fewer, simple words are better.
• Use silence to give them time to respond.

Below are short summaries of communication strategies outlined in the Provincial Violence Prevention Curriculum:

• Provide options: Identify alternatives that would give someone a choice in the matter which could resolve the issue.
• Validate: Acknowledge the difficulty of the situation the person is going through.
• Redirect: Steer the conversation into a different, more positive topic.
• Distract: Be curious and ask a follow-up question that gets the conversation on another topic.
• Clarify: Ask the person to tell you more about something they said.
• Listen Actively: Use non-verbal body language to demonstrate that you care and are paying attention.
  After this huddle, staff will be able to:
• Summarize a person’s concerns that are leading them to an escalated state.
• Apply active listening skills to demonstrate that they care about the person in an escalated state.
• Use communication strategies to de-escalate a difficult situation.

Notes to the huddle leader

• Reinforce that staff should conduct a point of care risk assessment before starting any task to establish whether it is safe to proceed.
• Do you have a violence prevention policy? When was it last updated? Are staff trained on how to apply it?
• Even though it may not feel like it in the moment, it’s important to remember that, at the end of the day, everyone is on the same team to ensure residents or clients receive the best care. In this scenario, it is difficult for family members to see a loved one go through the changes associated with dementia, and care staff play a large part in helping families along that journey.