De-escalation training: Nurses must also be able to set boundaries.

HOURErr Schneider sits at the table in the living room of his nursing home, pounding his fist on the table over and over again. He knocks loudly and persistently, no one manages to stop him. Who can, leaves the room. Others don’t want to give in to the noise and become loud themselves, shouting “Stop!” Nothing works. In this tense atmosphere, a nurse enters the room. He doesn’t say anything, but sits down next to Mr. Schneider and knocks on the table in time with him. Irritation makes itself felt: Mr. Schneider pauses and looks up.

Markus Waimetalik calls this type of approach contact reflection, which works without language when patients cannot be reached through words. Imitate what the other person is doing, accompany him without talking to him, and thus establish contact. Wimetalik, a former nursing service manager and now quality management representative at Markus Diakonie, is one of eleven de-escalation trainers who pass on their knowledge to colleagues at the nursing facility Agaplesion Haus Saalburg in practical training.

The employees there must be able to deal with such and similar situations. Even if most of the day is peaceful, there are times when patients suddenly become violent, hold up staff because they want something urgently, or become aggressive. If caregivers responded similarly emotionally and allowed themselves to be overcome by their own powerlessness, anger, or impatience, the mood could quickly change. To prevent this from happening, everyday scenes in the Saalburg House practice strategies for dealing with potentially difficult encounters and remaining calm.

“The bones of a ninety-year-old man break more easily.”

What to do if an elderly gentleman is holding a nurse’s sleeve? Vymetalik puts himself in the role of an employee and demonstrates: with his free hand he grabs the stretched material of his jacket and pushes it towards the hand that is holding it, and then releases it. Caution is always necessary: ​​“The bones of ninety-year-old children break more easily.” It’s about setting boundaries correctly, but gently.

Physical attacks are in any case an exception; verbal arguments are more likely. The motto here is “don’t let yourself be carried away by your own anger,” says the coach. If the nurse responded to an angry demand: “Bring me my newspaper immediately” with an equally angry refusal, it would lead to an argument. It’s better to “listen with the ear of fact rather than the ear of appeal,” as Waimetalik describes it, for example by responding, “So you’re looking for your paper?” It’s about finding out what the other person really wants, and maybe also. , what basic need is not met, what anxiety is hidden behind the surface anger. And regarding maintaining a professional distance: “As a rule, we are not thought of as a person, but only as representatives. We feel the same way as the gas station attendant who is blamed for raising gas prices.”

Serenke Darabpour, head of the Saalburg House, also received additional training as a de-escalation trainer. “It also helps with day-to-day communication, communication with patients, their families and employees.” But the courses do more, she said: “Residents have a right to well-trained employees, and employees have that right to a workplace where they feel safe.”

Resolve conflicts even after the fact

The offer of courses in enterprise healthcare management is supported by the Techniker Krankenkasse. In collaboration with the Prodem Institute, eleven de-escalation trainers were trained and simultaneously learned how to pass on the techniques they learned to colleagues. “We see this as an investment in future-proof medical care,” says Barbara Voss, head of TK’s representative office in Hesse.

Employees must learn to manage stress better to avoid premature burnout or even quitting their job.

In-house training now takes place in the Saalburg building in groups of up to twelve people for two consecutive days. The replayed scenes are recorded on a video camera so that they can be discussed later. It is about recognizing how participants unconsciously react to conflict situations and what signals they send. Revision and advanced courses are conducted several times a year to familiarize oneself with the techniques.

De-escalation training serves not only to prevent conflicts in advance, but also to resolve them later – if an incident does occur. Then it will be useful to talk about it as a team. Diakonia also has pastors, and every employee knows emergency phone numbers. Each qualifier can then become a point of contact for the others. The training is designed to “make our employees more resilient. And this is especially important in times when everything seems fragile and nothing is predictable,” says Darabpour.