Clinical placements

Using positive reinforcement to manage violence and aggression

Reminding a service user with learning disabilities how much her behaviour had improved helped nursing student Bradley Squirrell successfully de-escalate a violent situation 

Reminding a service user with learning disabilities how much her behaviour had improved helped nursing student Bradley Squirrell successfully de-escalate a violent situation 


Positive reinforcement can help defuse aggression. Picture: iStock

In my first year of training, I was on placement on a challenging behaviours unit for people with a learning disability. 

I was on a night shift, and it was about 11.30pm, when a service user, who I will call Charlotte, became physically and verbally aggressive towards staff members. This was due to an incident earlier in the day with another service user. 

Primary and secondary de-escalation methods, such as distraction techniques and asking Charlotte what had caused her to become upset, had been unsuccessful. Staff therefore had to use physical intervention to keep her, as well as other service users and staff members, safe. 

Supervised de-escalation

I was asked to go into the office next door for my own safety. But when there was no immediate threat, I asked if I could try and de-escalate the situation further, under supervision from qualified staff. 

After this was agreed, I slowly approached Charlotte. She was sitting on the floor, so I lowered myself to her height and sat a few feet away from her. 

As well as reassuring staff that I was at a safe distance, this meant I was not standing over Charlotte and being too authoritative, which could have made the situation worse. 

When Charlotte was admitted to the unit, she had been aggressive and violent towards staff. She had made significant progress since then though, so I calmly reminded her of this, and the recent multidisciplinary meeting I had attended with her in which her improvements in behaviour had been noted. 

Care and compassion

She then moved along the floor to sit across from me and started to talk to me. After about five minutes, the situation was de-escalated. Charlotte apologised to the staff involved and positive behaviour support planning was initiated. 

I learned de-escalation techniques at university as part of the care and compassion module. This enabled me to gain an insight into how Charlotte was feeling when the situation had escalated, and also helped me to become more self-aware, particularly in relation to how my body language and tone of voice can be used to help calm difficult situations with service users. 

This experience taught me how identifying a patient or service user’s positive behaviours and achievements can help to de-escalate things and if the person providing support is softly spoken and non-confrontational, the service user is more likely to listen and engage with them. 

Since this experience, I have always tried to use similar methods with other service users. But it is important to remember that a strategy which works for one person may not work for another, so care must always remain person-centred, tailored to the individual needs of the service user. 


About the author

Bradley Squirrell is a second-year learning disabilities nursing student at Northumbria University 

 

 

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