How to deal with difficult and aggressive patients and their families


How to deal with difficult and aggressive patients and their families

My experience working in the healthcare field has always reminded me of the extraordinary work that is done every day to provide care and support in the most challenging work environments. Dealing with life and death situations and supporting patients and families facing unexpected illness or health crisis means that many healthcare workers may be subjected to higher levels of stress, emotions. and aggressiveness.

The distinction between difficult and aggressive behavior is important. Difficult behavior can be linked to specific characteristics or emotions, while aggressive behavior can be defined as harassment, swearing, racial abuse, threats, or violence.

Clear procedures must be in place to manage assaults and support team members, as well as to set clear expectations for patients and families. All healthcare providers have a duty to ensure compliance with occupational health and safety obligations, identifying and mitigating potential risks to healthcare professionals and protecting their safety and well-being. at any time.

It is essential to develop and implement procedures that include:

  • Clear policies describing the management of aggressive behavior.
  • Actively and visibly promote zero tolerance for aggressive behavior.
  • Recommended wording or language that may help defuse the conflict.
  • Provide training in dealing with difficult behavior and aggression.
  • Climbing paths, including hospital emergency codes, duress alarms or police.
  • Video surveillance.
  • Presence of physical security.

Dealing with difficult behaviors and aggression is a primary skill when dealing with heightened emotions or complex health issues.

The ACER model

The goal of every difficult interaction is to diffuse the behavior while maintaining safety as a number one priority. Taking the time to understand why patients or families are expressing difficult behavior is the first step in providing an empathetic response. This can be very helpful not to excuse, but rather to understand where the behavior may be coming from. All behavior has meaning. The following “ACER” model is recommended to defuse difficult or abusive behavior:

To evaluate

It is extremely important to assess the condition of the patient or a family member. It is essential to be attentive to the signals of escalating behavior. Physiological signs can be observed including:

  • Face flushed.
  • Trembling.
  • Become red.
  • Tightening of the face, fists or facial muscles.
  • Abrupt or jerky movements.
  • Move to your personal space.
  • Grabbing your arm.
  • Shout or raise your voice.
  • Prolonged gaze.
  • Throwing things or banging your fist on a counter.

You will need to recognize if the situation worsens and whether you or someone else is at risk of physical injury. These signals can alert you to an escalation in behavior and help you make a decision about what actions to take. Ultimately, your judgment is essential in such situations.

C: calm

Stay calm, focused, and in control by focusing on your breathing. When appropriate and safe – if a client exhibits aggressive behavior – set clear boundaries by informing the patient or family member in a polite, respectful and non-threatening manner that the assault will not be tolerated and results of continued behavior.

E: Quit or hire

You will need to make an immediate decision regarding your personal safety – if you are in immediate danger, you may need to get out of the situation immediately. If you are able to engage and have a conversation with the patient or family member, and the behavior moderates, try to resolve the issue. Speak in a calm, firm tone without raising your voice. Allow the patient or family member to vent their frustration, listen carefully and empathize with their situation. Display open and neutral body language and be aware not to invade personal space. Work to resolve the problem in a calm and professional manner.

R: Report

Depending on the severity of the situation, the incident may need to be escalated immediately by using the appropriate hospital emergency code, calling security, pressing a duress button, or dialing 000 for the police. A formal report should be prepared and documented for the incident report and investigation.


Self-care is crucial immediately after an incident and also part of your daily work routine. If you don’t take care of yourself, it’s hard to take care of someone else. While there are many approaches to taking care of yourself, it’s all about finding what’s right for you. Strategies can include, where possible, taking a physical break from your work environment, taking time to recharge your batteries outside of work. Exercise, yoga or meditation can also be helpful in de-stressing.

Offer or seek additional support

In some assault cases where a team member may have been deeply affected (either after the incident or at some point), an EAP (Employee Assistance Program) should be offered. It is essential to recognize the signs of mental and emotional impacts that require professional counseling in yourself and in others and to seek additional support if necessary.

The important role of healthcare professionals in our community should never be underestimated. Patients and their families are expected to show respect and courtesy at all times. When difficult behavior or aggression occurs, it is about demonstrating quality care while setting and implementing clear boundaries to ensure the protection and safety of the team.

Monique Richardson is the author of “Managing Difficult Customer Behavior – A Practical Guide For Confident Conversations” and is one of Australia’s leading experts in service leadership and customer service. For more information, visit

Image Credit: © / au / WavebreakMediaMicro


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