De-escalating Dementia Patients: Helping Nurses Deal with Behaviours

Creating a safe work environment is extremely important for nurses, who are often exposed to aggressive and violent patient behaviour. Knowing how to effectively care for dementia patients and how to de-escalate a situation can be crucial in maintaining workplace safety. This blog post will provide nurses with some tips on how to recognize symptoms of dementia, as well as ways to stay safe when faced with an agitated patient.

What is dementia and how does it manifest in patients’ behaviour

Dementia is a medical condition that deteriorates the human brain and adversely affects its cognitive functions. The disease broadly impacts memory, attention and problem-solving abilities which makes it difficult to remember things and process information as required. Alzheimer’s disease is the most common type of dementia, but there are other equally serious conditions. You can learn more about the different types here. The symptoms of dementia can be difficult to manage for those who suffer from them. Some patients become aggressive, typically resulting from their inability to recognize their own needs, know how to meet them, or communicate with others about them. As their frustration mounts, so can their aggression.  In order to maintain a safe work environment when caring for dementia patients, it is imperative that nurses understand the causes of their behaviour, and develop a plan of action to mitigate dangerous behaviours.

Factors that contribute to aggressive behaviours in dementia patients

The causes of aggressive behaviour in dementia patients can be attributed to social, biological and psychological factors.

Biological factors:

• Pain, illness or physical discomfort 

• Side effects of medication, including confusion and drowsiness

• Hallucinations and delusions can cause fear and confusion, which may make a dementia patient respond in an aggressive way

Social factors:

• Lack of social contact and loneliness

• Boredom, inactivity and sensory deprivation

• Different caregivers or rotating nurses providing their care

Psychological factors:

• The perception that their rights are being infringed upon or that they are being ostracized, sometimes due to difficulties in the brain when processing and interpreting information

• Lack of understanding of the intentions of their caregivers or nurses

How nurses can recognize dementia

For people who have dementia early detection is important for their health. Nurses should know how to pick up on cues of aggression or agitation before any de-escalation techniques are used. The Alzheimer’s Society identifies the following top ten warning signs of dementia. It’s important to note that not all symptoms are listed here, just the most common ones:

• Memory loss that affects day-to-day abilities

• Difficulty performing familiar tasks

• Problems with language

• Disorientation to time and placeImpaired judgement

• Problems with abstract thinking

• Misplacing things

• Changes in mood and behaviour

• Changes in personality

• Loss of initiative

The important role ER nurses play in dementia screening 

Long term care homes aren’t the only healthcare facilities that treat patients with dementia. Hospital emergency rooms witness all sorts of patients, including those with undiagnosed conditions. Individuals with dementia often end up in the emergency room and often, there isn’t enough staff on hand to accommodate them appropriately.  That’s why ER Nurses play an important role in the screening process to ensure these patients receive the proper care they deserve. 

Tips for de-escalating aggressive behaviour in dementia patients

It’s important to recognize that violence can come from patients regardless of gender, age, or size and health care professionals should protect themselves regardless of these factors. Nurses can incorporate pro-active techniques and strategies to lessen aggression in dementia patients in their own care practice by trying the following:

Keep things simple. Ask or say one thing at a time and avoid open-ended questions. Use pleasant directives, such as “It’s time for our walk.”

Keep a daily routine. Consistency helps combat confusion, which can help avoid new daily struggles due to a lack of understanding. 

Reassure the patient. If they feel unsafe, reassure them that they are in a caring environment and that you are there to help.

Focus on their feelings rather than words. They may be struggling to express what they are feeling verbally, so take note of other signs of communication, such as body language, to understand what they are feeling.

Use humour when possible. Keep things light-hearted to avoid the escalation of aggression whenever possible.

Use distractions. Ask for help, such as, “Let’s set the table” or “I really need help folding the clothes.” Helping them fill up their time with social contact can help keep them engaged with something positive and channel their attention in a productive way.

Avoid arguments. It is not necessary to deny, correct, or try to reason with harmless delusions. Do they think the sky is a beautiful shade of pink today? Why yes, yes it is!

Provide support. Dementia patients also need emotional support, especially when they feel scared or grieved. While the family of these patients can play a significant role in helping them maintain a positive attitude, not all patients have close ties with their families and may need extra care in this area.

Travel nursing opportunities in long term care facilities

Travel nurses can find a variety of different jobs in dementia care. Long-term care facilities across Canada provide challenging and fulfilling careers for nurses who want to expand their skills while making a valuable contribution. The work that nurses do is incredibly important, no matter what their position. Nursing jobs that serve our ageing community with humanity and dignity cannot be understated. These are engaging roles that make a difference to important community members who need support.

Support and additional information for nurses

Regardless of age, gender, or experience, anyone can be the target of violence in healthcare settings. Violence is never acceptable and it’s everybody’s responsibility to stop this from happening. Safety and comfort are the top priorities when caring for dementia patients – and that includes safety for healthcare providers. By learning how to effectively de-escalate situations of violence, nurses can help protect themselves and their patients from potentially harmful situations. We recommend that every nurse take action to create a safer environment for themselves, their co-workers and their patients alike.

Resources for screening

• Alzheimer.ca: Tools for healthcare professionals to support dementia screening, assessment and early diagnosis

• Alzheimer.ca: Questions for health professionals to ask when cognitive impairment is suspected

• Alzheimer.ca: The 10 warning signs of dementia

Resources for professional development

• Alzheimer.ca: A selection of training and e-learning modules for healthcare providers

• Alzheimer.ca: Tip sheet/ Principles for a dignified diagnosis

• Alzheimer.ca: The First Link® patient referral program

Resources for workplace violence prevention

• Health Employers Association of BC: Violence prevention / Communication

• Health Employers Association of BC: Violence prevention / Performing de-escalation strategies