Hisn't Schneider sitting at the table in the recreation room of his nursing home and banging his fist on the table again and again. Knocks loudly and persistently, no one can stop him. All who can leave the room. Others do not want to give in to the noise and become loud themselves, shouting: “Stop!” Nothing works. Into this charged atmosphere, a nurse's assistant enters the room. He doesn't say anything, just sits down next to Mr. Schneider and knocks on the table with him in time. Exasperation sets in: Mr. Schneider pauses and looks up.
Markus Wymetalik calls this type of approach contact mirroring, which works without language when patients cannot be reached with words. Observe what the other person is doing, send them without talking to them and establish contact that way. Wymetalik, former head of nursing and now Markus Diakonie's quality management representative, is one of eleven de-escalation trainers imparting his knowledge to colleagues at the Agaplesion Haus Saalburg nursing facility during practical exercises.
The employees there have to deal with such and similar situations. Even if most of the day is calm, there are times when patients suddenly become violent, hold up staff because they want something quickly, or become aggressive. If caregivers reacted similarly emotionally and allowed themselves to be overwhelmed by their own helplessness, anger or impatience, the mood could change quickly. To prevent this from happening, daily scenes in the Saalburg house practice strategies for dealing with potentially difficult encounters and staying calm.
“Bones of an immature person break more easily”
What to do when an elderly gentleman has a caregiver by the sleeve? Wymetalik puts himself in the role of a worker and demonstrates: With his free hand, he grabs the jacket's stretchy material and pushes it toward the hand holding it, which is then released. Caution is always necessary: ”The bones of an immature person break more easily.” It's about setting boundaries appropriately but gently.
Physical attacks are an exception in any case; verbal arguments are more likely. The motto here is don't get caught up in your own anger, says the trainer. If the nurse responded to an angry demand, “Bring me my newspaper now,” with an equally angry rejection, an argument would ensue. It's better to “listen with the ear of fact, not the ear of appeal,” as Wymetalik describes it, by answering, for example, “So you're looking for your newspaper?” It is to find out what the other person really wants, maybe also, what basic need remains unsatisfied, what concern lies behind the superficial anger. And about keeping a professional distance: “As a rule, we are not meant as people, but only as representatives. We feel the same as the gas station attendant who is blamed for high gas prices.
Szerénke Darabpour, head of the Saalburg house, also benefited from the further training of the de-escalation trainer. “It also helps in everyday communication, communication with patients, their relatives and employees.” But the courses also provide more, as he says: “Household residents have the right to well-trained employees, and employees have the right to a workplace where they feel safe.
Deal with conflicts even after that
The provision of corporate health management courses is supported by Techniker Krankenkasse. In cooperation with the Prodema Institute, eleven de-escalation trainers were trained and at the same time they were trained to pass on the learned methods to their colleagues. “We see this as an investment in future-proof care,” says Barbara Voß, state representative of the Hessen TK.
Employees should learn how to better manage stress so they don't burn out prematurely or even quit their jobs.
Now the internal trainings take place in the Saalburg building on two consecutive days in groups of up to twelve people. Re-enacted scenes are recorded with a video camera for later discussion. It is recognizing how participants unconsciously react in conflict situations and what signals they send out. Repeat and in-depth courses are held several times a year to familiarize yourself with the techniques.
De-escalation training not only helps to prevent conflicts in advance, but also helps to deal with them later – if an incident does happen. Then it helps to be able to talk about it as a team. The diaconia also has pastors and every employee knows the phone numbers in case of emergency. Each qualified participant can then become a contact person for others. The purpose of the training is to “make our employees more resilient. And this is especially important at a time when everything seems fragile and nothing is predictable,” says Darabpour.