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Healthcare Training Institute - Quality Education since 1979

Section 19
Domineering Resident Technique #4
De-escalating Conflict

Table of Contents | NCCAP/NCTRC CE Booklet

When you find yourself confronted by a Domineering Resident’s complaints, and it has escalated into a very angry situation, here are some ideas you might try.  You will quickly see that these ideas on assertiveness can be applied to encounters with other Department Heads, staff, volunteers, and people in your personal life as well.

Step #1. Get information: Many conflicts stay unresolved because one or both parties harbor unexpressed feelings or needs. If a situation feels stuck between you and a Domineering Resident or a staff member, perhaps one of the best things you can do is probe to understand more about the feelings and needs of the other person.

Conflict Situation:  Helen yells at you in the hall, shaking her finger, "What!?! No Bingo today!?!" 

Step #2. Rephrase: This is important for de-escalating conflict. Probably your Domineering Resident wants to know that you understand what’s bothering him or her. They need to feel heard. What you might do is say in your own words what you understand his or her feelings or needs to be.  Here are three examples how this rephrasing might work:
1. “So what you want is _________.”
2. “So what concerns (worries) you is __________.”
3. “So what hurts (bothers) you is ___________.”

Permission is granted to duplicate this table for staff use.  Considering using these ideas as a guide for additional Journaling.

Be certain that you describe the resident’s position in a neutral, non-judgmental way. Your statement doesn’t have to be overly sympathetic or definitely not critical, just accurate.  If there’s any hint of sarcasm, ex­asperation, or judgment in your voice, the effort you made to rephrase will not only be wasted but will escalate and not de-escalate the conflict.

Rephrasing clarifies what the issue is and makes the resident feel you are hearing her.
Rephrase what you think your Helen’s issue is: 
"So, you are angry because we are not having Bingo twice a week…"
This is a two part statement
            A. about how you think Helen feels and
            B. what you think Helen’s issue is.
Your Domineering Resident may reply:  "You bet I am angry!"… Or, "Well, I would not say I am angry.  I just don't like it!"  Or, "It's not the Bingo game, it's the damn potatoes had lumps in them and were cold again."

Step #3. State your Case… briefly… unemotionally… calmly… matter of factly… without over-explaining.  Here’s a sample you might rephrase to fit they way you speak and the history of your relationship with your Helen.
You state, "Hester, we have Bingo once a week now."
She replies, "But it's your job to program for us!"
You state, "Yes, and we are having Bingo once a week now."
She replies, "Oh this is silly!  You aren't doing your job like the other Activity Director, Kitty, did!"
Reply with silence and a look like, “You are entitled to your opinion.”  Keep a calm, secure attitude.

Would Journaling additional "State your Case" examples be beneficial?

Step #4. Withdraw if no matter what you say escalates the situation.  If the Domineering Resident keeps getting more upset, withdraw.  Withdrawing is basically a time out. If things are con­tinuing to escalate despite a series of adaptive responses on your part, it’s time for damage control.  You might state, “It feels like you’re starting to get more upset. We can discuss this later if you would like.  I have Activities to conduct now and need to go.”
Just keep repeating the preceding statement, “I have Activities to conduct now and need to go.”, like a broken record until you can get disengaged. This idea of repeating will be expanded upon in Section 11.  With your Domineering Residents, give a specific time when you’ll return, if needed. 

I have found the key is to calmly keep stating my "withdrawal line" like “I have Activities to conduct now and need to go.” verbatim and then physically exit the situation as soon as possible.

Would Journaling additional "Withdrawal Lines" be beneficial?