What To Do When an Agitated Patient Starts Raising Their Voice  

Imagine being in the middle of a busy shift when an agitated patient starts raising their voice, screaming at you. How do you manage the situation without letting it affect your duties and patient care? 

You’re at work, with not enough hours in the day to do everything you need to. You’re exhausted, but if you don’t stay focused, many lives could be affected. You can’t afford to have a patient’s behaviour negatively impact how you perform your duties. 

For healthcare professionals, the distressed or agitated patient comes with the job. Far too often this distress and agitation lead to verbally volatile behaviour. 

In the moment it might seem appropriate to let them blow off some steam and calm down on their own. But what do you do when instead of getting calmer, an agitated patient only gets angrier, their behaviour moves toward being physically aggressive or violent, and you become another assault statistic? 

Guide Your Reaction to Behaviour

How you respond to disruptive behaviour plays a critical role in determining whether the incident will escalate into a crisis situation. 

The more an agitated patient escalates into distress, the less they can process your choice of words.  

When we speak to somebody we care about and respect, our tone and body language become relaxed, receptive, and nonthreatening. There is a special degree of patience and attention we show to those people. 

• Monitor and Moderate Your Behaviour: Your tone, stance, and choice of words matter. 

• Empathy and Patience: Patience and attention are exactly what a person in crisis needs to see so that they can safely de-escalate. 

Calm and Connect with Agitated Patients with Empathetic Communication

Empathy is an integral part of decreasing fear and anxiety. 

As taught during CPI’s Safety Intervention™ training programme, challenging or oppositional questions and emotional release or intimidating comments often mark the beginning stages of loss of rationality. 

These behaviours warrant specific, directive intervention aimed at stimulating a rational response and diffusing tension.  

Whether or not you think their feelings are justified, they are real feelings to that person.  

• Demonstrate Empathy: Pay attention to the patient, listen carefully, and respond with positive nonverbal messages like eye contact and head nodding. 

• Empathic Engagement: Repeat or paraphrase what the patient said, using their own words to ask clarifying questions. 

Recognising and Responding to Precipitating Factors

There is always an underlying cause that manifests itself in an agitated patient. Many temporary medical conditions can cause agitation, such as intoxication, or even just the anxiety and stress of being at a hospital. 

CPI refers to these as Precipitating Factors. These factors are out of our control and play a major role in your behaviour, as well as that of your patients. 

• All Behaviour is a Communication: Whether it’s screaming and swearing, angry gestures, or kicking and hitting, behaviour is often rooted in fear, frustration, pain, or unmet needs. 

Managing Your Reactions to Positively Influence Patient Behaviour

At the first signs of agitation, you need to stay calm and not overreact.  

You may not be able to control the behaviour of an agitated patient, but you can control how you respond to them. Remaining calm, rational, and professional will have a direct effect on whether the situation escalates or diffuses. 

Remind yourself that distress behaviour is often rooted in that person’s fear and anxiety. 

When behaviour begins escalating, nonverbals—your gestures, facial expressions, movements, and tone of voice—become even more important to diffusing the situation. 

• Stay Calm: Your nonverbal cues, like gestures and facial expressions, play a crucial role in diffusing the situation. 

• Personal Space: Stand between 1-3 feet away from the person. This decreases anxiety and can help prevent lashing out or harming themselves or others. 

• Explain Actions: If you must enter their personal space, explain your actions to reduce confusion and fear. 

• Allow Silence: Even if it might seem counterintuitive, sometimes, allowing moments of silence can give the patient time to process and reduce their anxiety. Pausing to give patients time process can avoid rising anxiety and stress for both of you. 

• Set limits and be flexible: If the primary reason for engaging with the patient is to get them to take some action, be thoughtful in deciding which rules are negotiable and which are not. For example, if a patient doesn’t want to shower in the morning, are you able to offer them the choice to do it in the afternoon or evening?  

Options and flexibility can help you avoid unnecessary confrontations. 

Develop the Skills to Handle Distressed Patient Behaviour Safely

Finally, remember that reacting safely to an agitated patient is not instinctive. It’s critical that you and your team prepare to respond in productive, safe ways when a crisis emerges, and keep communicating consistently and appropriately. 

De-escalation training teaches you to help someone regain control while keeping everyone, including yourself and bystanders, safe.  

Verbal de-escalation is, in fact, an essential part of helping avoid the need for the kind of physical response that may lead to a takedown or restraints.  

Knowing how to safely help a patient calm down will result in better outcomes for the patient, staff, and everyone nearby.