Scenario
Sally is 63 years old with early dementia who has recently been placed in the facility
where you work. She has a history of getting aggressive and angry; she has lashed
out at staff when they have tried to attend to her. This morning she does not want to
get ready for breakfast and refuses to get dressed. As you attempt to help her, she
starts shouting at you “Why should I listen to you?”.
How to you respond?
Read the scenario carefully and select the best response.
You raise your voice and
tell her that she is not to
act this way.
Tell her you are sorry she
is upset, but she is going
to be late for breakfast
Options
In a quiet voice, let her
know that she is not to be
behaving that way and
she must get dress now.
Apologize to her in a
calm voice and ask her
why she does not want to
get dressed.
Scenario
Sally now shouts at you, “Don’t tell me what to do! You need to leave me alone right
now! Are you even listening to me?”.
What do you respond?
Read the scenario carefully and select the best response.
Tell her that you are the
nurse in charge and
Options
she needs to do what
you tell her.
You face her and tell
her she needs to calm
down.
Scenario
Sally now shouts at you, “Don’t tell me what to do! You need to leave me alone right
now! Are you even listening to me?”.
What do you respond?
Read the scenario carefully and select the best response.
Tell her that you are the
nurse in charge and she
needs to do what you tell
her.
You face her and tell
her she needs to calm
down.
Options
You turn to her, and
calmly ask her how you
can help.
Scenario
Sally responds to you, not yelling but still in a very strained voice that she knows she
needs to get dressed but does not want to be rushed.
How do you respond?
Read the scenario carefully and select the best response.
You turn to her, and
calmly ask her how you
can help
You face her and tell her
she needs to calm down.
Options
Ask Sally if she is feeling
hungry and how you can
help her get ready for
breakfast.
Scenario
Sally responds to you, not yelling but still in a very strained voice that she knows she
needs to get dressed but does not want to be rushed.
How do you respond?
Read the scenario carefully and select the best response.
You turn to her, and
calmly ask her how
you can help.
Options
Ask Sally if she is
feeling hungry and how
you can help her get
ready for breakfast.
Scenario
Sally starts yelling, “I want to go home! I’m going to leave right now!”.
How do you respond?
Read the scenario carefully and select the best response.
With your hand on your
hip you tell her, “I don’t
Options
have time for this!”
and that she needs to
get dressed now.
To get her to focus,
you raise your voice
and tell her she would
feel better if she would
just get ready and eats
something.
Scenario
Sally starts yelling, “I want to go home! I’m going to leave right now!”.
How do you respond?
Read the scenario carefully and select the best response.
To get her to focus, you
raise your voice and tell
her she would feel better
if she would just get
ready and eats
something.
With your arms crossed
you tell her, “I don’t have
time for this!” and that
she needs to get dressed
now.
Options
Tell her that this is her
home now and you will
help her find a sweater to
wear.
Scenario
Sally cries and says she misses her purple sweater; she thinks it is still at home.
How do you respond?.
Read the scenario carefully and select the best response.
To get her to focus, you
raise your voice and tell
her she would feel better
if she would just get
ready and eats
something.
Tell her that this is her
home now and you will
help her find a sweater
to wear.
Options
Ask her why the purple
sweater is her favourite
and offer to help her look
for it.
Scenario
Sally cries and says she misses her purple sweater; she thinks it is still at home.
How do you respond?.
Read the scenario carefully and select the best response.
Tell her that this is her
home now and you will
help her find a sweater
to wear.
Options
Ask her why the purple
sweater is her favourite
and offer to help her
look for it.
Scenario
Sally now is very angry and starts pointing her finger at you and shouting, “You are
too bossy! I want someone else to help me!”
How do you respond?
Read the scenario carefully and select the best response.
You leave the room to
find help to get Sally to
calm down and get
ready for the day.
Options
You say, “I told you I
don’t have time for
this.” and tell her “You
need to get dressed or
you will miss
breakfast.”
Scenario
Sally now is very angry and starts pointing her finger at you and shouting, “You are
too bossy! I want someone else to help me!”
How do you respond?
Read the scenario carefully and select the best response.
You say, “I told you I
don’t have time for this.”
and tell her “You need to
get dressed or you will
miss breakfast.”
You leave the room to
find help to get Sally to
calm down and get
ready for the day.
Options
You tell her, “Don’t worry
dear, you will get to go
home soon.”
Scenario
Sally cries, “This is not my home! None of my things are here. Where is my purple
sweater?”
How do you respond?
Read the scenario carefully and select the best response.
You say, “I told you I
don’t have time for this.”
and tell her “You need to
get dressed or you will
miss breakfast.”
You tell her, “Don’t worry
dear, you will get to go
home soon.”
Options
You apologize and tell
her it is okay to miss
home. You will ask her
family to bring more of
her clothes on their next
visit.
Scenario
You helped Sally find her purple sweater and helped her get dressed. Sally now
seems more co-operative and asks, “Why can’t I just go home? Why am I here?”
How do you respond?
Read the scenario carefully and select the best response.
You apologize and tell
her it is okay to miss
home. You will ask her
Options
family to bring more of
her clothes on their next
visit.
You explain to Sally
that she made the
decision with her family
to move here so that
she could have all the
support she needs.
You were unable to de-escalate the situation.
Please review your feedback and try again.
Feedback:
You raised your voice and your non-verbal
communication demonstrated that you were taskfocused. You also placed demands on Sally with your
verbal communication. You were unable to develop a
therapeutic and trusting relationship with your patient.
This is not a good approach because it is not patientfocused, it does not use therapeutic communication
strategies, and you use your position of power to get the
patient comply. The outcome is unacceptable for the
patient and reflects poorly on your professionalism as a
nurse.
Try Again
Resources
You were unable to de-escalate the situation.
Please review your feedback and try again.
Feedback:
At times you did try to approach Sally calmly,
however, your chosen responses reflected poor verbal
communication. Your responses did not indicate that you
were actively listening to Sally which contributed to
escalating behaviour.
Take the time to really listen to what the patient is
saying. This can be an opportunity engage them in
positive dialogue and shift their focus from their
emotional reaction, to sharing the root cause of their
distress.
Try Again
Resources
You were able to de-escalate the situation.
Please review your feedback.
Feedback:
You did a great job! You were able to talk Sally
through her crisis You de-escalated the situation
while building trust and establishing a therapeutic
relationship that will support Sally’s care in the future.
This is the best response. You were assertive without
being authoritative with Sally, supporting her and guiding
her to have the best outcome. Re-directing her thoughts
by asking her about home demonstrated your ability to
use active listening to understand what is important to
her. Taking the time is not always easy, a few extra
moments demonstrates a patient-centered approach.
Resources
Resources
Remember, you always want to use de-escalation strategies when
managing a patient who is in crisis, or is confused, and uncooperative.
Making accusations and being demanding will only heighten their anxiety
and further escalate the situation.
Stay professional and assess the situation objectively. Use your
emotional intelligence to avoid contributing negatively to the situation;
remember not to take it personally. De-escalation ensures that you
remain effective in your communication and contributes to better
outcomes .
Please refer to the following College of Nurses of Ontario (CNO) practice
standards:
•
•
Nurse-Client Therapeutic Relationships
Conflict Prevention and Management
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