Managing aggressive patients is an increasingly common challenge for healthcare professionals. That’s why it’s important to know how to defuse the situation quickly and protect everyone. Discover 6 proven methods in this article.
Why can patients be aggressive?
Triggers are often multiple and cumulative. Knowing them helps you adapt your response and prevent escalation.
- Unrelieved pain: Pain is often a major trigger of aggressive behaviour. The patient channels their pain into anger and becomes aggressive.
- Feeling misunderstood: Frustration from feeling misunderstood or not sufficiently cared for can build up and turn into aggression.
- Fear, uncertainty, loss of control: A stay in hospital or a medical facility is frightening for many people. Unclear diagnoses, not knowing what the treatments involve, or a sense of losing control all contribute to emotional stress.
- Confusion/disorientation: Older patients or those with cognitive disorders such as dementia may be confused, not understand why certain interventions are necessary, or feel threatened.
- Psychiatric disorders: Severe anxiety, psychosis, PTSD, and substance intoxication or withdrawal can also be vectors of aggression.
- Conflicts over rules and expectations: If a patient perceives boundaries as unfair, is not treated quickly enough for their liking, or cannot access personal items like a phone, this can also lead to aggression.
In practice, the rise in violence often follows a progressive process:
- Everyday tensions → disruption of the unit → crisis.
Spotting the signs early, understanding them, and offering time to talk with the patient can prevent many escalations.
The 5 types of aggressive patients and how to recognize them
- Agitated: paces up and down, clenches fists, talks to themselves.
Objective: establish contact, offer simple solutions, and defer what can be deferred.
- Disruptive: shouts, disturbs others.
Objective: emotion-focused interventions (validate, rephrase), offer choices.
- Destructive: throws/breaks objects.
Objective: get others to safety, give clear instructions, make a strategic retreat, and call for help.
- Dangerous: violence directed at others/self.
Objective: firm request, announce consequences, intervene with several people. :content
- Lethal: weapon, severe threat.
Objective: gain time, limit space, alert security/police.
OneDoc Pro features that will help you take time with your patients
Our 6 effective tips to help you handle a crisis situation with a patient
1. Set a safety perimeter before speaking
Position yourself at ~2 m, body at a three-quarter angle, hands visible, calm tone. Keep the door accessible for you and the patient, remove potentially dangerous objects from your pockets, and ensure support is nearby (alarm button, colleague informed). These micro-adjustments reduce the perceived threat and allow you to anticipate a retreat if necessary.
2. Acknowledge and propose a calming appointment
When time is short, say what you can do and when.
Example: “I hear you. I’ll be back in 10 minutes to discuss and find a solution.”
Explicitly scheduling a short slot, then keeping your promise, reduces tension and avoids theatrics in the waiting room or corridor.
3. Validate the emotion and clarify with brief questions
Use short sentences that name the emotion:
Example: “I can see you’re very angry”),
then validate the emotion:
Example: “It’s legitimate to be upset when…”)
and finally clarify it:
Example: “What would help you first: reviewing the pain or calling someone close?”
Active listening, validation, and emotional regulation can de-escalate many situations.
4. Offer constrained choices
Constrained choices are options that are acceptable to you. You can offer 2 to 3 to the aggressive patient.
Example: “Let’s sit here where it’s quiet.” “I’ll come back with the doctor—what do you prefer?”
Limited choices reduce aggression because you are, at least in part, moving in the patient’s direction. This helps decrease opposition and sets the first step toward a resolution.
5. Set boundaries without confrontation
State limits and consequences using neutral language and “I” statements.
Example: “I want to help you and I can’t do that if you’re shouting.”
Negotiate what’s possible; don’t promise the impossible, and remind them of avenues for recourse if needed. This combination can help calm the patient’s aggression.
6. Create a calming bubble
When direct exchange fuels escalation, propose a calming break in a quiet space (room, dedicated area), reduce stimulation, and agree on a time to resume.
Example: “Let’s take a 5-minute break, I’ll be back at .”
You can also offer the patient various techniques to calm down: guided breathing, sitting down, drinking water.
What if, despite these tips, the situation worsens with an aggressive patient?
- Don’t stay alone: Inform a colleague/security officer.
- Protect third parties: Facilitate a retreat away from the problematic person if necessary.
If the situation deteriorates too much and becomes dangerous or lethal: gain time, limit the space, and call security or the police in accordance with protocols.
Important: Behaviours to avoid when dealing with an aggressive patient
To prevent the situation from escalating, here are some best practices you can apply.
- Engaging in a verbal competition (“being right”), making threats, or promising the impossible.
- Invading the aggressive person’s personal space, making abrupt gestures, unnecessary physical contact.
- Ignoring a request from the aggressive patient.
In any case, after the incident, we recommend always holding a debriefing with the team and the patient. This helps lay out the situation for everyone, prevent recurrence, and protect everyone’s mental health.
