1 On-the-job safety Managing resident-to-staff aggression February 2016

2 What is aggression? Negative physical, verbal, or sexual interactions that cause physical or emotional distress in the recipient. Aggression includes: Screaming Ethnic or racial slurs Pushing, grabbing, or hitting Unwelcome sexual advances Aggression in the workplace is never acceptable.

3 Common causes of aggression Dementia A new medical condition, such as a urinary tract infection Mental health problems such as depression Loss of inhibitions that come with aging Frustrations in the nursing home environment, such as noise Sensory impairments A combination of factors typically leads residents to become aggressive.

4 CNAs can help prevent aggressive behavior Listen actively to determine why residents are upset. Look for circumstances that trigger aggression in individual residents. Explain your care activities before beginning. Speak in a calm, low voice. Go slowly.

5 When residents become aggressive SAFETY FIRST. Ensure that you, the aggressive residents, and other residents are safe. Remove dangerous objects from the area. Remove other residents who may be in harm’s way. Do not touch an aggressive resident until he or she is calm. Call for another staff member to help you manage the situation. Keep an eye on the aggressive resident at all times.

6 When residents become aggressive Once everyone is safe, try distraction or de-escalation. Try to determine why the resident is agitated. Speak in a soft, reassuring voice. Determine if the resident has an unmet need, such as hunger or pain.

7 When a resident becomes aggressive Always report aggression to the nurse. Record aggressive behavior in your daily log. If aggressive behavior begins suddenly, report it so that medical staff can assess whether there is a change in medical condition. The multidisciplinary care team can help address the behaviors through social work, medications, and other changes in the environment.