1. Read the scenario carefully and select the best response.1
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.

2. Read the scenario carefully and select the best response.
1A – E+
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

3. Read the scenario carefully and select the best response.
1A – E-
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.

4. Read the scenario carefully and select the best response.
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 face her and tell her she needs to calm down.
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.

5. Read the scenario carefully and select the best response.
1A - DE
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.
Ask Sally if she is feeling hungry and how you can help her get ready for breakfast.
Options

6. Read the scenario carefully and select the best response.
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 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.
Options

7. Read the scenario carefully and select the best response.
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 arms crossed you tell her, “I don’t 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.
Options
Tell her that this is her home now and you will help her find a sweater to wear.

8. Read the scenario carefully and select the best response.
1B - N
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.

9. Read the scenario carefully and select the best response.
1B - DE
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.
Ask her why the purple sweater is her favourite and offer to help her look for it.
Options

10. Read the scenario carefully and select the best response.
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.
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.”
Options

11. Read the scenario carefully and select the best response.
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.
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.”
Options
You tell her, “Don’t worry dear, you will get to go home soon.”

12. Read the scenario carefully and select the best response.
1C - N
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.

13. Read the scenario carefully and select the best response.
1C - DE
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 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.
Options

14. FAIL 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 task-focused. 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 patient-focused, 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

15. fail 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

16. SUCCESS 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

17. 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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