General /

As caregivers we sometimes encounter situations where the person in our care becomes “upset” or “agitated”, perhaps demonstrating challenging behaviors. This behavior becomes a stimulus for the caregiver who must decide whether or not to intervene and do they move closer to the person or give them space?

Often instinct drives us to move closer to the individual. This reaction is driven by emotion, often fear. The intent in stepping closer may be to reassure, particularly when we believe we have a relationship and can influence their response. Perhaps the motivation is to control the environment by containing the person, getting them to “calm down, sit down or quiet down”.

Roger MacNamara, President of Abuse Prevention Specialists, has said that the leading cause of abuse is forced compliance, attempting to force a person to do something. The second leading cause of abuse is reacting instead of responding. When we react, we act on emotion. When we respond we are weighing options, and determining what action to take to gain the best outcome. In the Mandt System, caregivers are urged to respond instead of react. In determining their response, the caregiver must learn to assess themselves, the other person, and the environment with a focus of how to keep everyone safe using the least amount of intervention necessary for safety.

One of the most important pieces of the assessment is proximity. In performing the assessment, the caregiver should determine how the individual will react if the caregiver moves closer to the individual or if the caregiver takes a step away from the person and gives more space. In making this determination staff must think through the intended outcome. The actions of caregivers will vary depending on how the outcome is defined, i.e. keeping everyone safe, versus containing the person’s behavior. In an attempt to control the environment, caregivers may inadvertently cause the situation to escalate by intimidating the individual when the caregiver invades their space. The individual may perceive stepping closer as threatening and strike out to make the caregiver back off. The caregiver perceives this as aggression, moves even closer and may put their hands on the person. As soon as one person touches another without permission, the likelihood of injury increases. Ask yourself how you would react if you were in the same position. In those situations, the person will likely feel more at risk the closer people are to them, realizing that if someone can reach out and touch, they can also reach out and hurt. When individuals are stimulated, it is best to take a step away from the person, non-verbally communicating that it is not the intent of the caregiver to make the person uncomfortable or feel at risk.

Edward Hall did research on proximity, and concluded that comfort levels related to proximity issues will vary between cultures, people and circumstances. When people become stimulated, they are often assessing the risk of harm in the environment. In The Mandt System, the default position is “close is safe, and far away is safer”. How close or far away caregivers are from those who may need their assistance will vary with the situation, environment and relationships. Generally speaking, though, it is safer to be closer when providing assistance and support and safer to give a person distance if they appear frightened or agitated. We must always be aware of what our physical movements are communicating to other people, how they are interpreting our movement. We must keep in mind that the person’s reaction is based on their perception, not our intent.

We need to be aware of the manner in which we communicate, verbally and non-verbally and strive to create a relaxed atmosphere. This can be exhibited through our body language, with our hands visible, body open and relaxed. The individual will be assessing our tone of voice, volume, and the sounds being made. Instead of a loud, shrill or commanding voice, we should use a lower tone, shorter sentences, speak more slowly, and keep hand gestures to a minimum.

If you are relaxed, this will convey to the other person that you are not going to overreact or hurt them. This may cause the other person to relax and gives the caregiver a better likelihood of success in assisting the individual de-escalate. It is vital that in our non-physical interventions, physical presence, and proximity we strive to create a climate of safety to enable the individual to de-escalate. When we back off and quiet ourselves down we take positive steps toward that goal.

Aaryce Hayes – COO Mandt System