9. Module 8 · Dealing with specific situations

9.2. Application: responding in the moment

Application

Responding in the moment

This page shows what a calm response to a difficult situation can look like, step by step, and gives phrases you can adapt. Every setting has its own procedures, and your team’s rules take precedence.

Worked example: Mrs Adler and the school run

Five steps for exit-seekingFive steps when someone heads for the door (example: Mrs Adler)1Stay calmSlow voice, openposture, no blocking2Walk alongsideGo with her, keepa safe distance3Askabout the reason“Where are you going?”Listen to the answer4Offer a routeGarden loop, a task,a drink, a seat5Reportand reviewNote time, trigger,what helpedIf she is at risk (road, night, cold): stay with her, call for help, and follow your organisation’s emergency procedure.The sequence is a thinking aid, not a protocol. Numbers and colours only support the labels.
Figure 8.3: Five steps when someone heads for the door, using a fictitious example. Source: own illustration.

Return to Mrs Adler from the beginning of this module. At about 4 p.m. she puts on her coat and heads for the door. The team uses the five steps in Figure 8.3.

  1. Stay calm. The carer, Daniel (fictitious), does not block the door. He lowers his voice, stands to the side and greets her by name.
  2. Walk alongside. “Mrs Adler, I will come with you.” He goes with her along the corridor, a little behind and at a distance she can accept.
  3. Ask about the reason. “Where are you going?” She says that the children are waiting. Daniel replies, “You are worried about the children. Tell me about them.” She talks about her two sons and the school.
  4. Offer a route. After some minutes he suggests, “Shall we have a coffee before we go, and walk through the garden room?” She agrees. They sit by the window, then walk the loop.
  5. Report and review. Daniel notes the time (4 p.m.), the likely trigger (a former school-run routine), and what helped (accompaniment, talking about the children, coffee). At handover the team makes a fixed anchor point of a coffee at 3.45 p.m. and a short walk, and asks the son for photographs of the children.

Notice that nobody lied and nobody locked a door. The team respected the meaning of the walk and offered a safe form of it. They also checked for pain, thirst and the toilet, as they would on any day. The plan will need to be reviewed in a week, and the team will report any sudden change at once.

Phrases to adapt
SituationYou might say
Person heads for the door“I will come with you. Where are we going?”
Person says someone stole something“That sounds worrying. Let us look together.”
Person sees someone who is not there“You look worried. I am here. Shall we sit down?”
Person raises a hand“I can see you are upset. I will step back and give you space.”
Reporting a sudden change“Since yesterday she has been much more confused than usual. Please come and look.”
Exercise (voluntary self-check). Mr Haas (fictitious), 85, has been calm for months. Over two days he has become very drowsy in the morning and agitated in the evening. He says that men are standing at the end of his bed. He has eaten little, and his urine smells strong. Decide what this might be, whom you would inform and what you would say. Name two things you would observe and note, and one thing you would not do.
Hint 1
Compare the time course with Figure 8.1: slow or sudden? Think about what changes from hour to hour.
Hint 2
A sudden change with fluctuating attention is a warning sign. Think about who has to assess it, and what information they need from you.
Suggested answer
The change within two days, drowsiness and agitation, new hallucinations and reduced eating and drinking suggest delirium, not just “more dementia”. Inform the nurse in charge or the doctor promptly, without waiting for the next routine round, using clear facts: “Since the day before yesterday, Mr Haas has become very drowsy and agitated; he sees men at his bed; he has eaten and drunk little; his urine smells strong.” Observe and note drinking amounts, temperature if you measure it, pain signs, bowel and bladder, and how alert he is at different times. Do not simply accept it as the dementia progressing, do not argue with what he sees, and do not give any medicine without a doctor’s order. If he deteriorates sharply, follow your organisation’s emergency procedure.
In German practice you will hear …
  • Hinlauftendenz / Weglauftendenz – walking with purpose / exit-seeking; the urge to walk somewhere or to leave
  • Wahn / Halluzination – delusion / hallucination
  • Delir – delirium, acute confusion with a treatable cause
  • herausforderndes Verhalten – challenging behaviour
  • Deeskalation – de-escalation
  • Sundowning / Sonnenuntergangssyndrom – restlessness in the late afternoon and evening
  • Nachtunruhe – night-time restlessness
  • freiheitsentziehende Maßnahmen (FEM) – measures that restrict freedom of movement (Module 11)