Course content – PF23-Deeskalation
The modules of this course – work through them in order.
10. Module 10 · Aftercare & Follow-up
After the escalation
After an escalated situation, aftercare and follow-up matter – for the person concerned and especially for the care worker and the team. Follow-up has five parts: 1. Caring for the person, who may also be exhausted or upset: give safety, calm and attention, restore the relationship, and do not hold a grudge or punish. 2. Supporting the care workers involved, because aggression – verbal or physical – causes fear, hurt, stress and sometimes injury. 3. Documentation of the course, triggers, measures and any injuries – for traceability, learning and, where relevant, legal and occupational safety purposes. 4. Analysing the incident without blame: how did it come about, and what can we learn to prevent or de-escalate better next time? 5. A team debriefing for exchange, relief and learning.
The care worker's own follow-up is particularly important. Aggression and violence are stressful and must not be played down (‘it comes with the job’, ‘don't make a fuss’) or suppressed. What helps is exchange in the team, support from colleagues and management, acknowledgement of the strain and, especially after serious incidents, a debriefing or supervision. This protects against consequences such as anxiety, stress, trauma and burnout, and is part of the employer's duty of care (sections 3 and 5 ArbSchG). A violent incident at work that causes physical or psychological harm counts as an occupational accident. The employer must report it to the accident insurance if the employee is unable to work for more than three days; the statutory accident insurance recommends reporting violent incidents even without sick leave (section 193 SGB VII; DGUV, 2018).
Learning objectives of this module
- You know the importance and elements of aftercare/follow-up.
- You care for the person concerned and restore the relationship.
- You document, analyse (without blame) and learn.
- You take the care worker’s strain seriously and process it.
Taking the care worker’s strain seriously
Aggression and violence put more strain on care workers than is often admitted. Possible effects are fear – in the situation and afterwards, for example of it happening again; hurt from insults or attacks – verbal violence hurts too; stress and exhaustion; self-doubt and guilt (‘Did I react wrongly?’); physical injuries; and, after serious incidents, traumatic stress with fear, sleep problems or re-experiencing. These reactions are real, yet often played down – because ‘it is part of the job’, because violence against staff is normalised, or because people feel they have to be strong. Unprocessed strain can build up and lead to lasting anxiety, exhaustion, burnout, fear of going to work, withdrawal or even leaving the profession. What helps: talking in the team – the most important and most accessible support; acknowledgement by colleagues and management that the strain is real and that violence is not normal; support from management, such as relief, protective measures and follow-up; a structured debriefing after serious incidents; and, where needed, professional help such as supervision or psychological support. After an occupational accident, the statutory accident insurance institutions offer fast psychotherapeutic support (DGUV, 2018). The organisation must provide this framework as part of its duty of care (sections 3 and 5 ArbSchG). You yourself can take your strain seriously, seek exchange and accept help when you need it.
Aftercare & follow-up
| Element | In practice |
|---|---|
| Person concerned | Safety, calm, restoring the relationship |
| Care worker | Take strain seriously, exchange, support |
| Documentation/analysis | Document, analyse causes (without blame), learn |
| Team | Debriefing, where appropriate supervision/professional help |
Table: Elements of aftercare and follow-up. Source: own illustration, AI-assisted.
Learning from incidents – without blame
After an escalation, it is worth analysing what happened – constructively and without blame. Three questions guide the analysis in the team: How and why did it come about? – needs, triggers, early warning signs and what happened before (Modules 2–4). How did we respond? – what calmed the situation and what made it worse? What can we learn? – how can we prevent it (meeting needs, avoiding triggers, adapting the environment – Module 8) and de-escalate earlier? Record the results, for example known triggers and helpful approaches (Module 3). The analysis is not about finding culprits – neither the care worker who ‘reacted wrongly’ nor the ‘bad’ resident. Blame leads to incidents being hidden, makes staff feel guilty and blocks learning. Self-critical reflection is welcome, but as a chance to learn, not as a reproach (Modules 3–4). This needs an open, fear-free safety culture. Together, aftercare for those involved and constructive learning make good follow-up: it relieves the people involved and improves practice for the future.
Supported and learned
A resident hits and insults a care worker; afterwards she is upset and unsettled. The team takes her strain seriously: colleagues listen and support her, nobody dismisses it as ‘part of the job’, and the manager holds a follow-up discussion. At the same time, the incident is analysed without blame: the triggers were pain and hurried, unannounced care. The team agrees to pay attention to pain in future, to announce each step and to work at a calm pace, and documents these findings. The care worker feels supported, and the team has learned something – a good example of aftercare and constructive learning.
Back to business. The same incident, but the shift simply carries on. A colleague says: ‘Don't make a fuss, it's part of the job.’ The manager is not informed, nothing is documented, and nobody asks how the care worker is. At handover, the resident is described as ‘aggressive’. A few days later the same situation occurs during hurried morning care. The care worker sleeps badly and dreads her shifts with this resident.
How to classify it: Playing the incident down leaves the care worker alone with her strain and prevents learning: the triggers (pain, hurried care) remain unknown, so the escalation repeats. Calling the resident ‘aggressive’ labels the person instead of explaining the behaviour. Violent incidents should be documented; if there is an injury, it counts as an occupational accident and is reported according to the organisation's procedure. The employer's duty of care includes aftercare for staff (sections 3 and 5 ArbSchG).
| Aspect | Case study: supported and learned | Version B: back to business |
|---|---|---|
| Care worker's strain | acknowledged, support offered | played down as ‘part of the job’ |
| Management | follow-up discussion | not informed |
| Documentation | triggers and findings recorded | nothing recorded |
| Learning | pain, announcing, calm pace | no analysis, label ‘aggressive’ |
| Outcome | care worker supported, team has learned | repeat incident, ongoing strain |
Table: Comparison of the two versions of the case. Source: own illustration, AI-assisted.
Exercise: Think of the last escalated situation you experienced. Was it followed up – care for the person, documentation, analysis, learning? Was your own strain, or that of a colleague, taken seriously? And was the incident discussed without blame?
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Go through the five parts of follow-up for one incident: 1. Person – was the relationship restored? 2. Care worker – did someone ask how you or your colleague were, and was support offered? 3. Documentation – were course, triggers, measures and any injuries recorded? 4. Analysis – were the questions ‘How did it come about?’, ‘How did we respond?’ and ‘What do we learn?’ discussed without blame? 5. Team – was there a debriefing?
If something was missing, plan one concrete step, e.g. suggest a short debriefing after incidents, or ask your manager which aftercare procedure exists. If you notice lasting strain such as sleep problems or fear of going to work, speak to your manager, the company doctor or the accident insurance institution – getting help early is sensible.
- Good follow-up covers the person, the care worker, documentation, analysis and the team.
- The care worker's strain is real – it is taken seriously, not played down.
- Incidents are analysed without blame so that the team can learn and prevent repetition.
- Violence causing harm at work counts as an occupational accident; employers owe aftercare as part of their duty of care.
Self-reflection (voluntary)
Voluntary · not assessed – your thoughts are not saved or evaluated. Think about each question first, then open the prompt.
1. How do you usually deal with strain after a difficult situation at work?
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2. How does your team talk about incidents – looking for culprits or looking for causes?
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3. What would you need from colleagues or management after a violent incident?
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References for this module
Arbeitsschutzgesetz (ArbSchG) [Occupational Safety and Health Act], section 3 Grundpflichten des Arbeitgebers [basic duties of the employer], as in force in October 2026. https://www.gesetze-im-internet.de/arbschg/__3.html
Arbeitsschutzgesetz (ArbSchG) [Occupational Safety and Health Act], section 5 Beurteilung der Arbeitsbedingungen [assessment of working conditions], as in force in October 2026. https://www.gesetze-im-internet.de/arbschg/__5.html
Deutsche Gesetzliche Unfallversicherung (DGUV). (2018). Prävention von Gewalt und Aggression gegen Beschäftigte im Gesundheitsdienst und in der Wohlfahrtspflege: Eine Handlungshilfe für Arbeitgeber und Arbeitgeberinnen [Preventing violence and aggression against employees in health and social care: A guide for employers] (DGUV Information 207-025). https://publikationen.dguv.de/widgets/pdf/download/article/3429
Sozialgesetzbuch Siebtes Buch (SGB VII) [Social Code, Book VII – statutory accident insurance], section 8 Arbeitsunfall [occupational accident], as in force in October 2026. https://www.gesetze-im-internet.de/sgb_7/__8.html
Sozialgesetzbuch Siebtes Buch (SGB VII) [Social Code, Book VII – statutory accident insurance], section 193 Pflicht zur Anzeige eines Versicherungsfalls durch die Unternehmer [employers' duty to report an insured event], as in force in October 2026. https://www.gesetze-im-internet.de/sgb_7/__193.html