Healthcare Health and Safety Level 2 (VTQ)

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Understand the difference between aggression, assertiveness and passive

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The main characteristics of aggressive behaviour are hostile words, threatening tones and gestures, or confrontational attitudes. However, these can also have a defensive aspect to them.

There are three stages of aggression, the 1st is Anxiety. This can cause distress or uneasiness of mind and can be caused by fear of danger or misfortune.

The 2nd is Verbal Aggression, which manifests as communication of overt or suppressed hostility, either innate or resulting from continued frustration.

The 3rd is Physical Aggression which is a forceful action or procedure, as an unprovoked attack, especially when intended to dominate or suppress another person.

So what does Anxiety look like? The individual has their head down, their face flushed, eyebrows frown or twitch, they have a dry mouth, breathing is shallow and they may be pacing. This is by no means an exhaustive list.

So what does Verbal Aggression look like? the person may have a red face, lips pushed forward, they may maintain direct prolonged eye contact, breathing may be quicker and deeper, eyebrows frowning, head and shoulders back, shoulders square and they may be yelling & pounding their fists on walls or tables. This also is by no means an exhaustive list. The video description below will elaborate on these characteristics.

And what does Physical Aggression look like? The individuals face becomes white, their eyebrows drop covering their eyes, their lips tighten over their teeth, their head is down, their breathing is rapid, eye contact is broken and they may look at the target and lower their bodies’ centre of gravity, as if ready to act. This is also by no means an exhaustive list.

While looking at the differences between aggression, assertiveness and passiveness here are some de-escalation techniques for dealing with each part of the aggression. For Anxiety we use Supportive behaviour, for Verbal Aggression we use Assertive behaviour and for Physical Aggression, we would use Defensive behaviour.

The Characteristics of supportive behaviour for de-escalating Anxiety are always to be in control, to listen empathetically and relate to their situation. It is also to maintain a calm reassuring voice, communicating at their level and always speaking with respect.

De-escalation techniques for verbal aggression are assertive behaviour, such as being firm but fair, remaining calm, appearing confident and staying polite. You should not manifest into aggression and staff need to be aware of the difference between being assertive and not aggressive.

With Assertive Behaviour or actions we can allow the aggressor to vent, use an assertive stance or positive posture), we maintain eye contact, use the aggressor’s name or even sir or madam, we maintain a calm voice, set reasonable and enforceable limits or consequences and enforce them if necessary. Speak openly, remember that being assertive achieves goals whilst taking others into account and hurts no-one on the way. 

Assertive individuals believe ‘I am alright if you are alright’, they speak in a conversational tone, using positive eye contact, they show expressions which match the message, value themselves and others equally and have an open, non-threatening stance.

De-escalating physical aggression uses a defensive behaviour of moving back and away, using loud positive commands such as: “Stop, or No!”, they use extending commands such as: “Step back!” Or "Do it now!”, they use diversions to interrupt the aggressor’s focus or intent, for example, they will drop an object as a diversion and exit the room.

It is always important to leave potential aggressors with an exit route to allow for the flight response; it is also important to have your own exit route available in case of a physical attack, remember to provide space, as an angry person may feel threatened and become more aggressive in a confined area.

Passiveness is the actions of someone who allows things to happen or who accepts what other people do or decide without trying to change anything. A passive person makes little eye contact, looks nervous, moves restlessly, backs away, maybe flustered and is apologising too much. Passive behaviour is driven by passive thinking for example, "I mustn’t rock the boat”, “I’m not important”, “nothing goes right for me”. Whilst outwardly submissive, indecisive and helpless, inside there may well be an inner conflict, tension and stress, as the inability to meet their own needs fuels feelings of frustration and anger.

In conflict situations remaining assertive, or standing up for yourself is vitally important but also recognise the person and the situation.

Aggression vs Aggression means No Winner as they are both negative behaviours.

Aggression vs Assertiveness means the Winner will be Assertiveness due to the positive behaviour).

And the Aggression vs Passiveness means No Winner as the passive gives in, both being negative).

Not all conflict situations end with conflict or violence. Inhibitions can include self-control, personal values, the fear of retaliation and social or legal consequences and these can play a part in how an individual may act.

Individuals think about consequences of their actions based on facts or reason, especially if violence and aggression are present, these can be what may be the Legal consequences of their actions, perhaps they could be arrested, fined and possibly imprisoned. An Individual has fear of injury to self or even death. It may be that Their own personal belief that violence and aggression do not solve the situation, or the person may believe they may face Social exclusion from their family, a loss of status or the loss of their job.