Best Practices for De-escalation

Regardless of what health care speciality you work in, there will be a time when you’re confronted by someone who’s aggressive, angry, or noncompliant, whether a patient, a patient’s family member, or someone else entirely.

How you respond to that type of behavior greatly affects whether or not that confrontation escalates or diffuses. 

De-escalating tense situations can be difficult, especially if you aren’t prepared to do so. For your own safety and the safety of those around you, you need to know and practice how to recognize potentially volatile situations and what to do to quickly de-escalate them before you find yourself in a confrontation. 

Here’s what you should know about de-escalation techniques and methods and how to recognize when you’ll need to use them.

What is De-escalation?

De-escalation is a method that we use to diffuse a situation with the potential for threat or violence. When someone is or is beginning to become agitated, angry, or aggressive, your goal is to use your skills to help them calm down and prevent any violence.

The Joint Commission reports that violence is becoming much more common in health care settings. A study from the American Journal of Nursing reported that 25% of nurses have reported assault from patients or a member of the patient’s family.

Because violence against health care professionals is so common and simply getting worse, you as a health care professional must learn de-escalation techniques, so you have the tools and confidence during these often scary situations.

When to Use De-escalation?

There is no one method or technique that health care professionals can rely on to learn how to successfully de-escalate. Part of the process is first recognizing the need for de-escalation as soon as possible. 

The Joint Commission suggests several assessment tools that health care professionals can use in order to recognize when someone may need de-escalation. These tools include the following:

  • Staring, Tone and volume of voice, Anxiety, Mumbling, and Pacing (STAMP) for emergency departments
  • Overt Aggression Scale (OAS) for adult or pediatric inpatient units
  • Broset Violence Checklist (BVC) for adult inpatient psychiatric units
  • Brief Rating of Aggression by Children and Adolescents (BRACHA) for the emergency department when determining if a patient needs to be placed in inpatient psychiatric care

Which assessment tool you familiarize yourself with will depend on your speciality, as these tools can help you triage, document, and better decide the appropriate course of treatment for a patient or the need for intervention for someone else who is acting aggressively. 

However, even if you don’t work in any of the speciality areas described above, you should still be familiar with de-escalation techniques.

De-escalation Tips

As indicated by their name, the Crisis Prevention Institute (CPI) specializes in crisis prevention, and part of that is de-escalation training. For health care professionals who work in specialties where aggression or the potential for violent behaviors from patients or their family member’s is less common, you should still be familiar with best practice guidelines for de-escalation such as these.

The CPI lists the following 10 tips that can help you de-escalate a high-stress situation. 

1. Be Empathetic and Nonjudgemental

Feelings are not always logical and can very quickly become overwhelming. The person may not have experienced those feelings before, or they may not be able to communicate their concerns. 

Whichever the case, do not judge the way that someone is acting, even if you think it’s weird or it doesn’t make sense to you. Whatever they’re feeling is real and important to them. Being empathetic means understanding how real those feelings and concerns are and responding to them accordingly. 

2. Respect Their Personal Space

The CPI recommends standing at least one and a half feet away to give the agitated person space. Standing or moving in too close can feel threatening and make them want to lash out to protect themselves.

If you have to approach them to provide care, then take the time to explain what you’re doing and why.

3. Use Non-Threatening Nonverbal Communication

When we’re overwhelmed with our feelings, it’s much more difficult to hear and understand what someone is saying to us. Instead, we’re more likely to pick up on non-verbal cues.  

Use non-threatening body language when you’re talking to or approaching someone who is agitated. 

4. Don’t Overreact

Stay rational and calm throughout the entire encounter. Remind yourself that you are a professional in health care who has been trained for these situations and that you know how to handle the situation. 

5. Focus on Their Feelings

Acknowledge the person’s feelings. They might not know exactly what they’re feeling or why or how to express those feelings to you using words, and validating their feelings as real can help them find the words they need to do so. 

Taking the time to help them process how they’re feeling will give you clues to the reasons behind the aggression or noncompliance. You can say things like, “That must be frustrating” or “This must be very scary.”

6. Ignore Any Challenging Questions

Challenging questions are often the person attempting to get a rise out of you or challenge your authority. They might not believe what they’re saying and may be using the question to try to validate how they’re feeling.

Ignore the question, but don’t ignore the person. Validate them by acknowledging that there is something wrong and focus on the real issue behind the question. 

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7. Set Clear Limits

It can be difficult to focus on more than one thing at a time when someone is upset. Give clear and reasonable limits for them to follow, focusing first on any positive choices or options.

8. Choose Carefully What You Insist On 

It might seem sometime that some tasks are set in stone when and how they happen, but in reality, there is often a way to offer some flexibility. Giving the person some options and the ability to choose can help them feel better in control. 

9. Allow Silence

Silence gives the person time to think and process what is happening and how they’re feeling. Allow them that time without extra distractions, and they may be able to de-escalate themselves.

10. Give Time for Decisions

In addition to allowing silence, give the person time to think. Don’t rush them or put a time limit on the process. Whenever you say something or try a new tactic, take a moment to pause and let the person think about what you said or did. 

At-work violence can be traumatizing to the patient, their family members, the health care staff, and the people around them. Learning, practicing, and knowing when to use de-escalation techniques has the potential to positively turn these situations around before they get violent.

As health care professionals in an often stressful environment, we must be prepared for any situation. Protect yourself and those around you by learning how to manage these situations safely and effectively.