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A Nurse's Guide to De-Escalation Techniques

When people are sick, frightened, or concerned about their health or the health of a loved one, they may lash out in anger or frustration. Often, it's the nursing staff at the receiving end of this ire. Whether it is someone being verbally aggressive or physically confrontational, nurses must be able to defuse the situation to prevent it from escalating into a potentially dangerous one. In order to do that, they must understand various methods of de-escalation and know how to apply them to the situation at hand.

Move to a Private Space

An irate patient may grow increasingly upset and abusive if surrounded by others. To keep the situation from getting worse and prevent any onlookers from coming to harm, a nurse should attempt to persuade the patient to move to a location where they can speak privately. This, however, is not suitable in all situations. If a patient's anger has reached an irrational level or they are threatening bodily harm, moving to a private location may be too risky.

Active Listening

photo of nurse listening to patient

Aggressive or irate patients want to be heard. If they feel like this isn't happening, the situation is likely to escalate further. One way to reassure the patient is to apply active listening. Active listening is a conscious effort to fully understand what is being said. One way to do that is to verbally acknowledge what is being said. One may use statements such as "What I hear you saying is..." or "Let me know if I understand you correctly…" before repeating what they heard. Maintaining eye contact and nodding when appropriate will also let the patient know that they are being paid attention to and heard.

Be Empathetic

Whether a nurse feels the patient's aggression or upset is or is not justified, that individual's emotions are significant enough to cause them upset. By placing themselves in the patient's shoes, a nurse can empathize with and better understand where the emotion is coming from.

Acknowledge Their Concern and Feelings

An irate patient wants to know that they are not only being heard but that the medical staff understands their concerns and what they are feeling. Nurses who acknowledge a patient's concerns are showing them they aren't dismissing their feelings. Statements starting with "I understand that..." or "that must be hard/frustrating…" are examples of how one can acknowledge a patient's upset or frustration.

Be Calm and Not Provocative

As a person becomes increasingly irate, they respond to tone and body language before actual words. Nurses should maintain a calm demeanor and a level, yet firm, tone of voice when confronted with a patient's loss of control. They should avoid raising their voice, speaking with sarcasm, or in a clipped or irritated manner.

A neutral and open stance with visible hands is non-threatening and non-aggressive. While one should not be aggressive, one also should not cower or appear overly fearful, as this may worsen the individual's belligerence or irate behavior. Slow and deliberate movements are also non-threatening and ideally, a space of 1.5 to 3 feet should be between the nurse and the patient.

Communicate Clearly

photo of nurse consulting happy patient

It's important to speak clearly and plainly when dealing with an agitated patient or family member that's agitated. Depending on the severity of the individual's agitation, it may be difficult for them to process information that's too complex or technical. When speaking to an irate patient short sentences are best. It is also good to repeat the message being conveyed and to use vocabulary that is plain and easily understood. Avoid the use of medical jargon, and allow the individual time to respond to statements or questions.

Create Boundaries

Although it is important to be empathetic and helpful when a patient is irate, it's also just as important to establish boundaries regarding how a patient can speak and otherwise interact with the nursing staff. In addition, the patient should also be informed of the consequences, such as calling security or 9-1-1, should the unacceptable behavior continue and cross those boundaries. In doing this, the nurse should also express a desire for mutual respect in order to reach a resolution.

Offer Realistic Solutions, Not Promises

Although it may be tempting to promise the ideal resolution to an upset patient's problems, such action may create an even worse situation in the end. When talking with a patient, honesty is crucial. Assure them that every effort will be made to resolve the issue. Often, it helps to present them with a choice of potential paths that may solve their problem, thereby giving them an active part in the resolution.

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