Case: 12 year old Max is diagnosed with a major depressive disorder and is being admitted to CAMU Treatment Center. Max’s belongings are reviewed and he is unable to keep some of the objects as they could be used to harm himself. Max is upset and very agitated that his belongings are being taken away from him.
Approaching an angry patient can be unnerving or frightening. The goal is to facilitate the expression of anger in an adaptive, non-violent manner. This can be done through de-escalation techniques, which are methods and tools, including advanced communication skills, used to defuse any incident of acting out, anger, aggression, or violence. (Halter et al, 2019. pg. 519)
(Halter et al, 2019. pg. 519)
Steps for De-Escalating a Patient
1) Call for Help
Never try to de-escalate a potentially violent scenario without first ensuring that your colleagues are aware of what is going on.
2) De-escalate Yourself
The outcome of this situation will be heavily influenced by your emotional state. So take a deep breath and let the initial burst of fight-or-flight energy to dissipate.
Pertaining to the case, the nurse will not react to Max's situation, but rather respond with a specific set of skills and techniques to assist in supporting and recovering Max from his heightened agitated state. As well, while the nurse is de-escalating themselves, they can assess any potential issues in the immediate physical environment (such as objects that can cause harm to Max).
3) Body Skills
When dealing with an upset or hostile client, take a step back and keep at least two arm lengths away at all times.
In Max's situation, the nurse should assume a relaxed open stance, with their hands unclenched and face relaxed
4) Verbal Skills
People who are agitated may have difficulty processing verbal
information.
Thus with Max, the nurse should be authentic, be concise, keep words simple, and repeat phrases it as necessary, and try to get Max to verbalize his wants and feelings
5) Listening Skills
It is critical to try to truly grasp what another person is saying without imposing our own ideas or agendas on it.
6) Set Boundaries
These boundaries should be established early on, but not as threats or as a "show of power." Instead, utilize these boundaries appropriately during the conversation. The most crucial boundary to establish is one of physical violence.
In this case, the nurse should explain to the patient that any physical violence towards you, themselves, or anyone else is unacceptable.
7) If The Situation Continues to Escalate....
Give the patient alternatives to violence. Such as;
- Medication may be used to assist relaxing (but never sedating) the individual
- Use of chemical or physical constraint
If Max's agitation escalates, the nurse should move him to a calmer and secure environment.
8) Document and De-Brief
The need of accurate documenting of the escalation and response is important, as de-briefing among team members creates an opportunity to offer professional counselling.
In this case, the nurse can create a SOAPE note on Max's situation an notify Max's physician and psychiatrist.
(Kelly, 2022)
References
Halter,
M. J., Pollard, C. L., & Jakubec, S. L. (2019). Varcarolis's
Canadian Psychiatric Mental Health
Nursing: A clinical approach (2nd ed.). Elsevier Canada.
Kelly. A. (2022). De-Escalation Skills For Nurses
[PowerPoint Slides]. Mental
Health Nursing NURS 2207.
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