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April 2014, Volume 44 Number 4 , p 60 - 63


  • Jeff Phillips MSN, RN
  • Keith Stinson MSN, RN
  • Jeff Strickler MA, RN, CEN, NE-BC


AFTER STARTING YOUR SHIFT, you approach a patient who's been in the ED for several hours. The patient appears agitated and voices his frustration regarding the lengthy wait. Immediately, your mind is flooded with thoughts about how this interaction might unfold because you know that your initial response to a distressed patient is the foundation for the rest of the encounter. The ineffective use of nonverbal and verbal communication can swiftly increase, not decrease, a patient's agitation.In cases such as this, clinical nurses need the knowledge and skills to de-escalate an anxious or agitated patient. This article reviews how to recognize patient escalation and intervene with simple de-escalation techniques.Under the stress of hospitalization, some patients respond with aggressive behavior. This challenges nurses and other healthcare professionals who must provide patient care while recognizing and responding to cues of patient dissatisfaction and/or escalation.The incidence of reported cases of violence directed toward nurses and physicians increased by over 13% from 2009 to 2010.1 In 2011, 54% of healthcare staff responding to a survey by the Emergency Nurses Association reported experiencing verbal or physical abuse within 7 days of completing the survey.2To counter this increasing risk of violence in healthcare, many institutions have mandated de-escalation and personal safety training. The Joint Commission standards, for example, require hospitals to consider its response to violent situations. Implementing these standards has reduced seclusion and restraint events.Detection and early intervention are essential to achieve desirable de-escalation outcomes. Staff members must be able to intervene appropriately when a patient's behavior reflects anxiety or frustration. If staff members don't respond properly during the initial stages of de-escalation, an agitated patient may act on his or her emotions, escalating the situation.During de-escalation, nurses and other

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