De-escalation

Question 1

purpose of crisis prevention training

Answer 1

maintain safety (staff + pt)
recognize behaviors that can lead to aggression
identify appropriate staff intervention strategies
create therapeutic environment
eliminate pt abuse and coercion
promote collaborative team approach

Question 2

limitations

Answer 2

provides no guarantee to eliminate aggressive behavior

reducing aggressive incidents takes time

requires time and ongoing training

leadership and unit staff essential to promote change

Question 3

trauma

Answer 3

personal experience of interpersonal violence including sexual abuse, physical abuse, severe neglect, loss, and/or the witnessing of violence, terrorism, and disasters

An event or series of events experienced by an individual that has lasting adverse effects on the individual’s functioning.

Question 4

trauma informed care

Answer 4

focus = safety, connection, managing emotions

Question 5

what motivates behavior?

Answer 5

action in response to a person’s needs
a trigger (something that sets off an action or troubling reminder of past)

Question 6

factors affecting behavior

Answer 6

medical complications (ear infection, tooth ache, stomach pain
sleep, fatigue
hunger, satiety
# of people
staffing patterns + changes
time of day
location and setting
loudness

Question 7

physical signs

Answer 7

chest tightness
inc HR
change in breathing pattern

Question 8

behavioral warming signs

Answer 8

change in usual behavior
raising voice
staring
extreme quietness
argumentative
mumbling
restlessness
teasing others
rocking
pacing

Question 9

angry, frustrated, anxious behaviors

Answer 9

threatening consequences
yelling
reacting hastily/being judgmental
placing blame
disregarding behavior

Question 10

environmental considerations

Answer 10

furniture/objects that can be thrown
noise levels
visitors
locations exits and doors
location of phone
hot beverages
utensils
cigarettes
matches
lighters

Question 11

verbal de-escalation

Answer 11

verbal and non-verbal communication techniques

respect personal space, be in control, be concise, listen closely, identify wants and feelings, agree or agree to disagree, set clear limits, offer choices, review

Question 12

non verbal de-escalation strategies

Answer 12

modeling - control over own emotions
selective focus
eye contact - brief eye to contact w/ patient
proximity - show physical presence that is supportive and non-threatening
limitation of audience/stimuli

Question 13

verbal de-escalation strategies

Answer 13

ventilation
distraction - ask short questions or engage in brief comments
redirection
reassurance
understanding/active listening
one-to-one
exploration of consequence - encourage pt to verbalize consequences
fogging - dont react defensively
clarifying emotional status

Question 14

benefits of mastering de escalation

Answer 14

patient rapports dev
trauma informed unit
calm environment
reduction in restraint use
can improve pt

Question 15

debrief

Answer 15

always debrief after event
- plan for patient
- feedback (positive or room for improvement)
- how does the staff feel

rebuild patient relationships

Question 16

putting it all together

Answer 16

understand pt hx
assume pt may have trauma
look for antecedents
always check for environmental safety
collaborate as team
allow pt to “ventilate feelings”
never say “dont worry it will be ok”
build rapport
boundaries
have “toolbox”