Question

Scenario:

John, age 27, was brought to the emergency department by two police officers. He smelled strongly of alcohol and was combative with police and hospital staff. His blood alcohol level was measured at 293 mg/dL. His girlfriend reports that he drinks excessively every day and is verbally and physically abusive towards her and their small child. John states that if anyone else comes in his room he is going to “beat them senseless”. The physician recently ordered 10mg Geodon, IM, Once.

1. Discuss the techniques used during de-escalation.
2. Explain why these techniques are used and when they may not work as expected.
3. What is the priority for both the patient and staff? How might the nurse best accomplish this?

Answer 1

1. Discuss the techniques used during de-escalation?

Solution: De-escalation is used to bring a dangerous or threatening situation in control. During this process a potential dangerous situation can be prevented, so that one prevents causing harm to self or others. There are many verbal and physical skills used for this process. Some of the techniques involve communicating calmly with the person in order to manage and resolve their concerns and hence it helps with the agitation and aggression or violence. Here are the techniques that can be used for de-escalation

Techniques used during de-escalating process:

Listen and acknowledge: It is important that he is given enough time to calm down a little so that he is ready to talk. Acknowledging what the person is going through is important and hence this might reduce the anger. It is important to stay calm and listen to the person and hence this calms the person down. Allow patient to make decisions by self

Don’t look threatening: It is important that you look friendly and not threatening to the person. it is necessary that the person understands that you are only trying to help and not worsen the situation. Make sure not to point finger, keep a safe distance and try to talk it out.

Emphasize the situation but do not go overboard as it might agitate the person even more. Apologize when needed and try to clarify the situation and give him a chance to clarify and say things.

Do not raise questions which will trigger his anger or emotions and further agitate him

Do not over react to patients emotions because this can harm either the patient or the health care professionals.

2. Explain why these techniques are used and when they may not work as expected.

Solution: These techniques are used so that John can be calmed down and the agitation in him can be reduced. These techniques can help him calm so that a threatening or potentially harmful situation can be taken care of and things can be controlled. This helps in understanding the situation of the person and prevents him from acting aggressive. These situations might not work when there is aggression from both the sides and one is not ready to keep safe distance. It might also not work when the person is trying to bring John under control forcibly. At times people do have psychological disorder and it might not work during such situations. By arguing or not listening or judging someone for their behavior increases the aggression and hence the process of even trying to de-escalate might not work.

3. What is the priority for both the patient and staff? How might the nurse best accomplish this?

Solution: The priority for the patient and staff at the moment is to bring the situation under control. The priority for the staff is to use the de-escalation techniques to calm John down and prevent his aggression. The priority for patient is to calm down, take treatment and get rid of his bad addictive habits. The nurse should make an environment which is hazardous free before communicating or starting care for the patient. The nurses can accomplish this by keeping a proper control of the patient, helping in getting medications and being empathetic to the patient. They must use their de-escalation skills when needed to calm the patient.