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“If we want to reap the harvest of peace and justice in the future, we will have to sow seeds of nonviolence, here and now, in the present.”

–Mairead Corrigan Maguire


  • Identify the three interventional pathways for aggression

  • Identify key response tools

  • Find out the steps to de-escalation

  • Describe the assessment phase

  • Understand the importance of safety measures

  • Identify de-escalation techniques

  • Find out what to do after a de-escalation incident

  • Consider how to work with family members and caregivers

At present, healthcare workers experience the highest rate of workplace violence injuries. During the past decade, approximately two-thirds of nonfatal injuries due to workplace violence involved healthcare workers (The National Institute for Occupational Safety and Health [NIOSH], n.d.).

De-escalation is a valuable tool in the prevention of workplace violence. De-escalation involves using therapeutic communication and interventions to defuse agitated patients to prevent them from escalating to dangerous levels of aggression or violence.

The focus of de-escalation is on prevention of violence. De-escalation techniques stop violence before it starts (American Psychiatric Association, American Psychiatric Nurses Association, & National Association of Psychiatric Health Systems, 2007). Early intervention with de-escalation techniques breaks the cycle of escalation, defuses the situation, and prevents patients from acting on their aggression in a violent manner.

De-escalation is a critical element of all workplace violence prevention programs. The NIOSH and The Joint Commission (JC) on Accreditation recommend training initiatives in de-escalation for all healthcare workers as an essential part of a workplace violence prevention program.


So, what should you do when, after assessing the situation, you determine that you are in fact dealing with an aggressive patient? There are three interventional pathways for aggressive behavior (Chou, Kaas, & Richie, 1996). These pathways are as follows:

  • Psychological. When faced with an agitated or aggressive patient, this is the first interventional pathway you should take. This pathway helps address symptoms, decrease distress and anxiety, and in many cases avert a negative outcome. With this pathway, the primary nursing intervention involves verbal de-escalation techniques—for example, encouraging the patient to express feelings to relieve the pressure. Other de-escalation techniques, such as distraction techniques, are also effective. For example, you might offer to turn on the television, offer the patient a book or magazine to read, or accompany the patient for a walk. Finally, you could encourage the person to perform relaxation exercises such as deep breathing. Limit-setting is particularly important with this interventional pathway. And as always, the earlier the intervention, the more effective it will be.

  • Pharmacological. If psychological de-escalation interventions fail and dangerous escalation persists, the second interventional pathway is the pharmacological pathway (Patel et al., 2018). This pathway involves administering sedatives, benzodiazepines, or short-acting barbiturates to calm the patient’s aggressive behavior (Chou et al., 1996; Paton et al., ...

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