Chapter 4: De-Escalation Techniques

INTRODUCTION

In today’s stressful world, with its many conflicts and constant tension, it is imperative for all healthcare workers to know and use de-escalation techniques (Harwood, 2017; Hext, Clark, & Xyrichis, 2018). At any time, a healthcare worker could encounter an agitated person in the healthcare environment or in a professional role. How that healthcare worker responds can make the difference between whether the situation is peacefully resolved or whether it escalates to the level of physical aggression or violence toward others.

Psychological de-escalation techniques are among the most valuable skills a nurse or healthcare worker can possess. De-escalation is the process of helping a person regain self-control by using therapeutic communication and interventions to lower emotional tension, defuse the situation, and provide alternatives to escalation (Cowin et al., 2003; Distasio, 1994; Hamrin, Iennaco, & Olsen, 2009; Price & Baker, 2012). De-escalation is the least restrictive nonpharmacologic technique to prevent violence in a healthcare setting (Hext et al., 2018).

This chapter discusses key psychological de-escalation techniques. These include verbal, distraction, comfort, reorienting, and stress-management techniques, as well as milieu management. It also discusses principles and tips for safe and effective de-escalation. All nurses and healthcare workers need these vital skills to ensure a safe healthcare environment. Finally, the chapter discusses working with family members and caregivers and offers tips for handling an assortment of difficult situations.

VERBAL TECHNIQUES FOR DE-ESCALATION

The most important de-escalation technique is verbal de-escalation. Verbal de-escalation is both the simplest de-escalation technique and the easiest one to apply. Verbal de-escalation involves encouraging the agitated person to verbalize thoughts, feelings, and problems (Hallett & Dickens, 2015; Richmond et al., 2012). At the heart of verbal de-escalation is getting another person to talk.

There are two purposes for verbal de-escalation. One is to assess the situation to identify what has led to the person’s agitated behavior. This means asking the person questions to explore and understand the situation (Distasio, 1994). The other purpose is to help calm the person down. Research indicates that verbalizing one’s problems can lead to calming and emotional healing (Freud, 1961; Shah et al., 2016). Encouraging people to verbalize their fears, anxiety, or anger instead of acting out those feelings is a vital part of the helping process.