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“The care of human life and happiness, and not their destruction, is the first and only object of good government.”

–Thomas Jefferson


  • Study door safety protocols

  • Grasp the importance of paying attention to your surroundings

  • Find out how much space patients need

  • Assess the effects of body language

  • Find out what hairstyles and accessories pose a risk

  • Evaluate the dangers of threatening patients

With any intervention, the goal is to obtain assistance as quickly as possible while at the same time preventing harm such as physical injury (Chabora, Judge-Gorny, & Grogan, 2003). That means keeping yourself, the patient, and everyone in the area safe and secure.

Of course, the entire de-escalation process is focused on safety—from intervening early, to knowing and using de-escalation techniques, to maintaining control of yourself and the situation, to ensuring positive communication, and so on. That’s not what this chapter is about. Instead, this chapter discusses steps that you can take that relate specifically to safety to ensure the welfare of all involved. These include implementing certain safety protocols such as door safety protocols, paying attention to your surroundings, giving the patient plenty of room, watching your body language, avoiding clothing or accessories that might put you at risk, always having colleagues on hand to help, and more.


In mental health units, nurses are taught to stay close to the door in case they need to exit the area for safety reasons. This technique is useful for all healthcare nurses and staff.

Pay attention when a patient gets between you and the exit. If a patient who is agitated or aggressive, or exhibiting threatening behavior, positions himself between you and the door, it could mean you are in imminent physical danger. Were the patient to escalate to violence, you could be cornered or trapped—unable to get past the patient to escape. It’s critical that nurses and other healthcare workers recognize this behavior as an indicator of danger in the healthcare environment (Stokowski, 2007).

On a related note, anytime you enter the room of a patient on an inpatient mental health unit, you must keep a clear path to the exit available. This may mean moving the patient’s bedside table and any other obstacles out of the way. Position yourself so you have an easy unobstructed path to exit the room safely and quickly (Stokowski, 2007), and stay close to the door if you can.


When in a patient’s room, try to position yourself so the exit is accessible to both you and the patient. This may help reduce anxiety and tension for both of you.


During any de-escalation scenario, you must pay attention to your surroundings (Berring, Pedersen, & Buus, 2016). Visually ...

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