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Workplace violence towards health care workers is a major issue. Nurses commonly are exposed to aggressive and violent patient behavior. Health care organizations are now starting to acknowledge this trend and work towards combating it. As a nurse, one of the best things you can do to protect yourself and protect your patient from doing something they might regret is to learn how to utilize de-escalation techniques effectively.

Before you utilize those de-escalation techniques you must pick up on cues that a patient is becoming agitated or aggressive. This could include verbal threats, physical signs such as pacing, anxiety, or even confusion. It’s important to recognize that violence can come from patients regardless of gender, age, or size and health care professionals should protect themselves regardless of these factors. If you find a patient is becoming increasingly agitated, use these techniques to help de-escalate the situation.

Actively Listen

Patients in the hospital setting are often experiencing a significant loss of control over their body and this can lead them to feelings of helplessness and loss of control. Physicians, nurses, and social workers come in and out of their room to make life-altering decisions for them in a relatively short amount of time. Feeling that you cannot control what is going on can cause patients to get aggressive. Taking the time to hear your patient while being actively engaged with their concerns can go a long way in not only de-escalating their feelings and emotions but helping to build rapport with them. People still long for someone to put down their phone and pull up a chair and listen to them. Before emotions get out of control, active listening is an easy technique to utilize.

Express Empathy

Aggressive patients often don’t feel understood and this can lead to aggression. Hospitals are a place where frustration can trigger someone to act out who already doesn’t feel well. Day-time commotion, interrupted sleep, long waits, and uncertain outcomes is a lot to manage emotionally, and sometimes they receive little support from family or friends. Simply being able to acknowledge the difficulty of the situation can go a long way to help de-escalate your patient’s emotions. It is amazing how feeling understood can bring a sense of peace to patients.

Create Firm Boundaries

When patients are escalating the last thing you want to do is to promise something and not deliver. When patients become aggressive they can become demanding and push you to do things that you might not be able to do. Be sure to frame responses in ways that are non-committal. Use phrases like, “I’ll check with the doctor and see about that,” or “I’ll do my best to get that for you, but I cannot guarantee it.” Going back on your word and killing their expectation could lead to further aggression.

Creating a safe work environment is extremely important. Keep yourself and your coworkers safe by deploying these simple yet effective techniques to de-escalate aggressive patients.

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Tyler Faust, MSN, RN

Tyler Faust obtained his BSN from Winona State University and a Master's degree in Nursing and Organizational Leadership from Winona State University. He has worked at Mayo Clinic for the past 6 years and is in the process of transitioning from a staff nurse to a nurse manager. Tyler is passionate about professional development, nursing leadership, and strategic thinking.
Tyler Faust, MSN, RN

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