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STOP, THINK AND RESPOND
CRITICAL THINKING FOR DE-ESCALATION
DEFINITION
• A REDUCTION OF INTENSITY OF A CRISIS
THE CALMING DOWN OF A HEATED SITUATION
KEEP IN MIND THAT PATIENT BEHAVIOR MAY ESCALATE VERY QUICKLYTHE BRAIN HAS SEVERAL PARTS
• AUTONOMIC FUNCTION TELLS YOU TO BREATH, THE HEART TO BEAT, SO THAT YOU DON’T HAVE TO THINK ABOUT IT
• CONTROLS THE EMOTION
• THINKING AND ANALYSIS
• WHEN SOMEONE IS ANGRY OR OUT OF CONTROL, THESE PARTS OF THE BRAIN CAN BE AT ODDS WITH EACH OTHER
• THERE IS A FLIGHT/FIGHT RESPONSE . WHEN THE SURVIVAL BRAIN IS IN FULL GEAR THE THINKING BRAIN SHUTS DOWN
• FROZEN STATE ( WHEN BOMB GOES OFF) AND THEN EITHER FLIGHT OR FEAR ( I DON’T KNOW WHAT TO DO)
• WHEN THIS HAPPENS, YOU MUST STOP AND THINK WHAT CAN I DO NOW, TO HELP HIM/HER GET BACK IN CONTROL
SIGNS AND SYMPTOMS THAT SOMEONE IS “ESCALATED”• VOICE IS RAISED, SOMETIMES IN HIGH PITCHED TONE
• GESTURING EXCESSIVELY
• PACING
• HAND WRINGING OR HEAD IN HANDS
• SHAKING
• BALLED FISTS
• FIDGETING
• AGGRESSIVE POSTURING
BEFORE YOU ATTEMPT TO DEFUSE GET IN CONTROL• NO MATTER WHAT, KEEP A LEVEL OF RESPECT/NEVER GET DEFENSIVE
• GOOD EYE CONTACT
• GIVE YOUR UNDIVIDED ATTENTION
• LOOK CALM AND SELF ASSURED
• FIRM BUT FLAT VOICE
• VALIDATE FEELINGS
• TOLERATE SILENCE
• BE NON-JUDGMENTAL
TAKE NOTE OF YOUR BODY LANGUAGE!• NEVER POINT OR SHAKE YOUR FINGER
• KEEP A RESPECTFUL DISTANCE, NEVER EVER TURNING YOUR BACK
• DO NOT SMILE
• TOUCH IS RARELY ACCEPTABLE/ALWAYS ASK
• NEVER CROSS YOUR ARMS OR ASSUME THE DISCIPLINARY ROLE
• ALLOW THE PATIENT TO VENT
YOUR MANTRA IS WE CAN HANDLE THIS• SHOUTING OUT “ HELP ME HELP ME” RARELY WORKS
• LIMIT WHO SPEAKS WITH THE PATIENT/RESIDENT
• REMEMBER WHAT YOU HAVE PRACTICED
• WORK TOGETHER CALMLY.
VERBAL DE-ESCALATION• NEVER TALK OVER SOMEONE WHO IS AGITATED
• ALWAYS LISTEN AND SPEAK CALMLY
• BE CAREFUL WITH YOUR RESPONSE, BUT ASSUME THAT THE QUESTIONS ARE REAL
• KEEP YOUR ANSWERS SHORT AND CLEAR
WHAT YOU SHOULD DO AS A TEAM
• WORK TOGETHER TO UNDERSTAND THE BEHAVIORS OF PATIENTS
• DEVELOP A PLAN TO DEAL WITH DISRUPTIVE PATIENTS
• ALWAYS KNOW WHEN AND HOW TO CREATE A SHOW OF FORCE
• MYSTERY WORD
• FOLLOWING DEFUSING…DEBRIEF
WHEN THE INCIDENT IS OVER
• THIS REMAINS A SENSITIVE TIME
• TAKE CARE NOT TO RE-ESCALATE THE SITUATION
• MAKE CERTAIN THAT EVERYONE HAS BEEN ATTENDED TOO
• DON’T FORGET THE AFTERMATH FOR THE OTHER PATIENTS
• DEBRIEF/MAKING CERTAIN YOU ARE PREPARED FOR THE NEXT TIME