Heading off violence with verbal de-escalation

Abstract

Respect for the rights and dignity of patients is the underlying principle of therapeutic communication. Its effective practice requires the nurse to identify personal issues, stressors, and one's own anxiety and effectiveness levels. It is important that the caregiver maintain self-control to help others control themselves. By constantly observing patient behavior, the nurse should be able to detect agitation and intervene in a timely fashion, avoiding physical confrontation and the physical restraints that are its usual consequence. To make this outcome possible, the nurse should learn to recognize signs of agitation and escalation; should practice presenting himself or herself as a calm, caring professional; and should maintain poise even when facing a potentially violent patient. The nurse should remain open-minded, knowing that patients frequently react to assumptions made about them, and use the information acquired to find acceptable alternatives to aggression. These alternatives should be presented to the patient, making the choices clear, yet allowing the dignity of choice. Every effort should be made to provide opportunity for patients to be in control of their own behavior. Physical confrontation should always be a last resort, and one used only when there is a clear danger of immediate physical harm to a patient or staff member. Keep in mind that the use of force is an encouragement to aggressive behavior and a hindrance to treatment. Effective use of therapeutic communication encourages patients to express their feelings and become cooperative partners in their treatment.