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