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22 nd April 2009 Ethical Care - De-Escalation e-Learning

Objective • Demonstrate communication skills that can be used to calm anxious or agitated individuals • Understand common signs of escalating anxiety • Identify effective methods of de-escalating anxious or agitated behavior

De-escalation An interactive process by which the patient is redirected toward a calmer personal space. Stevenson, S (1991).

Communication Most people don’t think about the way they communicate on a day to day basis and are often unaware of how they relate to others, and yet communication is essential to our development as social beings.

Methods of Communication u 1 - Verbal ………… 7% of the message u 2 -Tone of voice… 23% of the message u 3 - Non Verbal…… 70% of the message

Verbal Aspects Pitch Tone Volume • Actively manage the pitch tone and volume of your voice. • Start with clear calm tone • Consider mood matching • Don’t get drawn into shouting match

Non Verbal Communication • Can complement or contradict verbal message • Can Regulate interactions for example to convey when the other person in the conversation should speak or not • Can be a substitute for a verbal message

Non Verbal Aspects Think about these: u Proximity (stance/posture/space) u Eye contact u Respect Touch Boundaries u Facial expression u Environment u Consider influence of appearance u Think about your hand movements

Initial Contact Attempt to calm the situation and take control by: (a) Listening carefully to what the client is saying. (b) Show understanding - paraphrasing what is being said, reflecting facts and feelings.

Open Questions u Allows the client to answer at their own pace. Encourages the client to clarify areas of concern. u Usually start with How, When, Where, Why, What. u

Closed Questions u Usually require a simple ‘yes’ or ‘no’ answer. u Can seem like an interrogation and inhibit the client telling their story. u They usually start with Do, Did, Can, Would, Could, Are.

During the Exchange If escalation is occurring, attempt to get a “breathing space” and regain control by: (a) Using open ended questions (how, what) (b) Using words or phrases designed to have a calming effect- “it looks like we might need to do…. . ”etc.

Signs of Agitation u u u u Pacing and shouting Glaring Change in tone of voice Change of expression Invasion of your personal space Posture (clenched fits) Gesture (pointing) Content of verbal communication (racist sexist etc)

Try to Avoid Being Provocative (a) Monitor the effects of your interventions and be prepared to adapt as and when the need arises. (b) Don’t use words or phrases which may antagonise -”you must stop this outburst”, “Don’t be silly” etc

Towards Resolution Attempt to get the client to take, or co-operate in, positive action to resolve the situation by: (a) Working one step at a time (b) Dealing with any blocks to action

Verbal Communication DON’T LEARN SAFETY BY ACCIDENT!!

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