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Questions and Answers
A patient in the emergency department is pacing rapidly, avoids eye contact, and is speaking in a loud, rapid tone. Which of the following is the MOST appropriate initial step in de-escalating this situation?
A patient in the emergency department is pacing rapidly, avoids eye contact, and is speaking in a loud, rapid tone. Which of the following is the MOST appropriate initial step in de-escalating this situation?
- Speak to the patient in a calm, non-threatening manner. (correct)
- Immediately call security to restrain the patient.
- Ask the patient direct questions about why they are agitated.
- Tell the patient to calm down and sit in the waiting area.
Which of the following communication elements constitutes the largest percentage of a communicated message, according to Albert Mehrabian's research?
Which of the following communication elements constitutes the largest percentage of a communicated message, according to Albert Mehrabian's research?
- Spoken words
- Body language (correct)
- Written text
- Voice and tone
Which of the following is an example of 'non-verbal communication' in the context of de-escalation?
Which of the following is an example of 'non-verbal communication' in the context of de-escalation?
- Asking open-ended questions to understand the patient's perspective.
- Maintaining a relaxed posture and open stance. (correct)
- Clearly stating expectations.
- Using simple and direct language.
A patient is exhibiting escalating agitation. Which of the following is LEAST likely to be an effective de-escalation technique?
A patient is exhibiting escalating agitation. Which of the following is LEAST likely to be an effective de-escalation technique?
The acronym 'STAMP' is used to remember key signs of agitation and potential aggression. What does the 'T' in 'STAMP' stand for?
The acronym 'STAMP' is used to remember key signs of agitation and potential aggression. What does the 'T' in 'STAMP' stand for?
Which of the following is considered a 'testing ritual' or manipulative tactic a patient might employ to get what they want?
Which of the following is considered a 'testing ritual' or manipulative tactic a patient might employ to get what they want?
Which of the following phrases is MOST likely to worsen a situation with an agitated patient?
Which of the following phrases is MOST likely to worsen a situation with an agitated patient?
What is the primary goal of de-escalation techniques in a potentially violent situation?
What is the primary goal of de-escalation techniques in a potentially violent situation?
In a 'fight or flight' response, which of the '4 Fs of Fear' involves attempting to appease or pacify a perceived threat?
In a 'fight or flight' response, which of the '4 Fs of Fear' involves attempting to appease or pacify a perceived threat?
Which of the following self-calming techniques is MOST crucial for a healthcare provider to employ before attempting to de-escalate an agitated patient?
Which of the following self-calming techniques is MOST crucial for a healthcare provider to employ before attempting to de-escalate an agitated patient?
When de-escalating an agitated patient, what is the recommended interpersonal distance to maintain initially?
When de-escalating an agitated patient, what is the recommended interpersonal distance to maintain initially?
Which of the following body positions is considered MOST non-threatening when interacting with an agitated individual?
Which of the following body positions is considered MOST non-threatening when interacting with an agitated individual?
During de-escalation, what is the primary reason for speaking slowly and confidently?
During de-escalation, what is the primary reason for speaking slowly and confidently?
Why is it important to 'focus on feelings' rather than just facts when de-escalating an agitated person?
Why is it important to 'focus on feelings' rather than just facts when de-escalating an agitated person?
When an agitated patient asks challenging or provocative questions during de-escalation, what is the MOST recommended approach?
When an agitated patient asks challenging or provocative questions during de-escalation, what is the MOST recommended approach?
Which of the following is an example of 'getting to common ground' during de-escalation?
Which of the following is an example of 'getting to common ground' during de-escalation?
The acronym 'T.A.C.O.S.' represents 'De-escalation Don'ts'. What does the 'C' in 'T.A.C.O.S.' stand for?
The acronym 'T.A.C.O.S.' represents 'De-escalation Don'ts'. What does the 'C' in 'T.A.C.O.S.' stand for?
During a tense situation, which of the following behaviors should be AVOIDED by the healthcare provider?
During a tense situation, which of the following behaviors should be AVOIDED by the healthcare provider?
Which of the following is an appropriate example of 'agreeing in principle' with an agitated patient?
Which of the following is an appropriate example of 'agreeing in principle' with an agitated patient?
Which of the following phrases is MOST effective for paraphrasing and showing understanding to an agitated patient?
Which of the following phrases is MOST effective for paraphrasing and showing understanding to an agitated patient?
When setting limits with an agitated patient, which principle is MOST important to ensure effectiveness and maintain a therapeutic relationship?
When setting limits with an agitated patient, which principle is MOST important to ensure effectiveness and maintain a therapeutic relationship?
In the context of offering choices to an agitated patient, what is a crucial consideration to ensure the choices are truly de-escalating?
In the context of offering choices to an agitated patient, what is a crucial consideration to ensure the choices are truly de-escalating?
Which of the following safety measures is MOST crucial for healthcare staff when interacting with a potentially agitated patient?
Which of the following safety measures is MOST crucial for healthcare staff when interacting with a potentially agitated patient?
When is the use of physical force justified in managing an escalating situation with a patient?
When is the use of physical force justified in managing an escalating situation with a patient?
What is the purpose of 'debriefing after an event' involving patient agitation and potential violence?
What is the purpose of 'debriefing after an event' involving patient agitation and potential violence?
What is a key element of 'debriefing with the patient' after a de-escalation event?
What is a key element of 'debriefing with the patient' after a de-escalation event?
Why is regular practice of de-escalation skills recommended for healthcare professionals?
Why is regular practice of de-escalation skills recommended for healthcare professionals?
Which of the following is an example of ineffective communication that should be avoided during de-escalation?
Which of the following is an example of ineffective communication that should be avoided during de-escalation?
In the context of verbal de-escalation, what does 'sequestering the person if in a group' refer to?
In the context of verbal de-escalation, what does 'sequestering the person if in a group' refer to?
A patient states, 'You people never listen!'. Which of the following is a helpful 'Agree' phrase in response?
A patient states, 'You people never listen!'. Which of the following is a helpful 'Agree' phrase in response?
Which of the following non-verbal cues is MOST indicative of a genuine smile and can enhance trust during de-escalation?
Which of the following non-verbal cues is MOST indicative of a genuine smile and can enhance trust during de-escalation?
Which of the following is considered a 'last resort' intervention in managing a severely escalated and potentially violent patient?
Which of the following is considered a 'last resort' intervention in managing a severely escalated and potentially violent patient?
In 'Staying Safe' during potential de-escalation scenarios, why is it recommended to 'watch those hands'?
In 'Staying Safe' during potential de-escalation scenarios, why is it recommended to 'watch those hands'?
What is the potential negative consequence of using physical force during patient de-escalation?
What is the potential negative consequence of using physical force during patient de-escalation?
If de-escalation efforts are consistently failing and the situation feels unsafe, what is the MOST appropriate action according to the 'TRUST YOUR INSTINCTS' principle?
If de-escalation efforts are consistently failing and the situation feels unsafe, what is the MOST appropriate action according to the 'TRUST YOUR INSTINCTS' principle?
A patient is agitated and yelling. Which of the following comments from the healthcare provider is LEAST helpful and could escalate the situation?
A patient is agitated and yelling. Which of the following comments from the healthcare provider is LEAST helpful and could escalate the situation?
Which of the following is an example of an 'aggressive question' that a manipulative patient might use?
Which of the following is an example of an 'aggressive question' that a manipulative patient might use?
In de-escalation, what is the benefit of 'allowing silence for reflection and decisions'?
In de-escalation, what is the benefit of 'allowing silence for reflection and decisions'?
Which of the following is NOT a recommended component of non-threatening behavior during de-escalation?
Which of the following is NOT a recommended component of non-threatening behavior during de-escalation?
Which of the following is NOT typically associated with characteristics of individuals who tend to escalate into a crisis state?
Which of the following is NOT typically associated with characteristics of individuals who tend to escalate into a crisis state?
According to communication studies, which aspect of communication has the LEAST impact on conveying a message?
According to communication studies, which aspect of communication has the LEAST impact on conveying a message?
Which of the following non-verbal cues is MOST likely to convey trustworthiness and sincerity during de-escalation?
Which of the following non-verbal cues is MOST likely to convey trustworthiness and sincerity during de-escalation?
During de-escalation, what is the potential risk of 'invading someone's space'?
During de-escalation, what is the potential risk of 'invading someone's space'?
Which of the following is the MOST appropriate initial action when encountering a patient exhibiting potential signs of agitation?
Which of the following is the MOST appropriate initial action when encountering a patient exhibiting potential signs of agitation?
A patient is yelling loudly and making demands. Which response is MOST likely to de-escalate the situation?
A patient is yelling loudly and making demands. Which response is MOST likely to de-escalate the situation?
What does the 'Fawn' response refer to in the context of the '4 Fs of Fear'?
What does the 'Fawn' response refer to in the context of the '4 Fs of Fear'?
What interpersonal distance is generally recommended when initially approaching an agitated individual to begin de-escalation?
What interpersonal distance is generally recommended when initially approaching an agitated individual to begin de-escalation?
Which of the following approaches is LEAST helpful when encountering challenging questions from an agitated person?
Which of the following approaches is LEAST helpful when encountering challenging questions from an agitated person?
You are attempting to set limits with a patient who is becoming increasingly agitated. Which approach is MOST likely to be effective?
You are attempting to set limits with a patient who is becoming increasingly agitated. Which approach is MOST likely to be effective?
When offering choices to an agitated patient, what is the MOST important factor to consider?
When offering choices to an agitated patient, what is the MOST important factor to consider?
Which of the following is an example of an action a healthcare provider should AVOID during a tense situation?
Which of the following is an example of an action a healthcare provider should AVOID during a tense situation?
What is the rationale behind recommending healthcare providers to 'allow silence' during de-escalation?
What is the rationale behind recommending healthcare providers to 'allow silence' during de-escalation?
In the context of staying safe during potential de-escalation scenarios, why is it recommended to 'stay between the patient and the door'?
In the context of staying safe during potential de-escalation scenarios, why is it recommended to 'stay between the patient and the door'?
What is the fundamental purpose of debriefing with colleagues after an event involving patient agitation?
What is the fundamental purpose of debriefing with colleagues after an event involving patient agitation?
A healthcare professional is evaluating a patient for signs of escalating aggression. The acronym "STAMP" helps identify signs of agitation. Which of the following behaviors is included in this acronym?
A healthcare professional is evaluating a patient for signs of escalating aggression. The acronym "STAMP" helps identify signs of agitation. Which of the following behaviors is included in this acronym?
When using effective de-escalation techniques, which of the following approaches is recommended?
When using effective de-escalation techniques, which of the following approaches is recommended?
Which phrase would be considered counterproductive and likely escalate a tense situation with an agitated patient?
Which phrase would be considered counterproductive and likely escalate a tense situation with an agitated patient?
A patient is becoming visibly agitated. According to lecture recommendations, your physical stance should ideally be:
A patient is becoming visibly agitated. According to lecture recommendations, your physical stance should ideally be:
Which of the following is an effective example of verbal de-escalation when dealing with challenging questions from an agitated patient?
Which of the following is an effective example of verbal de-escalation when dealing with challenging questions from an agitated patient?
According to your lecture slides, which communication approach should be avoided during tense or potentially violent interactions?
According to your lecture slides, which communication approach should be avoided during tense or potentially violent interactions?
In the context of setting effective limits with an agitated individual, what criterion is necessary?
In the context of setting effective limits with an agitated individual, what criterion is necessary?
A patient is trying to manipulate staff by invading personal space and touching inappropriately. This patient behavior is identified in your lecture as:
A patient is trying to manipulate staff by invading personal space and touching inappropriately. This patient behavior is identified in your lecture as:
When facing a violent or potentially violent patient scenario, the most critical and immediate goal of de-escalation is:
When facing a violent or potentially violent patient scenario, the most critical and immediate goal of de-escalation is:
After a violent event or escalated incident, the lecture emphasizes the importance of which practice to improve future responses?
After a violent event or escalated incident, the lecture emphasizes the importance of which practice to improve future responses?
Flashcards
Early signs of escalation?
Early signs of escalation?
Identify signs that a situation/interaction is becoming dangerous or escalating
Characteristics of people who escalate
Characteristics of people who escalate
These include poorly developed coping skills, repeated episodes, serious psychiatric illness, personality disorders, and drug use.
Non-verbal communication
Non-verbal communication
Includes facial expressions, eye movements, posture, and closeness.
Everyday Escalation Behaviors
Everyday Escalation Behaviors
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Signs of Agitation/Potential Aggression (STAMP)
Signs of Agitation/Potential Aggression (STAMP)
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Aggressive Tone of Voice
Aggressive Tone of Voice
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Anxiety Signs
Anxiety Signs
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Patient Manipulation
Patient Manipulation
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Things to avoid saying!
Things to avoid saying!
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De-escalation
De-escalation
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Goals of De-escalation
Goals of De-escalation
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Assure Your Safety
Assure Your Safety
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The 4 Fs of Fear
The 4 Fs of Fear
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Self Calming Techniques
Self Calming Techniques
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Non-Threatening Behaviors
Non-Threatening Behaviors
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Calm Demeanor
Calm Demeanor
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Techniques for De-escalation
Techniques for De-escalation
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Focus on Feelings
Focus on Feelings
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Ignore Challenging Questions
Ignore Challenging Questions
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De-escalating actions
De-escalating actions
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During a Tense Situation Avoid:
During a Tense Situation Avoid:
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Setting Limits
Setting Limits
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Offering Choice
Offering Choice
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Staying Safe
Staying Safe
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Physical Force in Escalating Circumstances
Physical Force in Escalating Circumstances
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Last Resorts
Last Resorts
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Reducing Distractions
Reducing Distractions
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Ideal Physical Stance
Ideal Physical Stance
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Redirecting Attention
Redirecting Attention
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Testing Rituals
Testing Rituals
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Primary Goal in Escalation
Primary Goal in Escalation
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Post-Incident Debriefing
Post-Incident Debriefing
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Enforceable Consequences
Enforceable Consequences
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Setting Effective Limits
Setting Effective Limits
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Avoid Humor/Sarcasm
Avoid Humor/Sarcasm
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Study Notes
Signs of Agitation (STAMP)
- STAMP is a mnemonic used to detect potential aggression.
- Includes Staring, Tone (loud or aggressive), Anxiety (fidgeting, sweating), Mumbling, and Pacing or rocking.
- Pacing or rocking movements indicate potential escalation.
De-escalation Techniques
- Effective de-escalation involves reducing distractions, like radios or TVs.
- Calmly remove the individual from stressful group dynamics to lower anxiety and agitation.
- Effective verbal de-escalation involves not engaging in power struggles; redirect the conversation to problem-solving and collaboration,.
De-escalation Don'ts (T.A.C.O.S.)
- Avoid telling an agitated patient you fully understand their feelings, as it can seem dismissive. Instead, validate emotions.
- Do not use humor or sarcasm, which can appear dismissive or mocking, further agitating the individual.
- Communication should remain serious, clear, respectful, and supportive.
Non-Threatening Behavior
- A non-threatening stance is approximately 4 feet away, slightly angled (L-shaped foot position), with hands unclenched and visible.
- This positioning appears non-aggressive and allows you to maintain safety.
Setting Limits
- Consequences should be clear, concise, related to the problematic behavior, reasonable, respectful, and enforceable to ensure understanding and compliance.
Potential Manipulation Strategies
- "Testing rituals" are manipulative strategies that include behaviors like invading personal space, inappropriate touching, and boundary-testing to assert control.
Maintaining Safety
- Safety for you, the patient, and others is the primary and immediate goal.
- Clinical assessment and other interventions may follow.
Post Event Processes
- Post-event debriefing with colleagues and the patient is crucial.
- It helps process the incident, allows expression of concerns, fosters understanding, and guides improvements in safety and response strategies.
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