Crisis Escalation and Communication

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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?

  • 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?

  • 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?

  • 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?

<p>Speaking in a loud and authoritative voice to regain control. (B)</p> Signup and view all the answers

The acronym 'STAMP' is used to remember key signs of agitation and potential aggression. What does the 'T' in 'STAMP' stand for?

<p>Tone of voice (D)</p> Signup and view all the answers

Which of the following is considered a 'testing ritual' or manipulative tactic a patient might employ to get what they want?

<p>Invading personal space and boundaries. (A)</p> Signup and view all the answers

Which of the following phrases is MOST likely to worsen a situation with an agitated patient?

<p>Calm down! (C)</p> Signup and view all the answers

What is the primary goal of de-escalation techniques in a potentially violent situation?

<p>To ensure personal safety and prevent harm to oneself or others. (A)</p> Signup and view all the answers

In a 'fight or flight' response, which of the '4 Fs of Fear' involves attempting to appease or pacify a perceived threat?

<p>Fawn/Fix (A)</p> Signup and view all the answers

Which of the following self-calming techniques is MOST crucial for a healthcare provider to employ before attempting to de-escalate an agitated patient?

<p>Taking a moment to assess their own emotional state and pulse. (C)</p> Signup and view all the answers

When de-escalating an agitated patient, what is the recommended interpersonal distance to maintain initially?

<p>Approximately 4 feet or farther. (D)</p> Signup and view all the answers

Which of the following body positions is considered MOST non-threatening when interacting with an agitated individual?

<p>Standing slightly angled to the person, with unclenched hands visible. (D)</p> Signup and view all the answers

During de-escalation, what is the primary reason for speaking slowly and confidently?

<p>To ensure the agitated person can clearly understand and process information. (D)</p> Signup and view all the answers

Why is it important to 'focus on feelings' rather than just facts when de-escalating an agitated person?

<p>Addressing feelings validates the person's experience and builds rapport. (A)</p> Signup and view all the answers

When an agitated patient asks challenging or provocative questions during de-escalation, what is the MOST recommended approach?

<p>Redirect their attention back to the issue at hand and their feelings. (A)</p> Signup and view all the answers

Which of the following is an example of 'getting to common ground' during de-escalation?

<p>Agreeing with a reasonable point the patient makes, even if in principle. (D)</p> Signup and view all the answers

The acronym 'T.A.C.O.S.' represents 'De-escalation Don'ts'. What does the 'C' in 'T.A.C.O.S.' stand for?

<p>Challenge (D)</p> Signup and view all the answers

During a tense situation, which of the following behaviors should be AVOIDED by the healthcare provider?

<p>Becoming rigid and inflexible in their approach. (C)</p> Signup and view all the answers

Which of the following is an appropriate example of 'agreeing in principle' with an agitated patient?

<p>Stating 'I believe everyone should be treated respectfully'. (B)</p> Signup and view all the answers

Which of the following phrases is MOST effective for paraphrasing and showing understanding to an agitated patient?

<p>So, let me see if I understand, you are saying that...' (A)</p> Signup and view all the answers

When setting limits with an agitated patient, which principle is MOST important to ensure effectiveness and maintain a therapeutic relationship?

<p>Limits should be reasonable, respectful, and clearly related to the behavior. (D)</p> Signup and view all the answers

In the context of offering choices to an agitated patient, what is a crucial consideration to ensure the choices are truly de-escalating?

<p>Choices must be realistic and within acceptable boundaries. (D)</p> Signup and view all the answers

Which of the following safety measures is MOST crucial for healthcare staff when interacting with a potentially agitated patient?

<p>Ensuring there is a clear and unobstructed path to an exit. (D)</p> Signup and view all the answers

When is the use of physical force justified in managing an escalating situation with a patient?

<p>When verbal de-escalation attempts have failed and there is imminent risk of harm to self or others. (C)</p> Signup and view all the answers

What is the purpose of 'debriefing after an event' involving patient agitation and potential violence?

<p>To review the incident, improve future responses, and support staff involved. (C)</p> Signup and view all the answers

What is a key element of 'debriefing with the patient' after a de-escalation event?

<p>To explore the patient's perspective, understand their concerns, and identify triggers. (A)</p> Signup and view all the answers

Why is regular practice of de-escalation skills recommended for healthcare professionals?

<p>Because de-escalation skills are perishable and require ongoing reinforcement, similar to other medical skills. (C)</p> Signup and view all the answers

Which of the following is an example of ineffective communication that should be avoided during de-escalation?

<p>Employing medical jargon to ensure clarity. (C)</p> Signup and view all the answers

In the context of verbal de-escalation, what does 'sequestering the person if in a group' refer to?

<p>Moving the person to a quieter, less stimulating environment away from a group. (A)</p> Signup and view all the answers

A patient states, 'You people never listen!'. Which of the following is a helpful 'Agree' phrase in response?

<p>I understand that it feels like you are not being heard. (C)</p> Signup and view all the answers

Which of the following non-verbal cues is MOST indicative of a genuine smile and can enhance trust during de-escalation?

<p>Smiling with crinkling at the corners of the eyes. (A)</p> Signup and view all the answers

Which of the following is considered a 'last resort' intervention in managing a severely escalated and potentially violent patient?

<p>Physical restraints or injectable medication. (C)</p> Signup and view all the answers

In 'Staying Safe' during potential de-escalation scenarios, why is it recommended to 'watch those hands'?

<p>To be aware of potential hidden weapons the patient might be concealing. (B)</p> Signup and view all the answers

What is the potential negative consequence of using physical force during patient de-escalation?

<p>It may result in injury to both the patient and staff. (B)</p> Signup and view all the answers

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?

<p>STOP de-escalation attempts, leave the situation, and call for help. (C)</p> Signup and view all the answers

A patient is agitated and yelling. Which of the following comments from the healthcare provider is LEAST helpful and could escalate the situation?

<p>I will not let you talk to me that way! (D)</p> Signup and view all the answers

Which of the following is an example of an 'aggressive question' that a manipulative patient might use?

<p>What gives you the right to ask me that? (B)</p> Signup and view all the answers

In de-escalation, what is the benefit of 'allowing silence for reflection and decisions'?

<p>Silence provides time for the agitated person to process their emotions and consider their next steps. (A)</p> Signup and view all the answers

Which of the following is NOT a recommended component of non-threatening behavior during de-escalation?

<p>Having multiple staff members interact with the patient simultaneously. (C)</p> Signup and view all the answers

Which of the following is NOT typically associated with characteristics of individuals who tend to escalate into a crisis state?

<p>Well-developed coping skills (C)</p> Signup and view all the answers

According to communication studies, which aspect of communication has the LEAST impact on conveying a message?

<p>Spoken words (A)</p> Signup and view all the answers

Which of the following non-verbal cues is MOST likely to convey trustworthiness and sincerity during de-escalation?

<p>Crinkling around the corners of the eyes during a smile (C)</p> Signup and view all the answers

During de-escalation, what is the potential risk of 'invading someone's space'?

<p>It may escalate agitation and be perceived as threatening (B)</p> Signup and view all the answers

Which of the following is the MOST appropriate initial action when encountering a patient exhibiting potential signs of agitation?

<p>Assess the environment for potential safety hazards (D)</p> Signup and view all the answers

A patient is yelling loudly and making demands. Which response is MOST likely to de-escalate the situation?

<p>&quot;I can see you're upset; what can we do to help?&quot; (D)</p> Signup and view all the answers

What does the 'Fawn' response refer to in the context of the '4 Fs of Fear'?

<p>Attempting to appease or pacify a perceived threat (A)</p> Signup and view all the answers

What interpersonal distance is generally recommended when initially approaching an agitated individual to begin de-escalation?

<p>4 feet or farther to create a safe zone (D)</p> Signup and view all the answers

Which of the following approaches is LEAST helpful when encountering challenging questions from an agitated person?

<p>Directly answering the questions to provide immediate clarity (D)</p> Signup and view all the answers

You are attempting to set limits with a patient who is becoming increasingly agitated. Which approach is MOST likely to be effective?

<p>Stating limits with clear and simple language, ensuring they are reasonable and enforceable (A)</p> Signup and view all the answers

When offering choices to an agitated patient, what is the MOST important factor to consider?

<p>The choices must be realistic and within your ability to provide (D)</p> Signup and view all the answers

Which of the following is an example of an action a healthcare provider should AVOID during a tense situation?

<p>Treating the individual as unintelligent (A)</p> Signup and view all the answers

What is the rationale behind recommending healthcare providers to 'allow silence' during de-escalation?

<p>To give the individual time to reflect and process their thoughts (A)</p> Signup and view all the answers

In the context of staying safe during potential de-escalation scenarios, why is it recommended to 'stay between the patient and the door'?

<p>To position yourself strategically, maintaining an exit route if needed, while preventing them access to the hallway. (D)</p> Signup and view all the answers

What is the fundamental purpose of debriefing with colleagues after an event involving patient agitation?

<p>To provide an opportunity to process the event, improve responses, and enhance personal safety (A)</p> Signup and view all the answers

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?

<p>Pacing or rocking (C)</p> Signup and view all the answers

When using effective de-escalation techniques, which of the following approaches is recommended?

<p>Reducing distractions and sequestering the person from others (C)</p> Signup and view all the answers

Which phrase would be considered counterproductive and likely escalate a tense situation with an agitated patient?

<p>&quot;I understand exactly how you feel.&quot; (A)</p> Signup and view all the answers

A patient is becoming visibly agitated. According to lecture recommendations, your physical stance should ideally be:

<p>About 4 feet away, at a slight angle (A)</p> Signup and view all the answers

Which of the following is an effective example of verbal de-escalation when dealing with challenging questions from an agitated patient?

<p>Redirecting attention back to the main issue (D)</p> Signup and view all the answers

According to your lecture slides, which communication approach should be avoided during tense or potentially violent interactions?

<p>Using humor or sarcasm (D)</p> Signup and view all the answers

In the context of setting effective limits with an agitated individual, what criterion is necessary?

<p>Ensure consequences are reasonable and enforceable (A)</p> Signup and view all the answers

A patient is trying to manipulate staff by invading personal space and touching inappropriately. This patient behavior is identified in your lecture as:

<p>Testing ritual (C)</p> Signup and view all the answers

When facing a violent or potentially violent patient scenario, the most critical and immediate goal of de-escalation is:

<p>Ensuring safety of everyone involved (C)</p> Signup and view all the answers

After a violent event or escalated incident, the lecture emphasizes the importance of which practice to improve future responses?

<p>Debriefing with co-workers, supervisors, and the patient (A)</p> Signup and view all the answers

Flashcards

Early signs of escalation?

Identify signs that a situation/interaction is becoming dangerous or escalating

Characteristics of people who escalate

These include poorly developed coping skills, repeated episodes, serious psychiatric illness, personality disorders, and drug use.

Non-verbal communication

Includes facial expressions, eye movements, posture, and closeness.

Everyday Escalation Behaviors

These include road rage, airline flight cancellations, fights with loved ones, and patient interactions in healthcare settings.

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Signs of Agitation/Potential Aggression (STAMP)

STAMP: Staring, Tone, Anxiety, Mumbling, Pacing.

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Aggressive Tone of Voice

Raised volume, yelling, high pitched voice, rapid speech, verbally abusive

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Anxiety Signs

Sweating, fidgeting, shaking, excessive hand gestures, tachypnea.

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Patient Manipulation

Strategies patients use to manipulate or get what they want

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Things to avoid saying!

“Calm down!”, “I understand/ know how you feel”, “Why?”, “You should”, “Snap out of it!”

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De-escalation

Tactics of calming language and other communication techniques during a dangerous/threatening situation.

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Goals of De-escalation

Your safety, establish rapport, gather information, lower emotions, encourage effective behavior change.

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Assure Your Safety

ALWAYS PROTECT YOURSELF! Retreat and leave if needed, call for help.

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The 4 Fs of Fear

Fight, flight, freeze, or fawn/fix.

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Self Calming Techniques

Mindfulness, tuning into your own feelings, breathing, and positive self-talk.

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Non-Threatening Behaviors

Introduce yourself, only 1 person interacts with the patient, be at the same level or lower.

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Calm Demeanor

Keep a calm demeanor; calm is contagious.

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Techniques for De-escalation

Speak slowly and confidently, loud enough to hear, use clear language, no medical jargon.

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Focus on Feelings

Facts are important, but how a person feels is most important. Watch and listen carefully for the person's real message.

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Ignore Challenging Questions

Answering results in a power struggle; redirect attention to the issue at hand; ignore the challenge but not the person.

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De-escalating actions

Comply with reasonable requests, problem-solve and offer solutions, ask how you can help.

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During a Tense Situation Avoid:

Avoid blaming, treating someone as unintelligent, dismissing their feelings, or trivializing their problems.

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Setting Limits

State your intention to assist but not be abused, state consequences; be concise/clear/reasonable/respectful/enforceable.

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Offering Choice

Offer alternatives to violent behaviors, give the patient a feeling of some control and agency, offer medication choices.

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Staying Safe

Stay between patient and door, no stethoscopes around your neck, keep office door locked; remove potential weapons.

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Physical Force in Escalating Circumstances

Avoid, but use if necessary; only as a last resort to prevent injury.

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Last Resorts

Restraints or injectable medication may be necessary to ensure safety.

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Reducing Distractions

Reducing environmental stimuli to minimize anxiety and agitation, such as dimming lights or turning off the TV.

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Ideal Physical Stance

Standing approximately 4 feet away at a slight angle, with hands visible and unclenched.

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Redirecting Attention

Focusing back on the main problem or concern to avoid power struggles.

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Testing Rituals

Behavior used by patients to test boundaries and exert control.

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Primary Goal in Escalation

Ensuring the well-being of yourself, the patient, and others in potentially violent situations.

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Post-Incident Debriefing

Reviewing a violent event with involved staff and the patient to improve future responses and safety.

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Enforceable Consequences

Ensuring the rules for the patient are consistently applied and can be upheld.

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Setting Effective Limits

Should be clear, concise, related to the problematic behavior, reasonable and respectful.

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Avoid Humor/Sarcasm

Humor or sarcasm can be perceived as mocking, exacerbating an already tense situation.

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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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