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The Positive Effect of Utilizing De-Escalation Techniques

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By: Emily Flagg, RN 

When I first entered the field of psychiatric nursing, the term ‘de-escalation’ didn’t mean very much to me. It was a term that I had occasionally heard, but it was rarely a part of my vocabulary. Now, it’s a term and a concept that I use often, both in my professional and personal life. As nurses, we are bound to encounter patients with strong emotions, both positive and negative ones. The nurse often bears the brunt of the patient’s emotions, whether it be happiness, despair, or anger, because we are the ones who work most intimately with the patients. While it can be an honor to share in the patient’s positive emotions, it can be just as difficult to experience the more negative ones. I work on an involuntary psychiatric unit and we are often faced with the most emotionally vulnerable patients. For a great number of the patients, there has been a disconnect from reality and the patient has very little insight into why they are being committed. This manifests as anger, frustration, agitation and hostility. In addition, their underlying diagnosis can also cause similar turbulent emotions. One of the concepts that I was introduced to during orientation, was the theory of a ‘steady object’. This concept postulates that as the caregiver we are the ‘steady object’, while the patient is the ‘moving object’. As the ‘steady object’ we are able to remain calm, supportive and neutral while the ‘moving object’ is experiencing a disruption to their emotional homeostasis. De-escalation techniques are effective in avoiding further escalation and a return to their emotional baseline. De-escalation techniques include active listening, validation of feelings, and exhibiting empathy. In addition, eye contact, a neutral pose and a calm expression are effective techniques. In my clinical experience, this has been an effective way to interact with escalating patients. I have employed many of these techniques, but have observed that the most effective techniques are having a calm voice, a neutral pose, active listening and validation. I have also found that providing the patient with the space to share their feelings and emotions is hugely beneficial. In-turn, it helps in building a rapport with the patient where they trust me and my clinical judgments. In many instances, the patient experiences decreased periods of emotional dysregulation and loss of behavioral control. I have also found the techniques to be helpful and effective in my personal relationships. As humans, we all have an innate desire to be recognized, validated and respected. It is no different for the patients that we care for. Effective utilization of de-escalation techniques partnered with the idea of being a ‘steady object’, can have a positive impact in helping to avoid increased escalation and additional interventions. I believe that if nurses utilize de-escalation techniques consistently and effectively, the quality of care will be increased and subsequently, it will provide a better healing environment for the patient.

Content of this article has been developed in collaboration with the referenced State Nursing Association.

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