Patients’ Safety

in Mental Health Settings(verbal de-escalation of aggression)

By Dr. Inas Ebeid

Ass. proff in psychiatric mental health nursing

Taibah University

Learning objectivesupon completion of this lecture the audience will be able to:

1- explain assault cycle 2- communicate effectively with aggressive patient during escalation phase of assault cycle

outlines1- Patient safety in mental health settings2- Safety Incidents in mental health settings3- cycle of assault4- Verbal de-escalation techniques

introduction What is patient safety?Patient safety is the absence of preventable harm. to a patient

during the process of health care.

The discipline of patient safety. is the coordinated efforts to prevent

harm ,caused by the process of health care itself, from occurring to

patients.

Over the past ten years, patient safety has been increasingly

recognized. as an issue of global importance, but much work

remains to be done.

Patient safety in mental health settings

Although many of the same patient safety risk

factors. that exist in medical settings. apply to

mental health settings, there are unique patient

safety issues that arise in the mental health

context that are common among individuals with

mental illness.

Safety Incidents in mental health settings

1. Violence and Aggression.

2. Suicide and Self-Harm.

3. Patient Victimization.

4. Seclusion and Restraint.

5. Patient Accidents.

Safety Incidents in mental health settings

6. Absconding and Missing

Patients.

7. Adverse Medication Events.

8. Privacy violations

9. Infectious Disease.

aggressive and violent incidents

are one of the most common

types of events leading to

patient safety incident reports.

Please watch this video carefully and then 1- determine the aggression phase that the patient is revealed

2- Analyze the nurse’s response to patients' aggression

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Using De escalation Skills in a Healthcare Setting - YouTube.3GP

Nursing management of aggression is vary

according to the stage of patient aggression or anger

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Triggering Phase

This is a circumstances where a

person is still on a non threatening

manner. Which can be managed easily

and without any hostile or aggressive

behavior.

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Escalation Phase

This is an event where the client

will indicate movement toward a

loss of control ( crisis phase).

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Crisis Phase

During this stage the client will loss his

control and will react to the environment by

kicking, punching, throwing objects and he

will have loss the ability to communicate

clearly.

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Verbal de-escalation of aggression

The first step toward preventing a physical crisis is to skillfully use verbal techniques whenever possible.

Verbal de-escalation techniques

Facial expressions RelaxedSerious looksGood eye contact (not staring)Attentive, focused on the personAvoid ‘’raised eye brow, and closed eyesStanding diagonally, about 3-5 feet awayHands down to the sides, palms facing personWeight equally balanced on both feet

Avoid staring

Avoid closed eyes

Avoid raised eyebrow

Avoid closed position with client

Verbal de-escalation techniques

Voice ToneCalm, quiet, remember to breatheSlow pacedSound confident that you can help them

Attitude I have time for youYou are an important personTogether we can make things betterLet’s talk about it

Verbal de-escalation techniquesWords Being Said•“Let’s go to a place where we can talk more privately”•“Please tell me more about what happened”•“Please tell me more so I better understand how to help you.”•Listen to the story without changing the subject/interrupting•Clarify those things you don’t understand•Listen on two levels-the meaning of the words and the emotional meaning•Use words that show you understand how he/she might be feeling •Be willing to hear a differing views or opinion. Look for the areas you can agree on

Verbal de-escalation techniques

Be an empathic listener

•Do NOT be judgmental.•Listen to what the person is really saying. •Try to establish rapport with the client. 

Reflect empathetic feeling

Verbal de-escalation techniquesBody language

•Finger pointing may seem accusing or threatening.

•Shoulder shrugging may seem uncaring or unknowing.

•Rigid walking may seem challenging.

•Jaw set with clenched teeth shows you are not open-

minded to listening to his/her side of the story.

•20 

Avoid closed posture

Finger pointing may seem accusing or threatening

Verbal de-escalation techniques

Protect yourself at all times

•While de-escalating another person, you want to

be in a self-protecting position.

•Slightly more than a leg’s length away, on an

angle.

•Stay far enough away that the other person

cannot hit, kick or grab you.

Protect your self all the time

Verbal de-escalation techniques

Remain calm

• Listen - really listen!

•Avoid overreaction.

•Validate! “I understand why you might be upset.” (This

does not indicate that you agree with them.)

•Watch for non-verbal clues or threats.

•Bring in another trained person to assist whenever

possible.

Thank You