Patients come in all shapes and sizes, and sometimes they can be aggressive. Whether they are mentally ill, intoxicated or angry, the challenge remains the same. A nurse has to keep her wits about her and disconnect from her own emotions for the good of the patient. If she hopes to de-escalate the situation and end the conflict peaceably, a nurse needs to know how to calmly and carefully talk and listen to an aggressive patient. There are certain techniques that are more helpful than others in achieving this goal.
The third-person technique is a method used to help de-escalate an aggressive patient. It involves asking another qualified nurse or staff member who was not there at the beginning of the conflict to enter the situation and attempt to speak to the patient. This allows for someone neutral to the situation to calmly talk with the patient. The person acting as the negotiator should use therapeutic communication techniques and try to develop a rapport with the patient to come to a peaceful resolution to the situation.
Techniques to Employ
A nurse should strive to remain an arm's length from an aggressive patient and she should try to maintain a calm demeanor. Acknowledge the patient's emotion so that he knows he is being heard. State, "It sounds like you are feeling angry," to communicate that you are aware of his emotional state. Use active listening skills by maintaining eye contact and paraphrasing what the patient is saying. Ask open-ended questions to find out the root cause of the anger. If an apology is warranted, then apologize, but do not lie. Set firm limits on what behavior is acceptable in the exchange. Always keep an exit lane to the door open.
Techniques to Avoid
Do not touch the patient or attempt to restrain him by hand. This may cause him to become physical. Do not try to interrupt a tirade with the truth. It will only make him feel as if you aren't listening and may make him angrier. Allow the patient to use any language he wants because scolding him may only make things worse. Don't allow the patient his delusions. Orient him to reality, even if it is harsh. Don't get angry, defensive or challenge a patient's opinions. These are sure ways to escalate the situation and potentially spawn a physical confrontation.
Most of the time, restraints should be avoided. They can lead to negative outcomes for patients, both mentally and physically. Sometimes there is no choice but to restrain a patient, but every other therapeutic intervention should be exhausted before resorting to such an extreme action. Restraints have been shown to cause injury and can even lead to death, according the Joint Commission. This intervention should be used only if the patient is going to harm himself or others and there is no way to communicate with him to inhibit his actions.