Effective De-escalation Techniques Every Psychiatric Nurse Needs to Know



The emergency department at UT Southwestern Medical Centre in Dallas, Texas is one of the most heavily used in America – with more than 240,000 patient visits every year.

Over the course of these years, MD Dr. Lynn P. Ropollo recalls a time when the facility’s ED staff would be physically assaulted by an acutely agitated patient almost every week. How did they overcome this? In the past, sedatives and ‘calming medications’ were administered to diffuse violent situations. But now, the implementation of Project BETA (Best Practices in the Evaluation and Treatment of Agitation) has seen a significant reduction in this practice being required – with Dr. Ropollo witnessing only one instance of physical assault at the facility in the last 5 years.

Let us take you through the fundamental principles of Project BETA, and also, how psychiatric nurses can utilize the de-escalation techniques the project promotes to diffuse instances of violence and agitation in their patients.

Project BETA: The Implementation of De-escalation Techniques

Suppose you’re a registered nurse who is in the process of qualifying as a psychiatric mental health nurse practitioner (PMHNP) by completing psychiatric nurse practitioner online programs. In that case, you will undoubtedly be exposed to the de-escalation techniques Project BETA promotes in healthcare settings. Some of the steps involved commonly include:

Step 1: Assessing the Patient’s Level of Agitation

The first step to de-escalation? Assessing how agitated the patient in question is. It’s important not to rush in, but to first take a step back. This will enable the psychiatric nurse to calmly determine the best course of action to de-escalate the situation.

Remember: it’s virtually impossible to communicate effectively with a patient who is enraged or acutely agitated. As a psychiatric nurse, your first port of call should be to calm the patient down to a point where you can reason with them and keep them – and yourself – safe. In saying this, protecting yourself is essential. It’s advisable to keep a safe distance from the patient – at least until they have calmed down substantially.

Step 2: Communicating Calmly and in a Non-Confrontational Manner

Using a low, calm, monotone voice, communicate to the patient that they are safe and you are there to help them. Comfort them using soothing language, and assure them that you are on their side, without validating their violent behavior. Some examples of this type of language can include:

  • “I understand that you are feeling upset, but you don’t need to hurt anyone.”
  • “Help me understand what you’re feeling upset about, so I can help you.”

Step 3: Utilizing Non-Verbal Communication and Body Language

Just like utilizing the right language, using comforting non-verbal communication techniques can also help diffuse a violent situation. Some examples of this include:

  • Maintaining appropriate and non-confronting eye contact with the patient.
  • Adopting a non-threatening, relaxed stance.
  • Inclining your head to the side, to show that you are listening.
  • Nodding to confirm your understanding of the patient’s point of view.

Step 4: Expressing Empathy and Understanding

Often, a patient will become agitated or violent when they are experiencing considerable emotional distress. As such, it is important for the psychiatric nurse to see from their perspective, and to be understanding and empathetic of the patient’s situation.

What is it that drove the patient to become violent or agitated? Addressing the root cause of the patient’s agitation with empathy and understanding will usually elicit the best result – both for the patient and for the staff.

As a psychiatric nurse, you will no doubt be exposed to confronting situations every day on the job. With distressed patients often becoming violent and acutely agitated, it’s important to be able to maintain your own calm and composure while working to diffuse these scenarios. Expressing empathy and understanding for the patient also goes far.

By using the de-escalation tips we’ve outlined today, psychiatric nurses can help ease the agitation and distress of their patients while also protecting themselves. In the case of Dallas’ UT Southwestern Medical Centre, emergency department staff’s adoption of the de-escalation techniques promoted by Project BETA has proven remarkably effective and is a shining example of best practices in the management of agitated healthcare patients.