This is a training film, in two parts, showing a range of de-escalation films being used by a nurse on a mental health inpatient unit. The first part shows poor practice, clearly demonstrating what it is a clinician might do, and what there might be in his response that makes a situation worse when faced with a patient who is highly aroused and distressed. In the second part, simple skills are used which rapidly de-escalate the same situation.
When watching the film, try and identify the factors that make things worse in part one and those that successfully de-escalate the situation in part two, breaking them down into environmental, non-verbal and verbal factors.
Behaviour:
- be polite and considerate at all times to patients, carers and staff
- introduce yourself to staff on placement and discuss who you are and what you are hoping to do
Preparation
- ensure you have had a local induction to clinical sites
- discuss patients you plan to see with a clinician in advance
- read the notes beforehand (often electronic) and inquire about risk
Personal
- clothes should be formal, non-restrictive and professional
- name badges should be worn on a lanyard
- avoid taking personal belongings, bags, drinks etc into clinical settings
Setting
- ask staff where to interview a patient (not normally at the bedside)
- consider going to interview patients in pairs (but this is not always necessary)
- consider room layout, open any “internal inspection” window
Interview
- introduce yourself & put the patient at ease (open questions initially)
- if a patient appears upset by a line of questioning, acknowledge this
- check if they are happy to continue
- practice your interview skills and seek feedback from peers and tutors
Escalation
- if you feel concerned or uncomfortable, then end the interview politely
- report back any concerns to clinical staff – do not keep it to yourself.
- if you do not feel your concerns have been heard, inform someone
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