De-escalation Techniques/ Redirection techniques for Crisis Situations

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    What are some de-escalation and redirection techniques to use to help calm a patient down when a patient is entering a crisis? I was thinking of redirecting the patient to another activity to help calm the patient such as taking a walk. Also I was thinking of offering the patient to move to a quiet room or his/her own room until they feel calmer. What other appropriate redirection activities could the nurse offer that would be safe for the patient?

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  2. 15 Comments...

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    If possible, I would always try to discuss this with the person before anything happens. Finding out what has worked for them before and what they find helpful. Getting to a calm environment helps and this could also involve removing others from the persons current place, talk the person through some breathing exercises, music can be of benefit (some might find calming music helps and I have found some feel calm with really loud music), depending on what is causing the crisis talking through it or distracting from it may help. Being able to recognise individual signs of an emerging crisis can help to nit it in the bud before more drastic action needs to be taken.
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    I agree learn what works before a crisis. I also like to give choices. That way people feel like they have power in a seemingly powerless world. Always make sure the choices you offer are something you can do. Use calm quiet tones and amazingly their voice will grow to match yours.
    nurse lala likes this.
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    one to one time
    prn medications ( offer them)
    remove from situation
    take them outside for fresh air ( we have a courtyard)
    quiet room ( ours is padded so if they want to punch the wall, go for it)
    Direct confrontation if appropriate.

    And one that I use at times, at it is totally dependent on the person/situation, but the few times I have used it, it has been more effective than anything else I have tried... I offer them a hug. Do I do this with the person who is screaming at me, threatening bodily harm... of course not. But with the person who is so distraught because it is the anniversary of the death of a loved one who the pt blames themselves for, Yes I will say " You look like you need a hug, would you like one?"
    CNA2RNhopeful likes this.
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    I have done the hug thing too. For some of the kids I worked with who had been in DHS custody for a long time. That offer of a hug was the first kind human contact they have had in a long long time.

    Sometimes it is just being present with them. There are many times I have just slid myself down a wall and sat on the floor near a patient. No words except do you mind if I sit here.
    nurse lala and CNA2RNhopeful like this.
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    what would you do if a person is in crisis and has a weapon? like a gun??
    I ask this because I have read about this occurring to police officers where I live.
    In my area the police deal with many mental health calls.
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    Thank you all for your responses! For asking the patient what has worked for them in the past, would it still be okay to do so AS the patient is in a crisis situation?
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    You can ask, but they probably wont be able to answer it. It is one of the questions we automatically ask on admission.

    Ive had patients in the middle of a crisis repeat, dont touch me, I dont want to hurt anyone, so please dont touch me, cause that will make me want to hurt you, dont touch me... so we didnt. He walked calmly with us into a safe area and said go ahead and give me the shots, I am not going to fight you. Ended up not needing to do any extra paperwork for a restraint or anything because we listened to him.
    macfar28 likes this.
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    I agree that recognizing that the patient is in a crisis in the early stages is key. Also, if you can try to establish good rapports with the patients when they are not in crisis, so that when they are they will be more willing to listen and trust you. You also have to remember that every patient is different so what works for one patient may not work for another, and different techniques may work best during different stages of the crisis.
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    Where I work if someone has a weapon the police are called.

    It depends on what sort of crisis the person is having. E.g. are they feeling anxious, suicidal, angry and agitated, paranoid? Intervening earlier rather than later is helpful, if you can. I find as I get to know patients this is easier to do. Luckily where I work we have a few nurses who have been there for years, and they have worked with quite a few of our patients in the past. They are a great source of information and I often ask if they've had previous experience with this particular patient and if they have advice on what might work.

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