Crisis Intervention In Dealing With Violent Patients: De .

2y ago
18 Views
2 Downloads
358.62 KB
17 Pages
Last View : 17d ago
Last Download : 2m ago
Upload by : Noelle Grant
Transcription

Crisis Intervention in DealingWith Violent Patients:De-escalation TechniquesKrystal Pope, JD/PhD

What is De-escalation- “transferring your sense of calms andgenuine interest in what the client wants totell you by using respectful, clear, limitsetting”- Verbal and Non-verbal techniques- Goal: build rapid rapport and sense ofconnection with agitated person

Identifying Agitated PatientsEmotional Signs:- Crying- Yelling- Mutism- Arguing- Inappropriate Laughter- Fear- Confusion

Identifying Con’tBehavioral Signs:- Rocking/Swaying- Shaking extremities- Tenseness in the body- Clenched fists- Pacing- Skitish Behaviors- Rapid Breaths- Pressured Speech- Loud or Quiet- Poor Eye Contact

Identifying Con’tCognitive Signs:- Defensive Statements- Overgeneralizing “never” “always”“everyone”- Black and White Thinking- Blaming- Obsessions/Preoccupations- Refusing to Listen

Environmental Responses- Space:-you to patient: 2 arm lengths, 45 degree anglepatient to room- Do not block exits- Ask if the patient needs water, a momentalone, to sit down, etc- Be aware of clinic/office resources

Provider Behaviors--Be a Mirror: if you reflect calm, cooperative, normaltone, the patient will mirrorNeutrality: facial expression, Relax your bodyNon-defensive posture: Hands in front of body, open,and relaxedMinimize gesturing, pacing, fidgeting – signs ofnervousness and increase agitation in othersEye level with Client but don’t force eye contactModulate tone of voice to reflect empathy or noemotional response

Provider Responses- Treat with Dignity and Respect vs. Shame & DisRespect- Do not Argue- Set boundaries- Encourage cooperation- Validate feelings (vs agreeing)- Ask Questions, Provide Choices- Repetition of boundaries/rules, offers of help,options, resources

De-escalation Techniques- Identify who you are; Patient identifiesthemselves-if you are new to the room/patient- Identify your purpose:-to help patient regain control and calm, no one hurt- Know Patient’s background-homeless, history of trauma or abuse, mental healthhistory, prior history in clinic or with providers- Patient as Teacher

Techniques Con’t- Active Listening-verbal and non-verbal acknowledgement of what thepatient is communicating- Reflections-“Tell me if I have this right” (then summarize whatthe patient says)“I’m confused, help me understand”- 1:1 verbal communication-do not overwhelm the Patient with multiple providers

Techniques Con’t- Emotional-less Response-The “i hate the world patient” or BPD patient- Small words-No Doctor Speak- Be concise-Attention/Concentration is poor during anger, stress,anxiety, fear- Trust your instincts

Patient Tools-Deep Breathing- 5 to 10 deep breaths tracking the breath from noseto stomach- Body Awareness- physical symptoms- Grounding- to the room, self, situation- Mindfulness- Object Focus, Senses

De-escalation Discussion- Goal: calm the patient down vs solve the problem thatcaused the agitation- Do Not Threaten, Argue, or try to ReasonDo not challenge delusions, hallucinations, fears- try to see “their truth”-- Set Boundaries/Rules“I understand its confusing when rules change, but.- Blame the Institution (don’t personalize)-

Discussion Con’t- Information Seeking Questions - Respond-“why do I always have to show my ID?”- Attack questions - Do Not Respond-“why is that doctor a .”- Give Choices of Safe Alternatives-“would you like to continue our discussion in a calmmanner or take a break to relax then resume?”“you frighten me when you pace, can you please sitdown or I’ll come back after you have walked andcalmed down

Discussion Con’t- Empathize Feelings, Not Behavior“I understand you are (use emotion the patientidentified) but it’s not ok to yell at staff”Focus on Cognitive: when the patient is teachingyou why they are upset they aren’t attacking- “Help me understand what you need”- “What has helped you in the past”- “I’m confused”- Not: “tell me how you feel”--

Discussion Con’t- Agree or Agree to Disagree- Ways to AgreeAgree with Truth: “yes she has stuck you three timesand it hurts, do you mind if I try”- Agree with Principle: if patient feels disrespected “Ibelieve everyone has a right to be respected”- Agree with Consensus “I’m sure other patients havefelt this way”Agree to Disagree (be honest, Patient’s will shut--down when they sense a lie)

Case Examples

- Goal: build rapid rapport and sense of connection with agitated person . . manner or take a break to relax then resume?”-“you frighten me when you pace, can you please sit down or I’ll come back after you have walked and .

Related Documents:

2/18/2016 7 17 Crisis Intervention Training Programs Organization Name Website Calm Every Storm, Crisis Intervention Training Crisis Consultant Group, LLC. crisisconsultantgroup.com Management of Aggressive Behavior (MOA B) MOAB Training International, Inc. moabtraining.com Nonviolent Crisis Intervention Program Crisis Prevention Institute crisisprevention.com

“Crisis Intervention Goals and Steps” introduces the goals and steps of crisis intervention with a nine-step model and discussion of crisis teams. “Crisis Intervention Assessment” provides suggestions for total family involvement in the assessment of the precip

ACCESS TO GENESEE COUNTY CRISIS SERVICES 08-2012 Additional Crisis Support Needed Emergency Department Refer to Hospital Emergency Dept. for emergent crisis needs that are unable to be met in community. Crisis Call Center GCCMH 24/7 Crisis Line (810) 257-3740 Crisis Needs Met With Crisis Call Center Phone Support CIRT

Crisis Lessons Learned In Crisis Management practice, few absolutes except: An effective Crisis Management program, that has adequate funding and management support, will only be put in place when facing an impending crisis that will produce significant losses. Every Crisis Is Different; If you've seen one crisis, you've seen one crisis.

The 4R Theory of Crisis Management ,which is composed by 4 stages—— Reduction, Readiness, Response, Recovery, was first put forward in the book named Crisis Management by the U.S. crisis management expert Robert Heath[6]. As is shown in the figure: Fig.1: 4R-model of Crisis Management . Crisis reduction management is the core

Mobile Crisis Response – Crisis Safety Plan 3 Version 1-October 2019 Crisis Identification Crisis: Crisis is a series of actions or behaviors that, when taken in environmental and situational context, result in an

PRE-CRISIS PLANNING CRISIS RESPONSEPOSTCRISIS RECOER AN REIE When a crisis strikes, many organizations feel overwhelmed. That is why pre-crisis planning—in a time of clear-headed calm—is essential. Thorough planning and preparation can help ensure every front-line employee and organization leader is ready to manage a crisis. PART I: PRE-CRISIS

DCPS School Crisis Response Plan Template 12 Roles and Responsibilities During a Crisis 14 Individual Student Crisis Protocol 17 Individual Student Crisis Plan Templates (Two Options) 20 . Each school has a crisis response plan and designated Lead for the school crisis team (SCT). 3. Central office conducts training and provides tools to .