What are the most common mistakes healthcare workers make when de-escalating patients?

Some keys aspects of listening are: Being and active listener; show you are not only hearing them but also listening by - Making eye contact Acknowledging their thoughts and feelings Giving the appropriate amount of time and space for the patient to express themselves without interruption Rephrasing back what you believe was conveyed to you *Remember that acknowledging one’s feelings is not synonymous with agreeing with one’s opinions but is crucial in cultivating effective communication.

Due to current healthcare shortages, staff overwhelm that goes unaddressed by leadership, and the toll of mental health challenges in healthcare workers who served during a pandemic, burnout can lead to an inability to demonstrate empathy for patients in healthcare environments. This can lead to escalation both in patients and staff, especially patients who receive discrimination that exacerbates symptoms and isolation. When staff needs go unremedied by leaders, the ill provide care to the ill, breeding toxicity. Healthcare businesses who recognize the value of their staff and nourish their ability to both experience and provide compassionate, knowledgeable, and effective care causes not just staff and patients to thrive, but communities.

How to be calm when de-escalating a patient (also applicable to clients, managers/employers, a child, etc.): ● Begin with the end in mind. What is your intention? Consider safety, understanding, and or building trust. ● Communicate calm. What type of energy are you sending out? Adjust your body language by taking a moment to breath, compose, and begin the active listening process. ● Remaining calm can be challenging. I find it helpful to really zero in on the biggest pain point being communicated. I acknowledge that pain point with confidence and reassurance by exuding calm as I interact. We are professionals with the antidote. ● Request assistance when the situation requires it.

As a former hostage/crisis negotiator and crisis hotline interventionist, remaining calm is a vital component of the de-escalation process. When attempting to transition a person or people out of an escalated, reactive, raw emotional state to a more cognitive state where they're able to cope with a stressor effectively and arrive at acceptance from resistance, the person performing de-escalation must be calm and reassuring. The bedrock of de-escalation is trust and if the person doing the de-escalation becomes escalated, the person reeling with stress, potential trauma triggers, fear, desperation, and possibly intoxication or medication related behaviors they can't control via will power alone, will intensify their chaotic spiral.

Untrained staff in emergency departments, triage, or other healthcare settings often don't know how to respectfully set a healthy boundary. They experience fear they will "get in trouble" if they do and often subsequently endure unnecessary abuse, anxiety, and discomfort as a result. When healthcare staff have leadership who recognize the need to train them in boundary setting and who practice it regularly themselves, it creates a culture of psychological safety and support that is vital to the healthcare professional as well as to excellent quality of care. As is the case in most other concepts as well, if there is no buy or embodiment in leadership, staff will not invest their time and energy in the training beyond checking the box.

This mistake is rarely the fault of the healthcare professional. Often this mistake is due to organizational culture that demonstrates little to no investment from leadership in supporting their staff with mental health or wellness concepts. The professional doesn't seek support because it has been demonstrated in prior occasions that when support has been desired or needed, healthcare staff have been ignored, chastised as inept, or even punished. This sends a clear message to staff to not seek support contributing to their exhaustion, burn out, trauma, and sense of helplessness that creates conditions for post-traumatic stress. When sufficient support is in place, employees thrive, grow, cope, and provide superior patient care.

In my experiences in psychiatric units and substance abuse detox facilities it is important to listen for what the patient is attempting to communicate. Many overwhelmed patients lack the emotional stability to communicate their needs. Misplaced aggression can be related to feeling out of control, anxiety related to various forms of discomfort, and challenges in understanding personal emotions.