The agitated patient

Here in Taupo we are fortunate to have regular educational simulations run by our resident ED specialist Dr Jared Bayless. Thanks to Dr Jeremy Webber and Andrew Tattle for workshopping how the agitated patient is cared for in the ED.

In an aggressive conflict situation, the best advice is to try to de-escalate and calm the situation. The following tips are taken from the ministry of education nz but are well applied to any threatening situation.

Safety

If you feel unsafe or threats are made, don’t react or argue. You should:

  • phone the Police 111, or ask for someone else to phone 111
  • leave and warn others to leave the area.

Keep a calm presence

Your tone of voice and how you stand show that you’re calm, willing to listen and are not a threat. For example:

  • using a calm, quiet voice, speaking slowly and repeating your message
  • standing slightly side-on instead of facing front-on
  • relaxing your shoulders and staying calm by breathing slowly
  • keeping an appropriate distance to make sure the person doesn’t feel trapped, and so you can move away if necessary
  • limiting eye contact. Direct eye contact can be challenging and intimidating. Looking down and briefly up can be supportive.

Keep communication minimal

In conflict situations, people are often looking to be heard and understood. Ways to achieve this include:

  • being clear, concise and specific in how you communicate
  • showing you’re listening by nodding your head at appropriate times repeating phrases you hear
  • allowing the person to communicate their position and not interrupting them
  • naming any emotion in a calm, even voice, for example: “I can see that you’re feeling very frustrated about…”
  • allowing wait time.

Find a solution by using collaborative problem-solving

While a person’s beliefs may be vastly different from your own, a conflict situation is not the time to try and change them. But you can look for ideas that might be similar so that you can move out of a conflict situation.

Ways to do this include:

  • inviting the person to consider some solutions. This can start by stating their values (the problem) and your values (the second problem)
  • taking a ‘wondering’ approach to find common values: “These responses seem to differ to my values, I wonder what we share in common, (such as the importance of belonging or freedom of speech.) Can we use these to find a way forward?”
  • asking for any ideas or solutions they have to the difficulties expressed and any next steps they might take or that you might be able to take
  • by being encouraging of and open to any solutions they offer. 

Avoid things that can escalate a situation

These can include:

  • your tone of voice, speaking loudly, arguing or interrupting.
  • being too close physically, holding direct eye contact, standing front-on to the person.
  • challenging or threatening the person.
  • trying to convince the person to change their beliefs and philosophies.
  • quoting statements from anyone else. 

Reflecting on your own values

Conflict situations can challenge our own beliefs about our environments, communities and places we live. After a conflict situation it can help to seek out others to inform, provide support and to understand what happened.

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