Registered Nurses' Association of Ontario

De-escalation Tips

  • Some suggestions that can be used by nurses to de-escalate client responsive behaviours and implement client-preferred interventions to assist them to cope.
  • De-escalation tips:
  1. Always identify yourself.
  2. Talk and think calm.
  3. Ask patients how they are doing, or what’s going on.
  4. Ask patients if they are hurt (assess for medical problems).
  5. Ask patients if they were having some difficulty or what happened before they got upset.
  6. Remember why the patient is in the hospital.
  7. Find a staff member that has a good rapport/relationship with the patient and have him or her talk to the patient. Let the patent know you are there to listen.
  8. Offer medication if appropriate.
  9. Help patients remember and use coping mechanisms they identified on the Patient reported Therapeutic Interventions Survey.
  10. If a patient screams and swears, reply with a calm nod, okay, don’t react.
  11. Use team or third-party approach. If patient is wearing down one staff, have another take over (10 minutes of talking might avoid a restraint incident).
  12. Reassure patients and maintain professional boundaries (tell patients you want them to be safe, that you are here to help them).
  13. Allow quiet time for patents to respond – silent pauses are important.
  14. Ask the patient if she/he would be willing, could try to talk to you (repeat requests, persistently, kindly).
  15. Respect needs to communicate in different ways (recognize possible language/ cultural differences as well as the fear, shame, and embarrassment the patient may be experiencing).
  16. Empower patients. Encourage them with every step towards calming themselves they take.
  17. Make it okay to try and talk over the upsetting situation even though it may be very painful or difficult.
  18. Acknowledge the significance of the situation for the patient.
  19. Ask the patient how else we can help.
  20. Ask the patient’s permission to share important conversations with other caretakers for on-going discussion
Clinical Management
Promoting Safety: Alternative Approaches to the Use of Restraints
Point of Care Resources