April 17, 2024

    Managing Aggressive Behavior in Acute Care Behavioral Health Patients

    Managing aggressive behavior in acute care behavioral health patients is an important task. It requires a comprehensive understanding of the causes and risk factors for aggression.

    However, current evidence cannot guide clinicians, administrators, and policymakers in preventing and de-escalating aggressive behavior. More research is needed.

    De-escalation Techniques

    Aggressive behavior can occur due to overwhelming stress, fear, and loss of control. When dealing with an aggressive patient, it is essential to de-escalate the situation as quickly as possible.

    Several types of de-escalation techniques, including active listening and communication skills, may be effective. You can also create a safe space your patients can go to when they get overwhelmed, you should equip this room with mental health chairs and other safe furniture so your patients have a safe comforting environment where they can calm down in without hurting themselves or others. These methods can diffuse the situation or help you explain to the patient that the behavior is unacceptable.

    Staff training and risk assessment strategies like that of Sam Lee Prospect Medical are common preventive interventions that aim to equip staff with new skills or attitudes to prevent and de-escalate aggressive behavior among patients at increased risk of developing violence. They are often combined with multimodal programs, environmental or group psychotherapeutic interventions, and medication protocols.

    Active Listening

    Active listening can be helpful when trying to de-escalate an aggressive patient. It involves paying attention to nonverbal cues such as tone of voice, inflection, and volume.

    It also involves looking for verbal signals, such as facial expressions and body language, that indicate interest in what the other person is saying. Paying attention to these clues can help the nurse identify what the patient is thinking and feeling and allow for a more effective de-escalation process.

    Several preventive strategies may be employed to reduce the risk of aggressive behavior, including risk assessment, multimodal interventions, and peer-based approaches. These interventions can apply to all patients (whether or not they become aggressive) or be aimed at high-risk individuals. They can include supportive or nonconfrontational language, cognitive-behavioral techniques, pharmacologic treatment, and recognition of triggers.

    Communication Skills

    Aggressive behaviors in patients are common, and healthcare professionals must learn how to handle them to promote patient safety effectively. In some cases, the aggressive behavior may escalate to violence.

    Managing aggressive behavior requires the use of communication skills. The health care professional should approach the patient positively and encourage them to participate in de-escalation without coercive techniques or threats.

    In addition to verbal de-escalation, healthcare professionals should be able to use nonverbal cues, such as tone of voice and body language, in the de-escalation process. This helps the healthcare professional understand the patient’s thoughts and emotions before they act out.

    Available evidence about strategies to prevent and de-escalate aggressive behavior among psychiatric patients is limited. Two preventive approaches, risk assessment, and multimodal interventions consistent with Six Core Strategies principles, may reduce aggressive behavior and use of seclusion and restraint. Still, more research is needed on these methods.

    Physical De-escalation

    Several different techniques can be used to de-escalate an aggressive patient. These include non-violent methods, such as calming them down with a friendly chat or removing dangerous objects from the room.

    Other strategies may also be necessary depending on the severity of the patient’s behavior. For example, if a patient starts to attack other patients or staff members, physical restraint can be an effective way to prevent violence from occurring.

    Psychiatric staff should be well-trained in using restraint and other forms of physical de-escalation when managing patients with aggressive behavior. This is to avoid severe or fatal injuries and to reduce the risk of harming others.


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