Transcript De-escalation

Northcoast Polytechnic
Institute
•
Crisis behaviors
•
Verbal and
Non-verbal tactics
•
De-escalation skills
Instructional Objectives
• Identify general physiological signs
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of anger
Identify common triggers to anger
Recognize the levels of anger
Learn appropriate interventions
for each level of anger
Tips to manage your own anger
Self- protection tips
“Anyone can become angry. That is
easy. But to be angry with the right
person, to the right degree, at the
right time, for the right purpose and
the right way… that is not easy.”
Aristotle
Physiological Signs of Anger
• Heart beating faster
• Breathing rate increases
• Fists clenched
• Face feels hot or cold
• Hands shaking
• Profuse sweating
• Higher body temperature
Physiological Signs of Anger
(con’t)
• Sudden dry mouth
• Stuttering
• Muscles tensing
• Goosebumps
• Face turns pale or red
• Teeth grinding, jaw clenching
• Losing power
. . . for
feelings of
anger
• Losing status
• Losing respect
• Being insulted
• Not having things
turn out the way you
expected
• Experiencing physical
. . . for
feelings of
anger
pain
• Experiencing
emotional pain
• Being threatened
with physical or
emotional pain by
someone or
something
. . . for
feelings of
anger
• Having an important
or pleasurable activity
interrupted,
postponed or stopped
• Not obtaining
something you want
• Expecting pain
. . . for
feelings of
anger
• Feeling that you have
been treated unfairly
and unjust
• Believing that things
should be different
#1
• Rigidly thinking “I am
right”
. . . for
feelings of
anger
• Judging that the
situation is
illegitimate, wrong or
unfair
• Ruminating about the
#2
event that set off the
anger in the first
place, or in the past
Anger FACTS
• Follows a predictable pattern of levels
• Levels have observable characteristics
• Opportunities for intervention are
present at every level
• May be about something other than
situation at hand (lack of sleep, work
problems, fight with significant other,
illness, etc)
The Anger Cycle
Levels overview
5. Outburst
4. Challenge
3. Refusal
2. Back Talk
7. In Control
1. Questions
6. Quiet Period
Anger Cycle by Chuck York
#1
Description
May be legitimate questions about an
activity, missed information, etc
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– “What are we suppose to be doing now?”
– “Why do I have to go?”
– “How does this stuff help me?”
#1
#2
•
May be an attempt to question your
authority
– “Why do I have to listen to you?”
– “Who died and made you boss?”
#1
• The easiest way to prevent escalation
from this point is simply to answer the
question
• Assume that questions are real. Do
not assume the person is trying to
“start something” or be manipulative
by asking questions
• Use “Reflective Listening” to maintain
clear communication
Reflective listening
– Let the person do the talking
– Focus on what the person is saying
– Focus on the person’s emotions (look
at body language, sound of voice,
etc.)
– Restate what the person is saying to
you to show you understand
– Keep your answers short and clear
Description
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Person is showing their anger and
trying to incite you to be angry
– “You’re always telling me what to do!
Why don’t you do it?”
– “You don’t know what you are
talking about”
#1 – “This is all just stupid”
• Stay calm and in control
• Be aware of your facial expressions, your
posture, and how your voice sounds
– Keep a distance of at least 3 feet between
you and the person
– Speak slowly and be civil
– Do not cross your arms or make yourself
look “closed
• Redirect the person back to the topic of the
discussion
Description
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The person is challenging your control of
the situation by refusing to comply with a
direction
– “I’m not going”
– “I’m not going to do that”
– Crossing arms, turning head, ignoring you
#1 – “Do it yourself”
• Stay calm, cool and collected
– Your behavior impacts the situation.
– If you are responding to the person’s
anger, the person will become more angry
• Give the person two clear choices that
are reasonable and appropriate.
Explain the consequences for each of
the choices
Description
•
The person is attempting to directly
challenge your authority
– “You can’t make me do it!”
– “I don’t have to do that!”
– “Pick on somebody else!”
#1
• Try to remove either the person
the audience
– The person may escalate faster if the
others are watching
or
• Seek help if you think this will escalate
further
• Check your own behavior and make
sure you are in control
• Increase distance between the
person and yourself
• Restate choices
Description
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The person is no longer able to
maintain control
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May take 2 forms: Verbal or Physical
– Verbal Outburst - screams, yells, shouts
profanity, cries, etc
– Physical Outburst - attacks, kicks, throws,
#1 breaks, runs, etc
If the outburst is verbal
• Keep a space between the person and
yourself
• Allow the person to vent
• Do not attempt communication at this
point
• Wait for the episode to progress
naturally to the next level; the “Quiet
Period”
Securit
y!
If the outburst is physical
• Remove the other bystanders from
the room
• Exit the room yourself, and attempt to
maintain visual contact with the
person
#1
Security!
• If your organization has a Crisis
Response Team (CRT), call the team
and implement Non-Violent Physical
Crisis Intervention
• If your organization does not have a
CRT, maintain observation and wait for
the person to move into the next level;
the “Quiet Period”
#2
Description
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•
#1
After every outburst, the person will
reach a “quiet period” in which their
emotional status is below their
average state
Usually represented by being quiet,
lack of energy, sometimes crying,
moving to a protected area, etc.
• Give the person space and time
to calm down
• Quietly offer support
Description
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The outburst is over, and the person
has regained control
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Still a sensitive time, and care should
be given not to re-escalate the
situation
#1
• Invite the person to rejoin
communication
• Ask the person to join clean up of any
messes or damage caused
• Ask the person which of the choices
they have selected
Always be aware of
• Stethoscopes around
your neck
• Badge lanyards that are
not “break-away”
• Long necklaces
• Dangling earrings
• Long hair (always
pull back)
• Men’s ties
Always be aware of
Things that can be used as weapons
• Scissors, Hemostats, Eating utensils (even
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plastic), plates, plate warmer, water pitchers,
vases, anything glass or ceramic
Belts, robe ties, tubing (IV, 02, etc)
Sheets, pillowcases, gowns
Pens/pencils
Furniture
REVIEW #1
1. Anger follows a predictable and
observable pattern
2. There are appropriate interventions for
each level of the anger cycle
3. You are an active participant in the cycle,
and can escalate or de-escalate the
behavior with your actions
REVIEW #2
4. When a person reaches the outburst level,
they are no longer in control of their actions
5. The key point during an outburst is to create
the safest environment possible to prevent
injury
6. NEVER attempt a physical intervention unless
you have received proper training and it follows
your organizational policies and guidelines