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How to Find Your Way Around
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22nd April 2009
Ethical Care De-Escalation e-Learning
Objective
• Demonstrate communication skills that can
be used to calm anxious or agitated
individuals
• Understand common signs of escalating
anxiety
• Identify effective methods of
de-escalating anxious or agitated behavior
De-escalation
An interactive process by which the patient is redirected toward a calmer personal space.
Stevenson, S (1991).
Communication
Most people don’t think about the way they
communicate on a day to day basis and are
often unaware of how they relate to others,
and yet communication is essential to our
development as social beings.
Methods of Communication

1- Verbal ………… 7% of the message

2-Tone of voice… 23% of the message

3- Non Verbal……70% of the message
Verbal Aspects
Pitch Tone Volume
•
Actively manage the pitch tone and volume of
your voice.
•
Start with clear calm tone
•
Consider mood matching
•
Don’t get drawn into shouting match
Non Verbal Communication
•Can complement or contradict verbal
message
•Can Regulate interactions for example
to convey when the other person in the conversation
should speak or not
• Can be a substitute for a verbal message
Non Verbal Aspects
Think about these:
 Proximity (stance/posture/space)
 Eye contact
 Respect Touch Boundaries
 Facial expression
 Environment
 Consider influence of appearance
 Think about your hand movements
Initial Contact
Attempt to calm the situation and take control
by:
(a) Listening carefully to what the client is saying.
(b) Show understanding - paraphrasing what is
being said, reflecting facts and feelings.
Open Questions

Allows the client to answer at their own pace.

Encourages the client to clarify
areas of concern.

Usually start with How, When,
Where, Why, What.
Closed Questions

Usually require a simple ‘yes’ or ‘no’ answer.

Can seem like an interrogation and inhibit the
client telling their story.

They usually start with Do, Did, Can, Would,
Could, Are.
During the Exchange
If escalation is occurring, attempt to get a
“breathing space” and regain control by:
(a) Using open ended questions (how, what)
(b) Using words or phrases designed to have a
calming effect- “it looks like we might need to
do…..”etc.
Signs of Agitation








Pacing and shouting
Glaring
Change in tone of voice
Change of expression
Invasion of your personal space
Posture (clenched fits)
Gesture (pointing)
Content of verbal communication (racist sexist
etc)
Try to Avoid Being Provocative
(a) Monitor the effects of your interventions
and be prepared to adapt as and when the
need arises.
(b) Don’t use words or phrases which may
antagonise -”you must stop this outburst”,
“Don’t be silly” etc
Towards Resolution
Attempt to get the client to take, or
co-operate in, positive action to resolve the
situation by:
(a) Working one step at a time
(b) Dealing with any blocks to action
Verbal Communication
DON’T LEARN SAFETY BY ACCIDENT!!
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