Table 2.

Essential elements of a verbal de-escalation technique [20]

• Talk with the patient in a gentle, relaxed, assured tone
• Answer calmly, maintaining a firm attitude
• Offer food, beverages and blankets
• Be flexible in the dialogue
• Reserve your own judgement regarding what the patient should or should not do
• Do not seek confrontation of ideas or reasons, only simple partnerships that calm and reinforce the patient
• Use simple language and short sentences, repeating as many times as necessary
• Be honest and accurate
• Clearly communicate that the patient is expected to maintain self-control and that the staff can help him/her achieve this
• Redirect the conversation when disruptive questions are asked
• Paraphrase what the patient says
• Reassure the patient that you have understood him/her well
• Use open-ended questions
• Establish limits whilst at the same time offering the patient acceptable and realistic opportunities to improve their symptoms
• When faced with imminent violence:  • Warn the patient that violence is not acceptable  • Propose a resolution to any problem through dialogue  • Offer pharmacological treatment  • Inform them that you will rely on physical restraint if necessary
• Consider a mild/moderate show of force in the form of an increased number of medical staff and even security guards ready to act if necessary