Foundations of De-escalation
What is the primary purpose of de-escalation in nursing?
A. To control patient behavior
B. To prevent harm and calming down agitation
C. To enforce hospital policy
D. To discharge difficult patients
B – To prevent harm and reduce agitation
The primary goal of de-escalation is to reduce/calm down emotional intensity and prevent harm to the patient, staff, and others.
Active listening involves:
A. Interrupting to give advice
B. Ignoring nonverbal cues
C. Paraphrasing and clarifying
D. Multitasking while listening
C – Paraphrasing and clarifying
Active listening includes reflecting and clarifying to ensure understanding.
An early behavioral sign of escalation is:
A. Cooperative conversation
B. Relaxed posture
C. Pacing and clenched fists
D. Sleeping
C – Pacing and clenched fists
These are classic early warning signs of escalating agitation.
During de-escalation, the nurse should:
A. Block the exit
B. Maintain access to an exit
C. Turn their back
D. Stand too close
B – Maintain access to an exit
Ensuring personal safety is essential during de-escalation.
De-escalation aligns with which ethical principle?
A. Nonmaleficence (do no harm)
B. Financial efficiency
C. Punishment
D. Obedience
A – Nonmaleficence (do no harm)
De-escalation minimizes harm and promotes safety.
De-escalation is considered:
A. A last-resort intervention
B. A punitive strategy
C. A first-line response to management of agitation
D. A security responsibility only
C – A first-line response to agitation
De-escalation should be attempted before restrictive measures such as restraints.
Which statement best demonstrates empathy?
A. “You’re overreacting.”
B. “Calm down immediately.”
C. “I understand this situation feels frustrating.”
D. “That’s not my problem.”
C – “I understand this situation feels frustrating.”
This validates feelings without judgment.
Which factor commonly contributes to aggression?
A. Effective pain control
B. Long wait times
C. Clear communication
D. Comfort measures
B – Long wait times
Environmental stressors like delays increase frustration and aggression risk.
If a patient becomes physically aggressive, the nurse should first:
A. Attempt restraint alone
B. Prioritize safety and call for assistance
C. Continue verbal discussion
D. Leave without notifying anyone
B – Prioritize safety and call for assistance
Safety is the first priority. Team support reduces risk.
Cultural competence improves de-escalation by:
A. Treating all patients identically
B. Recognizing cultural communication differences
C. Avoiding interaction
D. Assuming stereotypes
B – Recognizing cultural communication differences
Understanding cultural norms reduces misunderstandings and escalation.
3. Understanding stages of escalation (volcano illustration) is important as it helps nurses:
A. Predict mealtimes
B. Identify stages of aggression
C. Apply restraint faster
D. Avoid documentation
B – Recognizing stages allows early intervention
During de-escalation, appropriate eye contact should be:
A. Intense and prolonged
B. Avoided completely
C. Natural and non-threatening
D. Dominating
C – Natural and non-threatening
Appropriate eye contact shows engagement without intimidation.
A patient with untreated pain is at risk for:
A. Increased satisfaction
B. Reduced communication
C. Escalating irritability
D. Immediate sedation
C – Escalating irritability
Uncontrolled pain increases stress and lowers coping ability.
Physical restraints are:
A. First-line interventions
B. Used for staff convenience
C. Last-resort measures when safety is at risk
D. Appropriate for all agitated patients
C – Last-resort measures when safety is at risk
Restraints are used only when less restrictive measures fail.
Trauma-informed care emphasizes:
A. Control through authority
B. Recognizing past trauma impacts behavior
C. Immediate restraint
D. Ignoring patient history
B – Recognizing past trauma impacts behavior
Trauma-informed care reduces re-traumatization and improves trust.
Successful de-escalation results in:
A. Increased staff control
B. Patient humiliation
C. Reduced emotional intensity
D. Immediate discharge
C- Reduced emotional intensity
Successful de-escalation lowers agitation and restores calm.
A calm tone of voice helps:
A. Increase authority
B. Reduce perceived threat
C. End conversations quickly
D. Show impatience
B- Reduce perceived threat
A calm tone reduces anxiety and threat perception.
Patients experiencing psychosis may escalate due to?
A. Accurate perception of reality
B. Hallucinations or delusions
C. Improved insight
D. Relaxation techniques
B- Hallucinations or delusions
Psychosis can cause fear-driven reactions to perceived threats.
Proper documentation should include:
A. Personal opinions
B. Emotional reactions
C. Objective behavior descriptions
D. Assumptions about motives
C- Objective behavior descriptions
Documentation must be factual and neutral.
Reflective practice after an incident helps nurses:
A. Avoid similar patients
B. Improve future responses
C. Assign blame
D. Reduce documentation
B - Improve future responses
Reflection promotes professional growth and better clinical judgment.
4. Why is it important for a nurse to know a patient’s baseline behavior when using de-escalation techniques?
Knowing a patient’s baseline helps the nurse recognize changes in behavior and intervene early and appropriately.
When setting limits, nurses should:
Offer clear, respectful boundaries
Clear limits promote safety and predictability.
Recognizing triggers allows nurses to:
Prevent escalation early
Identifying triggers allows early intervention.
Involving security is appropriate when?
Safety is threatened
Security involvement is appropriate when there is imminent risk.
What De-briefing tool SVH uses for staff to utilize post incidents?
OK STOP