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Difficulty: MediumTherapeutic Communication

A triage nurse in an emergency department observes a client pacing rapidly in the waiting area, speaking loudly to other visitors about the delay in seeing a physician. Arrange the following nursing actions in the most appropriate sequence to therapeutically communicate and de-escalate the situation. All options must be used.

  1. 1Stand at a 45-degree angle to the client while maintaining an open, relaxed posture.
  2. 2State, "I can see that you are feeling very frustrated by how long this is taking."
  3. 3Ask, "Would you tell me more about what is causing you the most distress right now?"
  4. 4Explain the current triage process and the estimated timeframe for seeing a healthcare provider.
  5. 5Offer a collaborative choice, such as, "We can sit in this quieter consultation room while we wait for your name to be called."

Answer

The correct sequence is to first establish a safe, non-threatening physical posture, followed by validating the client's emotions, exploring their specific concerns, providing factual information about the wait, and finally offering a collaborative choice.
The correct sequence for verbal de-escalation prioritizes physical safety and non-verbal communication first. Once a non-threatening presence is established, the nurse must validate the client's feelings and explore their concerns through active listening. Only after the client's emotional intensity has decreased is it appropriate to provide logical information (like triage times) and offer collaborative choices to manage the situation.

Step-by-Step Solution

1
Establish physical safety and non-verbal readiness.
The nurse stands at a 45-degree angle with an open posture.
Non-verbal communication sets the tone for the interaction and ensures safety for both the nurse and the client before any words are spoken.
2
Acknowledge and validate the client's emotional state.
The nurse states that they can see the client is frustrated.
Validation demonstrates empathy and helps de-escalate heightened emotions by showing the client they are seen and heard.
3
Encourage verbalization of specific concerns.
The nurse asks an open-ended question about the client's distress.
Allowing the client to vent verbally reduces physical agitation and provides the nurse with context about the core issue.
4
Provide factual information to address the root concern.
The nurse explains the triage process and wait time.
Information giving reduces the anxiety of the unknown, but it is only effective after the client's emotional state has been validated and de-escalated.
5
Collaborate on a plan to restore a sense of control.
The nurse offers to move to a quieter consultation room.
Offering choices empowers the client, redirects their behavior constructively, and removes them from the stimulating waiting room environment.

Key Concept

Therapeutic Communication: De-escalation and Crisis Intervention Sequencing
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Topics

Therapeutic Communication

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