An adult client in the emergency department waiting area becomes increasingly agitated due to a prolonged wait time. The client begins pacing the hallway, clenching their fists, and shouting profanities at the triage desk. Which behavioral de-escalation interventions should the practical nurse implement? Select all that apply.
- Maintain a physical distance of at least two arm's lengths from the client.Cevap
- BStand squarely facing the client with arms crossed to establish boundaries.
- Use short, simple sentences while speaking in a calm and neutral tone.Cevap
- DInform the client that security will apply restraints if the shouting continues.
- Offer the client the choice to move to a quieter area away from the main triage desk.Cevap
- FAsk the client to sit down and logically explain the specific reasons for their anger.
Cevap
The correct actions are to maintain a physical distance of at least two arm's lengths, use short and simple sentences in a neutral tone, and offer the client the choice to move to a quieter area.
Effective de-escalation requires prioritizing physical safety, minimizing environmental stimuli, and using non-threatening communication. Maintaining a distance of two arm's lengths protects the nurse from sudden physical strikes. Using short, simple sentences is crucial because acute agitation severely limits a client's ability to process complex information. Finally, offering the option to move to a quieter area serves a dual purpose: it provides the client with a sense of control (choice) while simultaneously reducing the sensory overload that is exacerbating their agitation.
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Crisis Agitation De-escalation and Least-Restrictive Milieu Management
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