Introducing De-escalation Techniques in Nursing Education
Submitted by Gary Milligan, DNP, MSHA, CNE, RN and Laura Steadman, Ed.D., CRNP, MSN, CNS, RN
Tags: healthcare education nursing education nursing students student
The introduction of aggressive patient management is often neglected in the undergraduate nursing curriculum, leaving nursing students unprepared to handle the verbal and physical aggression they may encounter in their clinical practice. Unfortunately, encountering aggressive patients is an unavoidable reality in healthcare settings. Without the necessary skills and tools, nurses can find themselves at a heightened risk for personal harm or making errors in judgment under pressure. It is essential to equip student nurses with the knowledge and techniques to manage angry or aggressive patients effectively, ensuring patient and caregiver safety (Bernstein, et al., 2024).
One of the most effective ways to prepare nursing students for these challenging encounters is by introducing de-escalation techniques and physical intervention strategies. While no intervention can address all types of aggressive behavior, providing students with a broad understanding of available tools and approaches helps mitigate risks and ensures better outcomes for patients and staff (Spears & McNeely, 2018).
This introduction to escalation and crisis intervention is not focused on advanced crisis intervention tactics but aims to build a foundational awareness of de-escalation principles and physical intervention. The goal is to increase students' understanding of verbal and physical risks, enabling them to recognize early signs of aggression and take proactive steps to defuse potentially violent situations. In addition, students are encouraged to assess their emotional responses, as their feelings of anxiety, frustration, or fear can affect the way they manage an aggressive patient (Spears & McNeely, 2018).
It seems natural to incorporate this training into the behavioral health nursing course, where students are more likely to encounter patients exhibiting aggressive behaviors. Role-playing exercises are invaluable for demonstrating the reality of managing an angry or aggressive patient. While it acknowledges that some students may initially feel uncomfortable with these exercises, this discomfort is why they should be practiced in a controlled classroom rather than in a clinical facility's unpredictable, high-stress environment. By allowing students to experience and navigate these challenging interactions in a safe space, they are better prepared to respond calmly and effectively when faced with similar situations in the clinical setting (Berchtenbreiter, et al., 2024).
The emphasis on team-based care is also crucial in teaching de-escalation techniques. Aggressive patient encounters should never be seen as an individual responsibility but rather as an opportunity to engage the entire healthcare team in a coordinated approach. By fostering a team-based mindset, students are encouraged to communicate openly with their colleagues, share critical information, and alert each other when the potential for verbal or physical escalation is present. This collective awareness and preparedness can significantly reduce the likelihood of injury or escalation while promoting a safety culture and mutual support among caregivers.
Incorporating de-escalation and physical intervention techniques into nursing education prepares students to manage aggression effectively and helps ensure a safer, more compassionate environment for both patients and healthcare providers. As the healthcare landscape continues to evolve, it is increasingly vital that future nurses are trained to handle the complexities of patient behavior with skill, confidence, and empathy.
The team approach in managing aggressive patients is paramount to ensuring patient and staff safety. Aggressive verbal or physical behaviors can be unpredictable and escalate quickly, making it essential that healthcare professionals work together to de-escalate the situation effectively. By fostering an environment of open communication and mutual respect, the healthcare team can anticipate potential crises, coordinate interventions, and support one another in maintaining a calm, safe atmosphere. For instance, when a patient begins to show signs of agitation, team members need to communicate quickly, sharing observations and concerns while maintaining a unified strategy for intervention. Having a shared understanding of de-escalation techniques ensures that all team members respond consistently, reducing confusion or conflicting approaches that could exacerbate the situation. Furthermore, team-based care reinforces that no single staff member is solely responsible for managing aggressive patients. Instead, it promotes collective responsibility, with all team members offering support by monitoring the environment, providing backup during physical intervention, or facilitating a calm and therapeutic dialogue with the patient (Bernstein, et al., 2024).
The ultimate goal of integrating de-escalation techniques into nursing practice is to prioritize safety—both for the patient and for the healthcare team. Ensuring safety in these high-stress situations involves minimizing physical confrontations and reducing the risk of harm through proactive communication, early identification of warning signs, and appropriate intervention methods. Nurses must be equipped with physical strategies, emotional resilience, and the ability to remain calm under pressure. In addition, they are creating a culture where safety is prioritized by implementing regular training and simulations, allowing students and staff to practice and refine these skills before encountering real-life situations (Iennaco, et al., 2024). Beyond the immediate safety of the encounter, fostering a safety-conscious environment promotes a sense of security for all individuals involved, contributing to better patient outcomes. It also supports the long-term well-being of healthcare professionals by reducing the incidence of burnout, injury, and stress related to violent encounters. In this way, safety becomes a continuous, overarching goal deeply embedded in healthcare environments' daily practice and culture.
References
- Berchtenbreiter, K., Innes, K., Watterson, J., Nickson, C. P., & Wong, P. (2024). Intensive care unit nurses’ perceptions of debriefing after critical incidents: A qualitative descriptive study. Australian Critical Care, 37(2), 288–294. https://doi-org.uab.idm.oclc.org/10.1016/j.aucc.2023.06.002
- Bernstein, A. M., Clark, S. B., Pattishall, A. E., Morris, C. R., McCarter, A., Muething, C. S., Pavlov, A. C., Chun, T., & Call, N. A. (2024). The Development and Acceptability of a Comprehensive Crisis Prevention Program for Implementation in Health Care Settings. Journal of the American Psychiatric Nurses Association, 30(2), 424–433. https://doi-org.uab.idm.oclc.org/10.1177/1078390322109357
- Iennaco, J. D., Molle, E., Allegra, M., Depukat, D., & Parkosewich, J. (2024). The Aggressive Incidents in Medical Settings (AIMS) Study: Advancing Measurement to Promote Prevention of Workplace Violence. Joint Commission Journal on Quality & Patient Safety, 50(3), 166–176. https://doi-org.uab.idm.oclc.org/10.1016/j.jcjq.2023.11.005
- Spears, S., & McNeely, H. (2018). A systematic process for selection of a crisis prevention/de-escalation training program in the hospital. Journal of the American Psychiatric Nurses Association, 25(4), 298–304. https:// doi.org/10.1177/1078390318794281