Less invasive More invasive

1. Approach to the Agitated Patient in the E.D. • Behavioral interventions—the Four-S Model*: • Safety—assure the pt’s physical and emotional well-being via interventions such as modifying the environment to reduce stimuli and inducing a calming ambiance (e.g., maintain a calm demeanor and voice, avoid an argumentative stance). • Support—involves listening & talking in a supportive way, offering comfort measures (eg, food, nicotine replacement) or whatever else the pt feels is needed (ask "What will help you now?”); involves verbal de-escalation (“Meet the patient where the patient is at”). • Structure—techniques, like limit setting, that convey behavioral expectations and aid in constructive problem solving • Symptom management—aimed at specific symptoms; includes stress and relaxation measures (e.g., breathing exercises), diversionary activities, and assessing the need for medication. *Delaney KR, et al. (2000) Less invasive More invasive Medication recommendations—desired endpoint is to calm without sedation • Seclusion or physical restraint—the treatment of last resort • Appropriate medications should be administered concurrently (see above). • Hospital policy (stipulating physician orders, nursing documentation, patient monitoring, etc) must be followed.