Table 2 Essential elements of a verbal de-escalation technique [20]

• Talk with the patient in a gentle, relaxed, assured tone

• Answer calmly, maintaining a firm attitude

• Offer food, beverages and blankets

• Be flexible in the dialogue

• Reserve your own judgement regarding what the patient should or should not do

• Do not seek confrontation of ideas or reasons, only simple partnerships that calm and reinforce the patient

• Use simple language and short sentences, repeating as many times as necessary

• Be honest and accurate

• Clearly communicate that the patient is expected to maintain self-control and that the staff can help him/her achieve this

• Redirect the conversation when disruptive questions are asked

• Paraphrase what the patient says

• Reassure the patient that you have understood him/her well

• Use open-ended questions

• Establish limits whilst at the same time offering the patient acceptable and realistic opportunities to improve their symptoms

• When faced with imminent violence:

 • Warn the patient that violence is not acceptable

 • Propose a resolution to any problem through dialogue

 • Offer pharmacological treatment

 • Inform them that you will rely on physical restraint if necessary

• Consider a mild/moderate show of force in the form of an increased number of medical staff and even security guards ready to act if necessary