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Approach to the Agitated Patient in the E.D. Behavioral interventions— the Four-S Model * :

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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.