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