Unit two focuses on effective communication skills.

Learning outcomes:

By the end of this unit, you will be able to confidently use effective communication techniques to de-escalate agitated patients, collaborate with team members in high-stress situations, demonstrate empathy in patient care, and understand the value of senior mentorship in developing clinical confidence and competence.

What is Agitation?

Agitation is a state of heightened arousal and restlessness, often accompanied by:

• Irritability or verbal hostility
• Anxious or aggressive behavior
• Demands for attention or care
• Signs of frustration, often due to unmet needs

In healthcare settings, agitation often arises from:

• Pain or discomfort
• Delays in care or lack of communication
• Overstimulating environments (noise, overcrowding)
• Fear, anxiety, or feeling disrespected

Agitation is a warning sign, not just a behavior problem. If unaddressed, it can escalate into aggression.

Effective communication is the cornerstone of managing agitation safely and compassionately. It includes:

a. Verbal Techniques

• Calm, steady tone of voice
• Short, clear sentences
• Positive framing (e.g., “Let’s work this out together” instead of “Calm down”)
• Offering choices (e.g., “Would you prefer to sit over here or wait just a bit longer?”)

b. Non-Verbal Communication

• Open, non-threatening posture
• Maintaining appropriate eye contact
• Using slow, deliberate movements
• Respecting personal space (typically 1.5–2 meters)

💡 Non-verbal cues often speak louder than words during tense interactions.

Empathy is not just a soft skill—it is a clinical tool that can reduce agitation, build rapport, and enhance patient cooperation.

Key Empathic Responses:

• Acknowledging feelings (“It seems like you’re in a lot of discomfort.”)
• Validating experiences (“I understand it’s frustrating to wait while you’re in pain.”)
• Normalizing emotions (“Many people feel overwhelmed in busy places like this.”)

Research shows that empathic communication improves patient satisfaction, reduces complaint rates, and enhances clinician-patient trust—even when outcomes aren’t ideal.

Empathy defuses tension because patients feel heard, not dismissed.

When managing an agitated patient, coordinated teamwork is essential. Communication within the team should be:

• Clear and closed-loop (confirming instructions to avoid misunderstandings)
• Role-specific (e.g., one nurse de-escalates while the other manages the environment)
• Pre-briefed if possible (anticipate responses and assign tasks)

Example:

• Senior nurse: Leads verbal de-escalation and patient interaction
• Junior nurse: Monitors surroundings, signals for help if needed, supports with calm presence

In a busy A&E, teamwork helps distribute attention and prevent the escalation of multiple competing stressors.

In emotionally charged environments, senior nurses model professional communication and confident handling of agitation. This mentorship serves as:

• Real-time learning for junior staff
• Confidence-building through guided participation
• Role-modelling of calm demeanor, patient-centered language, and leadership

Junior staff benefit from:

• Observing verbal and non-verbal techniques
• Being included in reflection after the event (debriefing)
• Gradual responsibility, with safe support

Mentorship turns stressful encounters into valuable learning moments.

a. De-escalation Theory (Calm–Connect–Collaborate)

• Calm yourself and the situation
• Connect empathetically with the patient
• Collaborate on solutions (involve the patient when possible)

b. Communication Models in Nursing

• SOLER (Sit squarely, Open posture, Lean in, Eye contact, Relax)
• PEARLS (Partnership, Empathy, Acknowledgement, Respect, Legitimization, Support)

c. The Therapeutic Relationship

• Centered on trust, respect, and genuineness
• Requires intentional use of self to engage patients effectively

Exercises:

Scenario Recap

A 55-year-old man with an injured leg has been waiting in a busy A&E department for several hours. He is visibly in pain and becomes increasingly agitated. The senior nurse approaches to speak with him while the junior nurse observes and supports from a distance. The environment is loud, crowded, and stressful.

“Pause for thought”

• What signs in the patient’s behavior would alert you to increasing agitation?
  (Think about verbal and non-verbal cues.)
• How might the chaotic environment contribute to the patient’s emotional state?
  (Consider noise, movement, lack of information, and physical discomfort.)
• What could the senior nurse say or do to demonstrate empathy while de-escalating the situation?
  (List specific phrases or techniques.)
• As the junior nurse, how could you assist while maintaining a safe and calm presence?
  (Think about your role in observing, preparing equipment, or calling for help.)
• If the senior nurse later debriefs the situation with you, what insights or questions would you bring up to learn from the experience?
• How would you adapt your communication style if the patient had a cognitive or language barrier?
  (Think about body language, tone, and simplicity.)