Synopsis

This is focussed on a team debrief following a significant event on the ward. A delirious patient on the ward has just assaulted a fellow patient who he believed had been stealing from him. Staff attempted to de-escalate without success resulting in security being called. The ‘victim’ in this scenario has suffered minor injuries, with the ‘aggressive’ patient requiring restraint and sedation.

The Importance of Debriefing

Reflection and debriefing after incidents in healthcare are crucial for both patient safety and staff wellbeing. When something untoward occurs—whether a near miss, serious error, or emotionally difficult clinical event—structured reflection enables individuals and teams to identify what went well and what could have been done differently.

Debriefing promotes understanding of system-factors, communication breakdowns, workflow issues or latent risks that might otherwise remain hidden. It can reduce psychological distress among staff, help process emotional responses, prevent burnout, and foster resilience. Moreover, the insights generated can be fed back into practice to improve processes, refine protocols, enhance teamwork, and ultimately reduce recurrence of errors.

Methods of De-escalation

When healthcare workers face aggressive or agitated patients, effective de-escalation is vital to ensure safety while preserving dignity and therapeutic relationships. Methods include:

• Recognising early warning signs of agitation (e.g. restlessness, raised voice, pacing) so de-escalation begins early.
• Using calm, clear, and non-threatening verbal communication; simple sentences; avoid jargon; speaking gently and respectfully.
• Maintaining non-threatening body language: open posture, non-aggressive tone, keeping safe distance.
• Empathy and active listening: letting the patient express their feelings, acknowledging distress, which can defuse tension.
• Offering choices / allowing patient sense of control, giving options when possible.
• Environmental modifications: reducing noise, removing triggers, ensuring privacy / safe space.
• Clear limits: having boundaries about acceptable behaviour communicated in a respectful but firm way.

Discussion Points

• What is the purpose of debriefing? Who should be involved?
• What situations should we debrief after? Hot vs. cold debriefing.
• What is the intended focus of the debrief – staff welfare? Event and risk analysis?
• In what ways are we allowed or expected to intervene in incidents of patient violence/aggression e.g. can we physically restrain/grab patients to maintain safety of others/ourselves
• How should events like this be documented – can you name patients in other patients notes?
• In instances of delirium/dementia when patients clearly lack capacity, should police be involved in assault situations?
• What training/resources are involved in violence/aggression training?
• What training/resources are available in managing staff welfare following significant events?
• Methods of de-escalation

External Resources

• Violent and aggressive behaviours in people with mental health problems - NICE
• Group psychological ‘Debriefs’: Practice guidance for post-event team reflection (PETR) following distressing events at work