Introduction: Medical personnel are often exposed to different types of violence, mainly in the emergency or psychiatric wards. This may have physical, psychological, professional, social and financial consequences and, in turn, affect their attitudes toward patients. De-escalation techniques are recommended as a primary response to aggressive behaviour by patients. These techniques involve numerous intricate components, aimed at eliminating or reducing patient aggression and agitation. Purpose: To analyze the use of de-escalation techniques in the emergency treatment of aggressive or agitated patients. Methods: A descriptive literature review of 34 articles published between 2010 and April 2020, from the following databases: CINAHL, Medline and ScienceDirect. Results: De-escalation is an intricate web involving communication, self-regulation, evaluation, intervention and ensuring security. The main goals of de-escalation are reducing the potential for violence and injuries and reducing the need to restrain patients during interventions. In the acute escalation phase, it is important to adopt a clear, firm and authoritative approach towards the patient and to use objective scales to evaluate his or her level of agitation. De-escalation should be used before administering sedative agents and, in cases where it is necessary to restrain patients, both during and after restraint. The exact nature of de-escalation interventions must be subject to constant evaluation, dynamic reflection and regular identification of patient needs. Emergency and psychiatric personnel should be skilled in de-escalation techniques. Role-playing is recommended for this type of training. Tackling the issue of de-escalation should involve a holistic organizational approach encompassing interdisciplinary training of personnel, safety guidelines, strategies and active prevention of violence. Discussion and conclusion: A comparison between the theoretical frameworks and strategies for reducing violence within emergency departments and those for de-escalation techniques, in general, reveals many common features. Although evidence is lacking, we believe that employing de-escalation techniques in clinical practice would make medical personnel safer and improve patient treatment.
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