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Involve the patient in the decision making process. Maintain open palms and calming body language. Ensure you speak without emotion or show signs of frustration. Ensure safety to myself and staff and have security on standby if things escalate. Acknowledge the patients wants/needs and offer a 3 step plan to achieve the patients desires. Go into further details of the nicotine patch and ask reasoning around why the patient would prefer a ciggarette, incase there is an alternate reason they are requesting this. Try to deescalate the situation. If the patient is already stipulating that they are uncomfortable with a nurse/staff there, offer to replace this team member, with a female nurse or support worker so the patient feels more comfortable.

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I would have given her more time and space to self-regulate. The attendants were positioning themselves too close, putting themselves at risk of physical harm and keeping her in a heightened emotional state. They needed to step back and monitor her from a safe distance until she was calm enough to engage in a rational conversation.

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I would remain calm, and introduce myself. explain why I was in her room and what I was going to do. I would build rapport with her.

I would acknowledge her feelings, and actively listen to her.

I would let her know of the options we could give her to assist her with her cravings while we are getting to the bottom of why she is in pain.

I could see what she has been charted for pain relief and offer this to her.

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Introductions are first, asking the patient what brought them here today and what could you assist with? Next open the doorway its fairly obvious, yet just as easily overlooked that this person is clearly agitated or elevated and expressed feeling trapped by a staff member that simple act can ease tension. Acknowledge the patients' emotions, offer tissues when she beings getting upset and then providing space and time where the patient can observe me sitting and allowing her to take control of the situation and talk on her own terms. These simple gestures create a sense of trust, display a level of respect towards the patient, and foster a non-judgemental approach to providing care.

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Calmness, kindness and empathy will go a long way in this scenario. I believe the two men blocking the door was a triggering factor of this escalating situation, so potentially leaving the door open, bringing a calm energy and ensuring that both mine and the patients safety were considered. Establish rapport and acknowledge her vulnerabilities may be a positive enhancement here. If necessary, very subtly getting a colleague to call security to have them on standby may be required, however if the patient was adamant - respecting her decision and autonomy by having a cigarette may be reasonable given the context.

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I would ensure that I had introduced myself. I would remain calm and give clear instructions. I would ask for another nurse to enter the room due to the bias and ask the nurse that she was bias to to leave. I would acknowledge her concerns. I would give her the opportunity to review the options avaialable to her explaining clearly what she can ddo and how we can assist her. If she still didn't want help and wanted to go out for a smoke I would explain that smoking is not allowed on the hospital grounds and if she left she would have to wait again for treatment depending on other patients who entered while she was gone. I would also tell her that once we have assessed her stomach pain and addressed the issue that she would be able to leave and smoke if that was what she wanted to do. Providing education about the effects of smnoking when she had calmed down would also be helpful.

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I would first introduce myself, maintaining a safe distance and position myself so that I have access to a clear exit if required. I would speak in calm, non threatening tones and ask open ended questions, allowing time for the patient to process and answer. The patient may be feeling threatened by two male clinical staff (we don't know what the patient's social/emotional history is and whether there is previous trauma) therefore the introduction of a female staff member should be considered. Provide patient reassurance and work with the patient to agree on a plan that will help calm the patient and de-escalate the situation. If situation escalates further, I would remove myself from the room and notify the in charge nurse.

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The patient has already expressed a bias towards one of the nurses in the room. I would ask him to leave. In addition, having two male nurses who may be perceived as intimidating could be exacerbating the situation.

I may then sit on the adjacent chair in a non-threatening manner and, in a calm voice, try to build rapport with the patient. To do this, I would acknowledge her pain and her need for a cigarette and empathise with her. In this way, I could gradually move the situation away from the immediate tension and assess her needs.

I would offer a plan that addresses both her pain, which may be contributing to her agitation, and her need for a cigarette. I would include her in these discussions and ask for her input after establishing that I cannot immediately let her leave for a cigarette, but that we can work together to move forward and that I understand her anxiety.

In this way, I could offer analgesia, review the hospital’s smoking policy, and provide evidence-based information about what alternatives or support can be offered. Additionally, I would offer to contact a family member, or do this on her behalf, to help de-escalate the situation.

(proof read version )

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The Patents has already expressed a bias towards one of the nurses in the room, I would ask him to leave. In Addison to having two male nurses that were acting in a perceived intimidating manner were exacerbating the situation.

I may then sit on the ajusect chair in a non threatening manner and in a calm voce try to build a repour with the patinet. To do this I would acknowledge her pain her need for a ciggaret and empathise with her. In this way I could grtadualy move the situatin away from the immediate tention and assess her needs , Offer a plan that would address both her pain (possably attributing to the agitaion) and her need for a ciggette. I wopuld include her is these discussions and ask for her input after we have estabilished that I can not immedatly let her leave for a ciggartee but we can work together to move forward and that I understand her axiusness. In this way I could offer anagesigs and review the ssmoking polocy of the hospital and offer supported evidejce of what can be offered. Addsionaly I would offer to contact family memeber or do this on her bealf to help deescolate the situation.

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I would maintain a safe distance. I would introduce myself, using first names, and very briefly explain my role. I would monitor the patients body language, tone, volume of speach. Constantly assessing and reassessing the patients pain, comfort level. I would remain situationally aware, monitor if the patient is using any item for a weapon, reaching or walking towards specific items. I would avoid an escalation at all costs. I would try to gain the patients trust, ask if she has pain, discomfort, what else she if feeling. My focus would to deescalate the situation, by engaging the patient to trust me. Only discuss the patients condition and solutions to how to make her feel better. If my deescalation does not work, I would call Security

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I would keep the door open for my safety and for the patient, unless the patient is at risk of harm to themselves or others it's not necessary to keep them boxed in the room.

Knocking and asking the patient if for permission to come in and introducing self.

Remaining a safe distance from the patient

Acknowledge the patient and their concern

Reassuring the patient I want to help and suggest addressing the pain first and then address other needs.

Ask for informed consent before approaching or touching the patient.

If the patient is still escalated I would leave the room to allow the patient to calm down or ask if they would prefer another nurse to help

Inform security discreetly for assistance

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First I would introduce myself and explain my role. I would make sure the pt didn't feel boxed in by maintaining a safe distance and ensuring a clear exit if possible. I would use a calm, non threatening tone and ask open ended questions to encourage them to express how they are feeling. i would activitley listen, address the pt sign and symptoms, suggest a clinical solution such as a nicotine patch and pain relief and a doctor r/v. if pt escalates, i would remove myself from the pt environment and seek team leader advice and possible code black, document.

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staying calm non-threatening tone, keeping pt's and staff safe and yourself. working with the pt to make a plan by working it out together. addressing the nicotine withdrawal and pain. document call for assistance if needed.

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I would stay calm and speak kindly to the patient, acknowledging thajt she is upset because she wants a cigarette. I would explain hospital rules clearly and respectfully, offer support such as nicotine replacement if prescribed, and try to distract or comfort her while listening to her concerns. My focus would be to keep her safe, reduce her agitation, and maintain her dignity.

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Firstly I would consider the safety of myself, my peers and the patient. I would use de-escalating techniques to try and make the patient feel safe and try to provide a comfortable environment. I would address the nicotine withdrawal and pain she is experiencing.

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I would first introduce myself and let her know that I am listening. I acknowledge her frustration for not getting cigarette. Instead of saying everything getting to be fixed up, I would provide reassurance and tell her that we can work together on calming her. I would request her to explain what she is experiencing? pain, agitation, discomfort?Provide alternate options such as nicotine patch, message, breathing exercise. Make her comfortable and gain her trust to deescalate the situation.

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I would enter the room and introduce myself to the patient in calm voice with open posture. I would sit down and offer for her to sit with me or to remain however she is comfortable. I would not be getting to close to her personal space or blocking any exits. I want her to feel comfortable in my presence and not threatened.

I would then ask how I can help and address the pain that she is experiencing.

Lots of active listening would be used as well as non-threatening posture. The woman clearly needs to be heard and the health care team in the scenario continually spoke over the top of her which only lead to more frustration.

In these scenarios you need to remain calm and collected and continue to de-escalate the situation rather than escalate it.

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I would definitely be using de-escalation techniques to defuse the situation, whilst making sure myself and any other individuals are safe.

-Ensuring a safe distance and easy way out if needed. Definitely I wouldn't follow the patient around the room as this can be intimindating.

-Non-threatening posture; open posture, appropriate eye contact.

-Introducing myself and my intention.

-Repeating and rephrasing what I am saying to ensure understanding.

-Active listening and empathic responses; "It sounds like you are in a lot of pain, I would like to help you". Repeating what the patient is saying to show my understanding.

-Asking them what they want and what strategies that help them to calm down; food, tv etc, and providing these things to them.

-Offering positive solutions; 'the patient wanting a smoke', instead of offering patches when they are agitated, redirect saying things like "let's get your pain sorted first as you seem to be in a lot of pain". Then once calm explaining why they cannot smoke in the ward, and now offering alternatives like the patches.

-Not announcing security is coming as this would escalate them further.

-Not making promises you cannot keep; keep everything reasonable and true.

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I would start by introducing myself with open posture and sitting down rather than standing. Perhaps a female and just the one person would be less intimidating. Encouraging the patient to sit with me and definitely not blocking the exits. After things calm down a little then addressing the pain the patient is in.

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I would initial walk in with open posture, introduce myself and that i am there to help. I would take a seat, ask her to have a seat, and ask how i can help her today. Pacing around the door blocking it is not helpful and can make her feel unsafe. if she continues to be agresive or not listening, i would tell her that if she continues this behaviour that i would have to call security as i feel unsafe.

Once there is some calm in the room, i would address her pain. Using PQRST, and how it makes her feel. Get HX on how she normally deals with the pain, and talk about my concerns. And come up with some strategies etc.

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Initial approach should have had open posture, not crossed arms, and they should have introduced themselves and their intent to help her. Offer to sit with her vs standing and discussing by giving her a choice, 'Do you want to sit on the bed while I take this chair or do you want to sit in the chair?' Start the discussion by asking about her needs while acknowledging her distress, 'I wanted to ask you about this pain before you left, where exactly is it? Does it hurt more when you lie down or move about?' Express concerns for her own safety for her to leave while she is unwell, but not block the door, 'I want to address your pain before you leave the room, I don't want you to faint somewhere.'

Two men in the room was intimidating to her. Not sure if it was necessary for both to be there. They also did not introduce themselves or what their intent was.

The first response here is very comprehensive!

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Ensure Immediate Safety

Activate the duress alarm or call for assistance if there is risk of harm. Ensure other patients or staff are safe. Maintain my own safety: keep distance, avoid blocking exits, stay at eye level but not too close. Remove or secure objects that could be used as weapons.

Safety is always the first priority.

Use De‑escalation Communication

Approach with a calm, non‑threatening tone: “I can see you’re in a lot of pain and frustrated.” “I want to help you feel more comfortable.” “Let’s work together to sort this out.”

Key strategies: Keep voice low and slow, avoid arguing or correcting, use short, simple sentences, validate feelings without agreeing to unsafe behavior and maintain open body language.

Address Pain and Nicotine Withdrawal

Two major triggers for agitation here are likely: uncontrolled pain and nicotine cravings

As the RN i can: Assess pain using an appropriate scale, Administer prescribed analgesia, offer nicotine replacement therapy (NRT) (patch, gum, lozenge) if ordered or obtain a prompt medical order and explain that NRT can help reduce the urge to leave the ward. Which shows that you are addressing her needs, not just restricting her.

Set Clear, Safe Boundaries

You must be firm but respectful: “For your safety, you can’t leave the ward right now.” “I can help you with nicotine replacement, so you don’t feel like you need a cigarette.” and “We can talk about going outside once you’re medically stable.”

Boundaries should be: Clear, consistent, non‑punitive and focused on safety

Assess Contributing Factors

Once she is calmer, complete a focused assessment: Pain level, withdrawal symptoms, anxiety or fear, delirium risk, medication side effects and any other unmet needs (food, toileting, sleep)

Engage the Multidisciplinary Team

Depending on severity: Notify the medical officer, request security if behavior escalates, involve mental health liaison if needed and consider clinical review if behavior suggests delirium or acute deterioration.

Document all actions clearly and objectively.

Documentation

Record: Behavior observed, triggers, interventions used, patient response, team members involved and safety measures implemented

The use objective language (e.g., “raised voice”, “threw chair”, “pacing rapidly”).

Reflective, Person‑Centred Approach

Even in crisis, maintain dignity: Avoid shaming language, offer choices where possible, reassure him that your goal is to help and debrief with her once calm.