Using non-verbal communication to support de-escalation in patients experiencing acute psychosis in the emergency department

Emergency nurses are frequently the first point of contact for patients presenting to the emergency department (ED) with the symptoms of acute psychosis. Altered perception, fear and disorganised thinking can impair communication and precipitate distress, which may lead to agitation or aggressive behaviour, placing patients and staff at increased risk of harm. In these circumstances, verbal reasoning alone may be ineffective. Evidence indicates that non-verbal communication, such as body posture, eye-level alignment, proximity and tone of voice, can have a pivotal role in these situations by promoting calm and conveying safety, thereby preventing escalation to coercive or restrictive measures. Drawing on research and trauma-informed care principles, this article explores how emergency nurses can adapt Safewards interventions such as soft words, talk down and reassurance into effective non-verbal communication strategies in their practice. The authors provide guidance on embedding non-verbal de-escalation in routine ED nursing practice, highlighting approaches that are transferable to a wide range of mental health-related presentations and have the potential to improve safety, preserve dignity and strengthen therapeutic engagement in emergency care.