The Four S Model in action for de-escalation. An innovative state hospital-university collaborative endeavor

In this article, the Four S Model is presented as a working clinical framework for generating structured nursing interventions and treatment plans. The de-escalation process, formalized by the De-escalation/Alternative to Restraint Flowsheet, is one way in which the model is being operationalized to reduce seclusion and restraints. As shown by the flowsheet, the model allows for integration of mental health and mental illness. It spans the scope of nursing practice at all levels, from para-professional to advanced practice nurse, by integrating the mental health concepts of communication, leadership, clinical judgement, critical thinking, and caring within its framework. Most important, the flexibility to individualize treatment that is built into the model allows for generalization to all psychiatric presentations.