In the mental health setting, dealing with aggressive patients can be an everyday occurrence for nursing staff. Patient death or injury resulting from the use of restraint and seclusion is an increasing concern. Most facilities have a protocol to call for team assistance when a psychiatric patient begins to display aggression. Nurses often believe that there is power in numbers, which can be true in certain situations. However, the increased external stimuli of gathering staff members can also have untoward effects on the patient. The show of force may contribute to the escalation of combative behaviors.
If at all possible, non-coercive methods should be used to manage violent behaviour. The aim is to engage the patient in calming down and dealing with anger or frustration in a non-violent way. Techniques include de-escalation, time out, increased observation and support, and offering medication with consent, if indicated.
De-escalation
De-escalation, or talking down, involves the use of psychosocial techniques aimed at calming disturbed behaviour and redirecting the patient to a calmer personal space. The successful use of de-escalation techniques requires training and a sophisticated understanding of aggression and its management.
Developing good communication skills requires staff to be aware of and monitor their own non-verbal and verbal behaviour, for example body posture, eye contact, tone of voice, use of clear language, being at the same height as the patient, proximity to the patient, and avoiding reassuring touching of the patient, which may be experienced as provocative.
Time out
Time out differs from seclusion in that the patient voluntarily moves out of the aggressive situation to a less stimulating environment.
Observation
The primary aim of observation should be to engage positively with the patient
Restraint
If the more collaborative approaches fail or the situation is acutely dangerous, staff have to take immediate action to make themselves, others and the patient safe. This usually involves restraining the patient in some way, i.e. constraining their movement so they are unable to act violently. Restraining methods can broadly be separated into geographical restraint (moving the patient to a quieter place, a more secure ward or seclusion), physical restraint and chemical restraint (rapid tranquillisation). All should only be used as a last resort. Each of these interventions has rare but potentially fatal complications. The risks are increased by the high physical morbidity of psychiatric patients. However, avoiding these interventions altogether is not an option if serious injury to others is to be prevented.
Geographical restraint
Geographical restraint essentially involves moving the patient to an environment where they can more safely be managed. This might be a more secure setting such as a psychiatric intensive care unit or even a forensic unit, a less stimulating part of the ward or a seclusion room.
You can deal with aggressive patients by remembering some simple rules, but you should also consider how an aggressive patient impacts you emotionally. Nurses are harder on themselves than anyone should be, and you may expect yourself to “roll with” the abuse you regularly take from patients. This isn’t actually the case, and it can be quite detrimental over time.
--------------------------------------------
Follow us on Facebook
www.thefilipinonurse.net
The filipinonurse.net is always on the lookout for interesting stories about Filipino Nurses worldwide. If you know of a Filipino nurse who should be featured here, please feel free to send us a message via our Facebook Page.
0 Comments