_________________________________________________________________ Managing Disruptive Patients
• Use calming statements to lower the patient’s anxiety and decrease the likelihood of aggression. • Encourage the patient to talk things through rather than acting out. • Ask very simple, short-answer questions and not broad questions in these situations. • Anticipate potential problems. Have a plan for obtaining help from security and/or other staff members, as well as an escape route out of the patient’s room. • Know each patient’s history and current problems. Consider obtaining an order for medication to calm a patient who has a history of aggressive behavior (if this appears in the patient’s history or if the patient’s behavior suggests loss of control and emotional escalation). • Be alert to patients whose primary or secondary diagnoses are associated with a high degree of potential for violent occurrences (e.g., patients experiencing delirium or dementia, and patients with certain substance use disorders). Healthcare professionals should request a psychiatric consultation for any patient who demonstrates violent behavior. A thorough assessment is crucial in making a correct diagnosis so that appropriate treatment may be initiated (Halter, 2021). EARLY WARNING SIGNS Considering the source and target of the patient’s anger, as well as the likelihood of escalation, is important. Patients who are potentially violent are often demanding, argumentative, hostile, and perhaps challenging and blatantly threatening in all their interactions. This behavior may be directed toward staff members, other patients, or the patient’s family and friends, depending on the situation. Authority figures are often the recipients of verbal and other abuse, although anyone who is “in the way” may be the target of patients who cannot control themselves. A history of previous violence is the highest predictor of future violence. Patients who are at risk for violence often have a his- tory of recent acts of aggression or violence and might exhibit the following behaviors (NIOSH, 2024): • Becoming extremely loud, shouting, and making menacing verbal or physical threats. • Becoming physically tense and appearing rigid and tight. • Clenching their teeth and hands or wringing their hands. • Becoming quite agitated, anxious, and restless; pacing around if mobile; seeming quite jittery. • Exhibiting a labile mood but mostly anger.
In the U.S., home health care is the fastest growing industry, with a projected growth of 33% by 2030. A cross-sectional survey conducted by Small et al. (2023) found that home health care workers (HHCWs) are at increased risk for workplace violence (WV). Results from previous survey research
indicated the percent of home health care workers who reported exposure to any form of WV ranged from 2.5% to 65.1%. Non-physical aggression was most pervasive, with the highest percentage reported by HHCWs being 65.1% during a study that asked about their personal experiences of emotional abuse (e.g., name calling) committed by a client or someone else in the home. HHCWs reported concerns regarding safety as it relates to weapons in the home, neighbor- hood crime, and working evening shifts. For HHCWs, prevention should begin with risk assessments that include a patient history of violence and safety concerns in the patient’s home and surrounding neighborhood. Home health agencies should have adequate training for addressing workplace violence along with policies and procedures that address the growing problem of violence in healthcare (Small et al., 2023). PREVENTION AND EARLY DETECTION Healthcare professionals need to be aware of how they deal with patient anger. For example, becoming angry in response to anger will not be therapeutic and will create a situation in which the healthcare professional is unable to defuse a patient’s aggression. Such behavior will more likely intensify the patient’s emotions. Overly controlling behavior may lead to a power struggle with the patient. Simply withdrawing from an angry patient will almost always be ineffective. If the patient’s angry feelings are escalating, the patient is communicating loss of control and needs help regaining composure (Halter, 2021). Healthcare professionals should not overlook personal feel- ings of anxiety during an interaction with a patient. If their intuition gives them a message that a patient may become dangerous or that the situation may be getting out of hand, healthcare professionals should do the following: • Seek help early. • Use healthcare professional skills to establish and maintain a trusting relationship with the patient. • Conduct a thorough psychosocial and mental status assessment. • Be a good monitor of a potential crisis. • Pay attention to “gut” reactions. • Inform the patient that violent or aggressive behavior is not acceptable.
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