Managing Disruptive Patients _ ________________________________________________________________
be cautious and aware. Healthcare professionals should look around the area from the patient’s eye level so they can see what the patient sees. The safety of the patient and the staff should always be considered. The goal is to demonstrate no tolerance for the violence and to present the intervention as not punitive but an attempt to help the patient regain some self-control over violent behavior. Patients should be shown respect and allowed to maintain their dignity. The staff should know the patient’s name and use it. Healthcare professionals should use calming statements or phrases and always explain step-by-step to the patient what is happening. They should be firm and provide information on why the staff is acting the way they are. For example, if giving an injection, the healthcare professional should, for instance, tell the patient that the injection is intended to relax and calm the patient. While putting on restraints, the healthcare profes- sional should acknowledge that they may not be comfortable but that they will be removed as soon as possible. Providing these brief explanations will take away the unknown and, ideally, help the patient accept the interventions a little more calmly.
Healthcare professionals need to educate themselves on how to identify institutional policies that might put them at higher risk for workplace violence. They should learn how to recognize warning signs and behaviors and how to develop a workplace violence-prevention program. The Centers for Disease Control and Prevention offer a free online course, Workplace Violence Prevention for Nurses (https://www. cdc.gov/niosh/docs/2013-155/default.htmll). Developing an awareness of changes in the environment involves paying attention, intentionally. As both witnesses to and recipients of workplace violence, healthcare professionals can campaign this cause at their facility to increase the care and safety of all staff. The healthcare profession does not tolerate violence of any kind, from any source (American Nurses Association, 2021). The best way to deal with any patient’s violent behaviors is to defuse the agitation during the early stages of escalation. Healthcare professionals need to watch for early warning signs and try to avoid dangerous outbursts. When this fails, their own safety and that of other patients and staff members, as well as that of the patient, must be considered. UNFOLDING CASE STUDY: ERIK NILSSON’S HOSPITAL EXPERIENCE Erik Nilsson is admitted to a large general hospital for a surgical procedure scheduled for early the next morning. He is 68 years old and English is his second language. Although he can understand some words and phrases, his ability to speak in English is extremely limited. Erik is accompanied to the hospital by his daughter, Astrid, who can translate for Erik during the admission process. She tells Jackie, the healthcare professional conducting the interview, that her father lives with her and her family. Astrid says that she does not think he is especially worried about his surgery but did add that lately she has noticed that her father exhibited mood swings.
INTERVENTIONS FOR POTENTIALLY AGGRESSIVE BEHAVIORS
The role of the healthcare professional in the management of a patient’s aggressive behaviors will be found within the protocol, policy, or procedure manual of each institution, as well as in the scope of practice or mental health act of the state (Townsend & Morgan, 2017). Healthcare professionals need to remain nonconfrontational. A calm, quiet approach that acknowledges the patient’s anxiety and probable dislike of the situation will provide the best possibility of de-escalating the patient’s aggression. By acknowledging the patient’s feel- ings and providing the patient with an opportunity to talk, the healthcare professional establishes rapport and offers an opening for the patient to vent verbally rather than resorting to violence. Becoming aware of the potential of a violent episode before the situation escalates is a skill healthcare professionals should master. When a situation has arisen that requires inter- vention, healthcare professionals must carefully document all that happened, including any precipitating factors, attempted interventions, and the length of time it took to resolve the situation. Within this framework, the healthcare professional interventions in Table 2 may apply. HOLISTIC CONSIDERATIONS Healthcare is one of the professions where the incidence of workplace violence is particularly concerning to governing agencies such as the Joint Commission (2022), OSHA (2024), and, within the Centers for Disease Control and Prevention, NIOSH (2024).
Self-Assessment Quiz Question 1
What would Jackie’s best response be to this information? A) Make a note to ask Erik about his “mood swings.” B) Ask Astrid to describe what she means by “mood swings.” C) Tell Erik that Astrid said he had “mood swings.” D) Inform the doctor that Astrid reported Erik having “mood swings.” The correct answer is B. Rationale : While Astrid is available, it would be important for Jackie to get this information from her. Asking Erik directly about his “mood swings” and informing the doctor about what Astrid reported are actions Jackie could take later.
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