Managing the Violent Inpatient

It is stated that a number of mentally ill patients behave aggressively with nurses and react inappropriately to doctor treatment and diagnoses (Bowers, Stewart, Papadopoulos, Dack, Ross & Khanom, 2011). Violence in nursing from the patients’ side is a frequent cause, and nurses have to learn how to manage inpatient violence in a proper way because the relation between violence and mental disorders remains to be a significant pattern with a number of peculiarities (Rocca, Villari, & Bogetto, 2006). The studies have proved that violent behavior among patients has a serious and clear ground because the conditions of mentally ill people are hard to control, and they have nothing to do but express their feelings and emotions through aggression and violence that negatively influences medical care conditions (Petit, 2005). In addition, some researchers identify aggression as the only available means for patients to defend themselves against the activities that they can hardly understand (Psychiatric Nursing, 2015). Unfortunately, aggressive people usually ignore the rules and demands other people set. Their violence cannot be legally explained or supported as well as punished. This is why the identification of aggression and violence characteristics and the description of the process of managing this kind of behavior turn out to be crucial topics for discussions in many countries, where professional treatment of mentally ill people takes place officially.

Psychiatric Nursing (2015) defines anger “a strong uncomfortable emotional response to provocation that is unwanted and incongruent with one’s values, beliefs or rights” (para. 2). As a rule, anger is considered to be a reason for patient’s aggression against the medical staff. Patients may demonstrate physical or verbal types of aggression. Some studies identify a cultural aspect of aggression and explain that health care competency should be appropriate in regards to the cultural backgrounds of patients previously discussed with mentally healthy members of the patient’s family (Spencer, Stone, & McMillan, 2010). However, the development of aggressive behavior depends on not only the cultural, gender, or age differences. Violent inpatients can hardly recognize their personal traits or cultural characteristics being treated in specialized medical institutions, this is why more attention should be paid to how this kind of behavior is managed by professional nurses. The question about if nurses have a right to restrain violent behavior or not and what methods can be used bothers many people. Such writers like Duxbury and Wright make an attempt to give an answer in their work and offer several ideas on how to deal with violence and aggression among inpatients and what steps may be taken to decrease the level of stress among nurses, who have a direct relation to violent inpatients. A therapeutic philosophy of care is explained in the light of chemical restraint like rapid tranquilization, physical restraint as one of the last chances to solve the situation (Duxbury & Wright, 2011), or verbal interventions (Psychiatric Nursing, 2015).

The results of current investigations show that the development of sensory approach in special rooms for seclusion and restraint (Champagne & Stromberg, 2004) is another effective idea for implementation. These rooms promote a possibility to spread the idea of seclusion and restraint by means of different activities like watching relaxing video with fishes, listening to classical music, or playing games (Champagne & Stromberg, 2004) in case other interventions remain to be ineffective (McGann, 2011). Patients get a chance to change the environment and use some other form of demonstrating their emotions or attitudes to treatment. If the mental condition of a patient is too poor, the sensory room turns out to be a good way for a nurse to think about another method of treating this patient. Nurses should not forget about the required balance between the rights of patients to avoid any form of restraints and the rights of patients and nursing staff to be in safe (McGann, 2011). However, when the time to deal with an aggressive patient come and the situation is hard to be controlled, a nurse should put the safety concept at the first place. Managing violence inpatients cannot be controlled all the time, this is why, the evaluation of the possible urgent situation and adequate reactions have to be done beforehand (Knox & Holloman, 2012). Workplace violence is a dangerous hazard that requires certain abilities to be regulated in time (McPhaul & Lipscomb, 2004). The development of certain prevention programs is also another way of regulating violence among inpatients (McPhaul & Lipscomb, 2004). With the help of such programs, nurses learn how to reduce injuries among patients and nurses, react to unexpected changes in patient behavior, and get ready for any form of violent behavior at any time.

As soon as the evaluation of aggression behavior is done and the most appropriate nursing intervention is chosen, certain attention should be paid to the way of how nurses may survive the outcomes of inpatients’ aggression. Nurses turn out to be another group of people, who are in need of certain help and improvement of their emotional and physical conditions. Some nurses get frustrated with their inabilities to evaluate the condition of a patient beforehand in order to escape violence and take some precautionary methods (Simon, 2011). Nurses have to understand that their task is not only to decrease the level of aggression in a patient. It is also necessary to provide patients with a possibility to calm themselves (Richmond, Berlin, Fishkind, Holloman, Zeller, & Wilson, 2012). Not all patients are able to comprehend their true abilities, and nurses have to powerful and mature indeed to help patients without “helping” them.

Violent behavior and the necessity to manage are concepts that cannot be neglected by a nurse. The treatment has to be chosen in regards to the patient’s mental and physical conditions, the nurse’s abilities and experience, and the surroundings. Though inpatient aggression continues to be a serious problem in many institutions (Rocca et al., 2006), a variety of solutions like a sensory room promotion (Champagne & Stromberg, 2004), tranquilization (Richmond et al., 2012), or environmental manipulation (Petit, 2005) are offered and explained from different perspectives. Patients deserve the right to be treated in the most appropriate way, and nurses have to respect these rights considering their own safety at the same time. It is not an easy task, and the researchers like Duxbury & Wright (2015) or Simon (2011) underline the importance of management violent behavior recognition and nurse awareness of how to help patients and themselves avoid violence and injuries. Professionalism in nurses is a vital issue that has to be demonstrated while managing violent inpatients and understanding aggression from a pure theoretical point of view. The point is that violence and aggression among patients should be understood not only in practice. A theoretical approach and identification of their main characteristics are also helpful steps in the process of managing the violent patient by a professional nurse.

References

Bowers, L., Stewart, D., Papadopoulos, C., Dack, C., Ross, J., & Khanom, H. (2011). Inpatient violence and aggression: A literature review. Web.

Champagne, T., & Stromberg, N. (2004). Sensory approaches in inpatient psychiatric settings: Innovative alternatives to seclusion & restraint. Journal of Psychosocial Nursing and Mental Health Services, 42(9), 34-44.

Duxbury, J. & Wright, K. (2011). Should nurses restrain violent and aggressive patients? Nursing Times. 107: 9. Web.

Knox, D., & Holloman, G. (2012). Use and avoidance of seclusion and restraint: consensus statement of the American association for emergency psychiatry project BETA seclusion and restraint workgroup. WestJEM, 13(1), 35-40.

McGann, E. (2011). The sensory room: An alternative to seclusion and restraint. MedScape. Web.

McPhaul, K. M., & Lipscomb, J. A. (2004). Workplace violence in health care: Recognized but not regulated. Online Journal of Issues in Nursing, 9(3), 7.

Petit, J. R. (2005). Management of the acutely violent patient. Psychiatric Clinics of North America, 28(3), 701-711.

Psychiatric Nursing (2015). Nursing management of aggression. Web.

Richmond, J., Berlin, J., Fishkind, A., Holloman, G., Zeller, S., & Wilson, M. (2012). Verbal de-escalation of the agitated patient: Consensus statement of the American association for emergency psychiatry project BETA de-escalation workgroup. WestJEM, 13(1), 17-25.

Rocca, P., Villari, V., & Bogetto, F. (2006). Managing the aggressive and violent patient in the psychiatric emergency. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 30(4), 586-598.

Simon, R. I. (2011). Patient violence against health care professionals. Psychiatric Times, 30(4), 586-598.

Spencer, S., Stone, T., & McMillan, M. (2010). Violence and Aggression in Mental Health Inpatient Units: An Evaluation of Aggression Minimisation Programs. HNE Handover: For Nurses and Midwives, 3(1).