Transcript Chapter 28x
Preventing and Managing Aggressive Behavior, Chapter 28 Preventing and Managing Aggressive Behavior • Aggressive behavior • • • • • Assaultive Injuries Emergency services called to scene Increasing violence in society Increasing patient acuity Preventing and Managing Aggressive Behavior • Response to threatening situations: • Respond passively: Subordinate own rights to perception of rights of others • Respond aggressively: Ignore rights of others • Respond assertively: Self-assurance and respect for others Preventing and Managing Aggressive Behavior • Theories on aggressive behavior • Psychological • Predisposing life experiences that limits capacity to select nonviolent coping mechanisms • Organic brain damage, MR, etc. • Severe emotional deprivation, rejection in childhood, parental seduction • Exposure to violence in formative years as victim or observer Intergenerational Transmission of Violence (Stuart, 2013, p. 575) Preventing and Managing Aggressive Behavior • Theories on aggressive behavior (cont.) • Sociocultural • Cultural norms define unacceptable/acceptable behaviors • Biological • Limbic system, frontal lobes, and hypothalamus Brain Structures Implicated in Aggression (Stuart, 2013, p. 576) Preventing and Managing Aggressive Behavior • Neurotransmitters • Low levels of serotonin associated with irritability, overreacting to provocation, and rage • Impulsive arson, suicide, homicide: Low levels of 5-HIAA (breakdown product of serotonin) in spinal fluid • Other neurotransmitter associated with aggression: GABA, dopamine, norepinephrine, acetylcholine Preventing and Managing Aggressive Behavior • Expect aggression • Active psychotic symptoms • Substance abuse disorders • History of violence • Behaviors associated with aggression • • • • Motor agitation Verbalizations Affect Level of consciousness Hierarchy of Aggressive and Violent Patient Behaviors (Stuart, 2013, p. 578) Preventing and Managing Aggressive Behavior Nursing Interventions-assessment tool is Assault and Violence Assessment Tool (See Stuart text, p. 579) • • • • • • • Self-awareness Patient education Assertiveness training Communication strategies (verbal & non-verbal) Environmental strategies (comfort rooms, exercise) Behavioral strategies- (limit setting, time out, token economy) Psychopharmacology (examples next slide) Preventing and Managing Aggressive Behavior • Psychopharmacology examples for aggression: • • • • Antianxiety - Benzodiazepines: Lorazepam [Ativan]) Antidepressants (SSRIs) Mood stabilizers (Valproate, Lithium, Carbamazepine [Tegretol]) Antipsychotics (Haldol given with Ativan and/or Benadryl; Risperidone with Ativan) • Others: Beta-blockers, e.g., Propranolol Preventing and Managing Aggressive Behavior • Crisis response • • • • • • • Team: Show of force Identified crisis leader Notifications – (security) Move others to safe distance Leader uses calm, steady voice Follow leaders plan Debrief (staff and patients) Preventing and Managing Aggressive Behavior Containment Strategies – patient must be removed from any containment as soon as possible • Seclusion – involuntary confinement • Purpose: Quiet room with minimal furnishings to decrease stimuli or sensory input • Must have continual assessment, monitoring, and reevaluation • Always use least restrictive measures Preventing and Managing Aggressive Behavior Containment Strategies (cont.) • Restraint (physical or chemical) • Emergency intervention for safety when less restrictive methods have failed • Purpose: Protect patient from self/others • Must have continual assessment, monitoring, and reevaluation Preventing and Managing Aggressive Behavior Containment Strategies (cont.) • Chemical restraints • Medications used to restrict patient’s freedom • Emergency control of behavior Preventing and Managing Aggressive Behavior Debriefing • Team debriefs and discusses • Patient feedback • What helped the patient • What could have been done better • What to do different next time Preventing and Managing Aggressive Behavior • Employers have a duty to provide a safe and hazard free environment • A written plan is required by JACHO describing how security is provided to patients, staff, and visitors. • Nurses may be subjected to aggressive behavior and abuse from their nursing and physician colleagues (Stuart, 2013, p. 588) Preventing and Managing Aggressive Behavior • Horizontal or Lateral Violence • Aggression and intergroup conflicts • Verbal abuse • Intimidation • Bullying • Excessive criticism • Denial to career opportunities • Withholding of information Preventing and Managing Aggressive Behavior • OSHA guidelines for a safe workplace environment include: • • • • • Management commitment & employee involvement Worksite analysis Prevention & control Safety and health training Response plan Preventing and Managing Aggressive Behavior • Staff Development: • Education • What to do, what to say, who to notify, how to manage • Nursing interventions grounded in theory and current research • Pharmacological interventions • Crisis management Preventing and Managing Aggressive Behavior • Staff Support • Allow adequate time off after assault • Validation from others re: clinical competence and appropriate interventions can help in healing • Peer support group • use a nursing consultation support service for the victims of assault