When assessing your patient, what history is important to obtain?-hx of violence (exposure)
-comorbid disorders (c/t)
-coping skills (? capability of recovery)During assessment, what are you observing and asking about?-Observe for expressions of anger and anxiety
-Determine patient's perception of the issue
-Discuss willingness and capacity to learn alternative ways of handling angerWhy do we use a questionnaire?To identify things that upset them, how they respond, and how they want to be treated.What is the number one indicator of risk for future violence?History of violenceWhat are some other factors that put someone at risk for violence?History of violence
Delusional, hyperactive, impulsive behavior
Male gender, 14-24 y/o
Low socioeconomic status
Inadequate support system
History of prison time
Limited coping skills
Limit setting by the nurseWhat are some predictors of violence?-Hyperactivity (restless, pacing)
-Increasing anxiety and tension (banging on table. Clenched jaw/fists)
-stone silence
-verbal abuse
-drug/alcohol intoxication
-possession of a weapon
-milieu charactristics conducive to violenceWhat are some Nursing Dx's related to violence?Ineffective coping
Risk for self-directed violence
Risk for other-directed violence
AnxietyWhat are the 3 stages of the Violence Cycle?-Preassaultive stage
-Assaultive stage
-Post assaultive stageYou have a patient who is in the pre-assaultive stage. What are some interventions you can use to prevent the situation from moving to the assaultive stage?-Analyze patient and situation
-Use verbal techniques of de-escalation
-Demonstrate respect for patient's personal space
-Interact with the patient
-Invest time in the process
-Pay attention to the environment
-Assure your safetyWhat are some proactive things that are done to ensure staff safety against violence?-Attend annual staff training
-Ensure enough staff for backup
-Arrange furniture and eliminate obstacles
-Avoid wearing dangling earrings, necklacesWhat are some things you can do during patient interaction to keep things as calm as possible?-Avoid 'show of force
-Stand off to the side of the patient, encourage patient to sit
-Implement de-escalation
techniques
-Avoid verbal confrontation
-Provide adequate personal space
-STOP & GET HELPIf you are confronted by someone with a weapon, what will you do to attempt removal?- acknowledge that you are afraid
-assume patient is in control
-move slowly/maintain eye contact
-ask patient to put the weapon on the floor
-push emergency/panic button & get outWhat are some de-escalation techniques used to calm someone down?remain calm
identify stressors and stress indicators
be honest and assertive
establish what patient considers to be his/her need
be goal oriented
maintain a large personal space
offer several, clear options
use verbal/nonverbal communication skillsWhat are some Nursing Interventions implemented during the assaultive stage if a patient becomes violent?apply restraints
administer medications
move to seclusionWhat are the medications used when intervening with a patient who is becomes violent?- antianxiety agents (benzodiazepines)
i.e. lorazepam (Ativan)
- first-generation antipsychotics
i.e. haloperidol (Haldol)
- second-generation antipsychotics
i.e. risperidone (Risperdal)
- third-generation antipsychotics
i.e. aripiprazole (Abilify)When are restraints used?Used as a LAST RESORT after all alternative interventions are exhausted.If a person is in restraints, do they need to be a 1:1?YESWho should we avoid use of restraints on?Patients w/ history of self harmHow long should someone be in restraints?Limit time in restraints/seclusionIf assault occurs, there is a critical incident debriefing for the staff. What is discussed/evaluated?- staff analysis of the episode of violence
- evaluation of quality care provided to the patient
- examination staff's response to the patientAfter an assault situation with a patient, the patient is also debriefed. What does on during the debriefing?*Review of incident with patient
- to 'go over' what has occurred
- to allow pt to learn from situation
- to identify the stressors that precipitated the out-
of-control behavior
- to plan alternative ways of responding to stressorWhat behaviors by the nurse helps assist in controlling the patient's level of anger?-Understand and meet patient's needs
-Clear and concrete communication
-Use distraction
-Keep promises
-Consistent interactions with healthcare teamWhat helps control agitation for patients with cognitive deficits?-Reality orientation
-Medications
-Orientation aids
-Simple, predictable, comfortable environment
-Validation TherapyWhat is validation therapy?Reality Orientation first
if reality orientation is unsuccessful
- repeat some of what patient has said
- reflect what you perceive is the underlying feeling
- continue to talk about the topic
- redirect
- provide parting reinforcer
- provide orientation only if patient requests it
