Managing the Violent Patient

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Table of Contents

Introduction
Evidence-Based Solution
Erickson’s Modeling and Role-Modeling Theory
Comprehensive and Measurable Plan
Utilization of New Modalities of Scholarship
Conclusion
References

Introduction

One of the primary challenges that health personnel have to grapple with is dealing with violent inpatients. Violent patients attack health workers and put their lives in danger. In most cases, violence and aggression come as a result of psychiatric disorders (Ashcraft & Anthony, 2008). The complications include delusion, psychosis, personality disorder, and mania. On the other hand, some patients use violence as a means to accomplish definite objectives, like drawing the attention of doctors. Scholars maintain that prior to treating a violent patient, it is imperative to assess and establish the cause of violence (Ashcraft & Anthony, 2008). Some patients may behave violently due to organic causes such as stroke, sepsis, drug reaction or trauma. Besides, nurses should understand the history of a patient. Patients who suffer from epilepsy are likely to exhibit violent behaviors. Therefore, the first step in managing the violent patient should be conducting a general physical examination. This article will discuss the strategies for managing a violent inpatient.

Evidence-Based Solution

Medical professionals should strive to control their apprehension and disapproval in response to patients’ startling or weird behaviors. An apprehensive or antagonistic reaction to a patient can have adverse effects on the professional-patient correlation and hinder open communication (Bell, 2000). Besides, an anxious attitude may make it hard for a clinician to build a rapport with the patient. Doctors can control their antagonistic reactions to patients’ weird behaviors by appreciating that such traits are just precursors of an underlying sickness. Besides, health workers should exhibit calm deportment despite their degree of fear. A physician’s distress may intensify the patient’s agitation (Bell, 2000). A clinician may avert fear by encouraging an open dialog with the patient and identifying the dangerous behaviors of the patient. Patients use intimidating tactics when they develop a sense of helplessness. Consequently, clinicians should come up with a plan to decrease patients’ sense of vulnerability.

DiGiuseppe and Tafrate (2003) allege that scholars give limited attention to methods of aggression and anger management. They hold that medical practitioners use four methods to manage violent patients. The methods are cognitive-behavioral therapy, cognitive intervention, cognitive-relaxation, and stress inoculation method. Cognitive therapy is based on “a theory of emotional disorders, which holds that ongoing cognitive appraisals mediate emotions” (DiGiuseppe & Tafrate, 2003, p. 73). Duxbury and Whittington (2005) maintain that health workers can use cognitive interventions to manage violent patients. The interventions entail helping patients to stop focusing on matters that make them angry. Besides, cognitive response constitutes helping patients to think positively at all times despite their health conditions.

On the other hand, cognitive-behavioral therapy entails “identifying and modulating cognitive, behavioral and psychological responses to perceived provocation through various treatment techniques” (Duxbury & Whittington, 2005, p. 471). Fisher (2006) argues that nurses can manage violent patients by observing and comprehending their anger patterns. Understanding the factors that lead to patients getting violent may help the nurses to come up with adaptive alternatives to curb provocation. Health workers can use cognitive-behavioral therapy to mitigate symptoms and implement policies intended to help patients overcome anger. Cognitive-behavioral therapy contributes to managing violent patients, particularly women. Fisher (2006) maintains that women articulate their frustration and anger through self-destructive behaviors. The health workers take the advantage of passionate women who express their anger openly to develop mechanisms to resolve the prevailing challenges. They identify and deal with behaviors that make the women aggressive. Some medical practitioners apply “self-denigration and cognitive restructuring as strategies for dealing with anger” (Fulde & Preisz, 2011, p. 116).

Cognitive relaxation involves “training in progressive relaxation and relaxation coping skills, including deep-breathing cued relaxation” (Fulde & Preisz, 2011, p. 118). Health workers use a cognitive-relaxation approach to managing violent patients. They train patients in how to prepare for an angering incident. Equipping patients with skills to confront angering incidents goes a long way towards managing violent patients. Besides, medical professionals assist violent patients to face their worst challenges in dealing with anger. The professionals help violent patients to understand how they react to particular angering events and the difficulties they encounter. In the process, the medical professionals know the patients’ strengths and weaknesses in the case of an angering event, therefore capitalizing on the strengths.

According to Harris and Morrison (2004), medical professionals implement the stress inoculation approach in three stages. The stages are “cognitive preparation, skills acquisition, and application training” (Harris & Morrison, 2004, p. 207). Cognitive development entails identifying anger patterns. Cognitive development enables nurses to understand how frequently the patients get violent. The skills acquisition stage requires helping patients to espouse alternative strategies for dealing with irritant experiences. On the other hand, the application training involves encouraging violent patients to use alternative strategies when they encounter provocative incidences. Stress inoculation not only helps to control anger but also minimizes inapt expressions of fury. A study by Holloman and Zeller (2011) concluded that patients under stress inoculation treatment exhibit a considerable reduction in violence. The doctors endow patients with skills to handle and cope with stressful conditions, therefore managing violence.

Erickson’s Modeling and Role-Modeling Theory

Erickson’s modeling and role-modeling theory enable nurses to deal with individual patients based on their conditions and needs. The theory maintains that even though patients share common characteristics, they have multiple disparities (Holloman & Zeller, 2011). Health professionals can use the disparities to help individual patients. Besides, the theory holds that it is difficult for medical professionals to manage violent patients without building a rapport. The first step in managing violent patients is winning their trust. Besides, it is imperative to encourage constructive orientation among the patients. From Erickson’s modeling and role-modeling theory, it is evident that promoting patients’ strengths and setting standard health-directed objectives can go a long way towards managing violent patients. The theory emphasizes the importance of empathy. Nurses ought to show compassion when dealing with violent patients (Holloman & Zeller, 2011). Compassion helps to win the trust of the patients. Besides, clinicians should be open-minded and tolerant. Some violent patients are quite nagging. Consequently, it is hard for nurses to cope with violent patients unless they are tolerant. An open-minded nurse is versatile and eager to try different approaches to deal with violent patients. Being open-minded helps nurses to enhance the therapeutic relationship and avert violence.

Comprehensive and Measurable Plan

Medical professionals should take precautions when dealing with violent patients. They should ensure that they maintain an appropriate distance and respond to patients based on their body language (Knox & Holloman, 2012). The success of evidence-based treatment procedures depends on the ability of the nurses to establish a comprehensive and measurable plan. For instance, the nurses can develop a four weeks plan to manage violent patients. The first week would entail identifying the thoughts that provoke a patient. The week would culminate by creating a list of ideas and issues that make the patient violent. The second week would entail the formulation of psychological and behavioral responses. Besides, the nurses would spend the second week measuring anger-related mental arousal as well as anger frequency. The third week would involve training patients in how to cope with angering events. It would also entail examining how patients respond to different circumstances. The fourth week would involve evaluating and recording the anger patterns of the individual patients. The record can help to determine if a patient is responding to a treatment program. Besides, clinicians can use the record to establish the most appropriate treatment approach.

Utilization of New Modalities of Scholarship

Research indicates that psychoeducational programs go a long way towards managing violent patients. According to Tishler, Gordon and Landry-Meyer (2000), psychoeducational programs integrate some elements of cognitive-behavioral interventions and psychotherapy. The primary objective of the psychoeducational program is to educate patients about violence and make them understand how it affects their relationships (Tishler et al., 2000). Medical professionals can use psychoeducational programs to assist patients to contemplate on their actions and encourage them to report any possible violent behavior. Psychoeducational programs endow violent patients with skills to compose themselves even in the absence of medical professionals.

Conclusion

Patient violence is prevalent, particularly among people suffering from mental problems. Hence, it is imperative to establish an evidence-based treatment approach to managing violent patients. Clinicians can use diverse approaches to managing violent patients. They can use cognitive-behavioral therapy, cognitive interventions, cognitive-relaxation, and stress inoculation method. The objective of an evidence-based treatment approach is to identify and deal with factors that provoke patients. Showing empathy to violent patients may help to build a rapport and tolerate some behaviors. Tolerance is paramount in addressing violent patients.

References

Ashcraft, L., & Anthony, W. (2008). Eliminating seclusion and restraint in recovery-oriented crisis services. Psychiatric Services, 59(1), 1198-1202.

Bell, C. (2000). Assessment and management of the violent patient. Journal of the National Medical Association, 92(5), 247-253.

DiGiuseppe, R., & Tafrate, R. (2003). Anger treatment for adults: A meta-analysis review. Clinical Psychology: Science and Practice, 10(1), 70-84.

Duxbury, J., & Whittington, R. (2005). Causes and management of patient aggression and violence: staff and patient perspectives. Journal of Advanced Nursing, 50(5), 469-487.

Fisher, W. (2006). Restraint and seclusion: A review of the literature.” American Journal of Psychiatry, 151(1), 1584-1591.

Fulde, G., & Preisz, P. (2011). Managing aggressive and violent patients. Australian Prescriber: An Independent Review, 34(4), 115-118.

Harris, D., & Morrison, E. (2004). Managing violence without coercion. Archives of Psychiatric Nursing, 9(4), 203-210.

Holloman, G., & Zeller, S. (2011). Overview of Project BETA: Best practices in evaluation and treatment of agitation. Western Journal of Emergency Medicine, 13(1), 1-12.

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. Western Journal of Emergency Medicine, 13(1), 35-40.

Tishler, C., Gordon, L., & Landry-Meyer, L. (2000). Managing the violent patient: A guide for psychologists and other mental health professionals. Professional Psychology: Research and Practice, 31(1), 34-41.

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