Академический Документы
Профессиональный Документы
Культура Документы
PRACTICE
& SKILL
Authors
Nathalie Smith, RN, MSN, CNP
Cinahl Information Systems, Glendale, CA
Tanja Schub, BS
Cinahl Information Systems, Glendale, CA
Reviewers
Darlene Strayer, RN, MBA
Cinahl Information Systems, Glendale, CA
Eliza Schub, RN, BSN
Cinahl Information Systems, Glendale, CA
Nursing Practice Council
Glendale Adventist Medical Center,
Glendale, CA
Editor
Diane Pravikoff, RN, PhD, FAAN
Cinahl Information Systems, Glendale, CA
February 7, 2014
Published by Cinahl Information Systems, a division of EBSCO Publishing. Copyright2014, Cinahl Information Systems. All rights reserved. No
part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information
storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information
given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.
Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206
Flaring nostrils
Rapid respiration
Position yourself between the patient and the door so that you can leave the room if the patient becomes violent
Stand at least two arms-lengths away from the patient to stay out of his or her reach, and to reduce the chance that the patient will feel threatened
Never turn your back on a potentially violent patient. Continually facing the patient allows you to constantly watch and evaluate the patients behavior, and
to move to protect yourself if the patient becomes violent
If the patients behavior becomes unmanageable, call the facility security staff. Talk with the treating clinician about whether a psychiatric consultation should
be arranged for the patient
Update the patients plan of care, if appropriate, and document the encounter in the patients medical record including the following information:
Date and time of the encounter
An objective description of the patients angry behavior, including key statements verbatim using quotation marks around exact verbiage
Times and the names of mental health workers and/or other clinicians contacted about the patients anger and/or problem behaviors, and whether/when
they came to see the patient
Patients response to the encounter
Any unexpected patient events or outcomes, interventions performed, and whether or not the treating clinician was notified
Patient/family member education, including topics presented, response to education provided/discussed, plan for follow-up education, and details regarding
any barriers to communication and/or techniques that promoted successful communication
Red Flags
Never perform a clinical procedure on a patient who is angry, as this increases both the risk that the patients anger will escalate and that you will be injured
Procedures involving physical touch and close proximity to the patient may be perceived by the patient as threatening
If the patient experiences pain during the procedure, he or she may respond with intensified anger and perhaps physical violence
Procedure materials and equipment such as scissors may be used by the patient to inflict injury on you or another person
Note
Recent review of the literature has found no updated research evidence on this topic since previous publication on December 14, 2012
References
1. Communicating with difficult patients. (2013). Lippincott's nursing procedures and skills. Retrieved January 24, 2014, from http://procedures.lww.com/lnp/view.do?
pId=792087&s=p
2. Fundamental procedures. (2009). In J. P. Kowalak (Ed.), Lippincott's nursing procedures (5th ed., pp. 56-59). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
3. Jeffrey, D., & Austen, S. (2005). Adapting de-escalation techniques with deaf service users. Nursing Standard, 19(49), 41-47.
4. Luck, L., Jackson, D., & Usher, K. (2007). STAMP: Components of observable behaviour that indicate potential for patient violence in emergency departments. Journal of
Advanced Nursing, 59(1), 11-19.
5. Luck, L., Jackson, D., & Usher, K. (2009). Conveying caring: Nurse attributes to avert violence in the ED. International Journal of Nursing Practice, 15(3), 205-212.
6. Mller, J., Hallqvist, J., Laflamme, L., Mattsson, F., Ponzer, S., Sadigh, S., & Engstrm, K. (2009). Emotional stress as a trigger of falls leading to hip or pelvic fracture. Results
from the ToFa study: A case-crossover study among elderly people in Stockholm, Sweden. BMC Geriatrics, 9, 7.
7. Saleeby, J. R. (2012). Communication and collaboration. In A. G. Perry, P. A. Potter, & W. Ostendorf (Eds.), Clinical nursing skills and techniques (5th ed., pp. 19-23). St.
Louis: Elsevier Mosby.