Lecture 7a: Stress, Crisis, and Trauma: Other-Directed Violence and De-Escalation

mental health notes Lecture 7A: 2/10 Stress, Crisis, and Trauma: Other-Directed Violence and De-Escalation Anger, Aggression, and Violence Epidemiology & Etiology of Violence Causes & Signs of Feeling Unsafe Anger Epidemiology Hospital wetting Emotional response to frustration of desires, threat to one's emotional/physical needs, or a challenge Aggression Action or behavior that results in verbal/physical attack Violence Objectionable act that involves intentional use of force that (has potential to) results in injury to another person Feelings Triggering Anger In the hospital, violence is most frequent in: Psychiatric units Po;er dynamic bet;een a pt and healthcare provider Emergency departments Previous history/eRperiences ICUs: High-stress, coming oG sedation Leing surrounded by others Neriatric units: Beurocognitive disorders wigns Lody language. shunting Etiology Liological factors: Physical signs (eR1 increased H5) Areas of the brain: ximbic system, amygdala, prefrontal corteR Amygdala: 5elated to fear response Potential Comorbidities whame, pain Beurotransmitters: T-HD, SA, NALA Posttraumatic stress disorder (PDwS) Inadequacy Predisposition: Nenetics or neurological development AnRiety, depression 5ejection wadness Dhreat, vulnerability Psychological factors: Lehavioral theory: xearned response wubstance-use disorders (wUS) Psychosis, personality disorders wocial learning theory: Imitating others Short-Form Buss-Perry Aggression Questionnaire (BPAQ-SF) Risk Factors History is the best predictor of future violence Violence Risk Assessment Pts ;ho are delusional, hyperactive, impulsive, or predisposed to irritability Soes the pt have a ;ish or intent to harmW Pts ;ith a history of limited coping skills, including lack of assertiveness or use of intimidation Soes pt have the means to carry out the planW Semographics "ale gender Ages = -8 years xo; socioeconomic status Soes the pt have a planW Assess self for personal triggers and responses likely to escalate pt violence Assess personal sense of competence ;hen in any situation of potential con2ict. consider asking for assistance of another staG member Hospital 5isk actors Niven enough provocation, I may hit another person I often ?nd myself disagreeing ;ith people At times, I feel I have gotten a ra; deal out of life Dhere are people ;ho have pushed me so far that ;e have come to blo;s I can't help getting into arguments ;ith people ;ho disagree ;ith me Inadequate support system Prison time wcale: = M very unlike me. T M very like me Crisis Prevention and Intervention uality of nurse-patient relationship wometimes I 2y oG the handle for no good reason Other people al;ays seem to get the breaks In the conteRt of limit-setting by the nurse I have threatened people I kno; Verbal De-Escalation of an Agitated Patient "y friends say that I am some;hat argumentative 5espect Personal wpace I have trouble controlling my temper I ;onder ;hy sometimes I feel so bitter about things 8 arm's length minimum Lody a;areness of both you and the patient I sometimes feel like a po;der keg ready to eRplode eR1 je;elry/clothing, kicking distance, etc1 Consideration for potential past trauma 5espect request for more space So Bot Le Provocative Bon-threatening stance Pharmacological Interventions 5ecogniQe escalation early and oGer PO medications If I" medications are required: zT and 8z "ind your body language Haldol T mg, Ativan 8 mg injection 5emain calm wome also add benadryl T mg (LT8) So not humiliate. be respectful xong-term tR for the underlying condition Establish Verbal Contact Seclusion & Restraint Used as a means of last resort ;hen a pt is at risk of harm to self or others 7hen other less restrictive means have been tried Only one person should verbally interact ;ith the patient Introduce yourself Commitment in Virginia Le polite. use calm tone of voice Emergency Custody Order (ECO) ERplain your role, z"y job is to keep you and the other people on this unit safez Le Precise whort sentences. simple vocabulary Persistently repeat your message to clarify whort-term (up to 4 hours) order that a magistrate issues to compel a la; enforcement oFcer to take an individual ;ho meets certain criteria into custody for further assessment 5elates to the severity of mental illness Demporary Setention Order (DSO) Allo;s a person to be hospitaliQed for 08 hours ;hile the team treats and assesses ;hether the pt meets the criteria for involuntary commitment Suring this time, a hearing must be held to determine ;hether continued tR is ;arranted