The incidence of aggression is all too common and most healthcare workers have experienced it at one point or another in their career. Nurses have a 3x higher risk for encountering aggression/ violence than any other health care worker and they have a 1 in 10 chance of being injured by a patient during their careers. (Delaney, J., Cleary, M., Jordan, R., & Horsfall, J. 2001)
The objective of both of the studies was to review current evidence for managing aggressive patients behaviors, and the definition that was used in both studies was: “aggression is defined as any verbal, non-verbal or physical behavior that was threatening to the self, others or property, or physical behavior that actually harmed self, others or property.” (Foster, C.,
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(Foster et al 2007)
In both the, Chloe foster, Len Bowers, and Henk Nijman and the Delaney, J., Cleary, M., Jordan, R., & Horsfall studies the aim of the study was to explore how nursing staff manage and identify aggressive situations. The Chloe foster, Len Bowers, and Henk Nijman study utilized data from a staff observation aggression scale, and the Delaney, J., Cleary, M., Jordan, R., & Horsfall study utilized surveys, focus groups, and an audit of aggression incident forms.
According to their findings, aggressive behavior in patients can be shown in several forms, from a patient yelling to a violent attack. The evidence shows that regardless of the type of aggression experienced, the effects on nurses are not only physically, but psychologically damaging, which can lead to increased stress, fear, increased absence and low morale in the nurses working in psychiatric units. (Bowers et al.
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(Foster et al. 2007).
According a study done by Delaney, Cleary; Horsfall (2001), prevention and management of aggression is priority and should be the focus for all nursing staff. According to the evidence, prevention requires special skills and knowledge that staff can learn to utilize to predict and prevent aggression in patients, and there needs to be a more organized approach to data collecting and patient assessment to really understand the extent of the problem of aggression.
Some of the important processes that are discussed in Delaney, Cleary; Horsfall’s study that help to manage aggression are: de-escalation skills, risk assessments, communication skills, and when needed, restraint skills. The study also mentions the importance of continued education and training for nursing staff in preventing and controlling violent
Because A&E often has difficult and violent patients, your manager has asked you to give these new nurses some guidance on how to deal with challenging behaviour that they may encounter.
In health and social care settings, aggression could often be the result of fear, frustration or stress; consequently resulting in barriers to effective communication. Therefore care practitioners should device strategies to overcome this barrier by dealing with aggressive behaviour appropriately. For example:
Safety is an important factor and is a high priority in healthcare. Kelly, Fenwick, Brekke, and Novaco (2015) shared that workplace violence impairs the staff perceptions of safety. However, both patients and staff are affected by workplace violence in many ways, from physical to emotional aspects. There are many reasons why violence occurs, that will be explained later in this paper. The purpose of this paper is to explain the reason and importance of the chosen phenomenon of interest. Moreover, primary and opposing philosophic viewpoints will be discussed, as well as ways of recognizing and utilizing them in nursing. The ways of knowing patterns in nursing and the utilization of these patterns will be explained, pertaining to nursing care.
A lot of aggression is created by anxiety, regularly in light of the fact that individuals feel powerless and out of control. Aggression here and there results from frustration. To overcome defusing aggression as a barrier of communication, health and social care expert ought to stay calm and breath typically at all times, this will demonstrate that they are not going to become aggressive. Another methodologies is, health and social care expert ought to utilize listening skills to demonstrate that they are using so as to consider the other individual important non-verbal aptitudes to convey regard. In particular, as a care worker they ought to dependably attempt to meet the other individual's self-regard needs, this is by attempting to make
Workplace violence commonly occurs between nurses, between nurses and patient, between nurses and families, or even between nurses and physician. Violence from relatives and friends of patients may occur as a result of frustration with a perceived lack of care or communication (Roche et.al. 2010). According to Woefle and McCaffrey there two consequences of violence (physical and psychological) for nurses and organization. Physical by the mean nurses can possibly experience weight loss, cardiac palpitation, stress, hypertension and irritable bowel syndrome. Psychological by the means of being mentally drain of nurses that can cause danger in giving a quality care.
A practice that has been put in place is the use of call buttons that are installed and easily available for the staff to use when dealing with escalating patients. Within this Veterans Affairs Hospital, the inpatient geriatric unit has at least 2-3 cases of patient-on-patient assault each month. For those that are very aggressive, this is currently being addressed by the use of one-on-one staff and antipsychotic medications. Clinicians are expected to be able to assess whether intervention is needed to protect other patients and staff from patients’ violence, to assess when patients pose a sufficient level of risk, and to assess when patients who have been hospitalized can be safely discharged to the community. However, surveys of practitioners suggest that many receive little formal training in violence risk assessment. (McNeil, et al. 2009) The limitations of formal training in risk assessment for violence suggested by such surveys underscore the need for education in this topic, hence the relevance of this educational training. Nurses on the front lines of care are ill-prepared to deal with this, hence the need for training. (Peek-Asa, et al.
The QSEN competences which are affected are the focus on patient safety and teamwork and collaboration. QSEN defines teamwork and collaboration as the “ability to function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care.” (Pre-Licensure KSA 's). QSEN defines patient safety as “Minimizes risk of harm to patients and providers through both system effectiveness and individual performance” (Pre-Licensure KSA’s). Failure to work with and collaborate with each other can break down morale and communication which in turn can negatively affect the patient. It is important to continue research and studying this topic, because the lasting effects of lateral violence can affect the health of the nurse and the patient long term and affect the revenue and budget of the hospital.
Hayward, Bungay, Wolff, and Macdonald (2016) performed qualitative interviews on twelve registered nurses averaging sixteen years of experience that represented diverse areas of acute care, to investigate the factors that contribute to turnover. Three themes that influenced the nurses’ decision to leave nursing were challenging workplace environments, limited leadership support, and personal health issues. (Hayward et al.) Furthermore, Hayward et al.’s theme of challenging workplace environments detailed the nurses’ insight on harassment, negative behaviors, and bullying that resulted in nurses’ impaired job performance. Wilson, Diedrich, Phelps, and Choi (2011) investigated the quantitative prevalence of incivility related to the intent to leave nursing by obtaining the results of surveys replicated from the American Academy of
The role and responsibility of the nurse can be overwhelmingly complicated. Professional nursing is a fundamental component of health care, as patients and families view nurses as the foremost caring and trusted member of the multidisciplinary team (Van Wagoner, 2016). Unprofessional practice creates a threat to patient safety and can impact of patients feeling unsafe physiologically, psychologically and culturally ("Disruptive and unprofessional behavior", 2014).
The time to aggression onset was the outcome variable. The data used to calculated change over time was the baseline observation data and the last know observation data collected. This information was used to calculate the linear slope in the study with regards to change. The observed baseline measurements included psychosocial variables, nonaggressive physical agitation, patient-caregiver mutuality and nonaggressive physical agitation. A time of event variable was the time to the beginning of aggression.
Furthermore, there has been increasing correlation of lateral violence to poor leadership or management. In response to this, the Joint Commission on Accreditation of Healthcare Organization created a new standard in the “Leadership” chapter that tackle disruptive and inappropriate behaviors (American Nurses Association, 2012). This “Leadership” chapter, will further aid in seeking and preventing lateral violence.
Effectively, interpersonal conflict was found to be one of the major sources of stress for nurses. Fudge (2006) affirmed overt and covert types of horizontal and vertical violence. Overt violence is obvious for everyone to see whereas covert is the complete opposite while still encouraging cruelty to one’s peers (Fudge, 2006). However, partnerships within health care settings may be declining due to the fact that some nurses may feel overworked and stressed. Jacoba Leiper (2005) stated that nurses are under pressure to complete their workload during their shift. Thus the nurse who’s having trouble completing her work on time, may skip breaks or stay late to avoid the ire of those on later shifts. But if she doesn’t take these steps and regularly fails to complete her tasks during her shifts, she may irritate her peers or take her anger out on her peers as well. Thus, the
This paper explores five published articles as they relate to the concept of Lateral violence (LV) within the nursing profession and how it directly affects the work environment. The concept of LV is also known as abusive behavior, horizontal violence, bullying, aggression, horizontal hostility, verbal abuse or “nurses eating their young”. There are four main themes that appear throughout the five articles. The negative effects that LV has on nurses’ health, moral and sense of worth. The negative impact that LV has on patient care and outcome. The negative impact that LV has on the recruitment
Some may perceive aggression as unhealthy and anti social but managed in a positive way can be empowering and enabling to individuals, groups and society as a whole.
The steps you chose for your protocol on aggressive patients was very thought out and made some excellent points. I honestly couldn’t find anything I would change on your protocol, so great job! I especially enjoyed the article you found by Clearinghouse (2015). Making sure to ask the patient how you can help him or her with their care definitely will make the patient feel more in control. In healthcare and specifically in mental health situations this needs to be done more in my opinion. Giving the patient choices and allowing them a sense of independence can really help improve an overall situation. If your protocol was to be implemented into a health care facility I believe it would absolutely help improve patient and nurse satisfaction.