Most Patients With Mental Health Disorders Are Not Aggressiv ✓ Solved

Most Patients With Mental Health Disorders Are Not Aggressive

Most patients with mental health disorders are not aggressive. However, it is important for nurses to be able to know the signs and symptoms associated with the five phases of aggression, and to appropriately apply nursing interventions to assist in treating aggressive patients. Please read the case study below and answer the four questions related to it. Aggression Case Study Christopher, who is 14 years of age, was recently admitted to the hospital for schizophrenia. He has a history of aggressive behavior and states that the devil is telling him to kill all adults because they want to hurt him.

Christopher has a history of recidivism and noncompliance with his medications. One day on the unit, the nurse observes Christopher displaying hypervigilant behaviors, pacing back and forth down the hallway, and speaking to himself under his breath. As the nurse runs over to Christopher to talk, he sees that his bedroom door is open and runs into his room and shuts the door. The nurse responds by attempting to open the door, but Christopher keeps pulling the door shut and tells the nurse that if the nurse comes in the room he will choke the nurse. The nurse responds by calling other staff to assist with the situation.

Sample Paper For Above instruction

Introduction

Understanding the progression of aggression in patients with mental health disorders is critical for psychiatric nurses to ensure safe and effective interventions. Recognizing the signs and phases of aggression enables nurses to intervene appropriately and de-escalate potentially violent situations. This paper analyzes a clinical case involving a 14-year-old patient with schizophrenia exhibiting aggressive behaviors, emphasizing the phases of aggression, preventive strategies, de-escalation techniques, and the considerations associated with restrictive interventions.

Identification of Aggression Phases: Initial and Final States

In the provided scenario, Christopher initially exhibits hypervigilant behaviors, pacing, and self-talk. These signs suggest that he is in the provocation or triggering phase of aggression, where patients begin to show warning signs indicating heightened agitation (McLaughlin et al., 2014). His hypervigilance and pacing indicate increasing tension, which can escalate if not addressed promptly.

By the end of the scenario, Christopher is in the acting-out phase of aggression—specifically, a burst of violence. His behavior transitions into actively resisting the nurse’s attempt to enter his room, and he verbally threatens harm if approached. His physical actions—shutting the door and threatening to choke the nurse—indicate he is in the outburst or violent* phase, where overt aggression and threatening behaviors occur (Vander Wal & Levitt, 2014). The evidence supporting this includes his physical movement, verbal threats, and refusal to allow the nurse entry.

Preventive Interventions to Halt Escalation

Preventing escalation hinges on early recognition and intervention during the initial phases of agitation (Ogunsiji et al., 2012). Strategies that could have prevented Christopher’s escalation include:

• Environmental modifications: Providing a calm, low-stimulation environment to reduce triggers for hypervigilance.
• De-escalation communication: Engaging Christopher with a calm, empathetic tone, offering reassurance, and actively listening to his concerns.
• Behavioral cues monitoring: Staff observing early signs of agitation and addressing them before they intensify, such as prompting relaxation techniques or distraction.
• Medication adherence support: Ensuring that Christopher’s medication compliance issues are addressed proactively to prevent symptomatic exacerbation.

Implementing these interventions early can mitigate the risk of escalation into violence and promote a safer environment for both the patient and staff.

De-escalation Strategies for the Active Aggressive Stage

When a patient refuses to open the door and displays threatening behavior, nurses should utilize de-escalation techniques tailored to the situation:

• Maintain safety: The nurse, recognizing the risk of harm, calls for assistance to ensure safety in numbers and support.
• Use a calm demeanor: The nurse should speak in a calm, non-threatening tone, avoiding confrontation or sudden movements.
• Set clear boundaries: Communicate expectations assertively yet empathetically, such as “I want to help you, but I cannot do that if you threaten me.”
• Offer options: Provide choices that empower the patient, like choosing to speak outside the door or sit in a designated safe space.
• Redirect focus: Engage him in a distraction or grounding activity to divert attention from aggression.

The primary goal is to establish trust, reduce perceived threat, and encourage voluntary compliance, thus de-escalating the aggression without physical restraint.

Guidelines for Using Restrictive Interventions

If non-verbal de-escalation fails, and a restrictive intervention such as restraint or seclusion becomes necessary, it is vital for nurses to adhere to strict guidelines:

• Legal and ethical compliance: Follow institutional policies and state regulations, ensuring interventions are justified, proportional, and used as a last resort (American Psychiatric Association, 2017).
• Informed consent and documentation: Clearly document the circumstances, behaviors, and steps taken leading to restraint or seclusion, including efforts at de-escalation.
• Minimize duration: Restraints and seclusion should be maintained only as long as necessary to ensure safety, with continuous monitoring of the patient’s physical and psychological well-being.
• Monitoring and assessment: Regularly assess vital signs, skin integrity, and psychological state during restraint or seclusion.
• Post-intervention debriefing: After the restraint is discontinued, debrief with the patient when appropriate, and involve multidisciplinary teams to review circumstances and improve future responses.

Strict adherence to these protocols ensures safety, respects patient rights, and promotes therapeutic rapport.

Conclusion

Proper management of aggression in psychiatric settings requires an understanding of the phases of aggression, early intervention to prevent escalation, effective de-escalation techniques, and strict adherence to protocols when restrictive interventions are necessary. Recognizing warning signs early, employing calming strategies, and respecting patient dignity are essential components of safe psychiatric nursing practice, particularly with vulnerable populations such as adolescents with schizophrenia.

References

• American Psychiatric Association. (2017). The psychiatric assessment in the management of aggression. American Journal of Psychiatry, 174(4), 393-399.
• McLaughlin, D., Lyddy, F., Ronan, K., & et al. (2014). Recognizing the stages of aggression in mental health patients. Journal of Psychiatric Nursing, 25(3), 140-147.
• Ogunsiji, O., Peters, K., & Wilkes, L. (2012). Strategies to prevent aggression in psychiatric settings. Nursing Standard, 26(3), 35-42.
• Vander Wal, J. S., & Levitt, J. M. (2014). De-escalating aggressive behaviors in mental health settings. Psychiatric Annals, 44(1), 23-29.
• Johnson, S., & Wood, A. (2018). Protocols for restraint and seclusion in psychiatric care. Nursing Times, 114(2), 45-49.
• Chow, S., & Van Culm, H. (2015). Early warning signs of aggression in mental health patients. Australian & New Zealand Journal of Psychiatry, 49(9), 828-834.
• Krauss, B., & Silverstein, H. (2017). The management of violent and aggressive behavior in the psychiatric setting. Emergency Medicine Clinics of North America, 35(3), 739-753.
• Fernandez, A. M., & Walden, L. (2019). Ethical considerations in the use of restraint and seclusion. Nursing Ethics, 26(2), 529-536.
• Stewart, R., & Wright, J. (2020). De-escalation techniques to manage aggression in mental health patients. Mental Health Practice, 23(8), 24-29.
• Lee, K., & Mason, T. (2021). Patient-centered approaches to managing aggression. Journal of Psychiatric & Mental Health Nursing, 28(4), 514-521.