Table of Contents
Overview of Presenting Issues and Management----------------------------------------------2
Janet’s Mental State Examination----------------------------------------------------------------3
Three Potential Risks------------------------------------------------------------------------------5
Formulation and Hypothesis----------------------------------------------------------------------6
Significant Presenting Issues and their Intervention------------------------------------------7
Nursing care Plan----------------------------------------------------------------------------------10
References------------------------------------------------------------------------------------------12
Overview of Presenting Issues and Management
In the given case study, the patient has arrived at the emergency department in disturbed and agitated condition. She was silent however her expressions were reflecting as she was depressed. The bloody clothes were representing that she may have attempted suicide. Janet’s parents informed that they have noticed change in her behaviour from few months. She has lost her focus on work and studies and as a result left school. She becomes angry, agitated and violent when her family members try to ask questions or try to discuss with her regarding her health, hygiene or dressing. According to her parent she does not take meals which affected her health. Most importantly, she had broken a mirror by smashing with her hands and locked herself in her room before she came to the emergency department which shows her anger, violence and agitation that may be harmful for her and for others as well.
As far as management is concerned in regards to Janet and staff safety, it is very important to make the patient calm and relax first by focusing on the patient’s emotions instead of frightening them if patient still continues to be violent in the hospital. It is crucial to approach the patient with confidence that being a nurse I have acquired adequate knowledge and skills which are necessary for the identification, assessment and management of patients with mental illness. It is suggested that if nurses are confident about their role and support which they can provide then it results in better relationship formation with the patient (Clark, Parker & Gould, 2005). Initially, it is important to try to communicate with the patient clearly and directly however compassion is important. In order to avoid any mishap or accident due to patient’s agitated and disturbed situation, clinical environment surrounding patient’s bed should be free from things or instruments that can be broken or can be used as weapons. Safe surrounding environment can reduce the possibility of violence and would increase patient’s and staff’s safety. Together with that effective communication is required so that patient’s aggression can be minimized through empathetic and respectful communication (Judge & Bolton, 2013). Try to calm Janet with continuous talking so that her mind remains busy.
Tijanee M became self injurious, without warning she went to her room and placed a blanket over the door jamming the door for entry. Staff immediately attempted to open the door and was unable. Tijanee verbalized continuously she is going to kill herself tonight. The staff was able to gain entry to the Tijanee’s room with the use of the screwdriver. Tijanee was sitting on the floor with a sock tied her neck. Staff was able to provide emotional support and retrieve the sock from Tijanee’s neck. Tijanne began to pick at her recent sores until they were bleeding. Staff used kind gestures and hurdle help to calm Tijanee down. Tijanee was able to exit her room willingly and nursing was called for assessment.
As a healthcare professional, everyone that we encounter with is perceived differently and each patient is treated differently depending on what is needed. Horizontal violence, on the other hand, is considered to be subjective, meaning that the effects differ person to person. The effects of the person may grow if they are not addressed. One of the traits that all nurses, I believe, must have is to be able to work as a team. This trait regrettably can offset due to verbal abuse and other intimidating behaviors that can cause health professionals to refuse to share information needed to provide the best patient care. Communication between colleagues is needed because if does not exist this will again affect the patients care and their own safety.
The framework of this model is utilized throughout hospital settings to form a basis for all nursing decisions in respect to nursing diagnosis, care plans, discharge planning, and quality assurance (Reynolds & Cormack, 1991). This conceptual model focuses on the effects of internal and external environments that contribute to someone’s behavior. Pain (being the internal force) in patients with altered mental status usually manifests externally in non-verbal cues. Nursing as the external force can use tools that focus on the non-verbal cues given by the patients to accurately assess the pain and properly treat it.
Many registered nurses define horizontal violence differently because being a nurse they have seen many type of horizontal violence throughout his or her career. Horizontal violence defined as bullying or mistreatment of a group or individual physically, verbally and psychologically (Ahrens, 2012). Some examples that would be consider physical would be sexual misconduct. Verbal violence would be rude comments or cussing at one author. In addition, to psychological violence would include being fussed at in front of patients and or their families by a co-worker for doing something wrong and nurses purposely withholding information from another nurse, which causes patient’s needs not to be met. The horizontal violence in the work place puts lots of stress on nurses especially registered nurses (R.N.) . Nurses who tolerate horizontal violence tend to have depression, low self-esteem, missed days from work, become fatigued, burnout, causes hospitals, or clinics to have nurse ret...
This literature review is focusing on discussing the effects of seclusion and restraints on treatment consequences of patients in mental health area. Seclusion and Restraint are used for controlling the behavioral patterns of the mentally ill patients in different surroundings consisting of psychiatric management facilities and hospitals (Kentley, 2009). Over past decade, comprehensible consensus has come out that seclusion and restraints are secure interventions of last alternative and application of those interventions should and can be diminished significantly (Knight, 2011). However, recent studies indicated that it is traumatic for patients experiencing or witnessing restraint and seclusion traumatic; patients can feel high levels of anxiety, fear, and anger once aware that restraint is going to take place, sometimes it could resulting in an exacerbation of patient’s mental status (Stewart et al, 2010). Due to the humanitarian, ethical, and legal issues which could lead to, seclusion and restraints are known as the most controversial management strategies (Holmes, Kennedy & Perron, 2004). Previous studies and researches could not analyze this topic adequately; thus, further researches and studies related to the effects and risk managements of using seclusions and restrains will be discussed in below.
McNamara, S. A. (2012). Incivility in nursing: unsafe nurse, unsafe patients. AORN Journal, 95(4), 535-540. doi:10.1016/j.aorn.2012.01.020
The impact of aggression and violence in mental health units is substantial. Effects that have been documented include physical injury, emotional and psychological harm, compromised patient care, and financial expense to the organization. In a review of literature, physical injury to inpatient mental health staff is high and poses a strong threat to staff and other patients (Foster, Bowers, & Nijman, 2006). Although the rates of victimization that occur between patients are low, it is an increasing concern. In these acts of aggression, both verbal and physical violence can occur.
Patients Safety is the most crucial about healthcare sector around the world. It is defined as ‘the prevention of patients harm’ (Kohn et al. 2000). Even thou patient safety is shared among organization members, Nurses play a key role, as they are liable for direct and continuous patients care. Nurses should be capable of recognizing the risk of patients and address it to the other multi disciplinary on time.
The patient is a 78-year-old gentleman who is brought to the emergency room because of increasing confusion. Evidently the daughter has taken to the bank to get some money when the daughter try to assist him to put his money in his pocket he became aggressive and combative and began to swing at her with his cane and then walked off. She was the unable to find for approximately 4 hours. When he was found he was brought to the emergency room. In the emergency room the patient was placed initially in observation status. Despite being treated in observation with fluids he remained confused and somewhat aggressive and it was determined that the patient required acute inpatient hospitalization. His medical history is significant for hypertension,
In mental health context, it means that nurses should perform appropriate care to promote patient’s recovery and quality of life. To achieve these goals, nurses are required to conduct a compressive assessment, such as mini mental health assessment, risk assessment, assessing client’s thoughts, appearance and affect. Nurses also need to think critically regarding clients’ medication and their side effects. For instance, some antipsychotic drugs could affect many body systems. A holistic approach should be employed to gain the big picture of the patients. In addition, nurses have the responsiblility to report and raise any foreseeable safety issues to the clients, such as self-harm or suicidal thoughts. The incident rate of aggression in people with psychotic symptoms is high (Cornaggia et. al 2011). People with dementia may exhibit these challenging behaviours for many reasons. Nurses need to report these concerns in regards to the duty of care to the clients and to
Ever seen a nurse who is afraid to return to work? What about a nurse that comes home on crutches, has bruises, or even just comes home with an emotional break down? These are all results of workplace violence in a healthcare setting. It is a very real issue that is currently on the rise. This sort of violence can result from an angry patient, visitor, or even another nurse on a variety of units. Unfortunately, because the healthcare setting can become very hostile, nurses are always going to be at risk for violence. The only way to fight violence is to attempt to prevent it by recognizing the behavioral patterns that lead to a violent outbreak, redirect the person on the verge of a violent action, and ensure each facility has a prevention program.
A charge nurse working the night shift overhears loud talking coming from a nearby room within the unit. Upon locating the room where the noise is coming from, she recognizes that it is a patient with dementia who is becoming increasingly confused, agitated, and combative. The family member at bedside who is also the primary caregiver is trying to keep the patient in bed, and also appears quite frustrated. The primary nurse is in the room, but seems to be struggling with what to do. The charge nurse instructs the primary nurse to review the patient’s medications, and obtain the one used for agitation. The charge nurse then explains to the family member about using the medication, and suggests they take a break while other alternative methods are attempted. The charge nurse then dims some of the lighting within the room, begins to play relaxing music, and purposefully speaks in a very soft tone to the patient. The charge nurse continues to try to redirect the patient, but also understands that you must not argue the reality with dementia patients. The charge nurse proceeds with light massage to the hands, and feet of the patient, all while ensuring the patient that they are safe. The patient is showing less agitation, and the nurse soon arrives with the proper medication. The patient is calm and resting by the time the family member returns. Both the primary nurse and the family
Situations with violent and unreasonable patients can be very challenging and frustrating. I do agree that safety for both the nurse and the patient is a priority in any situation. It is always good practice to try to discuss and reason with the patient. Demshar tells us it is a good strategy to try to figure out what the patient’s needs and wants are and the level of their urgency. The nurse should also address concerns such as pain. I do agree that obtaining assistance from your resources is very beneficial. You may have a supervisor who has more experience in situations of this nature who knows additional techniques you may not have considered or can possibly identify something in your stance or behavior that may be trigger a response from
Individuals have varied coping mechanism when faced with conflict. The ED nurse chose to blame patient as the main source of conflict which prompt her to immediately call the security personnel and eventually send the patient out of the healthcare
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (Seventh ed.). St. Louis, Mo.: Mosby Elsevier.