Abstract
The scope of this report critically reviews a clinical incident in which unexpectedly violent patient behavior provided a safety threat to healthcare providers. The purpose is to place the situation within an academic framework to investigate current evidence of the required behavior of healthcare workers in this case. To do so, a field observation trial was conducted to document the patient’s violent behavior and to review published academic evidence that expands the understanding of the problem.
The analysis concludes that healthcare providers should prioritize their safety, refer to clinical safety services when necessary, and ensure that preventive, therapeutic care prevails over tranquilization in the long term. It is recommended that clinic staffing be expanded to incorporate a therapeutic patient care unit and that nurses be trained to deal with violent patients. Access to the security service is facilitated.
Introduction
This report describes an incident in the workplace where I performed my duties as an assistant acting nurse as usual. In the course of routinely examining patients and assisting with medication administration, we observed that a patient was behaving defiantly, shouting insults in our direction, and threatening physical harm for no apparent reason (Appendix A). The patient did not respond to any arguments from our side that he needed to calm down.
As a result, I decided to call the clinic’s security service, which forcibly subdued the patient. However, this situation showed that the safety of healthcare workers in such cases is not guaranteed, and drastic measures are needed. This report analyzes the situation in detail, describing the observational study results and recommendations for implementing changes in the security structure of the clinical facility. Thus, this paper aims to evaluate the incident that occurred in terms of further actions to improve the corporate welfare of nurses and their assistants.
Findings
The behaviors observed during regular interactions with the patient were characterized as deviant and providing a threat to my and my nurse’s safety. Research reports that healthcare workers are, on average, five times more likely to engage in dangerous workplace behaviors than workers in other industries (Pitts & Schaller, 2019). Tosswill et al. (2023) showed that up to 98% of healthcare workers are exposed to some degree of workplace violence.
Pitts and Schaller (2019) include any biological (brain abnormalities), psychosocial (stress and psychiatric disorders), and external (side effects from medications or drugs) factors as the leading causes of deviant patient behavior. Among other reasons for violent behavior, researchers cite an increased propensity for aggression from patients with psychiatric disorders, age-gender characteristics, and dissatisfaction with treatment (Caruso et al., 2021; Gabbey & Raypole, 2022).
One of the most influential and popular ways to limit the deviant behavior of a violent patient is the use of biochemical sedative injections (Tosswill et al., 2023). Dunsford (2022) points out strong measures that health care providers’ duties of care are not limitless; hence, in case of danger to the nurse’s well-being, there is a need to modify standard behavior with prioritization of personal safety. Prakash et al. (2021) expand on these findings and indicate that the use of tranquilizers is not an effective strategy in the long term as it only addresses symptoms of aggression; preventative therapeutic support is required to provide quality care even before conflict escalates.
Discussion
The observational field study conducted, combined with the results of the review of academic sources, allow several conclusions to be drawn regarding the incident. First, it is necessary to identify the preliminary reasons for the patient’s rowdy behavior in the ward and use them as a stimulus to provide therapeutic support (Pitts & Schaller, 2019; Prakash et al., 2021). In the case of aggressive patient behavior, the patient is hardly likely to make contact, but the practical point is not to bring the patient to this state. It is possible that the incident was a consequence of inattention to the patient and his needs on the part of the medical staff, which means that it is essential to pay more attention to each of the patients.
Secondly, suppose a patient behaves aggressively, jeopardizing the health and safety of the healthcare providers. In that case, there is no need to sacrificially help such a patient at the risk of themselves (Dunsford, 2022). If permissible and possible, coercive tranquilizer medication should be used to calm the violent patient. If not possible, clinic security should be contacted and act only after the threat to safety has been eliminated.
Conclusion
The scope of this report described a clinical incident in which a patient’s rowdy and aggressive behavior posed a safety threat to the nurse, me, and her assistant. The research showed that there are boundaries to the responsibilities of healthcare workers in such incidents, and it is only appropriate to assist the patient if it does not endanger the worker’s life. It was found that assistance can be coercive medication and tranquilizing, but such methods have no long-term practical impact.
Beneficial help involves facilitating and supporting the patient before his aggression escalates through therapeutic assistance. The difficulty with such a strategy, though, is that it requires more resources, whether it be time to discuss their needs and irritants with each patient or the number of staff able to spend time doing so. It is also worth noting that incidents of violent behavior against healthcare providers are not uncommon, which means that there is a need for a qualitative change in response practices for violent patients.
Recommendations
Based on the findings, it is acceptable to make recommendations on how to inhibit the violent behavior of patients in the future and how to create a safe environment for healthcare workers to perform their professional tasks. First, it is suggested that a psychotherapeutic department be established in each clinic, with specialists dedicated to the mental well-being of patients and preventing an escalation of aggression. Second, it is necessary to ensure quick access for medical workers to the security call button because in moments of violent behavior by a patient, speed of response is essential. Third, it is recommended to provide training, both group and individual, for healthcare workers to learn how to deal with violent patients and to prioritize their safety in such incidents.
References
Caruso, R., Antenora, F., Riba, M., Belvederi Murri, M., Biancosino, B., Zerbinati, L., & Grassi, L. (2021). Aggressive behavior and psychiatric inpatients: a narrative review of the literature with a focus on the European experience. Current Psychiatry Reports, 23, 1-12. Web.
Dunsford, J. (2022). Nursing violent patients: Vulnerability and the limits of the duty to provide care. Nursing Inquiry, 29(2), 1-6. Web.
Gabbey, A. E., & Raypole, C. (2022). Aggressive behavior: Understanding aggression and how to treat it. Healthline. Web.
Pitts, E., & Schaller, D. J. (2019). Violent patients. Europe PMC. Web.
Prakash, J., Yadav, P., Chatterjee, K., Chaudhury, S., & Srivastava, K. (2021). “SHAANT BHIM”: A simple algorithm for management of violent patients. Industrial Psychiatry Journal, 30(1), 1-3. Web.
Tosswill, H., Cabilan, C. J., Learmont, B., & Taurima, K. (2023). A descriptive study on the use of restrictive interventions for potentially or actually violent patients in the emergency department. Australasian Emergency Care, 26(1), 7-12. Web.
Appendix A
Field Observation Description
When I heard a man screaming from the room, I immediately alerted the nurse to it, and together we ran to the patient. The patient was in a highly agitated state, he had turned his bed around and thrown all the items from his bedside table to the floor. When the patient saw us, he started screaming even louder and saying that he hated the clinic and its staff and that no one could help him. The nurse and I tried to intervene and calm the patient down, but this only irritated him more. At a certain point, the patient grabbed a chair and swung it at us, which could be seen as a threat to our own safety. While the nurse tried to continue to calm the patient down, I radioed security. The security guards arrived one minute later and curled the patient up, forcibly placed him on the bed, and the nurse sedated him.
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