NursingLink

Truly these things happen but working five years as a mental tech a few safety tips were learnt.

1)never turn your back to a mentally ill person

2)maintain your personal space

3)complete course in technices to aggression management.....know how to block

4)Never attempt care on a angry patient allow time out or get back up help ...wait until the patient is calm or willing to accept help.

5)never argue or prolong conversation with an upset schizophrenic patient they are unable to proceess when upset.

6)Be on your gaurd at all times even when the patient appear friendly.

7)Learn to be quiet and still at times(a type of ignoring) some attention seeking patient can become viloent the more attention they receive the more their behavior may escalate....give them quiet time.

Any abuse by a mentally ill patient towards a nurse or care giver is unacceptable and ways to manage this must be implemented however in the same light the nurse or caregiver must look upon the aggressive behavior of the mentally ill patient as part of the clinicdal behavior of a psychosis and this in effect render the patient innocent.

By examining the abusiveness of the mentally ill patient in this light then the nurse can be prepared for some kind of violent outburst towards them and be prepared how to deal with the issue and not become overly defensive.

It is imperitive both to the safety of the patient and the nurse that no retaliatery measure be presented. The mentally challenge person is already dealing with trying to find there way back to appropriate behavior and for them to be overly punished for the loss of controll will compound there difficulty.

Any nurse or caregiver working with the mentally challenged should be trained how to prevent aggressiona and  how to deal with the aggressive patient.

Measures should be taken to enforce to the patient that certain types of abusive behavior is unacceptabe measures include time out in seclusion, close monitoring and documentation of the behavior as to how many times it occurs and the trigger.

Psychiatric medical interventoin  and stimulus reduction as well as behavior modification training should be implemented.

It should also be noted that many times the mentally ill patient is hospitalized because of their aggressive behavior so this should not be too alarming if those behavior continue.It therefore means sufficiently trained staff and adequate manpower must be available at alll times to ensure safety to all involved. 

I was a CNA in an alzheimer's unit a few years ago.  We had a resident (pt) who at times could be very aggresive.  Our problem was on the night shift when the only staff in the building was a CMA and a CNA (me). The resident got very violent raising his fist to hit me and my coworker.  We had called the administrater as we were supposed to and she didn't want to get dressed and drive to work at the time (she lived 30 min. away).  She wanted us to put him on the phone (which he didn't understand) and  he once again swung his fists at me.  He finally calmed down and went to bed.  Later that week the same coworker was working with another aide at night.  They were both in the residents room to help him get dressed.  He was very calm at the time and then all of a sudden he punched her in the jaw.  This was a horrible situation for us to be in.  We had some training but no one to back us up.

HI raylynsky

This is indeed an interesting point should a mentally ill person be considered innocent after being violent to someone.

I dont even know how to answer this question I can only say to protect the patient....they might have to be considered innocent henceforth they would not be subject to retaliation by the staff.

Even if they were helg guilty it would not stop there behavior.....par t of mental illness is unwarranted aggression......however what might need to be distinguished is the behavior just bad behavior ...or is it a psychotic display whic is caused by a malfunction of the thought life.

then we might conclude that every incident of violent display by thementally ill  patient should be investigated and those whose behavior is simple out of bad behavior example spite or revenge should be punished those whom act upon there delusion could be considered innocent. 

RayLysykRN says ...

Please refer to the August 2008 issue of RN magazine, they have an article on violence---one of the statements that I agree with in the article is that "Ultimately, we would like to see all assaults on healthcare workers as a felony crime in all states".   I do not agree that a person should be held "innocent" because he is mentally ill. 

I am with you on that one Ray. There have been several articles on violence on RNs. I am going to see if I can find them and post here.

There has been an interesting "discussion" on Twitter, started by a Dialysis Tech (who is also a student nurse) regarding feeling unsupported by management when patient become violent with healthcare worker. There appears to be consensus from several nurses that it isn't uncommon to feel that management acts like it is the staff member's fault when a patient does this.

My psych nursing experience is confined to my psych rotation in 1972, so I didn't have much to contribute. On the other hand, I have had patients (non-psych diagnoses) act out, sometimes violently. I have never felt it was the healthcare workers' fault, nor did I hear anyone discuss feeling that way.

Your mileage, however, may vary!