Understanding And Managing Aggression In Mental Health Patients

Understanding And Managing Aggression In Mental Health Patients

Adverse Impacts Of Restrictive Interventions

Incidents involving aggression and violence are frequent occurrences in an Adult Mental Health inpatient setting. These are managed utilizing restrictive measures, that are defined as deliberate acts by individuals which restrict a person’s movement, freedom and liberty to act with independence to take control over dangerous situations when there is a chance of harm to be imposed to the person or counterparts (Pelto-piri et al., 2020)Understanding And Managing Aggression In Mental Health Patients. Restrictive practices can include restraint, injection of sedatives, seclusion and constant observations. The behavioural change taxonomy includes innumerable techniques that can work as standards for initiating and reporting change interventions.  Adverse impacts of harmful practices can impose various risks on patients and staff in the healthcare setting. Safety is not a consideration in a clinical setting but poses the highest value. The study would recognize the adverse impacts of treating aggression in mental health patients through harsh restrictive interventions. The essay would also highlight alternative managerial techniques to mitigate aggression in mental health patients, instead of resorting to restrictive practices.

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People with mental health disorders can be dangerous to self, to others and towards property. It warrants emergency interventions by nurses and professionals in the clinical setting to use restrictive methods and restraint. Restraint should be implemented for policy matters under extreme scenarios, instead of being used as punishment (Mur-Cochrane et al., 2018)Understanding And Managing Aggression In Mental Health Patients. The management of concerning behaviour should be resolved through accurate interventions and induce reasons of safety, upholding human rights, while working in conjunction with evidence-based policies and collaborative research.

Mental health illnesses are caused by trauma derived out of neglect, abuse and violence, or genetic predisposition, excessive stress and biochemical imbalances. Restrictive practices remain widely used in international settings that is influenced by discrepancies in recording methods (Kinner et al., 2017). Containment involves brief physical holding of an agitated patient, continuous visual observations for staff to maintain uninterrupted visual contact with patients, physical escort in emergency situations are mediated (Laukkanen et al., 2019). Protective medical device, rapid tranquilization, and interventions that infringe the human rights of patients are observed to be implemented for curbing rash behaviour. However, principles of using restraint should ensure the dignity of patients, prevent violence, used for a minimum period, and appropriate actions undertaken by patient behaviour. Patients need to be monitored closely for tracing deterioration of physical conditions for prompt management that needs to be undertaken by trained staff (Townsend & Morgan, 2017)Understanding And Managing Aggression In Mental Health Patients.

Chemical restraints would use medications to restrain, differing slightly from therapeutic sedation which primary controls undesirable behaviour. Specially designed mittens are equipment in intensive care settings, and bed rails are used for stopping people from getting out of bed. Movement is often controlled through keys, keypads, and baffle locks as mechanical impositions. Seclusion places a person behind closed locked doors that prevent exits from the area. Psychological restraints include constantly disallowing people from doing things they intend to do, while depriving lifestyle choices (Vedana et al., 2018). It can also deprive patients of their possessions or rightful equipment.

Defensive practices are utilized in widespread settings of mental health by psychiatric nurses, where even nurses feel vulnerable (Turan & Kaya, 2019)Understanding And Managing Aggression In Mental Health Patients. Défense mechanisms in nursing can include compensations to make up for deficiency, regression or loss of emotional development and separation of sentiments from actions. The behaviours are often enabled to cope with anxiety and deal with aggressive mental health patients. Nurses face the need to employ direly protective mechanisms if the patients start posing danger to them. These behaviours are practices employed by nurses through two different typologies such as institution-protective strategies and self-protective strategies. The former uses strategic plans carried out for protecting a structure against the destruction of image or avoiding state admonitions while the latter includes practices performed for self-protection from litigation and negative judgements. It is suggested that these practices might be linked with regulated protocols for nurses as well as perceived lack of support in events generating adverse outcomes. The nursing of mental health requires skills to support patients for recovering using therapeutic evidence-based interventions. Priority for healthcare providers should be the use of coercion in facilities and the lowering of aggression. Proactive measures should anticipate the risks of violence to prevent aggression of patients towards the staff.

Alternative Managerial Techniques For Mitigating Aggression

Standardization for reporting behavioural change interventions importantly specifies mechanisms and content through which behaviour can be changed in patients and indicated (Chauhan et al., 2017)Understanding And Managing Aggression In Mental Health Patients. Various behavioural change techniques as alternatives can utilize the methods of role-playing, and verbal de-escalation, practices of social comparison and attainment of feedback on behaviour (NIHR, 2021). Identified behavioural change techniques encompass the cluster of setting goals, sharing knowledge, antecedents or factors that influence whether restrictive practices are avoidable. Feedback as well as monitoring the concerned outcomes like reduced restrictive practices is essential.

Induction of safety in nursing practices constitutes protection of patients from rising harm from various adverse events like medication errors, insufficient staffing, poor handover communication, and inadequate education on the introduction of new technology. In mental healthcare, discussion of the issues of patient safety is replaced often by the notions of risks (NIHR, 2021)Understanding And Managing Aggression In Mental Health Patients. It encompasses thoughts regarding the harms created by patients in the clinical environment including self-harm, suicide, aggression and violence.

Psychiatric inpatient settings envision patient risks to not only affect them but correspondingly also the ones responsible in catering to their well-being. As opined by Ellis (2019), the purpose of psychiatry is to keep everyone safe and should invaluably formulate necessary interventions based on clinical judgement. As argued by Slemon et al., (2017), mental institutions are created in a way of removing the individual connection to the outside world while developing an oppressive internal atmosphere encompassing an individual’s entire life. For instance, within mental institutions, inmates are monitored and observed continually, where they are given a very narrow margin of acceptable expression, that is not interpreted as synonymous to mental illness. These environments are characterized by surveillance where inmates tend to undergo mortification of autonomy, which is replaced with institutionally reformed behaviour (Kurchina-Tyson, 2017)Understanding And Managing Aggression In Mental Health Patients. Fear and stigma operate as primary forces to drive safety from madness and utilize rationalization for confinement.

Patients having mental health conditions are considered to be difficult. Nurses should not be judging patients based on their behaviour (Elayyan et al., 2018). On the contrary, care can be provided in respectful manner. Chronic health and traumatic issues trigger anxiety and depression, and medications can also make mental distress occur. Stress can necessarily activate HPA or the hypothalamic-pituitary-adrenal axis, controlling emotions and mood, while regulating bodily functions of immunity, digestion, and expenditure of energy (Baker et al., 2021). As nurses are in direct association with mental health patients, they act as best sources of information for implementing care for the patients. According to Dopeit et al., (2021) nurses are often apprehensively afraid of unknown patients who are not familiar with prior hospitalization and are deemed to be unpredictable. They can advocate the development of policies of funding for patients to have access to ongoing, affordable care, giving the necessary medications and therapy for the management of their mental illness. As opined by Wang et al., (2019), nurses can have a direct impact on generating a specific attitude from patients. If nurses are compassionate while delivering care, they would invariably improve the chances of successful patient outcomes. Nursing practices focus on supporting well-being. Empathy and assistance can be key factors for overcoming the stigma linked to mental illnesses.

Behavioral Change Techniques As Alternatives

Deinstitutionalization works to highlight nursing ethics through closure of asylums, and correspondingly the infliction of improved measures of informed treatment (NIHR, 2021)Understanding And Managing Aggression In Mental Health Patients. Individuals can be returned to their home communities for restoration of autonomy, and elimination of nursing practices incorporating punishment (Evans, 2017). If nurses fear aggression from patients, seclusion is utilized and it consequently reduces therapeutic engagement, while formulating unnecessary restrictions and cancelling out privileges. In the management of patient outcomes, therapeutic interventions are fundamental tenets for dramatically shifting the treatment standards and the experience of hospitalization in modern settings of healthcare, and require to be implemented. Nurses need to envision risk management strategies designed to uphold beneficial treatment. As per the WHO quality guidelines of mitigating seclusion and restrictive practices, working cohesively with mental health service users is important to understand their sensitivities, preferences and needs, for further being able to accommodate them (WHO, 2019). Improvement can be necessitated by continuous assessment of the practices that expectedly meet needs. Resolving conflictual situations should involve effective communication about the advantages and flaws of remedies with patients.

Primary prevention of violence in psychiatric inpatient care should aim to form a climate that helps in minimizing risks, for which the determinants of violence need to be imperatively understood (Cowman et al., 2017). As stated by Pelto-Piri et al., (2020) background factors leading to violent behaviour can be sorted into internal, external and contextual models. The internal factors deal with traits emanating from patient, external factors consider the environment, spaciousness, size of the ward, staff surveillance and so on, and situational factors highlight relationships occurring at the ward including staff-patient interaction. Multiple reasons can evoke a repelling and aggressive attitude from patients, after having gone through numerous stressors from the hospital, also known as flashpoints. Patients should be fundamentally understood initially as they have extreme deep-rooted causes for discontent. Nurses can communicate decisions amongst themselves to use collaborative techniques in places where the patient can get angry or exhibit displeasure. As opined by Akhter et al., (2019) the” Safewards model” suggests that staff can be able to prevent flashpoints from emerging at the first place, which would not induce hindrances to treating patients adequately. Staff would have to recognize the earlier signs that can lead to aggression and form de-escalation techniques (Slaatto et al., 2021)Understanding And Managing Aggression In Mental Health Patients. It also prevents the search for property or body without consent, and allows rapid tranquilization or seclusion to be exercised cautiously, only if deemed necessary, and ensures having respect for patient dignity. After having understood the aftermath of violent incidents that take place in the workplace, managerial practices need to be providing immediate support. Tertiary interventions of prevention would substantialize medical treatment, and induce measures like counselling or debriefing (Loeve, 2017). These can be designed for perpetrators, victims, staff and witnesses who remain inflicted by the incident. Nurses experiencing physical or verbal violence can experience enhanced job stress. Post-traumatic stress disorder prevails in psychiatric nurses to around 10% and can be directly linked to patient assaults (Nam et al., 2021)Understanding And Managing Aggression In Mental Health Patients. Both patient and staff perspectives need to be accounted for reduction of violence in mental healthcare settings.

Induction Of Safety In Nursing Practices

Contradictorily, as stated by Dinga et al., (2018) prediction of risks at an individual level can be frequently inaccurate, while at the population level, diagnostic and demographic factors need not be predictive. Continual use of patient factors can lead to promotion of stereotyping and improper intervention application.

Risk management policies are misapplied often to uphold the principle of safety instead of supporting wellness. However, as stated by Slemon et al., (2017) nursing patient care in psychiatric settings is grounded fundamentally in the concept of risk aversion. Therapeutic relationships should be centred around empathy, listening and time utilized in direct interactions as a primary treatment component. Nurses need to abide by the formulated theory of “protective empowering” where safety is not given a hierarchical position but acts as a crucial component in care alongside advocacy and therapeutic engagement (NIHR, 2021). After re-evaluation of risks, organizational shifts would be recommended for supporting shared responsibilities in upholding safety in the inpatient environment (Cooper & Cooper, 2018). Currently, as nurses and patients tend to view rules to be arbitrary and restrictive, effective development of unified guidelines can lend predictability and consistency of treating mental health patients. The internalized stigma around people with mental illnesses contributes to self-blame and dependence (Murr Cochrane et al., 2018)Understanding And Managing Aggression In Mental Health Patients. The focus should be mediated newly on re-integration of communities, recovery-oriented initiatives of mental healthcare and research into the efficacy of reducing conflicts due to aggression.

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Conclusion

Safety discourse has informed individual care for mental illnesses to be stringently utilizing institutionalization into modern psychiatric inpatient settings. Confinement has risen due to safety, out of fear for health safety, societal stigma and objectives to protect mental health patients from inflicting self-harm, or harming nurses in association with their care practices. Incidents of violence and aggression from mental health patients should be attributed to internal factors, and external factors which are although important would be easier to modify for evading pertinent risks. Restrictive practices which have been deemed to work more effectively than de-escalating practices have a reformed scenario in the present day. Nurses should fundamentally evoke empathy, formulate ways to therapeutically engage patients and resolve their inherent griefs through counselling. Additionally, managerial techniques to combat aggressive reactions would embody perseverance and benevolence on the part of the nurses. Understanding And Managing Aggression In Mental Health Patients