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Aggression (Prevention (Medication/Sedation (Antipsychotics…
Aggression
Prevention
Assessment
Training
Warning Signs
Change Mood/Composure
Verbal abuse
Agitated behaviour
Threatening gestures
Abnormal activity levels
Staff limit setting
Broset?
Impulsivness
Observation
Safety/Dignity/Privacy
Patient Rights
Signs of agitation
Reduce Seclusion
Reduce Restraint
Mental State/Cognition
Prediction
Disagreement Patient/Staff
Keep Records hx violence
Risk Assessment Protocols
Reduced seclusion/restraint/sever aggressive incidents
De-escalation
Training
Communication/Positive Engagment
Calm/controlled manner
Interpersonal communication
reduced seclusion
Reduced Restraint
ADE
Ward Atmosphere
Patient Coherence
Subjective Safety
Breakaway
Lack of Evaluation of?
Unable to recommend particular training?
<Restraint proved?
<Violence to nurses not proved???
Need to use other prevention as well? Beyond Training
Environmental
Banning Smoking
Limit setting
medication
seclusion
Physical interventions
Strong/mitigating effect
Acoustic
Lighting
ergonomic
Internet Training
Fidelity
Automated documentation
Minimal supervision
Short term/follow up Improvement
Psychological distress
Confidence coping
Reduced levels of exposure/violence
Reduced Aggression
No effect/aggression
Reduce Staff Injuries
Refresher Taining
Bergen Model
City Model
Positive Appreciation of clients
Emotional regulation
Effective Structure
Items?
Causes of patient aggression
Ward Rules
Staff's emotional regulation
Early interventions
more positive violence prevention climate
Needs Policy
Who will be trained
Those most at risk?Axt
Level of training
When/frequency
Outline techniques
Verbal
Non verbal
restraint
seclusion/restaraint
Lack of evidence @ effectiveness/safety for managing violence
Avoided if possible
Seclusion (short) rv 2 hours
Reduces Violence
Appropriate/Measured/Reasonable
Medication/Sedation
Droperidol
No QT prolongation
Midazolam
Additional doses
Oversedation S/E
Zuclopenthixol
less forced injections
low doses
No rapid onset
Haloperidol IM
No rapid onset
No reduction of aggression
Antipsychotics
Small effect/aggression
SE/Use judiciously
Antipsychotic/Benzos
Effect/safety only classes studied?
Gold standard not known?
Lorazapam IM
equal to haloperidol IM
Lithium citrate
<evidence/Safety/effect
Im Flunitrzepam
NO reduciton of aggression
IM Haloperidol plus IM lorazepam
More rapid reduction in aggression
but amount of reduction was not significant
Recommended 145
dont mix in same syringe
IM Droperidol
More rapid sedation/compared with lorazepam
greater overall sedation acheived/compared with lorazepam
Alarm Systems
Personal/Institional alarms
Lack Evidence/alerts staff?
Need Policy
Risk Axt on use
Risk related to Environment/service user/staff
Decision Making
Patients/Carers
Negotiation/Team
Mutual agreement
Responsibilities assigned
Patient Satisfaction
Patients
Recognise Triggers
Care Plans
Relationship Building
Meeting Needs
Physical
Improved sleep
Reduced pain
Psychological
Conflict Resolution
Policies
Violence
Post incident Reviews
Behaviour Agreements
Reasons Why interventions needed?
Absenteeism
Sick Leave
Reduced Productivity
Reduced Job Satisifaction
Reduced Recruitment
Reduced Retention
Costs
Security costs
Litigation
Worker's compensation
Property Damage
Incidence Violence
Verbal Aggression
Reluctant to report
Normalised
Policy Response
Safety
Staff/Patient/Carer
<Nurse Health
Frequent Exposure
Training
short term benefits
Knowledge/skills
reduced stress
Reduce Risk/Duration violence
Security Guards
Assessment plus Seculsion/Restraint
Lower aggression
Locking ward doors
No Conclusive Containement Strategies
beyond seclusion/restraint/meds
Nurse Percepton/Aggression
Containment Method?
Psychological Therapies
Reduces violence short term
Risk Factors
Patient hx Interpersonal conflicts
Patients hx of requiring force
Psychotic Patients
weaker evidence
Younger patients
weaker evidence
Schizoaffective disorder
Personality Disorders
Drug/Alcohol intoxication
weaker evidence
Longer admission
hx previous aggression
Involuntary admission
Longer admission
Aggressor/victim same gender
Risk of suicide
weaker evidence
Combination/high risk
Alcohol/drug/hostility/paranoid/psychosis
Post incident Support
Verbal Aggression/threats overlooked
Psychological Injury overlooked
Physical injury prioritized
Young staff
Previous exposure to violence
Resilience program
Causes
Under staffing
Misunderstandings
Long waits for service