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153 Containment Strategies (Outcome Measures (Acceptablility of treatment,…
153 Containment Strategies
special observation
de-escalation
if aggression evolves in a predictable and orderly manner
opportunities for health care professionals to intervene
Short term approach
Communication Theory
observe for signs of anager
approach in calm control manner
Provide choices
avoid confrontation
Therapeutic use of nurse's personality
and relationship with client
Behavioural Contracts
Longer-term approach
Social learning theory
appropriate behaviours are positively reinforced
Inappropriate behaviours ignored or have negative consequences
discharge from care or loss of privileges
Clear delineation of responsibilites
Mutual negotiation
Sparse literature
In use for 30 years
Locking doors
Manage staff patient ratios
Increased staffing is required
Non pharmacological approaches are not suported by evidence
1/20 aggressive incidents/patients
Financial implications
Psychological consequences
Suicidal pts
Want to harm others
Danger to staff or other pts
Over-stimulated by environment
Acutely confused
Sexually disinhibited
Prone to abscond
Maintain safety
Therapeutic Environment
Physical restraint
Seculsion
Containment
intensive supervision/medication
Isolation
Reduction of sensory stimuli
Alone in a locked room
What is the evidence to say seclusion is traumatizing?
How is this trauma being measured?
How does this trauma compared to physically harming oneself or others?
Ethical/legal/humanitarian concerns
No explicit methodology
Sometimes the only way to prevent a serious escalation in aggression
People diagnosed with severe mental illness
Dementia/Depression/substance abuse analysed separately
Outcome Measures
Death, suicide, or natural cuases
Acceptablility of treatment
Asking participatns
Clincal response
see long list of outcome mesures 153
RCT are possible to use to study aggression prevention