Managing Safety and Providing Care for an Emotionally Distressed and Aggressive Patient

QUESTION

You are a new nurse who just started working on a med surg floor. You are  assigned to Elijah, a 53 year old male patient who is a new amputee. His wife,  Daisy, states that ever since he learned he needed to have his left leg amputated  (above the knee), he has become hostile, depressed and angry, often going in  and out of various emotions. Unfortunately, this means that he has started to  become emotionally abusive to Daisy, his healthcare providers and care takers.

Additionally, his chart shows that he has a recent history of attacking another  nurse. After Daisy leaves, you go and meet your patient. The second he hears  that you are approaching, he immediately starts cursing and screaming for  you to leave him alone. However, you know it is time for a new set of vitals and  dressing changes. As you continue to approach him, you see him grab a book  and attempts to throw it at you. As the nurse, what do you do next? What are  all the steps you would take to ensure you are safe prior to greeting Elijah, during  the encounter and after? How can you help your patient safely

ANSWER

Managing Safety and Providing Care for an Emotionally Distressed and Aggressive Patient

Introduction

As a new nurse on a med surg floor, encountering a patient with emotional distress and aggressive behavior can be challenging. Elijah, a 53-year-old male amputee, is displaying hostility and anger following his recent amputation. This behavior has led to emotional abuse towards his wife and healthcare providers, including attacking another nurse. As the nurse assigned to care for Elijah, ensuring safety is of utmost importance during all interactions. This essay outlines the steps to ensure safety before, during, and after encountering Elijah, while also addressing ways to provide care and support for the patient.

Before Greeting Elijah

Review Patient’s Chart: Familiarize yourself with Elijah’s medical history, including recent incidents of aggression and any triggers that may provoke his behavior. Be aware of any documented communication techniques that have worked previously.

Seek Assistance: Inform other healthcare team members about Elijah’s behavior, so they are aware of the situation and can offer support if needed.

Protective Gear: Wear appropriate protective gear, such as gloves and gowns, as a precautionary measure to protect yourself during dressing changes.

De-Escalation Techniques: Equip yourself with de-escalation techniques and crisis intervention training to handle aggressive behavior effectively.

During the Encounter

Maintain Distance: Approach Elijah with caution, maintaining a safe distance to avoid physical harm.

Use Calm and Empathetic Tone: Speak in a calm and reassuring tone, expressing empathy for his feelings and frustrations.

Acknowledge Feelings: Validate Elijah’s emotions and let him know that you understand his distress and anger.

Set Boundaries: Clearly communicate expectations for behavior during the encounter, emphasizing zero tolerance for violence or aggression.

Offer Choices: Give Elijah choices when appropriate, allowing him to have some control over his care.

Active Listening: Listen attentively to his concerns and feelings without interrupting or judging.

Involve Family: If possible and safe, involve Daisy in the care process to provide comfort and support.

After the Encounter

Debrief with Colleagues: Discuss the encounter with other team members, sharing any concerns or potential improvements in care.

Report Incidents: Document any incidents of aggression or hostility accurately in Elijah’s medical record for future reference.

Monitor Progress: Continuously monitor Elijah’s emotional state and behavior, reporting any changes to the healthcare team.

Report to Supervisor: If aggression persists or escalates, report the situation to your supervisor for additional support and guidance.

Implement Safety Measures: If necessary, implement additional safety measures, such as requesting security personnel or restricting visitors during specific times.

Providing Care and Support

Consult with Mental Health Team: Collaborate with the mental health team to assess Elijah’s emotional state and develop an appropriate care plan.

Engage in Therapeutic Communication: Use therapeutic communication techniques to help Elijah express his emotions constructively.

Encourage Coping Strategies: Offer suggestions for coping with anger and frustration, such as deep breathing exercises or engaging in hobbies.

Refer to Support Groups: Refer Elijah and his wife to support groups or counseling services to help them cope with the challenges of amputation.

Conclusion

Encountering an emotionally distressed and aggressive patient requires careful planning and implementation of safety measures. As the nurse caring for Elijah, it is essential to approach him with empathy and understanding while prioritizing safety. Utilizing de-escalation techniques and therapeutic communication can help in providing care and support for Elijah during this difficult time. Collaboration with the healthcare team, family, and mental health professionals will contribute to a comprehensive approach in managing his emotional distress and promoting a safe and supportive care environment.