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When mental health patients become acutely psychotic and agitated, they need urgent and appropriate treatment that stabilises their mental status and decreases the risk of self-harm and violence towards others (Elder, Evans and Nizette, 2005). This can range from displays of threatening or assaultive behaviours including refusal to co-operate, intense intimidating hostile demeanour with staring or movements, aggression towards objects and the intentional or unintentional harm to self or others (Electronic Therapeutic Guidelines complete, 2014). This paper will outline the current clinical practice of the sedation of aggressive patients in the Geraldton Emergency Department were I work as well as identifying the gaps between the current practice and best practice and how to implement change so that Geraldton emergency nurses are providing the safest and best care possible. Unfortunately violence in the health care system is becoming more prevalent each year and the necessity to be able to sedate patients safely and quickly to protect themselves and others has almost become a day to day occurrence in the Geraldton Emergency Department. Before sedation is considered the three main causes for these patients to present need to be discussed which can include one or a combination of medical disorders usually associated with delirium, substance abuse either illicit drugs or alcohol and lastly the majority of patients that get sedated in emergency departments have a variety of psychiatric disorders such as mania, schizophrenia, post-traumatic stress disorder and personality disorders (Electronic Therapeutic Guidelines complete, 2014). Once sedation has been deemed the appropriate action and de-escalation strategies are not going to work ... ... middle of paper ... ...Pharmacological treatment of behavioural emergencies. [Online] Available at: http://online.tg.org.au.wachslibrasources.health.wa.gov.au [Accessed 25 Apr. 2014]. Jahan, N. (2013). Evidence Summary: Healthcare Facilities Patient Aggression and Violence. The Joanna Briggs Institute, pp.1-6. Long, K. (2013). Restraint: Chemical. The Joanna Briggs Institute, pp.1-3. Sharma, L. (2014). Aggressive Behaviour Management: Acute Care. The Joanna Briggs Institute, pp.1-2. Western Australian Department of Health WA Country Health Service, (2014). Sedation for mental health patients awaiting RFDS transfer from remote regions guideline. Perth: Western Australian Department of Health, pp.1-12. www.health.wa.gov.au, (2014). Mental Health Act 1996. [Online] Available at: http://www.health.wa.gov.au/mhareview/resources/legislation/wa_mental_health_act_1996.pdf [Accessed 25 Mar. 2014].
Polderman, K. H. (2007). Screening methods for delirium: don't get confused! Intensive Care Med , 3-5.
Several databases including Academic Search Premier, JSTOR, CINAHL, MEDLINE, and Cochrane were accessed using the key words “workplace violence,” “nurses,” student nurses,” horizontal violence,” “bullying,” “oppression,” and “intergroup conflict.” The purpose of the literature search was to determine the predominance of horizontal violence among new nurses and nursing students.
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This literature review is focusing on discussing the effects of seclusion and restraints on treatment consequences of patients in mental health area. Seclusion and Restraint are used for controlling the behavioral patterns of the mentally ill patients in different surroundings consisting of psychiatric management facilities and hospitals (Kentley, 2009). Over past decade, comprehensible consensus has come out that seclusion and restraints are secure interventions of last alternative and application of those interventions should and can be diminished significantly (Knight, 2011). However, recent studies indicated that it is traumatic for patients experiencing or witnessing restraint and seclusion traumatic; patients can feel high levels of anxiety, fear, and anger once aware that restraint is going to take place, sometimes it could resulting in an exacerbation of patient’s mental status (Stewart et al, 2010). Due to the humanitarian, ethical, and legal issues which could lead to, seclusion and restraints are known as the most controversial management strategies (Holmes, Kennedy & Perron, 2004). Previous studies and researches could not analyze this topic adequately; thus, further researches and studies related to the effects and risk managements of using seclusions and restrains will be discussed in below.
My colleague and I received an emergency call to reports of a female on the ground. Once on scene an intoxicated male stated that his wife is under investigation for “passing out episodes”. She was lying supine on the kitchen floor and did not respond to A.V.P.U. I measured and inserted a nasopharyngeal airway which was initially accepted by my patient. She then regained consciousness and stated, “Oh it’s happened again has it?” I removed the airway and asked my colleague to complete base line observations and ECG which were all within the normal range. During history taking my patient stated that she did not wish to travel to hospital. However each time my patient stood up she collapsed and we would have to intervene to protect her safety and dignity, whilst also trying to ascertain what was going on. During the unresponsive episodes we returned the patient to the stretcher where she spontaneously recovered and refused hospital treatment. I completed my patient report form to reflect the patient's decision and highlighted my concerns. The patient’s intoxicated husband then carried his wife back into the house.
Client safety is a primary role of the nurse, but the use of physical restrains with clients is an ethical issue when other important ethical principles such as autonomy and non- maleficence, as well as nurse's code of ethics, are considered (Schenker, Fernandez, Sudore, & Schillinger, 2010). In this scenario, Sam is agitated and physically aggressive with Camilla, a nurse. So, the medical team reviewed him and suggested to restrain and Julia, team leader of nurse advice Camilla to restrain and focus on care of other patient and states that patient like Sam is waste of time and they don't have enough staff to worried about him. In this general scenario, it shows that health care staff lacks understanding of the genuine requirements of restorative administrations sharpens which is imperative to shield patients from abnormal limitation. Furthermore, restriction ought to be considered if all else fails and specialists ought to consider elective mediation to advance security and regard the respect of the individual.(Kerridge, Low, & McPhee, 2009). However here in this scenario, medical team and nurse including team leader left Sam on physical restraint without supervision avoiding harm. Therefore, it clearly depicts the ethical issues
After review of the timeline of the events surrounding Mr. B, there are several causative factors that led to this sentinel event. These are inappropriate staffing, inability to identify trends of deterioration, policy for conscious sedation was not followed, inadequate observation and monitoring, failure to respond to alarms, inadequate home medication evaluation, medication dosing, appropriate medication administration times, and failure to start cardiopulmonary resuscitation in a timely manner.
The impact of aggression and violence in mental health units is substantial. Effects that have been documented include physical injury, emotional and psychological harm, compromised patient care, and financial expense to the organization. In a review of literature, physical injury to inpatient mental health staff is high and poses a strong threat to staff and other patients (Foster, Bowers, & Nijman, 2006). Although the rates of victimization that occur between patients are low, it is an increasing concern. In these acts of aggression, both verbal and physical violence can occur.
Lipscomb, J.A., & McPhaul, K.M. (2004). Workplace Violence in Health Care: Recognized but not Regulated. The Online Journal of Issues in Nursing, 9(3). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/ViolenceinHealthCare.aspx
It’s hard to leave a loved one in a hospital bed when night falls. Family members leave with a sense of responsibility, guilt, and sadness. They leave relying on the nurse to watch and care for their sick family member. Therefore, it is heart breaking to find out the next morning your loved one has suffered great brain damage due to nurses failing to check on alarm sounds. Now, the family is put on the spot to continue life support or disconnect their family member. One can only imagine what went wrong; up to the minute that you left the hospital, your loved one was doing fine. You are relying on the health care providers to take care of your loved one, just as you would, while you are gone. Staff made an error by ignoring the alarms sounds, warning them that the patient was deteriorating, and costing the patient’s family a great deal of pain. Jenifer Garcia’s life shattered when this exact event happened to her husband in July, 2010 (Kowalczyk, 2011). She left her husband Friday night, alive, and returned the next morning to find out he was brain dead. Advancements in technology are used to decrease and catch medical errors made by health care providers that can harm or kill patients, but alarm fatigue has proven that even technology cannot fully protect a patient from nursing errors, thus taking the lives of patients.
The term “failure to rescue” refers to a clinical scenario where hospital doctors, nurses, or caregivers fail to recognize symptoms. Responders do not respond adequately to clinical signs that would prevent harm (Morse, 2008, p.2). Dr. Jeffery H. Silber, Director of the Center for Health Outcomes and Policy Research, first coined the term “failure to rescue” in the 1990’s. He characterized the matrix of institutional and individual errors that contribute to patient deaths as “failure to rescue” (Aleccia, 2008). Since 1990, it has been well documented patients usually exhibit signs and symptoms of impending cardiac or respiratory arrest 6-8 hours before an arrest (Schein, Hazday, Pena, Ruben, & Spring, 1990). Buist, Bernard, Nguyen, Moore, and Anderson’s (2004) research reported similar findings. They found patients had documented clinically abnormal signs and symptom prior to arrest (Buist, et al., 2004). When certain abnormal signs and symptoms are identified early, critical bedside consultat...
In the early 1980s aggression and violence in the workplace have been a source of a lot of public discussion. (Piquero pg.383) The issues have risen again recently and have mostly been present in management and business fields. Workplace aggression often includes “behavior by an individual or individuals within or outside organizations that is intended to physically or psychologically harms a worker or workers and occurs in a work related”. (Schat& Kelloway Pg. 191) A national survey Conducted by the National Centers for Victims of Crime shows several statistics regarding workplace homicide by type show that is the year of (see fig. 1), violent crimes against victims working or an duty( see fig. 2) and nonfatal workplace violence committed by strangers(see fig. 3
Patients in the Intensive Care Unit are at a high risk to develop delirium. It is one of the most common conditions encountered by the staff in an Intensive Care Unit. Delirium can be hyperactive or hypo active according to the patients’ behavior. Disorientation, agitation, hallucinations, or delusions are characteristics that may be observed in the patient with hyperactive delirium. Apathy, quietly confused, withdrawal, lethargy, and even total lack of responsiveness are all symptoms of hypoactive delirium. Some or all of these symptoms may occur at any time.
In 2001, over 450 million people worldwide suffered from mental illness (World Health Organisation, 2001) and these numbers have increased by a wide margin since then. Using restraints in treatment for those who are mentally ill is a topic that creates a large amount of controversy. Many are concerned with how the use of restraints can affect the person and if they are necessary or if alternative measures could be used. The National Alliance of Mental Illness has indicated their position on restraints, “The use of involuntary mechanical or human restraints or involuntary seclusion is only justified as an emergency safety measure in response to imminent danger to a patient or others.” (The National Alliance of Mental Illness, 2001) There have
Research indicates the relationship between horizontal violence and the burn out rate of registered nurses to be epistemologically significant due to a determined prevalence of nonphysical violence in the health care setting and the potential nature, severity and ubiquitous state of its prospective consequences. This systematic review will examine the aforementioned phenomenon in further detail with a focus on specific implications, if any, on the burn out rate of registered nurses.