Most patients with mental health disorders are not aggressive. However, it is important for nurses to be able to know the signs and symptoms associated with the five phases of aggression, and to appropriately apply nursing interventions to assist in treating aggressive patients. Please read the case study below and answer the four questions related to it. Aggression Case StudyChristopher, who is 14 years of age, was recently admitted to the hospital for schizophrenia. He has a history of aggressive behavior and states that the devil is telling him to kill all adults because they want to hurt him. Christopher has a history of recidivism and noncompliance with his medications. One day on the unit, the nurse observes Christopher displaying hypervigilant behaviors, pacing back and forth down the hallway, and speaking to himself under his breath. As the nurse runs over to Christopher to talk, he sees that his bedroom door is open and runs into his room and shuts the door. The nurse responds by attempting to open the door, but Christopher keeps pulling the door shut and tells the nurse that if the nurse comes in the room he will choke the nurse. The nurse responds by calling other staff to assist with the situation. In-text citations and all references in APA format.
1. What phase of the aggression cycle is Christopher in at the beginning of this scenario? What phase is he in at the end of the cycle? (State the evidence that supports your answers). 2. What interventions could have implemented to prevent Christopher from escalating at the beginning of the scenario? 3. What interventions should the nurse take to deescalate the situation when Christopher is refusing to open his door?4. If a restrictive intervention (restraint/seclusion) is used, what are some important steps for the nurse to remember?
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1. At the beginning of the scenario, Christopher is in the phase of escalation in the aggression cycle. This is evidenced by his hypervigilant behaviors, pacing, and speaking to himself under his breath. These actions indicate increasing tension and agitation, which are characteristic of the escalation phase. At the end of the cycle, Christopher is in the phase of aggression. This is supported by his refusal to let the nurse enter the room and his verbal threat of choking the nurse if the nurse attempts to come in.
2. To prevent Christopher from escalating at the beginning of the scenario, several interventions could have been implemented. Firstly, the nurse could have utilized therapeutic communication techniques such as active listening and empathy to establish rapport and trust with Christopher. By acknowledging his feelings and concerns, the nurse may have been able to deescalate the situation and address any underlying anxiety or fear Christopher may be experiencing. Secondly, the nurse could have collaborated with the healthcare team to review and adjust Christopher’s medication regimen if necessary. Ensuring compliance with prescribed medications can help manage symptoms and reduce the risk of aggression. Lastly, the nurse could have assessed and addressed any environmental triggers or stressors in Christopher’s surroundings that may have contributed to his escalating behaviors.
3. When Christopher is refusing to open his door, the nurse should employ deescalation techniques to manage the situation. It is important for the nurse to remain calm, speak in a non-confrontational manner, and maintain a safe distance. The nurse can acknowledge Christopher’s feelings and validate his concerns while expressing a desire to understand and help. Offering choices and alternatives to Christopher may also help to empower him and diffuse the situation. If possible, the nurse can involve other staff members to provide support and assistance in managing the situation. It is crucial to prioritize the safety of both Christopher and the healthcare team throughout the deescalation process.
4. If a restrictive intervention such as restraint or seclusion is used, the nurse must adhere to important steps to ensure the safety and well-being of the patient. Firstly, it is necessary to obtain a clear and documented order from a qualified healthcare provider. The use of restrictive interventions should be a last resort when all other methods of deescalation have been exhausted. The nurse should assess the patient’s physical and mental status regularly and document these assessments. Additionally, the nurse should use the least restrictive form of intervention and ensure that the intervention is applied correctly, following established protocols and guidelines. Communication with the patient throughout the process is crucial, explaining the reasons for the intervention and comforting the patient as much as possible. Continuous monitoring and reassessment are essential to determine the need for continued use or discontinuation of the restriction, and appropriate documentation should be maintained throughout the entire process. Restraints or seclusion should only be used as a temporary measure and should be discontinued as soon as the patient’s safety and well-being allow.
Mental health disorders can present various challenges in healthcare settings, particularly when patients display aggressive behaviors. As a medical professor responsible for designing college assignments for medical students, it is important to address these challenges and provide guidance on understanding and managing aggression in patients. This case study focuses on the scenario of Christopher, a 14-year-old with schizophrenia and a history of aggressive behavior. The questions related to this case study aim to assess the students’ knowledge and understanding of the phases of aggression, appropriate interventions to prevent and deescalate aggression, and the use of restrictive interventions if necessary. By analyzing this scenario and providing well-supported answers, students can enhance their understanding of managing aggression in patients with mental health disorders.