Handling Behavioral Emergencies on a Non-Psychiatric Unit - Essay Example

? Handling Behavioural Emergencies on a non-psychiatric unit Introduction Psychiatric patients, whether ambulatory or hospitalized have rights as well as responsibilities. The patients are expected to be effective and engage positively when they are treated and should respect and obey the rights and needs of others. As they are citizens, they might be liable to the conducts in court if they commit a crime. Psychiatric literature explains some reactions of clinicians who might have been victims of non medical emergencies from their patients. The psychiatric literature suggested techniques for limiting and predicting the risk associated with emergencies and thereby addressing prosecution as the immediate responses. As per the forms of emergencies, they require skills, interventions, and special knowledge of their management. Despite the fact that treatment settings vary in terms of their organization and resources and health professionals may be having different ways and levels of experience of working, they must deal with dangerous situations when they arise (Kleespies, 2009, p. 65). There are no rules and guidelines to be followed and applied equally in all cases. However, certain principles should be understood and well known by all those who are exposed to non medical emergencies. This paper will attempt to explain some issues, which involve the management of non medical emergencies which can occur in a treatment setting. It acknowledges the importance of clinical officers in controlling and containing the expressions in treatment settings and stressing the needs of properly trained staff in limiting and identifying some risk factors. It reinforces some needs for members of the treatment group and patients to understand their roles in the treatment process. In addition, they should be aware of the impacts of undesirable code of conduct and behaviors if they occur. It is obvious that we learn from experience. When problems or difficulties are experienced in hospitals or health centers, all the staff, clinicians or the treatment team should learn from it and make some improvements. This is very important so that the same incidences cannot appear in the future. The first step is to examine the department or parts affected by the incident. Then they should identify the opportunity in which it needs an improvement. For example, the clinicians might have identified a process, which is not effective in the health Center or hospital. The clinicians or treatment team should question the production team about the process and how it was implemented. After all these stages, the team should consider if the process needs to be improved or replaced. In addition, it is very important to consider who will benefit from the improvement of the process (Kleespies, 2009, p. 129). After the treatment team has found the opportunity or process to be improved, they need to bring together and organize the team staff members who are closer and associated with the process. The selected employees are those who understand the process or associated with the ownership of the process. The next step is to define and discuss the facts of the process with the selected team of employees. The team will contribute individually to their personal knowledge of the process with the target of getting the information needed to examine the issue. After getting enough knowledge about the process, the team needs an understanding of the causes of process variation. This is the crucial part of the process because they will look at the main causes of ineffective process. The team will then select the process that needs immediate improvement. As they are selecting the process, they should consider the difficulties in implementation. When a new process is brought in place, it might take some time to adapt and stabilize the process. This will include the need for well trained staff that is able to cope up with the process easily. In addition, the cost of improvement of the process should be considered (Kleespies, 2009, p. 71). It should not be very expensive to both the government and the patients when they visit the hospital needing services where this process is implemented. The team should consider the first steps before rushing to the implementation of the intervention. The next step is developing a plan on how to improve the selected process. The team will need to make crucial decisions on how to improve the selected process. Action plans are initiated to improve the targeted area. Collection of data should be considered for the selected area of improvement. This is the most needed steps because what has been happening should be brought into place, and analyzed for better improvements. The next step is to do the improvement by critically analyzing the collected data and information, which determines how the process has been practiced before in the hospital. At this stage, the team will examine the process critically and determine if there are any surprises arising and the reasons for the surprise occurrence. After planning and improvement, the team will check on the results of the improvement. At this step, the team will check and evaluate to see if the changes made were implanted according the plans initiated. The team needs to monitor the effects of changes made. They should compare and analyze the actual results of the process with the results they had predicted in the planning of the improvement (Kleespies, 2009, p. 167). If the results of the process are as expected by the team, they will review the all steps to make some improvements. If the results experienced are what the team expected, they will have succeeded in changing or modifying the process for better performance. They will proceed to the last step acting on the process. In the last step of acting as the team will maintain the changes and feature a head to make more improvements in various departments in the hospital or health centres. Medical emergencies can occur in psychiatric wards, outpatient clinics, private offices, emergency rooms, community clinics, and during home visits. In all circumstances, the consequences of the situation are characterized by the high level of emotions, alarm, sense of confusion, ambivalence about how to proceed, and quite often. Many psychiatric patients are complex and difficult when treating as they do not abide by the instructions and treatment, fail to take medications, miss appointments, and unable to form working alliance with their clinicians (Kleespies, 2009, p. 78). Some patients behave in some ways that jeopardize the safety and health of others. The character of their illness structure results in poor impulse control and high levels of aggression. Unfortunately, despite the best plans and intentions, emergencies cannot always be prevented or foreseen because human behaviour is unpredictable. Even with skilled treatment teams and best-organized setting, non-medical emergencies will occur and should be managed. When the behaviours of patients threaten the integrity of other people around them, it will be difficult for the clinician to withstand the sense of objectivity and fairness. Strong feelings of counter transference tend to disturb the management of already anxiety provoking, guilt, and stressful situations. Identification with the aggressor, denial, anger, feelings of helplessness, and fear may be the most prominent features. In these circumstances, there might be a risk of underestimating or overestimating the potential urgency or danger of the emergency. The team of the treatment members may find themselves divided or ambivalent in deciding the appropriate action to take. Staff members may feel the use of seclusion or restraints, stricter limit setting, and withdrawal of privileges could be non-therapeutic or harmful for the patient. The responses of team members to emergencies might vary considerably due to limit setting which may provoke further acting out and personal experience with emergencies. Some team or staff members might be excessively fearful and alarmed while others might tend to deny or play down danger even when an emergency or immediate action is raised. The clinician to some extent might fear being seen as unfair or incompetent by peers. This causes the clinician to experience inner guilt, and fear direct retaliation from the patient for giving up traditional non-judgmental attitudes towards the patient. To reduce potential untoward reactions and responses, staff can establish a guideline within which the situation and patient-aggressor may be evaluated as objectively and rapidly as possible. Each incident should be investigated on its own advantages, but analysis must include variables like precipitants, degree of provocation or stress. Other variables, which should be considered, include motivation of the non-medical behaviour, psychiatric diagnosis, previous attempts of treatment, and impacts of the emergency on the victim. The benefits and risks of laying charges for the victim, clinical team, and the patient should also be considered. The decisions of the management team should not be based on various factors. For instance, considering the diagnosis is very much important but do not provide guidelines on how to proceed. Whether the patient has a personality disorder or psychotic might be relevant, but the results of diagnosis in determining the limits to set may not be obvious. Always in life, prevention is better than cure. It is very hard to predict an emergency in a systematic and reliable way. Instead, one should assess the risk through evaluation of the previous background and history of the patient with an appreciation of situational and clinical factors related to the increase of the same behaviour. In any treatment, setting of an organization or institution and its staff should be well organized to provide a neat and secure room for treatment. The staff members should be experts in the use of pharmacological and physical restraints and should be well trained to manage stress, interpersonal conflicts, and anger (Kleespies, 2009, p. 323). The staff must be familiar with patients’ previous history on substance abuse, condition, background, and other factors, which may be predictive of non-medical emergency. The staff should be experts in using treatment team as a resource in management and as a treatment tool in dangerous and difficult situations. They should know their limitations and weaknesses and feel comfortable when looking for support and assistance before an emergency is raised. Clinical staff throughout the process should support the victims when a legal action is initiated. This is because the victims should be in court in all stages of the legal process, which might take some months. They might be subjected to reactions and pressures from the treatment team, patients, lawyers, and police. The support they should be accorded is to show genuine sensitivities and feelings in the assurance and the decisions of their charges. There should be some protocols to follow when an emergency is experienced. The first step is the clinician to examine the signs and symptoms of the patient. The treatment team will diagnose the possible problem the patient is undergoing. This will enable the clinician or the treatment team to perform various categories of diagnosis. In addition, the treatment team needs to interact with the family members closer to inquire the previous medical history of the patient if he/she has been having any disorder problem (Kleespies, 2009, p. 432). If the patient does not have any disorder, the team should proceed assessing other possibility causes of the signs and symptoms. After assessing the problem, they should maintain a safe environment for the treatment process. They should use the available resources to intervene immediately and appropriately. If the need for, it should be develop a follow up plan for the process of treatment. The staff should ensure that all equipment to use when handling the emergency is in place to avoid wasting time when running up and down. This will enable the clinicians to save the patient’s life. In case a staff member is not able to handle an emergency, he/she should call for assistance from other experts. Well-developed transport system should be in place to rush the patient to a nearby better hospital when they are not able to handle. Conclusion Non-medical emergencies are stressful and unpleasant, but they provide important and useful learning experiences when handled properly. FOCUS-PDCA is an important procedure to follow when diagnosing and making some recommendations address various problems in an organization (Kleespies, 2009, p. 302). This is through finding the process, organizing the staff related to the process, clarifying, understanding and selecting the process or opportunity to be improved. There are no situations, which involve an emergency behavior, are identical, but the principles and guidelines applied in managing such situations are almost similar. More attention should be directed to the patient to protect his/her rights when a legal action is considered ethical and clinically appropriate. Reference Kleespies, P. (2009). Behavioral Emergencies: An Evidence-Based Resource for Evaluating and Managing Risk of Suicide, Violence, and Victimization, United States, American Psychological Association. Read More