The nursing incident under review involved a 64-year psychiatric patient called Jane. Although initially nonviolent, Jane turned aggressive during normal sampling for tests and punched the nurse who was collecting samples for the tests. …
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Although initially nonviolent, Jane turned aggressive during normal sampling for tests and punched the nurse who was collecting samples for the tests. On becoming excessively aggressive, the patient was secluded and further restraint to minimize harm to her, her loved ones and the facilities’ staffs and other clients. However, these interventions are rather controversial and the family members opposed their use just as health care and legal professionals and the public continue to question their therapeutic capacities. Consequently, their use is questioned and opposed in equal measures. Instead, aggression management strategies such as individualized safety plans, patient-specific and focused restraint management and prevention, staff notification of restraint and seclusion phenomena, official briefing and debriefing about restraint and nursing staff mentoring are encouraged. In applying these interventions, a nurse leaders and managers should work with all other stakeholders, especially other medical and nursing staff and the families or caretakers of the patient. Consultative approach to leadership would have been quite appropriate for dealing with Jane’s situation. Transformational leadership theory, which postulates that great leadership emerges in cases of problems and encourages collaboration and teamwork, could also apply in this situation. In addition, the contingency theory, which expects leaders to different behaviours and contexts or circumstances are and react accordingly is also appropriate for handling Jane’s aggression. This paper proposes strategies likely to help eliminate or reduce the use of restraint and seclusion as the first choice measures whenever a psychiatric patient turns aggressive on self or others. Introduction For many nurses working in psychiatric inpatient units, violence and aggression are common phenomena. Aggression continues to pose serious challenges to psychiatric inpatient unit nurses despite the many modern and universal methods and strategies of restraint (Schacht, 2006). The two most commonly used interventions applied in the treatment and management of violent and disruptive conducts in psychiatric patients are seclusion and intervention (Anderson & West, 2011). Notably, the application and management of these nursing interventions vary from one country and institution to another. The central role played by these interventions have been largely highlighted in quite a number of nursing and health care studies and literatures, with most of the authors citing numerous recommendations for managing and reducing mental patient aggression (Peterson, 2004). In most of the studies and literatures, the effects of seclusion and restraint on mental illness patients and the prevention of seclusion and restraint or the reduction of their use are among the most highlighted aspects of seclusion management (The Joint Commission, 2008). Whereas seclusion refers to retaining and placing a mentally ill inpatient in a room so that the immediate aggressive clinical situation is contained, restraint entails the use of different techniques that are custom-made to confine a mentally person to specific body motions (Cruzan, 1992). Despite the difference in meaning, both seclusion and restraint are measures generally used with the aim of preventing further injuries to patients, harm to nurses and to reduce violence and agitation (Centers for Medicare & Medicaid Services, 2006). This paper explores the appropriate management and leadership strategies for handling restraint of mentally ill inpatients by nurses. The following case study of an aggressive patient will form the basis of the proposed aggression management strategies outlined in the paper. Sample Case Jane (name changed for confidentiality)
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