Management of Assaultive Behavior and Its Factors - Essay Example

Essay Inserts His/Her Inserts Grade Inserts (25 01, Outline Introduction 2. Meaning of Crisis 2.1. Definitions 2.2. Background of Crisis 2.3. Features of crisis 2.4. Examples of Crisis 2.5. Corresponding factors of assaultive behavior/ crisis 3. Types of crisis and their causes 3.1. Criminal crisis 3.2. Patient crisis 3.3. Worker crisis 3.4. Domestic crisis 3.5. Verbal and physical crisis 4. Conclusion Crisis prevention and Intervention in healthcare 1. Introduction. The management of assaultive behavior is an effort to provide protection for the client and healthcare professional. Assaultive behavior in the work place compromises the safety of the healthcare workers, the patients and visitors to the hospital in their different setting. The abusive behavior undermines the efforts of the health care professional that are in many cases the victims. The behavior costs the hospital time, loss of healthcare workers and poor reputation. This essay will give the meaning of abusive behavior and crisis, and then discuss the types and causes of crisis. 2. What is Crisis? 2.1. Definitions. The meaning of crisis can be expanded by defining crisis, assaultive behavior and violence. According to Aguilera (1998, p. 12), crisis occur when a person is unable to deal with problems that do not have a way out. The unresolved problems give way to anger, emotional unrest, tension, anxiety and stagnation. Chou et al (2001, p. 139) notes that, assaultive behavior happens if the problem becomes persistent. The issues the person bears become intolerable because the coping methods and accessible resources are inadequate. Crisis is viewed as a psychological instability that result from extreme situation or condition where the resolution is not attainable by means of common remedies. Crisis is a word used to define to a situation where assaultive behavior or violence has occurred. Crisis is used to refer to assaultive behavior when it is extremely negative, unpredictable, uncontrollable and unacceptable in the society. Assaultive behavior requires an opportunity that the person in crisis can use to inflict injury or abuse another as Chou et al (2001, p. 139) mention. Violence is defined as the use of physical force with a motive to inflict injury. It is destructive, turbulent and forceful. Violence causes confusion and reveals accumulation of anger (Richter and Whittington 2006, p. 2). The word crisis, violence and assaultive behavior are used interchangeably. 2.2. Background of Crisis. Assaultive behavior can occur anywhere including the hospital. Medical departments have incidents that tantamount to assaultive behavior. The incidents of assaultive behavior in medical departments are on the increase and need to be addressed. Crisis in the form of verbal abuse and physical abuse have occurred in different departments. The waiting area, mentally disturbed departments and emergency departments are common areas where abuse can occur as Salmon and Varela (2007, p. 3) note. People without any history of assaultive behavior or psychiatric condition can suddenly become combative. Assaultive behavior can be as a result of medical conditions or illnesses as well as certain medication. People of all ages can become assaultive. Assaultive behavior is present in people of all cultures, socio-economic status. Crisis may also be as a result of unresolved emotional issues. People experiencing crisis desire to solve the problem as quickly as possible. They are influenced by actions or words from others, because they crave for a solution that can change their situation. Assaultive behavior may be directed to relatives or family members, neighbors, roommates, authority figures, men, women, medical professionals, peers, bystanders and passive peers. The assault can be done in the home, care facility, homeless shelter, hospital, school or correctional institutions. The common assaults involve the use of a weapon, physical violence and throwing of objects. Research shows that assaultive behavior is stimulated by anger, intimidation towards others, reaction to treatment, poor control of impulse, paranoia, and substance use, stimulation by auditory hallucinations and money gain or steeling (Shaver and Mikulincer 2010, p. 54). The medical conditions that have been found capable of leading to assaultive behavior include: vascular dementia, Alzheimer’s, diabetes, stroke, delirium, excessive alcohol and medicine intoxication. Aggressive behavior has been found to emanate from patients with anxiety, irritability and following a stressful situation. Life threatening and altering situations have also been found to trigger aggressive behavior. Some clients have encountered crisis after having disabilities (Duxbury and Whittington 2005, p. 471). In an attempt to deal with assaultive behavior in hospital departments, there is a color code frequently used to define the kind of assault. When color grey is used it means that the patient is while red means there is fire. Color blue means there is a medical emergency whereas code yellow means there is a bomb threat. Silver is used to refer to crisis. 2.3. Features of crisis. The meaning of crisis can be explained by explaining the characteristics or features which reveal the nature of crisis as Quanbeck (2007, p. 522) stipulates. Crisis that involves assaultive behavior or violence poses a threat. The crisis reveals a persistent inability to change condition or eliminate the effects of the underlying issues. Crisis invites tension, confusion and fear. The person in crisis experiences a lot of discomfort. The person in crisis remains in a disequilibrium state. Assaultive behavior or crisis portrays frustration, discrimination and antagonism. Assaultive behavior can be considered if the following signs are witnessed: a record of violence, violent expression, violent threats, intolerance and unmanageable anger. Crisis can be said to be forthcoming if the client has a record of violent behavior and tendencies of verbal abuse towards others. Actions such as bullying, cruelty to animals, lighting fires, general defiance of rules and disrespect to socially acceptable behavior signify crisis. The person may engage in excessive lying, robbing and covert behaviors. Crisis can be recognized from works of art such as painting and writing. People can write, paint, compose poems or songs and express their intention. Their thoughts can be revealed when they express their feelings. The expression is deemed to be a sign of assaultive behavior if the theme is against a specific person or come from same origin without clear intentions. When the negative theme is persistent over a long period it becomes a crisis. Constant threats from same origin towards a specific person constitute abusive behavior. The threat made out of anger, hostility or disappointment, where the description of how the threat has been executed may become a crisis. The threat is well calculated before it is issued. Intolerance, attitude motivated by beliefs, religion, mental abilities, sexual orientation, culture, ethnicity, and physical capabilities can signify crisis. The prejudice is reveled in the form of inability to cope with diversity. Unmanageable anger is a recipe for crisis because it motivates aggressive behavior. When anger strikes there is irritation, intimidation or bullying. Anger can lead to excessive violence. 2.4. Examples of Crisis. Crisis occurs when a person is physical sick or a close person is sick. Verbal abuse, insults, self injury, throwing of objects, breaking and destroying objects, biting and pushing are examples of crisis. Other examples of crisis include: divorce or separation, loss of a person through death, accident, natural calamity, financial constraints, unwanted pregnancy and unemployment. If crisis is not intervened it may lead to trauma. 2.5. Corresponding factors of assaultive behavior/ crisis. In an attempt to understand the meaning of crisis, Aguilera (1998, p. 13) discussed three corresponding factors that a person with assaultive behavior experience. The corresponding factors involves: perception, support and survival. Perception factors deals with the attitude and view the person with assaultive behavior has towards the underlying problem. The underlying problem could be finances, health, reputation, work, education and career which are very important to the person. The next factor is the support that the assaultive person can get from people who are close to them. The person in crisis needs to have trust in a friend or family. The friend or family will give relevant assistance when required. The other balancing factor is ability to find survival means. The person in crisis ability to cope with stress, anxiety and problems affects the response to crisis. The patients cope by doing exercise, denial, reasoning, taking medication and sleeping. When disequilibrium of the corresponding factors occurs, the person with assaultive behavior can be said to be in crisis. 3. Types of crisis and their causes. According to Colling and York (2010, p. 484) crisis can be distinguished according to the person who performs the assault and event. The four types of crisis include; criminal, patient, worker and domestic. 3.1. Criminal crisis/assaultive behavior. The individual performing the assault is not related to the healthcare institution or the patient. This can be a person who commits a criminal act in the healthcare facility. They may rob or steal items belonging to patients, visitors or the health care facility. Criminal crisis happens because of availability of weapon such as guns. When the hospital security is weak, the criminals may find the hospital accessible and commit crimes. The hospital may lack movement restrictions within the medical facility. The police have used the hospitals when holding criminals, who may take advantage of the situation and commit crime. Criminals are aware that hospitals have certain drugs that are controlled. The pharmacies or hospitals become a target for the criminals. The hospitals collect money from patients; the money becomes a target for robbery. Some criminals choose to abduct patients while they receive treatment and become violent when committing the act. Criminals causing abuse in hospitals consist of terrorists and unwanted visitors. The criminals pose as legitimate visitors to the patient or as health care workers Salmon and Varela (2007, p. 4). 3.2. Patient crisis. The patient receiving healthcare service commits the act of aggression. Patient crisis is caused by patients who are receiving treatment. Some of the patients may be mentally disturbed and cause harm to others. Some patients are mentally ill, abuse drugs, are traumatized or are frustrated by the situations; hence they become aggressive. The patient may take advantage of a situation where the healthcare worker is alone in the health care facility. The health care worker may be giving an examination in an isolated room without the company of another person. The patient may become abusive if they are not attended to after a long time healthcare facility may have many patients and take long to attend to all patients. The services being provided may become a cause of aggression. The patient may complain to get better services. Departments dealing with emergency, intensive care and head injury may have the highest cases of violence. The patient may attack the health care worker or another patient without warning. Patients with abusive behavior or crisis may take the form of verbal or physical abuse. They may use their nails, fists, body fluids, feet, teeth, food utensils, head, furniture or medical equipment to inflict injury on the healthcare professional (Charney and Fragala 2000, p. 163). 3.3. Worker crisis. Worker crisis involves a healthcare professional of the healthcare facility. The aggression may be directed to another worker, patient or a visitor. Healthcare workers may have underlying disputes with each other and result in aggressiveness. Depending on the nature of their dispute and anger management, they may result in convert violence. The employees may work within the same department and rank at the same level. Other disputes may be between a healthcare worker and their supervisor. The common forms of abuse can be overt or covert. Overt abuse can be in the form of verbal abuse. Covert abuse takes the form of psychological harassment. The crisis may be motivated by the workers withholding information from each other, change of duties without consenting and informing the other, criticism, isolation and refusing to assist at work (Richter and Whittington 2006, p. 3). Lannza (2006, p. 86) adds that, the health care worker may experience stress because of understaffing and workload. Another cause of worker crisis is if the healthcare worker does not have any training to recognize and manage assaultive behavior. 3.4. Domestic crisis. Domestic violence occurs in the heath care institution where the patient, the health care worker, relatives and friends to the patient engage in assaultive behavior. The relatives and friend to the patient and friend may become impatient if the hospital takes long to attend to the patient, delays treatment or medical procedures. The relatives or friends may have personal differences with the patient and resolve them in the hospital. Patient’s relatives become assaultive because of experiencing stress that comes with the patient illness. An argument can quickly escalate into a fight because of financial, emotional and excessive anger that either the patient or their visitor may be experiencing. 3.5. Verbal and physical crisis. Physical abuse is directed to others, self and objects. The patient, health care worker, visitor or criminal may become violent to another person and bit, bite, slap, hit or push them. The patient can hurt self by biting, cutting and inflicting injury on the body. In some cases, a patient, visitor, health care worker or criminal may throw objects towards another out of anger. Another form of physical crisis is sexual abuse. Aggressive behavior towards objects results in damaged property. Whether verbal or physical assaultive a patient can become uncomfortable in their environment and become irritable as Duxbury and Whittington (2005, p. 472) discuss. A restrictive environment can become a source of conflict. Patients who feel they are not listened to or treated accordingly can become abusive. Inadequate communication between the patient and the healthcare worker can be the cause of aggression. Crisis can be caused by internal, external or interactional factors. The patient may have mental illness or be under the influence of medication that can cause aggression. The healthcare worker or the patient’s visitor may also have internal perception of the issues concerned and become violent. Internal aspects of crisis involve thought disorders, alcohol abuse and substance abuse. External factors that emanate from the environment can trigger anger and violence. The patient can perceive the health care workers as the cause of their challenge and not being willing to assist. The healthcare workers may see the hospital structure and condition of work as dissatisfactory and become offended and hostile. Patients need to feel secure and confident with the care they receive in a hospital. If a patient feels insecure, their privacy is intruded and they do not have quality services, they may become angry. Patients disappointed with disrespect and unfriendliness when being given medication and meals can have crisis. Discomfort such as noise and extreme weather conditions triggered distress. Lack of freedom and rejection of examination or service in the hospital can cause irritation and violence. Interactional factors refer to the situations that cause tension and abusive behavior. Lack of communication between the patient and health care worker or the relative can cause aggressive behavior. Failure to listen and to be considerate contributes to disappointment that could lead to abusive behavior. Disagreement and poor relationship between the patient and the healthcare worker can stimulate conflicts that cause aggression. The healthcare worker may lose patient because the health facility pressure to work in a challenging environment. 4. Conclusion. Crisis refers to assaultive behavior or violence that occurs after an individual in unable to change uncomfortable circumstances, becomes unpredictable, unmanageable and their behavior is not approved in the society. Crisis happens when an individual cannot change circumstances and the available resources are limited. Types of crisis/ assaultive behavior include: criminal, patient, worker and domestic crisis. People with crisis engage in physical and verbal abuse. Crisis is triggered by internal, external and situational factors. Medication, illness, substance abuse, lack of training for workers, unresolved emotional issues, lack of communication, long waiting time, delayed or denied services and poor security could lead to assaultive behavior. Reference List Aguilera, D. C. (1998). Crisis intervention: Theory and methodology (8th ed.). St. Louis: Mosby Charney, W., and Fragala, G. (2000). The Epidemic of Health Care Worker Injury: An Epidemiology. Florida: CRC Press. Chou, K. R., Lu, R. B., and Chang, M. (2001). Assaultive behavior by psychiatric in-patient and its related factors. Journal of Nursing Research, 9 (15), 139- 151. Colling, R. L., and York, T. W. (2010). Hospital and healthcare security (5th ed.). New York: Elsevier Inc. Duxbury, J., and Whittington, R. (2005). Causes and management of patient aggression and violence: staff and patient perspectives Journal of Advanced Nursing 50(5), 469–478. Lannza, M. L., Zeiss, R and Rierdan, J. (2006). Violence against psychiatric nursing. Contemporary Nurse, 21(1), 85-93. Quanbeck, C. D. (2007). Categorization of aggressive behavior acts committed by a chronically assaultive state hospital patient. Psychiatric Services 58 (4), 521- 528. Richter, D., and Whittington, R. (2006). Violence in Mental Health Settings: Causes, Consequences, Management, Berlin: Springer. Salmon, N., and Varela, R. (2007) Learning to manage assaultive behavior. New York: AMN Healthcare Services Inc. Shaver, P. R., and Mikulincer, M. (2010) Human Aggression and Violence: Causes, Manifestations, and Consequences. Washington: American Psychological Association. Read More