Obtaining Patient History from a Patient with Violent Behaviors - Essay Example

Essay Inserts His/Her Inserts Grade Inserts (17 02, Outline Introduction. 2. Obtaining patient history from a patient with violent behaviors 2.1. Identifying sources of information 2.2. Preparing 2.3. Eliminate triggers of aggressive behavior and use appropriate communication skills 2.4. Gathering the information 2.5. Identify common issues. 3. Characteristics of aggressive and violent patients and victims 3.1. Emotional and behavioral characteristics 3.2. Physical characteristics 3.3. Personality characteristics 3.4. Relationship with others 3.5. Medical and substance use analysis 4. Conclusion Crisis prevention and Intervention in healthcare 1. Introduction. Healthcare professionals require the information of a patient with assaultive behavior to prevent and intervene in the crisis. This information is used in the implementation of appropriate preventive measures. Additionally, the traits of patients and victims of assaultive behavior should be recognized to assist the patient and the victim accordingly. This essay will discuss how patient history with violent behaviors is obtained. It will provide the characteristic of aggressive and violent patients and victims. 2. Obtaining patient history from a patient with violent behaviors. The history of an aggressive and violent patient can be difficult to obtain if there is no record. Hospital records can be handy when gathering information. The patient history enable the healthcare professionals give the most accurate intervention in a given situation. Obtaining a patients history can be viewed as a process that facilitate accumulation of information. 2.1. Identifying sources of information. Obtaining information from patients with aggressive behaviors may be challenging because the aggressive patient may not be willing to cooperate and give history. The information can be obtained from family members, medical records, friends, and police as well as healthcare workers. Some patients may be willing to provide information and be involved in the decision making and should be allowed. Family members may be a good source of information on how events happened and past events occurred. Friends of the violent patient can give additional information on behavior, if they have been abusing substance for instance. Some of the friends, family members, members of the public may have been victims of assaultive behavior caused by the assaultive patient. The police may have current and past history about criminal activities and arrests. The medical record is a reliable source of information (Dubin, 1993, p. 10). McNeil et al (2011, p. 23) add that, the healthcare professionals record all the information concerning the patient and the keep the record. If there are no existing medical records in the healthcare facility the healthcare professional may have to get information from family, friends or the public. Observing and questioning the patient could help generate information. 2.2. Preparing. The history of a patient behavior and condition is very significant when it comes to making decisions on healthcare practice and should be conducted when the healthcare professional is ready. Eichelman and Hartwig (1995, p. 84) suggest that, before attempting to gain the information from the violent patient, prepare self by clearing what is in the mind. If the records are available, the health care provider can view the last significant problem presented. Consider the available time for obtaining the information and if it is the correct timing. Develop a strategy to use in case the patient becomes violent. Handle the circumstances with confidence and calmness. Information should be sought after the patient and the healthcare professional are calm. Get ready for responses void of argument and heated disputes. The healthcare professional can acknowledge the upsetting situation the patient is experiencing and assure them of assisting them. Plan to distract the attention of aggressive patient. Eliminate situations where the patient might feel confronted. Prepare self by ensuring that you are in good health and ready before beginning obtaining information from the patient. The healthcare professional should deal with emotions that emanate from past experiences when dealing with an assaultive patient. Past experiences can cause distress and scare the healthcare professional. Obtain support and manage the experiences immediately after the incident and find a long term solution. Discuss with other professionals to prevent anger and temperament. Depending on the circumstances, the healthcare professional can ask another worker for company. Moreover, choose an appropriate environment. 2.3. Eliminate triggers of aggressive behavior and use appropriate communication skills. From observation made when the patient is aggressive, identify events that led to aggressiveness. This could be frustration, intrusion to the patient’s privacy, anxiety, fear, feeling threatened, discomfort, and pain. Manage their pain and avoid abrupt movement or noise. Avoid all the triggers that could lead to assault. They can be made comfortable by giving appropriate meals and adequate drinks. Keep away from rushing them to do something and giving demands. Explain actions before you attend to them, give simple explanation and give them time to give an answer. Do not show when offended and evade criticizing the patient. Gathering information requires the healthcare professional to use appropriate communication skills. Both vernal and non verbal skills matter. The physical distance between the patient and healthcare professional should be distance. Stay confident and calm when gathering information from the violent patient. An apology for waiting for long at the beginning is appreciated. Address the patient properly while showing respect. The healthcare professional can listen to the patient and avoid writing or getting distracted if what the aggressive violent patient is saying something of relevance to them. If there is need to write, notify them and allow them to complete talking. Take note of topics and activities that interest the patient and use them when necessary to call for their attention. Be a good listener and ask all relevant information without offending the patient. 2.4. Gathering the information. Different violent patients may take different forms when the healthcare professional begins obtaining information from them. They may give single letter answers, may present themselves with a self diagnosis and demand for medication, may need continuous reassurance, and may be angry or showing tendencies of assaultive behavior. Questions can be effective in gathering information if they are not leading. Polite steering phrases can also help get information. Reassure the patient of confidentiality at all times. Avoid interrupting the patient when giving their first statement (Kanel 2012, p. 33). Information sought consists of demographics. This includes their age, gender and marital status. Find out if they have social support from friends, family or community. Get details of their involvement in previous assaults, abuse of substance or alcohol and other sicknesses. Check and record physical traits that may imply involvement in aggressive behavior or crisis. Additionally, record verbal indicators that suggest the patient is in crisis. The healthcare professional should remain focused when questioning the patient, relatives, friend, other healthcare professionals, and police as well as when looking for relevant material. Concentrating and focusing on what causes, concerns and underlying issues that caused the patient to visit the hospital is essential. Focusing will cause the healthcare professional to make appropriate observation. The patient and their family or friends at times need reassurance and confirmation, which should be received well. Focusing gives the healthcare professionals ability to identify the needs of the patient and their anticipation. According to Tardiff (1996, p. 141), a patient has a right to give consent since they are responsible for their well being. The healthcare professional has a duty to examine, treat and eliminate risks that are related to medicine. The patient has to consent so that the healthcare professional is capable of assisting the patient. The patient is required to provide the healthcare professional with compelling information about their condition. 2.5. Identify common issues. After conducting the search on the patient with aggressive and violent behavior a record of the observations and information obtained can be documented. This will be useful in the future. Information obtained will reveal what causes or triggers the violence, intervention that is given and if it causes injury. The information makes it possible to identify underlying issues that need to be addressed. Issues that are unique to the patient are identified. The information will give details of social history, medical history, family history, use of drugs and excessive use of alcohol. 3. Characteristics of aggressive and violent patients and victims. 3.1. Emotional and behavioral characteristics. Shepherd (2001, p. 114) notes that aggressive patients may show negative emotions such as anger, discontentment and anxiety. The patient is very irritable and unfriendly. The assaultive patient could be frustrated from present, ongoing and future events they have no control over. The violent patients show signs of withdrawal if they have been abusing substance or alcohol. Common behaviors that violent people have include constant desire to call for attention. Violent patients show traits such as agitation and restlessness. A violent patient has fear and emotional in their conversation. Assaultive patients have an augmented motor activity. Violent patients are often disorderly, antisocial and disruptive. Consequently, aggressive patients may become confused and become wild. The victim of emotional and behavioral assaults may feel devalued or dehumanized. Poor communication will cause hostility and misunderstanding. 3.2. Physical characteristics. The violent patient uses verbal or physical abuse towards self, healthcare professionals, relatives, non relatives, animals or objects. Patients with assaultive behavior are young adults in their early twenties or teenagers. Although majority of violent patients are young, there are elderly patients who become violent. Both men and women commit assaultive behavior, although it is worth noting that majority are men. Women cannot be underestimated especially in the case of mental illnesses. Patients with violence could be having head injury and trauma. A violent patient may have a weapon, or objects that can inflict pain on others. Both fresh and old wounds may be seen on the violent person skin. Aggressive patients use inappropriate physical contact to inflict harm on self and others. They use force to slap, bit, bite, spit and kick. The physical actions of a patient with assaultive behavior by using unacceptable contact to create a situation that is uncomfortable and hostile. Victims of physical assault fear the aggressor. While some may have tendencies of revenge, others will leave the aggressive patient to be attended by others. The victim may have sustained injuries and need medical care. 3.3. Personality characteristics. Aggressive patients have a low level of tolerance when they are frustrated. Violent patients at times reject criticism and want to be in control. They tend to blame others for faulty results that involve others or self. Patients with violent personality may engage in antisocial behavior, selfishness, careless driving and egocentricity. Patients with low intellectual abilities can become violent when compared with the intelligent patients. Patients from a low social and economic status tend become assaultive when compared with those form a high social status. Assaultive patients are characterized by brutal behavior, intimidating actions and words together with yelling to scold others. Violent patients have a poor judgment (Tardiff, 1996, p. 27). Violent patients may be comfortable with the assaultive behavior and live as a lifestyle. In this case, the aggressive patient does not have remorse. Insults and aggressive behavior is used as a way of manipulating others. As a result, the aggressive person becomes involved in breaking laws. Some patients with violence have been trained on violence as police or military officers. 3.4. Relationship with others. Aggressive patients tend to have poor relationships with the healthcare professional as well as the other patients. The assaultive patient may try to convince and take on the other to an activity. The communication is very poor and they do not communicate effectively. The aggressive patient may want to intrude the personal or physical space of the healthcare professional, other patients, relatives or friends and disturbance the existing peace. The patient may react negatively towards treatment, relatives or assistance. They may retaliate if they feel not treated right. Violent patients may perceive others as being in competition and fail to cooperate when granted help. The aggressive patient can provoke and tease unspecific patients, relatives, friends or healthcare professional in the healthcare facility. The healthcare professional may retrain patients and have disputes with patients on administration of treatment. In the case of a poor relationship, the victim of violence may want to do something that the aggressive patient did not want. 3.5. Medical and substance use traits Tardiff (1999, p. 153) mentions that, mentally ill patients are likely to become violent. Patient with bipolar disorder, depression and schizophrenia tend to engage in violence. Similarly, patients who abuse substance and alcohol are at times violent. Paranoid patients and those with hallucinations can commit violence. Violent patients may have depression, accompanied with hopelessness and suicidal tendencies. This occurs if treatment has not shown remarkable improvement. If the patient does not adhere to medication this could explain the aggressiveness of the patient. The victim of violence becomes fearful and anxious after they experience assault. Their confidence and self esteem is affected which could lead to a withdrawal from giving support or adequate healthcare to the patient. The victim of violence attempts change behavior and please the aggressive patient to avoid being victimized again. The victims tend to withdraw and blame self for the aggressor’s violence. The victim becomes tensed and guilty. They are terrified and may want to run away. In some cases, they may want to defend self by inflicting harm on the patient. Other victims feel ashamed because they were helpless and not able to change situation. Healthcare professional who have experienced violence may not want to continue working with the identified violent patients. If persuaded to work, they may demand that the patient is restrained from causing violence and verbal abuse. Injuries or bruises from the assault may cause indignity on the victim. Victims who are counseled anticipate that the patient will change (Blumenreich and Lewis, 1993, 22). Healthcare professional who have encountered violent patients can make medical errors and fail to satisfy patients healthcare needs. Scared victims excuse themselves from working. The motivation to work for the healthcare is negatively affected especially if the violent patient is not responding to treatment. Victims of assaultive behavior become stressed over personal safety. Stress can cause the victim to begin abusing drugs and consuming alcohol. Healthcare professional handling violent patient tend to ask for leave. Burnout has been diagnosed on healthcare professionals, friends and family members of the aggressive patients. Consequently, those involved in helping the violent patient become inefficient at work. They may have stereotypes and believe in social myths about image. The victim’s self image of is low. They shun away from interacting with others and want to remain isolated. Because of trauma and fear, victims of violence may lack sleep (Kemshall and Pritchard, 2000, p. 109). Victims of assaultive behavior may become defensive for any critic from abuser. They lose interest in the existing relationship with the abuser. In extreme cases victims of victims of violence may attempt to commit suicide or harm self. Victims of assaultive behavior need attention. They require support and help. One should consider the relationship of the aggressor and victim before taking legal action against the aggressor. For instance, the situation is sensitive if the aggressor and victim are married and the aggressor is the bread winner. Violent patients have caused disability, permanent injuries and even death to the victims (Graham 1998, p. 135). 4. Conclusion. History of patients with aggressive and violent behavior can be obtained by identifying sources of information. Information can be obtained from the patient, relatives, friends, police, observation and medical records. The healthcare once the source is identified the healthcare professional can prepare self psychologically and physically. Get rid of triggers of aggressive behavior and apply appropriate communication skills. Gather the information by focusing on relevant information and get the patient’s consent. Identify common issues and keep and record. Violent patients are characterized by negative emotions and behavior. They may be physically aggressive and have personality traits of committing violence. They have poor relationships with other people, may have mental illness or use drugs. Victims of violence have fear, anger, blame self, are terrified and make effort to run away. Victims may have depression, low self esteem and negative self image. Some have injuries and tendencies of revenge. If not assisted victims may hurt self or die from injuries Reference List Blumenreich, P. and Lewis, S. (1993). Management of the Violent Patient in the Treatment Setting. New York: Routledge. Dubin, W. R. (1993). Clinician Safety. American Psychiatric Association. Task Force on Clinician Safety. Eichelman, B. S. and Hartwig, A. C. (1995). Patient Violence & the Clinician. Washington, DC: American Psychiatric Press. Graham, A., Hamberger, L. K., and Burge, S. K. (1998). Violence Issues for Health Care Educators and Providers. Binghamton, NY:The Haworth Press. Kanel, K. (2012). A Guide to Crisis Intervention. Belmont, CA: Congen Learning. Kemshall, H. and Pritchard, J. (2000). Good Practice in Working with Victims of Violence. Philadelphia, PA: Jessica Kingsley.   McNeil, D. E., Hung, E. K., Cramer, R. J., Hall, S. E., Binder, R. L. (2011).An approach to Evaluating Competence in Assessing and Managing Violent Risk. Psychiatric Services, 62(1) Shepherd, J. (2001). 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