aggressive behavior

  1. It's often difficult to know exactly what to "subject" the message in order to get the most views, and therefore, get some feedback.

    If you are reading this, hopefully you have experience with patients/clients/residents with aggressive behavior.

    Here is my question: In your area of work do you have systems that identify a patient/client/resident as potential for being or becoming aggressive. Specifically something other than the careplan.

    Scenario: Client A strikes out when other residents speak to them. Client B asks Client A a question, Client A strikes client B.

    How are staff alerted that Client A will behave in such a way, in order to intervene and avoid incident?

    Any ideas, thoughts?
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  2. Visit monkijr profile page

    About monkijr

    Joined: Aug '02; Posts: 250; Likes: 36

    27 Comments

  3. by   Nurse Ratched
    We have different types of precautions that patients can be placed on: suicide precautions, elopement precautions, and assault precautions. They have to be renewed every three days in the inpatient setting so the person is re-evaluated and the MD is forced to address what is being done to remedy the risk. Stating that a person is on assault precautions (AP's) alerts the staff that the person is potentially a danger to others, be they staff or other patients. All precautions patients are on are included in report.
  4. by   monkijr
    Thanks, Nurse Ratched

    Other than report, is there anything that identifies the patient?

    What would you think for example if all patients who were on AP's had blue shirts, and all patients on SP's had yellow shirts, and those patients on EP's had red shirts?

    I am interested in all feedback.
  5. by   OBNURSEHEATHER
    Originally posted by URSULA
    What would you think for example if all patients who were on AP's had blue shirts, and all patients on SP's had yellow shirts, and those patients on EP's had red shirts?
    Ummm... that just seems weird to me.

    Like, if I had all my patients that delivered boys wear blue shirts and girls wear pink shirts, so that I could easily know whether to say "he" or "she" when conversing with the parents?

    Quite frankly, if you're working on any type of psych unit, you should always be on your guard and aware of escalating behavior.

    Heather
  6. by   sunnygirl272
    i would think that colorcoding the residents by their behavioral probs would be a huge confidentiality/hipppppaaaa(can never remember if it's 2 p's or 2 a's...and i just had my level 1 inservice today too....)/civil liberties issue...

    also, nurse ratched..what are elopement precautions? have visions of 2 horny senior citizens trying to weeble out the door with their quad cane and walker to get to a JOP....
  7. by   OBNURSEHEATHER
    Originally posted by sunnygirl272
    also, nurse ratched..what are elopement precautions?
    Escape.
  8. by   sunnygirl272
    Originally posted by OBNURSEHEATHER
    Escape.
    nah...i like my definition better...
  9. by   Nurse Ratched
    Originally posted by sunnygirl272
    nah...i like my definition better...
    I do, too - sounds like a lot more fun, huh?

    Ursula, Heather is right about always being aware of escalating behaviors. The folks who are on assault precautions all did something violent to get on them.

    BTW Heather - how's the new job?
  10. by   OBNURSEHEATHER
    Originally posted by Nurse Ratched
    BTW Heather - how's the new job?
    LOVING it!

    I guess I didn't realize how much I enjoyed the psych aspect until I was admitting my first paranoid schizophrenic, and I got that thrilling/excited/adrenaline-pumping feeling when he kept "SHHH!"-ing the voices. :chuckle

    Thanks for asking!
  11. by   dingofred
    In our workshop setting each client has a "lifestyle" plan that
    staff are to be familiar with. It outlines their particular behaviors
    and how staff is allowed to intervene. Of course everyone gets
    thrown for a loop occasionally when someone does the unexpected!!
  12. by   monkijr
    The facility I work in is proposing that certain residents be identified as potentially aggressive, (along with diagnosis of course)and are suggesting that these residents be identified with a color. (not necessarily clothing.) I suggested we follow a holiday theme, not well taken.

    The argument that it is a hippa issue was discussed in that the response would be that "it has to do with their plan of care"

    I believe the different colors would be more of a dignity issue, and could cause isolation and different treatment toward the resident.

    Some believe that even though it is the care plan along with interventions, not everyone in the facility knows how to intervene and the "color" would clue them on the need to intervene appropriately. does that make sense?

    Heather, I agree with the shirt thing seems wierd, I just used it as an example. The decision makers could suggest it though.
  13. by   monkijr
    Bumping this up, hopefully to get more feedback.
  14. by   pattyjo
    Hi Ursula: A question: are you working in psych or a LTC/Alzheimer's/dementia setting? And how many patients are we talking about here?

    I agree with everyone who has said the color coding thing is a bit odd. Privacy issues, yes, but also dignity, and my guess is, all the patients will have figured out the code in about 30 minutes, so you have effectively "branded" the patients among their peers, and any visitors who show up.

    Do you do any type of assessment to determine the potential for aggression? (Although as others have already said, in certain settings there is *always* the potential for violence/aggression.)
    We don't have formal orders for specific precautions, but do pass on in report any suspicions. To some degree, we can anticipate escalating behavior, but there is always that impulsive, unpredictable outburst to deal with.
    Patty

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