Crisis Prevention and Intervention in Healthcare - Essay Example

Essay Inserts His/Her Inserts Grade Inserts (02 02, Outline Introduction2. The assault cycle 2.1. Trigger phase 2.2. Escalation phase 2.3. Crisis phase 2.4. Recovery phase 2.5. Post crisis phase 3. Aggression and violent predictive factors 3.1. Demography and personal history 3.2. Individual disorders, sickness and substance abuse factors 3.3. Situational factors 3.4. Actuarial and clinical predictive factors 3.5. Broset violence register 4. Conclusion Crisis prevention and Intervention in healthcare 1. Introduction. A number of healthcare professionals have experienced violence in the workplace. Violence has been committed by patients, workmates and visitors to the healthcare professionals. A clear pattern of how violence can be occurs has been identified. Moreover, there are preceding observations that can be made before a person progresses to become assaultive (Linsley, 2000, p. 48). This essay will describe the cycle of assaultive behavior and provide predictive factors for aggression and violence. 2. The assault cycle. The assault cycle has distinct patterns that can assist predict violence and enable the health care professionals to administer appropriate measures. The patterns in assaultive behavior are common in different groups, genders and persons. In every cycle different behaviors can be observed in particular phases. The five phases of the assault cycle include: trigger, escalation, crisis, recovery phase and post crisis. 2.1. Trigger phase. An individual begins to detect threats to their security or welfare. Feelings of being denied, being ignored or being refused something important to them step in. The aggressor then becomes frustrated as Linsley (2006, p. 48) highlights. A person in trigger phase perceives that they have lost control. They review the issues facing them and see the magnitude of the conflict as huge. Fear is real and the person in crisis endeavor is to compensate what they are denied. They may be in denial and reason with self to justify events. The trigger is as a result of other people actions, an argument with another person, upsetting information and in ability to do something they have been denied such as consuming alcohol. Crisis can be eliminated if the problems and conflicts are solved. Trigger phase is not associated with experiences of medication or hallucinations. Poor communication is experienced in the trigger phase. Interpersonal relations are poor and characterized by a lot of tension. The person in crisis may try to control self from causing outburst and motivating another person to have an outburst. The appropriate response towards the potentially aggressive person would be to divert their mind and destruct them. Exercising good communication skills where one remains neutral would be helpful. A healthcare professional can alert others and record observations. The healthcare professional should remain calm and avoid showing signs of fear. Keep distance, show the hands and stay close to exit. 2.2. Escalation phase. The person in crisis begins to prepare for aggression. Threats are presented verbally to the prospective victim if they are within reach. Anger steps in and the aggressor throws objects, begins pacing and kicks walls. The voice is raised and yelling that is sometime accompanied by banging is experienced is seen. The escalating phase provides an opportunity for a healthcare professional trained in assaultive behavior to employ de- escalating techniques to prevent violence from occurring. If possible, explaining to the aggressive person that consequences of violence can be severe can be helpful. This can be done with caution because it can be professed as a threat to the aggressor. Adamowski et al (2009, p. 740) adds that, the thinking process is affected by the high levels of anger and distress. Consequently, the aggressor begins to become dysfunctional, disorganized and lacks sleep. They may direct their anger to animals or objects rather than directing them towards a person. Very minor events become a cause of argument. When the healthcare professional recognizes escalating behavior, they should communicate to other professional and ask for company. If the situation has the possibility of becoming violent they should notify the authority and avoid attending to the person alone. Showing fear, disappointment, impatience and annoyance may convey negative information to the aggressor. Hands should be kept where they can be seen and space between the aggressor and others should be kept. Negotiation and conversation with persons who are drunk and under influence of drugs should be avoided. The security should be involved if the violent threat is imminent. Using communication skills for de-escalating violence to prevent the aggressor from becoming violent is necessary. 2.3. Crisis phase. Crisis stage involves actual aggressive behavior. The aggressor assaults the seeming threat. A lot of energy is used in violence. The person in crisis becomes weary very quick because the energy to sustain an attack is limited. In the crisis the aggressor dominates the victim by controlling with violence. The abuser is unpredictable and fears losing power, therefore, they use violence to control. The aggressor believes it is the victim on the wrong. The victim of assaultive behavior is abused, feels helpless and becomes traumatized. To ensure they have control, the abuser takes time to decide words to use and place they will use for abuse. They scheme and attempt to do what they have planned on the victim. Besides hurting the person they want to abuse, the assaultive person hurts pets and destroys property. The victim of violence blames self for suffering the violence because they might have contributed to causing violence. Alongside feeling terrified, the victim of abuse sense embarrassment, shame and humiliation. The victim experiences fear and shock. When attacked they should call for help. This is an attempt to remove them from the trap (Chou et al, 2001, p. 139). The abuser refreshes the conflict and uses it as an excuse for punishing the victim. Punishing the victim gives the aggressor a short lived feeling that they have resolved the problem. The abuser becomes irrational and continues threats. 2.4. Recovery phase. After becoming assaultive the aggressor slows down to recover. The aggressor is watchful and any impending threats could generate another assault. The feeling of being disorganized remains and the aggressor becomes confused. Some aggressors become depressed and commit crime against themselves such as self injury and suicide. In an attempt to recover what has been damaged, the aggressor reconciles by showing affection and apologizing. The abuser ends violence and demonstrates their desire to change. Because of feeling remorseful the aggressor becomes sad and shows that they are repentant. In some cases the aggressor refuses to apologize and ignores the violent event. They leave the victim without saying a word and disappear. Some return and request the victim to sympathize with them. They become very convincing to justify their act and profess that they will not repeat assault. Ways of de-escalating violence can be implemented to prevent the aggressor from becoming violent again, and listen to the aggressor (Ford et al 2010, p. 74). 2.5. Post crisis phase. Aggressive individual calms down and becomes emotional about their actions. They show intense remorse, fatigue and despair. They begin to blame self and hide from others. The aggressor might begin crying, sleeping or walk dangerously. The aggressor may attempt to mend their existing relationship with the victim. The post crisis is peaceful. In some cases the aggressor does not have remorse and may be happy about the violence. What causes the cycle to begin is when interpersonal difficulties arise. When the interpersonal issues continue to add, the situation becomes different and tension begins to build; causing the cycle to start. Positive talk and affirmation should be emphasized to decrease the chances of triggering another cycle of violence. The aggressor can engage in different activities like recreation and exercising to divert their mind. Mark the triggers of assault and avoid mentioning or accommodating them. Reaching out for spiritual help and mediation from a skilled person can assist destabilize crisis (Salmon, 2007, p. 14). 3. Aggression and violent predictive factors. As assaultive behavior continues to become a major concern in healthcare, and researchers have engaged in finding factors that can predict violence. The motive of conducting has been finding the most appropriate factors that can predict violence accurately. 3.1. Demography and personal history. In the healthcare facilities demography and personal history play a major role in proving information on the possibility of aggressive behavior. Chapman et al (2009, p. 476) mention that, individuals who have shown threats of hostility and belong to a group or subculture that engages in violence could be a prospective violent person. Male patients are believed to have higher likelihood of becoming violent than women. Healthcare professionals take into consideration the history of the patient, healthcare worker or visitor. Aggressive tendencies in the past can be identified as a possibility for aggression in the future. Incidents of cruelty towards self and others are used to determine the possibility of aggression. The presence of men as the majority in aggressive behavior may not be necessarily correct in relation to violent behavior in healthcare. Young people tend to be involved in violence than older people. There is a correlation of low income earners, unemployed, low literacy levels being a contributive factor to violence. Healthcare facilities report high cases of violence occur at night as opposed to the day. Aggressive people become violent towards the victim if the victim is alone and is female. When there is less surveillance from the hospital guards and visiting time for patients’ violence tend to occur. When the aggressor sees that there is no security, they are likely to take the opportunity to commit violence. The frequency of assaultive behavior in a given population is used as base line to predict violence. Use of rates to predict is considered to be an actuarial factor. 3.2. Individual disorders, sickness and substance abuse factors. The individual may be having personal crisis where they lost control or power. Anxiety disorder is regarded as a ground for causing aggression and can predict violence. The person causing violence may be using medication without a prescription. Delirium can cause violence if the patient has seizures, infection, and trauma or electrolyte imbalance (reversible). Brain injury, Dementia, excess alcohol and Alzheimer’s disease can contribute to the development of aggressive behavior. Previous mental problems like paranoia, personality disorders, psychiatric illnesses or psychosis can predict violence. When the person in crisis senses unmanageable powerlessness, humiliation and extreme fear, they may become violent as a way of controlling internal feelings. The desire is to defend them from danger and to gain control. Grieve is another factor that can cause an individual to become violent. A series of violence in the past can influence the person to become violent. Once they have become violent in the past, there is a tendency of becoming violent in the future. Morrison et al (1998, p. 558) argue that attacks towards healthcare professional are not abrupt. Patients and healthcare professionals who become assaultive can be identified before they become violent. Prior to becoming violent, the aggressor will experience increasing tension, give threats and become stressed. History of violence is one of the reliable factors for predicting violence. Employment, literacy level, ethnicity and gender are weak factors for predicting violence. Loss of trust for the physician, visitors, relatives and other healthcare professional in the hospital can led to wild suspicions that will inspire aggressive behavior. Provocation to cause violence is a situation that may eventually end up causing violence (Belayachi et al, 2010, p. 27). Individuals who are unable to tolerate stress can become assaultive. People with psychiatric disorders such as schizophrenia, depression and bipolar together with schizoaffective disorder are prone to becoming aggressive. Substance abuse and excessive consumption of alcohol is a prominent contributor of violence in healthcare facilities. Patients with mental disorders and the psychotic consuming alcohol have a higher tendency of becoming aggressive than those who do not consume alcohol or abuse substances. 3.3. Situational factors. Ferns (2006, p. 42) notes that, situations that facilitate occurrence of violence can be used as a predictive factor. The availability of weapons such as knives, guns, sharp objects where the person in crisis can access them could lead to aggressive behavior. The presence of a person who stimulates the feeling of injustice, oppression as well as inequality can trigger abuse. When the person is forced to feel threatened and defenseless they become aggressive. Individuals who have experience abuse from self or others in the past can quickly become aggressive if same condition is applied in the present. If the person feel isolated from the rest of the people and is removed from their place of comfort without consent, they may not welcome the change and instead become aggressive. When something unexpected occurs, the event can stimulate anger which can eventually erupt into violence. There are prevailing circumstances that encourage violence such as overcrowding, favors towards others and uninformed rules. Healthcare facilities have been used as a holding place for detainees and people serving a jail term when the correctional institutions are crowded. People who are brought to hospital are mentally disturbed, sick and aggressive. The emergency rooms have people who are under the influence of drugs. The police let the people stay in the emergency rooms until they become sober. When in the hospital the detainees, people under influence of drugs and the ill can become aggressive to self, other patients, healthcare providers and other people within reach. Antisocial personalities which are a personal trait can predict violence. The person disregards others and does not pay attention to other people’s rights. The antisocial personalities who are mentally ill are likely to commit recidivism especially to women and engage in substance use. Psychopathic is another predictive factor where the aggressor is self-centered and brutal. 3.4. Actuarial and clinical predictive factors. Prediction of aggressive behavior or violence has been given different approaches to include clinical actuarial and structured methods. Predicting violence has been seen as a very challenging task because assaultive behavior has occurred even in circumstances where no risk had been detected. Actuarial methods of predicting violence take into considerations risk factors such as diagnosis, psychopathological condition, gender and age (statistical assessment). Actuarial methods predicted violence if the same patient is exposed to same conditions in the future. As a result, the method does not recognizing the judgment of the healthcare professional dealing with the current situation and is often used for admitted patients. Data collected on the specific patient is used to make the judgment if the person is likely to become aggressive. Clinical methods of predicting violence have been used to predict overt behavior and consider factors such as psychopathology. Clinical methods are structured and assessment is done according to situation. 3.5. Broset violence registers. Abderhalden et al (2006, p. 17) note that, prediction of assaultive behavior is possible during routine care. Healthcare professionals can forecast violence using the violence register on a short term basis. Violence check list consist of six observations of the possible aggressive person. The observations include irritation, confusion, abusive and threatening words, and boisterousness, attacking animals and objects and physical threats. When the six observations are recorded, there is a higher probability of the person to become violent. 4. Conclusion. The assault cycle begins with a trigger when behavior of a person changes and tension begins to build up. The next cycle is escalation phase where the body and verbal words reveal unmanageable anger. The next phase is crisis where the aggressive person acts violently. After the crisis the aggressor enters recovery phase when they begin calming down. The final phase is post crisis phase where the assaultive person becomes remorseful. In an attempt to resolve issues the aggressor and victim disagree leading to a trigger; hence the cycle begins again. Ways of de-escalating violence should be exercised to prevent assaultive behavior. Aggression and violent predictive factors include: Demographic (age, gender), history, disorders, sickness and use of substance, situational (prevailing circumstances), Actuarial, clinical, and Broset violence register predictive factors. Reference List Abderhalden, C. A., Needham, I., Dassen, T., Halfens, R., Haug, H. J., and Fischer, J. (2006) Predicting inpatient violence using an extended version of the Brøset-Violence-Checklist: instrument development and clinical application. Bio Med Central Psychiatry, 6, 17. Adamowski, T.,  Piotrowski, P.,  Trizna, M., and  Kiejna, A. (2009). Assessment of types and incidence of aggression among patients admitted due to aggressive behaviors, Psychiatry Pol 43(6), 739- 749. Belayachi, J., Berrechid, K., Amlaiky, F., Zekraoui, A., and Abouqa, R. (2010). Violence toward physicians in emergency departments of Morocco: prevalence, predictive factors, and psychological impact. Journal of Occupational Medicine and Toxicology 5, 27. Chapman, R. Perry, L., Styles, I., and Combs, S. (2009). Predicting patient aggression against nurses in all hospital areas, British journal of Nursing, 18(8), 476-483. 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. Ferns, T. (2006) Violence, aggression and physical assault in healthcare settings. Nursing Standard, 13, 42. Ford, K., Byrt, R and James, D. (2010). Preventing and Reducing Aggression and Violence in Health and Social Care: A Holistic Approach. UK: M&K Update Ltd Linsley, P. (2006). Violence and Aggression in the Workplace: A Practical Guide for All Healthcare Staff. Abingdon: Radcliffe Publishing. Morrison, J. L., Lantos, J. D., Levinson, W. (1998). Aggression and Violence Directed Toward Physicians. Journal of general Internal medicine, 13(8), 556- 561. Salmon, N., and Varela, R. (2007) Learning to manage assaultive behavior. New York: AMN Healthcare Services Inc. 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