Management of a violent or aggressive client plays an important role in health care setting. This is very critical in mental health sector and as well as the prevention of violence and aggression is very essential since the main concern of the modern world has been directed towards preventive measures rather curative and therapeutic actions.
Researchers have found out that violence and aggression are common among mentally disordered clients than community controls. It is more common among schizophrenic and drug addictive clients than other mentally disordered clients. Furthermore this article reveals that the number of homicidal events for last few decades remains constant in UK although the technology has been improved. (Davison, 2005)
Furthermore some articles reveals that hundred percent of nurses who are working at mental health settings have experienced some kind of violent behavior from clients towards them. The more important thing is these behaviors vary from verbal threat to sexual harassments. And also this article reveals that nurses and health care workers who directly work with such clients are getting assaulted more often than doctors who visit them periodically. (Richter & Whittington, 2006) These facts prove the important of developing more effective strategies to manage violent and aggressive clients.
Since they are not completely independent and since they seek care it is very essential to plan strategies to cope with and to prevent or minimize such incidences while maintaining clients’ rights and dignity as health care workers.
The other important aspect of this discussion is to minimize or prevent injuries or harm to the coworkers while managing such clients in a dignified and well accepted manner.
Before look in to the management and the prevention it will be useful to be familiar with technical terms.
What is violence?
Violence has been defined as an intentional behavior towards any person or a property to damage, Injure, hurt, abuse or kill with a physical force. (Dictionary, 2012)
What is aggression?
Aggression is a set of behaviors which can cause physical and psychological injury, damage of harm to oneself, others or properties. (Cherry)
What causes aggression and violence?
It is critical to figure out the reason or the cause, why violence and aggression occurs in health care setting. Despite clients mental health condition or the physiology of the disease the environment and the way staff approach the client is important. Most of the articles reveals that clients with antisocial behaviors, schizophrenia, drug addictives and clients who are having problems with the insight may become aggressive than other traits. But it is important to notice that apart from above conditions the environment which is discomforting to clients and actions of outsiders may play a role towards clients’ violence and aggression. This may be common among health care settings the onset of aggression due to certain actions taken by staff members which can justify due to lack of systematic techniques and understanding even though it is unethical. Because with the more often aggression and harassment towards staff make their mind to take aggression and violence as a job related threat or hazard and make them helpless during a such incident. This will make their mind to be more focus on safety rather clients rights and dignity.
Prevention of Aggression & Violation
Identify your client
It is essential and critical to know your client very well before you approach your client. This includes the condition of your client, medical, social history & violent history. Knowing you clients medical & social history may help you to recognize what makes you client aggressive while violent history will reveal lot of important facts about you behaviors. Simply you should know likes & dislikes of your client, what makes them aggressive, how they express when they were above to behave aggressively & what would they do when they become aggressive. So you can anticipate & get prepared if you know above information about your client.
Pay your attention to aggravating factors
If you know your client, you can figure out what makes them aggressive. May be certain topics, actions, words or behaviors will make them aggressive. You need to avoid them as much as possible when you approach a client. This will help a healthcare worker to prevent such incidents.
Once you identify your client properly, you should take necessary precautions. Based on above assessment firstly you need to rule out factors which makes them aggressive. Secondly you should pay your attention and find out a way to identify such incidents before it occurs by your client’s expressions, specific behaviors, or gestures. Then you should know what they would do when they are aggressive or violent. Based on that information you should take necessary precautions. You may keep your coworkers informed before you approach your client, & keep an emergency communication system ready such as a call bell to use in case.
Arrange the environment
It is very essential to arrange your client’s environment. That should be calm, comforting environment with no clutters & threats. The surrounding should not posses any sharp objects, ropes, wires, tubes which can be use to harm self or others.
Managing Aggression & Violation
If your client become violent or aggressive; by using following measures you can try to control the situation.
Talk on behalf of your client
Always show your client that you agree with him or her and always take you client’s side though you strongly disagree with him or her. Because, your client becomes aggressive or violent since they are not fully mentally competent at the moment. Realize that this is not the best moment to discuss & prove your client is wrong or his or her actions are unacceptable. Talking on behalf of your client will help you to gain your client’s trust & faith which will be useful to calm down your client. Send victims or opponents out immediately while you are having someone around to assist you. Because seen his or her opponent would make your client more discomforting.
Try to calm down you client
Once you gain faith of your client you can control you client up an extent. Don’t try to over control your client. Calm down you client by giving them suggestions while listening to him or her. Offer him or her a seat to make your client comfortable. Give your client enough time without rushing.
Remove aggravating factors from your client’s sight
If aggression or violation has being occurred due to a person, send him out, the factor may be a picture, word which has being used or any behavior or can be any minor thing. You must avoid them & remove them immediately if it is possible to support him to calm down.
Keep supportive measures ready all the time
All the time the emergency alert system, urgent medicines such as sedatives, supportive staff should keep ready when you deal with such a client. This will help healthcare workers to minimize the damage if an incident occurs.
Go with a crowd
When you approach a client who is highly possible to become violent or aggressive it is preferable to go with one or more coworkers. In case if client becomes violent supportive staff can help you to restrain at least until medications has being administered. And it is very important that you should keep your eye on your client and should be at your sight whenever you are at your client’s room or area. This will provide your safety. By having your client at your sight all the time, you can see what they are doing & for what they are getting ready for. Your client may try to harm you since he is mentally incompetent. If you do not pay your attention to your client; it will make it easier for your client to harm you.
IM rout is preferable for emergency medicines
Always intramuscular route is preferable to administer medications such as sedatives during an violent or aggressive situation. The reason is you don’t need much of coordination to administer IM injections as IV. Even though IV act fast administering as IV medication will be difficult with a non cooperative client unless they are restrained or an IV canula has being inserted.
Do not Criticize
Once an incident occurred do not label your client since that will lead you client to become more aggressive when people treat them differently as well as that will help to recur the same situation. Treat them similarly as for the others & do not show them a difference.
Aggression and violence is common in health care related to mentally incompetent people such as patient with anti social behaviors, schizophrenia, personality disorders & drug addictives. Poor techniques, protocols and systems to deal with them put both clients and health care workers at a risk. Furthermore this will cause breaching client’s dignity, rights & health status while healthcare workers consider them as a job related risk. Proper education and awareness of healthcare workers would improve healthcare workers coping with such incidents & proper management of incidents. Knowing you client & being prepared is the best way to minimize aggression & violence in healthcare.