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The four factors that have been related to the scenario are he thinks his phone has been stealing by someone, staffs are involved in the stealing, the person not followed De-escalation and doctor not arrived to meet him. The study presented by Muthuvenkatachalam & Gupta (2013) discusses that patient aggressive behaviour can be due to the stealing of the belongings that lead to the negative behavioural aspect. The loss of the belongings increases the anger and stress of the patient which lead to irrelevant behaviour of the patient. One the other hand article presented by Grissinger M. (2017) added that irrelevant behaviour of the staff also increases the anger of the patient that leads to the aggressiveness of the patient.
Moreover, the study presented by McCann et al. (2014) discussed that during communication with the patient showing aggressive behaviour staffs are expected to de-escalate not aggregate the patient feels. The unsupportive behaviour of the staff can increase the aggressiveness of the patient which can lead to the violent behaviour of the patient. One of the studies presented by Pandey & Sharma (2019) added that during the aggression episode of the patient staffs are expected to address the need of the patient without showing negative behaviour toward the patient.
One of the strategies that can help in the de-escalate portion of the patient is nonverbal communication which can help to improve the relaxing the patient. The nonverbal communication helps the staff member to assist the patient in the care to relax and reduce anger which helps in decreasing the chances of violence. The nonverbal communication includes the different aspect and one of them is the silence that helps the patient to explain the issue. The silence in the conversation helps to improve the exchange of thought that is important to decrease aggression or anger of the patient. Another technique in the nonverbal communication is body language which plays a key role in the effective exchange of information and it helps to improve the chances of positive communication that lead to the decrease chances of irrelevant behaviour of the patient. The last technique that can be used to improve non-verbal communication is the facial expression that helps the person to connect and express the issue that is increasing the complication. The right facial expression can help the patient to relate with you during the conversation which decreases the negative behavioural aspect (Spielfogel & McMillen, 2016). Moreover, the study presented by Rabenschlag et al. (2019) added that empathetic attitude of the health care staff toward the patient is important for the de-escalate. Empathy helps the staff to understand the patient feels an issue by putting them in the same situation. Empathy is important to understand the patient issue and respect the patient feelings to address the issue of the patient to reduce aggression or stress. Empathy helps the staffs to be non-judgmental toward the patient viewpoint and belief which improves the care that is based on the personal preferences which will decrease the chances of irrelevant behaviour. Empathy promotes the safe clinical conditions that are important for de-escalation and address the issue of the patient by proper conversation. The empathetic attitude helps the patient showing aggressive behaviour to be calm by listening and incorporating their aspect in the care which will help to improve the health. Empathy promotes the positive attitude of the staff toward the patient issue which helps the patient to be assured that there will be an action for the issue that is increasing the complication.
Partnership with the patient is important to increase the understanding of the patient perspective concerning the care or issue. The staff member can adopt the partnership approach for the de-escalation process as it helps in the rapport formation between the staff and patient that is important to easy addressing of the patient issue. The partnership approach helps the patient to equally participate in the decision-making process and distribute equal power to the patient to stake care-related decision. Therapeutic communication helps the staff members to effectively talk with the patient which help to develop the trust that improves the partnership with the patient which is necessary for participation. During the conflict situation, health care professional can use the partnership skills to help in the calm down process which helps to reduce the violent behaviour of the patient. The patient and staff rapport develop due to the partnership help to teach the patient self-control process which is important to decrease the chances of anger which will also reduce the prevalence of violence in the setting. The staff can show cooperative behaviour toward the patient to understand the situation and reduce the irrational behavioural aspect of the patient to improve the communication that will help to address the patient issue (Edward et al., 2018). Moreover, the study presented by Spencer et al. (2018) discussed that anger management intervention can also help the staff and patient to reduce the chances of violence or irrelevant behaviour. Anger management intervention helps the nurses to improve the self-control of the patient to reduce the aggressive behaviour that can lead to the irrelevant scenario which harms any of the individuals. The aggression and irrelevant behaviour increases the chances of the harm to the patient that can lead to poor physical or mental wellbeing thus anger management will help to reduce the chances of the aggressive episode. The patient and staff poor behavioural aspect lead to the aggressive and violent behaviour which can be reduced by improving patient ability to control the anger or aggression which help to improve the conversation. The anger management intervention includes different strategies like monitoring the fluctuation in the mood, engaging in different activities and self-evaluates your behaviour that increases patient power to analyse their behavioural which need to be improved. The staff can assist the patient in understanding and implement a different approach that is important for the anger management process which leads to reduce the rate of the violence in the clinical setting.
Edward, K., Giandinoto, J.-A., Weiland, T. J., Hutton, J. & Reel, S. (2018). Brief interventions to de-escalate disturbances in emergency departments. British Journal of Nursing, 27(6), 322–327. DOI:10.12968/bjon.2018.27.6.322
Grissinger M. (2017). Disrespectful behaviour in health care: Its impact, why it arises and persists, and how to address it-part 2. P & T: A Peer-Reviewed Journal for Formulary Management, 42(2), 74–77.
McCann, T. V., Baird, J. & Muir-Cochrane, E. (2014). Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units. BMC Psychiatry, 14(80), 1-9. DOI: 10.1186/1471-244x-14-80
Muthuvenkatachalam, S. & Gupta, S. (2013). Understanding aggressive and violent behavior in psychiatric patients. Indian Journal of Psychology Nursing, 5(1), 42-46. DOI: 10.4103/2231-1505.261775
Pandey, S. & Sharma, V. (2019). Aggression and violence against doctors: How to address this frightening new epidemic. Indian Journal of Ophthalmology, 67, 1903-1905.
Rabenschlag, F., Cassidy, C. & Steinauer, R. (2019). Nursing perspectives: Reflecting history and informal coercion in de-escalation strategies. Frontiers in Psychiatry, 10, 231. DOI: 10.3389/fpsyt.2019.00231
Spencer, S., Johnson, P. & Smith, I. C. (2018). De-escalation techniques for managing non-psychosis induced aggression in adults. The Cochrane Database of Systematic Reviews, 7(7). DOI: 10.1002/14651858.CD012034.pub2
Spielfogel, J. E. & McMillen, J. C. (2016). Current use of de-escalation strategies: Similarities and differences in de-escalation across professions. Social Work in Mental Health, 15(3), 232–248. DOI:10.1080/15332985.2016.1212774
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