Group F: The violent patient

Question 1

Define the following terms (2)
* Emergent violence
* Aggression

Answer 1

• Emergent violence
  Physically forceful, assaultive or destructive patient that are endangering themselves and others
• Aggression
  domineering, forceful or assaultive verbalor physical action

Question 2

List three causes of violence in a psychiatric setting.(3)

Answer 2

• Aggressive * personalities
• Manic phase of bipolar disorder
• Acute psychotic episodes of schizophrenia
• Dementia
• Mania or agitated depression

Question 3

Explain the stages of violence & their associated goals of intervention (6)

Answer 3

1. Potential violence
   * Violence is the area of concern, such as thoughts of suicide or homicide without action.
   * The goal is prevention.
2. Imminent violence
   * Restless, irritable, aggressive, abusive or hostile patient threatening imminent action.
   * Aim of immediate management is de-escalation.
3. Emergent violence
   * A physically forceful, assaultive, destructive patient already endangering others.
   * Urgent goal, containment and safety.

Question 4

Outline 3 stages of management of an acute attack by a violent patient. (6)

Answer 4

1. A- Assessment: Look for signs oof the cause e.g head wounds or features of dementia. This should be don e before, during and after containment.
2. B- Back up: Staff such as security are required to protect other people and property for harm.
3. C- Containment:
   * Be calm.
   * Take control- this will ensure the patients and staff also remain calm.
   * Confidently manage the staff according to the pre-arranged plan for the setting.
   * Contain the patient with reassurance- relocate to a smaller and quet place and instruct the patient to be seated.
   * Physical or pharmacological constraint

Question 5

Differentiate between physical restraint and seclusion when managing a violent patient and when they should both be used in psychiatric settings (3)

Answer 5

Seclusion: Involves isolating a patient in a room to prevent harm.
Physical Restraint: Uses devices or hands-on techniques to limit movement.
Both are last-resort measures in psychiatric settings