Psych Flashcards
Trauma
Involves a single or multiple experiences
It is unexpected and is beyond a person’s control
Cannot be categorized- it is subjective (how the body responds physiologically) and individualized
Measured by the individual’s experience of the event and the meaning they make of it
Types of Trauma (5)
1) Single incident
2) Complex or repetitive (PTSD, first responders)
3) Developmental - “Toxic Stress” (abuse)
4) Intergenerational (cycle of abuse, legacy of violence)
5) Historical (residential schools, genocide)
Trauma-Informed Practice
Being sensitive to the impact of trauma in patients
Taking into account an understanding of trauma in all aspects of service delivery
Recognize the need for physical and emotional safety by creating an environment where patients do not experience further trauma or re-traumatization
Recognize the power differential and give pts a sense of control and power over their care.
Anger
Strong, uncomfortable and emotional response to a provocation that is unwanted and incongruent with one’s values, beliefs or rights.
Anger is the feeling and aggression is the behaviour.
Predictable > expressions of anger
Behavioural Expressions of Anger (3)
1st sign: Suspicious behaviour (anxiety, paranoia, questioning, frustration, hypervigilance.
2) Pt can start manifesting: Verbal hostility (sarcastic or blaming comments to hurt others) > has to be reported!!
3) Physical violence: act of striking out, throwing objects, pushing, … ; last line; very difficult to manage > chemical & physical restraints.
That’s why it is crucial to identify signs and cues early!!
1 risk factor for aggression:
Perceived disrespect
> this increases the risk of incidence of aggression
Step away and give pt time to process emotions and anger
Predictors of Violence
Violence is RARELY unpredictable
> Everyone in the hospital has a change of becoming violent
When there is a history of violence the chances of recurrence are higher
Assessment of risk factors
Risk factors for violence
Poor pain management
Withdrawal of benzos, ETOH, opiates/substance abuse, tobacco
Changes in diet - NPO
UTI, constipation, hypoglycemia, fear, anxiety, sleep deprivation, delirium d/t infection, dehydration
Brain injury, dementia
De-escalating violence behaviour
> Calm, respectful, assertive approach
Be aware of your verbal and non-verbal communication styles
Reduce stimulus (reduce visitors, dim lights, ..)
Offer distractions when appropriate (dementia)
Have hands in front of you
Position back to the door - have always a safe escape route
Set boundaries and limits
Do not be punitive
Offer choice to give pt a sense of control
Gently reality orient
Avoid touching the pt or use caution > ask for permission
Leave the situation or request help
Never put yourself at risk
If violence is imminent > 222 > Code White
Least Resistive to Most Resistive
Verbal redirection & behavioural expectations : limit setting
Environmental interventions: reducing stimulation, clear room of obstacles, reduce visitors, …
PRNs use (for agitation, atypical antipsychotics& benzo, olanzepine)
Chemical restraints for agitation
Seclusion (for emergency > order is needed)
Physical Restraints: very rare usedavoid> causes trauma
IH Restraint Policy
Assess and address causes if unsafe behaviour
Create care planning within 24h
Seek consent from pt or substitute decision maker
Only IH approved physical restraints to be used
Monitoring and reassessment q15min & 1:1 nurse
Documentation & communication> reassess need for restraint frequently
Emergency use of Restraints Policy
Only if:
> the pt is in serious danger to hurt self and is interfering with life-sustaining treatment
> Pt does NOT appear capable of giving or refusing consent to the use and there is NO substitute decision maker
> Restraint is least restrictive and used for the least time possible
> Assessment, intervention, care planning and consent are completed within 12h.
> An RN is to direct the emergency use of restraints
Monitoring of Restrained Patient
Assess q15-60 min
1:1 nursing as needed
Chemical restraints can be used with physical restraints > compassionate care to avoid trauma
Watch for: > ABCs > Level of sedation > Safety needs > Circulation/ sensation or restrained extremities - CWMS > Proper body alignment/ joint mobility
Fear versus Anxiety
Fear: during a perceived immediate threatm rising anxiety levels cause physical (SNS activates) and emotional changes in all individuals.
Anxiety is the most common psychologic disorder in children.
Higher rates of suicidal behaviour, early parenthood, drug & alcohol dependence and educational underachievement is noted in children and adolescents with anxiety disorders.
What is anxiety?
an uncontrolable feeling of apprehension or dread in response to internal or external stimuli.
it can result in physical, emotional, cognitive and behavioural symptoms.
> All symptoms of anxiety can be found in healthy individuals given particular circumstances.
It is the severity of the symptoms and the degree to which they impact daily functioning that dx into an anxiety disorder.
