violence (2)

Question 1

What kind of teams have been recommended to decrease the risk of developing trauma related disorders, but the research supporting such interventions is mixed

Answer 1

critical incident stress debriefing teams (CISD)

Question 2

describe “acting out”

Answer 2

Expressing one’s feelings behaviorally rather than verbally. Does it at times. Usually unconscious, not intentional. It can be positive, like hugging someone when you’re happy, or negative, like hitting staff in your frustrated

Question 3

What are the two main causes of acting out?

Answer 3

1) An inability to communicate coupled with…
2) A sense of desperation

Question 4

How can nurse help prevent acting out?

Answer 4

• Help someone communicate their feelings
• Reduce the patient’s degree of desperation
• Prevent secondary games via self awareness
• Help patient cope with their own responses

Question 5

What occurs when feelings are not communicated, or when they accumulate too quickly for the patient to be able to communicate or resolve them

Answer 5

desperation

Question 6

How can staff actions become part of the patient’s desperation cycle?

Answer 6

• Putting a patient in restraints if it is not truly necessary and essential can be seen as punitive and increase the patient’s desperation, anger, or fear
• If the staff shapes the patient, he may be overwhelmed by guilt or embarrassment and unable to communicate that feeling

Question 7

How can secondary gains increase further aggression responses

Answer 7

• If a patient throws a chair, the other patient’s not approvingly and the behavior is reinforced
• a patient hits a peer who has been bullying them, staff smirks and comments they got what they deserve, reinforces behavior

Question 8

Describe the state, seek, do method when a patient is escalating

Answer 8

• STATE what you see and what you’d like to see
• SEEK information on how patient sees things, and his ideas on what they think would help
• DO those reasonable things the patient suggests, or guide a patient’s response to be more doable

Question 9

How can you use dislocation of expectations to help deescalate a client

Answer 9

Do what the client does not expect

Question 10

How can you use altercasting to intervene when a patient is escalating

Answer 10

Convey positive expectations so that the patient will tend to assume the desired qualities

Question 11

How can you use anticipatory fantasy when a patient is escalating

Answer 11

Talk about what is likely if things continue on the same trajectory, and contrast this with what you and the patient would like to see

Question 12

How should you give bad news to a patient

Answer 12

Give it privately but in a public area of the unit but never in a closed room, Alert staff the need to share the information, give the news with another staff member present, provide support, and assure that staff subsequently follows up with the patient

Question 13

Describe “crisis post-mortem”

Answer 13

Once the situation has been de escalated, it should be processed asap with the patient and among team members. The goal is to learn from the experience in order to reduce reoccurrences

Question 14

What is important to provide with a patient in restraints or seclusion

Answer 14

Coimbation needs, nutritional needs, range of motion to prevent damage to tissues