Violence prevention

Question 1

What is Trauma?

Answer 1

􏰀 Involves a single or multiple experiences 􏰀 Contains common elements:

• It was unexpected
• The person was unprepared
• There was nothing the person could do to stop it from happening

Measured by subjectively

Question 2

Describe types of Trauma

Answer 2

􏰀 Single incident trauma
􏰀 Complex or repetitive trauma (War)
􏰀 Developmental trauma (“Toxic Stress”) 􏰀 (Negelct/Abuse)
Intergenerational and Historical trauma

Question 3

Describe 4 common responses to trauma

Answer 3

Stress response (fight or flight)
Behavioural (hypervigilance, fear)
Adaptation (forgetting incident)
Permanent biochemical (early trauma)

Question 4

What is Trauma informed Practice?

Answer 4

Service that incorporates understanding of trauma

􏰀 Recognize the need for physical and emotional safety

Opportunity for Choice, Collaboration and Connection with minimum power imbalances
􏰀
Strengths Based and Skill Building

􏰀Create an environment where patients do not experience further trauma or re-traumatization

Question 5

What is Anger

Answer 5

Affective state experienced as the motivation to act in ways to warn, intimidate or attack those who are perceived as challenging or threatening

􏰀 Part of the flight/fight response to help resolve a situation

Question 6

How does anger begin to manifest then develop often?

Answer 6

suspicious behaviour, verbal hostility, physical violence

Question 7

What are the three theories to explain anger

Answer 7

Biologic Theories
􏰀Psychological Theories 􏰀 (It has gotten you what you want)
Sociocultural Theories (power)

Question 8

What the #1 risk factor for anger

Answer 8

Perceived disrespect

Question 9

What is the best predictor of violence?

Risk Factors to consider?

Answer 9

Hx of violence (Predictable most of the time)

traumatic brain injury, substance use, missed medication

Question 10

Signs of escalating behaviour

Answer 10

􏰀Staring 
􏰀Tone of voice 􏰀 
Anxiety
􏰀Mumbling
Pacing

Question 11

Deescalation Response

Answer 11

Identify/treat underlying cause 􏰀 
Reduce stimulus
Stance open
A choice
􏰀Space
􏰀Vocal Communication
􏰀Body Language
􏰀Validation

Question 12

Do you need an order for restraints?

When do you use them

Answer 12

Need a docs order within 12 hours.

Only after all other interventionas have been attempted.

Question 13

What required as far as consent when using restraints

Answer 13

The patient must be an immediate danger to themselves or others

Always seek consent from patient or from family member

Otherwise it’s emergency restraint. Least restrictive and for the least time possible

Document a behavioral care plan

Question 14

How often does restrained patient need to be monitored

Answer 14

Assess patient every 15-60 minutes - or constantly if required. (1:1 nursing as needed)

Question 15

What does a behavioral care plan include?

Answer 15

• Description of baseline behaviour
• Description of the unsafe behaviour
• History of prior traumatic experience
• Proposed action plan
• preferred restraint type and why used
• where valid consent can be sought

Question 16

Least Restrictive to most restrictive

Answer 16

LEAST

Verbal redirection and behavioral expectations
􏰀Environmental intervention
􏰀Use of PRNs
􏰀Chemical restraints
􏰀*Seclusion
􏰀Physical restraints

MOST

Question 17

What might you check with restrained patient checks

Answer 17

circulation, body alignment, anxiety levels, abcs