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INTRODUCTION

“It isn’t enough to talk about peace. One must believe in it. And it isn’t enough to believe in it. One must work at it.”

–Eleanor Roosevelt

OBJECTIVES

  • Outline patient risk factors and effective interventions

  • Specify environmental risk factors and effective interventions

  • Delineate caregiver risk factors and effective interventions

  • Find out how to put all this information together into a healthcare violence-prevention plan

To prevent violence in the healthcare setting, you need a plan. This plan must account for common causes of violence, include specific techniques to prevent violence, and cite interventional strategies to de-escalate violent situations when they occur. Assembling a plan and a de-escalation educational program to combat violence in a healthcare setting helps foster a therapeutic environment and promotes safety, health, wellness, and optimal recovery outcomes.

Essentially, this entire book is focused on developing your de-escalation plan and educational program to prevent violence. In Chapter 2, “Variables and Risk Factors for Aggression,” you learned about common causes of violence, including patient variables, environmental variables, caregiver variables, and patient and caregiver interaction variables. Various chapters discussed specific techniques for preventing and de-escalating violence. And several chapters covered which techniques to use to de-escalate specific types of violent situations when they occur. This chapter simply helps you step through the process of actually assembling all this information to put your violence-prevention plan and de-escalation educational program into place. Organizing a healthcare violence-prevention plan by the holistic risk factor domains of patient, environment, and caregiver is an effective approach to preventing healthcare violence.

NOTE

As discussed throughout the book (but especially in Chapter 3, “Assessing an Escalating Situation for Early Intervention”), no matter what is causing a patient to escalate to behavior that is agitated, aggressive, or violent, early intervention is key—before the patient loses complete control. This breaks the cycle of aggression and prevents violence (Hodgins, 2008).

ADDRESSING PATIENT FACTORS

To review, patient factors indicating increased risk of aggression include the following:

  • Mental instability

  • The presence of delusions

  • The presence of command hallucinations with violent content

  • History of violence

  • Poor impulse control

  • Irritability

  • Attention-seeking behavior

  • An agitated state

  • Disorganized thought processes

  • Violation of personal space

Specific steps you can take to address these factors, and which should be delineated in your violence-prevention plan, include the following:

  • Perform mental status and risk assessment as per facility policy on admission. This helps the provider identify triggers for aggression and factors that might help mitigate the risk of aggression—especially with early intervention. (Refer to Chapter 10, “Performing a Mental Status Assessment,” for more information.)

  • Intervene and de-escalate early. The earlier the intervention, the more likely it is to be successful.

  • Provide patient education. The idea is to help patients develop coping skills and learn effective approaches for dealing with life’s tough ...

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