January 9, 2015
Article by Global Pre-Meds
Hospital doctor shadowing & global health experience programs.
Whether you are going to medical school, nursing school or physician assistant school, the odds are eventually you will encounter an aggressive patient. Aggression in patients can range from a verbal assault to physical violence.
There is a difference between a patient who is angry and one who is aggressive. Not all patients who become angry will get aggressive. But it is important to realize when a patient is becoming upset and try to prevent a situation from becoming worse. Spotting signs of aggression, and learning ways to defuse the situation can help you stay safe.
There are many reasons why patients can become aggressive in the hospital. For example, some people are just quick to anger and have a tendency towards hostile and aggressive behavior. Whether they are at home, work or in the hospital, they may not deal with negative emotions appropriately.
In other cases, patients become aggressive because of their situation. They may feel a loss of control over their medical condition and that combined with other emotions, such as fear and anxiety, leads to displaced anger or aggression.
It is also possible that a physical condition has led to aggressive behavior. For instance, patients who have certain organic brain diseases, such as Alzheimer’s disease sometimes develop aggression.
You may also encounter patients who have mental health issues in addition to a physical problems. Although most people who have a psychological problem, are not violent, a small percentage may become aggressive.
Aggressive behavior may start out suddenly or build. In cases where a patient has a mental health issue or dementia, aggression may come on quickly. In other instances, aggression develops a bit slower. Medical clinicians, including students, have to be aware of the signs of aggression and manage the situation to prevent patients from injuring themselves or others.
There are many ways to recognize a potentially aggressive patient. For example, know the person’s history. While some patients who become aggressive have no history of violence, other may. Pay attention when you are getting patient report. When you start your shift each day, you will get report on the patients you will be caring for. Depending on your role, you may get report from another student or the nurse or resident who is going off duty. If a patient has been combative or aggressive, pay attention to why and what was done about the situation.
There are a few other situations which may be red flags for possible aggression including the following:
The patient is in restraints: Restraints are usually the last option for dealing with aggressive patients. Most hospitals try to avoid restraints and use other means to deal with difficult patients. If you hear restraints were needed for a patient, make sure you find out why.
The patient is being treated for drug or alcohol withdrawals: Patients who are addicted to drugs or alcohol may go through withdrawals when they stop using the drug. Although withdrawal symptoms are often managed, some patients can become aggressive.
An aggressive patient alert was activated previously: Most hospitals have an alert or code, which is paged overhead to alert staff to an aggressive or violent patient. The page allows security and key personnel to respond to the situation and get it under control. It’s helpful to know if an alert was called in the past.
Signs of Aggression
In some instances, it will be obvious a patient is aggressive. Some patients will scream, use profanities and physically lash out. But all situations do not start out that way. Sometimes aggression builds slowly, which gives you time to prevent the situation from becoming more serious. There are many signs or behaviors, which may indicate a patient may become violent or aggressive including:
There are many things medical clinicians can do to defuse a situation before it becomes violent. First, it is essential to realize your limitations. As a student, you are still learning how to handle different situations. There may be times you feel comfortable handling things. But there may also be instances where you need help. If you are in doubt, err on the side of caution and get assistance.
In addition, there are ways to calm a patient, such as the following:
Listen to what is bothering your patient: They may have legitimate issues. If their problem is beyond your scope of care, get someone else who can help.
Acknowledge the patient’s concern. Sometimes just letting a patient know they are being heard can defuse the situation.
Keep some physical distance between you and the patient. Although not all aggressive patients will become physical, you want to allow yourself time to get away.
Speak softly, but demonstrate control over the situation. Raising your voice will only make the situation worse. Instead, speak in a soft voice, but with a firm tone to convey some control of the situation.
Look at the patient, but avoid intense eye contact which can be seen as threatening. By looking at the patient, you convey you are listening to what they are saying. But making intense eye contact and staring a patient down, can be taken as aggression and does not help.
Consider medication and restraints when needed. In some situations, talking with a patient may not be enough to prevent the situation from escalating. There are times medication to help the patient relax, or restraints are needed to prevent injuries.