Following a particularly violent incident which resulted in a ...

[clmills979]

Following a particularly violent incident which resulted in a client being placed in four-point restraints, the nurse recognizes feeling fearful of having to work with the client again. How should the nurse handle this emotion?
 
  1. Recognize that feeling fear and getting into physical confrontations is part of the job.
  2. Accept the fear, process the event with other staff, and continue working with the client.
  3. Ignore feelings of fear as it would impede the nurse's ability to manage the client effectively.
  4. Engage in debriefing with the client to clear up hard feelings.

Question 2

An inpatient psychiatric unit has been operating at an unusually high acuity level over the past week resulting in numerous incidents of seclusion or restraint.
 
  A review of each violent event reveals that appropriate crisis management strategies were implemented and unit policy followed. What action is most appropriate? 1. No action is necessary; the staff is following policy appropriately.
  2. Create a rotating schedule to allow staff to leave the unit for frequent brief breaks to alleviate stress.
  3. Identify the characteristics of the aggressive clients so that admission criteria can be adjusted to reduce risk of violence.
  4. Have an expert speak to staff about seclusion and restraint reduction strategies.

[jjorrostieta]

Answer to Question 1

2
Rationale: Experiencing fear is normal; understanding is critical and enhanced by processing the event with others who were involved. Debriefing with the client is not intended to help the nurse feel better; it is for the client's benefit. It is not healthy to assume that violence is part of the job and that fear should be ignored.

Answer to Question 2

2
Rationale: It is highly likely that staff members are experiencing an increased amount of stress given the high client acuity, so frequent breaks will enable staff to meet personal needs and continue to perform effectively. Taking no action ignores that staff have been operating under conditions that are more stressful than usual and may need supportive measures to cope with the increased job stress. Correct crisis management strategies were followed suggesting that seclusion and restraint interventions were warranted and could not be reduced or prevented. Having an expert speak about reduction at this time could imply that staff did not perform appropriately, which is not the case. Clients with a high risk for violence need treatment, therefore, admission criteria should not be altered to prevent such clients' access to treatment.

[clmills979]

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