This reflection is based on my observations of the need for of effective communication skills and knowledge of nurses regarding the management of aggression in elderly patients with dementia. Clinician need to be equipped with seclusion, medication and de-escalation skills to be able to manage patient aggressive behaviours safely. I have chosen these particular observations after realising how fundamental they are in implementation aggressive behaviour management strategies in patients.
While working in mental health I have observed how effective it is to communicate with a patient as a way of de-escalation during verbal and physical aggression incidents. Ford, Byrt, Dooher, & ebrary (2010) point out that it is imperative for health professionals to ensure compassionate and respectful communication at the same time promote the development of an empathetic and professional relationship with the client. During my research in my learning plan I discovered numerous researches that support the positive effects of communication with aggressive patients to de-escalate.
Sometimes it may feel as though nursing staff waste time repeatedly saying the same thing to an aggressive patient rather than utilising medications or seclusion. However, patients with dementia take time to process information and sometimes need information to be repeated to them several times to full y process and follow instruction. Communication is also important amongst the staff dealing with aggressive incidents as this ensures clear intervention plans are shared by the nursing team and prevent confusing situations that may escalate the problem.
Medication, seclusion and de-escalation techniques are some of the interventions that nurses can utilise in the management of aggression but at the same time there has to be careful consideration of their appropriateness and effectiveness. Medication can cause adverse effects and the use of seclusion can be traumatic to patients with dementia hence, the use of these interventions need careful consideration by weighing the risks versus the benefits. My feelings Through this learning I realise that attitudes of nursing staff have a pivotal role in the management of aggressive patients.
A nurse has to be competent with medication management and also has to have strong evidence based knowledge about the use of seclusion. Seclusion should be avoided as much as possible unless there is serious threat to the safety of the patient and others. Seclusion causes patients to feel disempowered, fearful of the confined space and not knowing when seclusion will end, anger associated with the physical restraint interventions that often accompany the seclusion process, and an ongoing sense of vulnerability (Whitecross, Seeary & Lee, 2013).
I feel that nurses can improve their skill in aggression management by actively engaging in programmes aimed at training them to acquire skills. To establish therapeutic relations with patients through communication enhances engagement and promotes trusting relations. When communicating with aggressive patients with dementia it is important for the nurse to remaining calm and constantly reassure the aggressive patients.
Lack or poor communication skill causes confusion to patients with dementia and leads to frustration that triggers aggressive behaviours. My observation about some of the causes of escalation in patient’s aggressive behaviours can be due to negative staff attitudes. I believe dismissing a patient’s feelings may lead the patient to being aggressive. In dementia, patients struggle to process their thoughts and it is imperative for the nurse to play a supportive and reassuring role to prevent frustration that leads to aggression.
Evaluation Despite the availability of evidenced based knowledge and information, it still remains clear that aggression is not always well managed by clinical staff due to lack of adequate training. A person centred approach should be implemented so as to understand the patient as an individual for effecting targeted interventions to be put in place. According to Krishnamoorthy and Anderson (2011) staff training programmes assist nurses in identifying causes of behaviours and developing of patient management plans.
During the development of my learning plan I discovered that I learnt a lot from purposefully observing senior nursing staff as they dealt with aggressive patients. Valuable information about the role of medications in aggression was made available to me after consultation with the hospital pharmacist. I was also able to explore different research article on the Notre Dame Library online resource databases about management of aggression in dementia and I gained a lot of evidence based practice information that will be essential in improving my aggression management skills.
Analysis Aggressive behaviour is so common in persons with dementia and carries a high risk for poor health outcomes, it is essential that clinicians understand best approaches to intervention that weigh the benefits and risks of using non-pharmacological interventions to prevent aggression and at the same time initiate pharmacological and non-pharmacological interventions during crisis (Dettmore Kolanowski and Boustani, 2009). Managing aggression can be very emotionally and physically challenging to the health care workers.
Notably according to Lim (2011) there are consequential effects noted such as negative psychological and emotional responses and job dissatisfaction that can lead to poor quality of care. Nurses may continue to experience violence but they still have a duty of care to ensure the patients safety and others is maintained hence, the importance of engaging in staff training and having clinical supervision sessions. Within health care settings, staff can participate in educational drills and this also enhances the confidence of individuals in the prompt decision making when faced with aggressive patients.
External organisations such Dementia Behaviour Management Advisory services (DBMAS) are available to provide support for staff and carers about how to deal with aggression. Conclusion According to the information reviewed during the formulation of the learning plan, it is clear that having effective communication skill and evidence based knowledge when managing aggressive patients is very essential in nursing. Nurses with adequate skill can manage aggression effectively with confidence in selecting appropriate evidenced based intervention.
It is for these nurses that other junior or nurses who lack the skills learn from by way of observation. Health care settings should ensure nursing staff in aggression prone departments such as mental health and emergency departments are receive formal training regularly to improve the skills in dealing with aggressive patients. Through training (Heckemann, Zeller, Hahn, Dassen, Schols & Halfens, 2015) there is increase in the nurses’ knowledge about risk assessment, management of aggression and it also boosts confidence in aggression management.
Organisational guidelines should be regularly updated and should be in line with the nurse’s regulation boards such as the Nursing and Midwifery Board of Western Australia. Nurses should also ensure they work within their scope of practice when managing aggressive patients. My action Plan I will continue to seek any opportunity with in my organisation to continuously engage in any staff development education regarding aggression management.
I will continue to research evidenced based up to date information to keep up my skills and I will share my knowledge with my work colleagues. I will reflect upon the learning theories discussed in this essay and effect changes according to the processes suggested and review their effectiveness. To maintain best practice standards, I will familiarise myself with my job description and aim to practice within the expected legal frame work.
