Risk Assessments And Assessment Tools Regarding Violence, Suicidal And Homicidal Ideation

Mr. Setzer is a 21 year old male who presented to the ED with suicidal ideation with a plan to stab himself with a knife. Mr. Setzer stated thoughts of self harm has been getting worst since girlfriend had fetal demise and then ended the relationship. At the time of the assessment Mr. Setzer denies suicidal ideation, homicidal ideation, and symptoms of psychosis. He acknowledges yesterday becoming overwhelmed with thoughts of harming himself. He proceeded to grab a knife and attempt to stab himself in the stomach, however was stopped by his grandmother. Mr Setzer reports recently he has been experiencing feelings of hopelessness, insomnia over the past 3 days, isolation, and tearfulness. Mr. Setzer expresses relational issues and loss of his

Kelly et al. (2015) continued with the statement that staff who are insulted tend to be younger, less experienced or educated, provide more direct care and spend more time with patients, receive lower pay, and possess low levels of qualifications (Kelly et al., 2015). The most common injuries on psychiatric units are kicking, hitting, shoving, and beating (Occupational Safety and Health Administration, 2015). The most common health complaints reported by staff that were involved in a physical assault are headaches, muscle soreness, and headaches; other complaints that are more serious include dizziness, shortness of breath, and numbness and tingling of the extremities (Kelly et al., 2015). These aggressive behaviors of patients are preceded by many things. Patients may be upset about being admitted to the unit or feel as if their control has been taken away. Literature suggested that poor medication compliance, positive symptoms (such as command hallucinations), and substance misuse makes act of violence (Graham, 2012). Graham (2012) stated that it should not be assumed that there is a direct relationship between a specific disease (or symptoms) and acts of violence. The reason for patient violence is varying and sometimes unknown. It was reported

Risk assessments can help address dilemmas between rights and health and safety concerns by helping reduce any risks created by undergoing certain tasks, risks assessments are not in place to prevent an individual doing things that they want to do, they are in place to concentrate on the risk factors and to look at any other ways to reduce the risk of the task in hand.

A practice that has been put in place is the use of call buttons that are installed and easily available for the staff to use when dealing with escalating patients. Within this Veterans Affairs Hospital, the inpatient geriatric unit has at least 2-3 cases of patient-on-patient assault each month. For those that are very aggressive, this is currently being addressed by the use of one-on-one staff and antipsychotic medications. Clinicians are expected to be able to assess whether intervention is needed to protect other patients and staff from patients’ violence, to assess when patients pose a sufficient level of risk, and to assess when patients who have been hospitalized can be safely discharged to the community. However, surveys of practitioners suggest that many receive little formal training in violence risk assessment. (McNeil, et al. 2009) The limitations of formal training in risk assessment for violence suggested by such surveys underscore the need for education in this topic, hence the relevance of this educational training. Nurses on the front lines of care are ill-prepared to deal with this, hence the need for training. (Peek-Asa, et al.

Ms. Webster is a 28 year old female who presented to the ED via LEO under IVC by her mother for suicidal ideation and alcohol dependence. Ms. Webster denies allegations to nursing staff. Per documentation she appears intoxicated. Per documentation Ms. Webster states, "Going through withdrawals". Before assessment this clinician spoke with nursing staff about Ms. Webster, they reports she has been asking for Ativan since she has been placed in her room. They reports she informed them that she had not consumed any alcohol today. At the time of the assessment Ms. Webster is found sitting upright in her room. Ms. Webster reports she had a plan to hang herself. She states, " you know I have to say that to get into detox." Ms. Webster reports alcohol abuse as primary stressor contributing to her distress. She denies depressive symptoms. Ms. Webster states,

Kimmy is presenting for “anger outbursts”, homicidal threats, and behavioral problems. The client reports these behaviors began eight months ago after the death of her mother. Her mother died in an auto accident, for which the children were not present. Kimmy has been hospitalized three times in the past 8 months for anger outburst towards her Uncle, older brother, and peers. She has made homicidal threats towards her older brother. Prior to her most

Violence and aggression refer to the manifestation of numerous behaviours (physical, verbal) that may cause injury or harm to others, (National Institute for Health and Care Excellence (NICE, 2015). The violent and aggressive behaviour are aimed towards themselves (patients), staff, properties, visitors and other service users. In England between 2013 and 2014, it was reported that 68,683 attacks took place on the staff, 69% in mental health settings, (NICE, 2015). To minimise dual diagnosis service users from

Julia, age 30, has recently been admitted to the inpatient psychiatric unit by police after an episode at the nearby pub. Julia began drinking and ordered several rounds for everyone at the pub. After had refused to pay her bar tab, she became loud, defensive and belligerent, knocking over beer bottles and threatening the bartender and all the patrons present. She was shouting that she knew the Chief of Police and that she would be able to get him to arrest the bartender and other patrons who were staring at her. Julia attempted to flee the scene, but was then detained by the police and put in restraints. Her appearance is disheveled, clothes are dirty, and hair us unkempt. She is currently agitated and restless.

Argument from health professional is that the use restraint is very vital to their security especially in situations where a patient poses the risk of being a menace to himself or others around them (Psychiatric Times, 2015).A study has showed that the act of violence and aggression against patients and nursing staff is unbelievably rising, with about ' more than half of NHS staff nurses 'being violently assaulted by patients in ‘2013-14’ (Nice, 2015). Even though, most of these attacks do not normally result in major injuries, they have caused staff to experience severe anxiety, emotional traumas and in some case ‘post-traumatic stress disorder’ (City University, London, 2009). Against these facts, it is believed that the use of restraint, especially in an Acute setting, is essential and ethical (Psychiatric Times, 2015). However, research has shown that there is a correlation between staffs reaction towards mental health patients and the violent and aggressive behaviour exhibited towards them. This typically occurs when patients feel they are being patronized, not made aware of what is going on around them and not treated well( Glover, 2005). With recent records of excessive and abusive use of restraint, there have being

As noted previously, the definition of risk changes depending on which literature is being examined, and what context the definition is provided in. The lack of a consistent definition can make it difficult for clinicians and researcher’s developing risk assessment, because it can muddy the picture of what exactly a risk tool is attempting to quantify. That being said, the best approach when attempting to quantify risk appears to be, as suggested by several researchers, to gather as much information as possible and then make an informed decision (Prentky & Righthand, 2003; Worling et al., 2001, Rich, 2009 Vilojen et al.,

To these ends, the crises professional has to engage an assessment to determine if the level of threat is real and in doing is faced with the decision of having the client “Bacaracted” meaning having the person institutionalized without their express consent. I contrast; the act of homicide represents an exterior action committed by the person in crises against one or more people. Like suicide, Kanal (2011), establishes that there are signs that a person may commit a violent act. Also reflective of suicide is the reality that a person does not have to be insane to kill another. The crises professional draws conclusions that this is or is not the probability that the person is in a state that an event is likely to occur. In this instance, the professional has to look at the person’s background to see if there is a history of violence. I addition, has the client communicated that he or she wants to commit a harm, poor impulse control, may feel that a person r group wants to harm he or she , as well as other indicators that affirm or disaffirm an event can take place (p.

When a patient-to-patient assault occurs, staff members are often stressed from fear of reprimand for lack of adequate observation (Luckhoff, et al.2013). This may lead to high turnover rates which further create understaffed units resulting in unsafe patient care ratios and demoralized staff. (Luckhoff, et al.2013). Furthermore, assault brings an increased chance of injuries which may lead to compromised health and even permanent disability. Taking these problems into account, it is evident that assault among patients can negatively impact the provision of healthcare services and management of care provided (Luckhoff, et al.2012).

Hey, Mary good idea about calling the police I don't know why I did not think of that because I work in the emerengency room and the police officer bring patients in often from referrals of crisis hotline or close family members. However I have witness in a few situations so bad that calling the police have made the situation worse. In my home town you are taken into protective custody until you can get a psychiatric evaluation if you have stated that you want to hurt yourself or others. A lot of the patients think they are under arrest becaause the police officers put handcuff on them, but it is not an arrest, it is just to protect the patient and the police office and it does not go on their record.

Risk management is considered one of the most important parts in healthcare, as it implements strategies to reduce financial loss and patient safety. Risk management is defined as ‘ the assessment and removal or control of hazard to patients, employees or institutions’ (Medical Dictionary, n.d.). Risk management strategies should be introduced throughout the hospital and ensure compliance from all levels of staff. The strategies are designed to identify, monitor, and manage risks including fraud while ensuring insurance arrangements are adhered to (Audit and Risk Committee Terms of Reference, 2015). If any hazard is deemed a risk it must be documented and reviewed, with the strategy altered to ensure patient and

However, just know about the risks is not enough; it is necessary also know the impacts of these risks. Generally,