Managing patient aggression and violence in psychiatric nursing settings

¶ … Nurse

Restraint and Seclusion Controversies

The use of physical restraints and/or seclusion as a method for dealing with aggression and violence in-patient settings is controversial for a number of reasons. First, these "solutions" do not really address he issues at the heart of the violence, which might include severe psychological disturbance and/or dementia and a host if other environmental and individual factors; restraining or secluding patients keeps them from being a danger to others and possibly themselves, but does not actually address the aggression (Mohr 2008). At times, restraints and seclusions can actually exacerbated psychological distress, and they are certainly general stressors for the body and the mind regardless of the underlying cause of the aggression (Mohr 2008). At the same time, the physical safety of the aggressive patient and those around the patient must be the paramount consideration of any responsible medical facility and medical professional, and thus it is sometimes necessary to use restraints and/or seclusion when other options are not available or when they are not proving immediately effective and danger is imminent (Mohr 2008).

The problem with any use of these methods, however, as well as with pharmaceutical methods that effectively act as physical restraints themselves, is that it can become increasingly enticing to employ even when it is not absolutely necessary. All medical professionals must work to ensure that these options are only used when they are truly necessary for the safety of the patient and those around the patient (Mohr 2008).

Attitudes Towards Abusers and Victims

It is very tempting to have feelings of nothing but anger, resentment, and disgust towards people who abuse others regardless of the situation, and in fact it can be very difficult to develop any other feelings towards such persons. I have attempted to cultivate some measure of compassion for these people, as it is almost certain that their lives and specific experiences have been largely negative and to such an extreme degree that an abusive personality is formed, but at some point I feel that people need to confront and deal with their issues rather than using them as an excuse to continue behavior that is harmful to others. In some ways, this attitude extends to victims of a certain age; while they are of course deserving of compassion and of care and protection to allow the emotional healing that they need to go through, it is also somewhat frustrating that so many adult victims of abuse simply put up with it and feel so powerless to stop it, when simply ending a relationship at the first signs of abuse is both wise and much easier than waiting.

My attitude towards victims certainly changes when the victim is a child or can elderly person -- when the victim is truly dependent on their abuser for the basic necessities of life. There is a distinction here between those that are physically dependent on their abuser and those that are dependent only emotionally or due to the specifics of a financial situation; though these attachments can make things difficult, they do not make ending or leaving the relationship truly impossible. When it is truly impossible, the victim deserves nothing but compassion and protection.