Pain Aggression and Fatigue in ER S

¶ … fuse the content of the third chapter from the class text and a selected article. The salient and primary point to be taken from the chapter reading is concept analysis and frameworks. The important point from the article that will be focused on is aggression in the emergency department. To be certain, the emergency department of any hospital or other medical institution is a place where the presence of aggression can emerge in some instances.

While some may say that concept analysis and frameworks are just a lot of navel-gazing, this is far from the truth so long as the practice is taken serious and is done as needed. As explained by the class text, it is important to have proper concept development and research because there is a common language that must exist. To use a simpler example, three widgets to one person should always be three widgets to another person.

As another example, the sky is blue (usually) and anyone who is asked that question on a normal clear day should be able to say that. When dealing with the complexities and idiosyncrasies that exist in the medical field, keeping such a common language and lingo can be much more difficult. A common framework and guide to proper concept synthesis is noted on page 58 of the class text. Specifically, box 3-1 talks about the proper steps of concept analysis as postulated by Walker and Avant in 2011.

The steps as they see them, in order, are the selection of a concept, a determination of the aims and purpose of the analysis, the identification of all the uses of the concept that are possible, a determination of the defining attributes, the identification of a model case, the identification of cases that are borderline or at least related, an identification of antecedents/consequences and the definition of empirical events.

When it comes to aggression in an emergency room setting, some common definitions and standards that would have to be agreed upon include the definition of aggression, the level of aggression (e.g. vocal, physical, etc.), the common and obvious precusors or aggression and how these instances of aggression would manifest from person to person and from situation to situation.

Of course, one could and should include both practitioners/physicians and patients when engaging in this analysis unless one of the two groups is designed and intended to be the lone focal point. However, patients would obviously be the aggressor in many to most instances. Beyond that, one could focus on particular subsets of those two large groups including cancer patients, nurses and people in rehabilitation, just to name a few (McEwen & Wills, 2011).

When applying this to an article that discusses aggression in an emergency room setting, the lessons learned are easy to apply. While some may feel or think that aggression is not commonplace in an emergency room setting, it really is not .. but it most certainly happens. Whether it be an addict demanding a new "fix," a patient becoming angry due to pain levels not being managed and so on, aggression can certainly happen.

To use the aforementioned principles of concept development and definition, one could identify medical situations and scenarios where aggression could all be a potential issue. Some work done by Bresler and Gaskell in 2015 hits on all three. They look at aggression through the lens of risk management and with the backdrop of three healthcare workers being assaulted at their respective clinics. The three assaults actually happened at three different types of clinics, although two of them were indeed emergency in nature.

One was a general emergency room, one was an emergency center dedicated to psychiatric patients and the third was a "short-stay" center for psychiatric patients. The authors point out that pain management clinics are also prime epicenters for such behavior given the huge spike in narcotic pill abuse in the United States (and elsewhere) and the lengths that some people will go to get those pills. In any event, the selected model can be used as follows. For step one, the obvious concept selected is aggression in clinics.

The author of this report would obviously focus on the first two events in the Bresler article given that the third location was not an emergency department. The aims and purposes of the analysis (step two) would be to how to limit, mitigate and prevent aggression in an emergency setting. The author would also identify all of the possible uses of the concept, which is step three.

The author would theorize and postulate all of the defining attributes inherent to aggression or potential aggression in an emergency setting, which is step four. The fifth step would be to identify a "model case." With that in mind, the two emergency examples in the chosen article might work but there perhaps might be a better one out there in the scholarly sphere. There would also be the identification of borderline, related and other cases in the sixth step.

There will also be cases looked at that are contrary or illegitimate. The seventh step would be to develop antecedents and consequences. In other words, there would be the identification of causes (antecedents) and after-effects (consequences) for aggression events.