Essentials of Aggression Management in Health Care - Softcover

A nurse in an emergency room is attacked by an enraged patient. A social worker visiting a patient's home in a dangerous neighborhood is attacked by a group of thugs looking for drugs or money. The driver of a vehicle involved in a motor vehicle accident suddenly becomes violent with the paramedic who is treating him. A psychiatric patient corners a nurse and nearly is able to attack her before help arrives. A hospital security officer is stabbed in the abdomen while trying to prevent a group of gang members from entering a treatment area where a fellow gang member is being treated.

Do these incidents sound as if they may have come right from the script of a prime-time television show? Unfortunately, that isn't the case. These are real incidents involving real healthcare providers who found themselves becoming the victims of violent behavior at the hands of patients, visitors, friends, or family members.

Healthcare professionals realize that providing care to the sick and injured has become a dangerous business. More and more providers are finding themselves victims of aggressive behavior. Fire departments, ambulance services, hospitals, nursing homes, home care agencies, social service agencies, public health departments . . . all of them have seen what aggressive behavior can do to the healthcare professional, and, sadly, some episodes have had catastrophic outcomes.

Dealing with an issue as sensitive as aggression management can be difficult, and many questions are presented when this topic is explored. What rights does the provider have in protecting him- or herself? To what extent can a provider defend him- or herself? Is it ethical for a healthcare provider to take aggressive actions to avoid becoming a victim? There are no easy answers to these questions. Each provider must look inside him or herself for answers. Legal counsel may provide safe information to prevent criminal prosecution or to fend off civil litigation, but the provider must still be comfortable with his or her choice.

The causes of aggressive behavior are numerous. Often aggressive behavior is secondary to some form of drug or alcohol abuse. Although we may frequently encounter this type of aggression, we cannot forget that there are many causes, including mental health diseases, metabolic disorders, head injuries, chemical exposure, and a host of others. For the purposes of this text, the cause is not critical. Regardless of the reason behind the violence, the provider still has to be able to protect him- or herself, not only for personal safety and survival, but also to continue to provide quality care.

In this text, the terms prehospital provider, healthcare provider, and caregiver are frequently used. It is important to understand the difference in terminology, so proper association may be made with the content. Prehospital providers are those professionals who provide emergency medical treatment prior to a patient's arrival to a hospital. Commonly, these are EMTs and paramedics. Healthcare providers are those professionals who provide healthcare services in a more structured setting, such as hospitals, nursing homes, and clinics. Caregiver refers to any provider, regardless of where the care is given or in what manner it is provided. This would include prehospital providers, healthcare providers, and others involved in the delivery of health services, such as midwives, home care providers, aides, and technicians.

This text is intended to help prepare the healthcare professional to deal with aggressive behavior. It is not about "fighting." It is about surviving. We have spent most of our adult lives as healthcare professionals dealing with virtually every form of aggression and violence. Our backgrounds are unique, complement each other, and encompass all aspects of health care including prehospital care, acute care, psychiatric care, home care, and long-term care. The methods of dealing with aggressive behavior that are presented in this text are not based on idealistic suppositions. Instead, they are based on experience, research, and practice. Every method introduced has been tried with success. It is not our intention that you read this book and consider yourself well versed in aggression management; we encourage you to treat it like every other clinical skill you've learned. Successful de-escalation of aggressive behavior is an art that requires practice, rehearsal, and evaluation.

Steve Wilder and Chris Sorensen

With statistics of violence against health care workers continuing to grow, this book is a must-have resource for recognizing and diffusing aggressive behavior before it becomes violent. Providing de-escalation techniques and step-by-step guidelines for recognizing aggressive behavior, Essentials of Aggression Management in Health Care uses specific case studies to emphasize the alternative approaches that will facilitate safer outcomes.

• Written by two respected authorities in the field of aggression management, Steven S. Wilder and Chris Sorensen, the text applies their techniques to all areas of health care - pre-hospital, acute, and long-term care.
• Includes talk-down techniques, types and use of restraints, legal considerations, and risk management implications.
• Details the simple, yet effective aggression continuum with which one can judge the appropriate response to different aggression levels.

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