A patient on a medical unit has a history of hostile and menacing behavior toward staff and sometimes even strikes them. Which plan would be best for forestalling such incidents?
a. Give the patient lorazepam (Ativan) every 4 hours to reduce anxiety.
b. Explain that the response to any violence will be to use restraints.
c. Arrange for security personnel to stand by during all nursing care.
d. Point out the problem and help the patient identify things that are causing frustration.
D
Identification of triggers to violent acting-out incidents allows the patient and nurse to plan interventions to avert such triggers and reduce frustration. This also provides practice in coping more adaptively in general. Benzodiazepines can reduce anxiety but would not give him skills that might also benefit him in other situations; benzodiazepines can also sometimes increase impulsiveness by disinhibiting the patient. Setting limits and indicating what consequences to expect can be a helpful adjunct, but as a primary intervention, it does not teach new skills to use to avoid problem behaviors in the first place; expecting the patient to behave differently without giving him the skills to do so is setting him up for failure and further frustration. Using security personnel would be expensive and disruptive to their work, but it would be a possible intervention if all other options prove unsuccessful.
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