An intramuscular dose of antipsychotic medication needs to be given to a patient who is becoming increasingly more aggressive. The patient is in the day room. Which intervention would be safest and most appropriate?
a. Enter the day room and say, "Would you like to come to your room and take some medication that your doctor has ordered for you?"
b. Take three staff members as backup and say, "Please come to your room so I can give you some medication that will help you feel more comfortable.".
c. Take two male aides with you and tell the patient, "You can come to your room willingly so I can give you this medicine, or we will have to take you there.".
d. Four staff should clear the room of patients, restrain the target patient, then administer the PRN medication and continue to hold him until he calms.
B
A patient gains feelings of security if he or she sees others are present to help ensure everyone's safety. The nurse gives a simple direction, honestly states what is going to happen, and reassures the patient that the intervention will be helpful. This positive approach conveys to the patient that he can act responsibly and maintain control, increasing the chances that he will act in the manner indicated. Asking the patient if he would like to take the medication implies incorrectly that he has a choice in this instance; if the decision has been made that the medication is to be given, offering him a choice and then retracting it if he declines will violate trust with staff and possibly increase his distress and agitation. All staff, regardless of gender, should have the training and skills necessary to de-escalate patients and assist in crises, including physically if needed. Physical control measures should be used only as a last resort; they can be perceived as assaultive or punitive and increase the risk of injury to the patient and/or staff.
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