Nursing Assignment 代写：护理工作场所暴力

enlunwen

8 年前

在美国有170万的事件每年在工作场所暴力的发生（马丁利，1994-2011年）。百分之十二事件中的涉及的医疗工作者或心理卫生工作者（马丁利，1994-2011年）。在护士的中西部地区六零七的人被殴打一次至少六个月内（马丁利，1994-2011年）。他们已经用只有化学约束及隔离和限制作为应对烦躁患者干预时间最长（马丁利，1994-2011年）。这已是一个长期的医疗工作者使用的干预。他们用这种方法对付侵略激动的患者在急救室、精神病医院（马丁利，1994-2011年）。已推出的一种新方法是去升级。根据国际精神卫生护理去升级的定义杂志是潜在的暴力或侵略的情况下通过言语和行为表达同理心的使用逐步解决，联盟，是基于尊重非对抗性的限制设置（Cowen，戴维斯，estall，柏林，菲茨杰拉德，和叫声，2003）。大多数的保健工作者没有必要的技能来照顾精神病的人群。本文将讨论：什么原因导致这个问题，什么是护士的作用，在照顾病人的其他替代品和结果，以及如何护士会使用这些干预措施在实践中。
有几个因素，导致医疗保健提供者面对困难，而积极和精神病患者的处理。如今，他们已经在有限的条件下工作（Bigwood和克洛，2008）。这些单位缺乏团队精神，领导和他们很散乱（Cowen，戴维斯，estall，柏林，菲茨杰拉德，和叫声，2003）。医院单位是拥挤的。在许多地区，为了在精神病医院有床位，病人在急救室等到一张床可用（Cowen，戴维斯，estall，柏林，菲茨杰拉德，和叫声，2003）。这结束了在一个拥挤的急救室，配备率低，护士无法忍耐，和病人变得越来越激动，因为他们只能在床上在急救室的一个角落（Cowen，戴维斯，estall，柏林，菲茨杰拉德，和叫声，2003）。医院不是以时间来训练这些医疗服务提供者，照顾这组（Cowen，戴维斯，estall，柏林，菲茨杰拉德，和叫声，2003）。他们也没有当谈到委托职能和角色的人员（Cowen，戴维斯，estall，柏林，菲茨杰拉德，和叫声，2003）。在危机中，当一个病人烦躁，如果角色功能下放，每个人都能够知道他们将参加哪些部分（Cowen，戴维斯，estall，柏林，菲茨杰拉德，和叫声，2003）。没有这种训练的医疗服务提供者往往缺乏关心和处理这些病人的信心（Cowen，戴维斯，estall，柏林，菲茨杰拉德，和叫声，2003）。
有干预措施，以采取当涉及到去升级一个病人。护士的角色是识别警告标志（汤森德，2006）。人们不只是开始升级。它开始与小阶段。病人可能变得焦虑不安。这可能是一个阻碍危险或威胁的迹象，病人面临不适（汤森德，2006）。他们可以开始起搏，这是一个背部和向前运动（汤森德，2006）。患者通常会作为一种处理压力或焦虑的方法。他们可能会表现出过度的身体动作包括：震颤、非目的性的运动和振动（汤森德，2006）。他们还增加了他们的声音的音量和节奏，和他们的面部表情（汤森德，2006）。认识到这些迹象可以帮助消除局势升级（汤森德，2006）（Cowen，戴维斯，estall，柏林，菲茨杰拉德，和叫声，2003）。

In the United States there are 1.7 million incidents each year where workplace violence has taken place (Mattingly, 1994-2011). Twelve percent of the incident involved a healthcare worker or a mental health worker (Mattingly, 1994-2011). In the Midwest sixty seven percent of nurses have been physically assaulted at least once within six months (Mattingly, 1994-2011). For the longest time they have been using only chemical restraints and seclusion and restraints as an intervention for dealing with agitated patients (Mattingly, 1994-2011). This has been an intervention used by healthcare workers for a long time. They use this method to deal with aggressive agitated patients in both the emergency room and the psychiatric hospitals (Mattingly, 1994-2011). A new method that has been introduced is de-escalation. According to International Journal of Mental Health Nursing the definition of de-escalation is the gradual resolution of a potentially violent and or an aggressive situation through the use of verbal and physical expression of empathy, alliance and non-confrontational limit setting that is based on respect (Cowen, Davies, Estall, Berlin, Fitzgerald, & Hoot, 2003). Most health care workers do not have the skills needed to care for the mentally ill population. This paper will discuss: what causes this problem; what is the nurse role in caring for the patient; other alternatives and the outcomes and how a nurse would use these interventions in practice .

There are several factors that cause healthcare providers to face difficulties while dealing with aggressive and mentally ill patients. Nowadays they have been working under limited conditions (Bigwood & Crowe, 2008). These units lack teamwork, leadership and they are much very unorganized (Cowen, Davies, Estall, Berlin, Fitzgerald, & Hoot, 2003). Hospital units are overcrowded. In many regions, in order to get a bed in the psychiatric hospital, patients have to wait in the emergency room until a bed becomes available (Cowen, Davies, Estall, Berlin, Fitzgerald, & Hoot, 2003). This ends in an overcrowded emergency room, low staffing ratio, the nurse is unable to exercise patience, and the patient is becoming increasingly agitated because they are confined to a bed in a little corner of an emergency room (Cowen, Davies, Estall, Berlin, Fitzgerald, & Hoot, 2003). Hospitals are not taking the time to properly train these healthcare providers that are caring for this group (Cowen, Davies, Estall, Berlin, Fitzgerald, & Hoot, 2003). They are also unorganized when it comes to delegating functions and roles to the staff (Cowen, Davies, Estall, Berlin, Fitzgerald, & Hoot, 2003). In a crisis situation when a patient is agitated, if functions and roles are delegated everyone would be able to know what part they will partake in the situation (Cowen, Davies, Estall, Berlin, Fitzgerald, & Hoot, 2003). Without this training the healthcare provider tends to lack the confidence in caring and dealing with these patients (Cowen, Davies, Estall, Berlin, Fitzgerald, & Hoot, 2003).

There are interventions to take when it comes to de-escalating a patient. The role of the nurse is to recognize the warning signs (Townsend, 2006). People do not just start off escalated. It starts off with small stages. The patient may become anxious. This may be a sign of impeding danger or threat that the patient faces discomfort (Townsend, 2006). They may start pacing, which is a back and forward movement (Townsend, 2006). Patients usually pace as a way to deal with stress or anxiety. They might exhibit excessive body movements which include: tremors, non-purposeful movements and shaking (Townsend, 2006). They also increase the volume and tempo of their voice, and their facial expression (Townsend, 2006). Recognizing these signs can help eliminate an escalating situation (Townsend, 2006) (Cowen, Davies, Estall, Berlin, Fitzgerald, & Hoot, 2003).