• Choose a category
• All
• Classic-Fiction

Warn the person that you will contact security staff/police if necessary – avoid threatening language. If possible, make a personal or practical appeal. People need clear information about the consequences of their actions. E

Attempt to talk the individual down, that is, calm them down by remaining calm and professional yourself, keeping your voice at a steady pace and a moderate volume. Try to engage the person in conversation. Your behaviour will have an impact on theirs. E

Avoid personalizing the anger but do not accept unwarranted personal criticism. If we personalize then we are likely to react in a way that exacerbates the situation but neither should you accept abuse. E

You may suggest walking with the patient to discuss issues but ensure you remain in a public/safe environment. Changing the environment may help to recontextualize behaviour and movement channels agitation. E

The key communication skills discussed in the skills section will be helpful here but fundamentally you need to listen to what the grievance is, treat the person as an individual, preserve their dignity and attempt to help where you realistically can. Avoid passing the buck or blocking in another way. People need to be heard and understood. E

If a patient is no longer abusive or threatening but is struggling to reduce their anger, they may benefit from some further psychological support or medication to help them feel calmer. The short-term use of some medication may be beneficial. C

In rare and extreme circumstances where patients are violent and do not respond to de-escalation attempts and where the safety of other people is compromised, you must take immediate action by involving security and the police. If an ambulant outpatient, you need to ask them to leave if their behaviour is not acceptable. Maintaining safety for all. E

Restraint and sedation may be required in some cases. Follow individual hospital security/ emergency procedures in these instances.

It can be distressing to be exposed to threatening or abusive people and it is good practice to seek a debriefing interview. This can help you and the institution reflect upon the experience and procedures in place to manage such situations. Check with your occupational health or human resources department to establish where you can access support facilities.

Delirium

Definition

Delirium is an altered state of consciousness or acute confusion caused by a severe medical illness (Sendelbach et al. 2009).

Related theory

In most cases, delirium is caused by a general medical condition, intoxication or withdrawal of medication/substances which act upon the neurochemical balance of the brain (Ross 1991). Causative factors like infection, post anaesthesia and medication (especially analgesics) need to be considered, particularly for sudden onset of delirium in the hospital environment.

Figures for the incidence of delirium vary, but up to 25% may experience a delirium whilst hospitalized. Up to 50% of postoperative patients may develop delirium (NICE 2008b). There is an increased prevalence for inpatients over the age of 65 years. Age, the severity of illness, pre-existing cognitive decline, immobility and malnutrition all increase risk (Irving et al. 2006).

The disturbance can develop quickly and fluctuate during the course of a 24-hour period (DSM IV 1994). Environmental cues during the daytime act as stabilizing factors and this makes symptoms typically worse at night. The disturbance can resolve within hours/days or can last longer if co-existing with other problems like dementia. A patient’s behaviour may change to indicate potential delirium before a full set of diagnostic symptoms is observable (Duppils and Wikblad 2004) (Box 5.12). There is considerable morbidity and mortality associated with delirium, delaying recovery and rehabilitation (Irving et al. 2006, NICE 2008b). Recognizing and addressing delirium is important because of the distress it causes