Working with People with Dementia Who Appear Aggressive to Staff : Presentation

Introduction

™During clinical practice, nurses are exposed to many challenging situations that affects their health and well-being (Cranage & Foster, 2022).

™This presentation aims to reflect on the issue of working with aggressive dementia patients and evaluate the challenges in handling the situation.

™The presentation will also explore the impact of the clinical issue on own well-being and strategies to professional manage the issue.

Overview of the Clinical Situation

™During my experience of working in the clinical environment, I have found that working with dementia patients with aggressive behaviour is very difficult.

™The situation affects my well-being as I have been exposed to risk of injuries, harms and psychological distress while experience violence and aggression from colleagues.

™It also affects my professional performances as such situations makes me feel incompetent and I experience dilemma regarding the best ways to handle such situations.

™Such situations also act as a barrier in conducting routine assessment in patients.

Rationale for Challenges in the Situation

I feel handling an aggressive dementia patient is challenging because of the following reasons:

™It leads to anxiety, depression and increase in stress

™It affects clinical performance

™Disruptions in clinical care and nursing asserssment.

™It leads to more frequent use of restraint and increase in ethical dilemma

™Managing emotions in such situation becomes difficult and affects work performance (Magnavita, Heponiemi & Chirico, 2020).

Literature Review on Challenges in Working with People with Aggressive Behavior

™Kang and Hur (2021) reports that nurses who suffer from injuries while handling aggressive dementia patients experience high level of distress and emotional challenges.

™The study by Dookhy and Daly (2021) reported about the challenges experienced by nurses while dealing with responsive behaviours of patients such as time pressures, shortage of staff and lack of dementia-specific education and training.

™In the study by Sim, Ahn and Hwang (2020), nurses experienced violence as an unexpected and fearful episode.

Strategies to Manage Well-being of Self

™Engage in relaxation techniques to manage frustrations and negative emotions in workplace

™Engage in positive coping methods to deal with stress

™Take break from work to rejuvenate mind

™Try to engage in activities of pleasure

™Take part in training activities to develop confidence in handling aggressive behaviour (Akbar et al., 2016)

Strategies to Manage Well-being of others

™One of the major concerns in controlling aggressive behavior in dementia patient is that restraint is used to control their behaviors.

™It affects patient’s dignity and leads to negative impact for patient such as feelings of fear, humiliation and demoralization (Hamid & Daulima, 2018)

™Some effective interventions that can be used to promote well-being of aggressive patient are the use of de-escalation strategies, anticipation strategies and (Celofiga et al., 2022). 

Consideration of Cultural and Social Sensitivities while Handling Aggressive Patients

™One of the major mistakes that nurses do while handling aggressive patient is that they disrespect them.

™They do not consider that they may have specific social and cultural needs. Instead of calmly handling the situation, they try to shout back or use restraint to control them (Wong et al., 2020).

™However, nurses have the duty to implement de-escalation strategy by the use of effective verbal and non-verbal communication strategy and considering cultural sensitivities of patient (Lisak et al., 2021).

Conclusion

™The presentation gave a summary on the impact of aggressive behaviour of dementia patient on own well-being and well-being of others.

™The issue was found to lead to injuries, psychological distress, frustration, poor performance and intention to leave the job.

™To prevent the above undesirable consequences, the presentation recommended use of many self-care strategies as well as education or training interventions to confidently handle aggressive patients

References

Akbar, R. E., Elahi, N., Mohammadi, E., & Khoshknab, M. F. (2016). What strategies do the nurses apply to cope with job stress?: a qualitative study. Global journal of health science, 8(6), 55.

Celofiga, A., Kores Plesnicar, B., Koprivsek, J., Moskon, M., Benkovic, D., & Gregoric Kumperscak, H. (2022). Effectiveness of de-escalation in reducing aggression and coercion in acute psychiatric units. a cluster randomized study. Frontiers in psychiatry, 13, 856153.

Cranage, K., & Foster, K. (2022). Mental health nurses' experience of challenging workplace situations: A qualitative descriptive study. International Journal of Mental Health Nursing, 31(3), 665-676.

Dookhy, J., & Daly, L. (2021). Nurses’ experiences of caring for persons with dementia experiencing responsive behaviours in an acute hospital: A qualitative descriptive study. International Journal of Older People Nursing, 16(4), e12379

Goldstein‑Levitas, N. (2022). Moving towards wellness in long-term care: Considerations for dementia-associated aggression. In Social Justice in Dance/Movement Therapy: Practice, Research and Education (pp. 151-166). Cham: Springer Nature Switzerland.

Hamid, M. A. Y. S., & Daulima, N. H. C. (2018). The experience of restraint-use among patients with violent behaviors in mental health hospital. Enfermería Clínica, 28, 295-299.

Kang, Y., & Hur, Y. (2021). Nurses’ experience of nursing workload-related issues during caring patients with dementia: a qualitative meta-synthesis. International Journal of Environmental Research and Public Health, 18(19), 10448.

Lisak, A., Efrat-Treister, D., Glikson, E., Zeldetz, V., & Schwarzfuchs, D. (2021). The influence of culture on care receivers’ satisfaction and aggressive tendencies in the emergency department. Plos one, 16(9), e0256513.

Magnavita, N., Heponiemi, T., & Chirico, F. (2020). Workplace violence is associated with impaired work functioning in nurses: an Italian cross‐sectional study. Journal of nursing scholarship, 52(3), 281-291.

NMBA (2016). Registered nurse standards for practice. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Sato, K., & Kodama, Y. (2021). Nurses’ educational needs when dealing with aggression from patients and their families: a mixed-methods study. BMJ open, 11(1), e041711.

Sim, I. O., Ahn, K. M., & Hwang, E. J. (2020). Experiences of psychiatric nurses who care for patients with physical and psychological violence: A phenomenological study. International journal of environmental research and public health, 17(14), 5159.

Wong, A. H., Ray, J. M., Rosenberg, A., Crispino, L., Parker, J., McVaney, C., ... & Pavlo, A. J. (2020). Experiences of individuals who were physically restrained in the emergency department. JAMA network open, 3(1), e1919381-e1919381.

Ye, J., Xiao, A., Yu, L., Wei, H., Wang, C., & Luo, T. (2018). Physical restraints: An ethical dilemma in mental health services in China. International journal of nursing sciences, 5(1), 68-71.

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