Management approach of patients with violent and aggressive behaviour in a district hospital setting in South Africa

Abstract

Aggressive and violent behaviour is very common in the hospital setting. Simple agitation may unpredictably progress to overt aggression and violence by any patient in the emergency centres (ECs). Aggressive behaviour often manifests in forms of verbally abusive language, verbal threats and intimidating physical behaviour. Violent behaviour comprises the intentional use of physical force or power, threatened or actual, against self (suicidal), or another (homicidal) or properties, group or community, that could potentially result in injuries, death, psychological harm or deprivation. Therefore, individuals with unusual agitation and aggression should be treated as an emergency in both the community and healthcare settings in order to mitigate the progression to physical violence. Whilst the incidence and prevalence of aggressive and violent behaviour are higher in individuals with an underlying mental disorder, substance use disorder or comorbid mental disorder and substance use disorder, other individuals can also present with these behaviours in the ECs. Therefore, the front-line clinicians must be knowledgeable and competent in managing patients with aggressive behaviour with a view to de-escalate the situation and preventing or curtailing violence. This paper presents an evidence-based approach for managing patients with aggressive and violent behaviour, including a review of the steps for admitting patients for assisted or involuntary care.

Patient aggression experienced by professional nurses in acute psychiatric ward: South Africa

“…From the participants’ findings, if the patient does not get calm after giving treatment, the patient is taken to the seclusion room following the doctor’s prescription. This supports Adeniyi and Puzi ( 2021 ) when stating that non-pharmaceutical management of aggressive patients includes calming the patient, communication and de-escalations techniques. Also, the doctor should complete the Mental Health Care Act (MHCA) form 48 when secluding the patient.…”

“…Also, the doctor should complete the Mental Health Care Act (MHCA) form 48 when secluding the patient. In pharmacological management, the patient should be sedated by treatment following a prescription by the doctor and should be done to calm the patient within a maximum of 2 h (Adeniyi & Puzi 2021 ).…”

Psychological impact of violence on male nurses in forensic units in Gauteng, South Africa

“…Moreover, Adeniyi and Puzi ( 2021 :4) assert that psychiatric nurses should develop effective communication skills to promote verbal de-escalation, as they are typically on the front line when a patient becomes violent. The above statements reflect what male psychiatric nurses in this study practised to calm violent state patients.…”

“…The act of violence may have detrimental effects on the individuals experiencing it. In addition, while violence can occur in any setting, it is even more prevalent in mental health institutions and may be worse in maximum-security forensic units (Adeniyi & Puzi 2021 ; Mulaudzi et al 2020 ). Male psychiatric nurses are key role players in caring for state patients in maximum-security forensic units.…”

Role of security guards in healthcare settings: a protocol for a systematic review

“…Many healthcare facilities employ security guards as part of their security strategy 1. Adeniyi and Puzi2 attribute this to violent and aggressive behaviours that are not uncommon in many healthcare institutions, including hospitals and psychiatric and emergency units 3–6. Such behaviours are among the key reasons for the employment of security guards 7.…”