A 

Abortion
Accounting
Advertising
Africa
African-American Studies
Aging
Agriculture
American Indian Studies
Anthropology
Archaeology
Architecture
Argumentative
Art: Artists (Alphabetized)
Art: General
Become an Affiliate and Earn $$$
Biographies (Alphabetized)
Book Reviews (Non-Fiction) (Alphabetized)
Business: Companies (Alphabetized)
Business: General
Business: Industries (Alphabetized)
Business: International
Business: Small
California
Canada
Caribbean
Child Abuse
China
Communication: Journalism
Communication: Language & Speech
Communication: Media
Communication: Non-Verbal
Communication: Television
Communication: Television & Children
Communism
Computer Science
Consumerism
Criminal Justice: General
Criminal Justice: Juvenile Delinquency
Criminal Justice: Police Science
Criminal Justice: Prisons
Cuba
Death & Dying: Euthanasia
Death & Dying: General
Death & Dying: Suicide
Drama: American
Drama: English
Drama: World
Drugs: Alcohol
Drugs: General
Economics: Banking
Economics: Economists (Alphabetized)
Economics: General
Economics: Inflation
Economics: International Trade
Economics: Macroeconomics
Economics: Microeconomics
Economics: Taxation
Education: Administration
Education: Curriculum
Education: General
Education: Higher
Education: Physical
Education: Psychology
Education: Reading
Education: Special
Education: Teaching Methods
Education: Theory
Energy: General
Energy: Nuclear
Energy: Solar
Environmental Studies
Evolution
Family & Marriage
Films: Artists (Alphabetized)
Films: General
Finance: Companies (Alphabetized)
Finance: General
Former Soviet Union: Post-1990
France
Gender & Sexuality
Geography
Germany
History: Ancient Greek & Roman
History: European
History: Great Britain
History: U.S. (After 1865)
History: U.S. (Before 1865)
History: U.S. Presidency
History: U.S. Presidents (Alphabetized)
Homosexuality
Immigration
India
Indonesia
International Relations: Arms Control
International Relations: Cold War
International Relations: Non-U.S.
International Relations: U.S.
Japan
Jewish Studies
Korea
Labor
Latin America
Law: Business
Law: Capital Punishment
Law: General
Law: International & Non-U.S.
Law: Supreme Court
Leadership
Literature, American: Authors (Alphabetized)
Literature, American: Faulkner
Literature, American: Fitzgerald
Literature, American: General
Literature, American: Hawthorne
Literature, American: Hemingway
Literature, American: Melville
Literature, American: Poe
Literature, American: Steinbeck
Literature, American: Twain
Literature, English: Authors (Alphabetized)
Literature, English: Chaucer
Literature, English: Conrad
Literature, English: Dickens
Literature, English: General
Literature, English: Joyce
Literature, English: Lawrence
Literature, English: Shakespeare
Literature, English: Swift
Literature, General: Children
Literature, General: Classic (Greek & Roman)
Literature, General: Russian
Literature, General: World
Management: General
Management: Japanese
Management: Motivation
Management: Theory
Management: Women
Marketing: Companies (Alphabetized)
Marketing: General
Marketing: Plans
Mathematics
Medical: Aids
Medical: Dentistry
Medical: Diseases & Disorders (Alphabetized)
Medical: General
Medical: Nursing
Mexican-American Studies
Mexico
Middle East: Egypt
Middle East: General
Middle East: O.P.E.C.
Military
Music: Classical
Music: General
Mythology
Nutrition
Parapsychology/Occult
Philosophy: Ancient Greek
Philosophy: Descartes
Philosophy: Eastern
Philosophy: General
Philosophy: Kant
Philosophy: Sartre
Poetry: American
Poetry: English
Poetry: Milton
Poetry: World
Political Science: Elections & Campaigns
Political Science: Foreign
Political Science: Lobbyists & Pressure Groups
Political Science: Machiavelli
Political Science: Mill
Political Science: Political Theory
Political Science: U.S.
Psychology: Behaviorism
Psychology: Child & Adolescent
Psychology: Disorders
Psychology: Dreams
Psychology: Experimental
Psychology: Freud
Psychology: General
Psychology: Jung
Psychology: Physiology
Psychology: Piaget
Psychology: Rogers
Psychology: Social
Psychology: Testing
Psychology: Therapies
Public Administration: General
Public Administration: Government Agencies (Alphabetized)
Racism
Real Estate
Recreation & Leisure
Religion: Eastern
Religion: General
Religion: Islam
Religion: The Bible
Research: Completed Studies (With Statistics & Results)
Research: Designs & Proposals
Research: Statistics & Methodology
Russia: Pre-1917 Revolution
Science: Astronomy
Science: Biology
Science: General
Science: Genetics
Sociology: Durkheim
Sociology: General
Sociology: Marx
Sociology: Social Problems
Sociology: Social Theory
Sociology: Social Welfare
Sociology: Weber
Soviet Union: 1917-1990
Sports: Drugs
Sports: General
Technology
Transportation: Automotive
Transportation: Aviation
Transportation: General
Transportation: Railroads
Urban Studies
Vietnam
Women Studies
 

AGGRESSION IN PSYCHIATRIC SUGRICAL PATIENTS WHO SUFFER FROM SUBSTANCE ABUSE.   Term Paper ID:30292 Click to get this paper

Essay Subject: Discusses actioins advanced registered nurse practitioners can take to reduce aggressive behavior.... More...

15 Pages / 3375 Words 11 sources, 24 Citations, APA Format $60.00 Return to List of Papers

Paper Abstract: Discusses actions advanced registered nurse practitioners can take to reduce aggressive behavior. Issues involved. Lack of training of staff nurses for handling this patient type. Increase of these patient types in health care system. Stress of nursing staff and impact on hospitals. Makes recommendtions on actions nurses and hospitals shoud take. Paper Introduction: HANDLING AGGRESSION IN PSYCHIATRIC SURGICAL PATIENTS WHO ALSO SUFFER FROM SUBSTANCE ABUSE Introduction What actions can be taken by the advanced registered nurse practitioner to reduce aggressive behavior in surgical patients with both a psychiatric diagnosis and a substance abuse problem? According to Morrison, Ramsey and Snyder (2000a), determining an answer to this question is important for several reasons. First, most staff nurses are woefully unprepared for handling the complexity of issues attending to this patient type which means that many of patients' needs go unmet. Second, Morrison et. al (2000a) report that an unfortunate reality is that the health care system is seeing an increase in these and similar patient types. Indeed, it is noted that up to Text of the Paper: The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper. In this regard, it was noted that alcohol and/or drug-dependent patientsbehave in ways that are difficult for nursing (as well as medical andsurgical staff generally) to manage. & Viens, D.C. According to Morrison,Ramsey and Snyder (2 a), determining an answer to this question isimportant for several reasons. Just as there are times to stand firm with a patient, there arealso times to accede to a patient's demands simply because anything lesswould lead to an escalation of aggressive behavior. According to Schafer andNowlis (1998), a diagnosis of a personality disorder, especially some formof dependent personality disorder, is quite likely to intensify a patient'saggressive behavior. Thus,advocacy in this regard will help to reduce patients tendency to aggressiveand this, in turn, is likely to also help nurses feel a greater sense ofsafety which is no doubt why research shows that under such conditions, thepatient-nurse relationship is much improved.Recommendation 3: Conduct Assessments According to Sanchez-Gallegos and Viens (1995), another way ofhandling these patients is for nurses to make some type of assessment ofeach patient's propensity for violent behavior. Sanchez-Gallegos, D. Anticipate that some patients will try to split staff. Make sure these limits are clearly andadequately communicated to patients.Implications The first implication of the research and theory reviewed in thisreport is that nurses are not victims. Morrison et. (1995). Alcohol withdrawal in thesurgical patient: prevention and treatment. (1999). Personality disorders amongdifficult patients. Journal ofPsychiatric Mental Health Nursing, 6(1), 15-2 . Martin, A.C., Schaffer, S.D. Conduct both preoperative and post-operative assessments. However, Morrison et. Palo Alto: Medmaster Series. Second, Morrison et. Confronted with this personality which itself is subject toaggressiveness, the hospital and nursing staff, unfortunately, then takeseveral actions that can operate to exacerbate the problem. Thepurpose of this paper is to first briefly present and discuss aninteractive conceptual model of factors giving rise to the aggressivebehavior and second, to delineate and discuss the steps advanced practicenurses can take to address the problem. Patch, Phelps and Cowan (1997) also stress assessment in terms ofsteps that advanced practice nurses can take to reduce aggressive behaviorin psychiatric patients with substance abuse disorders, especially theassessment of pain and the severity of withdrawal symptoms. al. Third, the increase in these patient numbers coupled with inadequatenurse training is producing sustained stress on nursing staff. (1996). In this regard, Sohrrecommends that hospitals adopt a "multiple levels of care" perspective.Thus, strong priorities are given to not only the patient's physicalcondition but also to his substance abuse problem and psychiatricdiagnosis. Of these, ten had to bedischarged for total non-compliance and for taking drugs even while in thehospital. In this report, the actions nurses can take both at the level of thepatient and the hospital were addressed. Additional contributors are the failure of manyhospitals to focus on anything but the patient's immediate physical problemrequiring surgery, the tendency of the hospital to under-treat thesepatients' pain, the deep sense of threat nurses often feel in interactionwith these patients, and often the resistance to proper care that arises onthe part of family members, girlfriends, and or spouses involved in co-dependent relationships with the patients. In other words, boththe nurses and the patients have to face the fact that a good deal of thepatient's behavior is due to withdrawal symptoms; simply confronting thisfact, according to the authors, will greatly help in terms of nursesfeeling somewhat safer in their interactions with the patient.Recommendation 2: Encourage the Hospital To Provide PharmacologicAssistance A second step that can help nurses dealing with surgical patientswith both a psychiatric diagnosis and substance abuse problem is one ofadvocacy. There must be an ongoing effort to better and better understand howalcohol and other substances contribute to aggressiveness in surgicalpatients with psychiatric disorders. There are however, some problems with the use of behavioralcontracts. Indeed, it is noted that up to 4 percent of all hospitaladmissions in the United States, are for patients who have some form ofsubstance abuse problem either alone or in addition to the reason foradmission. First, the authors note that psychiatric patientswith substance abuse problems have certain commonalities. In this regard, the authors note that there is such a largenumber of staff involved in patient care in the hospital setting that thecontract becomes difficult to implement. Act as an advocate, getting the hospital or other health caresetting to provide better pharmacologic support to these patients for theirpain and for their withdrawal from the substance they are abusing, e.g.,alcohol. (1999). 7. Not onlyis preoperative assessment and consultation said to assist staff to betterunderstand factors that can jeopardize the patient's physical condition, itis also said to help staff identify and prepare for those patients who willhave psychoemotional complications. 2. Managing the careof complex, difficult patients in the medical-surgical setting, Part I.Document available: www.nurses.com. Further the hospital will under-treat pain therebyincreasing patient anger and lowering the already flagging compliancelevels arising as a result of their personality and the substance abuse. al (2 a) report that an unfortunate reality isthat the health care system is seeing an increase in these and similarpatient types. (1999). al (2 b) report that they conducted a study of the effectsof signing behavioral contracts with 4 patients. These factors include the aggressive,demanding nature of the patient, his bizarre often weird, behavior, and hissense of entitlement. Structure the nurse-patient relationship by setting firm yetsomewhat flexible limits for both the patient and for oneself (e.g., do notengage in power struggles). (1999) Managing alcohol-related problems in the primary care setting. Make sure that nurses are provided by the hospital with inservicetraining that specifically addresses the complexities involved in handlingpsychiatric surgical patients with a substance abuse problem. In this way, patients will come to associate theirnursing staff with a lowering of stress.Recommendation 6: Provide Inservice Training A second recommendation by Sohr (1996) is to provide nurses with sometype of inservice training for handling these patients. Spies, C.D. Work in conjunction and as part of a team in a multidisciplinaryeffort to meet patient needs in the areas of his condition that requiressurgery, his psychiatric diagnosis, and his substance abuse problem.Further, nurses may wish to work with social workers to make sure thatstresses attendant to the patient's life style (e.g., inadequate finances)are dealt with in a manner to reduce tension in the patient's life. They tend to bemales with a history of violence, co-dependent relationships (especiallywith their spouses or girlfriends) who are often poor and sometimeshomeless. The authors reportthat there are instruments that can be used to assess these propensities.They further note that by using such instruments, nurses will not only bebetter prepared for the possible behavior of patients, they will also feelsafer with certain patients because they have a more precise idea of whatthe patient's limits are with respect to violent behavior. & Snyder, B.A. In the health care setting, these patients will typically displaystrange, bizarre behavior that alienates staff. & Maston, T. However, the paper did notspecifically address actions that can be taken in dealing with co-dependents who are working to disrupt efforts for the purpose ofmaintaining the co-dependency. It is noted that based on assessment and consultation, nurses andother staff can then formulate recommendations for handling the particularpatient once he is out of surgery. Sohr (1996) provides a complex list of various actions both nursesand staff can take to decrease aggression in difficult patients, stressingthe importance of consultation and assessment prior to surgery. Triumvirate nursing forpersonality disordered patients: crossing the boundaries safely. Kenney, J.W. Actions That Foster Quality Care and Reduction of Aggression In Psychiatric Surgical Patients With A Substance Abuse Problem Although the current literature on actions nurses can take to handlethe issues associated with caring for psychiatric surgical patients withsubstance abuse problems is relatively sparse, some recommendations havebeen formulated for maintaining quality care while reducing aggressivetendencies. In other words, nurses have to be willing to say things they mightnot say to other patients and to take those actions that produce a sense ofsafety. Anesth. Theseassessments should focus on the patient's propensity for violence, thenature of the patient's psychiatric diagnosis (whether or not it is apersonality disorder), the severity of his experienced withdrawal, and painmanagement. Theseare: 1. Rather, the behavior is the result of a complex interactionbetween the patient and the structure and processes of the health careenvironment in which he is placed with an additional contribution on thepart of those involved in co-dependent relationships with the patient. Archives of Family Medicine, 7(2), 126-129. First, most staff nurses are woefullyunprepared for handling the complexity of issues attending to this patienttype which means that many of patients' needs go unmet. Schafer, S. For example, some patientswill be violent only to the point of verbal abuse whereas for others, theirthreats will actually escalate to physical attacks. Thus, providing nurses with a general care framework for dealing withthe hostility and aggressiveness that is often associated with surgicalpatients with both a psychiatric diagnosis and a substance abuse problem(see: Melia, Moran & Maston, 1999) is an important need for nurses. According to Kemp (1996), hospitals providing such support tend toestablish far better relationships with these difficult patients. Once the behavioral contract has been developed and discussed withthe patient, both the nurse and the patient are required to sign it.Morrison et. However, they report that for best results, the drug regimensmust be individualized and symptom-oriented, using doses that are generallylarger that those that are used in detoxification units. However, as a consequence of these feelings,patients and nurses are never able to develop the kind of therapeuticrelationship that produces high quality care. The difficult patient. 6. Keep the number of nurses to a minimum and avoid using new graduate or inexperienced nurses. If possible, preoperative assessmentsshould be accompanied by some form of consultation with patients. Nurses are said to be veryvaluable in this regard and it is recommended by Sohr that hospitals formsome working liaisons between nurses and social workers taking care ofthese arrangements. In addition, the nursing staff will often respond to the behavior ofthese patients with active dislike and alienation, which increases thealready fairly high tension between the patient and the nursing staff.Melia, Moran and Maston (1999) state that the dislike and alienation arisebecause nurses simply do not feel safe with these patients who arebristling with hostility. Alcohol withdrawal ina medical-surgical setting: the 'too little, too late' phenomenon.Medsurg Nursing, 6(2), 79-85 and 88-89. In this regard, Martin, Schaffer and Cammpbell (1999) state thatnurses must be confrontive with such patients. In this regard, Morrison et. This section of the paper lists some of the recommendationsmost frequently made in the literature and examines them in depth.Recommendation 1: Nurses Must Take Actions To Feel Safe It will be remembered here that Melia, Moran and Maston (1999)reported that one of the factors contributing to the alienation of nursesto patients at risk for aggression (e.g., surgical patients with apsychiatric diagnoses and a substance abuse problem), is that nurses simplydo not feel safe during their interactions with these patients. & Nowlis, D.P. It can be noted here that understanding the issuesassociated with difficult patients has long been considered an importantelement of models of advanced nursing practice and making sure thatpatients are provided high quality nursing care (Kenney, 1999).Recommendation 7: Use Structure to Set Limits Morrison, Ramsey and Snyder (2 b) also state that giving thesepatients positive attention within a disciplined structure will decreasethe tendency to aggress. 1) Summary and ImplicationsSummary This paper presented an interactive model of factors that lead toaggression in psychiatric surgical patients with a substance abuse problem. Inaddition, research is said to show that in these hospitals, there is notonly greater compliance but also quicker healing from surgery. The Interactive Model What gives rise to aggressive behavior in psychiatric surgicalpatients with a substance abuse problem? Several steps were offered for dealing with these difficulties. al (2 a), state that the hospital willoften tend to focus on the physical problem requiring surgery (e.g., agunshot wound, the physical repercussions of an auto accident, etc.) ratherthan on the substance withdrawals the patient is going through in additionto his injuries. Thepresented model described the sources of these problems as due to thegeneral psychoemotional/personality issues of the patient, inadequacies andfailures on the part of the hospital and nursing staff, and the negativeinfluence of those in co-dependent relationships with the patient. With respect to the foregoing, Sohr (1996) notes that often difficultpatients' psychiatric/withdrawal issues can be increased because of worriesand concerns regarding finances. Withrespect to nurses' feelings of threat, the authors recommend that nursesbecome willing to cross boundaries they would not normally cross with otherpatients. (1995). A second limitation of the reviewed literature is that the problem ofaggression in psychiatric surgical patients with substance abuse problemsis not solely caused by the personality and psychopathology of the patienthimself. That, in a positive, butfirm manner, they must directly addressing their substance abuse problemsand the consequent withdrawal issues in particular. Morrison, E.F., Ramsey, A. It is noted thatmost nurses have very limited classroom and clinical experience with suchpatients and that inservice education could do much to help them tounderstand the patient. Moreover, it is noted that maintaining consistency and clearcommunication so as to make sure that all parties involved are fulfillingtheir contracts 24 hours a day seven days a week is very difficult in theoften chaotic environment of a health care setting. On the other hand, a diagnosis of some other form ofpsychopathology may mean that there is less chance that the patient willactually become physically aggressive. A final implication of this study is the fact that a good deal of thesource of aggressiveness in these patients is associated with the fact thatthey have a substance abuse problem and that frequently this is an alcohol-related problem. It is recommended that if this occurs, the nurse considerthe use of behavioral contracts. It will be remembered here that one of thecommonalities of these patients is poverty, even homelessness. Rather they can take severalactions both at the level of the nurse-patient relationship and at thelevel of the nurse-hospital relationship to provide the patient withquality care while still maintaining a sense of safety and dignity. References Kemp, C. Assessment data should then be used for developing andimplementing treatment interventions. They are not and do not have to bepassive recipients of verbal or any other abuse that may arise as afunction of working with surgical patients who have both a psychiatricdiagnosis and a substance abuse problem. Spies and Rommelspacher (1999) have also addressed the need forwithdrawal-related assessment in alcoholic surgical patients, combined withquick treatment for withdrawal. Sohr, E. Home HealthCare Nurse, 14(4), 255-261. This understanding will only be obtained on the basis of continued,well-controlled research. 3. When the client is armedor dangerous: management of violent and difficult clients in primary care.Nurse Practitioner, 2 (6), 26-32. HANDLING AGGRESSION IN PSYCHIATRIC SURGICAL PATIENTS WHO ALSO SUFFER FROM SUBSTANCE ABUSE Introduction What actions can be taken by the advanced registered nursepractitioner to reduce aggressive behavior in surgical patients with both apsychiatric diagnosis and a substance abuse problem? Not only isthe experience of stress a painful consequence for nurses, it is alsocostly for hospitals which can lead to increased absences from work,turnover, and burnout (Morrison et al, 2 a). Common problems include aggression,verbal and sometimes attempts at physical abuse, poor compliance,demandingness, and other odd and more bizarre alienating behaviors. In addition, they are oftenangry people with a sense of entitlement and a generally demanding nature. In summary then, there are several factors that give rise toaggressive behavior in surgical patients with both a psychiatric diagnosisand a substance abuse problem. Add prevention strategies to the care plan. If alcohol withdrawal symptoms develop after surgery or trauma,immediate therapy is required then. Morrison, E.F., Ramsey, A. Setting limits and defining boundaries has to take on newdimensions with these patients. However, in most of the patients, the improvement in theirbehavior was said to be immediate and fairly strong. Melia, P., Moran, T. Co-dependents, according to Martin, Schaffer and Campbell (1999) will oftenchallenge nursing staff in their attempts to meet patient needs. Regarding contracts, the authors note that there has been some goodresearch on the use of behavioral contracts by nurses in hospital settingswhich tends to show they can be quite effective. In other words, nurses must set limits to both the patient's behaviorand his or her own behavior. al (2 b) report that one controversial aspect of mostany behavioral contract is specifying the consequence for noncompliance.For example, while some contracts specify that discharge from the hospitalwill occur if the patient does not comply with the expectations, thisconsequence should probably be considered a "last resort." It is alsonoted that a behavioral contract should not be used for any patient unlessthe multidisciplinary team is in support, and risk management has beenconsulted. Some ofthese are directly applicable to the surgical patient with both apsychiatric diagnosis and a substance abuse problem. With respectto these actions, Morrison et. If any inconsistency or misunderstanding occurs, patients will use it to their advantage. & Snyder, B.A. (Morrison, Ramsey & Snyder, 2 b, p. Be upfront with the fact that the patient has a substance abuseproblem as communication in this regard will help to produce a sense ofsafety, allowing the nurse to feel less alienated from the patient andtherefore provide higher quality care. Specifically, they can take actions to encourage the hospital toprovide pharmacologic support to these patients in terms of both painreduction and substance abuse withdrawal. These contracts outlinethe expectations, plans, and responsibilities of the patient and theconsequences for not complying with the treatment. (2 b) have notedthat with very difficult patients, there can be no response to plannedinterventions. Philosophical and theoretical perspectives foradvanced nursing practice. Patch, P.B., Phelps, G.L. & Cowman, G., (1997). Some patients wereeven willing to be discharged to structured substance abuse programs. In addition, communication between the nurses caring for the patient must be exemplary. Whatthis means is that if efforts to reduce aggression in patients as well asto provide high quality care are to be maximally effective, all of thesefactors must be addressed. As the authors put it: Consistency in communication and in every aspect of the plan is very important [to setting structure]. The medical profession needs to come to terms with thefact that alcohol problems are a significant source of morbidity andmortality in the United States, and that denial and resistance to treatmentby patients and their families make detection challenging. This subject was not addressed becausethere the literature simply has not dealt with this problem in the contextof nursing care. al(2 a), this occurs as the result of both the nature of the patient, andhospital/caring factors. 4. The authors go on to note thatwithdrawal symptoms can be controlled using the combination of abenzodiazepine (in Europe, also chlormethiazole) with haloperidol orclonidine. Nonetheless, it isreported that when behavioral contracts are properly implement, highlydifficult patients can benefit greatly as can the staff who mustinteraction with them.Recommendation 5: Work With the Hospital Sohr (1996) has discussed several steps nurses and other medicalpersonnel can take when dealing with a difficult patient generally. Therefore, conducting such research is hererecommended to nurses. & Campbell, R. (2 b). According to Morrison et. If assessment shows a strong substanceabuse problem, the authors feel that the ideal treatment is to preventalcohol withdrawal prior to surgery by adequate prophylaxis. For very difficult and non-compliant patients, consider the use ofthe behavioral contract defined as an outline of the expectations, plans,and responsibilities of the patient and the consequences to the patient fornot complying with the treatment. Nurse Practitioner, 24(14),16-18, 21, 25-26. In terms of the type of structure that needs to beprovided, the authors report that nurses must make sure to avoid powerstruggles. It is therefore recommended here that future researchbegin to focus more on the nature of this contributing factor to patientaggressiveness and on actions nurses can take to remediate this problem. If a hospital works to quell financial fears in these patients, Sohr(1996) states that they can do much to reduce patient stress and sodecrease their chances of aggressive behavior. Further, because the patient mustdeal with so many other people, he is often reluctant to make a contractwith a nurse feeling that it will not effect his treatment by other staffpersonnel. Managing the careof complex, difficult patients in the medical-surgical setting, Part II.Document available: www.nurses.com. & Rommelspacher, H. In this regard, a quick easy assessment is merely to determine thenature of the patient's psychiatric diagnosis. However, it is noted that anyrecommendations involving patient behavior should be kept short as studieshave shown that adherence to recommendations diminishes after more thanfive.Recommendation 4: The Behavioral Contract Assessment can go far in terms of developing a plan for interventionsto reduce patient aggression. In their studyof the effects of pain assessment and assessment of alcohol withdrawalwithin a medical-surgical setting, it was found that multidisciplinaryassessment and withdrawal protocol produced higher quality care, fewer "against medical advice" discharges, fewer negative interactions betweenpatients and staff, and also decreased the length of stay in the hospital. 5. By gaining a more and more preciseunderstanding the nature of this problem as a contributor to patientaggression, nurses will be in a better position to take highly effectiveaction. al state that itis important to be clear, positive and consistent in all communicationswith patients. Adding to the difficulty of this situation is the co-dependentrelationship the psychiatric surgical patient with a substance abuseproblem often has with his spouse or girlfriend or even family members. Boston, MA: Jones and Bartlett Publishers. (2 a). Managing chronic pain in patients with advanceddisease and substance-related disorders. (1999). Analg, 88(4), 946-954.----------------------- 18 This isbecause they have a stake in the patient maintaining his dysfunctionalrelationship. Instead, use your older, more experienced nurses. If this paper is not what you are looking for, you can search again: Search for: or Click here to request an essay written just for you.