Agitated
Stress
Provide 3 examples of 'disruptive' behavior
Flipping someone off, blocking door, refusing care, swearing, accusing, videotaping, staff splitting
Provide 2 examples of 'destructive' behavior
Lunging, Throwing object across the room, destruction of property
Spit/hit/kick staff/family, grabbing someone, pulling a central line, stab with a needle
How do interventions change as behavior worsens?
The amount of possible interventions decrease. Early intervention is key!
Provide 3 examples of 'agitated' behaviors
Glaring, crying, pacing, hand ringing, sighs, leg bouncing, tapping, isolating, eye rolling
The secondary message of a 'disruptive' person
"Pay attention to me"
The secondary message of 'destructive' behavior
"I'm losing control"
The secondary message of a 'dangerous' person
"I'm out of control"
Provide an example of "Threat of Lethal" behavior
Threats, “I am going to kill myself/someone else”, "I'm going to leave and come back with a gun" (NOTE- It is key that the person CANNOT act on this statement at the given time)
The secondary message of an 'agitated' person
"I'm Distressed"
Notify medical team, make a plan, set limits, offer choices, offer meds (suggestion), remove crowd, call security to give heads up
The #3 indicator of violence
An increase in gross motor activity (GMA)
List 2 interventions used for a 'dangerous' person
Enact Emergency Response, Hands on ONLY if safe to do so (staff or security), restraints, medications
The secondary message of a "threat of lethal" person
List 2 interventions used for an 'agitated' person
Talk/listen, validate feelings, change environment, dim lights, offer break, deep breathing, meet basic needs/easy requests, consult social work or spiritual care
How do you offer a choice?
"_______, You can do A or you can do B. You choose”
List 2 interventions for 'destructive' behavior
360 scan, remove items that could be used as weapons, call security. Give choice, remove audience, have medical team present, offer meds using clear request
Should you try to use techniques to generate cooperation in a destructive person?
No, this is now a safety issue. The person may also be unwilling/unable to cooperate given the degree of disregulation.
List 2 main interventions for a "threat of lethal"
Be aware of surroundings, notify your coworkers/medical team, call security, tell them "don't do it" (situational), validate feelings, keep threatening person talking/distracted
The key feature of 'agitated' behavior
The behavior does not involve anyone else
The key feature of 'disruptive' behavior
It involves someone else
What do we look, listen, and test for at each stage of the red scale?
Degree of cooperation
How/where do you document 'dangerous' Red Scale behaviors?
Red Scale Behavior Navigator/Flowsheet. You should write a descriptive note/restraint note (see reference)
The three indicators of potential violence
1. History of violence
2. Change in baseline behavior (STRESS)
3. Increase in gross motor activity